Biomedical subjects

G Zimmer

Publications and source records attributed to G Zimmer.

186 records · Page 11Linked to original sources

PubMedDate not supplied

[Fatal incidences during arrest of highly agitated persons].

We report on four cases of sudden circulatory arrest during the physical restraint of extremely excited and repugnant men by the police. Three persons died, and one became apallic. The excited states resulted from acute schizophrenic disorder in one case, from intoxications (ethanol and drugs including cocaine respectively) in two others, and from encephalitis in the fourth case. In only one case one of the police officers was condemned for involuntary mansloughter, responsability was excluded in the remainder. Similar lethal events in "excited delirium" are given in the American literature, the main etiologic factors being acute psychosis and cocaine intoxication. Most of these events occurred, differing from ours, under "hogtying" which is a technique of physical restraint in a prone position with the wrists and ankles bound behind the back. These events are thought to be cardiac in origin and to result from oxygen-consuming motor hyperactivity, excessive catecholamine release, and impaired breathing. Police officers are recommended to restrict all measures of restraint to a mininum in extremely excited persons, and to avoid any compression of the trunk or neck. A continuous monitoring for vital signs is postulated in order to recognize a medical incident as quick as possible.

Adult↗

PubMedDate not supplied

[Serotonin, 5-hydroxyindolylacetic acid and cholesterol content in blood, cerebrospinal fluid and brain areas for differentiation of suicidal from non-suicidal cause of death].

In the present study serotonin and its metabolite 5-hydroxyindoleacetic acid was investigated in the cerebrospinal fluid and in discrete brain areas of the left and right hemisphere collected from 34 bodies. Sixteen subjects were suicide victims, and 18 were matched as controls. Matching was done for gender, age, sex and cause of death. In suicide victims the concentration of 5-hydroxyindoleacetic acid in cerebrospinal fluid (occipital) was significantly decreased whereas there was no difference comparing the particular results established from the various brain areas. Nevertheless, there was a non-significant trend towards a higher concentration of serotonin in the thalamic area and towards a lower level in samples collected from the mesencephalon in suicide brains. In suicide subjects, the level of 5-hydroxyindoleacetic acid was often found to be increased in the hippocampus and to be decreased in the thalamus. A differentiation between suicide and homicide seems promising only on condition that the distribution of serotonin and metabolite concentrations in various brain areas is considered. The amount of total cholesterol in blood is suggested to be of limited value.

Adult↗

PubMedDate not supplied

Studies of reperfusion injury in skeletal muscle: preserved cellular viability after extended periods of warm ischemia.

Four hours of complete normothermic ischemia in the rat hindlimb has been thought to produce extensive and irreversible damage and no possibility of salvage by reperfusion. This study tests the hypothesis that, in contrast to conventional wisdom, the cellular integrity is preserved after 4 hours of complete warm ischemia and control of the initial reperfusion can restore immediate contractility in these limbs. Ninety-two rat hindlimbs were isolated and 26 of the 92 did not undergo ischemia or reperfusion and served as controls. Sixty-six limbs were subjected to 4 hours of complete warm ischemia; of those 34 were assessed after the ischemic period without reperfusion and 32 were reperfused after the ischemic period. Nineteen hindlimbs were reperfused with Krebs-Henseleit buffer at a pressure of 100 mmHg to simulate embolectomy (uncontrolled reperfusion). In 13 legs a modified reperfusate at a pressure of 60 mmHg was used during the initial 30 minutes followed by an additional 30 minutes of reperfusion with 100 mmHg using Krebs-Henseleit buffer (controlled reperfusion). At the end of each experimental protocol, limbs were assessed by the following methods: muscle contraction, water content, volume, high energy phosphate content, muscle pH, effluent pH, mitochondrial function, ultrastructure, flow, and creatinkinase activity in the effluent. Data are expressed as mean +/- SEM. Significant differences were defined as probabilities for each test of p less than 0.05. Four hours of complete warm ischemia resulted in a severe reduction of adenosine triphosphate (4.0 +/- 0.8 vs 27.1 +/- 6.7 mumol/gm protein, p less than 0.001) and no contractions could be stimulated (0.0 +/- 0.0% CC). Muscle pH fell to 6.3 +/- 0.1 (p less than 0.001), and ultrastructural damage occurred (score 3.3 +/- 0.4 vs 0.8 +/- 0.1, p less than 0.002). However, there was only a slight increase in water content of the soleus muscle (78.7 +/- 0.2% vs 74.8 +/- 1.1%, p less than 0.05) without increase in limb volume (103.6 +/- 0.6% CV). In addition mitochondrial function was preserved well: mitochondrial oxidative phosphorylation capacity remained at 94% of control levels, ST3 at 93%, and ADP/O at 100% of control. Most importantly, controlled reperfusion restored immediate contractility in all limbs and was superior in all parameters investigated compared to uncontrolled reperfusion. These data support our inference that necrosis of skeletal muscle does not invariably occur after four hours of complete warm ischemia and suggest that muscle salvage by controlled reperfusion is possible after at least 4 hours of warm ischemia.

