Morphological findings in Zieve's syndrome (author's transl)]

The macroscopic and microscopic findings of a case of Zieve's syndrome are described (fatty liver, icterus, hyperlipemia and hemolytic anemia in chronic alcoholism). The outstanding macroscopic finding is milky turbidity of the blood in arterial and venous vascular channels as well as hepatomegaly and anaemia of internal organs. A prominent feature of the histological picture is the high-grade lipaemia of the large and small vessels (arteries and veins), capillary occlusions resembling fat embolism in all organs and severe diffuse fatty metamorphosis of the liver. Circulatory disorders and the cause of death are discussed.     

Forensic aspects of digoxin-poisoning: toxicological and morphological findings (author's transl)]

Case report. A 82 year old woman died 80 min after accidental ingestion of 5 mg beta-methyl-digoxin. The autopsy and the histological examination revealed non-specific alterations due to shock and preexisting coronary heart disease. Digoxin levels in various fluids and tissues were estimated by radioimmunoassay: bloodplasma 20--25 ng/ml, liquor 10--13 ng/ml, liver 100--110 ng/g, kidney 130--145 ng/g; the gastric fluid contained 0,6 mg. Forensic aspects of glycosid-intoxication, especially of the varying concentrations in different tissues, are discussed.     

Delinquency under drug influence (author's transl)]

In delinquency, connected with alcohol, the immediate and acute effect of the substance is prominent, whereas in delinquency connected with drugs, one has to deal with chronic effects. The criteria for judging drunken offenders also stand as a model for judging the responsibility of the addicted offender for his crime. We consider: 1. the personality of the offender 2. the way, the amount and the point of time of the last intake of the drug 3. the potential dependence 4. the psychopathological state at the time of offense and at the time of examination 5. the kind of the offense itself. Most cases, which have to be examined, deal with indictable offenses, which were undertaken, in order to get new supply, i.e. "supply-offenes". These cases surmise, that the offender is physically addicted, that he knows about withdrawal symptoms from own experience, and that he committed the crime purely for securing his personal supply. We differentiate between direct "supply-offenses" (i.e. direct stealing by the addict himself) and indirect "supply-offenses" (i.e. mainly trading and commission business). For the latter offenses the state of consciousness and insight at the time of offense does not serve as a suitable criterion for judging the responsibility for the crime, since these offenders usually are not deprived of their drugs and therefore in a stable state of mind. Therefore the inner situation and the motivation for carrying out the crime has to be analysed carefully. For these indirect "supply-offenses" reduced responsibility for the offense has to be considered, whereas for direct "supply-offenses" a total lack of responsibility can be assumed.     

Histo-morphological findings at the chiasma opticum in cases of craniocerebral trauma (author's transl)]

36 cases with pituitary haemorrhages were found histologically in 52 cases of lethal craniocerebral trauma. Simultaneously we found primary and secondary traumatic changes of chiasma opticum in 10 cases. The genesis and significance of the results are discussed.     

Acute lethal alcohol intoxication (author's transl)]

In 14,744 autopsy cases from an 18-year period 92 cases (of which 7 were ruled out because of decomposition were observed in which death was supposed to be due to direct acute alcoholic intoxication. In the police reports 81 persons were designated as chronic alcoholics or abusers of spirits. The blood alcohol level ranged between 2.04 and 4.92 o/oo. The cases studied were divided into two groups, one with low and the other with high lethal alcohol level. Fatty liver and cirrhosis were found with identical frequency in the two groups, whereas cardiac hypertrophy of obscure origin occurred markedly more often in the group with low lethal blood alcohol level. On the basis the possible mechanism of death in the cases with cardiac hypertrophy is discussed. Finally, the relation between the blood and urine alcohol concentrations observed in 72 cases is discussed. On the assumption that the water phase of the blood was 75 per cent of the total blood, death occurred in the persons without cardiac hypertrophy with fairly identical frequency either in the phase of absorption or the phase of elimination, whereas in the persons with cardiac hypertrophy death most often occurred in the phase of absorption. These statements should, however, be taken with some reservation, partly because the water phase of the blood may vary considerably post mortem (60-90 per cent) and partly because the urine alcohol concentration depends on serval variable factors.     

