Estimation of wound age and VCAM-1 in human skin

To estimate the age of skin wounds, the endothelial adhesion molecule VCAM-1 (CD 106) was detected in paraffin sections after autoclaving and using the ABC technique. The percentage of VCAM-1 positive blood vessels was determined after the blood vessels had been marked with PECAM-1 (CD 31). Low positive staining reactions were observed for VCAM-1 on endothelial cells of uninjured skin in 18% of the samples. In injured skin, 51% of the cases investigated showed a VCAM-1 expression. Strong positive staining reactions were observed 3 h at the earliest and 3.5 days at the latest after the time of injury. The immunohistochemical results for VCAM-1 differed significantly between the injured and uninjured skin (P < 0.01). In a few cases VCAM-1 was detected (n = 6) at low intensity in postmortem skin wounds and a moderate to strong expression of VCAM-1 is indicative of the vitality of the wound. The detection of VCAM-1 can be used for estimating the age of wounds in forensic applications if the degree of expression of further adhesion molecules, especially that of selectins, is taken into account.

Human hypersensitivity angiitis: an uncommon cause of death after trauma

INTRODUCTION

The article demonstrates, using a case report, that death following an accident may have rarely encountered causes that are not a direct result of trauma and that can only be detected by autopsy.

CASE

An unconscious woman aged 57 years was admitted to hospital. Despite immediate surgery for intracranial haemorrhage diagnosed by means of cranial computed tomography, the patient died showing clinical symptoms of circulatory depression after a brief period of stabilisation. The autopsy established myocardial infarction with hypersensitivity angiitis as the cause of death.

CONCLUSION

In this case, the authors hold the opinion that the intravenous application of antibiotics during the patient's stay in hospital resulted in hypersensitivity angiitis. The factors causing hypersensitivity angiitis, the morphological picture (clinical, histological) and therapeutic measures are described.

Enhanced expression of selectins in human skin wounds

The aim of the study was to characterize the vitality and age of skin wounds by the detection of selectins. A prospective study was conducted for this purpose in which 197 vital human skin wounds (time since injury ranging from 3 min to 790 days) were investigated immunohistologically. Of the samples tested, 97 were taken from autopsy material and 100 from patient material from the department of surgery at the university hospital. The selectins were detected in paraffin sections after autoclaving and using the ABC technique. The intensity was rated by a semi-quantitative evaluation using a four-stage ordinal scale. Strong positive immunohistochemical reactions were observed for the P-selectin 3 min at the earliest and 7 h at the latest after the time of injury. For the E-selectin a positive staining was evident I h at the earliest and 17 days at the latest from the time the skin was injured. The staining intensity decreased significantly after an interval of 12 h from the time of injury (P < 0.05). The L-selectin was regularly detected on leukocytes in the samples of injured skin. The immunohistochemical results for the P- and E-selectins were significantly different between injured and uninjured skin (P < 0.01). The expression of the selectins is indicative of the vitality of the wound. P-selectin was detected in a few cases (n=4) at low intensity while E-selectin could not be found in the control samples (n=31) of postmortem skin wounds. The use of P- and E-selectins for forensic purposes can help to achieve better estimates of the age of wounds with short survival times.

Screening of pharmaceuticals and drugs in synovial fluid of the knee joint and in vitreous humor by fluorescence polarization immunoassay (FPIA)

The investigations presented are aimed at testing whether ABBOTT's fluorescence polarization immunoassays for identification of drugs of abuse and pharmaceuticals in serum and urine are applicable to knee joint synovial fluid and vitreous humor. The survey confirms the general applicability of the tests to the respective body fluids without previous precipitation, only after liquefaction using hyaluronidase. The calculated cross-reactivities are shown in tables.

Time dependence of the expression of ICAM-1 (CD 54) in human skin wounds

To characterize the vitality and age of skin wounds by means of the ICAM-1 pattern, 157 intravital human skin wounds (time since injury ranging from 5 min to 730 days) were immunohistochemically investigated. ICAM-1 was detected in paraffin sections after autoclaving and using the ABC technique in 86% of the wounds investigated. The correlation between ICAM-1 expression and the degree of wound inflammation is weak. Strong positive staining was observed 1.5 h at the earliest and 3.5 days at the latest after the time of injury. ICAM-1 also appeared at low concentrations in samples of uninjured skin (n = 65), on keratinocytes and the endothelial cells of blood vessels. Moderate to strong ICAM-1 expression is a valuable indication of the vitality of the wound. However, at present the detection of ICAM-1 alone is not sufficient to fix the wound age with the accuracy which is required for forensics applications.

