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.     

Zur Spezifität der sogenannten Ertrinkungslunge

Ohne ZusammenfassungInzwischen haben wir eine Ertrinkungslunge bei einem Erhängten in 3 m Wassertiefe innerhalb von 65 Std erzeugen können (S.-Nr. 479/62).     

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.     

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     

Practical benefit of [123I]FP-CIT SPET in the demonstration of the dopaminergic deficit in Parkinson's disease

Loss of striatal dopamine (DA) transporters in Parkinson's disease (PD) has been accurately assessed in vivo by single-photon emission tomography (SPET) studies using [¹²³I]-CIT. However, these studies have also shown that adequate imaging of the striatal DA transporter content can be performed only 20–30 h following the injection of [¹²³I]-CIT, which is not convenient for routine out-patient evaluations. Recently, a new ligand,N--fluoropropyl-2-carbomethoxy-3-(4-iodophenyl)tropane (FP-CIT), became available for in vivo imaging of the DA transporter. The faster kinetics of [¹²³I]FP-CIT have been shown to allow adequate acquisition as early as 3 h following injection. In the present study, loss of striatal DA transporters in five non-medicated PD patients was assessed on two consecutive SPET scans, one with [¹²³I]-CIT (24 h following injection) and one with [¹²³I]FP-CIT (3 h following injection). The ratios of specific to non-specific [¹²³I]FP-CIT uptake in the caudate nucleus and putamen were consistently 2.5-fold lower than those of [¹²³I]-CIT. However, when the uptake ratio of both ligands in these brain regions of patients was expressed as a percentage of the uptake ratio found in healthy controls, both the decrease and the variation of the data were similar. It is concluded on the basis of these findings that [¹²³I]FP-CIT seems as good as [¹²³I]-CIT for the assessment of the dopaminergic deficit in PD. The faster kinetics of [¹²³I]FP-CIT are a clear advantage.     

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.     

Unusual MR manifestations of neurocysticercosis

Summary MR and CT features of neurocysticercosis are variable and depend fundametally on the stage in evolution of the infection, location, number and size of the worm. The authors retrospectively evaluated MR images obtained on a 2.0T superconducting unit in 22 neurocysticercosis patients and observed various MR features including some new findings. A variety of MR findings are presented with special reference to six case reports. The features include: (1) a large simple cyst containing both internal septations and a scolex; (2) suprasellar racemose cysts mimicking other cysts, (3) a fourth ventricular cyst readily depicted by aid of CSF flow-void in the sagittal plane; (4) degenerating cysts showing white target appearance; (5) granulomatous lesions having a black target appearance; and (6) a meningitic form showing Gd-DTPA enhancement of basal cisterns and of a subacute infarct.     

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).     

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.     

Early enzyme changes in skin wounds demonstrated by isoelectric focusing in polyacrylamide gel

Summary Esterase patterns in vital skin wound extracts were observed and compared to those seen in normal skin. Employing the relatively simple method of isoelectric focusing in polyacrylamide gel, it was demonstrated that three, consecutively appearing, characteristic changes were visible in the esterase zymograms of vital (pre-mortally) injured skin as compared with skin which was uninjured or post-mortally damaged. One of these characteristics (characteristic a), since it is found only in wound reactions and not in uninjured skin, may represent an enzyme specifically produced during the wound reaction process. All three features normally appeared within 30 min of trauma and the first change within 5 min, even though it had been generally assumed that vital reactions, i.e. wound reactions, could be demonstrated only after a longer period of time. It was possible therefore to determine victim survival time and distinguish between pre- and post-mortal wounds. Also the isoelectric focusing of enzymes apparently gives a more efficient pattern band separation than previous methods.

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Zusammenfassung Durch isoelektrische Fokussierung der Extrakte aus vital verletzter Haut wurden die -Naphthylacetat-spaltenden Enzyme aufgetrennt und mit gleichartig hergestellten Extrakten unverletzter Haut desselben Menschen verglichen. Es konnten 3 nacheinander auftretende Merkmale im Esterasemuster der verletzten Haut festgestellt werden. Die mit a, b und c bezeichneten Unterschiede im Esterasemuster sind für die frühen Wundreaktionen kennzeichnend. Das Merkmal a ist eine nur in vitalen Hautwunden nachweisbare Esterase-Fraktion, die innerhalb 5 min nach der Wundsetzung auftritt. Die Merkmale b und c erscheinen nach dem Merkmal a innerhalb 30 min nach der Verletzung. Der Nachweis von a, b, c in einer Wunde erlaubt eine Beurteilung der Überlebenszeit und ermöglicht außerdem eine Unterscheidung von vitalen und postmortalen Wunden. Die isoelektrische Fokussierung von Enzymen scheint leistungsfähiger zu sein als die bisher zur Kennzeichnung von Wundenzymen angewandten histoenzymatischen und elektrophoretischen Methoden.

