[Testing the efficacy of disinfectants during drinking water treatment. A new experimental set-up at the German EPA (Umweltbundesamt - UBA)]. / Prüfung der Wirksamkeit von Stoffen zur Desinfektion bei der Trinkwasseraufbereitung : Der Teststand im Umweltbundesamt.

A set-up for experiments in the flow-through mode was constructed in order to test the efficacy of substances used for disinfecting water during drinking water treatment. A flow-through mode - in contrast to experiments under stationary conditions (so-called batch experiments) - was chosen, because this experimental design allows experiments to be carried out under constant conditions for an extended time (up to one week) and because efficacy testing is possible repeatedly, simultaneously and under exactly the same conditions for short (about 0.5 min) and also longer (about 47 min) contact times. With this experimental design the effect of biofilms along the inner pipe surfaces can be included in the observations. The construction of the experimental set-up is based on experience with laboratory flow-through systems that were installed by the UBA's drinking water department (formerly Institute for Water-, Soil- and Air Hygiene (WaBoLu) Institute) for testing disinfection with chlorine. In the first step, a test pipe for the simulation of a water works situation was installed. Water of different qualities can be mixed in large volumes beforehand so that the experimental procedure can be run with constant water quality for a minimum of one week. The kinetics of the disinfection reaction can be observed by extracting samples from eight sampling ports situated along the test pipe. In order to assign exact residence times to each of the sampling ports, tracer experiments were performed prior to testing disinfectant efficacy. This paper gives the technical details of the experimental set-up and presents the results of the tracer experiments to provide an introduction with respect to its potential.

As(III) removal from groundwaters using fixed-bed upflow bioreactors.

The application of biological oxidation of iron and manganese, as a potential treatment method for the removal of arsenic from contaminated groundwaters, was examined in this paper. This method was based on the growth of certain species of indigenous bacteria, which are capable of oxidizing the soluble iron and manganese ions; the oxidized forms can be subsequently removed from the aqueous stream by over 97%, through their transformation to insoluble oxides and separation by a suitable filter medium. Arsenic was removed by around 80%, under certain conditions, which were found to be sufficient for Fe(II) removal (dissolved oxygen 2.7 mg/l, redox 280-290 mV, pH 7.2, U 8.25 m/h). The specific treatment technique presents several advantages towards conventional physicochemical treatment methods, such as enhanced coagulation or direct adsorption since: (a) it does not require the addition of other chemicals for oxidizing and removing As(III), (b) it does not require close monitoring of a breakthrough point, as in conventional column adsorption processes and (c) it could find application for the removal of, at least, three groundwater contaminants (Fe, Mn, As).

[Fatal child neglect in West Germany 1 January 1985 to 2 October 1990. Results of a multicenter study]. / Tödliche Kindesvernachlässigung in der Bundesrepublik Deutschland im Zeitraum 1.1.1985 bis 2.10.1990. Ergebnisse einer multizentrischen Studie.

UNLABELLED: Up to now reliable data were available on cases of lethal child neglect in the area of the Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period from 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 19 cases of lethal child neglect. Extrapolated to all institutes of legal medicine, this corresponds to 20 cases and thus 3.5 cases a year in the whole of West Germany in the period studied. There is to be added a dark-field which cannot be limited more precisely. However, the cases of fatal child neglect might have occurred much more seldom than fatal child abuse caused by use of physical violence. Slightly more than half the victims were younger than 1 year, the oldest one was 7 10/12 years old. Most frequently the children died of starvation and thirst. Mostly the mothers/nursing mothers killed the child alone or together with the victim's father/stepfather. In the majority of the cases there was not a close affection between parents and child. Nearly 30% female/male perpetrators suffered from chronic alcohol abuse. Only 15 (= 56%) of 27 female/male perpetrators were sentenced to imprisonment (period between 7 months on probation and 10 years). Mitigation circumstances existed for nearly half the persons sentenced to imprisonment. It is true that child neglect is a rarer crime, but the experts of legal medicine always have to indicate errors made during the external inspection of the corpse (among others failures to see indications of neglect).

[Fatal child abuse (caused by physical violence) in Germany during 1 January 1985 to 2 October 1990. Results of a multicenter study]. / Tödliche Kindesmisshandlung (durch physische Gewalteinwirkung) in der Bundesrepublik Deutschland im Zeitraum 1.1.1985 bis 2.10.1990. Ergebnisse einer multizentrischen Studie.