Enhanced expression of ICAM-1 (CD 54) in human skin wounds: diagnostic value in legal medicine

OBJECTIVE

It was the aim of this study to characterize the vitality and the age of skin wounds by verifying the presence of ICAM-1.

MATERIAL

132 intravital human skin wounds (time since injury 15 min-19 days) were investigated by immunohistochemistry. The samples were taken either after surgical treatment of the wounds or from autopsy cases.

METHODS

CD 54 was detected in paraffin sections by monoclonal antibodies after an autoclaving pretreatment using the ABC peroxidase technique.

RESULTS

In samples of uninjured skin (n = 30), ICAM-1 appeared at a low concentration on keratinocytes and the endothelial cells of blood vessels. In injured skin, an increase in the surface expression was found to occur initially after a post-trauma interval of 2 h. The evaluation was made on a semiquantitative basis. A moderate to strong ICAM-1 expression occurred in 80% of the wounds investigated.

CONCLUSIONS

The expression of ICAM-1 correlates with the degree of wound inflammation, which may be considered as an early evidence of the vitality of the wound.

Drugs in East Germany

Germany was divided into two parts after World War II. The closed border and a nonconvertible currency in the Eastern part were the factors that did not allow a drug market to develop. Alcohol and medicaments were used as substitute drugs. Since Germany was reunified 5 years ago, there are now the same conditions prevailing for the procurement and sale of drugs in East Germany as there are in the Western German states. This report describes the current state of drug traffic, especially in Saxony, under the new social conditions.

[Diagnosis of "fatal ethanol poisoning in the absorption phase"]

In cases of disputed fatal alcohol intoxication during the absorption (pre-peak) period it is strongly recommended to examine the blood ethanol level not only in blood taken from a peripheral vessel but also simultaneously in blood from at least one central. In the case reported, without such a duplex determination of the blood ethanol concentration it would have been impossible to establish the actual cause of death.

Efficacy of hepatobiliary scintigraphy in the differential diagnosis of neonatal cholestasis and postoperative follow-up after hepatoporto-digestive anastomosis

In the differential diagnosis of unclear neonatal and infant cholestasis the formerly applied 131-I-Rose Bengal scintigraphy has been widely abandoned in favour of hepatobiliary scintigraphy with 99mTc-labelled IDA derivatives excreted with the bile. Our results in 32 jaundiced children ranging from ages 2 weeks to 32 weeks show a high sensitivity of scintigraphy in proving an occlusion in 92% with a clearly lower specificity of 79%, if based on the demonstration of marked bile in the intestine as the only criterion. Diagnostic accuracy, however, can be further increased in additional criteria such as hepatocellular clearance and patient age are considered. The examination is of equally high importance for post-operative follow-up. Here, scintigraphy is superior to all other imaging procedures in the evaluation of bile flow situations. In 52 examinations of portoenterostomies, the prognostic value can be demonstrated not only with a good coincidence of the scintigraphic data with the bilirubin level, but also with the histological degree of liver fibrosis at the time of operation. Early and late complications of hepatoportojejunostomy can usually be recognised and localised. Since the prognosis of extrahepatic biliary atresia depends on an early operation-presently by means of reconstruction of biliary flow-indications for hepatobiliary scintigraphy must be given more widely and earlier (at the latest in the fourth week of life) in all unclear cases of cholestatic syndrome.

Lacrimal dacryoscintigraphy

Lacrimal dacryoscintigraphy facilitates definite diagnosis of obstructions and stenosis of the lacrimal drainage system with little stress to the patient. Together with x-ray dacryocystography it is an important diagnostic tool especially for pre- and postoperative evaluation of the drainage apparatus. Dacryoscintigraphy is the best method for measuring the dynamics of tear drainage especially in the canaliculi. Although it is not a substitute for other methods in general use, it complements them and expands their diagnostic accuracy.

