[Hemorrhage from the upper gastrointestinal tract as a cause of sudden death]. / Die Blutung aus dem oberen Gastrointestinaltrakt als Ursache des plötzlichen Todes.

During the period from 1971 to 1988 there were 212 fatalities out of 24,822 obductions because of gastrointestinal bleeding. Bleeding from oesophagus varices was most often found, followed by bleeding from duodenal ulcer (16%), gastric ulcer (14%) and haemorrhagic gastritis (11%). The sex-ratio was 2:1 in favour of men. In most cases alcohol related problems were found (with organic diseases such as fat liver, liver cirrhosis, pancreatitis as well as social deprivation, sometimes with acute alcoholization.

Postmortem viability of the human immunodeficiency virus.

In 1989 blood samples from 2581 fatalities investigated at the Institute of Forensic Medicine in Hamburg were screened for HIV-1-antibodies. Sera from 13 corpses were confirmed positive for HIV-1 (prevalence rate approx 0.5%).-Viable HIV was found in blood cultures of 4 cadavers stored under non-refrigerated conditions up to 36 hours after death.

[Causes of and circumstances in death due to subdural hematoma]. / Ursachen und Umstände des Todes bei subduralen Hämatomen.

This study concerns lethal subdural hematomas in the autopsy material at the Institute of Forensic Medicine of the University of Hamburg (n = 102; 0.9% of 11,462 autopsies 1980 to 1988). 63 fatalities were male (mean age 46 years) and 39 were female (mean age 53 years). Subdural hematomas were predominantly located parietotemporal (64%) and had an average volume of 125 ml. Rupture of the bridging veins and contusions of the cerebral cortex were frequent sources of bleeding. In one third of cases the exact topographical site of bleeding was not determined. 90% of the subdural hematomas were of traumatic origin, two thirds had an acute clinical course of less than twelve hours; 23 times neurosurgical intervention took place. With respect to the criminal and civil law it is of decisive significance to explain the causal relationship between subdural hematomas and preceding trauma. Recently there is an increase in blame against physicians in cases where the subdural hematoma (e. g. of inebriated persons) was not diagnosed and treated immediately.

[HIV-1 prevalence in deaths caused by drug overdose in various large cities of West Germany and West Berlin between 1985 and 1988]. / HIV-1-Prävalenz bei Drogentoten in verschiedenen Grossstädten der Bundesrepublik Deutschland und in Westberlin zwischen 1985 und 1988.

The development of the HIV-1-prevalence among drug deaths (n = 753) in several German cities (West Berlin, Frankfurt, Munich, Hamburg, Bremen, Cologne and Stuttgart) from 1985 to 1988 was evaluated; in 1988 43% of 674 deceased drug addicts were examined. The regional prevalence rate was between 15 and 25%; only in Berlin 42% of the drug deaths were HIV-infected (cumulated data of all cities over the 4-year-period: 26%). There was no uniform or steady regional development of HIV-1-prevalence in the different cities. The ratio men/women among drug deaths was 3:1. The HIV-1-prevalence among males was 22%, among females 40%. HIV-infected individuals were 2-3 years older than seronegatives. Predictions concerning the trend of prevalence rates are not possible up to now. Continuous monitoring of the HIV-status of drug deaths seems to be a worthful method to evaluate the spread of this disease among the risk group of intravenous drug addicts.

[Clinical recognition of early forms of malignant melanoma]. / Untersuchungen zur klinischen Erkennbarkeit der Frühformen des malignen Melanoms.

The clinical diagnosis of malignant melanoma (MM) is based on the subjective evaluation of objective measurable parameters (criteria). The accuracy of melanoma diagnosis by dermatologists is only 75%. Particularly difficult is the diagnosis of precursors or early stages of MM. Therefore, we have studied on the one hand the intra- and interindividual reproducibility of the clinical diagnosis of pigmented lesions, and on the other hand the clinico-histopathological correlation. In addition, we have conducted a preliminary investigation designed to evaluate whether image analysis (objective and reproducible) could be used as an auxiliary instrument to differentiate between benign and malignant melanocytic lesions. In the clinical study, the intraindividual reproducibility of the combination of criteria was 69%. The interindividual reproducibility of single criteria even exhibited a range of up to 36%. Histologically "atypical/dysplastic" melanocytic lesions were considered to require excision as frequently as histologically regular melanocytic lesions. Using image analysis (single threshold segmentation, standard deviation of intensity distribution, ratio of area to circumference, Fourier analysis), we could show that it may be possible to differentiate between benign and malignant melanocytic lesions. Therefore, image analysis may be very helpful in determining the dignity of melanocytic lesions.