Ute Lockemann

Multicontrast-weighted magnetic resonance imaging of atherosclerotic plaques at 3.0 and 1.5 Tesla: ex-vivo comparison with histopathologic correlation

The purpose was to analyze magnetic resonance (MR) plaque imaging at 3.0 Tesla and 1.5 Tesla in correlation with histopathology. MR imaging (MRI) of the abdominal aorta and femoral artery was performed on seven corpses using T1-weighted, T2-weighted, and PD-weighted sequences at 3.0 and 1.5 Tesla. Cross-sectional images at the branching of the inferior mesenteric artery and the profunda femoris were rated with respect to image quality. Corresponding cross sections of the imaged vessels were obtained at autopsy. The atherosclerotic plaques in the histological slides and MR images were classified according to the American Heart Association (AHA) and analyzed for differences. MRI at 3.0 Tesla offered superior depiction of arterial wall composition in all contrast weightings, rated best for T2-weighted images. Comparing for field strength, the highest differences were observed in T1-weighted and T2-weighted techniques (both P≤0.001), with still significant differences in PD-weighted sequence (P≤0.005). The majority of plaques were histologically classified as calcified plaques. In up to 21% of the cases, MRI at both field strengths detected signal loss characteristic of calcification although calcified plaque was absent in histology. MRI at 3.0 Tesla offers superior plaque imaging quality compared with 1.5 Tesla, but further work is necessary to determine whether this translates in superior diagnostic accuracy.

Effects of ageing on the insertion zones of the human vocal fold

The vocal ligaments insert at the anterior and posterior commissures of the larynx. These structures fulfil biomechanical functions, balancing the different elastic moduli of tendon, cartilage or bone and undergo age‐related changes that may be responsible for voice changes with increasing age. The aim of this study was to analyse the insertion structures of the vocal ligaments by means of macroscopic, histological, immunohistochemical and electron‐microscopic methods and to draw conclusions from age‐related structural changes on a functional basis. Investigations were carried out on the larynges of 22 males and 15 females (aged 1–95 y). In adolescence, the insertion zone of the vocal ligament tendon, a dense network of connective tissue rich in sulphated glycosaminoglycans at the thyroid cartilage, is characterised by a layer between tendon and cartilage comparable to fibrocartilage. The insertion zone lacks a perichondrium. Collagen fibrils of the vocal ligament tendon penetrate directly into the thyroid cartilage. In the insertion area, the chondrocytes are surrounded by collagen fibrils, which show positive reactivity to antibodies against type I and type III collagen. Sulphated glycosaminoglycans are integrated between the collagen fibrils. In the area of the posterior glottis, elastic cartilage rests like a cap on the hyaline base of the arytenoid cartilage. There is no distinctive border between the structures. With increasing age, ossification of the laryngeal skeleton occurs, involving hyaline cartilage at the posterior glottis and hyaline and fibrocartilage at the anterior commissure. At the same time, a loss of sulphated glycosaminoglycans is observed inside the vocal ligament tendon. Advanced ossification of the laryngeal skeleton, particularly in the area of the commissures, an increasing loss of glycosaminoglycans in the vocal ligament tendon and changes in the elastic tissue reduce the elastic modulus between tendon, cartilage and bone, thus ‘stiffening’ the insertion zones, which could be one factor among others favouring voice changes with advancing age.

Postmortem investigation of serum myoglobin levels with special reference to electrical fatalities

The serum myoglobin levels of 58 fatalities were investigated with special reference to correlations of the myoglobin-concentrations with the postmortem interval, the site of blood sampling and the cause of death (especially concerning death caused by electric current). An increase of the myoglobin values with the passage of postmortem time is obvious. The topographical sampling site plays an important role; the highest concentrations are found adjacent to striated muscles (i.e. in blood from the heart or the femoral vein). There was no significant correlation of myoglobin values and death by electric current.

