γ-Glutamyltransferase test as a new tool for identification of seminal stains

Summary A simple qualitative method for identification of seminal stains based on a high activity of -glutamyltransferase (-GTP) in human semen is described. It employs the release of -naphthylamine from N--glutamyl--naphthylamide by the -GTP action; -naphthylamine couples with Fast Garnet GBC salt to produce a strong brownish-red color. The data on its simplicity, specificity, and stability show that the present method is suitable for medicolegal examination of seminal stains as a preliminary test.     

Einige gerichtsmedizinische und kriminalistische Bemerkungen über Verletzungen durch Kleinkaliberwaffen

Zusammenfassung Aus der Gesamtanalyse von erzielten Ergebnissen der durchgeführten Untersuchungen geht hervor, da die Kleinkaliberpistole Pavliek eine gefährliche Schuwaffe ist, die sogar bei gröeren Schuentfernungen schwere Körperschädigungen oder den Tod des Menschen herbeiführen kann. Man darf dies vor allem auf die beträchtliche Durchschlagskraft und auf die starke Deformationsfähigkeit des Geschosse im menschlichen Körper zurückführen.Im deutlich fetthaltigen Schmutzring gibt es unabhängig von der Schuweite immer feine Pulverkörnchen, worauf man besonders bei chemischen Proben achtgeben mu.Charakteristische Nahschuzeichen entstehen bei Verwendung dieser Waffe nur bei verhältnismäig kleinen Schuabständen. Diese hängen nur im geringen Grade von der benutzten Waffe ab, ändern sich aber beträchtlich bei der Anwendung verschiedener Munitionsarten. In einzelnen Expertisen soll man also nicht nur verdächtige Exemplare der Waffe prüfen, sondern dabei vor allem genau dieselbe Munitionsart verwenden.Man darf es nicht ableugnen, da trotz immer fortwachsender Entwicklung und Besserung der kriminaltechnischen Untersuchungen, die vorgeführten einfachen Untersuchungsmethoden immer noch am Platze sind und ihre beträchtliche Bedeutung sowohl in laufenden gerichtsmedizinischen Expertisen wie auch in wissenschaftlichen Arbeiten über die Wirkungen der modernen Schuwaffen besitzen.     

Total dural calcification with secondary hyperparathyoidism: A rare entity

Summary A case of total, dense dural calcification in an adult female patient with secondary hyperparathroidism is presented. The often reported feature in the skull is that of a combination of osteopenia and osteosclerosis giving a granular bone texture described sometimes as grains of sand or salt and pepper appearance [6]. Extensive dural calcification with this condition has very rarely been reported [2, 3]. The purpose of this paper is to document the existence of the latter in a patient followed up for 19 years.     

Ossification and pseudoepiphysis formation in the “nonepiphyseal” end of bones of the hands and feet

Metacarpals, metatarsals, and phalanges were studied to assess the developmental morphology of secondary ossification in the nonepiphyseal ends of these bones as well as the formation of the pseudoepiphysis as an epiphyseal ossification variant. Both direct ossification extension from the metaphysis into the epiphysis and pseudoepiphysis formation preceded, and continued to be more mature than, formation and expansion of the classic epiphyseal (secondary) ossification center at the opposite end of each specific bone. Direct metaphyseal to epiphyseal ossification usually started centrally and expanded hemispherically, replacing both physeal and epiphyseal cartilage simultaneously. In contrast, when remnants of physis were retained, while juxtaposed epiphyseal cartilage was replaced, a pseudoepiphysis formed. There were three basic patterns of pseudoepiphysis formation. First, a central osseous bridge extended from the metaphysis across the physis into the epiphysis and subsequently expanded to create a mushroom-like osseous structure. In the second pattern a peripheral osseous bridge formed, creating either an osseous ring or an eccentric bridge between the metaphysis and the epiphysis. In the third pattern, multiple bridging occurred. In each situation the associated remnant physis lacked typical cell columns and was incapable of significantly contributing to the postnatal longitudinal growth of the involved bone. Pseudoepiphyses were well formed by 4–5 years and coalesced with the rest of the bone months of years before skeletal maturation was attained at the opposite epiphyseal end, which ossified in the typical pattern (i.e., formation of a secondary center de novo completely within the cartilaginous epiphysis). This process may also affect the development and appearance of ossification within the longitudinal epiphyseal bracket (delta phalanx).     

