Fatal Hemorrhage following perforation of the aorta by a barb of the Gianturco-Rösch esophageal stent.

Self-expanding metal stents are an established option in the palliative treatment of malignant stenoses of the esophagus. Herein, we report on a 60-year-old man with a recurrent stenosis that developed 2 months after radiochemotherapy for a squamous cell carcinoma in the middle part of the esophagus. To relieve progressive dysphagia, a Gianturco-Rösch stent (Cook-Z stent, 10 cm, PE-covered, manufactured by William Cook Europe) was implanted. Six weeks later, precipitous massive hemoptysis leading to the collapse and death of the patient occurred. Autopsy showed that a barb in the middle of the stent had perforated the aortic arch, resulting in massive bleeding into the gastrointestinal tract, and aspiration. Although hemorrhage and esophageal perforation are known late complications of all types of metal stents, our case is the first description of a perforation involving a fixation barb. These barbs are a particular feature of the European version of the Cook-Z stent, and are intended to prevent stent migration. In future, any hemorrhage observed after stent implantation should prompt a search for perforation by a barb (autopsy!). If necessary, the European version of the Gianturco Z stent should be modified.

[Fatal intracerebral gas gangrene in a 10-month-old child]. / Tödlich verlaufende intrazerebrale Gasbrandinfektion bei einem zehn Monate alten Kind.

Today, intracerebral infections by gas forming bacteria are very rare. They are mostly seen after penetrating injuries and more rarely after trivial trauma. Although prognosis of this kind of infection is severe, the general outcome of these patients after surgical and antibiotic treatment is good. We report a ten months old boy suffering a pecking injury just above the left ear with perforation of the temporal bone and dura. In between 48 hrs he developed a rapidly progressive gas gangrene encephalitis due to infection with C. perfringens and died despite of surgical and antibiotic treatment due to massive brain swelling and cardio-pulmonary failure.

The forensic value of the immunohistochemical detection of oestrogen receptors in vaginal epithelium.

This study investigated whether oestrogen receptors can be immunohistochemically detected in paraffin-embedded vaginal mucosa samples using monoclonal antibodies and whether the method would be suitable for the identification of vaginal cells in cytological smears. Samples of vaginal mucosa were obtained from living females and female corpses, as vaginal smears. For comparison purposes, resected prepuce samples and samples of postmortem male urethral mucosa were also investigated. Nuclear oestrogen receptors could be regularly detected in the basal, parabasal and deeper intermediate epithelium layers of freshly fixed vaginal mucosa but proved to be highly sensitive to autolytic changes. In the cytological smears obtained from living subjects, no oestrogen receptors were detectable. Oestrogen receptors were also detected in the basal epidermal cells of the male prepuce.

Differential diagnosis of postoperative liver failure in a 12-year-old child.

The case of a 12-year-old child who died of fulminant hepatic failure a few days after tonsillectomy is reported. Histological examination revealed large areas of massive centrilobular hepatic necrosis. Hepatotoxicity of postoperatively administered paracetamol in high dosages combined with enflurane exposure is discussed as a cause for the hepatic failure. The fulminant clinical course could have been influenced by an infection with hepatitis G virus which was detected in liver tissue by in situ hybridisation and was probably transmitted via transfusion of blood plasma.

Forensic value of the Lugol's staining method: further studies on glycogenated epithelium in the male urinary tract.

This study presents findings from a series of investigations on the presence of glycogenated epithelium in the male urinary tract and on the penile surface in order to assess the forensic value of the Lugol's method for the identification of vaginal cells. Direct smears obtained from the urethral opening, glans penis, and penile shaft, along with post-mortem samples of the fossa navicularis, and histological sections of the penis were examined. The presence of polygonal, glycogenated, Lugol-positive epithelium cells in the male urinary tract was found to be common. Our results suggest that these cells originate from the fossa navicularis. Because of the possibility of exfoliation of glycogenated male cells and transfer to the penile surface a Lugol-positive reaction in epithelial cells on penile swabs can no longer be assumed to prove the presence of vaginal cells.

The value of the Lugol's iodine staining technique for the identification of vaginal epithelial cells.

