Differential diagnosis: blue gastric mucosa. Post-mortem staining of the gastric mucosa with methylene blue

An intense discoloration of the gastric mucosa or the gastrointestinal tract found at autopsy gives rise to the question of its cause. Such discolorations are mostly described in the context of intoxications. However, traditional foods and diagnostic procedures using indicator dyes can also lead to an unusual discoloration of the mucous membranes. The authors report on the autopsy findings in a man who died from a bleeding gastric ulcer and whose gastric mucosa showed intense blue discoloration. Experimental postmortem examinations (on stomachs) were performed with methylene blue, a dye used in gastroenterology, resulting in a blue discoloration resembling the appearance of the stomach in the autopsy case. Together with the outcome of the toxicological analyses, the experiments pointed to a diagnostic procedure using methylene blue (chromoendoscopy).     

An unusual case of a double casualty during sexual intercourse

Sudden death during sexual activity is generally caused by natural diseases, like coronary sclerosis and myocardial infarction. Only a few case reports describe outer circumstances as responsible for the fatal outcome. This is a case report of a couple that drowned within a car sinking into a river. The extraordinary scenery led to the supposition that sexual intercourse was involved with these fatalities. The victims--a young woman and a young man, both had children, the man was married--kept up an extramarital liaison. Both were reported missing by their relatives days before the corpses could be recovered.     

Editorial

Ohne Zusammenfassung

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Editorial

     

An initially unexplained death during prison sentence. Diagnostic verification by atomic absorption spectrometry

The authors report on the death of a 25-year-old man due to electric current in prison, which was not recognized at first. The fatal accident was caused by a self-made electric kettle. The only electrothermal skin lesions were some pinhead-sized electric marks on the left thumb. Careful external inspection of the body in combination with an analysis of the conductor material (aluminium) by means of atomic absorption spectrometry (AAS) revealed the cause of death and the source of accidental electrocution.     

3 case examples of intravital maggot infestations

The authors report on three cases of myiasis which rarely occurs in the civilized world. Poor social conditions, old age, alcoholism, diabetes and vascular occlusive disease were predisposing co-factors. All three victims showed large necrotizing skin ulcerations, but in no case a generalized infection had developed. Therefore the probable benefit from the maggot infestation concerning these ulcerating skin lesions is discussed. For centuries clinicians have observed that maggots provide debridement of necrotic wounds particularly in Military Medicine. With the advent of antibiotics their therapeutic use declined. Recently "biosurgery" (syn. maggot or larval therapy) again became a promising tool for therapy of infected, necrotizing skin-ulcerations. Besides wound debridement marked anti-microbial activity and secretion of proteolytic enzymes could be detected. Maggot debridement is an valuable and cost-effective treatment option for patients with nonhealing wounds.     

Sudden death resulting from epidermoid cyst of the brain

Epidermoid cysts of the brain are rare tumor-like lesions, most often of maldevelopmental origin. They are benign in nature, causing symptoms depending on their localization. Surgical resection leads to excellent results. A case is reported of a 68-year-old-man who died suddenly and unexpectedly. Postmortem examination revealed signs of central dysregulation and a bifrontal epidermoid cyst. To the authors' knowledge, death resulting from epidermoid cyst of the brain has not been reported so far.     

The Foreign and European Policy of the German Lander

Although the German federal government is responsible underthe Basic Law for foreign affairs, the Länder may, undercertain circumstances, conclude treaties with the consent ofthe federation. The Länder have also become involved directlyand indirectly in other international activities. European integration,especially through the European Communities (EC), presents theLänder with new challenges. The Länder have soughtmeans to influence the federal government and the EC Commissionand Council of Ministers, in order to protect their sphere ofautonomous decisionmaking, but EC procedures and the realitiesof federal government involvement do not place the Länderin a strong negotiating position.     

Attitudes of people with disabilities toward physician-assisted suicide legislation: broadening the dialogue

This article presents the methods, findings, and implications of a participatory action research project that attempted to shed additional light on the debate over death with dignity (DWD) or physician-assisted suicide (PAS) legislation. In-depth, qualitative interviews with forty-five physically disabled residents of the San Francisco Bay Area, conducted by others with disabilities, revealed a wide breadth of opinions about and attitudes toward such legislation. For close to half of the participants, the desire for autonomy in making end-of-life decisions was a primary concern, yet fear that PAS legislation could violate this autonomy in various ways was a deep concern as well. Also reported were widespread accounts of disability-based discrimination and frequent expressions of fear about openly discussing positions that diverge from the official, publicly held opinions of disability leaders who oppose such legislation. The findings support those of a recent Harris poll demonstrating considerable diversity of opinion about PAS legislation among people with disabilities. The findings further suggest the need for additional research on the apparent disjunction between the diversity of attitudes held by those interviewed and the more unified position taken by many disability activists. Use of the study findings to promote greater dialogue within the community and to better position people with disabilities to take their place at the policy table also is discussed. In addition, the findings are seen as reinforcing the need for the public health community to become more engaged in this central ethical debate.