Adenosine Triphosphate↗

PubMedDate not supplied

[Catecholamines, myofibrillary degeneration of the heart muscle and cardiac troponin T in various types of agony].

The stress of agony (the death struggle) induces a rise in serum catecholamines. High doses of catecholamines cause myofibrillar degeneration (MFD), a form of cardiac injury. Severely damaged cardiac myocytes release troponin T (TnT), a myofibrillar cardiac protein, into the circulation. We studied serum catecholamine levels, MFD and TnT in 119 medico-legal autopsy cases. Catecholamine levels increased with the duration of agony: In the instantaneous death cases, the levels were similar to levels in humans at rest, whereas the levels in prolonged agony were comparable to concentrations found in humans in acute maximal stress. Still, it was not possible to infer the duration of agony from the catecholamine level in an individual case. The exceptionally high dopamine levels found in the group 'resuscitation and/or intensive care before death 'were most likely caused by antemortal treatment with dopamine. Slight MFD was diagnosed in nearly all hearts; its severity was neither related to catecholamine levels nor to duration of agony. TnT, not found in blood of healthy people, was present in nearly all postmortem samples, indicating autolytic effects. Heart blood contained more TnT than femoral blood. We could not detect a relationship between the serum cardiac troponin T level and MFD; but cardiac deaths had significantly higher levels of TnT in heart blood than deaths from other causes. The postulated interrelation between catecholamines, MFD and TnT was not evident from the results.

Biomarkers↗

PubMedDate not supplied

[Errors in treatment of soft tissue phlegmon : expert assessment and forensic evaluation].

In ten cases of soft part phlegmons resulting in death (8) and amputation (2) respectively, various types of medical malpractice were evident. The diagnosis was missed, or the disease was correctly diagnosed but underestimated. Typical therapeutic mistakes were the omission of bacteriological investigations and of the proper antibiotical therapy, a delayed hospital admission, or a delayed or insufficient surgical intervention. These errors however could never be proved to have caused the unfavorable outcome in view of the doubtful prognosis of soft part phlegmons even under proper treatment. Thus, evident malpractice never resulted in a condemnation for bodily injury or involuntary manslaughter.

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PubMedDate not supplied

[Capacity to act after stab and cutting injury].

Among 31 cases of death by stab or cut from the years 1989 to 1991 a common injury pattern cases was brought out and related to surviving-time and the capacity to act. The results revealed a short surviving-time if a great blood loss can occur in a short time. There was no correlation between the volume of blood loss and the capacity to act or the lungs weight. From these cases, three cases are reported. First, a single throatcut with cut of the trachea and a surviving-time of 30 minutes. Second, one case of a single heart stab in which the victim could run about 100 meters, and third, one case of an isolated cut of the A. pericardiaca and an estimated surviving-time of 4-12 hours.

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