[Chronic central alveolar hypoventilation (Undine syndrome)].
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Autopsy↗
Biomedical subjects
J Wilske
Publications and source records attributed to J Wilske.
Lipoma of the hypopharynx. A case report and a review of the literature.
The clinical and pathological-anatomical features of lipomas of the hypopharynx, based on a review of 23 cases presented in the literature and exemplified by a new case, are discussed. The tumour may be solitary or multiple and appears mostly in men over the age of forty. Although it may reach a considerable size, it may be asymptomatic, until it appears in the mouth or suffocation occurs. Recurrences are rare but metachronous multiple lipomas may appear. Long-term follow-up is therefore recommended. The difficulties of differential diagnosis between lipomas and well-differentiated liposarcomas are discussed.
Aged↗
Computer assisted tomography in primary malignant lymphomas of the brain.
Computer assisted tomography (CAT) data from 10 patients with histologically verified primary malignant lymphomas of the brain are reported. Studies both prior to and after contrast medium administration were done on nine patients. In all these patients, tumor nodules presented with slightly increased density in the precontrast scan and considerable contrast enhancement. The appearance of malignant lymphomas in the CAT scan may be similar to that of meningiomas. Pituitary adenoma, medulloblastoma, and metastasis of malignant melanoma may not be ruled out in a particular case from the CAT picture alone. Blurred margin of the tumor after contrast enhancement was found in half the patients. Diffusely growing malignant lymphomas produce low density areas in the CAT scan without contrast medium uptake.
Adult↗
Computerized transaxial tomography and cerebral serial scintigraphy in intracranial tumors--rates of detection and tumor-type identification: concise communication.
In 215 cases of intracranial tumors with subsequent histological identification, computerized transaxial tomography (CTT), and cerebral serial scintigraphy (CSS) with [99mTc] pertechnetate were carried out to compare the efficiency of each method in detecting and classifying such tumors. With a tumor detection rate of 99%, CTT turned out to be superior to CSS (91%). On the other hand, CSS findings enhanced the CTT rate of correctly identified tumor types in meningiomas from 85 to 92% and in high-grade gliomas from 82 to 89%. In metastases, low-grade gliomas, and various other tumors, CSS supported CTT by confirming a number of these tumor types. Therefore, the most important use of CSS in intracranial tumors today is its role as a supplement to CTT in order to establish and confirm type-specific diagnoses.
Brain Neoplasms↗
[An unusual postoperative incident].
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Appendectomy↗
[Brain changes after transiently successful reanimation].
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Adult↗
[Computerized axial tomography of the skull - diagnostic possibilities and clinical results (author's transl)].
Computerized axial tomography is a new method of tissue examination with x-rays whereby a picture can be produced which is a representation of a slice of the skull. This is done by irradiating the skull from 180 or 225 incremental angles and measuring the absorption at each of these angles. Then with the aid of a computer a tomogram is produced which can be displayed on a screen. These tomograms are representations of a cross-section of the skull composed of 160 X 160 points showing the various intracranial structures with great detail. The present study demonstrates the diagnostic possibilities of the high definition matrix with reference to brain disorders in a large sample of patients for the first time. Some tumours are shown as areas of decreased absorption compared with normal brain tissue. Others, however, have been found to have higher absorption values. With glioblastomas very contrasting pictures are produced with coexistng areas of decreased, increased and similar values to brain tissue. The most important finding is the visualization of brain oedema which appears as a low density area. A grading system of brain oedemas is proposed. The brain oedema associated with tumours has been found to propagate mainly in the white matter producing finger-like shapes. Out of 209 intracranial tumours 203 were recognized in the plain scan, a further five after contrast enhancement. In patients who have suffered from a stroke the differentiation between haemorrhage and infarction is made simple due to the contrasting appearance between the two types of lesion. Location, size and propagation direction of a haematoma as well as rupture of a haemorrhage into the ventricular system can be defined exactly. With brain infarction the hypoxically damaged tissue is well delineated and readily attributable to a given vascular area. In head injuries, for the first time it is possible to differentiate brain contusion with oedema from intracerebral haematoma. Coup and contre-coup are demonstrated. All types of acute intracranial haematomas may be diagnosed easily. With chronic subdural haematomas the new method fails if the contents of the haematoma shows the same absorption values as brain tissue. Late sequelae of head trauma such as contusion defects and necrosis of tissue after oedema can be seen in the tomogram. With infantile hydrocephalus, subdural effusions and malformations of the brain, computerized axial tomography offers a complete diagnosis so that other invasive, neuroradiological investigations may be avoided. Orbital tumors are picked out with great clarity. The high definition matrix allows the demonstration of the optic nerve, the lense and the suspension of the eyeball. Without doubt in the coming years computerized axial tomography will play a dominant role in the diagnosis of brain disorders.
Absorption↗
[Fatal child abuse (caused by physical violence) in Germany during 1 January 1985 to 2 October 1990. Results of a multicenter study].
UNLABELLED: No reliable data are available on cases of lethal child abuse (by active force) in the area of Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 58 cases of lethal child abuse. Extrapolated to all institutes of legal medicine, this corresponds to 62 cases in all of West Germany in the period studied. An approximately equal number of unreported cases should be added to this figure. Including unreported cases, at least 20 cases of lethal child abuse occurred per year; thus only one in every two cases ever came to light. Almost two thirds of the victims were younger than one year old. At autopsy 59% exhibited signs of repeated abuse at autopsy. By far the most common cause of death was direct impact from a blunt object, usually to the head. Mostly, the male person to whom the victim relates most closely (father, stepfather, partner of the mother) has killed the child. Twenty-one of the 74 persons charged saw the charges against them dropped or were acquitted due to lack of evidence; 51 received sentences ranging from one year probation to life. In the remaining two cases the outcome of the trial was unknown. Signs of abuse were readily apparent at autopsy in almost all cases. The high number of unreported cases underscores the need to educate medical students and practicing physicians to be on the look-out for signs of abuse and argues for an increase in the rate of autopsy.
