Biomedical subjects

W Eisenmenger

Publications and source records attributed to W Eisenmenger.

At least 19 recordsLinked to original sources

PubMed1999

Sudden natural death 'at the wheel': a retrospective study over a 15-year time period (1982-1996).

In order to investigate the incidence and implications of sudden natural death at the wheel, a retrospective study was carried out over a 15-year time period ranging from 1982 until 1996. During this time period 147 drivers of motor vehicles were found out of 34,554 cases examined at the Institute of Legal Medicine, Ludwig-Maximilians University, Munich, Germany. There were 13 females and 134 males and the mean age was 56.8 years (range 20-86 years). The main cause of death was ischemic heart disease which was found in 113 cases. There were mainly minor injuries to the driver, or to other passengers, or to other road users and only minor property damage. Our study confirms previous investigations that sudden natural death at the wheel is a rare event in proportion to unnatural death at the wheel and is not a substantial threat to other road users. Despite existing guidelines for granting a driving licence, medical screening to exclude high risk patients from driving cannot prevent the occurrence of sudden natural death at the wheel.

Accidents, Traffic↗

PubMed1999

Nerve cell loss in the thalamic mediodorsal nucleus in Huntington's disease.

We estimated the total neurone number, glial number, and glial index (ratio glial cells/neurone) in the thalamic mediodorsal nucleus (MD) in seven patients suffering from Huntington's disease (HD; four males, three females, mean age 52.4 +/- 13.6 years) and age- and sex-matched controls (four males, three females, mean age 53.6 +/- 12.1 years) by means of a stereological protocol. The mean total neurone number (N(T)) in the MD of controls was 2,985,188 +/- 174,710, the mean glial number (G(T); astrocytes, oligodendrocytes) 21,785,008 +/- 2,986,678, and the glial index 7.29 +/- 0.88. In HD, the average neurone number was decreased by 23.8% to 2,275,321 +/- 247,162 (Mann-Whitney U-test P < 0.05), the mean glial number by 29.7% to 15,318,895 +/- 1,722,524 (Mann-Whitney U-test P < 0.05), the glial index was slightly reduced to 6.81 +/- 1.06. Gallyas' impregnation for the demonstration of fibrous astroglia gave strongly positive results in all cases with HD and negative results in the controls. The morpho-functional correlation of the results is complicated because individual variability, presence of segregated and parallel neuronal circuits, and plasticity of the adult human CNS must be considered.

Adult↗

PubMed1999

Energy loss due to radiation in postmortem cooling. Part B: Energy balance with respect to radiation.

With the help of the law of Stefan and Boltzmann and a model for the cooling of exposed skin derived from the data of Lyle and Cleveland, the radiation energy loss ER can be calculated according to the following formula: [formula in text] where epsilon represents the emissivity of the skin (0.98), sigma the Stefan-Boltzmann constant, AR the radiating surface area, TS(0) the skin temperature at death, TE the environmental temperature and Z' = 0.1017 the gradient of the skin temperature curve. Additionally, an energy loss due to conduction and convection EC has to be taken into account. Comparing the energy losses due to radiation, conduction and convection with the decrease ET of the thermal energy in the body, calculated from mean heat capacity (3.45 kJ/(kg degrees K)), body mass and decrease of mean body temperature, there is a surplus of energy in the very early postmortem period, which can be explained only by an internal source of energy EI. Alltogether the following balance equation can be formulated: ET + EI = ER + EC Since the body temperature decreases in the early postmortem period, EI can be estimated by: EI(t) > or = max (ER(t) - ET(t), 0). The values obtained range up to 500 kJ for a medium sized (175 cm), medium weight (75 kg) body at an environmental temperature of 5 degrees C and are compatible with estimations of Lundquist for supravital energy production by breakdown of glycogen.

Body Mass Index↗

PubMed1999

Immunohistochemical and morphometrical study on the temporal expression of interleukin-1alpha (IL-1alpha) in human skin wounds for forensic wound age determination.