     

The “lamellated” skull in β-thalassaemia

The skull in homozygous -thalassaemia may present several abnormalities, such as osteopenia, widening of the diploic space, and a hairon-end appearance. In some cases it presents also a particular stratified appearance caused by a variable number of osseous lamellae, parallel with the inner table. This lamellated skull was observed in 16 out of 150 patients affected by the disease (10.6%). Possible mechanisms are discussed. The lamellar osseous changes could be due to repeated periosteal osteoblastic reactions to the sinusoidal neovascularization associated with marrow hyperplasia in poorly transfused patients.     

The dynamics of inflammatory cytokines in the healing process of mouse skin wound: A preliminary study for possible wound age determination

The dynamics of inflammatory cytokines such as interleukin-1 (IL-l, interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF) during the healing process of mouse skin wounds were examined using the enzyme-linked immunosorbent assay and immunostaining. The applicability of this examination for wound age estimation is discussed from the perspective of forensic pathology. After wound induction, mice were sacrificed at intervals ranging from 0 to 240 h. The levels of TNF and IL-1 began to elevate rapidly after wounding and reached a peak at 3 h. The IL-l level reached a peak at 6 h, and IL-6 peaked at 12 h. An infiltration of numerous leukocytes, indicatingacute inflammation, was observed at 3 and 6 h, and the main source of the cytokines was immunohistochemically identified as neutrophils. These results indicate that TNF and IL-1 play an important role in the commencement of inflammation. Rebound of cytokine levels, i.e. a re-increase, was observed at 72 h after wounding. Histological examination of the 72-h-old wound showed migration of fibroblasts and the formation of new granulation tissues, indicating the proliferative stage of the wound healing process. These experimental findings indicate that these cytokines have a close relationship to wound remodeling as well as to inflammation. From the viewpoint of forensic pathology, it is considered that inflammatory cytokines may become one of the markers for wound age estimation, but further studies are needed, especially those involving the investigation using human wound specimens with known time intervals after injury.This study was presented at the 79th Congress of the Medico-Legal Society of Japan (Yamagata, May 1995), the 16th Annual Meeting of the Japanese Society of Inflammation (Tokyo, July 1995) and the 74th Annual Meeting of the German Society of Legal Medicine (Aachen, September 1995).     

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.     

Transcatheter Closure of Patent Foramen Ovale in Patients with Platypnea-Orthodeoxia: Results of a Multicentric French Registry

Background Dyspnea and the decrease in arterial saturation in the upright position in elderly subjects is described as platypnea-orthodeoxia syndrome (POS). POS is secondary to the occurrence of an atrial right-to-left shunt through a patent foramen ovale (PFO).Methods This French multicentric study reports on 78 patients (mean age 67±11.3 years) with POS who had transcatheter closure of the PFO; frequently associated diseases were pneumonectomy (n=36) and an ascending aortic aneurysm (n=11). In all patients, the diagnosis was confirmed by transthoracic or/and transesophageal echocardiography. Five different closure devices were used: Amplatz (n=45), Cardioseal (n=13), Sideris (n=11), Das Angel Wings (n=8) and Starflex (n=1). Closure was successful in 76 patients (97%).Results Oxygen saturation increased immediately after occlusion from 84.6±10.7% to 95.1±6.4% (p < 0.001) and dyspnea improved from grade 2.7±0.7 to grade 1±1 (p < 0.001). A small residual shunt was immediately observed in 5 patients (3 with the Cardioseal device, 1 with the Sideris and 1 with the Amplatz) leading to the implantation of a second device in one case (Cardioseal). Two early deaths occurred unrelated to the procedure (one due to sepsis probably related to pneumonectomy, another due to respiratory insufficiency). Other complications were: a small shunt between the aorta and the left atrium, two atrial fibrillations and a left-sided thrombus which disappeared with anticoagulant therapy. At a mean follow-up of 15±12 months, there were 7 late deaths related to the underlying disease.Conclusion Percutaneous occlusion of the foramen ovale is safe and gives excellent results thanks to continuing improvement in available devices. This technique enables some patients in an unstable condition to avoid a surgical closure.     

