Klaus-Steffen Saternus

The shaking trauma in infants - kinetic chains.

The findings in three children who died as a consequence of shaking and those in another child who survived are presented. In the three fatal cases, a combination of anatomical lesions were identified at autopsy which appear to indicate the sites where kinetic energy related to the shaking episodes had been applied thus enabling the sequence of events resulting in the fatal head injury to be elucidated. Such patterns of injuries involved the upper limb, the shoulder, the brachial nerve plexus and the muscles close to the scapula; hemorrhages were present at the insertions of the sternocleidomastoid muscles due to hyperextension trauma (the so-called periosteal sign) and in the transition zone between the cervical and thoracic spine and extradural hematomas. Characteristic lesions due to traction were also found in the legs. All three children with lethal shaking trauma died from a subdural hematoma only a few hours after the event. The surviving child had persistant hypoxic damage of the brain following on massive cerebral edema. All the children showed a discrepancy between the lack of identifiable external lesions and severe internal ones.

A functional polymorphism in the tyrosine hydroxylase gene indicates a role of noradrenalinergic signaling in sudden infant death syndrome.

OBJECTIVES Catecholamines may contribute to the cause of sudden infant death syndrome (SIDS). TH01, a tetrameric short tandem repeat marker in the tyrosine hydroxylase gene, regulates gene expression and catecholamine production. STUDY DESIGN We investigated TH01 in 172 German Caucasian SIDS cases and 390 sex- and age-matched control subjects. RESULTS The *9.3 alleles were more frequent in patients with SIDS than in control subjects (40.12% vs 31.15%; P = .006). For homozygotes the odds ratio was 1.83 (95% confidence interval: 1.09-3.05), for carriers 1.58 (1.09-2.28). Moreover, *9.3 alleles were significantly more frequent during the winter (47.73% vs 35.38% in the warmer seasons), and the frequency of *9.3 alleles varied significantly with the age at death (weeks 7 to 12: 49.04% vs 29.63% within the first 6 weeks). Other risk factors (sleeping position, gestation, smoking) had no significant impact on the frequency of *9.3. CONCLUSIONS Our results indicate a relationship between SIDS and TH01 genotype, presumably caused by an impairment of breathing regulation or arousal. We propose that noradrenalinergic neuronal activity contributes to the cause of a major subset of SIDS victims. Moreover, the results further stress that SIDS is a highly heterogenic group.

Macrophage subsets in mechanical brain injury (MBI) – A contribution to timing of MBI based on immunohistochemical methods: A pilot study

Cortical hemorrhages as a consequence of closed mechanical brain injury (MBI) trigger an inflammatory response including a distinct increase of macrophages. According to published data this reactive macrophage population is heterogenous as to their immunological properties. The expression of certain immunohistochemically detectable epitopes of macrophages, however, may correlate with the posttraumatic interval (PTI). In a pilot study, 50 selected cases of cortical hemorrhages with 1 min to 1.5 years PTI were examined by light microscopy and macrophages were labeled with CD68-, HLA-D-, HAM-56-, LN-5-, and 25F9-antibodies, while hemosiderin was detected by a Prussian-blue reaction. Qualitative and semiquantitative investigations were performed. The semiquantitative study included 5 different classes. The results of the study revealed a distinct timetable of the appearance of macrophages labeled with certain antibodies. While HLA-D immunoreactivity was detected after a PTI of 6h in the cortex and white matter bordering the traumatic hemorrhage, CD68 immunopositive macrophages were present after 12h, LN-5 and HAM-56 after 48h, and 25F9 within 10d. Hemosiderin-containing macrophages were detectable within 100h in the same region. Within the hemorrhage itself a certain immunoreactivity of macrophages starts several hours before: CD68 after 3h, LN-5 after 24h, HAM-56 after 31h, hemosiderin after 76h, and 25F9 after 4d. For forensic purposes these observations are of crucial importance because the time course of the appearance of certain immunopositive macrophages labeled with different antibodies allows a differentiated timing of contusional injuries; however, the cause of this different immunopositive reaction remains unexplained. The observed time dependency of different macrophage antigen expressions in cortical hemorrhages after closed head injury is a suitable method to estimate the PTI and will allow a forensic reliable estimation if future investigations are extended on higher numbers of cases and/or additional markers.

