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Landwehr T, Sinicina I, Graw M. Todesfälle beim Sport. Rechtsmedizin (Berl) 2019. [DOI: 10.1007/s00194-019-0311-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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2
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Sinicina I, Inthorn D, Pankratz H. Undetected severe complication after elective lumbar surgery - How could it happen? Leg Med (Tokyo) 2018; 36:43-46. [PMID: 30368113 DOI: 10.1016/j.legalmed.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/10/2018] [Accepted: 10/18/2018] [Indexed: 10/28/2022]
Affiliation(s)
- I Sinicina
- Department of Legal Medicine, Ludwig Maximilians University, Munich, Germany.
| | - D Inthorn
- Department of Legal Medicine, Ludwig Maximilians University, Munich, Germany
| | - H Pankratz
- Department of Legal Medicine, Ludwig Maximilians University, Munich, Germany
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3
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Sinicina I, Pankratz H. Kniegelenkverletzung: überraschende Wende bei Begutachtung vor Strafgericht. Rechtsmedizin (Berl) 2018. [DOI: 10.1007/s00194-018-0282-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Doll D, Bosche F, Hauser A, Moersdorf P, Sinicina I, Grunwald J, Reckel F, Luedi MM. The presence of occipital hair in the pilonidal sinus cavity-a triple approach to proof. Int J Colorectal Dis 2018; 33:567-576. [PMID: 29488088 DOI: 10.1007/s00384-018-2988-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Hair in the pilonidal sinus is not growing within the sinus cavity, as hair follicles are not present there. Not few pilonidal patients do not have intergluteal hair, which is said to be the causative agent of folliculitis and pilonidal genesis. So, what is the real source of the hair forming the typical pilonidal hair nest? METHODS A trifold approach was used: First, axial hair strength testing of pilonidal hair and body hair harvested from head, lower back (glabella sacralis), and cranial third of intergluteal fold. Hair strength match was compared clinically. Second, comparative morphological examination by expert forensic biologist of hair from sinus and dorsal body hair. Third, statistical Bayesian classification of every single sinus hair based on its strength was done to determine the most probable region of origin. RESULTS Using clinical hair strength comparison, in 13/20 patients, head hair is the stiffest hair, followed by intergluteal hair. Only in 6/20 patients, this is the case with hair from the glabella sacralis. According to comparative morphological comparison, a minimum of 5 of 13 hair nests with possible hair allocation examined contain hair from the occiput. In 5/18 nests, hair could not be determined to a specific location though. Statistical classification with correction for multiple testing shows that 2 nests have hair samples that are at least 100 times more probable to originate from head or lower back than from intergluteal fold. CONCLUSION We saw our null hypothesis that "hair in the sinus cavity is from the intergluteal region" rejected by each of three different approaches. There is strong evidence that occipital hair is present regularly in pilonidal sinus nests. We should start thinking of occipital hair as an important hair source for the development of the pilonidal hair nest.
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Affiliation(s)
- Dietrich Doll
- Department of Procto-Surgery, St. Marienhospital Vechta, Academic Teaching Hospital of the Medizinische Hochschule Hannover, Vechta, Germany. .,Chris Hani Baragwanath Academic Hospital, University of Witwatersrand Medical School, Johannesburg, Republic of South Africa. .,PSD Research Group, Vechtaer Institut für Forschungsförderung e.V., Marienstr. 6-8, 49377, Vechta, Germany.