UNLABELLED: No reliable data are available on cases of lethal child abuse (by active force) in the area of Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 58 cases of lethal child abuse. Extrapolated to all institutes of legal medicine, this corresponds to 62 cases in all of West Germany in the period studied. An approximately equal number of unreported cases should be added to this figure. Including unreported cases, at least 20 cases of lethal child abuse occurred per year; thus only one in every two cases ever came to light. Almost two thirds of the victims were younger than one year old. At autopsy 59% exhibited signs of repeated abuse at autopsy. By far the most common cause of death was direct impact from a blunt object, usually to the head. Mostly, the male person to whom the victim relates most closely (father, stepfather, partner of the mother) has killed the child. Twenty-one of the 74 persons charged saw the charges against them dropped or were acquitted due to lack of evidence; 51 received sentences ranging from one year probation to life. In the remaining two cases the outcome of the trial was unknown. Signs of abuse were readily apparent at autopsy in almost all cases. The high number of unreported cases underscores the need to educate medical students and practicing physicians to be on the look-out for signs of abuse and argues for an increase in the rate of autopsy.

Nasal decongestion with imidazoline derivatives: acoustic rhinometry measurements.

OBJECTIVE: The objective of this single-blind study was to establish whether there are any differences between conventional imidazoline-containing nasal drops with regard to duration of action and decongestion potential. METHODS: Six different substances were each administered to 108 healthy volunteers (nine groups of 12 adults), respectively, in the concentration recommended for adults (and two also in that recommended for infants) over a period of 8 h in comparison with 0.9% NaCl. The volumetric measurement of the nasal lumen was conducted by means of acoustic rhinometry (Rhinoklack). RESULTS: The decongestive effect of all imidazoline preparations set in relatively uniformly, without any appreciable differences. After 20 min all the products exhibited approximately 60% of their maximum decongestive effect, which was achieved after approximately 40 min, having produced an increase in volume of approximately 20%. In contrast, in terms of duration of action, considerable differences between the individual products were to be discerned: indanazoline 0.118%, naphazoline 0.02% and tetryzoline 0.1% had no effect whatsoever after 4 h. Oxymetazoline 0.05% and 0.01%, xylometazoline 0.025% and 0.1%, and tramazoline 0.1264% still had an appreciable effect after 4 h, while after 8 h only oxymetazoline 0.05% and 0.01% still had a relevant decongestive effect. A rebound effect associated with reactive hyperaemia was observed after 8 h in all short-acting products (indanazoline, naphazoline, tetryzoline and tramazoline), which in the case of indanazoline was even associated with a reduction in the nasal lumen. Interestingly, there were no differences between the xylometazoline and oxymetazoline concentrations recommended for adults and those for infants in terms of efficacy. The low-dose concentrations of the preparations for infants appear to be sufficient to produce a satisfactory therapeutic effect.

[Fatal carbon dioxide embolism as a complication of endoscopic interventions]. / Tödliche Kohlendioxid-Embolie als Komplikation bei endoskopischen Eingriffen.

Fatal complications during laparoscopy mostly originate from injury to major pelvic vessels, causing severe hemorrhage or carbon dioxide embolism. We report a case of a 30-year-old patient who--after unsuccessful resuscitation--died during gynecologic laparoscopy. The noted signs corresponded to acute gas embolism, particularly as ultrasound revealed intravascular gas pulsation. At autopsy, 2 days post mortem, a puncture of the left common iliac vein was discovered. Despite this, gas bubbles in the right heart could not be confirmed. Pre-conditions for fatal carbon dioxide embolism are stressed. To prove the presence of carbon dioxide gas post mortem, autopsy has to be performed as soon as possible and the corpse has to be stored without cooling.

Phrenic nerves and diaphragms in sudden infant death syndrome.

Disturbances of the respiratory system may be an important factor in the cascade of events leading to sudden infant death syndrome (SIDS). Even though the diaphragm is the major respiratory muscle in infants, little is known about alterations of this muscle and of the phrenic nerve in SIDS. In the present study, diaphragms and phrenic nerves of 24 SIDS infants and seven controls were analyzed. Morphometric analysis revealed only slightly larger cross sectional areas of phrenic nerve axons but no increase in myelin sheath thickness in SIDS cases. However, in one SIDS case, myelinated nerve fibre density was severely reduced. Using electron microscopy, several nerve fibres of SIDS infants showed focal accumulations of neurofilaments. Muscle fibre diameters in SIDS diaphragms were significantly larger compared to controls (P < 0.0001). However, in almost all SIDS and control cases, axons and myelin sheaths were artificially swollen, and acute segmental muscle fibre ruptures and contracture bands were found. These prominent nonspecific ultrastructural alterations should advise caution in the interpretation of morphometric data. Thus, in some cases exemplified by one case of the present series, decreased density of phrenic nerve myelinated axons might contribute to SIDS. Still, the present results indicate that development of phrenic nerves and diaphragms is not delayed in most SIDS infants.

