Self-expanding metal stents are an established option in the palliative treatment of malignant stenoses of the esophagus. Herein, we report on a 60-year-old man with a recurrent stenosis that developed 2 months after radiochemotherapy for a squamous cell carcinoma in the middle part of the esophagus. To relieve progressive dysphagia, a Gianturco-Rösch stent (Cook-Z stent, 10 cm, PE-covered, manufactured by William Cook Europe) was implanted. Six weeks later, precipitous massive hemoptysis leading to the collapse and death of the patient occurred. Autopsy showed that a barb in the middle of the stent had perforated the aortic arch, resulting in massive bleeding into the gastrointestinal tract, and aspiration. Although hemorrhage and esophageal perforation are known late complications of all types of metal stents, our case is the first description of a perforation involving a fixation barb. These barbs are a particular feature of the European version of the Cook-Z stent, and are intended to prevent stent migration. In future, any hemorrhage observed after stent implantation should prompt a search for perforation by a barb (autopsy!). If necessary, the European version of the Gianturco Z stent should be modified.

Today, intracerebral infections by gas forming bacteria are very rare. They are mostly seen after penetrating injuries and more rarely after trivial trauma. Although prognosis of this kind of infection is severe, the general outcome of these patients after surgical and antibiotic treatment is good. We report a ten months old boy suffering a pecking injury just above the left ear with perforation of the temporal bone and dura. In between 48 hrs he developed a rapidly progressive gas gangrene encephalitis due to infection with C. perfringens and died despite of surgical and antibiotic treatment due to massive brain swelling and cardio-pulmonary failure.

Today, intracerebral infections by gas forming bacteria are very rare. They are mostly seen after penetrating injuries and more rarely after trivial trauma. Although prognosis of this kind of infection is severe, the general outcome of these patients after surgical and antibiotic treatment is good. We report a ten months old boy suffering a pecking injury just above the left ear with perforation of the temporal bone and dura. In between 48 hrs he developed a rapidly progressive gas gangrene encephalitis due to infection with C. perfringens and died despite of surgical and antibiotic treatment due to massive brain swelling and cardio-pulmonary failure.

Für das forensische Nutzungspotential postmortaler Zahnbefunde sind Umfang und Qualität der prämortalen Befunddokumentation entscheidend. Die Befragung von 143 Zahnärzten der Region Mittelfranken ergab, daß in 65% nur ein Zahnbefund nach den Vertragsrichtlinien („Minimalbefund”), in 19,5% ein Befund, der darüber hinaus auch selbstgefertigte Restaurationen enthält („Fortschreibungsbefund”) und in 15,5% ein Befund, in dem sämtliche, auch vorbestehende Restaurationen, eingetragen sind („Musterbefund”) dokumentiert wird. Die durch Nachuntersuchung von 61 Patienten ermittelte Fehlerquote lag bei den einzelnen Befundtypen zwischen 21,3% („Musterbefund”) und 55,6% („Minimalbefund”).

The case of a 12-year-old child who died of fulminant hepatic failure a few days after tonsillectomy is reported. Histological examination revealed large areas of massive centrilobular hepatic necrosis. Hepatotoxity of postoperatively administered paracetamol in high dosages combined with enflurane exposure is discussed as a cause for the hepatic failure. The fulminant clinical course could have been influenced by an infection with hepatitis G virus which was detected in liver tissue by in situ hybridisation and was probably transmitted via transfusion of blood plasma.

This study investigated whether oestrogen receptors can be immunohistochemically detected in paraffin-embedded vaginal mucosa samples using monoclonal antibodies and whether the method would be suitable for the identification of vaginal cells in cytological smears. Samples of vaginal mucosa were obtained from living females and female corpses, as vaginal smears. For comparison purposes, resected prepuce samples and samples of postmortem male urethral mucosa were also investigated. Nuclear oestrogen receptors could be regularly detected in the basal, parabasal and deeper intermediate epithelium layers of freshly fixed vaginal mucosa but proved to be highly sensitive to autolytic changes. In the cytological smears obtained from living subjects, no oestrogen receptors were detectable. Oestrogen receptors were also detected in the basal epidermal cells of the male prepuce.

This paper reports on the specificity of the Lugol's iodine staining technique for the detection of vaginal epithelial cells on penile swabs. Air-dried swabs taken from the glans of the penis of 153 hospital patients and from 50 healthy volunteers, whose last sexual intercourse had taken place at least 5 days previously, were stained with Lugol's solution. Glycogenated cells were found in more than 50% of the cases studied, even in healthy volunteers without urethritis. In almost all of these cases the smear contained at least a few polygonal nucleated epithelial cells showing an unequivocal positive Lugol reaction. These cells cannot be distinguished from superficial or intermediate vaginal cells, by cytomorphology or staining. Urinary tract infections had no influence on the glycogen content of male squamous epithelial cells. On the basis of these results the Lugol's method can no longer be assumed to prove the presence of vaginal cells in penile swabs.

