Biomedical subjects

G Mall

Publications and source records attributed to G Mall.

At least 19 recordsLinked to original sources

PubMed2005

The petrified heart in sepsis.

We report the case of a 33-year-old transsexual man who developed severe sepsis after an accidental intravenous injection of urine (3-5 ml) instead of methadone. He died unexpectedly 28 days after the onset of sepsis. On postmortem examination, the outstanding findings were restricted to the heart with an unusual macroscopic presentation. On histological examination extensive calcifications of the heart muscle, particularly of the left ventricle were found. The pattern of calcifications on the right ventricle was also striking. In contrast, the entire cardial conduction system was unaffected. Furthermore, there were no calcium deposits in other organs and tissues. The advanced widespread cardial calcifications in the present case can be attributed to endotoxin-related myocarditis in severe long-term sepsis. The only treatment would have been an urgent heart transplantation. Without prior knowledge of such a condition, it is impossible for clinicians to correctly recognize, diagnose and treat or prevent in due time such a complication.

Accidents↗

PubMed2005

[Upper gastrointestinal bleeding after long term, high dose NSAID medication: a wolf in sheep's clothing?].

A 71-year-old patient with melena, abdominal and lower back pain was admitted to hospital under suspicion of upper gastrointestinal bleeding. He had mild anemia and an elevated C-reactive protein. Endoscopy and ultrasound failed to localize the source of bleeding. The patient died 2 1/2 days after admission on an exsanguinating hemorrhage. On pathologic examination a fistula between the small aortic aneurysm and duodenum and periaortic inflammation in contact with a spondylitis were found. When clinical presentation is subtle, with a herald bleeding followed by a period of grace, the diagnosis of aortoenteric fistula may be extremely difficult.

Aged↗

PubMed2005

Analysis of forces of ACL reconstructions at the tunnel entrance: is tunnel enlargement a biomechanical problem?

Bone tunnel enlargement is a common phenomenon following reconstruction of the anterior cruciate ligament (ACL). Biomechanical and biological factors have been reported as potential causes of this problem. However, there is no analysis of forces between the graft and bone, as the graft changes direction at the bone tunnel entrance. The purpose of this study was to study these 'redirecting forces'. Magnetic resonance images of 10 patients with an ACL reconstruction (age: 26+/-6.8 years) were used to determine the angle between graft and drill holes. Vector analysis was used to calculate the direction and magnitude of the perpendicular component of the force between the bone tunnel and the graft at the entrance of the bone tunnel. Force components were projected into the radiographically important sagittal and coronal planes. Tension of ACL reconstructions was recorded during passive knee motion in 10 cadaveric knee experiments (age: 28.9+/-10.6 years) and the tension multiplied with the force component for each plane. Results are reported for the coronal and sagittal planes, respectively: For -10 degrees of extension, the percentages of graft tension were determined to be 17+/-7 (max: 26; min: 7%) and 26+/-9 (max: 39; min: 16%) for the tibia. They were 59+/-6 (max: 66; min: 48%) and 99+/-1 (max: 1.00; min: 99%) for the femur. Force components were 14.68+/-6.54 and 25.73+/-12.96 N for the tibial tunnel. For the femoral tunnel, they were 52.48+/-19.03 and 90.77+/-32.06 N. Percentages of graft tension and force components were significantly higher for the femoral tunnel compared with the tibial tunnel. Moreover, in the sagittal direction, force components for the femoral tunnel were significantly higher compared with the coronal plane (Wilcoxon test, p < 0.01). The differences in force components calculated in this study corresponds with the amount of tunnel enlargement in the radiographic planes in the literature providing evidence that biomechanical forces play a key role in postoperative tunnel expansion.

Adolescent↗

PubMed2005

Immunohistochemical differentiation of eosinophilic heart diseases using antibodies against eosinophil activation markers.

AIMS: Eosinophilic heart syndromes are rare in Western countries and include endocarditis parietalis fibroplastica (EPF) and hypersensitivity myocarditis (HM). There are striking differences in natural history and morphological findings. Since diagnosis can be difficult when analysing small myocardial biopsies lacking the characteristic histological features, we studied a set of immunohistochemical markers in order to characterize the activation status of the infiltrating eosinophils to distinguish between these two entities. METHODS AND RESULTS: This study is based on the investigation of seven explanted hearts and one left ventricular specimen collected during implantation of a left ventricular assist device from a total of seven patients with HM. Also investigated were three right and three left ventricular specimens from five patients with EPF. We used antibodies (Ab) against EG1, and EG2, CD44, and CD69 which have been described as markers to distinguish between resting and activated eosinophils. The EG1 to EG2 ratio of eosinophils and the immunoreactivity against CD44 showed no differences between the two entities. However, eosinophils in the EPF were completely negative for CD69, whereas eosinophils reacted positively within the HM group. CONCLUSION: The immunohistochemical investigation of eosinophilic heart diseases using antibodies against CD69 can be a useful tool to distinguish between hypersensitivity myocarditis and endocarditis parietalis fibroplastica.