| | - F Bosche
- Department of Procto-Surgery, St. Marienhospital Vechta, Academic Teaching Hospital of the Medizinische Hochschule Hannover, Vechta, Germany
| | - A Hauser
- Bern University of Applied Sciences, Burgdorf, Switzerland
| | - P Moersdorf
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Kirrberger Str. 100, 66421, Homburg, Saar, Germany
| | - I Sinicina
- Institute of Forensic Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - J Grunwald
- Bavarian State Criminal Police Office, Forensic Science Institute, Maillingerstr. 15, 80636, Munich, Germany
| | - F Reckel
- Bavarian State Criminal Police Office, Forensic Science Institute, Maillingerstr. 15, 80636, Munich, Germany
| | - M M Luedi
- Department of Anesthesiology and Pain Therapy, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
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Sinicina I, Pankratz H, Schöpfer J. Ungewöhnliche Fälle von pulmonaler Embolie. Rechtsmedizin (Berl) 2017. [DOI: 10.1007/s00194-017-0219-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Drubba S, Schweitzer S, Penning R, Graw M, Sinicina I, Gleich S. Fentanyl-Verordnungen im Zusammenhang mit Drogenmissbrauch und Drogentodesfällen 2015 in München. Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1601973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S Drubba
- Referat für Gesundheit und Umwelt der Landeshauptstadt München, München
| | - S Schweitzer
- Referat für Gesundheit und Umwelt der Landeshauptstadt München, München
| | | | - M Graw
- Institut für Rechtsmedizin, München
| | | | - S Gleich
- Referat für Gesundheit und Umwelt der Landeshauptstadt München, München
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Hubig M, Muggenthaler H, Sinicina I, Mall G. With reference to the letter to the editor by Henssge (Leg Med (Tokyo). 2015 Jul 29. http://dx.doi.org/10.1016/j.legalmed.2015.05.005.): "'With reference to the article by Hubig et al.: Temperature based forensic death time estimation: The standard model in experimental test' (Legal Med 2015 XX)". Leg Med (Tokyo) 2015; 17:304-5. [PMID: 26415654 DOI: 10.1016/j.legalmed.2015.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 08/27/2015] [Indexed: 11/20/2022]
Affiliation(s)
- M Hubig
- Institute of Forensic Medicine, Jena University Hospital - Friedrich Schiller University Jena, Fürstengraben 23, 07743 Jena, Germany.
| | - H Muggenthaler
- Institute of Forensic Medicine, Jena University Hospital - Friedrich Schiller University Jena, Fürstengraben 23, 07743 Jena, Germany
| | - I Sinicina
- Institute of Legal Medicine, Ludwig Maximilians-University Munich, Germany
| | - G Mall
- Institute of Forensic Medicine, Jena University Hospital - Friedrich Schiller University Jena, Fürstengraben 23, 07743 Jena, Germany
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Hubig M, Muggenthaler H, Sinicina I, Mall G. Temperature based forensic death time estimation: The standard model in experimental test. Leg Med (Tokyo) 2015; 17:381-7. [PMID: 26028161 DOI: 10.1016/j.legalmed.2015.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/17/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
The determination of the time since death is essential to forensic homicide investigations since the time of death represents the presumed time of the offence. Erroneous death time estimates may lead to false acquittal or conviction of suspects. Since its introduction 30years back, the nomogram method by Henßge has been established as the standard procedure of temperature-based death time determination in the early post-mortem period. The present study provides an independent investigation of the validity of its death time estimates and their corresponding 95%-confidence intervals. Comparison to post-mortem cooling curves recorded under controlled conditions of 84 suddenly deceased with known death times yielded the following results: Since in the light of our experiments the validity of the nomogram method seems to be problematic, death time estimates - and particularly their 95%-confidence interval limits - have to be interpreted carefully and should only be restrictively used as court evidence to support or refute alibis. Systematic overestimation of the post-mortem interval in bodies of high mass and large surface area must be taken into account.
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Affiliation(s)
- M Hubig
- Institute of Forensic Medicine, Jena University Hospital - Friedrich Schiller University Jena, Germany.