Identifikation unbekannter Toter durch odontologische Untersuchungen

Bei der Identifikation unbekannter Toter hat die Untersuchung des Zahnsystems einen sehr hohen Stellenwert. Mit Hilfe der Unterlagen aus der zahnärztlichen Praxis ist es möglich, prä- und postmortale Befunde zu vergleichen und somit eine Identifizierung durchzuführen. Durch unvollständige und fehlerhafte Unterlagen aus den zahnärztlichen Praxen wird aber in vielen Fällen eine Identifizierung unnötig erschwert oder sogar unmöglich. Röntgenbilder können hier Abhilfe schaffen. Prämortal angefertigte Panoramaschichtaufnahmen (Orthopantomogramme) eignen sich in besonderer Weise zum Vergleich mit möglichst deckungsgleichen postmortal angefertigten Bildern. Die Panoramaschichtaufnahme sollte daher schon zu Beginn der vergleichenden Untersuchungen vorliegen und eingesetzt werden.If an unknown corpse has to be identified the examination of the dental system can be important by comparing the pre-mortem dental charts and post-mortem findings. But in many cases the reports of dental practitioners are incomplete and incorrect and the identification process will be unnecessarily complicated or even impossible. Orthopantomograms can be especially useful as these special extraoral radiographs of the dento-maxillo-facial region are the routinely used X-ray diagnostic in the overwhelming majority of dental practices and give a complete overview of the upper and lower jaw. Orthopantomograms should be made available and used from the beginning of any comparative dental investigation.

Spine Injuries due to Horse Riding Accidents - an Analysis of 30 Cases

INTRODUCTION Horseback riding entails several risk factors that predispose the participant to injury. Especially craniocerebral as well as spinal trauma were common reasons for severe injuries. Hence, it is important to use effective protective gear during riding activities. However, the protective effect of actual safety vests and helmets in case of accident is still unknown. In the present study reasons, mechanisms and patterns of equine-related spine injuries were analyzed. Based on these data the effectiveness of used protective gear during accident was assessed. MATERIAL AND METHODS 30 equestrians took part in a questionnaire survey. Based on these answered questionnaires reasons, mechanisms and patterns of equine-related injuries as well as used protective gear during accident were evaluated and analyzed. RESULTS 24 patients (80 %) were female and 6 (20 %) were male. The median age at the time of injury was 36 years (range 14 - 72 years). The causalities suffered from 18 fractures (60 %) and 11 discoligamentous injuries (37 %), in one case a bone-bruise-injury (3 %) was found. 7 equestrians (23 %) wore a safety vest at time of injury. DISCUSSION Despite wearing a safety vest, the spine can get damaged when accident occurred. It is not possible to create vests for equestrians capable of protecting against all spine injuries in all accidents. If the energy impact is too high, serious injuries can result, even though protective body gear is worn. But the development of improved safety vests is necessary to reduce the number of severe spine injury in the future.

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).

Bakterielle Meningitis als Ursache des plötzlichen Todes – Phänomenologie, Histomorphologie und Erregerspektrum