Organic lesions after application of hashish in rats and rabbits (author's transl)]

Toxic lesions were found in liver, kidney and brain of rats and rabbits after oral application of hashish for 7 or 30 days. The brain tissue showed hyperemia and edema. The cerebral cortex, brain stem and cerebellum contained ganglion cells with eccentric nuclei and an icreased number of nucleoli. Different stages of cell lesions could be distinguished by nuclear vacuoles, pyknosis and karyolysis. The cytoplasma was loosened and showed numerous vacuoles. In the kidney we found, besides interstitial hemorrhage, cloudy swelling of the proximal tubules with vacuolous degeneration and nuclear pyknosis and karyolysis in all stages. The glomeruli were often enlarged with thickening of Bowman's capsule and surrounding cellular infiltration with cell fragments. The liver cells showed irregularities of nuclei and vacuolated nuclei, plasma vacuoles and cell necrosis. Infiltrations of round cells at the portal-biliary areas were usually combined with an activation of the Kupffer cells and intracellular bile stasis.     

Mesothelioma of the septum interatriale (author's transl)]

Sudden death of a 21-year-old women. The cause of death was mesothelioma situated in the region of the interatrial septum that has been manifested since childhood as a complete heart block. Neither gravidity nor delivery led to the aggravation of her state of health. The cause of this heart lesion, which was the mentioned rare tumor, was discovered only during the autopsy.     

Post mortem determination of bromureides (author's transl)]

Concentrations of carbromal, carbromide and bromisoval are determined in blood, urine, brain, kidney and muscle taken at autopsy from 41 fatal cases after overdosage of bromureides. In addition values of total bromine in blood are presented. Contents of total bromine can only lead to the deduction that a chronical abuse of bromureides is existent or not. Concentrations of bromureides and carbromide show a wide range according to the different time between taking the drug and death particularly in cases of pure carbromal intoxications which sometimes cause death after several days. In such cases quantitative determination of carbromide, a pharmacologically active metabolite of carbromal, is the only way to prove an acute carbromal intoxication. Especially in cases of additional foreign substances death may occur in early the phase of poisoning. Bromureides decompose post mortem by putrefaction a high degree so that the condition of the cadaver is important. Brain tissue is the most usable material for examination but other organs, particularly muscle and kidney, can be analysed with success. For differential diagnosis fatal cases are presented which were not caused by drug intake.     

Examinations to phenomenon of shock-lung (author's transl)]

The pathogenesis of shock lung as well as the success of therapy in this condition was studied in 79 cases of extrathoracic trauma. The water-, hemoglobin-, and DNA contents of the lungs were measured in order to determine the extent of edema, the rate of perfusion, and proliferation. The cases were divided into two groups according to whether they had or had not received medical therapy before death. The data from these two groups were compared using statistical methods in which time of survival was especially taken into account. The fluid balance, pO2, pCO2, central venous pressure, pH of the serum, total serum protein and serum creatinine were also studied in these cases. Results of the study are as follows. Three phases of the posttraumatic syndrome of shock-lung could be distinguished: phase I (initial phase): blood perfusion is increased, edema is beginning to form, and medical treatment has not yet begun. Phase II (early phase = sydrome of early respiratory failure): pulmonary edema is developing rapidly while perfusion is decreasing. Phase III (late phase = syndrome of late respiratory failure): proliferative changes predominante and the edema is still increasing. The mean weight of the lungs was 397 g (s = 170) in phase I, 774 G (S = 361) In phase II, and 1124 g (s = 310) in phase III. The survival times correlated significantly and positively with the amount of water and DNS in the lungs and significantly and negatively to the amount of hemoglobin in the lungs. Thus, increasing pulmonary edema and increasing proliferative changes occurred with decreasing pulmonary perfusion. This correlation was even noted in groups of patients who had not received medical treatment and whose survival times were short. In treated cases, the fluid balance was significantly and negatively correlated to the total serum protein.     

