[Combined analysis of findings in the diagnosis of diabetic metabolic disorder].
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Biomedical subjects
Publications and source records attributed to B Brinkmann.
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Three car accidents are described in which microtrace analysis was of special significance in the clarification of the seating positions. In all three cases the occupants were under the influence of alcohol. In each case the accident occurred at night and without witnesses. The pattern of injuries in two cases was non-specific. In the first case, no fiber traces were visible to the naked eye; in the other two the fibers were recognizable to the naked eye after close examination. In all three cases, the seating position was ascertained by means of fiber trace analysis.
The stains produced from micro-blood-drops (blood volume 0.2 microliter) on different substrate materials were examined with respect to morphological characteristics. Micro-stains made on paper showed the same general pattern as larger (macro-)bloodstains on the same substrate. The use of shirt material as substrate, however, resulted in differences in the stain pattern, particularly a greater variation within otherwise identical series. In addition when the angle of the bloodstains was acute, a variable number of smaller stains became detached. In these cases definite criteria can still be found for a description of bloodstains and for estimating the approximate angle of impact.
Nine cases of a syndrome are described, which is known as the "Currarino triad" and which belongs to the group of malformations in which there is a persistent neurenteric communication. The features of the triad consist of ano-rectal anomalies (particularly ano-rectal stenoses), a curved, but limited, sacro-coccygeal defect ("scimitar sacrum") and a presacral tumour, which may be an anterior sacral meningocoele, a teratoma, a cyst (dermoid or neurenteric a cyst (dermoid or neurenteric cyst) or a mixture of these. In at least 50% of cases, the triad is familial and autosomal dominant. Of our nine cases, seven were familial. A dangerous complication is meningitis due to infection of the cystic component, or fistula formation between the colon and spinal canal (one of our cases). Other complications are a fixed filum terminale ("tethered cord") and malformations of the urogenital tract. The risk of malignancy in a teratoma is low, but exists. When considering the indications for surgery, this must be kept in mind, as must the risk of infection, and damage to neural structures during operation. In all cases of early obstipation the sacrum should be x-rayed in order to exclude a Currarino triad. The finding of a sacral defect and a presacral mass makes it essential to obtain CT of the pelvis with contrast in the distal gut and in the meningeal sac. The same is true for screening of the family (including views of the sacrum).
The existence of tracks of electric current in the skeletal muscles was checked by electron-microscopic investigations in animal experiments on rats. Hypercontraction bands alternating with dilated sarcomeres and tumefaction of tubular apparatus and mitochondria with cristiolysis were established. The most severely expressed alterations were found in the vicinity of the electrodes and adjacent to the joints; they are thought to be caused by electrically induced tetanus and local hyperthermia. The forensic aspects of these findings are discussed.
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44 patients with acute hepatitis B virus (HBV) infection were observed until recovery and formation of anti-HBs or in case of development of chronic infection for up to 18 months. With the exception of 3 patients the infection resolved clinically within 3 to 16 weeks, HBs and HBe antigen were eliminated. Anti-HBs and anti-HBe formation could be demonstrated in 39 patients. An accurate prognosis of the course of the disease could be predicted in 42 out of 43 patients by comparison of the serum HBs antigen concentrations at the beginning of clinical symptoms with those after 4 weeks. Inclusion of HBe antigen demonstration enabled predictability in all patients. In 15 patients with acute HBV infection the risk of infection (occupational exposure, transfusion etc.) was known. By investigation of contact persons (family members, sex partners etc.) of the remaining patients HBs antigen und partly HBe antigen in serum could be demonstrated in 11.8% of these persons (11 out of 93). In contrast, in contact persons of patients with known risk of infection HBs antigen could be demonstrated in only one case (1 out of 36). No one of the HBs antigen positive contact persons was aware of the possibility of infectiousness. They did not perceive any connection between their own chronic infection and acute HBV infection occurring around them.
Twenty-nine corpses were subdivided into three groups. Normally from the 3rd h post mortem on, they were suspended undressed in a tub holding 1,000 l in nearly still water of temperatures approximately 20 degrees, 10 degrees and 0 degrees C. The rectal temperature was measured, normally until the 33rd h post mortem. Time of death was calculated by means of the mathematical analytical two-exponential formula suggested by Marshall and Hoare (1962), in the version used by Brown and Marshall (1974). The adapting parameters of the formula were standardized according to the principle of Henssge (1979, 1981) and related to standardization by adjusting factors to body weight stated for standard values of cooling, i.e., undressed corpses in calm air. After termination of the post mortem temperature plateau, it was found that undressed corpses suspended in water of temperatures of approximately 20 degrees and 10 degrees C cool as quickly as undressed corpses of half the body mass in calm air of the same temperatures. As to the duration of the post mortem temperature plateau in water suspension time from the time of death, it may only be indirectly concluded that it is linked to the subsequent speed of cooling in the same way which is well known in the case of air cooling. Statistical standard values are given concerning the differences between the computed and the real times of death. Unexpectedly, the experiments in water at approximately 0 degrees C yielded distinctly slighter temperature which were especially marked at rectal temperatures up to approximately 11 degrees C in corpses of great body mass and small body surface in proportion to and equally, without regard to body mass. As an explanation of this, a decrease in the thermal conductivity of the subcutaneous adipose tissue in connection with a decrease in tissue temperature is discussed.
Sixteen dummies wearing seat belts were exposed to an impact of 50 km/h. Their clothing was examined for traces of melting and other textile changes caused by the seat belt. Such marks were found in the thorax area in 87.5% of the cases and in the pelvis area in 44%. They were located at protruding parts of the body, i.e., parts exposed to high pressure caused by the seat belt.
Gene frequencies of coagulation factor XIIIB polymorphism were determined in a random population sample of east Westphalia (n = 417). Furthermore, mendelian inheritance of alleles was examined in 60 families. Determinations were made after treatment of serum samples with neuraminidase by immunofixation on agarose gels. All six phenotypes were observed in our population sample. The gene frequencies were: FXIIIB1 = 0.71, FXIIIB2 = 0.11, FXIIIB3 = 0.18. The family data confirm the hypothesis of autosomal inheritance of three common alleles and disprove the two-allele model of Kera et al. [5].
The central brain temperature was recorded in 53 human corpses, stored at constant ambient temperatures between 10 degrees and 30 degrees C. The measurements were started on average 1.6 h post mortem and continued for 8-50 h. The sigmoidal shape of the temperature curves fitted the mathematical model of Marshall and Hoare (1962). This model provides a precise description of the temperature curves. For 44 corpses, studied at temperatures between 10 degrees and 25 degrees C, the time of death was calculated using fixed values for the adaptation parameters of the model. The margins of error for the 95% tolerance limit were +/- 1.5 h up to 6.5 h post mortem, +/- 2.5 h between 6.5 and 10.5 h post mortem and +/- 3.5 h between 10.5 and 13.5 h post mortem. For the recommended practical application a "brain temperature--time of death" nomogram is presented. We found that the rate of cooling was influenced by the amount of hair. Furthermore, it has been argued that the study method could be improved further. In consequence, we expect the central brain temperature to be even more accurate in the calculation of the time of death than has been discussed and shown on the basis of the present material.
A 26-year-old healthy female died a few hours after having fallen on her chin. Death had been caused by an epidural hematoma which originated from a hole fracture following impression of the condyle of the mandible through the socket of the temporo mandibular joint.