[Radioimmunoassays in oncology]

Aside from imaging techniques several (radio-)immunological analyses are used for tumor diagnosis. Oncofetal antigens, for instance the carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP), have become the most important substances for many malignancies. However, nearly all of the so-called tumor markers are not suitable for early diagnosis or screening either because of low sensitivity or low tumor specificity. On the other hand follow-up measurements give a very sensitive index of the success of treatment and may indicate tumor progression when other signs are still not present. In some carcinomas and under some clinical circumstances tumor specific markers are available and mandatory for detection and/or staging: AFP in hepatoma, acid phosphatase in metastasizing carcinoma of the prostate and serum thyreoglobulin in differentiated thyroid cancer.

[Myocardial scintigraphy and radionuclide ventriculography in myocardial infarction (author's transl)]

149 patients with acute (n = 75) myocardial infarction and 74 post-infarctions, angiographically confirmed, were investigated by 201T1 myocardial scintigraphy and subsequent radionuclide ventriculography. Quantitative evaluation of the scintigram showed 201T1 storage defects in 92% in the acute stage in 79% in the later stage. The sensitivity of identification of the posterior wall infarction was consistently markedly less than for anterior wall infarctions and could not be increased by additional application of 99mTc methylene diphosphonate. By the combined application of myocardial scintigraphy and radionuclide ventriculography the functional effects of the infarction can be described non-invasively.

[Scintigraphy of acute myocardial infarction with ligands of 99mTc-phosphate]

Of the wide range of radiopharmaceuticals which accumulate in acutely myocardial tissue and subsequently enable its scintigraphic detection compounds of 99mtechnetium phosphate have proven clinically practicable in numerous investigations. As opposed to the similarly non-invasive method of myocardial scintigraphy with ionic tracers (201thallium scintigraphy), infarct detection through positive delineation is possible, at the earliest, six to twelve hours faster the onset of pain and meaningful for those in whom the classical ECG and enzyme changes are equivocally diagnostic and for patients with delayed hospital admissions. After approximately one week the concentration of activity in the necrotic zone and, in turn, its detectability, declines. Persistent activity is indicative of extensive infarction and poor prognosis. The sensitivity of the infarct scintigram, which is primarily carried out with 99mTc-pyrophosphate or 99mTc-methylendiphosphonate, is about 86% with small and sudbendocardial infarcts more frequently eluding detection. The method corresponds with electrocardiographic assessment of localization. The combination with 201thallium scintigraphy is useful in differentiating remote from acute infarction and in detection of right ventricular involvement associated with inferior infarction. In spite of a good correlation between the experimentally-determined infarct weight and scintigraphic findings, clinical investigations employing conventional methods of measurement (scintillation camera) have not been able to yield an early and accurate quantification of the appearance may occur, for example, in unstable angina pectoris. Thus, a negative infarct scintigram carried out at the optimal time of uptake assumes its most useful role in ruling out acute myocardial infraction in the presence of otherwise equivocal clinical findings.

[Value of 201-thallium serial myocardial imaging in coronary heart disease (author's transl)]

There has been clinical evidence that a perfusion defect on a stress image fills in over time. The diagnostic value of initial and 120 min post exercise redistribution thallium-201 myocardial images (RMI) was determined in 120 pts. with suspected coronary heart disease (CAD), all of whom had coronary arteriography. Significant (greater than or equal to 75%) lesions were present in 88 pts. 30 pts. without CAD showed a normal tracer uptake immediately after exercise. Scintigrams taken 120 min after exercise revealed a decrease of 201-Tl concentration in every area of the myocardium. 80 pts. with CAD showed an area of decreased tracer uptake in the initial scans. 120 min RMI in 51 pts. revealed a segnificant increase (p greater than 0.01) of countrate time ratio in previous underperfused area. In 37 pts. persistent defects were present, in every case the defect correlated with the site of a myocardial infarction as determined by the finding of an akinetic area in the left ventricular angiogram. Thus RMI following a single dose of 201 Tl can differentiate between scar- and exercise-induced transient ischemia.