Internally concealed cocaine: analytical and diagnostic aspects.

Thirty persons arrested at Frankfurt airport for smuggling internally concealed cocaine in 1993/1994 were investigated. An X-ray examination (in all 30 cases), immunochemical examination of urine (in 27 cases) and of saliva (in 20 cases) was performed in parallel. An X-ray examination gave positive results in all examined persons. EMIT cocaine metabolite assay (cut off 300 ng benzoylecgonine (BE)/mL) was positive in eight urine samples. After reducing the cut off to 150 ng BE/mL urine, eleven samples were classified as positive. The results were confirmed by means of chromatographic determinations. These findings showed limited role of immunological examination of urine as a screening test in suspected smuggling of internally concealed drugs. All saliva samples showed negative immunochemical results. The number of concealed containers ranged from 44 to 135 per person. The amount of cocaine hydrochloride found in particular cases ranged from 242 to 1050 g net weight, divided into containers weighing from 5.7 to 13.8 g. Drug packages were obviously machine-made. The packages smuggled by a particular person were uniform. However, a distinct interpersonal variability in drug packages was observed, in regard to the number of protective layers (4-7), size, weight, and cocaine purity. This may be helpful for the identification of production site. The leaching of cocaine from selected containers was investigated in a stirring bath and was independent of the conditions applied.

Trends in occurrence of drugs of abuse in blood and urine of arrested drivers and drug traffickers in the border region of Aachen.

The region of Aachen is located in a triangle on the German, Dutch and Belgian borders and is heavily exposed to drug traffic, due to the differences in national drug policies. The analysis of toxicological casework in the Institute of Forensic Medicine in Aachen was undertaken for the period 1987-1993, i.e. 6 years before and 1 year after the partial suspension of the border control due to the Maastricht Treaty; 2653 cases were registered, among them 988 automobile drivers. The profile of the casework has changed after the opening of the border: up to 1992 most cases were obtained from the customs. In 1993 the prevalence of police samples was noticed. In the population of drivers, blood samples were only taken in 30% of all the cases. In other cases, concerning mainly motorized drug smugglers, only urine samples or seized drugs have been sent for examination. The urine samples in this group were mostly drug-positive. Drug-smuggling drivers appeared to be a risk-generating group for road traffic safety. The analyses of blood and urine samples revealed multiple drug use in most of the cases. Since 1992, a steep increase in the frequency of cocaine-positive blood samples among drivers was noticed. The results of the study indicate that the abolition of the border control affected the road traffic safety in the region of Aachen.

[A correlation between level of blood alcohol and repeated offense]. / Zur Korrelation zwischen Höhe der BAK und wiederholter Auffälligkeit.

Statistical analysis of 46,972 recorded blood samples and the relevant BAC classification revealed the following points: 1. A correlation between the BAC level at the time of the first offence and the probability of a recurrence could not be proved. 2. Most recurrences took place within three years. 3. The probability of a recurrence rises with the number of offences.

Arrangement of elastic fibres in the integument of domesticated mammals.

The hairy skin of important domesticated mammals (12 species) was studied with scanning electron microscopy, transmission electron microscopy, laser scanning microscopy, and several light microscopical methods, to obtain more information about three-dimensional elastic fibre arrangement. It was obvious that there is a basic construction scheme of the elastic fibre meshwork as present in the upper and mid-dermis, with special regard to the size, number, and grouping of hair follicles. In the densely-haired species, in particular, a typical elastic mat with horizontal fibres is formed. In many of the sparsely-haired animals, the upper and mid-dermis show a sponge-like elastic system. In the rather massive, collagen-rich skin of large species, the lower two thirds of the dermis without hair follicles only possess a loosely-structured elastic network, but thick elastic sheets are found at the border zone with the hypodermis. Specific features appear with regard to the type of mechanical strain exerted, different body regions, varying hair follicle density, or as connected with the anchoring of the hair follicle complex, blood vessels, and nerves.

[Limits for recognizing linear fractures of the cranial vault in radiologic diagnosis]. / Grenzen der Erkennbarkeit von linearen Frakturen der Schädelkalotte in der radiologischen Diagnostik.

In case of failure to detect a vault fracture in fatal head injury the physician is often accused of medical negligence. The material for the study consisted of a macerated vault with fractures in different widths. In order to detect the threshold of perceptibility it underwent radiographic examination taking pictures under different projections. Our finding is that the presence or absence of a radiographic fracture depends on the width and direction of the fracture. Therefore it is impossible to detect every single linear fracture of the vault in routine skull examination. Clinical and medico-legal consequences are discussed.

Translocation of the nuclear autoantigen La to the cell surface of herpes simplex virus type 1 infected cells.

