Petechial bleedings in sudden infant death.

The autopsy reports of 484 cases of deceased infants (201 females, 283 males) were analysed retrospectively for the existence of external and internal petechial bleedings (PET). The cases were divided into five groups on the basis of the cause of death (sudden infant death syndrome, sepsis, airway infections, asphyxia and trauma). Internal PET (pleural, pericardial, epicardial, thymic and peritoneal) were observed in each group with a lower prevalence in cases of trauma. The highest prevalence of external (cutaneous and conjunctival) PET was detected in cases of asphyxia (38% and 31%, respectively). However, even if with low prevalence, such bleedings were detected in every group. Factors like sex, age, cardiopulmonary resuscitation and its duration did not influence the presence of PET. The detection of external PET at autopsy is a suspicious finding that suggests asphyxia. Because of the possible natural origin of these bleedings, the medicolegal investigation has to be as complete as possible and has to include histology as mandatory.

Nicotine and cotinine in infants dying from sudden infant death syndrome.

The aim of this component of the German Study on Sudden Infant Death was to determine (1) nicotine concentrations in hair (NCH), as a marker of long standing exposure to tobacco, (2) cotinine concentrations in pericardial fluid (CCP) and (3) cotinine concentrations in liquor cerebrospinalis (CCL), the latter measures being markers of recent exposure to tobacco in the last few hours of life. The results obtained were compared with data on parental smoking revealed from interviews. In 100 cases of sudden infant death syndrome, material was taken at autopsy to determine NCH. In 41 cases, NCH and CCP, and in 70 cases, NCH and CCL were determined. Infants of mothers who stated having smoked during pregnancy had higher NCH than infants of non-smoking mothers (p = 0.008). Furthermore, there was a weak but statistically significant relationship between NCH's and the daily cigarette consumption of the mother during pregnancy (n = 64, r = 0.24, p = 0.05). In 43% of infants, nicotine could be detected in their hair, although the mothers had said at the interview that they did not smoke during pregnancy. On the other hand, in 33% of infants whose mother stated they had smoked during pregnancy nicotine was not detectable in the infant's hair. CCP's were strongly correlated with CCL's (r = 0.62, p = 0.0027). For this reason, both parameters were treated as equivalent for the detection of tobacco smoke exposure in the last hours before death. The influence of breast-feeding was evaluated by comparison of the nicotine concentrations in breast fed and non-breast-fed infants from smokers and non-smokers. Fivefold higher nicotine concentrations were determined in non-breast-fed infants of parents who smoked as compared to all other groups. It can be concluded that nicotine intake by passive smoking is much more important than by breast-feeding. We conclude that both interview data and biochemical measures should be sought to understand the true exposure to tobacco smoke.

[Postoperative therapy of an alcoholic patient with an unusually high ethanol metabolic rate]. / Postoperative Therapie eines alkoholkranken Patienten mit ungewöhnlich gesteigerter Ethanolabbaurate.

To avoid alcohol withdrawal syndrome (AWS) a pre-operative withdrawal, post-operative drug therapy or continued substitution of ethanol may be tried. However, substitution of ethanol needs an exact dosage and has to be controlled very carefully. The dose calculation is based on an assumed breakdown rate of 0.15 g%/1000/h, as evaluated in forensic studies. We report on a patient who throws the basis for these calculations into question. The breakdown rate of this 43-year-old man was extraordinary higher than the average turnover. This high level of the turnover rate occurred with no detectable impairment of the liver or other organs. This case demonstrates the importance of a close control of the blood alcohol level during the post-operative administration of ethanol. The individual doses of ethanol to avoid AWS has to be found individually for each patient.

Transglutaminase immunoreactivity in the male genital tract of the rat.

The distribution of transglutaminase immunoreactivity in the male genital system of the rat has been studied at the light and electron microscopic levels using a highly specific polyclonal antibody. The antibody is obviously secreted in an apocrine fashion in the dorsal prostate as well as the coagulating gland. This moiety is responsible for semen clotting. In addition to the secretory moiety, epididymal sperm contain endogenous immunoreactive material in the cytoplasmic droplet. Whether this is added to the sperm within the epididymis--as is the immunoreactive material on the sperm head--or already present in developing sperm has to be elucidated by further immunoelectron microscopic studies.