This paper reports on the specificity of the Lugol's iodine staining technique for the detection of vaginal epithelial cells on penile swabs. Air-dried swabs taken from the glans of the penis of 153 hospital patients and from 50 healthy volunteers, whose last sexual intercourse had taken place at least 5 days previously, were stained with Lugol's solution. Glycogenated cells were found in more than 50% of the cases studied, even in healthy volunteers without urethritis. In almost all of these cases the smear contained at least a few polygonal nucleated epithelial cells showing an unequivocal positive Lugol reaction. These cells cannot be distinguished from superficial or intermediate vaginal cells, by cytomorphology or staining. Urinary tract infections had no influence on the glycogen content of male squamous epithelial cells. On the basis of these results the Lugol's method can no longer be assumed to prove the presence of vaginal cells in penile swabs.

[The maxillary sixth-year molar and its relation to the maxillary sinus. A comparative study between the panoramic tomogram and the computed tomogram]. / Der Oberkiefer-Sechsjahrmolar und seine Beziehung zur Kieferhöhle. Eine Vergleichsstudie zwischen Panoramaschichtaufnahme und Computertomogramm.

Panoramic radiographs (OPGs) and computer tomograms (CTs) of 30 patients, the latter taken on average 2.5 months later, were evaluated for the purpose of comparing the relation of their roots to the bottom of the maxillary sinus. The CT and OPG images yielded significant differences in the topographic relations between the roots and the maxillary sinus. In the OPG 64 out of 129 roots seemed to penetrate the maxillary sinus. In the CT transversal slices, on the other hand, penetration could be observed for only 37 roots. This phenomenon became more apparent when the relations between the mesial, distal, buccal, and oral root surfaces and their relations to the sinus were assessed. Applying a three stage scoring scheme, it was found that in the large majority of cases only the apices were in contact with the mucosa of the sinus. Thus, the possible loss of anchorage in these cases is below five percent.

[A new examination program for forensic assessment: performance of computers in medicine]. / Ein neues Untersuchungsobjekt für die rechtsmedizinische Begutachtung: Computerleistungen in der Medizin.

Computerizing of medicine is expected to increase very rapidly in the next few years. This will bear new questions for forensic judgement. We report a case and our expert opinion concerning the use of a very simple computer program at a private hospital to obtain comments on laboratory findings. Furthermore we discuss questions we consider to be of importance for forensic judgement in this field.

[Sudden death in urticaria pigmentosa]. / Plötzlicher Tod bei Urticaria pigmentosa.

A case of sudden death of a 25-year-old man, with a six years history of Urticaria pigmentosa, is reported. On a cold morning in November he was found lying dead on the lawn. Histology revealed no signs of systemic mastocytosis. The biochemical investigations (high free histamine level in urine) in addition to a BAC of 0,72 mg/g and the scene conditions (cold irritation) explained the mechanism of death, a systemic anaphylactoid reaction.

Fatal complications after myelography with meglumine diatrizoate.

A case of inadvertent intrathecal injection of diatrizoate meglumine is presented. After myelography with 10 ml i.e. 6.5 g Angiografin, a 76-year-old man rapidly developed myoclonus, drowsiness and excessive metabolic acidosis. He died only a few hours later. Postmortem showed non-specific brain edema. RP-HPL-Chromatography confirmed high concentration of the contrast medium in CSF (6 mg/ml) which must have induced refractory central nervous dysregulation. The lethal effects of the misapplication of this agent on the nervous system are discussed.

Problems in establishing norm values for nickel and chromium concentrations in human pulmonary tissue.

In 15 random autopsies, nickel (Ni) and chromium (Cr) were determined quantitatively by atomic absorption spectrometry (AAS) in human lung tissue to evaluate norm values. None of the deceased persons had had an occupational exposure to Cr or Ni or their compounds. In all, 22 tissue samples were taken from each lung at specific topographical anatomical locations. The analytical procedure is described in detail. The results showed substantial variation in concentrations both within a single lung and also between individuals. Median values found were 204 ng/g for Cr and 25.6 ng/g for Ni. Topographical concentrations of Cr and Ni were 1.3-1.9 times higher in the upper lung areas. In view of the variability in metal concentration, analysis of only one part of lung tissue is not sufficient for determining the content of the entire lung. The evaluation of norm values is an important precondition for appraisal of Cr and Ni accumulation in human pulmonary tissue that may be due to occupational exposure.

Cadmium concentrations in autopsy material from differently polluted areas of West Germany (FRG).

