[The refusal of life-sustaining therapeutic measures in moribund patients].
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Brain Death↗
Biomedical subjects
R Dettmeyer
Publications and source records attributed to R Dettmeyer.
[Legal principles and discretionary power regarding official autopsy order (administratively determined dissection)].
In Germany, autopsies can be ordered by the representatives of the board of health according the Epidemics Law as so called administrative autopsy. If the autopsy is not absolutely necessary, it is mandatory to take into consideration the rights of the deceased persons as well as the rights of the relatives. The decisions of the legislature concerning clinical autopsies must also be considered. The juridical aspects and different types of organising the interrogation of the relatives are explained.
Adult↗
Immunohistochemical techniques improve the diagnosis of myocarditis in cases of suspected sudden infant death syndrome (SIDS).
Immunohistochemical techniques have improved the diagnosis of myocarditis. In a post mortem study, eight specimens in each case of the formalin-fixed and paraffin-embedded hearts of 20 suspected cases of sudden infant death syndrome (SIDS) were investigated with traditional hematoxylin-eosin staining and immunohistochemical methods. The hematoxylin-eosin stained specimens were examined for myocarditis according to the Dallas criteria; only in one case was a myocarditis diagnosed. The subsequent definition of the major histocompatibility complex class II antigens (HLA-DP,DQ,DR and HLA-DR), known to be enhanced in cases of myocarditis, the quantification of leucocytes with leucocyte common antigen (LCA) and characterization and quantification of T-lymphocytes using a specific marker (CD-3) allowed the definite diagnosis of myocarditis in three additional cases, six cases were found with moderate changes and ten cases without signs of inflammation.
Diagnosis, Differential↗
A systematic regional study of dopamine and dopamine-derived salsolinol and norsalsolinol levels in human brain areas.
Dopamine and the dopamine-derived tetrahydroisoquinoline alkaloids salsolinol and norsalsolinol were measured by high-performance liquid chromatography with electrochemical detection in 15 regions of the human brain. The regional distribution of dopamine in 32 brains was similar to previous reports with highest concentrations in the basal ganglia, especially in the striatum, followed by the substantia nigra and the hypothalamus. Significant amounts of salsolinol and norsalsolinol were only found in these dopamine-rich areas, whereas in the other regions no alkaloids were detected. These findings suggest that the concentration of the substrate dopamine may determine the alkaloid level during in vivo formation.
Adult↗
Sudden death in cases with anomalous origin of the left coronary artery.
UNLABELLED: Ectopic origin of the left coronary artery from the right sinus of valsalva with anterior and posterior courses are thought to be benign anomalies. CASE REPORTS: a 58-year-old woman died suddenly after a car accident without having sustained any injuries. The only abnormal finding was an ectopic origin of the left coronary artery from the right sinus with anterior free wall course. The anomaly was complicated by the absence of a left descending branch and a hypoplastic circumflex artery. A 38-year-old male died suddenly during work. Beside the ostium of the right coronary artery originated the normal calibered circumflex branch of the left coronary artery which passed behind the aorta. The left anterior descending branch had a normal origin. There was a 2 cm in diameter transmural infarct observed microscopically.
Adult↗
Sudden cardiac death due to atypical isolated coronary arteritis?
A case of probable isolated primary arteritis of the coronary arteries (coronaritis) in a 68-year-old man who died suddenly and unexpectedly is presented. The histologic presentation of the disorder is discussed, especially the differential diagnosis of arteritis of the coronary arteries versus distinct coronary artery sclerosis with concomitant inflammatory change.
Aged↗
Heroin associated nephropathy--a post-mortem study.
Renal specimens were obtained from 179 autopsies of persons autopsied in the Institute of Forensic Medicine, University of Bonn, from 1987 to 1997. All persons were known as intravenous drug addicts. All renal specimens were examined with hematoxylin-eosin, PAS, Siriusred and Gomori (methenamine silver trichrome stain) and investigated with primary antibody against LCA (leucocyte common antigen), CD 68, IgG and IgM. 105 specimens (61.7%) showed a mono-lymphocytic membranoproliferative glomerulonephritis (MPGN), 48 specimens (45.7%) deposits of IgM. No case with focal segmental glomerulosclerosis (FSGS) as reported in male African-American intravenous drug addicts was found. In 37 out of 54 cases, hepatitis antibodies were detected in serum and three out of these 54 cases were HIV-positive. Chronic hepatitis B and C are known to be associated with glomerulonephritis. We found some cases without detection of hepatitis antibodies but with severe glomerulonephritis. In contrast to African-American drug addicts, European drug addicts do not develop a FSGS but a MPGN, partly due to heroin or other adulterants and apparently independent from hepatitis infection.
Adolescent↗
Two cases of unexpected sudden death due to cystic medionecrosis of the aorta associated with bloodless aortic dissection.
