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Biomedical subjects

M Graw

Publications and source records attributed to M Graw.

At least 19 recordsLinked to original sources

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↗

[Inspection of a corpse by the family physician (general practitioner) in practice and nursing home].

Inspection of a corpse by the physician is a responsible last service he can offer his patient. Apart from reliably establishing death and the time of its occurrence, the physician must thoroughly inspect the corpse to clarify the cause of death. Regrettably, the results of an autopsy are often at odds with the cause of death as entered in the death certificate. Poor nursing care and homicides can be detected only on the basis of correct information about the cause of death. Only then do statistics on causes of death in the population make sense and can provide useful data. If an unnatural cause of death is suspected, or if it is not possible to ascertain the cause, the police or public prosecutor (coroner) must be notified.

Aged↗

Course of the meatus acusticus internus as criterion for sex differentiation.

The importance of features that allow the determination of an individual's gender even with skulls that have been largely destroyed is undisputed in archaeological and anthropological practice. Due to its extreme mechanical strength, the pars petrosa ossis temporalis is usually preserved in skulls and the sex dimorphisms of this skeletal part are therefore of particular significance. In the present study, we aimed at clarifying the controversial question whether the course of the meatus acusticus internus (M.a.i.) beneath the superior surface also reveals sex-specific differences. Using 410 forensically modern petrous portions, the course of the canal was examined and the respective angles determined using a specifically developed casting and cutting technique. The median values certainly reveal sex differences: the lateral angle on the male petrous portions is 10 degrees smaller than that of females; the medial angles on female petrous portions are approximately 5 degrees smaller than those of male skulls. Using discriminant analysis, approximately 66% of the specimens can be determined accurately.

Adult↗

Characterization of soils containing adipocere.

The formation of adipocere (commonly known as grave wax), a spontaneous inhibition of postmortem changes, has been extensively analyzed in forensic science. However, soils in which adipocere formation occurs have never been described in detail. Therefore, this study is intended as a first step in the characterization of soils containing adipocere. Two grave soils (Gleyic Anthrosols) that prevent the timely reuse of graves due to the occurrence of adipocere and a control soil (Gleyic Luvisol) were selected from a cemetery in the Central Black Forest (Southwest Germany). Descriptions of soil morphology and a wide assay of physical, chemical, and microbiologic soil characteristics were accomplished. In contrast to the control soil, the grave soils were characterized by lower bulk density and pH. The degradation of the soil structure caused by digging led to a higher water table and the expansion of the reducing conditions in the graves where the prevalent absence of oxygen in range of the coffins inhibited decomposition processes. Although the formation of adipocere led to the conservation of the buried corpses, phosphorus, dissolved organic carbon, and cadavarine leaching from the graves was observed. Microbial biomass and microbial activity were higher in the control soil and hence reflected the inert character of adipocere. The study results clearly show the need for additional approaches in forensic, pedologic, and microbiologic research.

Bacteria↗

Ninhydrin-dyed latent fingerprints as a DNA source in a murder case.

In this case report, we describe the possibility of using ninhydrin-dyed fingerprints as a DNA source for STR typing. Preliminary tests prove that ninhydrin-dyed material still can be useful for STR typing. The case material consisted of seven ninhydrin-labeled latent fingerprints found at a murder crime site, which could not be typed in a classical manner. We were able to swap DNA from the ninhydrin-treated areas and successfully use it for STR typing.

DNA↗

Concentration dependency of the BAC/BrAC (blood alcohol concentration/breath alcohol concentration) conversion factor during the linear elimination phase.

According to the theoretical pharmacokinetical considerations put forward by Wehner et al. the BAC(ven)/BrAC conversion factor Q is not a constant value and varies depending on the pharmacokinetic phase deduced from the alcohol concentration curve. Based on these considerations we propose that Q must be inversely proportional to the BrAC during the postabsorptive linear elimination phase, expressed as the hyperbola Q=1/kappa+(CT)/BrAC. The constants kappa or 1/kappa and (CT)--where (CT) consists of different parameters which remain constant during the linear elimination phase--can be experimentally determined from the linear relationship BrAC = kappaBAC(ven)-kappa(CT). To test this hypothesis 12 human volunteers received parenteral doses of ethanol. During the elimination phase, BAC and BrAC of each volunteer were measured between 18 and 34 times in a BrAC range between 0.65 mg/l and 0.12 mg/l. The conversion factor Q was either expressed in the form of the hyperbola Q=1/kappa+(CT)/BrAC or directly calculated from the ratio BAC(ven)/BrAC and the results obtained using both methods were found to be very similar. The values of 1/kappa of the hyperbolic functions varied between 1.808 and 2.165 and those of (CT) between 0.004 and 0.127. For a BrAC of 0.25 mg/l, an average value of 2.308+/-0.080 could be calculated for the conversion factor Q(0.25). On average, the value of Q(0.40) amounted to 2.207+/-0.048 and that of Q(0.55) to 2.160+/-0.056.