Aged↗

PubMed2004

Death due to neurogenic shock following gastric rupture in an anorexia nervosa patient.

We report a case of fatal gastric rupture discovered after death, which developed due to a bulimic attack of a 19-year-old woman suffering from anorexia nervosa. An autopsy revealed an acute gastric dilatation and rupture without commonly observed ischemic damage of gastric wall structures. However, it may be difficult to determine the cause of death despite the marked findings. The death as a consequence of neurogenic shock accounts for all the results of gross examination and histologic analysis. This case is the first reported case of fatal gastric rupture of an anorectic patient discovered after death.

Adult↗

PubMed2003

[Tonsillectomy by CO@ laser microsurgery--an analysis of clinical and morphological data].

BACKGROUND: Tonsillectomy by CO(2) laser microsurgery is an almost bloodless procedure that has developed to an alternative to traditional dissection tonsillectomy during recent years. It has been suggested that the laser technique more precise than the conventional one, however, attempts to investigate this morphologically have not yet been undertaken. In addition, there is a need for large clinical studies to compare the postoperative bleeding risk of both procedures. METHODS: The charts of 617 patients who underwent routine tonsillectomy between 1995 and 1998 at the ENT department of Darmstadt Hospital, were retrospectively investigated with regard to postoperative bleeding events. A total of 467 patients were treated by the conventional technique and 150 by CO(2) laser microsurgery (continuous mode, 5 W). Moreover, 2 mm serial sections of tonsils of 56 consecutive patients treated in 1999 (31 conventional and 25 laser tonsillectomies) were used to determine peritonsillar (Vp) and tonsillar tissue volumes (Vt). RESULTS: The postoperative bleeding risk following laser tonsillectomy differed slightly from that following the conventional technique (12.0% vs 14.6%; P=0.499; Fisher's exact test). However, the incidence of severe bleeding events requiring revision in general anesthesia was significantly reduced (0.7% vs 4.9%; P=0.015; Fisher's exact test). Tonsillar specimens that were removed by laser surgery contained significantly less peritonsillar tissue than those from conventional procedures (Vp/Vt 5.1%+/-0.6% vs 10.8%+/-1.1%; P below 0.001; Mann-Whitney U-test). CONCLUSION: CO(2) laser microsurgery improves the precision of tonsillectomy and provides a maximum protection for the peritonsillar tissue. The incidence of severe bleeding events is markedly reduced. Laser tonsillectomy is therefore recommended for patients with clotting disorders or those requiring a particularly exact preparation technique.

Adolescent↗

PubMed2003

Impingement pressure and tension forces of the anterior cruciate ligament.

This study examined the impingement behavior of the uninjured ACL and the impingement pressure and tension forces of the ACL to draw conclusions for ACL reconstructions. A miniature pressure sensor was inserted between the ACL and the intercondylar roof of 15 knees of human cadavers before and after a 3-mm notch roof resection (thickness of the sensor); tension of the ACL was measured after attaching the tibial insertion to a load cell. A long-arm goniometer was used to determine corresponding extension angles. The beginning of contact of the ACL with the notch roof was between -1 and -2 degrees of knee extension. Pressure for full passive extension was 855.6+/-279.1 and 346.4+/-287.7 kPa, and ACL tension averaged 101.9+/-38.4 N. Tension forces in passive hyperextension were higher than those detected when a 200-N Lachman test was performed (83.5+/-25.1 N). There was a significant correlation between extension capability and impingement pressure. Impingement of the ACL was detected in all knees. Full passive extension exerts biomechanical pressure and tension on the ACL. Tension forces of the ACL are higher in passive hyperextension than during a Lachman test with 200 N. The impingement behavior found for the uninjured ACL is simulated in an ACL reconstruction when the center tibial tunnel position is used.

Adolescent↗

PubMed2003

[No detection of Chlamydia pneumoniae in normal and atherosclerotic femoral arteries by polymerase chain reaction (PCR)--an autopsy study].

