Daniele Risser

Similar deficits of central histaminergic system in patients with Down syndrome and Alzheimer disease

In order to study whether Alzheimer-like neuropathological changes involve the central histaminergic system we measured the concentration of histamine, its precursor histidine as well as the activity of histidine decarboxylase (HDC) and histamine-N-methyl-transferase (HMT) in frontal cortex of aging Down syndrome (DS) patients, Alzheimer patients and control individuals. The study populations were also investigated for choline acetyltransferase (ChAT) activity, since reduced ChAT activity is an established biochemical hallmark in DS and Alzheimer disease (AD). HDC and ChAT activity were reduced in brains of both DS and Alzheimer patients versus control patients. Additionally, we observed a significant decrease of histamine levels in the DS group. Histamine levels in AD brains tended to be decreased. Histidine concentrations and HMT activities were comparable between the three groups. Thus, our results for the first time show histaminergic deficits in brains of patients with DS resembling the neurochemical pattern in AD. Neuropathological changes may be responsible for similar neurochemical alterations of the histaminergic system in both dementing disorders.

Risk of dying after a free fall from height

Falls from height are predominantly an urban phenomenon and represent an important form of blunt trauma. Disagreement predominates regarding the height at which death results. The aim of this study was to investigate the risk of dying after a free fall from height in relation to the distance fallen. Therefore, medical records of victims of a fall from height treated in 1989 at Viennese emergency units were analysed. In addition, post-mortem reports of deaths due to falls from height, examined in the same year at the Institute of Forensic Medicine in Vienna, were studied. For the purpose of an homogenous investigation sample in regard to physical condition, only people aged from 20 to 50 years were taken into account. A total of 11 females and 30 males suffered an accidental fall from buildings, seven men from scaffolding and two men from a tree. A total of 18 females and 18 males jumped from residential buildings. One woman and nine men intentionally fell from other buildings. All victims landed on concrete or pavement. Suicidal jumps occurred from significantly higher places than accidental falls. The results of this analysis suggest that death usually occurs when distance is more than five storeys.

Polyamines in frontal cortex of patients with Down syndrome and Alzheimer disease

Polyamines may play an important role in brain development, mature brain function and also in neurodegenerative conditions. We investigated polyamine levels in frontal cortex of human post-mortem brain samples of elderly patients with Down syndrome (DS), Alzheimer disease (AD) and normal controls by means of chromatographic separation after dansylation. Spermidine and spermine concentrations were markedly decreased in DS and AD. Polyamine levels were neither related to age and post-mortem interval nor to choline acetyltransferase activity, as indicator of neuronal loss. Our results support the idea that besides other neurotransmitter systems, endogenous polyamine levels are altered in dementing illnesses such as Alzheimer disease and Down syndrome.

CARBON MONOXIDE-RELATED DEATHS FROM 1984 TO 1993 IN VIENNA, AUSTRIA

Carbon monoxide poisoning occurs frequently in industrialized countries. Between 1970 and 1978 in Vienna, the capital of Austria, carbon-monoxide-rich coal gas was replaced with natural gas. Despite this fact, people still die of unintentional carbon monoxide poisoning. The main purpose of this study was to determine the reasons for unintentional carbon monoxide-related deaths, and further to describe the epidemiology of these fetal poisonings in Vienna between 1984 and 1993. A secondary purpose was to investigate whether intentional carbon monoxide poisoning still plays a role among suicides as was the case up to the 1970s. For this purpose we analyzed carbon monoxide-related deaths in Vienna from 1984 to 1993, based on actual autopsy reports of postmortems performed at the Viennese Institute of Forensic Medicine. Deaths due to fire were excluded. The main reason for unintentional carbon monoxide-related deaths in Vienna between 1984 and 1993 was flueless gas-fueled water heating appliances, overused especially by old people during the cold period of the year. The frequency of unintentional carbon monoxide-related deaths in 1993 was almost as high as in 1984. A total of 53% of deceased persons were over age 60. Most fatal carbon monoxide poisoning occurred during the cold period of the year. Suicides decreased significantly during the investigation period. In 76% of these deaths car exhaust fumes were inhaled, especially by men. In conclusion, we recommend programs to prevent unintentional carbon monoxide-related deaths. These programs should especially target the elderly. Flueless gas boilers should not be overused. Furthermore, apartments should be aired sufficiently, even during the cold period of the year.(ABSTRACT TRUNCATED AT 250 WORDS)

Mortality of opiate users in Vienna, Austria

The purpose of this study was to investigate whether there are differences in overall and cause-specific mortality rates of opiate users in maintenance treatment and of opiate users not in any drug treatment program in Vienna, Austria. A cohort of opiate-users enrolled in maintenance treatment in Vienna and a cohort of individuals involved in opiate-related emergencies from 1995 to 1997 were retrospectively analyzed. The standardized mortality rate of opiate-users enrolled in maintenance treatment was 12.1 and that of individuals involved in opiate-related emergencies was 48.8. Excess mortality was found for all categories for both groups. In the face of the extremely high excess mortality of opiate users involved in opiate-related emergencies, measures have to be taken to get these individuals in drug treatment programs as soon as possible.

