Complications following cell therapy

So far, the law in the Federal Republic of Germany still allows the injection of fresh-cell preparations from animals as a roborant to increase the vitality of the organism and to strengthen the body's immune defense system. The use of "sicca-cell" preparations was provisionally forbidden in 1987 by the Federal Health Organization (Bundesgesundheitsamt; BGA). Prohibition of fresh-cell injections would have exceeded the authority of this office, although the same serious reservations also applied in the case of this treatment method. Several publications that have appeared since 1955 have reported serious complications of this therapy, some life-threatening and some even lethal. Two further cases are now added: (1) A woman aged 69 had been receiving treatment with cell injections for 9 years. Immediately after an injection of sicca cells she collapsed and was hospitalized; 7 days thereafter she developed an ascending paralysis with increasing inability to swallow or breathe. She died 25 days after the injection as a consequence of central and peripheral respiratory failure. Autopsy revealed the alterations typical for acute Landry-Guillain-Barré-Strohl syndrome. (2) A 76-year-old healthy woman had been receiving treatment with fresh-cell preparations for several years. After an injection of cell suspensions a painful local swelling was observed. The symptoms were interpreted as the consequence of an iatrogenic local hematoma, and repeated punctures were performed to obtain blood. The patient was transferred to a surgical department for further therapy. Two days after the injection she suddenly died with signs of acute cardiovascular failure. Autopsy revealed the signs of a fulminating clostridial infection and also the characteristic signs of Landry-Guillain-Barré syndrome with involvement of the autonomic nervous system. In both cases the development of an inflammatory process in the peripheral nervous system could be interpreted as an immune-mediated allergic disease, related to the repeated injection of heterologous antigenic material containing nervous tissues. This hypothesis would also explain the two other cases already published and would be consistent with the observed perivenous leukoencephalopathy of the central nervous system. The human disease pictures correspond to the well-established animal models of EAEM (experimental allergic encephalomyelitis) and EAN (experimental allergic neuritis). The pathogenesis is discussed; the major role of the central and peripheral nervous system is stressed, with special reference to the risk of acute autonomic failure. The need for specific autopsy techniques for the investigation of the entire nervous system, including spinal cord, roots, spinal ganglia and peripheral nerves with sympathetic chains, is raised.     

The "utility" principle within the scope of forensic determination of blood kinship using serostatistics

A "realistic" prior probability is always based on case experience (Akten-a-priori). In serological opinions pertaining to parentage, the realistic prior probability is only one piece of information in the whole body of evidence before the judge and does not have any special significance per se. There is no such thing as a "neutral" prior probability. It either implies "ignorance," in which case it cannot be "information," or it must be taken in connection with the utility principle, in which case it is not a "probability." The utility principle is defined in law and cannot be expressed in figures. The utility principle takes effect only when the judge reaches a decision (on the basis of all the evidence before him). It determines the relative importance of the participant's objects of legal protection which are at issue in the case. The expert is bound to apply a neutral utility component, i.e., in a two-hypothesis case (the normal situation) the significance of both the null and the counter hypothesis must carry the same weight. A null and/or a counter hypothesis can combine several single hypotheses; the mean value of their frequencies is taken. As a rule, one should avoid using a "prior case probability" ("Akten-a-priori") when calculating a W value. An "expectation of error" should be as realistic as possible and hence be obtained using a "prior case probability."     

The cutaneous ink sign: a tipoff to suicide or suicide notes

The presence of smeared or unsmeared ink on the skin resulting from the writing process has been observed in a number of suicide victims who have left suicide notes. The authors report a case of a palmar "cutaneous ink sign" and discuss its forensic science import.     

Deaths allegedly caused by the use of "choke holds" (shime-waza)

Shime-waza or the "choke hold", when properly applied, should not cause death; therefore, its primary purpose should be to subdue violent suspects. When properly applied, the choke hold causes unconsciousness in 10 to 20 s. No fatalities as a result of shime-waza have been reported in the sport of judo since its inception in 1882. Among the methods of "control holds" taught to law enforcement officers is the choke hold similar or identical to shime-waza used in judo. Using the choke hold, officers may afford themselves maximum safety while subjecting the suspect to a minimum possibility of injury. The author has reviewed 14 fatalities with autopsy findings where death was allegedly caused by the use of choke holds.