The death of the Empress Elisabeth of Austria and Queen of Hungary-retold and reassessed with reconstruction of her autopsy.

In this publication 125 years after the violent death of the famous Empress Elisabeth (1837-1898) of Austria, known as Sisi, a modern evaluation as well as valuation will be presented. The day after her assassination by the young anarchist Luigi Lucheni using a file, a partial autopsy was performed to find out the exact cause of death-a pericardial tamponade. The complete translation of the autopsy report is part of this article, the intention being to avoid unclear wording and translation errors, which have often caused some confusion in the past. A pictorial illustration of the puncture canal will provide clarity through medical facts as to how Empress Elisabeth's death came about by correct pathological and anatomical description and, thus, counteract former interpretations.

Multifactorial White Matter Damage in the Acute Phase and Pre-Existing Conditions May Drive Cognitive Dysfunction after SARS-CoV-2 Infection: Neuropathology-Based Evidence.

BACKGROUND: There is an urgent need to better understand the mechanisms underlying acute and long-term neurological symptoms after COVID-19. Neuropathological studies can contribute to a better understanding of some of these mechanisms. METHODS: We conducted a detailed postmortem neuropathological analysis of 32 patients who died due to COVID-19 during 2020 and 2021 in Austria. RESULTS: All cases showed diffuse white matter damage with a diffuse microglial activation of a variable severity, including one case of hemorrhagic leukoencephalopathy. Some cases revealed mild inflammatory changes, including olfactory neuritis (25%), nodular brainstem encephalitis (31%), and cranial nerve neuritis (6%), which were similar to those observed in non-COVID-19 severely ill patients. One previously immunosuppressed patient developed acute herpes simplex encephalitis. Acute vascular pathologies (acute infarcts 22%, vascular thrombosis 12%, diffuse hypoxic-ischemic brain damage 40%) and pre-existing small vessel diseases (34%) were frequent findings. Moreover, silent neurodegenerative pathologies in elderly persons were common (AD neuropathologic changes 32%, age-related neuronal and glial tau pathologies 22%, Lewy bodies 9%, argyrophilic grain disease 12.5%, TDP43 pathology 6%). CONCLUSIONS: Our results support some previous neuropathological findings of apparently multifactorial and most likely indirect brain damage in the context of SARS-CoV-2 infection rather than virus-specific damage, and they are in line with the recent experimental data on SARS-CoV-2-related diffuse white matter damage, microglial activation, and cytokine release.

Beethoven's death mask and a short history of face masks.

The year 2020 was also about the 250th anniversary of Beethoven's birth. On this occasion, his rarely discussed life and death masks should be presented. In addition, a short historical outline is given of the history of face masks in general, which now accompanies us in everyday life in the form of the face-nose mask due to the COVID-19 pandemic.

Gerard van Swieten, the Dutch personal physician of Empress Maria Theresia (1700-1780).

Born as orthodox catholic in 1700 in Leyden, Gerard van Swieten was orphaned as a child in 1712. He studied medicine under Herman Boerhaave in Leyden from 1720, recording the lectures of his mentor and publishing them after his death. Following his graduation in 1715, van Swieten practiced medicine and pharmacy in Leyden, giving private lectures to students in both fields. Van Swieten became known as a brilliant doctor, and it was expected that he might succeed to Boerhaave's position after his death in 1738; however, his catholic faith was an obstacle for the protestant State University. These very beliefs, however, contributed to his instatement as the personal physician of the Austrian Empress Maria Theresia (1717-1780) in October 1744. In the summer of 1745 he was appointed physician to Maria Theresa in Vienna by Franz I. and at the same time appointed prefect of the court library. In addition to taking care of the library, other tasks he received from Maria Theresia included reformation of the medical faculty, improving the quality of Vienna's clinics and promoting healthcare in the empire. Van Swieten is seen as one of the founders of the so-called First Wiener Medical School (Erste Wiener Medizinische Schule) in 1745, and was at the founding of the first modern clinic in 1754. Van Swieten died June 18, 1772.

From natural philosophy to modern medical science: a short survey of Central European pathology.

The evolution of thought and thinking made possible the remarkable development in medicine. Starting with the period of Enlightenment that flourished between the years 1740-1830, a new creative spirit entered science, during which 'reason' itself was emphasised. This so-called 'age of rationalism' triggered innovation and produced a scientific revolution. The novel idea of interpreting nature by means of reason gave a new perspective on natural phenomena. Such a radically new mental climate sowed ideas that led to a fundamental transformation not only of thought, but also of ways of thinking. A short survey with its key persons is given especially for the general and surgical pathology.

Morgagni and Boerhaave in 1719 : The European academic network in the 18th century demonstrated by a letter from Giovanni Battista Morgagni.

