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Biomedical subjects

K S Saternus

Publications and source records attributed to K S Saternus.

At least 37 records · Page 2Linked to original sources
PubMed1986

Neck extension as a cause of SIDS.

The intradural sagittal diameter at the second cervical vertebra (SD/C2) of 62 SIDS cases was measured myelographically. This SD/C2 proved to be dependent on body size, body weight, and age. A clear, age-dependent difference is to be found in the primarily narrow spinal canal. This parameter (SD/C2), which is more precisely defined in adults on the basis of clinical, radiological, and autopsical findings is assumed to have the value of 0.5 cm in the first 2 months, 0.6 cm in the third month, and 0.65 cm in the fourth month. The resulting potential danger to infants is dependent upon their position. The SD/C2, was significantly decreased in extension as compared to a neutral posture. With consideration of the primarily narrow spinal canal in the infant, there is, according to our measurements, a potential hazard for the infant in any further, significant shortening of the SD/C2. This is independent of the width of the spinal canal under maximal extension. We found individual cases in which the SD/C2 was decreased by almost 50% from the normal value in neutral position. No correlation was found between the primary width of the spinal canal and the degree of luminal reduction upon extension.

Age Factors↗
PubMed1986

[Deaths following wasp stings].

Two cases of death have been reported following a wasp sting. In both cases an anaphylactic reaction after sensitization can be assumed (positive RAST result). In one case an expert witness report was required because of questions concerning insurance law (accident at work?) in addition to the cause of death. The stinger of the wasp was examined from the zoological aspect and is compared with that of the honeybee and hornet.

Accidents, Occupational↗
PubMed1986

[Morphometric studies of the vertebral artery in infants and small children].

The internal circumference of the vertebral artery and the cross-sectional area of its tunica media were measured planimetrically at three different topographical sites in 48 cases of sudden infant death syndrome (SIDS) and 18 reference cases. Based on preliminary determination of the error of measurement, both groups studied showed significant differences between sides. As the degree of differences is often marked, impressive haemodynamic consequences can be expected. The findings are discussed with regard to SIDS.

Cerebrovascular Circulation↗
PubMed1986

[Forms of fracture of the dens axis in the application of ventral flexion force].

In fracture experiments in 220 cast models of the axis and atlas, an attempt was made to separate two different factors influencing the position of the dens fracture (superior and inferior type): the direction of the force application and the inclination of the dens axis. For this purpose, two extreme forms of dens inclination in the sagittal plane were used, namely a form with a ventrally inclined axis (kyphotic form) and a dorsally oriented axis (lordotic form). The force was applied in ventral flexion in 11 single steps between 10 and 75 degrees. The fracture types occurring under natural conditions could be reproduced with this experimental paradigm. Depending on the direction of the force application, both types of dens fracture occurred in ventral flexing traction alone. Independent of the inclination of the dens axis, this ventral flexion led to an inferior fracture type with a shallow angle, and a superior fraction type with a steep angle. With 75 degrees flexion, no longer the dens fracture, but the Hangman's fracture was the usual fracture type in both dens forms. With fundamental agreement of both dens forms with regard to the direction-dependent genesis of the fracture pattern, the lordotic dens and kyphotic dens displayed differences in the details which are discussed exhaustively. In this connection, the differences in the size of the horizontal thrust component due to the primary form of the dens with the same direction of force application is pointed out. According to the present investigations, a classification of dens fractures should be made more precise by specification of the dens form.

Axis, Cervical Vertebra↗
PubMed1986

[The spectrum of hangman's fracture].

The hangman's fracture is since Wood-Jones (1913) considered to be a pedicle fracture of the axial arch, combined with extensive lacerations of the intervertebral disk and the longitudinal ligaments in spine motion segment C2/3. In its mechanics it is ascribed to a non-physiological strain in the sagittal plane in particular due to added submental pressure. The various forms of strain which cause the phenomenon of the hangman's fracture are discussed in detail. In this context it appears that for the model conception chosen one must invariably also consider a rotary component. The definition of the pedicle fracture requires profound reexamination, since this topographic region manifests itself only from C3 onwards but not in the area of the axial arch. After the consideration of the location of the fracture plane the proposition is made to comply with clinical considerations instead and to define it as an intraarticular or extraarticular arch fracture. In the conclusion it is demonstrated in an exemplary manner that the monosegmental injury of the intervertebral disk and the longitudinal ligaments in the segment C2/3 considered to be typical need not be mandatory. However, if it is not present, injuries in the soft-tissue of the lower motion segments are to be expected.

Adult↗
PubMed1985

[Sudden infant death. Postmortem flow measurements in the large vessels of the neck for the demonstration of posture-dependent cerebral hypoxemia].

