Letale Magenruptur eines 5-jährigen Mädchens mit Rett-Syndrom

The Rett syndrome is associated with gastrointestinal disorders in motility and the swallowing of air, resulting in gastric distension or even rarely in gastric rupture. A 5-year-old girl with Rett syndrome and acute bronchopneumonia died suddenly and unexpectedly. A forensic autopsy revealed a lethal gastric rupture with 650 ml fluid and gas in the abdominal cavity without signs of peritonitis. The cause of death was neurogenic shock due to the gastric rupture caused by local necrosis of the gastric wall. Diagnosing an acute life-threatening emergency in mentally retarded patients can be very difficult.     

Hirnstammenzephalitis eines 8-j?hrigen M?dchens

Encephalitis is often caused by viral infections and can affect various brain regions. The clinical symptoms are highly variable. Oligosymptomatic cerebral infections may remain undetected but there are also cases with very severe symptoms (e.g. paralysis, convulsions). This article presents the case of an 8-year-old girl who suffered from headaches and vomiting for several days following a harmless fall with impact on the back of the head. The health condition decreased rapidly and 7 days after the fall the girl was presented to a children??s hospital. After a further foudroyant course of the disease the girl was hospitalized 2 days later. Resuscitation became necessary due to convulsions and pulmonary obstruction. Cranial computed tomography (cCT) revealed temporal hypodense areas and local edema. Cardiac echocardiography revealed a decreased left ventricular pump function so that encephalitis and myocarditis were suspected. Despite antiviral and antibiotic therapy the girl died 4 days after admission due to intravital brain death and multiorgan failure. This cause of death was confirmed by forensic autopsy. The fall had not led to any intracranial injury and predisposing diseases were not found. Histological examination revealed necrotizing brainstem encephalitis.     

Über einige nicht alltägliche Krankheitsvortäuschungen durch Selbstbeschädigung

Ohne Zusammenfassung     

Abschiedsbrief auf dem Körper nach genitaler Selbstbeschädigung

The case of suicide of a 29-year-old schizophrenic male who hanged himself in an atypical manner following partial circumcision is described and discussed. This was probably in the context of a long-lasting but currently acute exacerbated hebephrenic schizophrenia with hallucinatory-delusional symptoms. At autopsy, apart from the signs of atypical hanging, sentences and fragments of sentences resembling those of a suicide note were found written with a felt-tip pen and also superficially scratched on the skin over the entire body. The sentences were on the subject of suicide in a delusional form and were thus considered as having been written in close chronological connection with death. The unusual findings are presented and discussed as a supplement to the current literature.     

Männliche homosexuelle Betätigung mit einem Hunde mit Todeserfolg

Ohne Zusammenfassung     

Tötung eines Kindes durch rohe Salzsäure

Ohne Zusammenfassung Aussprache zum Vortrag Schranz-Budapest: HerrSchmidt- Bonn betont, daß der chemische Nachweis der Salzsäurevergiftung schwierig zu erbringen sei, da Salzsäure und Chloride normalerweise im Magen vorkommen. Fäulniserscheinungen können die Schleimhautverätzungen durch Ablösung der Schleimhaut bis zur Unkenntlichkeit verändern. Bei einer einschlägigen Beobachtung hatte die Schleimhaut sich unter der Fäulnis abgelöst. Nur die intensive dunkelbraune Farbe und Thrombose der submukösen Gefäße deuteten auf die Vergiftung hin. Der Mageninhalt und der Darm reagierten sauer.     

Aneurysma arterio-venosum mit mykotischen Auflagerungen bei Endocarditis lenta. Dienstbeschädigung

Ohne Zusammenfassung     

Beitrag zur Frage der Selbstbeschädigungen mit besonderer Berücksichtigung derer bei Gefangenen

Ohne Zusammenfassung     

TIPSS-Kontrolle mit Farbduplexsonographie unter Anwendung eines Ultraschallverstärkungsmittels Erste Ergebnisse

A study was performed to determine the visualization of the transjugular intrahepatic portosystemic stent shunt (TIPSS) and the detection of stenosis by the use of a capillary transversing signal enhancer. In 37 patients 37 colour-coded duplex sonographies were performed before and after intravenous injection of the ultrasound signal enhancer Levovist (Schering, Berlin). The examinations were evaluated using a four-category score. Special attention was paid to the detection of stenoses in the TIPSS. Transjugular portal venograms of the same day were used as gold standard. The use of Levovist provided better colour and flow signals for the portal vein end of the shunt in only 9 of 37 sonograms and for the hepatic vein end of the shunt in 37 of 39 sonograms. Eleven of 13 stenoses requiring reintervention in portal venography could be correctly identified with signal enhancer. Eleven of these 13 stenoses were located in the hepatic vein end of the shunt. Ultrasound signal enhancer can significantly improve the sonomorphological visualization especially of the hepatic vein end of TIPSS in colour-coded duplex sonography. Stenoses which usually occur in the hepatic vein end of the shunt may be better detected.     

Extreme Form der chronischen Unterernährung eines Säuglings in Deutschland

In European industrial countries severe underweight children due to malnutrition are uncommon. The case of a 7?month-old infant girl hospitalized with severe underweight is presented. The child suffered from considerable chronic malnutrition with a severe reduction of body weight (3470 g) and reduced growth as well as general retardation. In hospital the infant quickly recovered after adequate food supply. A predisposition to disease could be clinically excluded. In such cases the degree of malnutrition as well as the duration of food shortage has to be estimated with a classification as acute or chronic malnutrition.     

Verhalten von 2′-Hydroxymethylmethaqualon-Glucuronid bei der Spaltung mit Salzsäure

Zusammenfassung Das Glucuronsäurederivat von 2-Hydroxymethylmethaqualon wurde unter verschiedenen Bedingungen mit Salzsäure hydrolysiert. Mit Methode I (12–13% HCl; 30 min im kochenden Wasserbad) wurden nur etwa 27% des Glucuronids gespalten. Mit Methode II (20% HCl; 6 min azeotrop erhitzt) war die Spaltung fast vollständig (94–95%). Methode III (ca. 5% HCl; 30 min im kochenden Wasserbad unter Rückfluß) brachte die schlechtesten Ergebnisse; nur ca. 3% des Glucuronids wurden gespalten.     

Tod eines 79 Jahre alten Mannes mit einem linksventrikulären Herzunterstützungssystem

Cardiovascular illnesses are among the most common diseases in the western world and can lead to high-grade lesions of the myocardium. Consequently for example, in cases of refractory terminal heart failure, a heart transplant may be unavoidable as the last treatment option. Ventricular assist devices have been developed to improve the quality of life for patients waiting for a donor heart. Such devices are also used in patients unsuitable for a heart transplant and as a temporary support for cardiac function. Despite a correctly working ventricular assist device, the underlying disease can still lead to death. This article deals with a 79-year-old man who was found lifeless in the bathroom and who had worn a left ventricular cardiac support system for approximately 6 years. The ventricular assist device was found to be technically error-free, so that in the light of the assessment of the control data, clear overweight of the fibrous heart and severe coronary artery disease, acute (right) heart failure could be assumed to be the cause of death. Based on this case, the functioning of such a heart assist system is explained, the explantation is described and possible causes of death are discussed.     

Tötung durch Erwürgen mit nachträglichem Aufhängen der Leiche zur Vortäuschung eines Selbstmordes

Ohne Zusammenfassung