Gasbrandabsceß des Gehirns nach „Bagatellverletzung“ des Kopfes

Zusammenfassung An Hand eines Falles von Gasbrand-Hirnabsceß nach angenommener Bagatellverletzung der Kopfschwarte werden Schwierigkeiten der gutachtlichen Beurteilung im Strafverfahren aufgezeigt:Unzureichende, verspätete Ermittlungen, unvollständige Befundberichte erschweren in Ermangelung objektiver Feststellungen und Daten eine gutachtliche Stellungnahme, die sich auf den konkreten Fall beziehen muß. Allgemein gehaltene Fragestellungen sind irreführend, es ist Bezug zu nehmen auf strafrechtliche Bestimmungen und Begriffe. Eine Fahrlässigkeit, im Strafverfahren unter Umständen nicht erwiesen oder erweisbar, kann zivilrechtliche Konsequenzen haben.Es bleibt die Tragik des Einzelfalles; muß der u. U. tödliche Ausgang ein unvermeidbares Risiko bleiben? Dies ist kein juristisches, sondern überwiegend ein medizinisches, aber auch sozial- und gesundheitspolitisches Problem; Fragen der ärztlichen Aus- und Weiterbildung, der instrumentellen und personellen Ausrüstung, der organisatorischen Voraussetzungen fordern eine Lösung. Objektive Stellungnahmen im Raum juristischer und medizinischer Vorstellungen und Begriffe abzugeben ist eine Aufgabe; Impulse zu setzen, Prävention, ist gleichfalls Anliegen der gerichtlichen Medizin.

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Summary In discussing the case of a gas-gangrene abscess of the brain with presumed minor injury of the scalp medico-legal problems in criminal trial are discussed:The missing of objective statements and data due to insufficiently made, delayed inquiries or uncomplete medical reports impedes expert's opinion on the actual case. As general formulations are misleading, penal provisions and definitions have to be stressed. Negligence which possibly is not to be proved in the criminal trial may have consequences according to civil law.There is the tragedy of each single case: an accident, possibly turned out fatal, must it remain an unavoidable fact? This is not a juridical but predominantly medical problem and is even of major importance to the social policy and public health administration: Problems of medical primary and continued education, equipment and staff, organizational implications require solution.To submit statements and expertises in the scope of juridical and medical conceptions is one field of forensic medicine; to give impulses, to show preventive feasibilities, is another.

Herrn Professor Dr. G. Dotzauer zum 60. Geburtstag     

Mitochondrial oxygen tension within the heart

By using a newly developed optical technique which enables non-invasive measurement of mitochondrial oxygenation (mitoPO₂) in the intact heart, we addressed three long-standing oxygenation questions in cardiac physiology: 1) what is mitoPO₂ within the in vivo heart?, 2) is mitoPO₂ heterogeneously distributed?, and 3) how does mitoPO₂ of the isolated Langendorff-perfused heart compare with that in the in vivo working heart? Following calibration and validation studies of the optical technique in isolated cardiomyocytes, mitochondria and intact hearts, we show that in the in vivo condition mean mitoPO₂ was 35 ± 5 mm Hg. The mitoPO₂ was highly heterogeneous, with the largest fraction (26%) of mitochondria having a mitoPO₂ between 10 and 20 mm Hg, and 10% between 0 and 10 mm Hg. Hypoxic ventilation (10% oxygen) increased the fraction of mitochondria in the 0–10 mm Hg range to 45%, whereas hyperoxic ventilation (100% oxygen) had no major effect on mitoPO₂. For Langendorff-perfused rat hearts, mean mitoPO₂ was 29 ± 5 mm Hg with the largest fraction of mitochondria (30%) having a mitoPO₂ between 0 and 10 mm Hg. Only in the maximally vasodilated condition, did the isolated heart compare with the in vivo heart (11% of mitochondria between 0 and 10 mm Hg). These data indicate 1) that the mean oxygen tension at the level of the mitochondria within the heart in vivo is higher than generally considered, 2) that mitoPO₂ is considerably heterogeneous, and 3) that mitoPO₂ of the classic buffer-perfused Langendorff heart is shifted to lower values as compared to the in vivo heart.     