Since Saikku's investigations in 1988 a direct relation between atherosclerosis and infection with Chlamydia pneumoniae has been suspected. The aim of the present study was to examine histologically normal and atherosclerotic femoral arteries of autopsy cases and to correlate histological findings with the presence of Chlamydia pneumoniae which was tested with nested polymerase chain reaction. The study included all of the femoral arteries (of which 16 male, 15 female, aged between 50 and 88 years) obtained by autopsy from the cases occurring between July 1, 1999 and August 31, 1999 in the Medical Clinic Darmstadt. Each paraffin block supplied us with six consecutive sections of which the first two sectional areas were histologically stained, while the other four were used in PCR examination for DNA extraction. The polymerase chain reaction did not reveal presence of Chlamydia pneumoniae in any of the cases, neither in atherosclerotic lesions, nor in normal arteries. Because of the negative results, an additional PCR test was performed with primers that amplify another region of the Chlamydia genome, but the result did not change. The negative result of our prospective study does not contradict the assumption that infection with Chlamydia pneumoniae may enhance the progress of atherosclerosis in single cases. However, the results do not favour the concept of atherosclerosis as an infectious disorder caused by Chlamydia pneumoniae.

Aged↗

PubMed2003

[Coronary thrombosis and ectasia of coronary arteries after long-term use of anabolic steroids].

Chronic abuse of anabolic steroids is widespread. Hypertrophy of skeletal and heart muscle is a well-known effect of chronic anabolic steroid abuse. Structural alterations of blood vessels are new side effects. We report a case of a 32-year-old bodybuilder after long-term use of anabolic steroids who died of cardiac arrest. Coronary angiography and autopsy findings showed especially a hypertrophic heart, structural changes of coronary arteries, intracoronary thrombosis and myocardial infarction, ventricular thrombosis and systemic embolism

Adult↗

PubMed2002

[Granulocytic sarcoma of the tonsils associated with myelodysplastic syndrome].

HISTORY AND ADMISSION FINDINGS: A 60-year-old man with anaemia was found to have a myelodysplastic syndrome (MDS) which was classified as refractory anemia with ringsideroblasts (RAEB). Because of severe fever the patient was hospitalized. Waldeyer's throat ring revealed signs of acute inflammation. LABORATORY FINDINGS: Indicated severe anemia and thrombocytopenia. Leucocytes were 8000/ml with a pathological shift to the left (1920/ml blasts). CRP (4.7 g/dl) and BSG (59/91mm) were abnormal. An axial CT of the neck showed a left sided paratonsillar abscess. DIAGNOSIS AND THERAPY: The tonsillitis was treated with antibiotics. Persistent fever up to 39.8 degrees C suggested resistance to therapy. After three weeks the patient developed septicemia and died. Autopsy revealed MDS with excess of blasts in transformation (RAEBT-t). Granulocytic sarcoma was found in the throating where there was no paratonsillar abscess. Generalized miliary tuberculosis was proved at autopsy, explaining the continuous fever resistant to antibiotic treatment. CONCLUSION: Granulocytic sarcoma is rarely associated with myelodysplastic syndrome. Deficiency in the immune system may facilitate the occurrence of miliary tuberculosis.

Anemia, Refractory, with Excess of Blasts↗

PubMed2002

Endometriosis results from the dislocation of basal endometrium.

BACKGROUND: The hypothesis is tested that both adenomyotic and endometriotic lesions are derived from basal endometrium. METHODS: Normal uteri and uteri with adenomyosis obtained by hysterectomy, excised endometriotic lesions and menstrual blood of women with and without endometriosis were used. Estrogen receptor (ER), progesterone receptor (PR), progesterone receptor B isoform (PR(B)) and P450 aromatase (P450A) immunohistochemistry was performed with the use of specific monoclonal antibodies. RESULTS: With respect to the parameters studied there was a fundamental difference between the cyclical patterns of the basalis and the functionalis of the eutopic endometrium. The endometrium of endometriotic and adenomyotic lesions mimicked the cyclical pattern of the basalis. The peristromal muscular tissue of endometriotic and adenomyotic lesions displayed the same cyclical pattern of ER and PR expression as the archimyometrium. There was a significantly higher prevalence of fragments of shed basalis in menstrual blood of women with endometriosis than in healthy controls. CONCLUSIONS: These data suggest that ectopic endometrial lesions result from dislocation of basal endometrium. Dislocated basal endometrium has stem cell character resulting in the ectopic formation of all archimetrial components such as epithelial and stromal endometrium as well as peristromal muscular tissue.

Adult↗

PubMed2001

[ Update 2001. Myocarditis--cardiomyopathy].