An immunohistochemical and morphometrical study on the temporal expression of interleukin-1alpha (IL-1alpha) was performed on 40 human skin wounds with different wound ages. Immunohistochemically, polymorphonuclear neutrophils mainly showed positive reactions for IL-1alpha in wounds aged between 4 h and 1 day, but with increasing wound age, neutrophils were no longer present, and macrophages and fibroblasts were positively stained. Morphometrically, the ratio of the number of IL-1alpha-positive infiltrating cells to the total number of infiltrating cells was evaluated. A considerable increase in the IL-1alpha-positive cell ratio was observed in wound specimens aged 4 h to 1 day, and the maximum ratio was 46.5% in a 7 hold wound. The mean value of the IL-1alpha-positive ratio in 10 wound specimens with different wound ages between 4 h and 1 day was 32.8 +/- 9.7%. In most cases the ratio of IL-1alpha-positive cells gradually decreased in wounds aged between 1.5 and 21 days to less than 30%, and the mean value was 17.5 +/- 7.2% (n = 27). These results suggest that ratios of IL-1alpha-positive cells considerably exceeding 30%, indicate a postinfliction interval of 1 day or less.

Adolescent↗

PubMed1998

A contribution to a possible differentiation between SIDS and asphyxiation.

The singular and combined appearance of conjunctival petechiae, of acute pulmonary emphysema and of signs of aspiration was evaluated in resuscitated and non-resuscitated children dying of SIDS (n = 115), of other causes of natural death (n = 17), of severe head injury (n = 10) and of asphyxiation/strangulation (n = 7). Conjunctival petechiae occurred in all of the asphyxiated victims and in five out of 10 children dying of severe head injury, but were exclusively found in four resuscitated babies and one baby with questionable resuscitation trials of the SIDS-group (4%), furthermore in one resuscitated child dying of a congenital heart defect. Acute pulmonary emphysema was detected in six out of the seven children of the asphyxiation/strangulation group, in two resuscitated children with head injury and in five resuscitated babies dying of SIDS. Both parameters were observed exclusively in the asphyxiation/strangulation group (71% of the cases) but not in the control cases. Therefore, it can be concluded that the simultaneous appearance of conjunctival petechiae and of acute pulmonary emphysema strongly indicates death by asphyxiation.

Asphyxia↗

PubMed1998

DNA analysis in the case of Kaspar Hauser.

In 1828 a mysterious young man appeared in Nürnberg, Germany, who was barely able to speak or walk but could write down his name, Kaspar Hauser. He quickly became the centre of social interest but also the victim of intrigue. His appearance, his origin and assassination in 1833 were, and still are, the source of much debate. The most widely accepted theory postulates that Kaspar Hauser was the son of Grand Duke Carl von Baden and his wife Stephanie de Beauharnais, an adopted daughter of Napoleon Bonaparte. To check this theory, DNA analysis was performed on the clothes most likely worn by Kaspar Hauser when he was stabbed on December 14th, 1833. A suitable bloodstain from the underpants was divided and analysed independently by the Institute of Legal Medicine, University of Munich (ILM) and the Forensic Science Service Laboratory, Birmingham (FSS). Mitochondrial DNA (mtDNA) was sequenced from the bloodstain and from blood samples obtained from two living maternal relatives of Stephanie de Beauharnais. The sequence from the bloodstained clothing differed from the sequence found in both reference blood samples at seven confirmed positions. This proves that the bloodstain does not originate from a son of Stephanie de Beauharnais. Thus, it is becoming clear that Kaspar Hauser was not the Prince of Baden.

Base Sequence↗

PubMed1998

Energy loss due to radiation in postmortem cooling. Part A: quantitative estimation of radiation using the Stefan-Boltzmann law.

Conduction and convection are assumed to account for most of the energy loss from the dead body to the (cooler) environment. There are no quantitative estimations in the literature for the contribution of radiation to heat loss. The aim of the present paper was to estimate the radiation energy loss in postmortem cooling. The Stefan-Boltzmann law is used and combined with a single-exponential model for the cooling process of the skin derived from experimental data of Lyle and Cleveland (1956). The influence of various factors (e.g. skin temperature, environmental temperature, body mass and body height) on the amount of radiation emitted was investigated. The radiation energy is quantitatively described as a function of time. The radiation energy loss ranged from approximately 200 kJ in small (165 cm) and lean (50 kg) bodies at room temperature (20 degrees C) to approximately 600 kJ in tall (185 cm) and over-weight (100 kg) bodies at outdoor temperature (5 degrees C) in the first hour postmortem.

Body Constitution↗

PubMed1998

Extracorporeal shock waves act by shock wave-gas bubble interaction.