Tumoral calcinosis: radiologic-pathologic correlation

Objective Tumoral calcinosis is a frequently misdiagnosed disorder. This study details the radiologic and pathologic characteristics of tumoral calcinosis that distinguish it from most other entities.Design Radiologic and pathologic findings, and medical records of 12 patients with tumoral calcinosis were reviewed and compared with equivalent information about 5 patients with other calcified lesions.Patients The 12 patients ranged in age from 15 months to 62 years. Six had idiopathic tumoral calcinosis and 6 had secondary tumoral calcinosis.Results and conclusions A consistent radiologic finding for tumoral calcinosis was a dense calcified mass that was homogeneous except for a chicken wire pattern of lucencies, which correlated histologically with thin fibrous septae. Other characteristics of tumoral calcinosis included fluid-calcium levels, demonstrated in four patients, and smooth osseous erosions adjacent to the mass, demonstrated in three patients. Five cases of tumoral calcinosis were originally confused with other calcified lesions; however, the radiologic findings were characteristic of tumoral calcinosis in retrospect.     

Recurring osteoblastoma initially presenting as a typical osteoid osteoma

Two patients each underwent inadequate excision of an osteoid osteoma and some months later developed a large tumor in the same location showing the radiographical and histological features of osteoblastoma. This rare occurrence again suggests that osteoid osteoma and osteoblastoma are closely connected benign neoplasms. Indeed some authors in the past have suggested classification as a single tumor showing different clinical and radiographical patterns.Supported by: Grant n 88.01124.44, Italian National Council of Researches, Special Project Oncology. A.I.R.C. (Italian Association for Cancer Research). Regione Emilia-Romagna, law n 1970 of May 13th, 1986. Istituto Ortopedico Rizzoli Research Funds. Interdepartmental Center for Cancer Research G. Prodi of the University of Bologna     

Die besonderen konstruktionsmerkmale des japanischen „Tan-to“-(Messers) als Kriterien für dessen Gefährlichkeit

Zusammenfassung Es wird auf die besondere Klingenform japanischer Blankwaffen und auf die Neuentwicklung eines Verwandlungs-Tan-to verwiesen. Bei letzterem läßt sich die Klinge in der Handgriffmitte um 90° drehen und arretieren, eine ideale Fixierung dieses Messers durch Faustschluß am Quergriff. Durch diese Bedingungen ist eine hohe Verletzungsgefährdung mit tödlichem Ausgang gegeben. Diese seit kurzer Zeit im Handel erhältlichen Messer sollten nach § 37 Waff G umgehend als verbotene Gegenstände definiert werden.     

Problems with the “dural tail” sign

Prominent enhancement of the dura mater, the dural tail adjacent to a peripherally located mass on gadolinium-enhanced MRI has been described as being characteristic of meningiomas. We present a cerebral glioma showing the classical dural tail.     

Neuropsychological correlates of brain atrophy in Huntington's disease: a magnetic resonance imaging study

Summary Magnetic resonance imaging and a comprehensive cognitive evaluation were carried out in a series of 29 patients with mild to moderate Huntington's disease (HD). A factor analysis of the neuropsychological test scores provided three factors: a memory/speed-of-processing factor, a frontal factor, and a response inhibition factor. The memory/speed factor correlated significantly with measures of caudate atrophy, frontal atrophy, and atrophy of the left (but not the right) sylvian cistern. There were no significant correlations between the frontal or response inhibition factors and measures of cortical or subcortical brain atrophy. Our findings confirm that subcortical atrophy is significantly correlated with specific cognitive deficits in HD, and demonstrate that cortical atrophy also has important association with the cognitive deficits of patients with HD.     

Calcinosis in juvenile dermatomyositis

A retrospective study of the radiographs and clinical records of 39 children with dermatomyositis, followed up at a referral centre for a mean period of eight years, revealed calcinosis in 29 children (18 giris, 11 boys). Clinical presentation of calcinosis was unpredictable and variable, ranging from four months to 12 years after onset of disease. Subcutaneous calcilication, often associated with subsequent ulceration of overlying skin, was observed more frequently than calcinosis in intermuscular fascial planes (29:7). Subcutaneous calcinosis was demonstrated most commonly about the knees and elbows and in the fingers and toes. Intermuscular calcinosis affected the fascial planes around the quadriceps, deltoid, biceps, and the gastrocnemius/soleus muscles.Calcinosis, predominantly of the subcutaneous lesions, regressed spontaneously in eight of 11 children where this could be assessed over a one to four year period. This high rate of spontaneous resolution must complicate evaluation of the efficacy of proposed anti-calcinotic treatments in juvenile dermatomyositis.While no apparent relationship was established between subcutaneous calcinosis, which was present in all 29 of the affected patients, and disease activity or severity, all seven children with the additional, extensive, and classical intermuscular fascial plane calcification developed this complication early and had severe disease.These findings are discussed in relation to previous studies.     

Spondylometaphyseal dysplasia: further heterogeneity

The spondylometaphyseal dysplasias are a very heterogeneous group of disorders. Only one has been clearly defined, namely, the spondylometaphyseal dysplasia — Kozlowski type, known also as the common type. This disorder is inherited as an autosomal dominant trait. In this report we describe an Arabic-Moslem kindred with spondylometaphyseal dysplasia, not of the common type, with an autosomal dominant mode of inheritance, indicating further heterogeneity.     