Exceptional suicide of a physician (author's transl)]

A 57 years old psychiatrist committed suicide through insufflation of powder from a chemical fire extinguisher his respiratory and gastrointestinal tract. Death was due not to mechanically induced asphyxia but to asystolia. The latter disturbance is explained as a vagal reaction to trauma because of the characteristic position of the corpse at the scene and because the victim did not exhibit any signs of gas or foreign body embolism. A further point of interest in the context of trauma mechanism, is the absence of significant disruptions in spite of the high pressure (10-12 atu) developed by the extinguisher. No conclusive interpretation can be given about the psychological mechanisms behind this suicidal act. On the other side the modality of the procedure used by the victim became manifest already a few months before the critical act.     

Suicides in hospitals of Vienna (author's transl)]

An analysis of the autopsies ordered by the Viennese Forensic and Health Authorities between 1967 and 1976 has shown that 2.3% of all suicides were committed in hospitals. Two thirds of the 77 examined cases were carried out by males. Thirty-five patients were in stationary psychiatric treatment; their average age was 50.7 years. In all other kinds of hospitals 42 (mostly male) patients committed suicide at an average age of 65.3 years. Preferred methods of performance were jump and fall from height (44.1%) and hanging (40.3%). Rare methods used were one case of abdominal incisions (harakiri), one self-strangulation, and one case of suffociation in plastic bags. The act was usually accomplished early in the morning or in the late afternoon. Among the suicidal patients who were hospitalized because of organic diseases those with malignant neoplasms [18] and cardiovascular diseases [12] were predominant. Also taking the suicides outside hospitals into consideration the numerical ratio between natural deaths due to cancer and the suicides of cancer patients is about 1:1,000. Amont the suicides in psychiatric institutions schizophrenics [11] and endogenous depressives [7] were the most numerous. In 4 cases the suicide was preceded by acts of injury or homicide.     

Mechanical tolerance of tentorium cerebelli (author's transl)]

In some cases of accidents primary traumatic brain stem hemorrhages are seen in conjunction with lesions of the tentorium cerebelli. In order to decide, whether accelerations of the infra- or supratentorial brain tissue are actually capable of causing tentorium lesions, burst and teartests of tentorium tissue were conducted. The mean dynamic biaxial tearing force was found to be about 4 bar. This value supports the hypothesis that a main injury causing factor of the tentorium in cases without skull fracture could be the relative motion between the tentorium and the brain hemispheres. The mass of the cerebellum however seems to be insufficient to cause such injury producing deceleration forces on the tentorium.     

Impairment of performance by alcohol and diazepam (author's transl)]

An investigation was carried out on the effect of the intake of diazepam and alcohol on simple performance tests. The combined administration of diazepam and alcohol led to an increase of the plasma diazepam concentration as compared to that obtained after diazepam without alcohol. Furthermore, after combined intake of diazepam and alcohol a decrease of performance was observed, that was significantly higher, than the effects obtained after either alcohol or diazepam alone. This impairment was especially noticeable duirng the first hour of the experiment, i.e. until the plateau of the diazepam plasma concentration was reached, while afterwards a correlation between diazepam plasma concentration and impairment of performance could not be established. The relevance of these findings for the interpretation of diazepam plasma concentrations in relation to the impairment of performance are discussed.     

Exhumation for suspected poisoning--reticulum cell sarcoma (author's transl)]

A 57-year-old woman showed somnolence, extreme stiffness of the neck and atypical CSF findings which led to her death within a few days. During legacy controversy the possibility of poisoning was considered. The post mortem, pathological and toxological examinations of the exhumed corpse permitted the diagnosis of reticulum cell sarcoma 16 months after death. Such a diagnosis 16 months after death has, to our knowledge, not previously been reported.