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Biomedical subjects

U Zollinger

Publications and source records attributed to U Zollinger.

At least 19 recordsLinked to original sources
PubMed2005

[Certain or possible lethal medical malpractice: what is to do afterwards?].

In case of a possible or certain lethal case of medical malpractice the following procedure is recommended: 1. Scrutinize every death of a patient during or after a medical treatment. Address the following questions: "Did everything proceed correctly?", "Could death have been prevented?", "This should not have been happened". 2. Report to the head physician, to the hospital management and administration in order to coordinate the further procedures. 3. Save all the evidence: Perfusions, empty phials, opened drug packages. Leave all catheters, tubes, drainages on the body! Leave any technical equipment, for example anesthetic machines untouched. Save all prior blood and urine samples taken from the patient. Seal medical history and documentations. 4. Order a memory protocol of the events by all involved persons. 5. Refrain from clinical autopsy. Forensic autopsy, indicated in these circumstances, can only be authorized by the district attorney (see point 7). If in doubt, seek counseling from an institute of forensic medicine by telephone (if requested: anonymously). 6. Put "non natural death" on the death certificate in case of a certain and unclear death in case of a possible medical malpractice. 7. Report any possible or certain case of lethal medical malpractice to the district attorney (obligation to report). The district attorney will authorize a 8. Inform the relatives of the deceased. Apologize, show regret and concern but do not address the question of guilt. 9. Inform your third party insurance (this does not mean an admission of guilt).

Autopsy↗
PubMed2005

Fulminant cerebral malaria in a Swiss patient.

Malaria remains the most important parasitic disease worldwide. Falciparum malaria is a medical emergency and requires immediate diagnosis and treatment. Cerebral malaria is a rapidly progressive, potentially fatal complication of Plasmodium falciparum infection. This case, including post-mortem observations, histology, and laboratory diagnosis, emphasizes the necessity of appropriate advice regarding malaria prophylaxis before travel to an endemic area. Malaria should always be considered in the differential diagnosis of patients presenting with fever and/or nonspecific flu-like symptoms after traveling to endemic countries.

Adult↗
PubMed2005

[The unusual cause of death--a special assignment for the doctor in emergency service].

The emergeny physician summoned to a sudden, unexpected death is confronted by various uncommon problems such as the certification of death on the "frontline" without destroying important evidence, the estimation of time since death, deciding whether the death must be reported to the authorities as well as taking care of mourning relatives. To all this questions the authors offer answers and practical advices.

Acute Disease↗
PubMed2005

[Survived offenses of physical and sexual integrity--the responsibilities of the emergency physician].

The examination of living victims of physical and sexual assault as well as the documentation of injuries are tasks of the emergency physician. His observations and the documentation by photography, diagrams and description of findings are the basis for further legal proceedings. This article addresses the duties and responsibilities as well as the practical procedures of the physician regarding the announcement of incidents indicating crimes against the corporal and sexual integrity of patients to the authorities and the documentation of findings in general and addresses some special situations likely to occur in any medical emergency.

Acute Disease↗
PubMed2004

Forensic assessment of survived strangulation.

By a retrospective analysis of all survived strangulation cases examined at the Institute of Forensic Medicine of Berne, Switzerland between 1987 and 2002, the authors tried to find out, if findings and symptoms of victims could be related to the fierceness of the assault and the mode of strangulation and if general evaluation criteria could be established on the basis of objective findings. One hundred and thirty-four survived strangulation cases were analysed on the basis of written reports, photographies and schematical sketches. Findings and symptoms reflected the fierceness of the assault in 71% of all cases by displaying a continuum of findings from minor injuries to severe traumatisation. This applied especially for cases of manual strangulation while other modes of strangulation resulted in different constellations of findings. As a result of this study, the authors deem the following classification of three degrees of severity as practical on condition that a complete forensic medical examination was performed upon the surviving victim shortly after the incident of strangulation: Light strangulation, confined to skin abrasions and/or reddening of the skin of the neck. Moderate strangulation, defined as bruising to, and/or bleeding from the neck, and/or damage to deeper soft tissues or the larynx, as exhibited by the symptoms of sore throat, difficulty in swallowing, and hoarseness. Severe, life-threatening strangulation if the victim presents petechial bleedings as a result of venous congestion with or without accompanying loss of consciousness.

