Biomedical subjects

B Karger

Publications and source records attributed to B Karger.

At least 37 records · Page 2Linked to original sources

PubMed2001

Arrow wounds: major stimulus in the history of surgery.

To illustrate how the high incidence of arrow wounds provided a major stimulus for the development of surgery until a century ago, we conducted a literature search. Our research shows that archaic peoples developed considerable surgical skill for extraction of arrows, including thoracotomy and trephination. A classical Hindu veda describes a variety of extraction methods, and Homer's Iliad introduces the term iatros, which means "he who extracts arrows." Hippocrates of Kos and Galen, representatives of the humoral doctrine, both shunned surgical intervention and considered purulence a drainage of materia peccans (spoiled humors). Cornelius Celsus was the first to systematically differentiate removal of arrows per extractionem and per expulsionem. Celsus recommended the spoon of Diocles, an ancient surgical instrument specially designed for extraction of arrows. Paulus of Aegina favored rapid extraction, aggressive therapy, and ligature on both sides of a vessel before extraction efforts. Paulus was the first to describe a special instrument for the removal of detached arrowheads per expulsionem (propulsorium). In medieval Europe, the standard of surgery declined drastically. The classical procedure under the dominant influence of the humoral concept was to await pus before extraction and to burn the wound with boiling oil and a branding iron. Arab authors had conserved the knowledge of Celsus and Paulus, and in Europe a renewal was achieved by Ambroise Paré, who has been called the creator of modern surgery. The incidence of arrow wounds increased once more in the American West. Joseph H. Bill, a famous U.S. Army Surgeon preoccupied with arrow wounds, favored rapid extraction and aggressive therapy, and he taught recruits not to apply traction on the shaft. The principles established by Celsus, Paulus, Paré, and Bill not only mark important landmarks in the evolution of surgery but can also serve as the basis for modern treatment of arrow wounds, which still occur, although on a small scale.

General Surgery↗

PubMed2001

A case of "boomerang" bullet ricochet.

A .375 Holland & Holland Magnum Winchester Fail Safe bullet was fired against a steel plate. The big-game hunting bullet (17.4 g, approx. 810 m/s) has a solid copper-alloy hollow point design including a lead core limited to the rear portion. The range of firing was 20 m and the angle of impact was 90 degrees. A large fragment (10.9 g) consisting of the main part of the copper portion was deformed in a peculiar manner similar to a tube or ring and wounded the left hand of the person shooting. The unique fragment trajectory strictly against the line of fire and the velocity sufficient to shatter bone after a distance of 20 m can be explained by an extraordinary deformation mechanism. Unlike in tissue, the high resistance of the steel plate caused the lead core in the rear of the bullet to move forward perforating the central copper barrier behind the hollow point cavity. Thus, the peculiar fragment was created. The subsequent backwards acceleration of the ring-like fragment was probably caused by the partly elastic impact of the copper-alloy portion against the hard steel plate. Due to the perpendicular impact resulting in a centric and symmetrical deformation, the fragment moved in a direction exactly backwards along the original line of fire.

Hand Injuries↗

PubMed2001

Scratched pustule or gunshot wound? A medical odyssey.

The diagnosis of a gunshot wound can be difficult especially if the morphology is not typical. In the case presented a neck injury was not recognised as a gunshot wound by several clinicians and radiologists although the bullet could be seen at the base of the patient's tongue and on all X-rays taken. This misinterpretation may have been caused by a "professional blinkers phenomenon".

Cervical Vertebrae↗

PubMed2001

Trajectory reconstruction from trace evidence on spent bullets. I. Deposits from intermediate targets.