Myocarditis is a common cardiological disease. New molecular biological and immunohistological methods have confirmed the persistence of viral infection and chronic myocardial inflammation in a considerable number of patients. A causal link between viral myocarditis and the development of dilated cardiomyopathy has been recognized. This has prognostic implications and helps for the decision of a specific immunosuppressive, immunomodulatory and antiviral therapy.

Antihypertensive Agents↗

PubMed2001

Sex determination and estimation of stature from the long bones of the arm.

The determination of sex and the estimation of stature from bones play an important role in identifying unknown bodies, parts of bodies or skeletal remains. In medico-legal practice statements on the probable sex of a decomposed body or part of a body are often expected even during autopsy. The present study was, therefore, restricted to few easily accessible dimensions from bones which were prepared only by mechanically removing soft tissues, tendons and ligaments. The specimens came from the Anatomical Institutes in Munich and Cologne from the years 1994-1998 including a total of 143 individuals (64 males and 79 females). The mean age was 79 years (46-108), the mean body height 161cm (134-189). The following measurements were taken: maximum humeral length (mean: 33.4cm in males; 30.7cm in females), vertical humeral head diameter (mean: 5.0cm in males, 4.4cm in females), humeral epicondylar width (mean: 6.6cm in males; 5.8cm in females), maximum ulnar length (mean: 26.5cm in males, 23.8cm in females), proximal ulnar width (mean: 3.4cm in males, 2.9cm in females), distal ulnar width (mean: 2.2cm in males; 1.8cm in females), maximum radial length (mean: 24.6cm in males; 22.0cm in females), radial head diameter (mean: 2.6cm in males, 2.2cm in females) and distal radial width (mean: 3.6cm in males; 3.2cm in females). The differences between the means in males and females were significant (P<0.0005). A discriminant analysis was carried out with good results. A percentage of 94.93% of cases were correctly classified when all measures of the radius were applied jointly, followed by humerus (93.15%) and ulna (90.58%). Applied singly, the humeral head diameter allowed the best distinction (90.41% correctly grouped cases), followed by the radial length (89.13%), the radial head diameter (88.57%) and the humeral epicondylar width (88.49%). The linear regression analysis for quantifying the correlation between the bone lengths and the stature led to unsatifactory results with large 95%-confidence intervals for the coefficients and high standard errors of estimate.

Adult↗

PubMed2001

Angiogenesis stimulation in explanted hearts from patients pre-treated with intravenous prostaglandin E(1).

BACKGROUND: Prostaglandin E(1) (PGE(1)) is a potent vasodilator and induces angiogenesis in animal tissues. Previous clinical studies demonstrated that PGE(1) improves hemodynamic parameters in patients with heart failure listed for heart transplantation (HTX). Therefore, we designed a retrospective immunohistochemistry study to investigate various markers of angiogenesis using hearts explanted from PGE(1)-treated patients with idiopathic dilated cardiomyopathy (IDCM). METHODS AND RESULTS: We investigated neovascularization in 18 hearts explanted from patients with IDCM: 9 patients received treatment with chronic infusions of PGE(1) for end-stage heart failure before HTX, whereas the remaining patients with IDCM did not receive PGE(1) and served as controls. We used immunoreactivity against CD34, von Willebrand factor (vWf), vascular endothelial growth factor (VEGF), and MIB-1 (Ki-67) to quantify angiogenesis, and used sirius red staining to determine the degree of fibrosis. Compared with the control group, PGE(1)-treated patients had significantly more CD34-, vWf- and MIB-1-positive cells in the sub-endocardium, myocardium and sub-epicardium (p < 0.01). The degree of fibrosis in the hearts of PGE(1)-treated patients was significantly lower than in control patients (p < 0.05), but we did not see any difference in the percentage of muscle mass. Finally, throughout the ventricles, we found significantly more VEGF-positive capillaries in the PGE(1) group (p < 0.0001). CONCLUSIONS: The data suggest that PGE(1) could be a potent inducer of angiogenesis and the angiogenic factor VEGF, and could cause reduced fibrosis in the failing human heart.

Alprostadil↗

PubMed2001

Progressive idiopathic bilateral striato-pallido-dentate calcinosis (Fahr's disease) in a person with anabolic steroid abuse.

A 33-year-old male black student suddenly died during a basketball game. His previous medical history, including his neurological status, was unremarkable, but he was known to take anabolic steroids for several years. At autopsy, the cause of death was due to a fresh myocardial infarction. On neuropathological examination, there was extensive bilateral symmetrical calcification involving the basal ganglia as well as the dentate nuclei and the white matter of the cerebellum (Fahr's disease). A possible correlation between anabolic steroid-induced hypercalcemia and brain calcification is discussed.

