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  • 1
    ISSN: 1434-5196
    Keywords: Schlüsselwörter Rechtsmedizin ; Didaktik ; Ökologischer Kurs ; Unterrichtsevaluation ; Keywords Legal medicine ; Didactic ; Ecology course ; Evaluation of instruction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Description / Table of Contents: Abstract In the winter semester 1998/1999 the course of legal medicine included 26 h of obligatory teaching. The course consists of several seminars of 2 h and an accompanying lecture. The contents of the seminars included a practical execution of an external post-mortem examination, participation at an autopsy with recording of the findings and subsequent discussion, legal aspects of the medical profession as well as clinical-forensic opinions on injuries. The acceptance of the curriculum could be verified by a questionnaire filled out by the students. Of the 361 students, 72% participated in the survey. The course was graded with an average of 1.7 on an scale of 1–6. The answers on the structure and content of lectures were graded on a scale from 1 (not relevant) to 7 (relevant). The logical construction, organisation, presentation and interest value of the topics were graded with an average of 6 points. A continual evaluation is also planned for subsequent semesters.
    Notes: Zusammenfassung Der Kurs Rechtsmedizin an der Medizinischen Hochschule Hannover sah im Wintersemester 1998/99 für jeden Studierenden ¶26 Pflichtstunden vor. Er bestand aus mehreren 2-stündigen Seminaren und einer kursbegleitenden Vorlesung. Die Seminare hatten folgende Inhalte: Praktische Durchführung einer Leichenschau, Teilnahme an einer Sektion mit Protokollerstellung und Nachbesprechung, Berufsrecht und -kunde sowie klinische Rechtsmedizin mit Verletzungsbegutachtung. Zusammen mit den zusätzlichen Lehrangeboten umfasste die Lehre für das Fach Rechtsmedizin etwa 15 Semesterwochenstunden. Die Akzeptanz des Curriculums sollte durch eine Befragung der Studierenden überprüft werden. Von insgesamt 361 Studierenden beteiligten sich 72% an der Befragung. Auf einer Notenskala von 1–6 wurde der Kurs insgesamt mit der Durchschnittsnote 1,7 bewertet. Auf einer Skala von 1 (= trifft nicht zu) bis 7 (= trifft zu) wurden Aussagen zu Struktur und Inhalt von Vorlesungen und Seminaren eingeordnet. Mit einer durchschnittlichen Bewertung von über 6 Punkten wurden logischer Aufbau, Organisation, Anschaulichkeit und interessante Darbietung des Stoffes bewertet. Auch für die kommenden Semester ist eine kontinuierliche Lehrevaluation vorgesehen.
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  • 2
    ISSN: 1437-1596
    Keywords: SIDS ; Infection ; Rhinitis ; Upper respiratory tract
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Notes: Abstract The nasal cavities were examined in 56 cases of sudden infant death syndrome (SIDS) and 26 control cases and the following criteria were compared: inflammatory infiltration of the nasal mucosa (SIDS 59% — controls 65%;P = 0.577), diapedesis of inflammatory cells (SIDS 38% — controls 42%;P = 0.678), epithelial desquamation (SIDS 62% — controls 85%;P = 0.043); hyperemia (SIDS 66% — controls 65%;P = 0.951) and hypersecretion of the seromucous glands (SIDS 55% — controls 69%;P = 0.233). Only epithelial desquamation was found significantly more often in the controls than in SIDS cases, but these alterations are unspecific and are influenced by the postmortem interval. The intensity of rhinitis was not different between the SIDS and control groups. The frequency of rhinitis is therefore not specific for the sudden infant death syndrome, and seems to be merely a result of the high incidence of upper respiratory tract infections in this age group. We speculate, however, that infections of the nose in conjunction with other factors, such as prone position, covering of the head, hyperthermia, parental smoking and immaturity of the central nervous system, could play a role in the pathogenesis of the sudden infant death syndrome.
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  • 3
    ISSN: 1437-1596
    Keywords: SID ; SIDS ; Hyperthermia ; Swaddling ; Death scene investigation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Notes: Abstract To determine whether preterminal hyperthermia is significantly associated with sudden infant death (SID), 140 structured interviews with parents of SID victims were compared with questionnaires filled in by a control group of parents living in the same area. All SID autopsies were performed between 1986 and 1992 at the Institute of Legal Medicine of Hannover Medical School according to the same protocol. Signs of profuse sweating (i.e. moist head, damp clothing or bedding) were present at the scene of death in 35.7% of cases. SID victims with signs of profuse sweating were more frequently found under their bedding (p 〈 0.001), were older (178 vs. 130 days) and the time period between when they were last seen alive and when they were found dead was longer (6.5 vs. 4.5 hours p 〈 0.01) compared to cases without sweating. Sweat on the head [odds ratio (OR) = 1.9; 95% confidence interval (CI) = 1.0, 3.6], and sweaty clothing and bedding (OR = 17.9; 95% CI = 8.7; 37.1) showed a significant association with the risk for SID. The pathophysiological basis for hyperthermia in SID remains to be determined. Hyperthermia could result from infection, overinsulation from excessive clothing with high environmental temperatures, covering of the infant's head or immature central thermoregulatory centres. The influence on the fatal outcome and the role in the pathogenesis of these deaths requires further research.