Discovery of decomposed and mummified corpses in the domestic setting--a marker of social isolation?

Mass media reports attribute the occurrence of decomposed or mummified corpses in a domestic setting mainly to an increasing social isolation of elderly people. Not much is known about the demographic and medical conditions under which individuals are found months or even years after death in their homes. For this study, autopsy reports of individuals found dead and mummified or decomposed between 1993 and 1997 with those from 1963 to 1967 were retrospectively analyzed. Between 1993 and 1997, a total number of 320 individuals were found decomposed at home compared to 412 such cases between 1963 and 1967. The proportion of individuals older than 64 years was significantly higher during the 1990s study period. Furthermore, the proportion of deaths attributable to natural causes was significantly lower during the 1990s, whereas the rate of suicides was nearly three times higher.

Suicide of a body packer

The smuggling of illicit drugs by means of body packing has become a common problem at European airports. Europe is considered to be the fastest growing market for cocaine worldwide, and the air route is the most frequently used method of trafficking cocaine. Smuggling illicit drugs by use of body packing is considered to be a high toxicological hazard because of the risk of leakage or a package bursting. We report about the first case of suicide of a body packer by re-ingesting the content of excreted cocaine packages. The consequence of this case is that the death scene investigation and autopsy assessments in case of a body packers death should always consider the possibility of re-ingested packages. Detention personnel should be instructed by forensic and criminalistic experts to take preventive measures.

Should coroners be able to recognize unintentional carbon monoxide-related deaths immediately at the death scene?

The aim of this retrospective survey of unintentional carbon monoxide-related deaths in Vienna was to determine whether the cherry-pink coloring of livor mortis is a reliable finding for the coroner to suspect a carbon monoxide-related death immediately at the death scene. In addition, we investigated the recognition pattern of unintentional carbon monoxide-related deaths by Viennese coroners between 1984 and 1993. Therefore, we analyzed autopsy reports of postmortems performed at the Viennese Institute of Forensic Medicine between 1984 and 1993. The study involved 182 unintentional carbon monoxide-related deaths: 92 females and 90 males. We found a strong association between the carboxyhemoglobin level and the cherry-pink coloring of livor mortis. In 98.4% of unintentional carbon monoxide-related deaths livor mortis were clearly cherry-pink. During the 10-year study period Viennese coroners recognized only 61% of unintentional carbon monoxide-related deaths immediately at the death scene. The percentage of unrecognized carbon monoxide fatalities with a clear cherry-pink coloring of livor mortis almost doubled from 1984 to 1993. The older the victim, the worse the coroners recognition. In summary, we have shown that coroners should be able to recognize unintentional carbon monoxide-related deaths immediately at the death-scene, because fresh corpses with carboxyhemoglobin levels greater than 31% show a clear cherry-pink coloring of livor mortis. Therefore, coroners should be encouraged to examine naked corpses thoroughly, especially regarding the color of livor mortis. Thus, a carbon monoxide-related death can be recognized immediately and the source of gas release identified as soon as possible protecting people who otherwise would also be at risk of poisoning.(ABSTRACT TRUNCATED AT 250 WORDS)

HIV-1- prevalence among drug deaths in major cities of central and northern Europe

Since 1985, a number of Institutes of Forensic Medicine in Germany have cooperated in a multicenter study, to provide a constant monitoring of HIV-1-prevalence among drug related deaths. In 1990/91, the Institutes in Copenhagen, Stockholm, Vienna and Zürich also participated in this study. HIV-1-prevalence is decreasing in the German cities, whereas the epidemiological development is not uniform in the other major cities. Regional differences are obvious. In 1991, the prevalence rates were as follows: Berlin 15% (n = 220), Hamburg 4% (n = 179), Frankfurt 17% (n = 167), Munich 9% (n = 136), Stockholm 10% (n = 79), Copenhagen 14% (n = 130), Vienna 20% (n = 56), and Zürich 23% (n = 84).

Forensic autopsies from 1984 to 1993 in Vienna, Austria.

In Austria every death is subject to an examination by a medical doctor authorized by the local health authority. If death is suspected to be natural and/or perpetrated by another person, this doctor has to report it to the police. Depending on the investigation results, the examining magistrate in charge demands a judicial autopsy at the Institute of Forensic Medicine. In 1989, 41 murders of old patients by nursing assistants in a Viennese public hospital were disclosed. The main aim of this retrospective study was to determine any change in the demand for forensic autopsies by the Viennese health authority, as well as by the criminal court, after 1989. Furthermore, it was of interest to analyze the reporting practices of medical doctors examining corpses, as well as thr reaction of the criminal court during the study period. After 1989, there was a significant increase of non-judicial and judicial autopsies, performed by Viennese forensic pathologists. In addition, there was a significant increase of reports to the police by coroners as well as by forensic pathologists, paralleled by a higher rate of forensic autopsies demanded by the examining magistrate. This increase of forensic autopsies took place even though the overall rate of deaths in Vienna significantly decreased during the 10-year study period. Thus, the disclosure of 41 murders in the Viennese hospital in 1989 can be assumed as a turning point in the reporting practices of Viennese coroners, as well as the autopsy rate handled by Viennese forensic pathologists.