The effect of extracorporeal shock waves on hemoglobin release from red blood cells was recently found to be minimized under minute static excess pressure. It was proposed that this can be explained by shock wave-gas bubble interaction. We substantiated this further by two experiments by applying shock waves to suspended human RBC in a lithotripter at a lower frequency (1 pulse every 5 s) and by administering just a single or 2 strong shock waves at 30 kV. Compared to the usual application rate of 1 discharge per s, the lower frequency reduced the hemoglobin release under minimal static excess pressure in the range from 0-100 kPa. A single strong shock wave released a small amount of hemoglobin at ambient pressure and a similar amount at 200 kPa excess pressure. Two strong shock waves increased the hemoglobin release considerably at ambient pressure when there was a 1- or a 10-s pause between them. Under 200 kPa excess pressure, the hemoglobin release was minimal. A similar low hemoglobin release was also found with 1 shock at ambient and the other at excess pressure. The results are interpreted as clear evidence of shock wave-gas bubble interaction as a dominant mechanism of shock wave action.

Erythrocytes↗

PubMed1998

Analysis of human sodium iodide symporter gene expression in extrathyroidal tissues and cloning of its complementary deoxyribonucleic acids from salivary gland, mammary gland, and gastric mucosa.

The ability to concentrate iodide is a fundamental property of normally functioning thyroid tissue and represents the first step in the production of thyroid hormones. Iodide uptake has been demonstrated in various extrathyroidal tissues, including salivary gland, gastric mucosa, and lactating mammary gland. Recently, cloning and molecular characterization of the human sodium iodide symporter (hNIS) have been reported; however, the patterns of hNIS gene expression in human tissues have remained unidentified. To examine the profiles of human hNIS gene expression in various normal human tissues, we performed high-stringency Northern blot analysis using a 32P-labeled hNIS-specific complementary DNA (cDNA) probe (nucleotides 1184-1667). To detect rare hNIS transcripts in small tissue samples, RT-PCR was performed with a pair of hNIS-specific oligonucleotide primers designed to amplify a portion (nucleotides 1184-1667) of the hNIS gene. hNIS-specific transcripts were confirmed by Southern hybridization using a digoxigenin-labeled internal hNIS-specific oligonucleotide probe (nucleotides 1460-1477). To monitor cDNA integrity and quantity, and to rule out DNA contamination and illegitimate transcription, all samples were coamplified with two pairs of intron-spanning primers designed to amplify fragments of the human beta-actin and thyroglobulin genes, respectively. Using Northern blot analysis, hNIS transcripts of approximately 4 kb were detected in thyroid gland and parotid gland but not in a broad range of endocrine and nonendocrine tissues. RT-PCR and Southern hybridization revealed hNIS gene expression in thyroid gland, salivary gland, parotid gland, submandibular gland, pituitary gland, pancreas, testis, mammary gland, gastric mucosa, prostate and ovary, adrenal gland, heart, thymus, and lung. By contrast, hNIS transcripts were not detected in normal orbital fibroblasts, colon, and nasopharyngeal mucosa. To further analyze hNIS gene sequences in parotid gland, mammary gland, and gastric mucosa, the EXPAND High Fidelity PCR System and three sets of overlapping NIS oligonucleotide primers were used for amplification and cloning. The resulting PCR products were subcloned into pBluescript-SKII(-)vector, and at least two independent cDNA clones derived from each tissue were subjected to automated sequencing. The nucleotide sequences of hNIS cDNA derived from parotid gland, mammary gland, and gastric mucosa revealed full identity with the recently published human thyroid-derived NIS cDNA sequence. In conclusion, our results demonstrate markedly variable levels of hNIS gene expression in several extrathyroidal tissues. Although the physiological role of hNIS in these tissues awaits further study, our results suggest that the capacity to actively transport iodine may be a feature common to several secretory and endocrine tissues. The diminished capacity to transport and concentrate iodide in extrathyroidal tissues (such as parotid gland, mammary gland, and gastric mucosa), compared with thyroid gland, does not seem to be caused by an altered primary structure of the hNIS cDNA. Variability of NIS gene expression levels in normal extrathyroidal tissues may rather be caused by differences in NIS gene transcriptional activity. Further studies will address this hypothesis and examine the mechanisms of tissue-specific regulation of NIS gene expression.

Blotting, Northern↗

PubMed1997

Fractures at the base of the skull in gunshots to the head.