| | - H Muggenthaler
- Institute of Forensic Medicine, Jena University Hospital - Friedrich Schiller University Jena, Germany
| | - I Sinicina
- Institute of Legal Medicine, Ludwig Maximilians-University Munich, Germany
| | - G Mall
- Institute of Forensic Medicine, Jena University Hospital - Friedrich Schiller University Jena, Germany
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9
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Matevossian E, Doll D, Hüser N, Brauer R, Sinicina I, Nährig J, Friess H, Stangl M, Assfalg V. Liver transplantation in the rat: single-center experience with technique, long-term survival, and functional and histologic findings. Transplant Proc 2010; 41:2631-6. [PMID: 19715990 DOI: 10.1016/j.transproceed.2009.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Orthotopic liver transplantation (OLT) in rats is frequently used as an experimental model. Numerous surgical techniques have been developed that enable the investigator to conduct clinically relevant studies. The objective of this study was to develop a rat model of acute and chronic rejection, to explicitly study technical modifications of vascular anastomoses with precision, and to examine histopathologic and functional changes in the graft. MATERIALS AND METHODS With DA-(RT1av1) rats as donors and Lewis-(RT1) rats as recipients, arterialized OLT was performed using a combined suture, cuff, and splint method. Recipients were divided into 5 groups: syngeneic control rats (group 1), allogeneic control rats (group 2), allogeneic OLT rats with low-dose tacrolimus (FK506) immunosuppression (group 3), allogeneic OLT rats with high-dose tacrolimus immunosuppression (group 4), and allogeneic OLT rats with high-dose tacrolimus immunosuppression and retrograde reperfusion via the infrahepatic caval vein (group 5). After OLT, serum parameters were determined and hepatic biopsy specimens were sampled. We examined the effects of acute rejection with or without immunosuppression therapy at histopathologic evaluation. RESULTS Liver grafts in syngeneic and allogeneic rats (groups 1, 2, 4, and 5) demonstrated normal serum parameters and histopathologic findings at 10 days after OLT, and 93% survival at 3 months. The simplified technique using 1 suture and 2 cuff anastomoses provided the best short- and long-term survival after OLT in all groups. Retrograde perfusion via the infrahepatic caval vein resulted in lower postoperative liver enzyme values. CONCLUSION The present model is feasible, enabling comprehensive preclinical experimental research on liver transplantation. Furthermore, we provide helpful instructions for learning this surgical technique.
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Affiliation(s)
- E Matevossian
- Department of Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
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Matevossian E, Doll D, Sinicina I, Kern H, Bald C, Nährig J, Stangl M, Thorban S, Hüser N. Microsurgical technique of simultaneous pancreas/kidney transplantation in the rat: clinical experience and review of the literature. Eur Surg Res 2009; 43:245-51. [PMID: 19590217 DOI: 10.1159/000228250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 03/31/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND For experimental basic research, standardized transplantation models reflecting technical and immunologic aspects are necessary. This article describes an experimental model of combined pancreas/kidney transplantation (PKTx) in detail. MATERIALS AND METHODS Donor rats underwent en bloc pancreatectomy and nephrectomy. Revascularization was performed using the aorta with the superior mesenteric artery and the inferior vena cava with the portal vein. Exocrine drainage of the pancreas took place over a segment of the duodenum which was transplanted side-to-side to the jejunum. The kidney vessels were transplanted end-to-side. The ureter was anastomosed by patch technique. Postoperatively, serum parameters were monitored daily. Biopsies for histopathology were taken on days 5, 8 and 12. RESULTS All 12 recipients survived the combined PKTx without serious surgical complications. One thrombosis of the portal vein led to organ failure. Blood glucose levels were normal by the 3rd postoperative day. The transplanted duodenal segment showed slight villous atrophy, and the kidneys were well perfused without vascular complications. The anastomosis between ureter and bladder was leakproof. CONCLUSIONS Excellent graft function and survival rates can be achieved due to simplified operation technique and short operation time. It may thus have high clinical relevance to immunologic issues within the scope of basic research.
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Affiliation(s)
- E Matevossian
- Department of Surgery, Klinikum rechts der Isar, Munich, Germany
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11
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Sinicina I, Pankratz H, Bise K, Matevossian E. Forensic aspects of post-mortem histological detection of amniotic fluid embolism. Int J Legal Med 2009; 124:55-62. [PMID: 19449024 DOI: 10.1007/s00414-009-0351-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 04/14/2009] [Indexed: 11/28/2022]
Affiliation(s)
- I Sinicina
- Institute of Forensic Medicine, Ludwig-Maximilians-University Munich, Munich, Germany.
