Principles of proximal cavity preparation and finishing with ultrasonic diamond tips.

Conventional treatment of proximal cavities can result in significant damage to the adjacent dentition. This paper describes a recently developed technique of proximal cavity preparation and finishing by use of selectively diamond-coated, ultrasonically driven instruments. By using these instruments for composite, compomer, ceramic, amalgam, and even gold restorations, the inadvertent damage to neighboring teeth is completely avoided. This article demonstrates the effective utilization of the diamond-tipped ultrasonic instruments for the preparation of primary lesions and the replacement of existing restorations.

[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.

Operative dentistry: the missing clinical standards.

Since the development of advanced adhesive technology, the use of amalgam has declined significantly. The search for amalgam substitutes, i.e., restorative materials which maintain similar clinical function and cost-effectiveness as amalgam, has so far been unsuccessful. It has also become evident that a considerable confusion prevails regarding the objectives of restorative procedures. In absence of national and international standards, the products--the restorations--are assessed according to varied criteria. In placing restorations, three objectives are attained, at most: a) tooth preservation, b) tooth preservation and function, and c) tooth preservation, function, and imperceptible restitution. The learning objective of this article is to discuss the positive effects that could be attained by defining the standards, terminology, and the quality assessment criteria for operative dentistry in regard to the patients and the dental profession.

Advanced adhesive restorations: the post-amalgam age.

Due to patient demand for biocompatible, safe, and tooth-colored restorations, the use of amalgam as a restorative material has been declining. Currently, the profession of operative dentistry is in a state of transition from the amalgam age to the post-amalgam age. The learning objective of this article is to discuss the current state of the art of tooth-colored restoratives--amalgam substitutes and amalgam alternatives--used either as direct or laboratory fabricated restorations nationally and internationally. Adhesive dentistry is discussed in detail, with tooth preparation as the key element. The challenges facing the clinician during the transition period include clinician education, restorative concepts and teaching competence, costs, prevention, and maintenance.

[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.

[Liver enzyme values (gamma-GT, GOT, GPT) in intoxicated drivers at the time of the offense]. / Leberenzymwerte (Gamma-GT, GOT, GPT) bei Trunkenheitstätern zum Tatzeitpunkt.

The enzyme activities (GGT, GPT, GOT), especially of the gamma-glutamyl-transpeptidase, is considered to be a sign of alcohol abuse. Of 219 blood samples taken from drunken drivers for blood alcohol determination, 81 (37.6%) exhibited pathological enzyme activities. In 55.6% of them specifically pathological gamma-Gt values were found. In the cases with normal enzyme activities the average value of blood alcohol concentration was 1.61%, the pathological cases had 1.81%. In the latter cases more than 50% of the drunken drivers involved were workers. Most of them were 30-49 years old (45%), but also young drivers up to 21 years old were represented (about 25%). There was also a difference between the group with normal and pathological enzyme activity concerning their drinking behaviour. The group with pathological values occurred during the week, the other group was mostly arrested at the weekends. Of the total, 6.8% (15) were women, 4 exhibited pathological enzyme activities; three of them were 21-29 years, one was 36 years old. The data obtained demonstrate that drunken drivers exhibit a tendency to alcohol abuse.

[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.

[Effect of low blood alcohol concentrations in relation to time of day]. / Wirkung niedriger Blutalkoholkonzentrationen in Abhängigkeit von der Tageszeit.

The physical performance of 23 persons was tested at different time of day (morning, noon, evening) under the influence of low doses of alcohol (0.8%). The results obtained indicate, that the capability of performing the tests was remarkable reduced. In the evening the effect of alcohol was significantly higher than at noon and morning; the time of recovery was also prolonged. Under these aspects the limit of 0.8% for car drivers in (West) Germany has to be reconsidered.

[Study of traffic aptitude in relation to dental interventions]. / Untersuchung zur Fahrtauglichkeit im Zusammenhang mit zahnärztlichen Eingriffen.

Applying a video game the traffic aptitude of patients was investigated before and after dental surgical treatment and local anesthesia. Local anesthesia or operative removal of impacted third molars does not reduce the psychophysical performance important for driving a car if there is no influence of other factors. The consequences of the obtained results are discussed even under forensic aspects.

[New aspects of alcohol-induced crime by adolescents and young adults]. / Neue Aspekte alkoholbedingter Delinquenz Jugendlicher und Heranwachsender.

Statistical evaluation of data of forensic blood alcohol determinations revealed, that young delinquents (up to 20 years old) represent 11.4% (1981), 13% (1984), and 8.8% (1988) of the total, respectively. Out of them 5% were female delinquents, a number which doubled compared to a study performed during the years 1961-1976. The percentage of accident involvement (about 68%) and of the fleeing the scene cases (about 20%) was constant. Criminal delinquency decreased from 32% to 26%, but unemployed nearly doubled their participation. Young delinquents of the age group up to 16 years exhibited a significant decrease in the percentage of high-blood alcohol levels. Delinquency occurred mainly at weekends between midnight and 4 a.m. The data suggest a changing pattern of drinking behaviour.

[Fatal bicycle accidents--causes and legal responsibility]. / Tödliche Zweiradunfälle--Ursachen, Verschulden.

Ninety-nine bicycle and motorcycle accidents were analyzed that had taken place from 1980 to 1984 in and around Frankfurt on the Main. The postmortem examinations were done in the Center of Forensic Medicine at the University of Frankfurt. Twenty-five percent of the bicycle riders were children up to the age of 15 years and 25% were elderly people over the age of 60. Most of the people involved in motorcycle accidents were between 17 and 24 years of age. The greatest amount of accidents took place in the summer, but in October there was also a peak. On weekdays, Thursday was the day when most of the accidents happened and Sunday showed the least. About 50% of the bicycle accidents happened in the city; 44% of the motorcyclists had lethal accidents on normal roads in the country. The most dangerous situation for bicycle riders was created by fast vehicles following them, but intersections proved to be a danger point, too. Nearly 40% of the motorcycle accidents were not caused by other vehicles. The most frequent cause of death was head injuries (45%), followed by injuries of the internal organs and spine. Many bicycle riders caused the accidents themselves (43.6%). Most of the fatal motorcycle accidents were caused by others (56%). In all of the cases studied, 30% of the participants involved had a relevant blood-alcohol concentration.

[Amnesia and responsibility following brain concussion. A study of 70 patients]. / Amnesie und Handlungsfähigkeit nach Commotio cerebri. Eine Erhebung an siebzig Patienten.

Hit- and run traffic accidents frequently occur because an intention to hide drunkenness. Later, the accused claims that he or she had amnesia due to concussion at the time of accident and what followed. In most cases, the question arises as to whether it is the truth or just a story to protect the defendant from punishment. To study this question, 70 patients (39 male, 31 female) were interrogated. They were asked about the duration of their amnesia and their ability to recall their own actions, or what they had been told. In 80% of the persons examined there was only a short period of amnesia (less than 30 min). Of 12 cases with a longer period of amnesia, 7 were also intoxicated from alcohol (one case had a concentration of 3.1%). In only one person suffering from concussion could it definitely be proved that the actions taking place long after the accident, were usually not comparable with evidence given in court.