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  • 4
    ISSN: 1437-1596
    Keywords: Key words Sudden infant death syndrome ; Prone ; position ; Face-down position ; Hypoxia ; Death-scene investigation ; Head covering
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Notes: Abstract We examined the position of the body and head, and the covering of the head by bedding on discovery in cases of sudden infant death (SID) in Lower Saxony. Between 1.1.1986 and 31.12.1992 structured, questionnaire-based interviews were carried out with parents of 140 SID victims. Control data were taken from a population-based cross-sectional study on infant sleeping position performed by the German Health Office (BGA) in autumn 1991. Of the SID cases 86.4% were discovered in the prone position [odds ratio (OR) = 7.4, 95% confidence interval (CI) = 4.3, 12.7] and 41.4% were found with the head covered. These infants were significantly older than those where the head was uncovered (p 〈 0.001) and covering of the head showed a significant association with a risk of SID (OR = 20.8; 95% CI = 11.5–37.6). Of the SID cases 27.9% were discovered in the face-down position. These infants were significantly younger than the infants who were discovered with the head in a side or supine position (p 〈 0.001). This study confirms the increased risk of SID associated with the prone position and suggests that this association could be related to the development of hypoxaemia or hypercapnia. Together with other factors such as heat stress or an infection, hypoxaemia or hypercapnia could culminate in SID if the arousal from sleep and auto-resuscitation apparently fails.
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  • 5
    ISSN: 1437-1596
    Keywords: Backspatter ; Blood stain morphology ; Close-range shots to the head ; Gunshot wounds ; Reconstruction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Notes: Abstract Backspatter is the ejection of biological material from a gunshot entrance wound against the line of fire. Backspatter of blood was investigated experimentally in transverse gunshots to the heads of calves (n=9) from shooting distances of 0–10 cm. The resulting bloodstains were documented on white paper placed horizontally 60 cm below the impact site. The morphology of bloodstains and the distribution of microstains (diameter 〈0.5 mm) is reported. The number of microbackspatter stains per gunshot varied between 39 and 262 and the maximum travelling distance was 69cm while the vast majority of microdroplets accumulated between 0 and 40cm. The direction a single droplet can take comprises every possible angle between the most tangential ones to the skin surface. Microstains exclusively were circular to slightly oval. The morphology of macrobackspatter stains (diameter 〉0.5 mm) varied from round to elongated with circular, drop-like and stains in the form of exclamation marks predominating. Small macrostains (0.5–4 mm) made up more than 90% of the macrostains and no systematic relationship between distance travelled and size of the stains could be established. The necessity of appropriate lighting and magnification in the investigation of surfaces for backspatter is stressed because many microstains are located in the proximity of the entrance wound where the firearm and the shooting hand are located in cases of close-range shots.
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  • 6
    ISSN: 1437-1596
    Keywords: Key words Bronchus-associated lymphoid tissue ; (BALT) ; Larynx-associated lymphoid tissue (LALT) ; Respiratory mucosal immunity ; Sudden infant ; death/syndrome (SID/S) ; Young children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Notes: Abstract The respiratory tract of children in the first two years of life, unlike that of adults, contains bronchus-associated lymphoid tissue (BALT) and larynx-associated lymphoid tissue (LALT) with no differences in frequency between SID and control children. Using immunohistochemical methods we examined the distribution of B, T, CD4+ and CD8+ lymphocytes, HLA-D+ cells, CD68+ macrophages and proliferating cells, comparing bronchus-associated and larynx-associated lymphoid tissue of sudden infant death cases and controls. In all groups the lymphoid tissue was organized in lymphoid follicles and parafollicular areas. With no differences in the cellular composition of BALT and LALT the lymphoid follicles contained mainly B lymphocytes with some CD4+ lymphocytes in the germinal centers. Remarkably T lymphocytes of both subset types and B lymphocytes were observed in equal numbers in the parafollicular areas in contrast to gut-associated lymphoid tissue. However, the respiratory tract of young children with no differences between SID and controls might play a similar role in mucosal immunity and might function as an inductive site.