Contact of a fired bullet with an intermediate target of sufficient resistance commonly causes the bullet to ricochet, fragment or perforate together with a deviation in trajectory. The transfer of intermediate target material to bullets and subsequent detection on the bullet surface after recovery from a bullet collector, were examined using a scanning electron microscope and an energy-dispersive X-ray spectrometer (SEM/EDS). A total of 76 gunshots (9 mm Luger FMJ RN bullets) were fired at various intermediate targets and at combinations of intermediate targets and tissue located in line. Elements already present on unfired bullets and elements from the bullet collector, the jacket, the charge and primer could be consistently detected as a "background". Abundant deposits of "fragile" (brittle) materials such as concrete, flat glass, asphalt and gypsum board could be visualised on every bullet by SEM. The transfer dynamics involved a direct imprint of target material on the bullet surface and thus preferential locations at the tip but also indirect deposition over the entire surface ("powder effect"). X-ray microanalysis demonstrated matching spectra of the elemental composition of these deposits and of the targets contacted. After perforation of "ductile" (flexible) materials such as wood and car body parts, the deposits on the bullets did not show characteristic spectra. If multi-layered car metal targets were hit, few and uncharacteristic fragments were scattered over the bullet surface and titanium indicative of paint-work could be determined on only a minority of bullets. The elemental composition of wood itself was heterogeneous but the fibrous morphology of the deposits was typical. The SEM/EDS findings in gunshots including subsequent perforation of tissue were similar. In particular, the trace evidence primarily transferred to the bullets was not eliminated by secondary contact and the determination of the fragile target materials was not affected. So when a person is killed or injured by a gunshot, the presence of a ricochet and the target material can be determined. This possibility needs to be considered before an evidential bullet is cleaned or contaminated.

DNA-Binding Proteins↗

PubMed2001

Trajectory reconstruction from trace evidence on spent bullets. II. Are tissue deposits eliminated by subsequent impacts?

STR-based individualisation of biological deposits on bullets after perforation of tissue, can identify the person injured or killed by a particular bullet and comparison with the firearms used can identify the weapon and thus possibly the person who did the shooting. In this study, the effect of subsequent impacts on intermediate targets such as loss of cells was investigated by amplification of mitochondrial (mt) DNA. Bovine tissue was perforated and the 9 mm Luger FMJ bullets were recovered from the bullet collector. The mt cytochrome-b (cyt-b) gene could be amplified by the polymerase chain reaction (PCR) from 14 out of 15 bullets. Examination with a scanning electron microscope (SEM) and an energy-dispersive X-ray spectrometer (EDS) demonstrated the presence of minute dried tissue deposits on all bullets (n = 10) but was not able to establish preferential locations. In a series of 25 gunshots, various intermediate targets (glass, wood, car metal, gypsum board, asphalt) were perforated/impacted following perforation of tissue and the cyt-b gene could be typed from all bullets. It is concluded that subsequent impacts on intermediate targets do not eliminate enough biological deposits to render DNA analysis impossible and that the amplification of mtDNA is a useful additional method.

Animals↗

PubMed2001

Neglect-associated fatal Marchiafava-Bignami disease in a non-alcoholic woman.

We present the case of an 80-year-old malnourished and non-alcoholic woman who died from neglect-associated Marchiafava-Bignami disease, an illness usually almost exclusively occurring in male alcoholics. The patient had been bedridden for several months and had been looked after by her son. The patient was admitted to hospital in an extremely poor care condition suffering from severe exsiccosis, pressure sores and marasmus and died shortly afterwards. The initial post-mortem examination could not establish a definite cause of death, however, upon neuropathological examination a necrotising cystic lesion in the left cingulate gyrus as well as a central necrosis in the corpus callosum indicative of Marchiafava-Bignami disease were revealed. This is the first known case of Marchiafava-Bignami disease in a non-alcoholic woman and the first case in the forensic setting of neglect.

Aged↗

PubMed2001

Suicide by more than 90 stab wounds including perforation of the skull.