Adult↗

Fatal pedestrian-bicycle collisions.

Although, fatal collisions between pedestrians and bicycles are relatively rare, they are still of forensic relevance because of the need to explore the circumstances of the accident. Based on three reconstructed cases, situation and injury patterns are presented that might prove useful in future cases: usually the person causing the accident is the cyclist while the pedestrian generally suffers more severe injuries; the situation at the site of accident is important for its reconstruction: end location of the persons involved in the accident, injuries and traces on pedestrians and cyclists, traces at the site of accident and on the bicycle; because of the lack of pre-crash traces and any eyewitness accounts, the pedestrian's injuries are the best starting point for the reconstruction of the accident; a characteristic wound on the lower leg of the pedestrian that reveals the initial impact between the front wheel and the leg is crucial not because of its seriousness, but because of its external morphology; the injuries that can be expected by the following impact between body and handlebar are unspecific and only minor; the most severe injuries to the pedestrian as a result of the accident are caused secondarily by falling and hitting the head on the road; the fall of the cyclist, however, corresponds to a throw-off followed by a sliding phase with less impact load when the head hits the ground [maximum abbreviated injury scale 1 (MAIS 1)]; the cyclists involved are mainly younger persons on fashionable bicycles (here: mountain bikes); in the great majority of cases, the injured pedestrians are frail, elderly people with a lower tolerance of trauma.

Accidents, Traffic↗

Investigations on the reliability of determining an individual's age from the proximal femur.

In the context of individual identifications the reliable determination of age is important. It has been suggested that the femur is appropriate for reliably determining age and excellent results were indeed claimed but calculated errors of estimation were often missing in the studies. In order to check the reliability and validity for forensic diagnostics, two independent investigators who were not informed of the actual age of the femur specimens evaluated x-ray views of 90 femurs according to methods described in the literature. The results of the two investigators differed by maximally 5 years in 64.4% of all cases examined; the average error of estimation amounted to 10.1-17.0 years. Only one-seventh of all cases examined could be precisely grouped into the 5-year class. Deviations of more than 15 years occurred in nearly one fourth of all cases. In particular, individuals over 50 years of age were estimated as being much younger. We must therefore conclude that the method under examination is only appropriate for rough estimations of age. A more accurate estimation within a five-year interval is only rarely possible.

Adolescent↗

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↗

Metric sex differentiation of the pars petrosa ossis temporalis.

The importance of the petrous portion for metric sex determination is a controversial subject in the archaeological and anthropological literature. To achieve a forensically suitable method for sex differentiation, 10 measuring distances were determined on recent forensic material in the form of 410 petrous portions, which had proved to be reliable in the preliminary examinations. The most important findings can be summarized as follows: the petrous portion revealed significant metric sex differences, in particular the width:height index (P < 0.001); the sex differences are age-dependent; differences in the measuring distances on the petrous portion can be observed with regard to their lateral location on either side of the skull; the discrimination analysis allows a correct classification of two-thirds of all petrous portions studied. To some extent, these findings contrast with those already published, but the discrepancies can be attributed primarily to the different composition of the samples used in the respective studies.

Adult↗

Y chromosomal short tandem repeat (STR) loci in a representative group of males living in South Württemberg: a database for application in forensic medicine.

In this study, we resolved the allelic distribution of three Y chromosomal short tandem repeats (STRs), DYS19 (n=218), DYS390 (n=257) and DYS393 (n=215), in a population study of 257 unrelated men living in the area of South Wüerttemberg/Hohenzollern. In DYS19 and in DYS393, five different alleles were discovered, and in DYS390, six different alleles. Forty-nine different haplotypes were found in 202 unrelated male individuals. By investigating each of the three STR systems separately, the most powerful results were found in DYS390, with a PE (power of exclusion) of 0.74, followed by DYS19 (PE: 0.65) and DYS393 (PE: 0.47). Using a combination of two systems (n=202), the PEs ranged from 0.79 (DYS19 and DYS393) to 0.89 (DYS19 and DYS390). The combination of all three STR systems revealed a PE of 0.93.

DNA Fingerprinting↗

DNA typing of human remains found in damp environments.