Journal Article↗

PubMed2001

The diagnostic relevance of cerebral amyloid angiopathy in the setting of forensic pathology - a report of two cases and review of the literature.

The neuropathological features seen in two cases with cerebral amyloid angiopathy (CAA) are presented. An 85-year-old woman was found comatose at home and died on the way to the hospital. The cause of death was an intracerebral hemorrhage (ICH) in the right parietal lobe. A 93-year-old woman with a history of traumatic subarachnoid hemorrhage was operated on for a chronic subdural hematoma. Intraoperatively, she developed severe ICH and died. The cause of death was an ICH in the parieto-occipital lobe. The morphology of the vessels was studied on differently stained sections and the neuropathological findings of the surrounding brain tissue were investigated. The affected vessels showed the characteristic alterations seen in CAA and included vascular amyloid deposition, fibrinoid necrosis, double-barrel lumen, splitting of the internal elastic lamina, defects of the vessel wall, and microaneurysms. Visualization of beta-amyloid protein was performed by histological and immunohistochemical methods. The immunohistochemistry for beta-amyloid was more sensitive and yielded better results compared with Congo red. In cases of ICH, CAA has to be considered in the differential diagnosis. Besides the use of Congo red stain, the application of beta-amyloid immunohistochemistry is requested to reliably make the diagnosis of CAA. Additional staining with a modified silver impregnation technique (AgNOR) is useful to detect associated neurodegenerative changes.

Journal Article↗

PubMed2000

The neuropathology of heroin abuse.

A broad spectrum of neuropathologic changes are encountered in the brains of heroin abusers. The main findings are due to infections, either due to bacterial spread from bacterial endocarditis, mycoses, or from HIV-1 infection. Other complications include hypoxic-ischemic changes with cerebral edema, ischemic neuronal damage and neuronal loss, which are assumed to occur under conditions of prolonged heroin-induced respiratory depression, stroke due to, for example, thromboembolism, vasculitis, septic emboli, hypotension, and positional vascular compression. Myelopathy is believed to be the result of an isolated vascular accident within the spinal cord due to an as yet unknown mechanism. A distinct entity, spongiform leukoencephalopathy, has been described mainly after inhalation of pre-heated heroin. A lipophilic toxin-induced process was considered to be due to contaminants and to be induced or enhanced by cerebral hypoxia, but a definite toxin could not be identified. At the cellular level, abnormalities in signal transduction systems and changes of various receptor densities have been reported. The exact etiology of the different neuropathological alterations associated with heroin abuse is still unclear, but may also be related to additional substances used as adulterants.

Autopsy↗

PubMed2000

Determination of time-dependent skin temperature decrease rates in the case of abrupt changes of environmental temperature.

The present study deals with the development of a method for determining time-dependent temperature decrease rates and its application to postmortem surface cooling. The study concentrates on evaluating skin cooling behavior since data on skin cooling in the forensic literature are scarce. Furthermore, all heat transfer mechanisms strongly depend on the temperature gradient between body surface and environment. One of the main problems in modelling postmortem cooling processes is the dependence on the environmental temperature. All models for postmortem rectal cooling essentially presuppose a constant environmental temperature. In medico-legal practice, the temperature of the surrounding of a corpse mostly varies; therefore, an approach for extending the models to variable environmental temperatures is desirable. It consists in 'localizing' them to infinitesimal small intervals of time. An extended model differential equation is obtained and solved explicitly. The approach developed is applied to the single-exponential Newtonian model of surface cooling producing the following differential equation:T(S)'(t)=-lambda(t)(T(S)(t)-T(E)(t))(with T(S)(t) the surface/skin temperature, T(E)(t) the environmental temperature, lambda(t) the temperature decrease rate and T(S)'(t) the actual change of skin temperature or first-order derivative of T(S)). The differential equation directly provides an estimator:lambda(t)=-T(S)'(t)T(S)(t)-T(E)(t)for the time-dependent temperature decrease rate. The estimator is applied to two skin cooling experiments with different types of abrupt changes of environmental temperature, peak-like and step-like; the values of the time-dependent temperature decrease rate function were calculated. By reinserting them, the measured surface temperature curve could be accurately reconstructed, indicating that the extended model is well suited for describing surface cooling in the case of abrupt changes of environmental temperature.

Autopsy↗