Die Aufklärungspflicht bei endoskopischen Operationen

Ohne Zusammenfassung     

A highly variable STR at the D12S391 locus

A total of 103 fragments in the STR D12S391 locus were sequenced. 24 different alleles were found which can be grouped into 12 allelic classes based on the total number of repeats. The structure of this compund STR consists of blocks of (AGAT) and (AGAC) repeats with a consensus structure (AGAT)_8–l7 (AGAC)_6–10 (AGAT)_0–1. Whereas shorter alleles only have (AGAT) repeats, > 225 bp alleles are more complex, having two motifs (AGAT) and (AGAC). Population data showed that this to be a highly polymorphic STR with a heterozygosity of 0.9. This fact together with its simple structure make this STR very suitable for forensic and genetic purposes.     

The importance of self-examination in the earliest diagnosis of multiple primary cutaneous melanomas: a report of 47 cases

BACKGROUND: Development of more than one primary melanoma in a patient is a relatively uncommon but well-recognized phenomenon. Its frequency has ranged from 1.2% to 8.2% in several series. This subgroup of patients with multiple primary lesions has not been characterized sufficiently. We report the experience of the Melanoma Unit of University Hospital Spedali Civili of Brescia, Italy. METHOD: Study subjects were drawn from 1240 patients with histologically confirmed melanoma, including melanoma in situ. From this group, multiple melanomas developed in 47 patients (3.79%). Every one of our patients has been taught to perform self-examination of the skin to detect suspicious pigmented lesions. RESULTS: Of the 47 patients described in this study, 38 had two primary melanomas, 7 had three melanomas and 2 had 5 and 10 melanomas, respectively. Mean age at first diagnosis was 46.2 years. The majority of subsequent melanomas (74.5%) were removed within 5 years of the initial operation. Synchronous lesions were found in 10 patients. In male patients, the lesion appeared most frequently on the trunk; in female patients, melanoma appeared mostly on the lower extremities. The second primary melanomas developed in the same anatomic region from the first in 53.2% of our patients. The proportion of in situ to invasive melanomas was greater for the second melanomas compared with the first melanomas. Regarding invasive melanomas, the mean thickness of the first melanomas was 1.31 mm compared with 0.66 mm for the second ones. Dividing patients into two groups, of more and less than 50, it is highlighted that in older patients synchronous lesions appear more frequently (36.4% vs. 8.0%); the median time interval between sequential melanomas is longer (84 vs. 63.7 months); and the ratio between the primary and secondary melanoma mean thickness is lower (1.21 : 1.08 vs. 1.43 : 0.63 mm). CONCLUSIONS: The study confirms that second primary melanoma is usually thinner than the first lesion, and it is more common in the same region of the body as the initial melanoma. The highest risk for a second melanoma is during the first 5 years, but a much longer time interval of 28 years is possible. Continued medical follow-up with complete skin examinations seems prudent, but it is very important to promote self-skin evaluation in patients to detect not only metastases but also subsequent primary melanomas in their earliest phases.     

Expertisen an biologischen spuren

Zusammenfassung Das Referat unternimmt den Versuch einer kritischen Bestandsaufnahme mit besonderer Betonung der Blutspuren-Analyse. Die Integration in die Praxis ist hierbei ein wesentliches Ziel. Als Grundbestandteile der Spurenexpertise werden beschrieben: (1) Analyse der Spurenform, (2) Diskriminierende und zuordnende Analysen, (3) Individualisierende Analysen. Zu 1: Die Analyse der Spurenform basiert auf einem umfangreichen experimentellen Schrifttum seit 1895 im wesentlichen im kontinentaleuropäischen Bereich. Seit 1971 finden sich auch Publikationen im amerikanischen Schrifttum. — Die große Familie der Formspuren und deren Abhängigkeit von zahlreichen Variablen wird beschrieben. Besonders gilt dies für die Entstehungsmodalitäten, für die Aufprallenergie, für die physikalischen Eigenschaften der Spurenträger. Die wesentlichen Elemente für die Tatrekonstruktion werden genannt. Einige Bereiche der Anwendung werden fallgruppenartig skizziert. Da in der Praxis das Spurenbild durch zahlreiche Artefakte und Überlagerungen kompliziert ist, wird es für notwendig gehalten, daß der forensiche Pathologe, welcher die Arten und Reihenfolgen der Verletzungen kennt, der ideale Experte auch für die Analyse des Spurenbildes sei. In der praktischen Anwendung wird die Analyse der Spurenform nicht immer in der erforderlichen Qualität durchgeführt. Die Fortbildung und Weiterbildung der Obduzenten in diesem Punkt sollte verbessert werden. Eine gezielte Analyse der Spurenform ist auch eine wesentliche Voraussetzung für sinnvolle weitergehende Untersuchungen. Zu 2: Durch die diskriminierenden und zuordnenden Analysen werden in der Regel mit einem Test entscheidende Antworten erzielt. Dies gilt sowohl für grundlegende Fragen wie den Blutnachweis usw. als auch für den Ausschlußbeweis. Zu unterscheiden ist zwischen klassichen Methoden, dem neuen Bereich der Immunchemie und den sog. seltenen Methoden. Durch den Einsatz der Immunchemie ist es in den letzten Jahren möglich geworden, die Blutgruppenprägung von Haaren sicher zu bestimmen. Sog. seltene Methoden werden u.a. deswesen in der Praxis selten angewendet, weil das erforderliche ständige Training fehlt. Es wird hierzu empfohlen, Referenz-Laboratorien einzurichten. Zu 3: Die individualisierenden Analysen untergliedern sich in 2 große Unterbereiche: Non-DNA-Individualisierung und DNA-Individualisierung. Es wird postuliert, daß beide Bereiche im zukünftigen Spurenlabor nebeneinander Bestand haben werden. In der Non-DNA-Individualisierung sind wesentliche Fortschritte dadurch erzielt worden, daß der Nachweis der Proteinpolymorphismen durch Blot-Verfahren mit nachfolgender Visualisierung durch Enzym-Substratreaktionen zu erheblicher Empfindlichkeitssteigerung und Spezifitätssteigerung geführt hat. Unter Berücksichtigung auch der klassischen Nachweismethoden beträgt im Non-DNA-Bereich der Discrimination-Index nunmehr 1×10^–6. Dieser Discrimination-Index ist mit sehr kleinen Spurenmengen erreichbar. — Die DNA-Individualisierung hat erhebliche Fortschritte gemacht. Offen ist z.Zt. noch, welche System — hochpolymorphe Systeme oder mittelpolymorphe Systeme — in der ferneren Zukunft in die Spurenanalytik einbezogen werden. Beide Systemgruppen haben ihre Vor- und Nachteile. Erhebliche Arbeit muß noch bei der Standardisierung der Methoden geleistet werden. Dies gilt auch für zukünftige Methodenentwicklungen und für die erforderliche Steigerung der Empfindlichkeit. Ein letzter Abschnitt ist der Qualitätssicherung gewidmet. Hier wird empfohlen, daß zur Vermeidung von Fehlern bestimmte Sicherheitsvorkehrungen eingehalten werden. Bei der Einführung neuer Systeme sollte ein mehrphasiges Verfahren angestrebt werden.     