Resolution of spinal epidural vascular pseudotumor following balloon occlusion of a postoperative vertebral arteriovenous fistula

Summary We describe a case of a vascular mass arising secondary to a postoperative vertebral arteriovenous fistula mimicking recurrent cervical neurofibroma on CT in a patient with neurofibromatosis. Angiography was required for diagnosis. The recurrent tumor resolved following balloon embolization of the fistula.     

Headache after lumbar iohexol myelography: the influence of a history of headaches and early ambulation

Whether a history of headache or early versus late ambulation (no bed rest or bed rest for 24 h) influence the occurrence of headache after lumbar iohexol myelography was studied by blinded interviews in 158 consecutive patients referred for elective lumbar myelography (LM) because of suspected lumbar disc prolapse or spinal stenosis. Headache after LM occurred more often in patients with a history of headache (57%) than in patients without such a history (29%),P<0.001. Patients with normal myelographic findings complained of headache after LM more often (55%) than patients with abnormal normal myelographams (31%),P<0.008. No difference in the incidence of headache after LM was demonstrated in early versus late ambulation.Died 27 July 1991     

New Retrievable Coil Anchors: Preliminary In Vivo Experiences in Swine

Purpose To design and test retrievable coil anchors to improve the safety and efficacy of coil embolization.Methods Fifty-two 0.038-inch homemade retrievable stainless steel coils were equipped with one of four different pre-shaped nitinol anchors and tested in 38 pigs. All coils with the anchor were completely retrieved and redeployed 3–18 times (median 7 times) prior to release. Types 1 and 2 anchored coils were acutely deployed in the external iliac arteries (n=10 each), and chronically tested (1 week) in the common carotid arteries (n=6 each). Larger type 1 (n=4), type 3 (n=6), and type 4 (n=4) anchored coils were acutely deployed in the abdominal aorta. The largest type 1 anchors (n=6) were acutely tested in the inferior vena cava.Results All anchored coils were successfully retrieved and repositioned several times. All but two coils formed a compact plug and there was no coil migration except with two mechanically defective type 3 anchors.Conclusion The use of retrievable anchors allowed the coils to be retrieved and repositioned, prevented coil migration, and enabled compact coil configuration.     

β-Methyl-15-p-iodophenylpentadecanoic acid metabolism and kinetics in the isolated rat heart

The use of 15-p-iodophenyl--methyl-pentadecanoic acid (Me-IPPA) as an indicator of long chain fatty acid (LCFA) utilization in nuclear medicine studies was evaluated in the isolated, perfused, working rat heart. Time courses of radioctivity (residue curves) were obtained following bolus injections of both Me-IPPA and its straight chain counterpart 15-p-iodophenyl-pentadecanoic acid (IPPA). IPPA kinetics clearly indicated flow independent impairment of fatty acid oxidation caused by the carnitine palmitoyltransferase I inhibitor 2[5(4-chlorophenyl)pentyl]oxirane-2-carboxylate (POCA). In contrast, Me-IPPA kinetics were insenstive to changes in fatty acid oxidation rate and net utilization of long chain fatty acid. Analysis of radiolabeled species in coronary effluent and heart homogenates showed the methylated fatty acid to be readily incorporated into complex lipids but a poor substrate for oxidation. POCA did not significatly alter metabolism of the tracer, suggesting that the tracer is poorly metabolized beyond Me-IPPA-CoA in the oxidative pathway.     

Sclerotic changes of the manubrium sterni

Six females with nearly identical sclerotic and hyperostotic changes of the manubrium sterni are reported. Malignancies, bacterial inflammatory processes, and Paget disease, which were first suspected, could be excluded. The youngest patients also had sclerotic changes of other bones, including the lumbar spine, the pubic bone, and the clavicle, and may be classified as having chronic recurrent multifocal osteomyelitis (CRMO). The two oldest patients had ossification of the costoclavicular ligament(s) and may be classified as having inter-sterno-costo-clavicular ossification (ISCCO). One had only hyperostotic and sclerotic changes as seen in sterno-costo-clavicular hyperostosis (SCCH). The pathogenesis of these uncommon diseases is unknown, but they are all frequently associated with pustulosis palmoplantaris and have similar clinical courses and laboratory abnormalities. None of the present patients had HLA-B₂₇. The similarity of the radiological abnormalities of the manubrium sterni suggests that the diseases themselves may be similar, but with different courses depending on age, CRMO being present in children and young adults and ISCCO or SCCH in older adults.     