A man committed suicide in his bathroom using a small pocket knife. At the autopsy a total of 92 stab wounds on the forehead, in both temples, the anterior aspect of the neck, the back of the neck, the chest and the sides of the trunk were found. In addition, repeated stabbing had caused a large soft tissue defect on the forehead. The frontal bone showed 3 perforations but no brain injury was present and two ribs were severed in the bony part, one of which carried a star-like pattern from repeated stabbing. No major vessels were injured and the cause of death was exsanguination after a considerable survival time. The large number of stab wounds, the perforation of bone and some injury sites, especially the head and back of the neck, are extraordinary findings in suicides which were probably favoured by insufficient anatomical knowledge and the use of a short-bladed knife. A psychiatric history could not be verified.

Adult↗

PubMed2001

Proof of a gunshot wound and its delayed effects 54 years post injury.

In 1945 a 6-year-old girl received a tangential gunshot injury to the left posterior inferior skull. After hospitalisation because of septicemia she was unable to walk for several months. Since 1967 she had been repeatedly applying for compensation because of pseudoneurasthenia and residual ataxia and many medical examinations were performed including X-ray, CT and MRI. Although certain objective findings (e. g. cerebellar atrophy) could be verified, a causal connection between the gunshot injury and the clinical findings could not be established. Therefore previous investigators concluded on a vascular origin of the disease. During the present re-examination of the patient, the authors found patch-like scars at the left posterior inferior skull base and behind the left ear, a cord-like scar formation in the subcutaneous tissue, connecting both skin scars, a gutter-like defect in the left occipital base of the skull and an indention of the left mastoid process, both again in line between the skin scars and a large defect of the left cerebellar hemisphere. It could be concluded with certainty that the anatomical findings and the clicinal symptoms were the direct result of a gunshot injury. Previous investigations had failed because of deficient investigations and techniques. In addition to an anatomical reconstruction, three dimensional reconstructions from CT scans proved most helpful.

Ataxia↗

PubMed2001

DNA analysis of abortion material assisted by histology screening.

In cases of rape leading to fertilization, paternity testing can retrospectively identify the assailant. Abortion material commonly represents a mixture of maternal and fetal tissue and blood, which cannot be differentiated with the naked eye. Consequently, DNA typing of abortion material may be complicated, including band overlap if maternal tissue predominates. Therefore, histology screening of the abortion content for typical fetal tissue components, such as chorionic villi, followed by selected DNA typing of this sample is suggested. This combined approach is illustrated by a selected case demonstrating the reliability and concurrence of the histology and genetic results.

Abortion, Induced↗

PubMed2000

Relationship between impact velocity and injuries in fatal pedestrian-car collisions.

The most common type of fatal pedestrian-car collision, i.e. a passenger car with a wedge or pontoon shaped front striking an erect adult with this front, was investigated. A reliable calculation of the impact velocity range by a technical expert and a comprehensive autopsy suitable for traffic accidents were performed in every case. A total of 47 fatalities form the material of this study and the impact velocities varied between 18 and 142 km/h. Primary and secondary injuries did not show a relationship to impact velocity. The occurrence of four types of indirect injuries revealed a clear relationship to impact velocity, i.e. spinal fractures, ruptures of the thoracic aorta, inguinal skin ruptures and dismemberment of the body. Important parameters such as the type of car, impact velocity range and indirect injuries are listed for each individual case. Because of the limited number of cases, the impact velocity ranges (3-30 km/h) instead of mean values were considered. A cautious interpretation of the data can be summarised in the following conclusions: If there is no spinal fracture, the velocity was below 70 km/h and probably below 50 km/h. Aortic and inguinal skin ruptures are always present if the velocity was above 100 km/h but never occurred below 50-60 km/h. If dismemberment occurs, the velocity was above 90 km/h. Consequently, an estimation of the impact velocity from the presence or absence of indirect injuries is possible in pedestrian-car collisions of the type examined. However, the selection criteria applied in this study and additional parameters influencing the collision dynamics have to be considered carefully.

Accidents, Traffic↗

PubMed2000

Criminal anticipation of DNA investigations resulting in mutilation of a corpse.