Unter den im Zeitraum von 1992–1999 am Institut für Rechtsmedizin der Universität Hamburg durchgeführten 8305 gerichtlichen und wissenschaftlichen Obduktionen fanden sich 20 Fälle (männliches Geschlecht n = 10, Durchschnittsalter 49,2 Jahre; weiblich n = 10, Durchschnittsalter 53,4 Jahre) erst autoptisch diagnostizierter bakterieller Meningitiden. Dies entspricht einer Häufigkeit von 0,23% im untersuchten Sektionsgut. In 8 Fällen befanden sich die Verstorbenen kurz vor dem Tode wegen unklarer Beschwerden in ärztlicher Behandlung, in 10 Fällen konnte der Verlauf retrospektiv als perakut eingeordnet werden. Erkrankte im Alter < 40 Jahre verstarben weit häufiger im Krankenhaus als Erkrankte des Alters > 60 Jahre, die überwiegend zu Hause verstarben. Erkrankte im Alter zwischen 40 und 60 Jahren zeigten signifikant häufiger Kopfschmerzen und Unwohlsein als initiale Symptome als Erkrankte mit einem Alter von < 40 Jahren und > 60 Jahren. Ein postmortaler Erregernachweis von Abstrichen der Leptomeninx gelang in 12 von 14 diesbezüglich untersuchten Fällen (Streptococcus pneumoniaen = 8; Neisseria meningitidis, Kapseltyp C n = 2; Staphylococcus aureusn = 1; Streptococcus pyogenesn = 1). Häufigste autoptisch festgestellte Begleiterkrankungen waren eitrige Tracheobronchitis, Pneumonie und eitrige Sinusitis, wobei eine definitive Feststellung der Eintrittspforte der Erreger am Autopsiematerial in der Regel nicht möglich ist. Histomorphologisch dominierte der Typ der Haubenmeningitis mit vorwiegend gemischtzelliger Entzündungsreaktion. Bei der forensischen Beurteilung von Meningitistodesfällen kann neben der Verkennung der Erkrankung vor dem Hintergrund evtl. unzureichender ärztlicher Diagnostik insbesondere der Prognose in Abhängigkeit vom Zeitpunkt der korrekten Diagnosestellung unter straf- und zivilrechtlichen Aspekten Bedeutung zukommen. Auch wirft die Anamnese eines vorausgegangenen Schädel-Hirn-Traumas aus rechtsmedizinischer Sicht Fragen hinsichtlich des Kausalzusammenhangs auf.Between 1992 and 1999, 20 cases of a previously undiagnosed meningitis (10 males, mean age 49.2 years; 10 females, mean age 53.4 years) out of a total of 8305 autopsies were identified, corresponding to a frequency of 0.23% in the reviewed autopsy material. In 8 cases, the deceased seeked medical advice shortly before death due to unspecific complaints. In 10 cases, a peracute course of the disease was considered retrospectively. Affected persons under 40 years of age frequently died in hospital whereas persons over 60 years of age died more often in their domestic environment. At the onset of symptoms, persons between 40 and 60 years of age complained of headaches and indisposition significantly more often than persons under 40 years or over 60 years of age. Postmortem swabs of the leptomeninx resulted in cultural growth of pathogenetic germs in 12 out of 14 cases examined (Streptococcus pneumoniaen = 8; Neisseria meningitidis (capsular type C) n = 2; Staphylococcus aureusn = 1; Streptococcus pyogenesn = 1). Most frequent concomitant diseases diagnosed at autopsy were acute tracheobronchitis, pneumonia and purulent sinusitis but in general a definitive identification of the entry site of bacteria is not possible postmortem. Histomorphologically, the predominant type was tegmental meningitis with a mixed polymorphonuclear cell infiltrate. In the forensic elucidation of fatalities due to meningitis, questions concerning medical malpractice can be raised (e. g. misdiagnosis, late diagnosis). In cases with preceding craniocerebral trauma, the forensic expert is confronted with the question of causality between trauma and death.

Unsuspected (clinically silent) multiple sclerosis: Quantitative investigations in one autoptic case

The incidental retrieval of a few, well-circumscribed, chronic multiple sclerosis plaques in a 49-year-old female who died from myocardial infarct is reported. In serial gallocyanin stained frontal sections of the brain one plaque in the left and four plaques in the right hemisphere were encountered. A total of 1.25 cm3 or 0.24% of the right hemispheric volume and a total of 0.93 cm3 or 0.2% of the left hemispheric volume was afflicted. The size as well as the topography of the plaques could explain the absence of clinical symptoms. Methodological issues concerning in vivo and postmortem diagnosis of multiple sclerosis and their impact on the epidemiology of this disease are discussed.

HIV-1 prevalence among drug deaths — a multicenter study

Since 1985 several European Institutes of Forensic Medicine have cooperated in a multicenter study providing a constant monitoring of HIV-1 prevalence among drug-related deaths. From 1985 to 1991 the HIV status of 5372 drug-related fatalities (4328 males, 1044 females) has been tested. A total of 764 (14%) drug deaths were HIV-positive (13% of the males, 21% of the females). In contrast to the steadily increasing number of drug-related fatalities the HIV-1 prevalence is decreasing, especially in the German cities. Regional differences are obvious. The development of the HIV prevalence of drug deaths is comparable with that of the still living intravenous drug addicts.

Intracranial arteriovenous malformations presenting as sudden unexpected death: a report of 3 cases and review of the literature.

Intracranial arteriovenous malformations (AVMs) are cerebrovascular abnormalities due to maldevelopment of the regional capillary bed, producing lesions with arteriovenous shunting. AVMs may account for as many as 1% of all sudden deaths; however, case reports in the literature are exceedingly rare. We present 3 cases of sudden death due to hemorrhage of AVM and discuss the literature and the differential diagnosis in cases of sudden death due to intracranial hemorrhage.