[An unusual complication after an insect bite? Diagnostic procedures in a case of granular cell tumor]. / Ungewöhnliche Komplikation nach Insektenstich? Zur Diagnostik des Granularzelltumors.

Granular cell tumors are, in almost all cases, benign soft tissue tumors, although malignant variants have rarely been described in a variety of anatomical locations. In the case presented here, a so-called atypical granular cell tumor was diagnosed based on two criteria, being differentiated from the usual histological findings by enhanced mitotic activity and focal spindle cell proliferation. Further suspicious characters of the tumor were its size of 13x10x5 cm on MRT as well as its long-term clinical course (1.5 years). The diagnostic procedures undergone until resection of the tumor, including the macroscopic and histological findings, are presented. The diagnosis can be made with certainty by using conventional histology in combination with immunohistochemistry. The tumor cells react positively with antibodies against S-100 protein, NSE, laminin, myelin proteins and myelin-associated glycoproteins. These staining patterns underscore the neural origin of the tumor tissue. In this case a mitotic frequency of two per ten high power fields and focal spindle cells led to the diagnosis of an atypical granular cell tumor, whereas the criteria for a malignant variant were not met.

Traumatic venous aneurysm of the popliteal vein with outcome: a case report and review of the literature.

A case of sudden death due to recurrent pulmonary thromboembolism is described. The fatality took place three and a half weeks following blunt trauma to the left popliteal region. The patient died unexpectedly. Autopsy revealed the source of the emboli as a sacciform venous aneurysm of the popliteal vein, an entity seldom described, but important to consider in cases of soft tissue popliteal masses or unexplained pulmonary embolism, especially in otherwise healthy individuals.

Morphometric assessment of testicular changes in drug-related fatalities.

Testicular sections of 50 deceased drug addicts were examined by light microscopy using morphometric methods and determining the extent of spermatogenesis by application of the Johnsen score count. Twenty cases of violent death served as reference sample. The study was aimed at obtaining data about the degree of germinal gland damage following the duration of the individual drug career, which was correlated to the histologic findings. Progressively reduced maturation of germinal cells, decrease of tubular diameter and height of sperm-producing epithelium were found the longer the individual case history has been. The results clearly indicated a substantial impairment of male fertility in the course of a drug career, but etiology seems to be multifactorial, since most of the deceased were polytoxicomanic and more than 40% were under the influence of alcohol at the time of death. Testicular damage is obviously a sequel of long-lasting abuse and a very complex process, presumably progressing with the duration of the adverse habit.

[Self-impalement after thoracic stab wound. An unusual method of suicide in psychotic symptomatology]. / Selbst-Pfählung nach Thoraxstichen. Eine ungewöhnliche Suizid-Methode bei psychotischer Symptomatik.

A 35 year-old male was found dead within a vast collection of garbage in his parent's house with 13 stab wounds of the thorax. 6 years before death he had suffered from a severe cerebral trauma with intracranial hemorrhage, after which an organic psychosis had ensued. At autopsy besides the stab wounds measuring 1-3.5 cm in length and partly exhibiting a so-called "fish-tail" formation a piece of wood was detected, having penetrated the fourth intercostal space along the sternal border and lacerated the pericardium, right pulmonary hilum and the pleura parietalis at the paravertebral line between the eight and ninth rib. There the leading part of the tool had apparently broken and bent to the left in a nearly 90 degrees angle, thus penetrating the left pleural cavity with a slight laceration of the lower lobe of the lung. From the forensic pathologist's point of view this case of multiple stabbing and additional impalement was at least remarkable and at first sight might have raised a suspicion of homicide due to the extent of the rib penetrations and especially the intrusion of the wooden device, which had been pushed by substantial force into an already existing wound. The police presupposed a suicide based on the personal history and situation at the site, where no traces suggesting an activity of somebody else could be ascertained. Reconstruction of the case and resulting differential diagnostic considerations are to be discussed.

Death caused by a chain saw--homicide, suicide or accident? A case report with a literature review (with 11 illustrations).

A 31-year-old farm worker was found dead beside a chain saw. Based on the testimony of a colleague and because of the situation at the site, the police very soon presupposed an accident. It was assumed that the victim had slipped on the sudden ground and had been killed by the subsequent swerving of the saw when starting the engine. The body presented with a deep lacerated wound at the right side of the nape of the neck, including the first cervical vertebra, the medullary canal and the right mandible as well as multiple fissures of the occipital bone, which were attributed to repeated forceful use of the chain by another person. A second wound with relatively sharp edges and a tangential fissure in the corresponding area of the skull raised the suspicion that an axe or some similar device had been used. Although the forensic medical findings seemed to give clear evidence of external violence, no further investigations have been carried out so far by the authorities.