The European academic network in 18th century Europe and the interaction between two eminent 18th century scientists is illustrated by a recently recovered letter from 25.IX.1719 by Giovanni Battista Morgagni (1682-1771). It appears from this letter that Morgagni was interested in the latest edition of Boerhaave's Institutiones Medicae exactly in the same year that Boerhaave tried in vain to persuade him to transfer from the University of Padua to the University of Leiden.

An 18th century description of endometriosis : The autopsy of the Countess von Reitzenstein.

Descriptions of endometriosis in 18th century monographs and manuscripts are rare and the recorded macroscopic features of endometriosis seldom support this attribution to the described cases. Recently, we became aware of an anonymous German autopsy report from the 18th century. After transcription, the manuscript was assessed by pathologists with historical expertise. This revealed that the patient died because of a malignant tumor, most probably of a gynecological origin. Furthermore, the described ovarian pathologic findings strongly support the diagnosis endometriotic ovarian cyst. Like Giovanni Battista Morgagni (1668-1772) in his landmark publication De Sedibus et Causis Morborum per Anatomen Indagatis (1761), the author correlated the pathological findings at autopsy with the symptoms of the patient. The identity of the patient could, with high probability, be established as being the Countess of Reitzenstein, the wife of a Prussian general major in the army of Friedrich the Great: Karl Erdmann von Reitzenstein (1722-1789).

Acute dyspnea caused by a giant spindle cell lipoma of the larynx.

BACKGROUND: The spindle cell lipoma (SCL) is a special type of lipoma and this is very rare in the head and neck regions. There are only five reported cases exist, which describes the occurrence of a SCL in the hypopharynx. METHODS: Our case report presents a case of a very large SCL in the larynx. We want to describe that how we treated the patients and compared the situation with other reported cases. RESULTS: Intraoperatively, we found a tumor mass of 7 × 5 cm. It was successfully removed with the carbon dioxide laser. No postoperative complications occurred. CONCLUSIONS: Although SCL is a very rare diagnosis in the larynx/hypopharynx, it should be included in the differential diagnosis of larynx/hypopharynx tumors. Our case is the first report of such a large SCL in the larynx. The clinical symptoms occurred relatively late and ended up in an acute situation of stridor and dyspnea.

[The Malady of Emperor Frederick III. and Virchow's diagnostic role]. / Die Krankheit Kaiser Friedrichs III. und Virchows Rolle.

Crownprince Frederick Wilhelm of Prussia was once the hope of the liberal movement in Germany. He embodied and lived a humanistic ideal based on the spirit of the enlightenment. Starting in January 1887 the passionate pipe smoker suffered on an unusual long hoarseness. A polyp of the vocal cord was diagnosed. Although this diagnosis seemed harmless, an odyssee was launched that made history. Rudolf Virchow-the foremost pathologist of that time-was involved in the following histological diagnosis. His role and that of the sprouting histopathology will be presented in this essay.

[Vienna's Department of Pathology at the Medical University--a chronology of the past 200 years]. / Die Wiener Universitätspathologie - eine Chronologie der letzten 200 Jahre.

In December 2012 we celebrated the reconstruction of the Department of Pathology at the Vienna Medical School. This short report presents the evolution of this institute by its directors and their main achievements. From Rokitansky to Kerjaschki we follow the path from the work at the morgue to the modern diagnostic methods für personalised medicine.

Type A dissection and chronic dilatation: tenascin-C as a key factor in destabilization of the aortic wall.

OBJECTIVES: Tenascin-C plays an important role in myocardial and vascular remodelling. We hypothesized that tenascin-C is a key factor in the development of degenerative disease of the ascending aorta, leading to chronic dilatation and acute aortic dissection. METHODS: Ascending aortic wall specimens were obtained during surgery for chronic dilatation (n=52) and acute Type A dissection (n=30). Patients (n=12) undergoing aortic valve replacement served as controls. Tenascin-C expression was evaluated by immunostaining and semi-quantitatively assessed using the ImageJ software. TN-C levels in peripheral blood were determined by enzyme-linked immunosorbent assay. RESULTS: Histological examination showed a clear difference between chronic dilatation and acute dissection. In chronic dilatation, tenascin-C staining was homogenously distributed throughout the media parallel to vascular smooth muscle cells. In acute dissection, a strong staining with a heterogenous and spotty distribution was detected. Control aortas showed no tenascin-C staining. Tenascin-C expression was significantly higher in Type-A dissection compared with chronic dilatation. This was accompanied by a significant elevation of tenascin-C levels in peripheral blood in acute dissection. There was no statistical correlation between the tenascin-C level in peripheral blood and the aortic diameter either in dissection or in dilatation. CONCLUSIONS: Tenascin-C is a marker of progressive destabilization of the aortic wall independent of size in chronic dilatation and acute dissection. Therefore, it might be a valuable tool in guiding intervention strategies in patients with disease of the ascending aorta.