Adolescent↗
PubMed2003

Gunshot residue patterns on skin in angled contact and near contact gunshot wounds.

The goal of this study was the reproduction of shape and pattern of gunshot residues in near contact and contact gunshot wounds by a series of experimental gunshots on a skin and soft tissue model. The aim was to investigate the shape and direction of soot deposits with regard to the muzzle according to different muzzle-target angles, firing distances, type of ammunition and weapon and barrel length. Based on a review of the literature and on the results of the experiments the authors could make the following statements of gunshot residues in angled contact and close contact gunshot: (1) gunshot residues on the target surface can be differentiated in a "inner" and "outer powder soot zone"; (2) the outer powder soot zone is much less visible than the inner powder soot zone and may lack on human skin; (3) with increasing muzzle target distance both inner and outer powder soot halo increase in size and decrease in density; (4) in angled shots the inner powder soot halo shows an eccentric, elliptic shape which points towards the muzzle, regardless of ammunition, calibre and barrel length; (5) the outer powder soot points away from the muzzle in angled contact and close contact shots.

Animals↗
PubMed2003

Bite mark documentation and analysis: the forensic 3D/CAD supported photogrammetry approach.

Bite mark identification is based on the individuality of a dentition, which is used to match a bite mark to a suspected perpetrator. This matching is based on a tooth-by-tooth and arch-to-arch comparison utilising parameters of size, shape and alignment. The most common method used to analyse bite mark are carried out in 2D space. That means that the 3D information is preserved only two dimensionally with distortions. This paper presents a new 3D documentation, analysis and visualisation approach based on forensic 3D/CAD supported photogrammetry (FPHG) and the use of a 3D surface scanner. Our photogrammetric approach and the used visualisation method is, to the best to our knowledge, the first 3D approach for bite mark analysis in an actual case. The documentation has no distortion artifacts as can be found with standard photography. All the data are documented with a metric 3D measurement, orientation and subsequent analysis in 3D space. Beside the metrical analysis between bite mark and cast, it is possible using our method to utilise the topographical 3D feature of each individual tooth. This means that the 3D features of the biting surfaces and edges of each teeth are respected which is--as shown in our case--very important especially in the front teeth which have the first contact to the skin. Based upon the 3D detailed representation of the cast with the 3D topographic characteristics of the teeth, the interaction with the 3D documented skin can be visualised and analysed on the computer screen.

Bites, Human↗
PubMed2003

A high-speed study of the dynamic bullet-body interactions produced by grazing gunshots with full metal jacketed and lead projectiles.

Experimenting upon a synthetic, non-biological Skull-Brain Model, our goal was to document and study the bullet-body interaction of grazing (glancing, tangential) gunshots. Thanks to the high-speed study of the dynamic bullet-body interaction it was possible to document the glancing behavior of projectiles with a resolution of 50 million pictures per second. It was possible to demonstrate the differing deformation and fragmentation patterns between the 9mm Luger full metal jacketed projectile and the 38 Smith & Wesson (S & W) lead round nose projectile. In a true-to-life manner the morphologic fracture systems could be documented by utilization of the model in dependence of the projectile's behavior, deformation, and fragmentation. Based on these experimental studies with body models, conclusions could be drawn for surgical and reconstructive forensic questions in real cases. In summary, model substitutes offer a suitable basis for the study of the bullet-body interaction because the experiments are reproducible, totally independent of the biological variances of corpse and animal experiments, and are harmless from the ethical perspective.

Brain Injuries↗
PubMed2002

The dynamic development of the muzzle imprint by contact gunshot: high-speed documentation utilizing the "skin-skull-brain model".