The autopsy findings from two rare cases of sudden death concerning a 31- and a 44-year-old woman are reported. Autopsy and morphological examination revealed a dissection of the aorta but no rupture into the pericardial sac. In both cases mucoid deposits in all layers of the media and rarefication of the elastic fibers were found, rendering cystic medionecrosis as the cause of the aortic dissection. In these unusual cases, only a very small intimal tear was present, but no blood in the dissected aortic wall. Evidence of left ventricular hypertrophy and a history of hypertension were reported in both cases. No extension of the aortic dissections into the left or right coronary artery and no other clinical or pathological findings associated with aortic dissection were present. Cystic medionecrosis was the cause of the aortic dissection in these cases. The mechanism of death in both cases is discussed.
Adult↗
Sudden death of an 18-year-old man with homocystinuria and intracranial inflammatory pseudotumor (IPT).
An 18-year-old mentally deficient man with well-known homocystinuria died suddenly within a few minutes. He had a history of severe oligophrenia, bilateral ectopia lentis requiring extraction of both lenses and operatively corrected genu valgum on both sides. In 1993 a hypergammaglobulinemia was noticed and a decortication on the left side after purulent pneumonia became necessary. Four months before death multiple abscesses in the spleen and pancreas lead to splenectomy and resection of the pancreatic tail. Furthermore, an isolated inflammatory pseudotumor (IPT) of the brain was found. Autopsy revealed as cause of death a pulmonary embolism. The pathogenesis of the cause of death and concomitant diseases will be discussed.
Adolescent↗
Intracranial plasma cell granuloma and homocystinuria.
A rare case of plasma cell granuloma (PCG) of the brain is reported. An 18-year-old man with a well known homocystinuria and a history of severe oligophrenia, grand-mal-epilepsia, bilateral ectopia lentis requiring extraction of both lens and operatively correlated genu valgum, died suddenly within a few minutes. In 1993 a hypergammaglobulinemia was noticed and a decortication on the left side after purulent pneumonia became necessary. Four months before death, multiple abscesses in the spleen and pancreas led to splenectomy and resection of the pancreatic tail. Autopsy revealed a pulmonary embolism and an isolated intracranial plasma cell granuloma of the left hemisphere.
Adolescent↗
Medico-legal aspects of doping.
Abuse of anabolic steroids is an increasing problem not only among athletes but also body-builders and teenagers. A fast-developing black market has been established since the opening of the borders to eastern Europe. Medico-legal aspects of doping are addressed with particular reference to toxicology and pathology. Constituents of anabolic steroids bought on the black market were identified using gas chromatography/mass spectrometry; the products did not contain the expected ingredients in 35% of cases. Long-term effects and fatalities because of anabolic steroid abuse are reported here based on our own case material and a literature review. In our own cases, severe cardiovascular side-effects developed after long-term abuse of Dianabol (methandrostenolone) and Oral-Turinabol (chlordehydromethyltestosterone), i.e. myocardial infarction, stroke, organomegaly and/or severe atherosclerosis. The pathogenesis of cardiovascular complications (cardiotoxic effect, risk of atherosclerosis, thrombogenic risk) is discussed based on the available literature reports following fatal outcome after the abuse of anabolic steroids.
Journal Article↗
[Suspected SIDS and diagnosis of myocarditis].
BACKGROUND: During the last years immunohistochemical techniques have improved the diagnosis of myocarditis using specific markers for quantification of leucocytes and characterization of T-lymphocytes together with the definition of MHC class II Antigens (HLA-DP, DQ, DR), known to be enhanced in cases of myocarditis. These techniques allow the diagnosis of myocarditis in an early stage of the inflammatory process in contrast to the conventional diagnostic with hematoxylin-eosin. MATERIALS AND METHODS: 20 autopsy cases were examined in a retrospective study with conventional histological and immunohistological methods. After routine investigations including toxicological and histological examination of internal organs all cases were considered as cases of Sudden Infant Death Syndrome (SIDS). RESULTS: Increased number of LCA-positive leucocytes and CD-3-positive T-lymphocytes together with enhanced expression of inflammatory marker leads to the diagnosis of a lymphomonocytic myocarditis in three cases, in one case myocarditis could be diagnosed by conventional hematoxylin-eosin staining. In one of these four cases of myocarditis a positive immunohistochemical reaction was found using a new antibody against enteroviruses. CONCLUSION: Immunohistochemical techniques improve diagnosis of myocarditis in cases of suspected sudden infant death syndrome. Further studies using immunohistochemical inflammatory markers to control the incidence of acute myocarditis are necessary.
CD3 Complex↗
[Sudden death after release from police detention].
3 fatalities shortly after discharge from police custody are reported. Case 1: A 55-year old alcoholic was discharged from police custody after taking a blood sample under violent conditions and found dead in his flat 2 days later. Cause of death: arrhythmia due to acute coronary insufficiency or alcoholic cardiomyopathy. Case 2: A 27-year-old alcoholic was met highly intoxicated twice in the course of one day, was put in the family's care and was found dead the next morning. Cause of death: alcohol/drug intoxication with agonal aspiration. Case 3: A 32-year-old man known to be prone to seizures and to become aggressive under the influence of alcohol was left by the police in medical care confined to a litter in a "hog-tied" fashion with the help of 3 belts. Cause of death: cerebral hypoxia after respiratory and cardiac arrest of unknown reason. A causal relationship with positional restraint is discussed. The cases reported underline the duty of the police to examine prior to discharge from custody with the appropriate lot of care whether the person held in custody has recovered from the helpless state due to disease, injury or intoxication or if medical treatment is required.
