Carolin Edler

A prospective time-course study on serological testing for human immunodeficiency virus, hepatitis B virus and hepatitis C virus with blood samples taken up to 48 h after death

The transmission of viral and non-viral infectious pathogens continues to be the most serious of the potential adverse effects of allogenic tissue transplantations. EU Directive 2006/17/EC stipulates that cadaveric blood specimens for serology testing in the context of post-mortem tissue donation must be taken not later than 24 h post-mortem. An expanded time slot would significantly improve the availability of tissue donations, but there are no significant data on the stability of infectious serology assays for anti-human immunodeficiency virus (HIV), anti-hepatitis C virus (HCV), hepatitis B virus (HBV) surface antigen (HBsAg) and anti-HBC core antigen (HBc) in samples collected more than 24 h post-mortem. In this prospective study, serum samples of 30 deceased persons were taken upon admission to the Institute of Forensic Medicine (University Hospital Hamburg-Eppendorf, Germany) and at 12, 24, 36 and 48 h post-mortem. All samples were measured twice, first using the Abbott AxSYM system, and then after ~9 months of storage at -70 °C using the BEP III System with Siemens and Ortho reagents. For HIV, six deceased persons with a pre-mortem HIV history were included. All samples (at committal and at 12, 24, 36, 48 h) were reactive. Indeterminate or false-negative results did not occur. For HCV, 17 deceased persons with a pre-mortem HCV history were included; 16 samples were reactive up to 48 h and one was reactive at 36 h post-mortem (48 h sample was not available). Indeterminate or false-negative results did not occur. For HBV, nine deceased persons were included: five samples were initially positive for HBsAg and remained positive up to 48 h, and eight of the samples were reactive for anti-HBc up to 48 h and one up to 36 h post-mortem (48 h sample was not available). Indeterminate or false-negative results did not occur. These data suggest that infectious serological testing may be extended for blood samples of potential tissue donors collected up to 48 h post-mortem to detect antibodies or antigens for HIV, HBV and HCV.

Virus NAT for HIV, HBV, and HCV in Post-Mortal Blood Specimens over 48 h after Death of Infected Patients – First Results

Objective: According to EU regulations (EU directive 2006/17/EC), blood specimens for virologic testing in the context of post-mortal tissue donation must be taken not later than 24 h post mortem. Methods: To verify validity of NAT in blood specimens collected later, viral nucleic acid concentrations were monitored in blood samples of deceased persons infected with HIV (n = 7), HBV (n = 5), and HCV (n = 17) taken upon admission and at 12 h, 24 h, 36 h and 48 h post mortem. HIV and HCV RNA were quantified using Cobas TaqMan (Roche), HBV DNA was measured by in-house PCR. Results: A more than 10-fold decrease of viral load in samples taken 36 h or 48 h post mortem was seen in one HIV-infected patient only. For all other patients tested the decrease of viral load in 36hour or 48-hour post-mortal samples was less pronounced. Specimens of 3 HIV- and 2 HBV-infected patients taken 24 h post mortem or later were even found to have increased concentrations (>10-fold), possibly due to post-mortem liberation of virus from particular cells or tissues. Conclusion: Our preliminary data indicate that the time point of blood collection for HIV, HBV and HCV testing by PCR may be extended to 36 h or even 48 h post mortem and thus improve availability of tissue donations.

Blood Trace Evidence on Washed Textiles - a systematic approach

Luminol has been used for a long time for detecting latent blood traces during police investigations because it is easy to use and does not pose any health risks, while providing trace evidence for DNA analysis. It is often the method of choice for examining clothing. Clothes worn during the offense are often destroyed or washed afterwards by the offenders. The purpose of this study is to show the possibilities of blood and DNA detection on washed clothes by documenting the macroscopic results and their chemiluminescence after washing. The tests comprised different fabrics and laundry detergents including different washing and drying methods. Chemiluminescence was detected on almost all blood-marked samples (95.9%), even after all traces visible to the naked eye have been removed by washing. Evidence of a complete DNA profile or individual alleles could be confirmed in almost all of the test cases (93.3%).

Vermeidung der Leichenverwechslung

ZusammenfassungEine Machbarkeitsstudie zur Vermeidung von Leichenverwechslung mithilfe des Fingerabdruckscanners wird vorgestellt. Die Aufnahme der Zeigefingerabdrücke beim Ein- sowie Ausgang der Leichen im Institut für Rechtsmedizin und ein Abgleich („matching“) mit den personenbezogenen Daten sichern die Identität und verhindern eine Verwechslung.AbstractA feasibility study on the avoidance of mistaken identity of corpses through the use of a fingerprint scanner is discussed. The recording of index fingerprints on admission and release of corpses from the Institute for Legal Medicine and a comparison (matching) of personal data ensures correct corpse identification and prevents interchange.