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Matevossian E, Hüser N, Kern H, Assfalg V, Preissel A, Sinicina I, Stangl M, Thorban S. Nitric oxide inhibition and consecutive Aspisol application show a prolonged survival of orthotopic transplanted livers in a rat model. Transplant Proc 2008; 40:971-3. [PMID: 18555092 DOI: 10.1016/j.transproceed.2008.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is generally accepted that nitric oxide (NO) plays a crucial role in acute rejection caused by inflammatory responses. Therefore, the purpose of this study was to investigate the effect on survival following arterialized orthotopic rat liver transplantations (o-RLTx) of NO inhibition and consequent blockade of platelet aggregation by application of Aspisol. MATERIALS AND METHODS Inbred LEWIS-(RT(1)) rats underwent arterialized o-RLTx under ether anesthesia with DA-(RT1av1) rats as organ donors. After liver transplantation, serum parameters were determined and hepatic biopsy specimens were sampled on postoperative days 5, 8, 10, 30, and 90. Sixty-one rats were divided into 5 groups: syngenic controls (group I, n = 12); allogenic controls (group II, n = 11); allogenic with FK506 immunosuppression (group III, n = 12); allogenic with AGH-treatment (group IV, n = 13); and allogenic with AGH/low- dose Aspisol treatment for 5 days after liver transplantation (group V, n = 13) (Bayer, Leverkusen, Germany). RESULTS Rats of group V with AGH/low-dose Aspisol treatment showed significantly longer graft survival (18.2 days +/- 1.8 days) compared with group II rats with untreated grafts (11.3 days +/- 1.7 days) the allogenic group IV with AGH treatment (11.2 days +/- 1.8 days; P < .05). Histological examination revealed moderate graft rejection among the AGH-treated group IV; however, marked platelet aggregation in sinusoids was present, which was not observed in the AGH/low-dose Aspisol-treated animals (group V). CONCLUSION Our data suggested that simultaneous treatment with AGH/low-dose Aspisol leads to a significant increase in survival and inhibition of platelet aggregation in the graft after orthotopic liver transplantation.
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Affiliation(s)
- E Matevossian
- Department of Surgery, Technical University of Munich, Munich, Germany.
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13
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Matevossian E, Novotny A, Knebel C, Brill T, Werner M, Sinicina I, Kriner M, Stangl M, Thorban S, Hüser N. The Effect of Selective Inhibition of Inducible Nitric Oxide Synthase on Cytochrome P450 After Liver Transplantation in a Rat Model. Transplant Proc 2008; 40:983-5. [DOI: 10.1016/j.transproceed.2008.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Krumbholz M, Theil D, Steinmeyer F, Cepok S, Hemmer B, Hofbauer M, Farina C, Derfuss T, Junker A, Arzberger T, Sinicina I, Hartle C, Newcombe J, Hohlfeld R, Meinl E. CCL19 is constitutively expressed in the CNS, up-regulated in neuroinflammation, active and also inactive multiple sclerosis lesions. J Neuroimmunol 2007; 190:72-9. [PMID: 17825430 DOI: 10.1016/j.jneuroim.2007.07.024] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 07/30/2007] [Accepted: 07/30/2007] [Indexed: 01/16/2023]
Abstract
CCL19 and CCL21 bind to CCR7, which is crucial for both inducing an immune response and establishing immunological tolerance. We report that in the normal human brain CCL19, but not CCL21, is transcribed, and detectable as a protein in tissue lysates and in cerebrospinal fluid. In both active and inactive multiple sclerosis (MS) lesions CCL19 transcripts were elevated. In cerebrospinal fluid from MS and OIND patients CCL19 protein was increased. In relapsing-remitting and secondary progressive MS patients CCL19 correlated with intrathecal IgG production. This study suggests that CCL19 plays a role in both the physiological immunosurveillance of the healthy CNS and the pathological maintenance of immune cells in the CNS of MS patients.
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Affiliation(s)
- M Krumbholz
- Department of Neuroimmunology, Max-Planck-Institute of Neurobiology, Am Klopferspitz 18, Martinsried, Germany
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Sinicina I, Bise K, Pankratz H. Late effects of radiation on central nervous system. Diagn Pathol 2007. [DOI: 10.1186/1746-1596-2-s1-s18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
We report the case of a 33-year-old transsexual man who developed severe sepsis after an accidental intravenous injection of urine (3-5 ml) instead of methadone. He died unexpectedly 28 days after the onset of sepsis. On postmortem examination, the outstanding findings were restricted to the heart with an unusual macroscopic presentation. On histological examination extensive calcifications of the heart muscle, particularly of the left ventricle were found. The pattern of calcifications on the right ventricle was also striking. In contrast, the entire cardial conduction system was unaffected. Furthermore, there were no calcium deposits in other organs and tissues. The advanced widespread cardial calcifications in the present case can be attributed to endotoxin-related myocarditis in severe long-term sepsis. The only treatment would have been an urgent heart transplantation. Without prior knowledge of such a condition, it is impossible for clinicians to correctly recognize, diagnose and treat or prevent in due time such a complication.