Recommendations for the use of botulinum toxin type A in the management of cerebral palsy

Botulinum toxin type A (BTX-A) is increasingly being used for the treatment of childhood spasticity, particularly cerebral palsy. However, until very recently, all such use in this indication has been unapproved with no generally accepted treatment protocols, resulting in considerable uncertainty and variation in its use as a therapeutic agent. In view of the increasing awareness of, and interest in, this approach to the treatment of spasticity, and also the recent licensing in a number of countries of a BTX-A preparation for treating equinus deformity in children, it would seem timely to establish a framework of guidelines for the safe and efficacious use of BTX-A for treating spasticity in children. This paper represents an attempt, by a group of 15 experienced clinicians and scientists from a variety of disciplines, to arrive at a consensus and produce detailed recommendations as to appropriate patient selection and assessment, dosage, injection technique and outcome measurement. The importance of adjunctive physiotherapy, orthoses and casting is also stressed.     

Pathological assessment of mismatch repair gene variants in Lynch syndrome: Past,present, and future

Lynch syndrome (LS) is caused by germline mutations in DNA mismatch repair (MMR) genes and is the most prevalent hereditary colorectal cancer syndrome. A significant proportion of variants identified in MMR and other common cancer susceptibility genes are missense or noncoding changes whose consequences for pathogenicity cannot be easily interpreted. Such variants are designated as “variants of uncertain significance” (VUS). Management of LS can be significantly improved by identifying individuals who carry a pathogenic variant and thus benefit from screening, preventive, and therapeutic measures. Also, identifying family members that do not carry the variant is important so they can be released from the intensive surveillance. Determining which genetic variants are pathogenic and which are neutral is a major challenge in clinical genetics. The profound mechanistic knowledge on the genetics and biochemistry of MMR enables the development and use of targeted assays to evaluate the pathogenicity of variants found in suspected patients with LS. We describe different approaches for the functional analysis of MMR gene VUS and propose development of a validated diagnostic framework. Furthermore, we call attention to common misconceptions about functional assays and endorse development of an integrated approach comprising validated assays for diagnosis of VUS in patients suspected of LS. Hum Mutat 33:1617–1625, 2012. © 2012 Wiley Periodicals, Inc.     

Prevalence of early stages of chronic kidney disease in healthy army personnel

Introduction: Chronic kidney disease (CKD) is associated with significant morbidity and mortality. Screening and detection of early stages of CKD can help institute interventions that may delay the progression of the disease. One aim was to study the prevalence of early stages of CKD in the Army.Methods: A cross-sectional study ofArmy Personnel in an Army cantt in Central India was carried out. All participants filled a structured questionnaire and anthropometric data was collected. Investigative profile included routine urine exam, semi-quantitative microalbuminuria (MAU), serum creatinine, lipid profile and fasting blood glucose. Glomerular Filteration rate (eGFR) was calculated using the Modification of Diet in Renal Diseases (MDRD) study equation.Result: A total of 1920 subjects were examined with 731 (38.07%) from Arms and 1189 (6I.93%) from Services. 348 were excluded and of the remaining 1572 subjects, 141 (8.97%) had MAU and 157 (9.99%) had deranged Albumin Creatinine Ratio (ACR). Mean eGFR by MDRD equation was 102 ± 25.84 ml/min/1.73m². Early CKD was seen in 150 (9.54%) with 84 (5.34%) in stage I CKD, 55 (3.5%) in stage II and 11 (0.7%) in stage III. Multiple logistic regression showed BMI > 23, the presence of DM and HTN were independent risk factors for CKD.Conclusion: 9.54 % of healthy army personnel were found to have early stages of CKD. Institution of screening programs can result in early detection of CKD.     

Neuropsychological aspects of childhood multiple sclerosis: an overview

While cognitive impairment, major depression, and fatigue have been well documented in adult patients with multiple sclerosis (MS), there is still little information regarding MS-associated cognitive disabilities in infants and adolescents who represent 3 to 5% of all MS cases. Recent studies show that cognitive decline related to MS profoundly interferes with academic success and psychosocial adjustment. Neuropsychological dysfunction affects quality of life more significantly than mere Expanded Disability Status Scale is able to reflect. We herein give an overview of the knowledge available to date. Affective and emotional disturbances together with other comorbidities interfering with cognition are also reviewed. Finally, possible suggestions and future directions for the assessment of cognitive capabilities in children with MS are envisioned.