Fatal air embolism in hospital confirmed by autopsy and postmortem computed tomography

Vascular air embolism is caused by penetration of air into veins or arteries through a surgical wound or other connection between the external and internal aspects of the body. Vascular air embolism has various causes, and iatrogenic air embolisms are the most frequently described. We report a case of fatal air embolism in an 83-year-old woman who was admitted to hospital. At the time of the incident, she was alone in her ward receiving an intravenous infusion of antibiotics via a peripheral line in her right forearm. She was also inhaling air through a mask, which was connected via a tubing system to a compressed air connection in the wall behind her bed. Autopsy and postmortem computed tomography (PMCT) findings are presented. The case illustrates the high diagnostic value of PMCT, which is an effective procedure for detecting the presence of air or gas.

Chronische Schmerzen@@@Chronic pain: Vergessener Tupfer nach Appendektomie@@@Retained sponge after appendectomy

ZusammenfassungFremdkörper, die nach operativen Eingriffen im Körper des Patienten versehentlich belassen werden, können mit Gesundheitsschäden sowie Schmerzensgeld- und Schadenersatzforderungen einhergehen. Der Fall eines vergessenen Tupfers nach laparoskopischer Appendektomie und Revisionsoperation verdeutlicht die Notwendigkeit, die Differenzialdiagnose „Fremdkörper“ zu bedenken und frühzeitig eine radiologische Abklärung durchzuführen. Die hinlänglich bekannte Problematik des Corpus alienum relictum wird durch diese Kasuistik aktualisiert.AbstractForeign bodies left inside the patient after surgery can cause damage to the patient’s health and lead to medical compensation claims for suffering. The case of a retained surgical sponge after laparoscopic appendectomy and revision surgery underlines the necessity of considering the differential diagnosis of “foreign body” and the importance of early x-ray examination. The presentation of this case offers an update on the well-known problem of corpus alienum relictum.

Sudden death from acute epiglottitis in a toddler

The bacterium Haemophilus influenzae type b (Hib) can cause severe and life-threatening infections such as epiglottitis and meningitis. The course of the disease can be very rapid, resulting in sudden death. The incidence of Hib-induced epiglottitis in children has declined since the introduction of vaccinations in countries where such vaccinations are routinely administered. We herein present a case involving a 2.5-year-old boy who died suddenly at home. He had developed acute-onset throat and abdominal pain and a high fever. Despite an emergency cricothyrotomy due to a complicated intubation because of a massively swollen epiglottis, the efforts to resuscitate the child were unsuccessful. He was a previously healthy toddler, but he had not yet been vaccinated. Microbiologic analysis revealed the pathogenic bacterium Hib. The main autopsy finding was acute epiglottitis with swelling and cherry-red coloring of the epiglottis. Postmortem cultures of the cerebrospinal fluid and heart blood also revealed Hib as the pathogenic agent. Acute pneumonia was also diagnosed microscopically. The present report describes a rare case of Hib-induced acute epiglottitis and presents the key findings of forensic investigations in this type of disease.

Erratum to: Blood Trace Evidence on Washed Textiles - a systematic approach

The original version of this article unfortunately contained an error in fig. 12 and 13. The correct fig. 12 with the DNA results of cotton denim sample A you can find below. The fig. 12 in the article shows the DNA results of micro fleece, blended fabrics and cotton jersey (see original subtitle of fig. 13). Fig. 13 in the article shows the results of sample B as stated in the last paragraph of BDNA analysis^.

Todesfeststellung und Leichenschau – Todeszeichen erkennen und richtig deuten

Die Todesfeststellung steht am Beginn jeder arztlichen Leichenschau. Unter Berucksichtigung sicherer Todeszeichen ist eine zweifelsfreie Einschatzung schnell und einfach moglich. Sind keine sicheren Todeszeichen vorhanden, ist zu reanimieren. Sichere Todeszeichen sind Totenflecke, Totenstarre, Faulnis sowie nicht mit dem Leben zu vereinbarende Verletzungen. Grundkenntnisse uber postmortale Veranderungen ermoglichen eine grobe Todeszeitbestimmung und konnen ggf. Hinweise auf die Todesursache geben.

Todesfeststellung und Leichenschau – Keine Angst vor der Leichenschau!

Die Leichenschau ist die letzte arztliche Tatigkeit am Patienten. Mit ihr erfolgt eine Einschatzung, ob die Umstande eines Todesfalles weiter untersucht werden sollten oder nicht. Primare Aufgabe des leichenschauenden Arztes ist die Feststellung des Todes. Dazu kommen Angaben zur Todeszeit, der Todesursache und der Todesart auf der Todesbescheinigung. Bei Anhaltspunkten fur einen nicht naturlichen oder ungeklarten Tod ist die Polizei zu rufen. Ein standardisiertes Vorgehen hilft bei der Leichenschau.