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  • 7
    ISSN: 1437-1596
    Keywords: Kehlkopfveränderungen, plötzlicher Tod ; plötzlicher Tod, Kehlkopfveränderungen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Description / Table of Contents: Zusammenfassung Mehrere in letzter Zeit beobachtete Fälle eines “plötzlichen Todes” durch Kehlkopfveränderungen gaben Anlaß zur eingehenden Erörterung dieser Problematik, zumal im Institut für Rechtsmedizin der Universität München unter 10 747 Obduktionen in den Jahren 1949 bis 1970 nur 6 Fälle gefunden wurden. Nach einer kurzen Beschreibung des anatomischen Aufbaues vom Kehlkopf werden entsprechend der in der allgemeinen Pathologie benutzten Gliederung die 4 Faktoren angeführt, die ätiologisch Ursache eines Kehlkopfverschlusses sein können: 1. Fehlbildungen 2. Kreislaufstörungen 3. Entzündungen 4. Geschwulstbildungen. Jeder der genannten Faktoren wird gesondert erörtert und die Fälle aus unserem Beobachtungsgut ihnen entsprechend zugeordnet. Neben der Frage nach der rechtsmedizinischen Bedeutung derartiger Todesfälle wird die Schwierigkeit der Beurteilung mancher pathomorphologischer und feingeweblicher Befunde diskutiert. Gleichzeitig wird auf die oft leere Anamnese hingewiesen, so daß lebensrettende Maßnahmen, wie zum Beispiel die Notfalltracheotomie und anderes, gar nicht oder sehr spät einsetzen können. Abschließend wird die Problematik der forensischen Begutachtung diskutiert, die sich bei der Abgrenzung der Larynxzysten hinsichtlich ihrer Ätiologie ergibt. Hier ist die Abklärung eines Kausalzusammenhanges zu eventuell vorangegangenen Intubationen von besonderer Bedeutung.
    Notes: Summary Several recently observed cases of “Sudden Death” caused by larynx lesions give reason for a special discussion of this problem. At the Institute of Legal Medicine only six cases were found in 10.747 autopsies between 1949 and 1970. A brief description of the anatomical structure of the larynx is followed by a discussion of the 4 general pathological entities, which might be the etiological cause of laryngeal obstruction: 1. Abnormalities 2. Disturbances of circulation 3. Inflammations 4. Tumors Besides the question of the forensic-medical importance of such fatal cases, the difficulty of evaluating some of the patho-morphologic and histologic findings is discussed. Simultaneously attention is drawn to the frequent lack of a clinical history, so that life-supporting measures such as tracheotomy and others are applied very late or not at all. Finally the problem of forensic evaluation of larynx-cysts and their etiology is presented. In this context the clarification of a causal relationship with possible previous intubations of the larynx is of major importance.
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  • 8
    ISSN: 1437-1596
    Keywords: Alpha-1-antichymotrypsin ; Alpha-2-macroglobulin ; Lysozyme ; Immunohistochemistry Wound age ; Alpha-1-Antichymotrypsin ; Alpha-2-Makroglobulin ; Lysozym ; Immunhistochemie Wundalter
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Description / Table of Contents: Zusammenfassung Die Verteilung der Proteinasehemmer alpha-1-Antichymotrypsin (α-1-ACT) and alpha-2-Makroglobulin (α-2-M) sowie die Verteilung von Lysozym wurde in 27 intravitalen Hautwunden, drei postmortalen Hautwunden und in neun Entnahmen unverletzter Haut immunhistochemisch untersucht. Die intravitalen Wundränder zeigten mit allen untersuchten Antikörpern deutliche positive Reaktionen (α-1-ACT 66,6%; α-2-M 51,9%; Lysozym 25,9%). Der gegenüberliegende, vital unverletzte Hautrand wies jedoch bei diesen Entnahmen ebenfalls häufig schwache Reaktionen auf (α-1-ACT 51,8%; α-2-M 37,0%; Lysozym 25,9%). In nicht wenigen Fällen war diese Reaktion jedoch so stark, daß der vital unverletzte und erst durch die Hautprobenentnahme postmortal entstandene Schnittrand von der vital entstandenen Wunde nicht zu unterscheiden war (α-1-act 22,2%; α-2-M 29,6%, Lysozym 59,2%). In den Kontrollfällen (Entnahmen unverletzter Haut) fanden sich mit allen drei Antikörpern in nahezu der Hälfte der Fälle geringe positive Reationen, die jedoch aufgrund der Intensität nicht mit deutlich positiv reagierenden Hautwunden verwechselt werden konnten. Als Ursache der falsch positiven Farbreaktionen kommen artefizielle Verunreinigungen infolge Kontakts mit Serumbestandteilen, fortgeschrittene Autolyse des Präparates, Einflüsse der Fixierung und Vertrocknungen der Hautränder in Betracht. Die immunhistochemische Untersuchung von α-1-ACT, α-2-M und Lysozym ergibt zwar häufig Hinweis auf Vitalität einer Wunde, kann diese jedoch nicht beweisen, da eine sichere Differenzierung von richtig- bzw. falsch-positiven Reaktionen nicht in allen Fällen gelingt.
