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Biomedical subjects

V Schmidt

Publications and source records attributed to V Schmidt.

137 records · Page 8Linked to original sources
PubMedDate not supplied

[Lactobacillus paracasei endocarditis in an 18-yeard-old patient with trisomy 21, atrioventricular septal defect and Eisenmenger complex: therapeutic problems].

Endocarditis caused by lactobacilli is very rare and so far has been rarely published in adults with cardiac valve diseases especially after dental manipulations. Because of diagnostic and therapeutical problems we hereby report on one case of a female adolescent with Down's syndrome who did not undergo surgical correction of atrioventricular septal defect because of early development of Eisenmenger's syndrome. The onset was subacut and the diagnostic procedures were considerably delayed. Risk factors for the development of endocarditis in this case were preceding antibiotic treatments which increased the risk of selective growth of the causative germs as well as the tricuspidal valve incompetence with simultaneous pulmonary hypertension. The antimicrobial treatment was difficult due to resistance to antibiotic drugs generally applied in such cases and the restricted bacteriological diagnostic methods. Finally we had successfully administered chloramphenicol. The course was complicated by cerebral embolic events. FACIT: Lactobacillus species are facultative pathogenic which should be consideration in cases of subacute endocarditis in children and adolescents with ventricular septal defects and valve diseases. The determination of minimal bactericidal concentration of antibiotic agents and time-kill studies of combined antibiotics are recommended. For initial therapy we recommend high dose penicillin combined with an aminoglycoside. In cases of resistance chloramphenicol should be taken into account as second choice antibiotic drug. The duration of antibiotic therapy should at least over six weeks. In cases of risk systemic embolization is suspected therapy with low dose acetylsalicyclic acid or cardiosurgery should be assumed as therapeutic options.

Administration, Oral↗
PubMedDate not supplied

[Drowning in the bath tub after choking: Unusual death, accident or suicide? Reconstruction of an unusual fall].

A thirteen-year old girl attending a special school who had been suffering from genuine epilepsy for about one year was found dead completely clothed in the full bathtub in the bathroom of her parent's flat. The characteristic features of death by drowning but also signs of strangulation as well as a condition after shackling of the hands were found in the forensic post-mortem examination and autopsy. The putative strangulation instrument was a pair of tights which was floating in the bathwater. The hands were probably tied with the lace of a sneaker. In the further course of events, the inquiries and investigations initially commenced on the assumption of a capital crime gave reason to consider suicide. A reconstruction experiment under comparable external conditions indicates that this is possible. From a forensic-psychiatric point of view, an exacerbative mental crisis situation can be inferred as a final motive from the known personality configuration and the immediate circumstances. The tragic outcome in the final phase appears to have been determined by the additional complication of a provoked grand mal epilepsy attack. All in all, this hypothesis is the most plausible. However, subjective and objective observations do not rule out the possibility of homicide.

Adolescent↗
PubMedDate not supplied

[Dura mater chondroma. A case report and review of the literature].

Intradural chondromas are exceedingly rare intracranial tumors. We present a case of intradural chondroma. It is a clinical and radiological presentation, with special emphasis on CT appearance. The CT scan demonstrated a mass lesion with intratumors calcification areas, and slight enhancement after intravenous injection of contrast. The differential diagnosis with calcified meningioma is histological.

Adult↗
PubMedDate not supplied

[Body packing: the value of modern imaging procedures in the detection of intracorporeal transport media].

The necessity of rapid objective appraisal of the suspicion of intracorporeal drug smuggling (body-packing) by effective methods of investigation in the course of the first criminal investigation department measures raises the questions of suitable and admissible methods. The proportion of undetected crimes in intracorporeal narcotic smuggling must be rated as very high according to the data of the Federal Criminal Investigation Department. In the present paper, the suitability of various imaging techniques for drug detection are reported in terms of their risk, practicability and costs. For this purpose, the value of digital radiography, two-spectra radiography and X-ray computer tomography as compared to conventional X-ray investigations is examined in human experiments. A reality-oriented narcotics dummy (glucose pressed hard in preservative) was developed and administered to nine volunteers per os with a variable initial alimentary situation. Four radiograms were taken at fixed times up to 12 hours after administration with each imaging technique. The highest rate of detection was attained with computer tomography. In contrast to the other methods, more than 90% of the body packs could be identified here. Nevertheless, an application in criminal investigation practice cannot be recommended owing to various disadvantages. The recovery rate of the remaining methods is between 20% and 25%.

Adult↗
PubMedDate not supplied

[Death of a twin--infanticide or intrauterine fetal death?].

The authors report an intrauterine death in a twin pregnancy. Due to external circumstances, infanticide was initially suspected. Forensic examination of fetus and placenta, however, revealed a placental cause for the death of the twin. The macerated fetus, which had been retained for at least one week, was expelled, apparently unnoticed, shortly before the live birth of the hypotrophic second twin. The question of the possibility of unnoticed fetus expulsion was discussed.

Adult↗
PubMedDate not supplied

[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↗
PubMedDate not supplied

[Cadaver lipid: various origins add to the difficulty of assessing postmortem time].

Establishing the length of time since death is particularly difficult in corpses showing advanced putrefaction. One particular sign of advanced decay is the formation of adipocere, as observed mainly in drowned bodies or following a long period of storage under airtight conditions. During storage in an open, damp environment (e.g. water) the formation of adiopocere becomes visible after approximately 3-6 months and can be found in more extensive form after approximately one year. In this state bodies show evidence of a partly waxlike and partly pasty condition. Continued storage ultimately results, among other things, in further decomposition due to the action of microorganisms from the surrounding area-even if this is chronologically delayed. An exception is provided by the formation of adipocere under air-tight conditions (e.g. wrapped in plastic material or in mass graves). Initially autolysis and heterolysis also occur, involving the release of fatty acids from the lipids produced naturally in the body. As a result of the subsequent hydrogenation of the fats by the action of bacterial enzymes, the unsaturated fatty acids are partially converted into saturated fatty acids. As the fatty acids released in large quantities during adipocere formation clearly have a bactericidal effect, further bacterial decomposition is stopped at this early adipocere stage. Additional microorganisms from outside can no longer infiltrate when this hermetic seal is in place. In addition, the lack of calcium (e.g. from water or moist earth) can be a reason for the fact that further adipocere development, leading to wax-like hardening of the fat, is arrested. The soft parts of the body retain a soft, viscous consistency. Thus the condition of the body can remain constantly preserved over many years and no longer allows a reliable estimate to be made of the period of time since death.

ABO Blood-Group System↗
PubMedDate not supplied

[Suicide by a borderline patient at the end of fatal self-destructive behavior].

The presence of a borderline personality disorder must also be considered in forensic medicine appraisements, beside the various motivations for a self injurious behaviour and apart from other psychiatric illnesses. This personality disorder is frequently characterized by cuts and scratches made by the patients using sharp objects to inflict themselves when in situations causing great psychological distress. A case of a young female student is presented who exhibited a clear auto-destructive behaviour. Due to a tragic psychodynamic development, she committed suicide by means of carbamazepine intoxikation. In addition to the impressive morphological and traumatological injury pattern, the psychiatric case history of the female patient also showed that she had suffered from a typical borderline personality disorder.

Adult↗