Many contact gunshots produce a muzzle imprint in the skin of the victim. Different mechanisms have been discussed in literature as being responsible for the creation of the muzzle imprint. Experimenting upon the synthetic non biological skin-skull-brain model, our goal was to document and study the creation of the muzzle imprint with the aid of high-speed photography. In our experiments, we could document with our high-speed photography (at exposure rates in the range of nanoseconds) the bulging, the pressing against the muzzle, and the splitting of the artificial skin. Furthermore, it was possible to photographically record the back pattern of synthetic tissue particles. And, the soot and gunpowder cavity could be reproduced experimentally. In conclusion the experiments completed with the skin-skull-brain model, using high-speed photography for documentation, show the promising possibilities of experimental ballistics with body models.

Brain Injuries↗
PubMed2002

The "skin-skull-brain model": a new instrument for the study of gunshot effects.

In order to create and study wound morphology, a "skin-skull-brain model" had to be designed which would make the laboratory reproduction of a real ballistic injury possible. To simulate the human skin, an artificial skin (a silicon cap) is used. This silicon scalp contains synthetic fibers (artificial leather) to simulate the collagen and fat of the scalp. The artificial skull is a layered polyurethane sphere (19 cm o.d.; and 5, 6, or 7 mm thick) constructed in a specially designed form with a Tabula externa, Tabula interna, and a porous Diploe sandwiched in between. The periostium of the artificial skull is made of latex. This elastic latex layer prevents the bone fragments from scattering after the model has been struck by gunfire. The brain itself is simulated with ordnance gelatin, 10% at 4 degrees C, a material well known in wound ballistics. Gunshots were fired at a distance of 10 m from the model. During the evaluation of the "skin-skull-brain model", it was possible to show that injuries inflicted to this model are fully comparable to the morphology of equivalent real gunshot injuries. Using the "skin-skull-brain model" has some significant advantages: the model is inexpensive, easy to construct, instantly available for use, and eliminates ethics conflicts. The main advantage of such a model is, in comparison with biological substances, the high reproducibility of inflicted traumas.

Brain Injuries↗
PubMed2002

A study of the morphology of gunshot entrance wounds, in connection with their dynamic creation, utilizing the "skin-skull-brain model".

The goal of this study was to document the dynamic effects created within, and the developing mechanisms of a gunshot entrance wound to the skin utilizing high-speed photography and the "skin-skull-brain model". The high-speed photography was taken with an Imacon 468/Hadland-Photonics camera. Full metal jacketed, 9 mm Luger projectiles were fired at the target model from a distance of 10 m. During the evaluation of the "skin-skull-brain model", it was possible to show that injuries inflicted to this model are fully comparable to the morphology of equivalent real gunshot entrance wounds. It has been possible to document and study the dynamic process of the "bullet-skin-interaction" in the gunshot entrance wound. The development of the morphologic terms of the entrance wound are discussed. In combination with high-speed photography, this "skin-skull-brain model" is a perfect tool for the documentation and the study of the dynamic development of gunshot entrance wounds in the skin.

Brain Injuries↗
PubMed2001

Body models in forensic ballistics: reconstruction of a gunshot injury to the chest by bullet fragmentation after shooting through a finger.

Forensic science uses substitutes to reconstruct injury patterns in order to answer questions regarding the dynamic formation of unusual injuries. Using a case study, an experimental simulation of a finger was designed, for the first time with a combination of hard wood and glycerin soap. With this model as an intermediate target simulation, it was possible not only to demonstrate the "bullet-body (finger) interaction", but also to recreate the wound pattern found in the victim. This case demonstrates that by using ballistic models and body-part substitutes, gunshot cases can be reproduced simply and economically, without coming into conflict with ethical guidelines.

Finger Injuries↗
PubMed2000

The challenge of identification following the tragedy of the Solar Temple (Cheiry/Salvan, Switzerland).

On October 5, 1994, 48 members of the Sect of the Solar Temple were found dead at two different locations in Switzerland: 23 victims in Cheiry and 25 victims in Salvan. Our Institute was commissioned to solve the forensic problems presented by this tragedy. Our goals were to establish the time of death, determine its causes, help elucidate the surrounding circumstances and identify the victims. This work presented us with the following challenges. This catastrophe was of an 'open' type: there was no list of 'passengers'; the victims were of five different nationalities and many had just arrived in Switzerland to participate in this event; family ties were very complex within this group; half of the victims were burned and sometimes charred; the exceptionally intense media converage of the story put a lot of pressure on the investigators and our Institute. In spite of these difficulties, all the victims were positively identified within 1 month. In the present report, we describe the steps realized to progress in our work. A special section describes our relationship with the journalists and their invaluable help in our investigations. The importance of being prepared for such an event is discussed.