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Affiliation(s)
- I Sinicina
- Department of Forensic Medicine, Ludwig Maximilians University Munich, Frauenlobstr. 7 a, 80337 Munich, Germany.
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Sinicina I, Matevossian E, Mall G. [Upper gastrointestinal bleeding after long term, high dose NSAID medication: a wolf in sheep's clothing?]. Internist (Berl) 2005; 46:452-6. [PMID: 15657719 DOI: 10.1007/s00108-004-1343-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 71-year-old patient with melena, abdominal and lower back pain was admitted to hospital under suspicion of upper gastrointestinal bleeding. He had mild anemia and an elevated C-reactive protein. Endoscopy and ultrasound failed to localize the source of bleeding. The patient died 2 1/2 days after admission on an exsanguinating hemorrhage. On pathologic examination a fistula between the small aortic aneurysm and duodenum and periaortic inflammation in contact with a spondylitis were found. When clinical presentation is subtle, with a herald bleeding followed by a period of grace, the diagnosis of aortoenteric fistula may be extremely difficult.
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Affiliation(s)
- I Sinicina
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München.
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Sinicina I, Pankratz H, Büttner A, Mall G. Death due to neurogenic shock following gastric rupture in an anorexia nervosa patient. Forensic Sci Int 2004; 155:7-12. [PMID: 16216705 DOI: 10.1016/j.forsciint.2004.10.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2004] [Accepted: 10/26/2004] [Indexed: 02/08/2023]
Abstract
We report a case of fatal gastric rupture discovered after death, which developed due to a bulimic attack of a 19-year-old woman suffering from anorexia nervosa. An autopsy revealed an acute gastric dilatation and rupture without commonly observed ischemic damage of gastric wall structures. However, it may be difficult to determine the cause of death despite the marked findings. The death as a consequence of neurogenic shock accounts for all the results of gross examination and histologic analysis. This case is the first reported case of fatal gastric rupture of an anorectic patient discovered after death.
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Affiliation(s)
- I Sinicina
- Institute of Legal Medicine, Ludwig-Maximilians-University, Frauenlobstrasse 7a, D-80337 Munich, Germany.
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Oehler U, Sinicina I, Helpap B. [Extensive bilateral lower leg muscle necrosis after nasal application of heroin. Macroscopic and histologic findings in a 23-year-old man]. Pathologe 2002; 23:318-20. [PMID: 12185787 DOI: 10.1007/s00292-002-0531-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Rhabdomyolysis is one of the less known complications of heroin abuse. A case of lower leg muscle necrosis after nasal application of heroin is reported with repeated resection of the necrotic muscles. Superinfection with a methicillin-resistant Staphylococcus aureus (MRSA) strain was present. After 4 weeks, bilateral amputation could not be avoided. We regard a direct toxic effect of the heroin as the most probable mechanism of the muscular damage, with possible influence of the reduced oxygen delivery due to central respiratory and circulatory depression.
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Affiliation(s)
- U Oehler
- Institut für Pathologie, Singen, Akademisches Lehrkrankenhaus der Universität Freiburg
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20
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Sinicina I, Helpap B. [Extreme cardiomegaly]. Z Kardiol 2002; 91:508-12. [PMID: 12219700 DOI: 10.1007/s00392-002-0802-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the case of 65 year old male patient with extreme heart enlargement. The patient was admitted to the hospital due to acute bleeding from varicose veins of the cardia. The endoscopic treatment by means of hemostatic clips and fibrine was successful. However the patient died two weeks later without having any complaints. The heart of the patient weighed 1350 g. Multiple coronary bypasses were found. There was also a recent myocardial infarction. The adoptive pathophysiologic changes accompanying extreme cardiomegaly are discussed. Numerous cases have been recorded of unusually large hearts, which in a few instances have even exceeded the one reported here. The analysis of observations reported in the literature reveals that rheumatic myocarditis and syphilitic aortitis were responsible for the majority of cases with extreme cardiac hypertrophy. Valvular deformities were also frequent findings. The occurrence of extreme cardiac enlargement in an elderly patient associated with multiple coronary bypasses has been not described so far.
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Affiliation(s)
- I Sinicina
- Department of Pathology, Hegau-Klinikum Singen 78207 Singen, Germany
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