This study presents findings from a series of investigations on the presence of glycogenated epithelium in the male urinary tract and on the penile surface in order to assess the forensic value of the Lugol's method for the identification of vaginal cells. Direct smears obtained from the urethral opening, glans penis, and penile shaft, along with post-mortem samples of the fossa navicularis, and histological sections of the penis were examined. The presence of polygonal, glycogenated, Lugol-positive epithelium cells in the male urinary tract was found to be common. Our results suggest that these cells originate from the fossa navicularis. Because of the possibility of exfoliation of glycogenated male cells and transfer to the penile surface a Lugol-positive reaction in epithelial cells on penile swabs can no longer be assumed to prove the presence of vaginal cells.

Anhand des Obduktionsgutes des Institutes fuer Rechtsmedizin der Universitaet Erlangen-Nuernberg wurden 220 toedliche Fussgaengerunfaelle, bei denen es zu einer typischen Anfahrung gekommen war, analysiert. Dabei wurden die Verletzungen der Getoeteten, ihr Alter, Geschlecht, Groesse und Koerpergewicht sowie der Unfallmonat, die BAK und die Anfahrrichtung erfasst und eine Zuordnung der Verletzungen zu den Fahrzeugprofilen mit Hilfe der Stossstangenhoehe, Motorhaubenkantenlage und der Windschutzscheibenhoehe vorgenommen. Unter den Maennern fanden sich je 20 Prozent der Faelle bei den 40-50- und den 70-80-Jaehrigen, zwei Drittel der Frauen waren zwischen 70 und 90 Jahren alt. Die mittlere Kollisionsgeschwindigkeit lag bei 54 km/h, bei Maennern signifigkant hoeher als bei Frauen. Als Todesursachen dominierten Schaedel-Hirn-Traumen (37 Prozent) und innere Blutungen (17 Prozent). 71 Prozent der Unfaelle fanden im Winterhalbjahr statt. Bei Frauen traten Knie- und Beckenverletzungen haeufig auf, waehrend Maenner vermehrt Kopf- und Armbrueche und Bachtraumen erlitten. Bei steiler Fahrzeugfront ergab sich eine signifikant niedrigere Ueberlebenszeit als bei flacher Karosserie, bei der auch die Kollisionsgeschwindigkeit im Mittel niedriger lag. Trotz teilweiser widerspruechlicher Ergebnisse betrachten die Autoren die Untersuchung als vorlaeufigen Diskussionsbeitrag zur Optimierung der Fahrzeugkarosserie, die durch die Vielzahl einfliessender biomechanischer und technischer Variablen erschwert wird. Siehe auch Gesamtaufnahme IDS-Nummer 328013.

Es wird die Rekonstruktion eines Unfalls beschrieben, bei der eine auf die Fahrbahn gestuerzte Radfahrerin von einem Pkw ueberrollt wurde. Die atypischen Spuren und Verletzungsmuster werden zum Anlass genommen darauf hinzuweisen, dass moderne Stossstangenkonstruktionen (Kunststoffschaum mit graduierter Festigkeit) schwerste toedliche Verletzungen verursachen koennen, ohne dass dies adaequat am Bauteil abzulesen ist. Dies hat zur Folge, dass das Spurenbild aermer wird und die technische Unfallanalyse diffiziler.Siehe auch Gesamtaufnahme IDS-Nummer 328013.

Es wird über den plötzlichen Tod eines 25jährigen berichtet, bei dem seit 6 Jahren eine Urticaria pigmentosa bekannt war. Er wurde an einem kalten Novembermorgen auf dem taunassen Rasen tot aufgefunden. Histologisch fanden sich keine Anhaltspunkte für eine systemische Mastozytose. Die biochemischen Untersuchungen (stark erhöhter Histamin-Wert im Urin) erklärten zusammen mit der BAK von 0,72ℵ und der Auffindesituation (Kältereiz) den todlichen Pathomechanismus, eine generalisierte anaphylaktoide Reaktion.

Computerizing of medicine is expected to increase very rapidly in the next few years. This will bear new questions for forensic judgement. We report a case and our expert opinion concerning the use of a very simple computer program at a private hospital to obtain comments on laboratory findings. Furthermore we discuss questions we consider to be of importance for forensic judgement in this field.

A case of sudden death of a 25-year-old man, with a six years history of Urticaria pigmentosa, is reported. On a cold morning in November he was found lying dead on the lawn. Histology revealed no signs of systemic mastocytosis. The biochemical investigations (high free histamine level in urine) in addition to a BAC of 0,72 mg/g and the scene conditions (cold irritation) explained the mechanism of death, a systemic anaphylactoid reaction.

A case of inadvertent intrathecal injection of diatrizoate meglumine is presented. After myelography with 10 ml i.e. 6.5 g Angiografin, a 76-year-old man rapidly developed myoclonus, drowsiness and excessive metabolic acidosis. He died only a few hours later. Postmortem showed non-specific brain edema. RP-HPL-Chromatography confirmed high concentration of the contrast medium in CSF (6 mg/ml) which must have induced refractory central nervous dysregulation. The lethal effects of the misapplication of this agent on the nervous system are discussed.