Auftreffgeschwindigkeiten manueller Stichversuche

Zusammenfassung Es wurde eine Versuchsanordnung mitgeteilt, die geeignet ist, die Auftreffgeschwindigkeiten manueller Stichversuche zu messen. Von 96 erwachsenen Probanden (je 48 Männer und Frauen) wurden mit der rechten und mit der linken Hand je 5 Einzelstiche ausgeführt. Die festgestellten Geschwindigkeiten wurden statistisch ausgewertet. Dabei ergaben sich signifikante Unterschiede zwischen den Werten von Männern und Frauen sowie den Werten der Arbeitshand und der Nicht-Arbeitshand. Die männlichen Probanden erzielten ca. 45% größere Auftreffgeschwindigkeiten als die weiblichen Probanden.

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Summary An experimental test is reported, which is suitable for measuring the impact velocities in manual stabbing tests. 96 adult test persons (48 men and 48 women) carried out 5 single stabbing thrusts, with the right and left hand respectively. The measured velocities were statistically analysed. Here significant differences between the values for men and women in general, as well as the values of the work hand and the non-work hand were discovered. The male test persons achieved about 45% greater impact velocities than did the female test persons.

Für die hilfreiche Unterstützung, die Meßwerte dieser Arbeit zügig zusammenzutragen, gilt unser persönlicher Dank dem Ärztlichen Direktor der Klinischen Anstalten der RWTH Aachen, Herrn Professor Dr. med. Klages (Abteilung Psychiatrie), Herrn Oberverwaltungs-direktor Lämmersdorff sowie Herrn Professor Dr. med. Effert (Helmholtz-Institut), Herrn Professor Dr. med. Gahlen (Abteilung Dermatologie) sowie Herrn Professor Dr. med. Repkes (Abteilung Medizinische Dokumentation) und seinem Mitarbeiter, Herrn Roebruck. Weiterhin bedanken wir uns bei allen Probanden für ihren persönlichen Einsatz.     

Gallium scintigraphy in Hansen's disease

Gallium 67 imaging was used in 12 patients with documented Hansen's disease undergoing treatment or not, in an attempt to determine the pattern of the disease. Diagnosis was confirmed by histopathology in all patients. The Mitsuda reaction was seen in all patients. Specific nuclear studies were performed when needed to evaluate particular organs better. Gallium 67 images show homogeneous, diffuse and moderate accumulation over the entire skin surface (except for the face) of untreated patients with multibacillary disease. The facial skin in these cases presented homogeneous, diffuse but very marked uptake of gallium. Internal organ involvement was variable. There was a very good correlation among clinical, scintigraphic, immunological and histopathological data. The pattern of the body skin (skin outlining) and facial skin (beard distribution) may be distinct for untreated patients with multibacillary leprosy.     

Indirekt ermittelte Vaterschaftswahrscheinlichkeit für einem verstorbenen Beklagten,errechnet anhand der Blutgruppeneigenschaften bei dessen Eltern und der Mutter-Kind-Dublette

Zusammenfassung Anhand eines realistischen Gerichtsfalles wird gezeigt, wie auf indirekte Weise die Wahrscheinlichkeit der Vaterschaft eines verstorbenen Putativvaters errechnet werden kann, wenn Blutgruppenbefunde vom Kind und seiner Mutter sowie von den Eltern des mutmaßlichen Erzeugers zur Verfügung stehen. Im vorliegenden Fall wurde eine Wahrscheinlichkeit von 99% dafür erhalten, daß die angeblichen Großeltern dieleiblichen Großeltern des klägerischen Kindes sind. Entsprechend ist deren verstorbener Sohn höchst wahrscheinlich der biologische Vater dieses Kindes.

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Summary The plausibility of paternity of a deceased is evaluated on the basis of the blood group of the offspring, his mother and the parents of the questionable father. In the case under discussion a probability of 99% was obtained that the grandparents of the child are factual. The likelihood of paternity of the deceased was thus determined as most probable.

Herrn Professor Dr. H. Gärtner zum 60. Geburtstag gewidmet.     

Three-dimensional display of myocardial perfusion detection of ischemic lesions using a new image subtraction method

A recent, commercially available computer program for the three-dimensional (3D) display of single-photon emission tomography (SPET) data was used to study myocardial perfusion in patients with coronary artery disease (CAD). To enable the detection of small ischemic lesions, the authors proposed a new distance-subtraction method: after suitable centering of the axial slices, 3D distance-shaded images of the stress study were subtracted from the corresponding views of the rest study. With this technique, small changes in surface-to-observer distance were highlighted, thus enabling us to detect nontransmural ischemic areas of the myocardium. General characteristics and possibilities of the subtraction technique were tested on a simple myocardial phantom. Some clinical results of the application of this method on CAD patients are presented and discussed. In CAD patients in whom only nontransmural ischemic lesions are present, the subtraction of distance-shaded images is decisive for a correct diagnosis.