Adult↗
[Victim-related aspects of homicide of elderly persons in the catchment area of the Bonn Forensic Medicine Institute].
The present study examines the circumstances of 19 homicides involving 10 males and 9 females 60 years of age or older, which were submitted to the Bonn Institute of Forensic Medicine for autopsy. The incidence of these homicides sharply decreased by age. The causes of death were blunt force injuries alone or in combination in 8 cases and strangulation in 5 cases, thus reflecting the importance of the direct physical assault. Defense wounds were found in only 6 cases. The deceased unexceptionally suffered from diseases of the cardiovascular or respiratory system. Robbery or family/partner conflicts accounted for the vast majority of motives. Both, the most common location for homicide being in the victim's own residence and the high proportion of neighbours, acquaintances and relatives among the assailants underline that violence in the close social context endanger the elderly more than conventional violent street crimes. In the victims of homicide the elderly were represented in a smaller proportion than their percentage in the population at large. Over the 8 years of the present study there was no increasing tendency in the homicide rate in the elderly population.
Aged↗
[Unusual carbon monoxide poisoning].
Despite of indicative death scenes or characteristic findings of the external examination, about 40% of the accidental fatal intoxications due to carbon monoxide are not recognized before the performance of the autopsy. Six cases are reported which illustrate possible reasons for the delayed establishment of the diagnosis: unusual circumstances of the intoxication or sources of carbon monoxide, only subtle degree or lack of external signs of the intoxication or a competing cause of death at autopsy.--Cases 1 and 2: 53, respectively 54-year-old couple, found dead in a caravan, extreme putrefaction of the bodies, spectrophotometric detection of the fatal carboxyhaemoglobin level in oedema fluid of the scalp.--Case 3: 23-year-old lorry driver, found dead in the tightly closed cab of his lorry, operation of a source of electricity with "environmentally friendly" fuel, carboxyhaemoglobin level 83%.--Case 4: 19-year-old man, found dead in the flat of friends, removal of the CO-source before alerting the police forces, lack of the bright pink coloration of livor mortis, haemopericardium due to atrial rupture at postmortem examination, carboxyhaemoglobin level 65%.--Case 5: 27-year-old man, found dead in his flat, advanced decomposition of the body, residues of a charcoal fire in a metal bucket in the sink, carboxyhaemoglobin level 80%.--Case 6: 42-year-old woman, lying dead in the garage beside her car, engine switched-off, ignition key next to the body on the floor under the car, carboxyhaemoglobin level 46%.
Accidents↗
[Site of injuries in falls on staircases].
52 autopsy cases in combination with falls on staircases examined in the Bonn Institute of Legal Medicine in 1992 to 2000 were evaluated with respect to the query whether the morphological criteria were valid for reconstruction of the fall, in what way facial injuries were involved and whether isolated trunk injuries caused the death. In 80 per cent of all cases the localization of impact on skull and trunk could be deliminated in regards to heaviness of injuries with fractures and involvement of inner organs. Facial injuries were noticed in 50 per cent and were--as well as arm and leg injuries--caused by strike in fall or after impact. In only two cases in consequence of falls on staircases trauma of the trunk led to death by bleeding.
Accidental Falls↗
[Forensically relevant unexpected delivery after unrecognized or denied pregnancy].
The authors report on two cases of supposed unknown pregnancy, in which the newborns were found dead in the lavatory by the emergency physician. Besides the classical questions of newborn's autopsies concerning vitality, viability and cause of death, position was to be stated towards the probability of an unexpected birth. In the first case the mother's statement of not having been aware of her pregnancy was plausible considering the general circumstances such as corpulence, continued bleedings and intact family situation; autopsy proved a (rare) twin stillbirth as a result of fetal hypoxaemia caused by grave placental dysfunction and misinsertion of the umbilical cord. Contrary to this, in the second case, a live birth, a denial of pregnancy was more likely to be assumed due to misinterpretation of typical symptoms of pregnancy in combination with professional and private stress.
Autopsy↗
[Death in the bathtub--rectal drug administration].
A young nurse was found dead in a bathtub. An autopsy revealed the following results: pulmonary emphysema, severe edema of both lungs, transudation in both pleural cavities. Conspicuous were skin sticks of a white wax material. In chemical-toxicological analysis diazepam, tetrazepam and phenobarbital were detected in this material. After anal-rectal and additionally oral ingestion the following blood concentrations were determined: BAC 0.03/1000; diazepam 500 ng/ml; nordiazepam 65 ng/ml; tetrazepam 180 ng/ml; phenobarbital 9.4 mg/l. In connection with this drug effects an acute, multifocal, suppurating bronchopneumonia in both lungs was revealed as the cause of death.
Administration, Rectal↗