[Death caused by "attack dog" bites. A contribution to current discussion]. / Tod durch "Kampfhund"-Bisse. Ein Beitrag zur aktuellen Diskussion.

Two cases of fatal dog-bite incidents caused by males of the "American Staffordshire terrier" breed currently known as "fighting dogs" are reported. Both happened in elderly women, one of them handicapped. Reconstruction of the accidents revealed some peculiar characteristics of these dogs, namely the ability to attack undesirably and forcefully as well as the enormous grip of their jaws. Considerable public attention has been drawn to some breeds which seem to predominate in dog-bite statistics and are summarized as "pit bulls". For the animal behaviourist it is not justifiable to condemn only the dog and blame it solely for damage inflicted. Scientific casework has to encompass the situational background of any case and the animal's holder because there is often a close association between the character of the dog and its human counterpart. Implications of such incidents for public safety policy and forensic science are to be discussed.

Myocardial sarcoidosis as a rare cause of sudden cardiac death.

Two relatively young women died suddenly due to myocardial sarcoidosis. Necropsy in both cases revealed compact infiltration of the ventricular septum by fibrous tissue. Histologic sections elucidated extensive granulomatous degeneration and giant cells of the Langhans' and foreign body type without central necrosis of the granulomas. Both women had been entirely free of symptoms, but in the second case of a 35-year-old, who had been 6 months pregnant, an ultrasound sonography of the heart had documented a suspicious area in the ventricular septum interpreted as a scar. Further investigations had been postponed until delivery. Isolated myocardial sarcoidosis should be taken into account as one possible cause of sudden death, especially in young people.

[Epidemiology of suicide]. / Zur Epidemiologie des Selbstmordes.

1. Nationwide surveys in single countries concerning epidemiology of suicide are in fact valuable despite serious doubts often mentioned against them. 2. From the beginning of this century until the 1980's there has been an almost continuous increase in the number of suicides in males. Since the end of the 1950's the figure of female suicide has risen in various countries as well, although the situation is not the same everywhere. 3. Denmark proved to be the country with the highest suicide rate within the European Community, whereas it is Hungary in Eastern Europe. The former GDR had rates above the average in 1988-90. Extraordinarily low rates were seen in Greece, Spain, Ireland and Italy. 4. The elderly tended to have increasing rates in most countries--with the exception of regional varieties in connection with drug abuse and alcoholism as well as unemployment. 5. Suicides in psychiatric clinics demonstrated a rise worldwide--studies carried out in the Federal Republic of Germany reported of such suicides having doubled since the beginning of the 1970's. 6. Vast regional differences in major cities of the FRG had been described in the 60's and 70's. In the former GDR there were strong discrepancies between various regions in 1988-90. Those data are not explainable yet.

Preliminary results of an interdisciplinary survey of drug victims.

In an interdisciplinary study, 53 cases of drug-related death were investigated. Forty per cent of these cases exhibited acute or chronic hepatitis; foreign body granulomas were detected in 30%. By CT-scan of the left lung, small abscesses and pneumonic focuses could be localized. The spectrum of bacterial strains isolated from lung tissue did not differ significantly from that of a control group. Severe alterations of the testes, i.e. reduction of spermatogenesis, was present in a considerable number of cases. The high rate of myocarditis diagnosed (18%) supports the idea that besides acute intoxication, drug-related death is due to multifactorial origin.

["Alco Screen"--a reliable method for determining blood alcohol concentration by saliva alcohol concentration?]. / "Alco Screen"--eine brauchbare Methode, über die Speichelalkoholkonzentration (SAK) die Blutalkoholkonzentration zu ermitteln?

About two years ago pharmacies in the Federal Republic of Germany began to offer motorists test sticks named "Alco Screen" in order to evaluate the concentration of alcohol in the saliva. According to the producers it should be a quick and simple method giving a high correlation between the alcohol level both in blood and saliva. As advertised, a drunken driver could estimate his own extend of alcohol impairment by himself. We checked the reliability of this method by comparing the alcohol level in the blood with the extend of colour change of the sticks in 20 adult volunteers engaged in drinking tests. 85% of them demonstrated distinct discrepancies. In most cases the saliva concentration estimated was too low. Those, depending on the result of this test kit, take a high risk of being misled and can probably assume sobriety in contrast to their actual state. A warning concerning this test is necessary.

[Suicide in a large West German city (1985-1989)]. / Suizide in einer westdeutschen Grossstadt (1985-1989).

Frankfurt/M. is a city with a high proportion of foreign inhabitants (20.3%), households with one person only (49.4%) and a decreasing number of persons associated to a religious community. Suicides committed in 1985-89 were reviewed. Among the 631 cases, 408 were men and 223 women. 30% of these male and 22% of the female suicides were performed by singles. 30% of all persons were between 20 and 40 years old. With increasing age the percentage of women increased too. In the suicide rate a peak was observed in April. During the week men committed suicide frequently at the weekend and on Monday, women more often on Friday. 61% of women and 74% of men used violent methods of suicide, such as hanging, shooting or jumping. About 37% of female and 51% of males were under the influence of alcohol, but only 2% of women and 12% of men reached a concentration exceeding 1%. Foreign people were represented less than expected, only 10.9%, and unemployed were also rare. The results confirm those observed in other big cities.