Zur forensisch-medizinischen Bewertung von Fußspuren

Zusammenfassung Zur Frage der Identifizierung mit Hilfe von Abdruckspuren des unbekleideten menschlichen Fußes wurden Untersuchungen an einem Kollektiv von 100 Personen durchgeführt.Die vergleichende Auswertung von 200 Standspuren und ca. 600 Gangspuren durch Messung und Formbeschreibung diente zunächst der Erkennung der Variabilität innerhalb des Untersuchungskollektives wie zwischen Stand- und Gangspur der gleichen Person. Als typische Gangveränderungen wurden eine Verlängerung des Sohlenabdruckes, insbesondere der Zehen mit spitzer Ausziehung derselben, und eine Verbreiterung der Großzehenbasis beobachtet. Ballen, Brücke und Ferse waren in der Gangspur häufiger verbreitert als verschmälert. Sehr variabel erwies sich die Form des Brückenanteils, relativ konstant hingegen die Anordnung der Zehenbeeren.In den Formmerkmalen völlig übereinstimmende Fußabdrücke zweier Personen wurden nicht gefunden. Die Formunterschiede zwischen Stand- und Gangspur der gleichen Person waren jedoch vereinzelt nicht geringer als die Unterschiede zur Standspur einer anderen Person.Aus diesen Beobachtungen ergaben sich Empfehlungen für die Praxis der Identifizierung von Abdruckspuren des unbekleideten Fußes ohne erkennbare Papillarleistenmuster.

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Summary 100 persons were examined for the footprints using unclad human feet. The comparison of 200 standing footprints and about 600 gait footprints were evaluated w. r. t. the form and served first the purpose of identification of the variability between whole material and between the standing and gait footprints of the same person.The typical changes during the movement were seen to be the elongation of the sole prints, especially of toes and broadening of the proximal part of the first toe. Ball, Bridge and Heel-patterns were in most cases broadened rather than narrowed down. The form of bridge showed the most variation and least variation was found in the position of toes. Completely identical footprints of 2 persons were not found. The variation between the standing and gait-footprints of the same person were sometimes equal to the variation from the standing footprints of another person.According to these observations it would be advisible to identify the prints of unclad human feet without visible dermatoglyphic patterns.

Herrn Prof. Dr. B. Mueller zum 75. Geburtstag.     

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.     

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.     

Technical parameters influencing the severity of injury of front-seat,belt-protected car passengers on the impact side in car-to-car side collisions with the main impact between the front and rear seats (B-pillars)

Summary Authentic car-to-car side collisions (n = 30) with the main impact area at the B-pillar were analyzed to find technical parameters corresponding with the injury severities of the front seat, belt-protected car passengers on the impact side. EES (Energy Equivalent Speed) and Av (delta v, change in velocity) were highly significant predictors of the severity of thoracic and abdominal injuries and total injury severity coded according to the Abbreviated Injury Scale (AIS). At an EES or v 40 km/h all front-seat car passengers on the impact side sustained a total injury severity of Maximum AIS (MAIS) 4 and died. Although a passenger could survive the crash without injury to one or more body regions up to the highest EES- and Av-values, at EES or v 40 km/h fatal injuries were sustained in at least one body region. At an EES 35 km/h or a Av 15 km/h no front-seat car passenger on the impact side remained uninjured.     

Estimation of pulmonary hypertension by perfusion lung scintigraphy: gravitational effect of postural changes between the lateral decubitus positions

To estimate pulmonary hypertension in patients with various heart diseases, we devised a new method using perfuison lung scintigraphy with technetium-99m-labelled macroaggregated albumin. In this method, changes in the distribution of pulmonary perfusion caused by gravitational effects, namely, changes in the total count ratios of the right lung against the left lung between right and left lateral decubitus positions (rt/lt), were assessed in 62 patients and in 10 normal subjects. The rt/lt ratios were calculated as indices of the above changes. They correlated significantly with mean pulmonary arterial pressure (mPAP) (= –0.62,P < 0.001), pulmonary capillary wedge pressure ( = –0.63,P < 0.001) and pulmonary arteriolar resistance ( = 0.50,P < 0.001) in all subjects. In 17 patients with valvular heart diseases, the ratio correlated significantly with mPAP ( = – 0.84,P < 0.001). In 10 patients with various heart diseases, the U/S ratio, i.e. the index of changes in the count ratios of the upper field against the lower field for the right lung following postural change from the upright to the supine position, was also obtained as well as the rt/lt ratio. The latter evidenced a better correlation with mPAP ( = –0.90,P < 0.001) than the former (=–0.64,P < 0.05). We conclude that this method is valuable as a noninvasive approach for the estimation of pulmonary hypertension.     

Positron CT imaging of an impending stroke

Summary We present PET findings of a case of a transient ischemic attack which later progressed to cerebral infarction. Cerebral blood flow at the stroke focus in the right parietal cortex measured after a TIA attack and before stroke was as low as 24 ml/100 g/min with some increase in oxygen extraction fraction and blood volume. The condition was compatible with misery perfusion. This case may be an example suggestive that the misery perfusion sign is a warning of impending stroke and its poor prognosis if left without appropriate treatments.