Recently we developed a procedure to translocalize one of the extractable nuclear antigens (ENAs), the La protein, to the cell surface of CV-1 cells. Here we report that herpes simplex virus type 1 infection can also induce a translocation of the autoantigen to the cell surface. On the cell surface we detected La protein assembled with large protrusions. Within these protrusions La protein colocalized with virus particles. These protrusions are known to be released from the cell after virus infections. Such complexes consisting of self and virus could provide helper determinants for an anti-self response, and therefore be important in generation of autoimmunity.

[Acute fatal hemorrhage in craniocerebral trauma?]. / Akuter Verblutungstod bei Schädelhirntrauma?

At necropsy of fatal cases due to craniocerebral trauma it is highly recommended that the intraosseous course of the internal carotid arteries are dissected, as detected injuries of these vessels may allow improved conclusions concerning the course of death. Suitable preparation techniques are presented. On the basis of the anatomical and physiological situation as well as pathophysiological considerations the acute lethal outcome of traumatic rupture of the intraosseous part of these arteries is not to be interpreted as death by hemorrhagic/hypovolemic shock but rather as lethal cerebral hypoxia subsequent to a rapidly developing insufficiency of the brain circulation.

Airway resistance of the posterior nasal pathways in sudden infant death victims.

In order to test the hypothesis that infectious swelling of parts of the inner nose causes airway obstruction and is of aetiological significance for sudden infant death (SID), we measured the airway resistances of the prepared posterior nasal pathways of 55 SID victims and 7 infants who died of other causes. About 25% of the SID victims but none of the control cases had strongly elevated nasal resistances; over 4000 kPa.s.m-3 up to unmeasurable values. A histological survey showed that about 50% of the SID cases and only 1 of the control cases exhibited distinct to severe signs of inflammation of the nasal mucous membranes. No correlation was found between nasal resistance and age, sex, body weight, body length, head circumference, or histological findings. We conclude that an elevated nasal resistance plays a role in some SID cases and that SID is rather the result of different processes than a monocausal disease.

[Comparative immunological studies of SID-victims and hospital-treated infants of the same age]. / Vergleichende immunologische Untersuchungen von SIDS-Fällen und altersgleichen stationär behandelten Säuglingen.

A group of 103 SID victims was compared with a group of 87 clinically treated infants at the same age with respiratory and enteral infections. It was stated that immunological parameters were in agreement in both groups. These findings show that SID victims are ill before sudden death.

[Significance of functional conclusions for "determination" of the cause of death]. / Die Bedeutung funktioneller Rückschlüsse für die "Feststellung" der Todesursache.

On account of the usual expectation it is often assumed, that an autopsy allows the definitive determination of the manner and cause of death. This paper discusses in a critical way the problems associated with this endeavour. It is often the case, that extensive investigations, associated with structural-functional conclusions and consideration of all available evidence are necessary to permit a retrospective interpretation of the course of death. This assumes a scientifically orientated approach to dynamic pathophysiological mechanism.

[Digital autopsy archive using the personal computer]. / Digitales Sektions-Archiv (DSA) auf dem PC.

The development of a dissection register for Legal medicine well differentiated and considering special requirement of the subject was not achieved in history because of complexity of post mortem findings in many cases. Realizing that an all satisfying concept failed we looked for the possibility of using electronic data processing for rapid and flourish collection of autopsy results not requiring much time for the coroner. Based on personal computer software "dBase" a database program was developed easy to handle using different forms asking for characteristic circumstances of the case and essential post mortem findings. Short codes for locations and ascertainments were chosen to enable rapid selection of interesting statements as far as handling for statistical evaluations later on. Less then 10 minutes are needed for recording post mortem results in this way short time after autopsy.

Possible association of sudden infant death with partial complement C4 deficiency revealed by post-mortem DNA typing of HLA class II and III genes.

Based on evidence of an increased rate of respiratory infections in sudden infant death (SID) infants as well as the observation of familial occurrence, we analysed in a retrospective study class II and class II genes of the major histocompatibility complex in 40 cases of SID by Southern blot analysis of DNA obtained post mortem from tissue samples. In 24 cases, the parents were interviewed and confirmatory human lymphocyte antigen (HLA) and DNA typing was carried out. Using HLA-DR beta and -DQ beta probes, no evidence of an abnormal HLA-DR frequency distribution in SID infants was detected (P = 0.97). Using DNA probes for the tandemly arranged complement C4 and steroid 21-hydroxylase genes, an increased number of C4B gene deletions in SID cases was found. The increase in C4 gene deletions was significant (P = 0.0125) in infants with recurrent infections. These data indicate a possible role of partial C4 deficiency as a genetically predisposing risk factor in SID.