The distribution of fractures at the base of the skull was investigated in 147 victims with lethal head shot wounds caused by handguns or small calibre low-velocity rifles. In individuals without an impact of the projectile at the base of the skull, bullets lodged in the head were found up to a calibre of 7.65 mm (pistol) or .38 special (revolver), respectively. In cases with a trajectory through the cranial fossae positive results were obtained up to 9 mm (pistol) or even .45 (revolver). Fractures in anterior parts of the base of the skull were a rather frequent finding (82% of the cases) and could also be observed in victims shot by low energy guns. Fracture lines in particular in all cranial fossae, however, indicate a comparatively high energy missile and were found in victims without a direct impact of the bullet at the base of the skull after the use of guns with a calibre of at least 7.65 mm. Severe fractures leading to a hinge-like mobility of the base of the skull point also to projectiles of rather high energy. On the other hand, such fractures were also found in a victim with a contact shot by a .22 rifle. Therefore, it must be emphasized that individual factors such as the constitution of the base of the skull, the path of the bullet, technical parameters of the gun and ammunition used are of great importance if conclusions are to be drawn on an unknown gun by evaluation of fractures at the base of the skull.

Adolescent↗

PubMed1997

[Prevention of thrombosis in trauma surgery--current legal aspects].

To date, current jurisdiction has not permitted an answer to the a question as to how long thromboembolism prevention therapy is to be carried out after trauma surgery. However, the Bundesgerichtshof (BGH) reached a decision in 1995 on this matter. Accordingly, patients have to be informed about possible alternative treatment as well as the applicable form of thromboembolism prevention therapy in each specific case. In combination with the fact that the Deutsche Gesellschaft für Phlebologie (DGP, German society for phlebology) has published guidelines on thromboembolism prevention therapy via the internet, this may have considerable impact on the outcome of civil litigation, with consequences for financial compensation. Since civil action requires the medical doctor to prove that he has provided an adequate and acceptable basis for informed consent in patients, in concurrence with the above-mentioned DGP guidelines being potentially misunderstood as representing state-of-the-art treatment, it is deemed necessary to present a list of points that must be brought to the patient's attention when requesting informed consent and, furthermore, the manner in which the guidelines of the medical specialist societies may bring about problems must be pointed out. In the specific context of the German judicial system, criminal law will virtually never lead to a conviction in a case of fatal pulmonary embolism following neglect of or insufficient thromboembolism prevention therapy.

Expert Testimony↗

PubMed1997

Radial alveolar count as a tool for the estimation of fetal age.

A total of 53 normal fetuses with a gestational age ranging from 15 up to 39 weeks was investigated and the radial alveolar count (RAC) was estimated as a parameter for lung maturation. Values lower than 2.0 could only be found in lungs of fetuses aged less than 18 weeks. Between 18 and 25 weeks of gestation, relatively constant levels of RAC were observed but with considerable interindividual variation. In fetuses with a gestational age of more than 25 and especially 30 weeks, a slight or rapid increase in RAC occurred respectively. Values lower than 3.0 were found up to a fetal age of less than 30 weeks and a RAC of more than 4.0 was only found in lungs of fetuses aged more than 30 weeks. Values exceeding 6.0 occurred only in fetuses at near full-term birth. Since the estimation of RAC overcomes the effects of varying degrees of alveolar collapse, such an analysis also seems to be useful for the determination for fetal age in cases of advanced putrefaction.

Gestational Age↗

PubMed1997

Retrospective study on skin reddenings and petechiae in the eyelids and the conjunctivae in forensic physical examinations.

Skin reddening with or without additional changes such as pinpoint intracutaneous hemorrhages and/or minute superficial scratches was observed in 165 out of 739 physical examinations (reddening with additional changes: n = 81; reddening only: n = 84). The most common site where reddening was observed was the neck region (reddening with additional changes: n = 30; reddening only: n = 34). In over 85% of the cases, the postinfliction interval (Pi) was < or = 1 day, and there were 12 and 10 cases with 1 < Pi < or = 3 days, respectively. Among these 22 cases, there were 5 cases with 2 < Pi < or = 3 days, (reddening with additional changes: n = 4; reddening only: n = 1). The maximum Pis were almost 3 days, and 2 days and 13 h, respectively. These results demonstrate that reddening of the skin with and that without additional changes (in particular petechiae) were detectable up to approximately 3 and 2 days after the event, respectively. Furthermore, in 17 out of 64 cases with reddening in the neck, petechial hemorrhages were seen in the eyelids and/or conjunctivae (reddening with additional changes: n = 10; reddening only: n = 7). The maximum Pi in which petechial hemorrhages were detectable in the eyelids and/or the palpebral conjunctivae was 1 day and 21 h. The present study indicates that physical examinations within 2 or 3 days after the event seem to be more suitable to find skin reddening and/or petechiae in the eye lids and/or the conjunctivae.

