Beitrage zur gerichtlichen Medizin最新文献

The authors treat questions involving post-mortem examinations and autopsies, as regulated in the "Order Pertaining to Post-mortem Medical Examinations" in the former GDR. The administrative autopsy is of special importance in this respect. This regulation, which has been demanded by German physicians for more than a century and has existed for a long time in Austria (1857), should finally be introduced in the Federal Republic of Germany as well. It should at least be retained in the new Federal States. In the field of alcohol-related traffic law, the authors advocate a reduction of the blood-alcohol limit throughout Germany, even if the zero limit in the former GDR does not appear to be implementable. The time-tested regulations applying to organ graftings are presented as the third topic. In the GDR there was a uniform order based on the right to object.

Various histomorphometric methods and their use in clinical-pathological and forensic investigations are described. The methods are 1. manual point counting using an integrating eyepiece, 2. semi-automated histomorphometry using a manual digitizer and 3. automated image-analysing. Although the semi-automated and automated techniques are less time consuming and provide more information about the specimen, every method is regarded as having its specific range of application. It is pointed out that there is often a need for quantitation of histological findings especially in forensic medicine.

Two cases of sudden unexpected death at home (girl 16 year-old, woman 26 year-old) are reported. Both persons suffered from anorexia nervosa. Morphological investigation revealed heart atrophy as well as atrophy of other organs (striped muscle, spleen, mammary glands, ovaries, skin). Also lipofuscin accumulation (myocardium, liver, spleen) was noted. Especially conspicuous was serous (gelatinous) atrophy of fatty tissue. Anorexia nervosa is a common psychiatric disorder, therefore legal consequences--especially treatment without patient's consent--have to be considered. The legal situation in Austria is discussed. Concerning the 16 year-old girl the authors think that medical malpractice and carelessness of the parents were involved.

Our recently developed method for rapid quantitative evaluation of carboxyhemoglobin in liquid as well as in dried blood samples has been considerably improved by the incorporation of an infrared microscope. Besides the characteristic bands at V = 1953 (cm-1) in liquid and V = 1968 (cm-1) in dry blood we found, upon addition of D2O, a dislocation of the bands at V = 1949 (cm-1). This reversible dislocation still permits a reliable identification of the COHb complex at the extremes of the capacity range of the measuring unit. Thus identification of the COHb complex was successful even in isolated erythrocytes. By means of this improved technique reliable quantitative evaluation may be carried out in a concentration range of between 2% and 0.05% whereas semiquantitative evaluation was possible at concentration down to 0.01%, allowing for instance the evaluation of the effects of a single inhalation of cigarette smoke. The positive identification of endogenous COHb fractions as well as of exogenous agents (smoking, environmental factors) which this method permits is prerequisite for a dependable interpretation of forensic-toxicologically relevant COHb findings.

The post-mortem examination of a 50-year-old man, who had died suddenly, revealed a massive intraabdominal hemorrhage resulting from the rupture of an ectatic vein situated in the gall-bladder bed; the consecutive hemorrhage first led to a hematoma of the gall-bladder and secondarily to a tear of its wall. A macronodular alcoholic cirrhosis of the liver had caused a thrombosis in the hilar branches of the portal vein. The link in the pathogenesis between this portal vein occlusion and the venous bleeding into the gall-bladder is to be seen in a collateral circulation between the portal and caval system via the vena cystica. This unusual portal bypass using the veins of the gall-bladder extends the wide scope concerning the differential diagnosis of sudden natural death.

Resulting from a historical study of the so-called bolus death (choking) an 8-years analysis of 11 bolus cases is presented, the autopsies of which were carried out at the Institute of Forensic Medicine Chemnitz. External conditions, autopsy findings, and accompanying investigations carried out are considered. In five cases a bolus was found in the pharynx, just in front of the larynx entrance, and three times each in the larynx, causing the blockade of the larynx entrance, and in the trachea. A correlation between the localisation of the foreign substance and the presence respectively expression degree of the macromorphological signs of asphyxia was not evident. In conclusion a discussion to differentiate reflex mechanisms from asphyxia mechanisms following foreign substance aspiration is given.

Gene technology is still a very young area of research. Advantages or disadvantages of this development cannot be tangibly predicted. Irrational desires and fears have surfaced resulting from the fact that we are now in a position of cultivate certain biological characteristics hitherto impossible to reproduce. Individual cases of genome analysis under working conditions, genome analysis as a genetic fingerprint, outdoor plant experiments and gene testing procedures in prenatal diagnoses should all be considered. Analysis uncertainty exists in all these fields, not least caused by multifunctional factors affecting genetic features. The question regarding the right to know or not to know, and the data protection problem irrevocably connected to this, is constantly being raised. It must be recorded that, in spite of the latest scientific findings, opportunities for therapy are frequently lacking. In all our efforts, the psychological conflicts of those concerned and the resulting socio-economic consequences must be taken into consideration.

The classical generalized Sanarelli-Shwartzman phenomenon (SSP) in animal experiments is induced by two conservative endotoxin injections. The experimental animals mostly die within 24 hours in irreversible shock. They show numerous microthrombi with as high fibrin content in the peripheral vessels of many organs (especially the kidneys) in the context of a consumption coagulopathy. In a 49-year-old man who died within one day of a condition associated with high fever, the clinical picture could be defined on the basis of the clinical and morphological findings as a human equivalent of SSP. The detection of a gram-positive bacterium (Diplococcus pneumoniae), which has been described as the causative organism of SSP only in a few exceptional cases, was noteworthy. The special features of the pathophysiology are described.

It can be assumed, that the morphological structures of the blood-brain-barrier (BBB) and blood-cerebrospinal fluid-barrier (BCB) are built at the same principle and stops considerably the transport of water soluble substances to the cells of the brain. To these belong polar groups of active substances, which improve their water solubility (OH-, COOH-, CO-, NH2- and SH-substitutes). On the other side lipophilic solvents as vehicles support the penetration of such polar substances into the brain. Our aim in this paper was to investigate the distribution of unchanged barbiturates and their polar metabolites in the brain within the scope of animal experiments. All the animals (cats) got an overdose of Pentobarbital, to which a small quantity of the hypnotic marked with a 14C atom was added. Pentobarbital metabolizes in the organism in short times to hydroxy- and carboxy-pentobarbital. After different times of killing the organs and body fluids, especially the brain were examined and the results compared. It could be shown that in the brain of all animals in spite of different killing times 75-90 per cent of the unchanged barbiturate has been found. On the other side, only a maximum of 20 per cent of the pentobarbital metabolites was found in the brain cells. In the other organs and body fluids the part of the unchanged barbiturate was much lower, between 10 and 50 per cent, depending on the killing time. The quantity of the metabolites was essential higher, with variations between 50 and 90 per cent.(ABSTRACT TRUNCATED AT 250 WORDS)

In 677 unrelated persons from the Central Hessian region, the following distribution of amylase 2 phenotypes was found: type 1 in 89.22%, type 2-1 in 8.57%, type 2 in 0.30%. The special bands 3 and 4 could be detected in 0.59% and the new bands F1-6 (on the anodal side of the 1 band) we have described could be demonstrated in 1.33%. In 244 cases, paternity could be excluded on the basis of amylase 2 in seven cases (i.e. 2.9%); this was a classic exclusion in six cases. In the biostatistical calculation of the probability of paternity, this enzyme system provides probabilities which justify routine determination of amylase 2.