The concept of position-dependent cerebral hypoxaemia as a mechanical cause of sudden death in infants is based on the possibility of flow impairment in the large neck vessels (carotid and vertebral arteries) on marked rotation and (or) flexion of head and neck. To test this hypothesis systematic flow measurements were performed post-mortem with 21 different angles of head and neck in 16 infants who had died suddenly. The angles chosen were those taken especially during sleep with the infant in a prone position. The measurements demonstrated flow impairment, especially as a result of mechanical narrowing of both vertebral arteries. On the other hand, the range of variation in the internal carotid artery was marked and individual circumstances could not be estimated. There was no certain connection between flow impairment in the vertebral artery and possible increase in the carotid artery. The least dangerous extreme movement for an infant is dorsal flexion of the neck with reclining of the head, a favoured position of many infants. Particularly dangerous is flexion combined with rotation. Judged by the number of complete flow stoppages in the vertebral and carotid arteries, the danger is greatest with rotation in dorsal flexion. Since the dangers of supine position have been known for a long time, lateral position is urgently recommended as the sleeping position in infants.

Carotid Arteries↗
PubMed1984

[Sudden death in medical practice. Quality assurance and control as a task of forensic medicine].

During the last twenty years 72 deaths occurred in Cologne in medical practices. The cause of death was determined by autopsy on judicial order in 13 cases only. Public interest in complete diagnosis existed only in case of acute death during a medical intervention. Where there was no such interest, but clarification was possible in the sense of a quality control, the autopsy rate was below 20%. In all other cases the cause of death was certified in accordance with clinical findings, usually as cardiac death. In 87% of all cases the death certificate had been signed by the doctor who had last treated the patient. In 57% the certified cause of death could be based on a knowledge of the underlying disease. A closer collaboration between practising doctors and forensic pathologists is desirable for the purpose of quality control.

Autopsy↗
PubMed1984

[Hangman's fracture in ventrally flexed traction].

Hangman's fracture in ventrally flexed traction between 10(6) and 75 degrees is analyzed on the basis of 220 fracture trials on plaster of real bone preparations of the atlas and axis of two adults. Hangman's fractures, which are usually regarded as a form of injury from dorsal flexion, occurred in 25% of the fracture trials under this kind of strain. Frequency depended on flexion angle, as well as on inclination of the dens axis. Thus Hangman's fractures occurred, as a whole, more frequently in the kyphotic dens type than in the lordotic type and were found as a rule at 75 degrees flexion. Furthermore, the investigations showed that pedicles can by no means be regarded as the sole predilection site for fracture. A detailed description is provided on why the Hangman's fracture type, due to ventrally flexed traction, can be included in the group of bone injuries arising from flexion, with tensile stress of the dorsal parts of the dens and the corpus axis, on the one hand, and the upper side of the axis arch on the other. Hence, the injury picture ranges from the dorsal arch fracture to the horizontal rupture through the superior articular facies and the corpus axis, as documented by substantial evidence.

Adult↗
PubMed1984

Injury of the vertebral artery in suicidal hanging.

The vertebral artery was investigated in suicidal hanging for specific forensic, but also general traumatological reasons. The objective was to establish the extent to which the vertebral artery in its relatively protected position is injured at all and if so, in what form. For this purpose, cervical spine preparations with the posterior space of the skull were fixed in formalin and detached in the sagittal plane in 36 unselected cases of suicidal hanging after angiographic visualization of the vertebral artery. Afterwards, both vertebral arteries were visualized, and vascular injuries were compared with injuries of the soft tissues of the neck, of the cervical spine, and of the external types of hanging. The vertebral artery was shown to be injured quite frequently (rupture, intimal tear, sub-intimal hemorrhage), namely in one quarter of all cases, and indeed in more than half taking into account the perivascular bleeding. In this way, frequencies were found which were far in excess of those of the common carotid artery. The different mechanical behavior of these two paired neck arteries in traction are dealt with and the form of injury explained.

Cervical Vertebrae↗
PubMed1983

[Congestion in the area of the head and changes in the brain caused by suicidal hanging death].

In a prospective study of 204 unselected cases of suicidal hanging congestion bleedings of different degrees were found in 51%. In typical symmetrical hanging (n = 38) they occurred in 42% of cases, in atypical suspension (n = 152) in 53%. The difference had no statistical significance. Statistically, no connection could be secured between the outer congestion bleedings including those within the neck soft tissue on the one hand, and the form of hanging, the kind of loop or the breadth of the strangulation tool on the other. Only a slight dependence on the blood alcohol content was established. The brain weight of the hanged cases was higher in all age groups than in a clinical autopsy collective. Likewise, it showed statistically no relation to the degree of the outer congestion signs. In 36 cases the brain was histologically investigated. In 78% of cases hyperemia was found, concerning predominantly the supply tract of venules, but also the capillary part. It existed both in typical and in atypical hanging. Independent of outer congestion signs and of cerebral hyperemia, small bleedings into the cerebral perivascular space could be observed in 50% of cases. The increase in brain weight in association with histological signs of edema in hanging was put down to a definite terminal-postmortal brain swelling, as it is known in all forms of peracute death. There is no connection with the type of suspension and the existence or non-existence of congestion signs. Also in atypical forms of hanging no reference to a cerebral residual perfusion is given.

Adult↗