Disasters↗
PubMed1997

Gas chromatographic examination of postmortem specimens after maprotiline intoxication.

Ingestion of an unknown quantity of Ludiomil (maprotiline)-costed tablets in a suicide is described. Although maprotiline is known for over 20 years now, relatively few cases of intoxications due to maprotiline overdose have been reported. The authors report a new and quick method to analyze and determine maprotiline and N-desmethylmaprotiline concentration in body fluids and postmortem specimens. The analytes and an internal standard (amitriptyline) were extracted from alkalinized samples into ethyl acetate before GC-NPD analysis. The proposed method resulted in a rapid procedure most useful in cases of deliberate poisoning with the tetracyclic antidepressant drug Ludiomil.

Antidepressive Agents, Second-Generation↗
PubMed1997

[Medical function in case of death: a final service to the patient and a key factor in legal safeguard].

The final service a doctor gives to his patients is to confirm death and to comfort the relatives. The unequivocal confirmation of death can, with complete justification, be considered the most important diagnosis so that it must be reached with every precaution. Apart from special conditions in intensive care units, where the guidelines of the Swiss Academy of Medical Sciences have to be followed with a view to using organs for transplantation, for example, the presence of reliable signs of death must absolutely be confirmed. The doctor who confirms death plays a key role in detecting so-called unusual deaths which require notification even in "clear", non-suspicious circumstances. This also applies to late deaths in hospital after an accident or other violence, where the clarification of the causal connection between this event and death is of decisive relevance. The detection or unequivocal exclusion of an outside influence in the death thus depend on the quality of the medical post-mortem examination and compliance with the duty of notification. The additional tasks falling to a doctor when he undertakes a legal inspection at the request of the examining authority in the case of an unusual death are discussed here only in passing. These tasks presuppose that the doctor has appropriate experience, which is why only official or district physicians from named institutions are accepted from the legal and forensic points of view in some Cantons.

Autopsy↗
PubMed1997

[Medical examination of sexual assault victims].

Two vital tasks have to be taken into account in the examination of a victim and, if necessary, of one or more suspects also: Firstly, medical evidence must be reliably obtained, and secondly, the knowledge based on the findings obtained must, as soon as the victim has decided to notify the police, be interpreted in an expert form so that apart from explaining the criminal matters to an examining judge, i.e. a medical layman, it allows a legal assessment of the incident. Doctors in general practice and working in hospitals may occasionally be entrusted with the examination of sexual assault victims. As a rule, a forensic examination is only performed if a victim has notified the police and this examination and opinion are requested by the police or court. The most pressing medical task in such examinations is to confirm the assault and to undertake correct documentation and exhibition of biological traces. As has been shown by regular questioning of doctors, there is considerable uncertainty concerning the nature and method of correct documentation of the findings as well as the techniques for preparing exhibits. Each institute of forensic medicine in Switzerland maintains a flying service and keeps doctors available for advice round the clock; they can best be contacted through the emergency numbers of the local police forces.

Adolescent↗
PubMed1989

[Intestinal drug smuggling--a new diagnostic and therapeutic problem].

Since spring 1985 81 persons were examined because of suspected intestinal drug-smuggling (body-packing). 46 patients (57%) had drug-packages in the gastro-intestinal tract, in 35 persons (43%) the suspicion was not confirmed. 26 patients had swallowed the drugs (mostly cocaine) whereas in 20 cases drugs were found in the rectum (mostly heroine). Most important for diagnosis was abdominal x-ray whereas in our hands abdominal sonography was unreliable. When body-packing is diagnosed, observation and mild laxative in conjunction with sufficient beverages are recommended. Serious complications in our series comprised one patient with mechanical ileus and another with heroine-poisoning after rupture of a package.

Adult↗