A corpse of a female was found in her apartment in a state of advanced putrefaction. Both hands were amputated, the external genitals were excised and the body parts had been removed from the scene. The subsequent investigations proved that the body parts had been severed post mortem. The cause of death was determined to be manual strangulation. A 33-year-old man later confessed that he had strangled the victim 9 days prior to discovery of the body and that he had had sexual intercourse post mortem. According to the confession, the rational motive for the subsequent mutilation was to eliminate biological stains (e.g. semen inside the vagina, epithelial cells below the fingernails from scratching) suitable for forensic DNA analysis. This constitutes a new type of defensive mutilation intended to prevent the identification of the perpetrator. An increase in the occurrence would be detrimental to the elucidation rate of homicides: in a total of 171 homicides investigated at this institute, DNA analysis of biological stains gave reliable evidence in 45 cases.

Adult↗

PubMed2000

Suicides by sharp force: typical and atypical features.

A total of 65 consecutive cases of suicide by sharp force were investigated by evaluating the autopsy and prosecution department records. Suicides constituted 17% of all fatalities from sharp force autopsied between 1967 and 1996. Young males and persons with a psychiatric history predominated among the persons who chose this "hard" method of suicide. The most common implements used were knives (62%) and razor blades (15%). Cutting injuries in isolation were present in 26, stab injuries in isolation in 24 and a combination of both in 15 fatalities. The number of injuries per case varied from 1 to 37 but 1/3 showed one injury. More than 85% of the cutting injuries were located at the wrist, elbow crease or neck whereas 79% of the stab injuries involved the ventral aspect of the trunk. Perforation of clothing was present in 16 (52%) out of 31 stab injuries to the trunk. Injuries to more than one body region were observed in 34 (52%) cases. Tentative marks were present in 50 (77%) fatalities and the number varied from 1 to 60 per case. Superficial incisions of the fingers were found in 15% with razor blades constituting the weapon in half of these cases. Deviations from these typical patterns occurred not infrequently. The utter determination of the victim to carry it through or the use of unusual weapons resulted in a few bizarre cases which are outlined briefly.

Abdominal Injuries↗

PubMed1999

Injuries from hand grenades in civilian settings.

Four cases of hand grenade detonations in civilian life with homicidal intent are reported. The detonations always occurred in close proximity to the victims but there were only two fatalities out of seven victims directly attributable to the hand grenades. The relatively low mortality rate results from the ballistic characteristics of hand grenade missiles such as low mass and sectional density. This leads to rapid deceleration and thus to a poor penetration capacity of intermediate targets and tissue. Window glass at a distance of 2 m was not perforated in one case and the vast majority of fragment wounds showed a short wound tract of small diameter. The potential for physical activity can be unaffected even after a detonation inside a car. However, body parts almost in contact with the hand grenade, such as in a struggle, suffer large lacerations and comminuted fractures. At a distance, the chance of striking a vulnerable body region is increased by the multiple missiles but the wounding potential clearly decreases with increasing distance due to rapid deceleration and decreasing fragment cloud density. The effective range of detonation shock waves from hand grenades is very short and can only contribute to wounding in close-to-contact detonations. The forensic reconstruction is based on the directed radial character of the forces generated and on the sharply decreasing intensity of these forces with increasing distance from the detonation.

Autopsy↗

PubMed1999

Physical activity following fatal injury from sharp pointed weapons.

Cases of suicide from sharp pointed weapons (n = 12) witnessed by one or more persons are reported with regard to the potential for physical activity. One case each involved the ulnar artery, the great saphenous vein and the periphery of the lung and liver and the physical activity following these injuries lasted for several hours. In one case, the left carotid and vertebral arteries were transected and the physical activity lasted for approximately 10 s. An extraordinary case involved a protracted incapacitation due to heart tamponade from a small myocardial injury caused by a cannula. In the remaining seven cases, a stab wound to the heart was present. With regard to the physical activity, a long-term group (2-10 min, n = 4) can be differentiated from a short-term group (approximately 10 s, n = 2) and one case of immediate incapacitation. The size of the myocardial perforation was 7-10 mm in length in the long-term group compared to 1.4-2 cm in the short-term group. So small perforations of the heart or incisions of the carotid artery offer a potential for considerable physical activity. Large perforations of the heart or a transection of the carotid and vertebral arteries can result in short-term activity.