    Notes: Abstract The distribution of the proteinase inhibitors alpha-1-antichymotrypsin (α1-act), alpha-2-macroglobulin ((α-2-m) and lysozyme was analysed immunohistochemically in 27 intravitally acquired wounds, 3 postmortem skin lacerations and 9 specimens of undamaged skin. Intravitally acquired wounds demonstrated distinct positive reactions for all antibodies examined (α-1-act 66.6%; α-2-m 51.9%; lysozyme 25.9%). However the undamaged skin margins opposite the wound margins also gave positive reactions (a-l-act 51.8%; (α-2-m 37.0%; lysozyme 25.9%). Nearly half of the control cases (specimens of undamaged skin) exhibited weak positive reactions for all 3 antibodies. These could be easily distinguished from the strong positive reactions observed in intravitally acquired wounds. False positive reactions were observed due to contamination resulting from contact with serum components, in cases of advanced autolysis of specimens, and as a result of fixation and drying artefacts. Even though immunohistochemical studies of α-1-act, (α-2-m and lysozyme give some indications concerning wound vitality, they cannot be considered as proof because irrefutable differentiation of true positive and false positive reactions is not possible in all cases.
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  • 9
    ISSN: 1437-1596
    Keywords: Forensic serology, Hp subtypes ; Haptoglobin subtyping, by isoelectric focusing ; Forensische Serogenetik, Hp-Subtypen ; Haptoglobin-Subtypisierung
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Description / Table of Contents: Zusammenfassung Beschrieben wird eine Methode zur Haptoglobin-Subtypisierung mittels isoelektrischer Fokussierung im 0,2 mm Ultradünnschicht-Polyacrylamidgel nach ionenaustauschchromatographischer Isolierung und reduktiver Spaltung des Haptoglobins. Durch die Anwendung ultradünner Gele wird bei geringem Zeit- und Materialaufwand eine hohe isoelektrophoretische Auftrennung der Hp-Subtypen erreicht sowie eine sequentielle Visualisierung durch Fixierung und Protein-Färbung ermöglicht. Die Subtypenverteilung in einer Stichprobe von 1500 unverwandten Erwachsenen aus Hannover und Niedersachsen wird mitgeteilt, aus der sich folgende Allelfrequenzen errechnen: Hp*2FF=0,0030; *2FS=0,5620; *2SS=0,0290; *1F=0,1537; *1S=0,2523. Die Segregationsanalyse bei 68 Familien zeigt keine Abweichung vom autosomal-kodominanten Erbgang. Für die untersuchte Population beträgt die isolierte Vaterschaftsausschlußchance des subtypisierten Hp-Systems 33,91%.
    Notes: Summary This report describes a method for subtyping haptoglobin by means of isoelectric focusing in 0.2-mm ultrathin-layer polyacrylamide gels. Haptoglobin (Hp) is purified by ion-exchange chromatography and reduced. The well-known advantages of ultrathin-layer gels combine high isoelectrophoretic resolution of the Hp subtypes with less demands for time and material and make sequential visualization by fixation and protein staining possible. The distribution of the Hp subtypes in 1500 unrelated adults from Hanover and Lower Saxony is presented. Allelic frequencies are calculated to be: Hp*2FF=0.0030; *2FS=0.5620; *2SS=0.0290; *1F=0.1537; *1S=0.2523. Segregation analysis for 68 matings shows an autosomal codominant mode of transmission in all cases. For the population investigated the chance of isolated paternity exclusion with the subtyped Hp system amounts to 33.91%.
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  • 10
    ISSN: 1437-1596
    Keywords: Key words Proteinase inhibitors ; Fibronectin ; Lysozyme ; Immunohistochemistry ; Autolysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Notes: Abstract The influence of postmortem damage of tissues on the immunohistochemical diagnosis of wound age has not as yet been clarified. We utilized antibodies against the proteinase inhibitors α-1-antichymotrypsin and α-2-macroglobulin, fibronectin and lysozyme to study samples of skin which had been intact intravitally, but were damaged postmortem either by autolysis or compression with a surgical clamp at the time of dissection. Even in the absence of autolysis, antibodies against the proteinase inhibitors and fibronectin exhibited staining of tissue margins. Autolysis caused an increase in false positive results. In contrast, antibodies against lysozyme did not give false positive staining. There were no antigens sensitive to postmortem clamping and false positive results were not observed. Antibodies against proteinase inhibitors are not useful for the diagnosis of wound age because of a high number of false positive reactions in marginal areas. Fibronectin also showed false positive band-shaped staining patterns at the tissue margin. In addition, autolytic processes increase the number of false positives. The antibody against lysozyme is much less sensitive to autolysis and no false positive reactions were observed in our series of tests.
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