Autopsy↗

PubMed1997

Colloid cysts of the third ventricle with fatal outcome: a report of two cases and review of the literature.

Two cases of sudden death due to colloid cysts of the third ventricle are presented with a review of the literature. In the first case, a 40-year-old woman suffered an acute onset of severe frontal headache after an intercontinental air flight. The next day, she was found comatous and died 7 h after admission to a hospital. In the second case, a 33-year-old man with a medical history of recurrent headaches was found dead in his car. Autopsy in both cases revealed a colloid cyst of the third ventricle and hydrocephalus involving the lateral ventricles. These cases demonstrate that fatal cases still occur. Nevertheless, prompt diagnosis using computed tomography (CT) or magnetic resonance imaging (MRI) is essential, since colloid cysts are histologically benign tumors that can be removed safely by neurosurgical intervention.

Adult↗

PubMed1997

Comparison of wound patterns in homicide and dyadic death.

A comparison of patterns of injuries between homicides and cases of dyadic death was performed. In 195 homicides, 139 deceased (71%) showed exclusively one type of trauma (mainly gunshot wounds) whereas two and even three types of trauma were detectable in 45 (23%) and 11 (6%) of the cases, respectively. In contrast, 18 out of 20 victims of dyadic death (90%) showed one type of injury (mainly gunshot wounds) and only two victims showed two types of injury. Even though different methods of killing seem to be unusual in dyadic death, even in cases with more than one victim and evidence of different types of injuries, such features cannot provide reliable information useful for a differentiation between homicide and extended suicide.

Adolescent↗

PubMed1997

Self-mutilation with needles.

Two cases of self-mutilation with needles are reported. One of the deceased suffered from chronic schizophrenia and committed suicide by plastic bag suffocation. At autopsy several needles were detected grown into the connective tissue of chest or abdominal organs. In the other case a knitting needle was used for repeated manipulations at the forehead leading to a defect of the skin and the skull. At least one vessel was injured leading to an extensive haemorrhage in the left hemisphere of the brain. The forensic and etiologic aspects of the cases are discussed.

Aged↗

PubMed1997

Suicidal attempt with a handsaw.

The case of a 54-year-old male suffering chronic schizophrenia is reported. The deceased was found in the workshop of his house lying in a pool of blood. The blood loss was caused by several stab wounds, in particular to the neck, due to the use of a screwdriver. Additionally, two superficial cuts were detected at the front of the neck, with a wave-like course consisting of several linear scratches apparently caused by the teeth of a handsaw found near the corpse.

Autopsy↗

PubMed1997

Nonoxidative ethanol and methanol changes in the heart and brain tissue of alcohol abusers.

Fatty acid ethylesters (FAEE) are synthesized from ethanol and fatty acids in the heart and brain. Similarly fatty acid methylesters (FAME) are synthesized from methanol and fatty acids. Whereas methanol reportedly indicates recent or chronic consumption of alcoholic beverages, an elevated serum methanol concentration (SMC) indicates mainly chronic alcohol intake. We compared levels of FAEE and FAME in cardiac and brain tissues with the blood ethanol concentration(BEC) and SMC in 18 alcohol abusers and 29 control subjects without history of alcohol abuse(control) to clarify the relationships between BEC and FAEE levels and that between SMC and FAME levels. We also assessed the possibilities of discriminating the alcohol abusers from the control group and of detecting FAEE and FAME accumulations in cardiac and brain tissues. Levels of FAEE and FAME were determined by gas chromatography (GC) in autopsied cardiac and brain tissues. Heart FAEE (HFAEE) levels correlated with BEC (r = 0.61) and it was possible to distinguish between alcohol abusers and controls using discriminant analysis. HFAEE levels in the alcohol abusing group were elevated even with low BEC. Therefore, HFAEE levels indicate ethanol accumulation in cardiac tissues of alcohol abusers. Brain FAEE (BFAEE) and heart and brain FAME (HFAME and BFAME) levels did not correlated closely with BEC and SMC, respectively. However, there are some possible means of discriminating between the two groups in terms of BEC and BFAEE, and SMC and FAME respectively, using discriminant analysis. Employing this analysis, the rate of misclassification was 17-25.5%. The mean levels of HFAEE, BFAEE, HFAME and BFAME were higher in the alcohol abusing group than in the control group, even when their BEC and SMC were quite low.

Acyltransferases↗