Analyses of Cadmium (Cd) in human specimens demand special interest since the Federal Environmental Agency of West-Germany (UBA, FRG) has published calculations and high figures of renal disturbances due to Cd. We analyzed autopsy material from the Cd-polluted area of Goslar/Harz Mountains (N = 28) and from the less contaminated region Erlangen/Nürnberg (Franconia) (N = 50). As determinants of Cd-concentration special regard was given to age, smoking habits, residence (urban/rural), and medical findings (nephropathy, hypertension). A balanced distribution of age is found in all subdivisions, the mean age of death is 66 and 68 yrs., respectively, in both regions. Median values of Cd-concentrations in the target organs from Franconia were found to be half the amount of those from Goslar (renal cortex: 12/19, medulla: 8/16, liver: 1/3 micrograms Cd/g wet weight). Significant local differences are found for renal medulla and liver (p less than 0.05). In both regions the Cd-content is independent from sex and residence (urban/rural). The influence of tobacco smoking on the Cd-burden is evident (greater than 50%). Cases of hypertension show maximum values, although this trend can't be confirmed by the median values. Regional Cd-pollution seems to have more effect than pathological findings: normotensive persons from Goslar have higher median renal Cd-concentrations than hypertensive patients from Franconia. Analyses of renal diseases reveal the same result. All Cd-concentrations are far below the critical value (200 micrograms Cd/g renal cortex, w.w.). The evaluation of such limit values and the results of similar studies are briefly discussed.

[Pentachlorophenol concentrations in the organs and blood of 11 dead infants]. / Pentachlorphenolkonzentrationen in Organen und im Blut von 11 verstorbenen Kleinkindern.

For 11 children, died on age between 2.5 and 57 month due to different causes, the concentrations of pentachlorophenol in liver, kidney, brain and blood were located in the lower part of the spread of test values found for adults which had died in the same region and during the same time phase. The concentrations of pentachlorophenol in the blood of the 11 children were compared further with the findings from 20 living children with an age up to 10 years and were all located below the median of the test values (45,4 micrograms PCP/1) from the group last mentioned. There are no hints for connections between the body-burden of pentachlorophenol and the death-cases concerning the 11 children.

Acute fatal selenium poisoning. Toxicological and occupational medical aspects.

Neutralizing selenic acid with caustic soda caused a hyperintensive exothermic reaction, with about 450 1 of the reaction mixture erupting in a factory hall. A 44-year-old industrial worker was fatally intoxicated, suffering from second-degree skin burns, necrosis of oral mucous membranes and hemorrhagic lung edema. He died 90 min later. Analysis of body fluids and tissue samples showed high selenium concentrations in blood serum, urine, stomach content and lungs. The analytical results are discussed in comparison with normal selenium levels of non-exposed groups.

[Cadmium and copper concentrations in feces, urine and blood after ingestion of wild mushrooms]. / Cadmium- und Kupferkonzentrationen in Stuhl, Urin and Blut nach Aufnahme wildwachsender Champignons.

Because of concern about possible long-term accumulation of cadmium caused by the ingestion of wild mushrooms of the agaricus species we collected feces, urine and blood of eight subjects who had eaten meals of wild (agaricus) mushrooms. The anticipation of high concentrations of fecal cadmium after the diet was confirmed, whereas no increase was found in the levels of cadmium in blood and urine. These results suggest that due to the chitinous nature of fungi there may be no relevant absorption of cadmium from mushrooms in humans.

[Nickel and chromium content of selected human organs and body fluids]. / Untersuchungen zum Nickel- und Chrom-Gehalt ausgewählter menschlicher Organe und Körperflüssigkeiten.

Nickel and chromium analyses were performed in lung and kidney as well as in blood and urine samples of 45 autopsies from northern Bavaria area. The analyses were carried out with electrothermal atomic absorption after wet oxidative digestion. Median metal concentrations in blood were 4.5 micrograms Ni/kg resp. 2.8 micrograms Cr/kg, in urine 2.7 micrograms Ni/kg resp. 4.9 micrograms Cr/kg. The calculated values agree with the metal levels given in the new literature. Median metal concentrations in lung tissue were 7.4 micrograms Ni/kg resp. 36.5 micrograms Cr/kg; in the kidneys medians of 13.9 micrograms Ni/kg resp. 9.6 micrograms Cr/kg are found. In the literature only a few values for comparison are given. The metal concentrations in the different samples were not influenced by age or sex.