Adult↗

PubMed1999

Fatal brain injury caused by the free-flying blade of a knife - case report and evaluation of the unusual weapon.

A man suffered a fatal injury from a self-inflicted accident while handling a special type of knife. A spring in the shaft of the knife accelerated the blade, which perforated the orbital cavity and the frontal lobe at the right side. Death was due to central disregulation. The initial velocity of the blade was measured to be 15 m/s. In a total of 20 experimental shots to a fresh pig cadaver, the blade always penetrated the skin and 5-10 cm of soft tissue as long as the distance did not exceed 1 m. Thin layers of bone were also perforated. The free flight of the blade did not remain stable if the distance was more than 1 m, which resulted in superficial wounds only. So this unusual construction resembling a knife can be considered an effective combat weapon for close range fighting instead of a tool.

Accidents↗

PubMed1998

Fatalities from black powder percussion handguns.

Three suicides and one homicide from black powder muzzle loading handguns are reported and the muzzle velocities of two weapons are recorded. The fatal head shots caused wide wound tracts traversing the brains and intracerebral haemorrhages remote from the tract were present in every case. The skulls showed considerable fractures which were pronounced in the cases of contact shots but were also present when the range of fire was 5 m. These extensive injuries from soft lead spheres with muzzle velocities of only approximately 200 m/s are attributed to the expansion of the spheres. The regularly occurring deformation resulted in 13-16 mm calibre missiles in the cases of .44 spheres. The special features of black powder such as incomplete and slow combustion resulted in intense soot deposits in the vicinity of the entrance wound and in long ranges the gunshot residues travelled. In contact shots, large pocket-like underminings even in deeper tissue layers, abundant soot along the trajectory and skin burns were observed.

Adult↗

PubMed1998

Experimental bloodstains on fabric from contact and from droplets.

The differentiation between contact bloodstains and stains produced by projected droplets on fabric can be crucial in crime scene reconstruction since suspects can explain bloodstains on their clothing by contact with the victim post mortem. Experimental smear and contact pressure stains on three different types of fabric were compared with stains produced by falling and projected droplets ("dynamic" stains) of equivalent size. The morphology of the small stains (0.1-10 microliters) was investigated with a macroscope. Characteristic for "dynamic" stains are symmetry and rhythmicity (secondary droplets) of the stain and a zonal drying pattern. Contact stains lack the characteristic features of "dynamic" stains and show a clear impregnation of the material resulting in a blood-soaked reverse side of cambric and cotton and in a paler overall colour. The mode of formation of microstains (blood volume 1 < microliter) on irregular surfaces (e.g. terry cloth) can be difficult to determine since the rough surface structure and the small blood volume reduce the characteristics of dynamic stains. In these cases, comparison with experimental stains on the same surface material is recommended.

Blood Stains↗

PubMed1998

Fatal wounds to the thorax caused by gunshots from blank cartridges.

Lethal injuries of the thorax due to shots fired from blank cartridges calibre 8 mm are reported in three cases. The muzzle of the weapon was in contact with the left side of the breast (contact discharge) and injuries to bones were absent in all three cases. In two of the cases the pericardium was not involved but the anterior wall of the right heart ventricle was ruptured and death was due to cardiac tamponade. In the third case the pericardial sac and the left ventricle were both ruptured and the victim died due to rapid exsanguination. The cases demonstrate that the gas pressure from the exploding propellent of blank ammunition can be powerful enough to penetrate the thoracic wall.

Adolescent↗