DNA typing is often used to determine identity from human remains. The environment to which the material has been exposed, however, is crucial for the success of the investigation. Damp conditions in particular can cause a rapid degradation of DNA, even in bone and teeth, and thus reduce the chances of successful typing. Here, we present the results of investigations performed on four skulls that had been lying in a damp environment for periods ranging from almost 1 year to about 45 years. In none of these cases was DNA typing successful on bone or, where present, on teeth. Where remnants of brain tissue were used, however, complete STR typing was possible in one case, partial STR typing in another, and mtDNA sequencing could be carried out in three cases. These findings suggest that brain tissue is relatively resistant to putrefaction in damp environments and, unlike bone, appears to exhibit a certain degree of protection against DNA degradation.

Aged↗

Determination of sex from femora.

The determination of sex from bones or bone fragments considerably contributes to identifying unknown bodies or skeletal remains. Due to temporal change and regional differences anthropometric standards have to be constantly renewed. The present study provides measurements of femoral dimensions in a contemporary German population and analyses sexual dimorphism by discriminant analysis. Maximum length (male: 46.4+/-2.4 cm, female: 43.4+/-2.4 cm), maximum midshaft diameter (male: 3.1+/-0.2 cm, female: 2.8+/-0.2 cm), condylar width (male: 8.4+/-1.0 cm, female: 7.7+/-0.5 cm), vertical head diameter (male: 4.9+/-0.3 cm, female: 4.4+/-0.3 cm), head circumference (male: 15.7+/-0.8 cm, female: 13.8+/-1.0 cm) and transverse head diameter (male: 4.9+/-0.3 cm, female: 4.3+/-0.3 cm) were measured in 170 femora, 100 from male (age: 16-92 years, mean: 60.8 years; body height: 153-190 cm, mean: 171 cm) and 70 from female (age: 20-96 years, mean: 72 years; body height: 146-175 cm, mean: 161 cm) individuals. In the discriminant analysis (leave-one-out-method) 67.7% of cases could be grouped correctly with the maximum length alone, 72.4% with the maximum midshaft diameter, 81.4% with the condylar width, 86.8% with the vertical head diameter, 87.7% with the head circumference and 89.6% with the transverse head diameter. The stepwise procedure with all head measurements showed that the results for the transverse head diameter could not be improved. With all measurements subjected to stepwise procedure 91.7% of cases could be classified correctly combining midshaft diameter and head circumference (D=3.012xmidshaft diameter in cm+0.780xhead circumference in cm 20.569).

Adolescent↗

Invasion and distribution of methanol.

After the enzyme systems responsible for methanol oxidation were blocked by ethanol, five test persons were given methanol at a dose of approximately 10 mg/kg weight, once orally and once parenterally. Taking into account the endogenous blood methanol levels detectable before the administration of methanol, C0 concentrations of 11.1-15.9 mg/kg were reached. This corresponds to a distribution volume of approximately 0.77 +/- 0.07 l/kg, which is comparable to the 0.78 +/- 0.09 l/kg obtained for ethanol. After parenterally administering methanol as a bolus, the distribution half-life was on average 8 min (range: 3.8-13.8 min). After oral administration of methanol diluted in 100 ml water on an empty stomach, invasion took place with a half-life of approximately 5 min (3.8-6.9 min). In one case, however, due to vegetative disturbances the invasion half-life was 23.1 min.

Administration, Oral↗

The form of the supraorbital margin as a criterion in identification of sex from the skull: investigations based on modern human skulls.

Sexual dimorphism in the shape of the supraorbital margin was reported by Broca and various subsequent authors, but no consistently applied, precise definition has been established. In this study of modern human skulls, the value of our definition of the sex-related difference in this area in the identification of sex from the skull was investigated. It was found that this feature can be assessed reliably, is strongly related to sex, and is independent of the side. The accuracy of identification of sex using this method alone was found to be about 70%.

Female↗

Curvilinear increase in methanol concentration after inhibition of oxidation by ethanol: significance for the investigation of endogenous methanol concentration and formation.

Endogenous methanol production was assessed over a period of 5 h in subjects given an infusion of ethanol to inhibit methanol oxidation in the liver after a period of fasting and abstinence from alcohol. Ethanol was administered to each of five subjects at rates of 0.35 g/kg per hour and 0.70 g/kg per hour. The rise in methanol concentration was biphasic regardless of the rate of ethanol administration, with a steeper gradient in the first 10-30 min. This may be due to the existence of a deep compartment from which methanol can be displaced by ethanol. This could take the form of loose binding of methanol to the hepatic oxidation enzymes as an enzyme-substrate complex, or a shift of the oxidation-reduction equilibrium between methanol and formaldehyde. The biphasic nature of the increase, with an initial steeper rise, means that the values obtained in the first 30 min should be excluded from the calculations when the rate of endogenous methanol production is determined by linear regression analysis. Endogenous methanol concentrations to be taken into account after ethanol administration are on average 0.4-0.6 mg/kg higher than those detectable in the absence of ethanol due to the additional method displaced from the deep compartment.

Adult↗