[Body packing as a fatal risk--results of a questionnaire survey in Western Europe]. / Bodypacking als tödliches Risiko--Ergebnisse einer Fragebogenaktion in Westeuropa.

A questionnaire was sent to 138 institutes of Forensic Medicine in 18 countries of Western Europe to obtain information concerning bodypackers, who had died between 1980 and 1990. The total number of dead was 17 (4 own cases). 8 cases were reported from the Federal Republic of Germany, 4 from Italy, 2 from Great Britain and 1 from Austria, Spain and Norway each. In 15 cases some circumstances were told. Most of the bodypackers had transported heroin (10), in 2 cases cocaine and amphetamine were found and in 1 case marihuana inside of stomach and bowel. The related risk seems to be low in comparison to police authorities presuming that about 80% of drug-couriers move the stuff inside their body to and fro.

[Means for identifying unknown cadavers. A report of experiences from forensic practice]. / Wege zur Identifizierung unbekannter Leichen. Ein Erfahrungsbericht aus der gerichtsärztlichen Praxis.

98 cases of unidentified corpses found in the region of Frankfurt/M. during the period 1981-1986 were investigated. The different methods used in the investigation processes were compared. The most important results: 1. The condition of the body had very little influence on the time required for identification. 2. The estimated ages tended for ages up to 50 years to be too low and for ages of 50 years and over too high. 3. Visual recognition of the deceased and comparison of finger prints proved to be the most successful methods and provided the best results. 4. In more than half of the cases distinguishing bodily features, clothing and jewelry were helpful in the identification procedure; in 9% of the cases they alone formed the basis of identification. 5. Abductions were carried out in only 30% of the cases, 43% of which led to conclusive results.

Long-term results of percutaneous pulmonary valvuloplasty in adults.

We performed percutaneous balloon valvuloplasty of the pulmonary valve in 24 patients (aged 17 to 72 years) and in two juvenile patients. There were no major complications. In almost all the patients the procedure resulted in a successful pressure gradient reduction from a mean of 92 +/- 36 mmHg to 43 +/- 19 mmHg (P less than 0.01). In seven patients there was a residual pressure gradient greater than 50 mmHg which, however, decreased in all patients within the following 3-12 months due to a decrease in subvalvular muscular hypertrophy (from a mean of 70 to 35 mmHg). No restenosis was observed. Only one patient, who had calcified valve leaflets, developed pulmonary insufficiency and this was of only minor haemodynamic importance. Balloon dilatation of the pulmonary valve can be considered a technique with a high success rate and low complication rate even in the elderly. Good long-term results support this approach as the first choice in the treatment of pulmonary valve stenosis.

[Aortic aneurysm after dilatation of aortic isthmus stenosis]. / Aortenaneurysma nach Dilatation einer Aortenisthmusstenose.

An aneurysm in the region of the dilatation occurred in two of 23 patients (a 17-year-old boy and a 29-year-old woman) three and one years, respectively, after balloon dilatation for coarctation of the (thoracic) aorta. The aneurysm in the boy was small (18 mm diameter) and he was symptom-free so that no operation is as yet indicated. But the woman had progressively increasing backache after physical exertion and the aneurysm was 4 cm in diameter. Therefore, the aneurysm and coarcted segment were resected and a Dacron prosthesis interposed. As the ultimate value and risk of balloon dilatation of coarctation of the aorta cannot as yet be definitively judged, all patients should be carefully and repeatedly examined over a longer period.

[Transluminal angioplasty of aortic isthmus stenosis in juveniles and adults]. / Transluminale Angioplastik der Aortenisthmusstenose bei Jugendlichen und Erwachsenen.

Percutaneous transluminal balloon angioplasty of coarctation of the aorta was performed on eleven patients, aged 5-35 years (mean 25 years). Three patients had had surgical resection of the coarctation previously. There were no complications. The balloons used had a diameter up to 20 mm and were inflated with pressures of 3-5 bar for 10-60 sec. In two of the preoperated patients dilatation did not succeed. It was successful in the remaining nine. In these patients the gradient was reduced from a mean of 58 +/- 17 to 18 +/- 11 mm Hg, the stenosis diameter being increased from 4.5 +/- 2.4 to 11.9 +/- 5.1 mm. In five of six patients, angiography three or twelve months postoperatively demonstrated persisting dilatation. It is concluded that this procedure can be successfully used in both juveniles and adults, not only in children.