Autopsy↗
[Fatal child neglect in West Germany 1 January 1985 to 2 October 1990. Results of a multicenter study].
UNLABELLED: Up to now reliable data were available on cases of lethal child neglect in the area of the Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period from 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 19 cases of lethal child neglect. Extrapolated to all institutes of legal medicine, this corresponds to 20 cases and thus 3.5 cases a year in the whole of West Germany in the period studied. There is to be added a dark-field which cannot be limited more precisely. However, the cases of fatal child neglect might have occurred much more seldom than fatal child abuse caused by use of physical violence. Slightly more than half the victims were younger than 1 year, the oldest one was 7 10/12 years old. Most frequently the children died of starvation and thirst. Mostly the mothers/nursing mothers killed the child alone or together with the victim's father/stepfather. In the majority of the cases there was not a close affection between parents and child. Nearly 30% female/male perpetrators suffered from chronic alcohol abuse. Only 15 (= 56%) of 27 female/male perpetrators were sentenced to imprisonment (period between 7 months on probation and 10 years). Mitigation circumstances existed for nearly half the persons sentenced to imprisonment. It is true that child neglect is a rarer crime, but the experts of legal medicine always have to indicate errors made during the external inspection of the corpse (among others failures to see indications of neglect).
Cause of Death↗
[Suicide by double bolt gunshot wound to the head: case report and review of the literature].
Suicidal gunshot wounds from a livestock stunner with infliction of two shots against the head are extremely rare events. A case with these characteristics is presented and the corresponding literature is reviewed. A 61-year-old butcher was found dead with two entry wounds of the forehead on the right side and in the centre being typical for captive bolt pistols (symmetrically localized powder burns). The issues of the sequence of shots and the capacity of action are discussed on the basis of morphological findings and pathophysiological considerations. A literature review revealed only 4 case reports with double gunshot wounds of the skull caused by "humane killers" (Tovo 1956, Wolff and Laufer 1965, Schiermeyer 1973, Pollak 1977).
Brain↗
[Suicide with a walking cane gun: weapon, injury picture and psychopathology].
In Germany firearms camouflaged as items of daily use are forbidden. While reports on ball-point pen-guns have repeatedly been published in literature, the use of a walking-stick gun is a rarity. The report deals with the suicide of a 31-year-old schizophrenic man who inflicted a shotgun injury to his head with typical morphological characteristics. The weapon used was a normal-looking walking stick with a barrel, cal. .410. Under forensic and criminological aspects the significance of a walking-stick gun is comparable to that of ball-point pen-guns. Both weapons can be carried and used inconspicuously, but from a walking-stick gun also ammunition of larger calibres with a higher potential of injury can be fired.
Adult↗
[Suicide bomber using a pipe bomb].
Suicidal deaths caused by pipe bombs are rare. An 18-year-old man was found dead in a forest by hikers. In immediate proximity to the body, a crater was located obviously induced by a detonation. The postmortem examination revealed severe damage of the head, upper-body and both arms and hands along with the extensive presence of soot and dirt. Particularly noticeable were numerous "entry wounds" and the presence of five bullet like pieces of metal in the body. The young man had a history of drug abuse and psychiatric problems. On the basis of autopsy findings, the conclusions of the police investigation and psychopathological considerations regarding the victim's case-history, discussion centers upon the differentiation between suicide by self-explosion, homicide by explosion or death as a consequence of numerous bullet wounds followed by an attempt to burn the body. Also considered is the possibility of paranoid psychosis induced by cannabis use as a cause of suicide.
Adolescent↗
[Unnatural causes of death in children].
Of the unnatural deaths in childhood, those following child abuse are among the most disturbing. The incidence of unknown cases is high, although a rising number becomes known with increasing awareness by physicians, but obviously also with higher frequency of autopsies. Fatal physical child abuse is mainly related to head and abdominal trauma, besides meeting worst cases of neglect again and again. Diagnostic differentiation between falling from baby's dressing-tables, washing-machines, bed or rockinghorse--as stated generally--may be difficult in individual cases, but in most cases there is rather repeated abuse, so that the different age and nature of the injuries make it possible to draw decisive conclusions. The casual discrepancy between insignificant external and serious internal injuries again and again complicates discovery and identification of such abuses in time, but also of culpable homicides and accidents. From our point of view, it is imperative to perform an autopsy in every unclear case of death in infancy or childhood for further clarification.
Autopsy↗
[Sudden fatalities in mechanically restrained patients].
We report on 7 nursing home or hospital patients who died suddenly and unexpectedly during physical restraint. Four of the patients were found dead hanging beside their beds, with their waist restraints displaced to the thorax. In spite of a variety of preexisting diseases, asphyxia by thorax compression was the most probable cause of death. Three other patients, when falling out of their beds, were strangulated by the head opening of a nursing bedcover fixed to the bed. In all instances the fatal accidents resulted from improper handling of the restraint devices, namely from the omission of bed rails as well as of the obligatory waist belt lateral fixations. The bedcover type involved in three fatalities is destined for care purposes but not licensed as a restraint device. Physical restraint fatalities can be avoided to a large extent if the producers' instructions are strictly observed, and only especially trained and supervised personnel is admitted to this field of duties.
Aged↗