Hypertrichosis lanuginosa acquisita in ulcerative colitis with colon cancer]

Hypertrichosis lanuginosa acquisita is regarded as an obligatory cutaneous paraneoplasm and is defined as the sudden and excessive appearance of lanugo hairs on the entire integument associated with malignant neoplasm of internal organs. We observed such a case of hypertrichosis in a 30-year-old man with a long history of ulcerative colitis who developed carcinoma of the caecum with lymph node metastasis.     

Synthesis and post-translational modification of the androgen receptor in LNCaP cells

Androgen receptor synthesis and modification were studied in the human LNCaP cell line. Immunoblotting with a specific polyclonal antibody showed that the androgen receptor migrated as a closely spaced 110–112 kDa doublet on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) gels. Most of the receptor protein is present in the higher molecular mass form. Pulse labelling experiments with [³⁵S]methionine showed that the androgen receptor is synthesized as a single 110 kDa protein which is rapidly converted to a 112 kDa protein. Alkaline phosphatase treatment of cytosols from [³⁵S]methionine pulse labelled cells caused a gradual elimination of the 112 kDa isoform with a concomitant increase of the 110 kDa isoform. This indicates that the observed 110 to 112 kDa upshift of the newly synthesized androgen receptor reflects receptor phosphorylation. Both isoforms can bind hormone and can undergo a hormone dependent transformation to a tight nuclear binding form, indicating that the 110 to 112 kDa conversion is not an obligatory step for hormone binding or receptor transformation.     

Backspatter from experimental close-range shots to the head

Backspatter is the ejection of biological material from a gunshot entrance wound against the line of fire. This phenomenon was investigated experimentally in transverse gunshots to the heads of calves (n = 9) using two types of 9 mm Parabellum ammunition from shooting distances of 0–10 cm. The resulting bloodstains were documented on white paper placed horizontally 60 cm below the impact site. In this report the analysis was restricted to stains with a diameter > 0.5 mm. Backspatter was documented after every gunshot. The number of stains varied from 31–324 per gunshot and appeared to be independent of the shooting distance. The maximum distance droplets travelled varied from 72–119 cm. The majority of droplets accumulated between 0 and 50 cm. The number of droplets and the distances travelled should be higher in man for anatomical reasons. The direction a single droplet can take comprises every possible angle between the most tangential ones to the skin surface. This resulted in a semi-circle of 180° covered with stains. Skin ruptures of the entrance wound were not observed. The succession of events was documented on high speed film and started with the recoil of the firearm, immediately followed by a blow-out effect of the skin. Large droplets exited approximately 0.7–4 ms after the bullet impacted the skin. The calculated minimum initial velocity of these droplets was 13–61 m/s. Backspatter from gunshots to the head likely is caused by the hot gases expanding subcutaneously and by cavitation-related intracranial overpressure and tail splashing. In three out of nine gunshots, secondary backspatter additionally occurred as a result of droplets produced by a stream of blood from the entrance wound impacting the paper surface.     

Critical ovarian hyperstimulation syndrome in a coasted in-vitro fertilization patient

We report an instance of critical ovarian hyperstimulation syndrome in a highly responsive in-vitro fertilization patient despite the preventive measure of a 4 day 'coast' interval during which no gonadotrophins were administered while gonadotrophin-releasing hormone agonist therapy continued until serum oestradiol concentrations fell below 3000 pg/ml.