Fatal outcome of varicella in children

Varicella or chicken-pox are one of the most frequent diseases in childhood. Severe or even lethal complications are rare (in about 0.03 per thousand ). Our paper presents two cases of varicella infections leading to sudden deaths (3- and 7-year-old children). In one of these cases, the paediatrician in charge was accused of an impaired medical treatment. Both of the children showed multiple typical efflorescences in different stages. Furthermore were observed affections of the respiratory tracts and serious involvements of the hearts, the lungs, and the livers. In one case an immunological identification could be made of an acute varicella infection. Based on autoptical, histological, bacteriological, virological, and neuropathological findings is given an analysis of such uncommon and severe courses of chicken-pox in children being identified as haemorrhagic form and massive abscess-forming varicella pneumonia.

Natural Rubber Latex Allergy Is Not a Cause of Sudden Infant Death

Background: The causes for sudden infant death (SID) remain unclear. As infants can become sensitized to NRL allergens by pacifiers and latex mattresses, we tried to establish whether there is a relationship between SID and natural rubber latex (NRL) allergy. Methods: We determined NRL–specific IgE concentrations in 112 unselected cases of SID by the CAP–FEIA method. Results: NRL–specific IgE could be detected only in 1 sample (0.64 kU/l; CAP class 1). Conclusions: We conclude that NRL allergy is not a cause of SID.

Klinische Rechtsmedizin und forensisch-klinische Untersuchungen

Aufgrund des Erfahrungsschatzes in der Erhebung, Protokollierung und Dokumentation von Verletzungsbefunden sind Rechtsmediziner seit altersher auch mit der Untersuchung Lebender nach rechtserheblichen Korperverletzungen befasst (Beweismittelsicherung am Lebenden), damit sich entsprechend erhobene Befunde und ihre Beurteilung im weiteren Verfahrensablauf als tragfahig erweisen. Das rechtsmedizinische Untersuchungsspektrum inkl. Asservation nach Sexualdelikten ist weitgehend normiert. Bei Kindesmisshandlung steht die Abgrenzung von haufig behaupteten akzidentellen Verletzungen im Vordergrund. Selbstbeschadigungen weisen typische Verletzungscharakteristika auf. In den letzten Jahren spielt die forensische Altersdiagnostik bei Lebenden eine zunehmende Rolle. Aufgabe eines Altersgutachtens ist eine Aussage zum chronologischen Alter aufgrund des physischen Entwicklungszustandes eines Individuums, welcher als biologisches Alter bezeichnet wird.

Aufklärung oder Gruseleffekt

Körperwelten nennt sich eine Ausstellung anatomischer Präparate in verschiedenen Techniken vom Schnittpräparat bis zum präparierten ganzen Menschen, Ganzkörperplastinate genannt, die vom 30.10.1997 bis 1.3.1998 (nach Verlängerung) im Landesmuseum für Technik und Kultur in Mannheim gezeigt wurde. In der Öffentlichkeit ist sie auf ein geteiltes Echo gestoßen. Als Zielsetzung der Ausstellung benennt der Heidelberger Anatom Prof. Dr. Kriz in seiner Einführung zum Katalog u.a. die „Aufklärung über den Aufbau des menschlichen Körpers“ und einen Beitrag „Zum Abbau des Schauerns vor dem Tode“. Der Motor dieser Ausstellung ist Prof. Dr. Gunther von Hagens (Lehrbeauftragter am Heidelberger Anatomischen Institut), auf den die Technik der Kunststoffimprägnation (Plastination) von Körperteilen oder auch von ganzen toten Menschen zurückgeht. Von seinem Privatinstitut für Plastination stammen die Exponate, und zwar in der formulierten Erwartung, daß von dieser Ausstellung in Mannheim eine Reform der deutschen Anatomie ausgehe. Diese sieht er darin, daß es dem Laien erlaubt sein solle, „eine Ausstellung echter menschlicher Präparate anzusehen“. Gleichzeitig bemerkt er andererseits „ein ungutes Gefühl“ in Deutschland als Reaktion auf diese Ausstellung „modern konservierter anatomischer Präparate“.