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Pfäfflin F, Stegemann MS, Heim KM, Achterberg S, Pfitzner U, Götze L, Oesterhelweg L, Suttorp N, Herzog C, Stadtmann B, Uhrig A. Preparing for patients with high-consequence infectious diseases: Example of a high-level isolation unit. PLoS One 2022; 17:e0264644. [PMID: 35239726 PMCID: PMC8893674 DOI: 10.1371/journal.pone.0264644] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Patients with high-consequence infectious diseases (HCID) are rare in Western Europe. However, high-level isolation units (HLIU) must always be prepared for patient admission. Case fatality rates of HCID can be reduced by providing optimal intensive care management. We here describe a single centre’s preparation, its embedding in the national context and the challenges we faced during the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic.
Methods
Ten team leaders organize monthly whole day trainings for a team of doctors and nurses from the HLIU focusing on intensive care medicine. Impact and relevance of training are assessed by a questionnaire and a perception survey, respectively. Furthermore, yearly exercises with several partner institutions are performed to cover different real-life scenarios. Exercises are evaluated by internal and external observers. Both training sessions and exercises are accompanied by intense feedback.
Results
From May 2017 monthly training sessions were held with a two-month and a seven-month break due to the first and second wave of the SARS-CoV-2 pandemic, respectively. Agreement with the statements of the questionnaire was higher after training compared to before training indicating a positive effect of training sessions on competence. Participants rated joint trainings for nurses and doctors at regular intervals as important. Numerous issues with potential for improvement were identified during post processing of exercises. Action plans for their improvement were drafted and as of now mostly implemented. The network of the permanent working group of competence and treatment centres for HCID (Ständiger Arbeitskreis der Kompetenz- und Behandlungszentren für Krankheiten durch hochpathogene Erreger (STAKOB)) at the Robert Koch-Institute (RKI) was strengthened throughout the SARS-CoV-2 pandemic.
Discussion
Adequate preparation for the admission of patients with HCID is challenging. We show that joint regular trainings of doctors and nurses are appreciated and that training sessions may improve perceived skills. We also show that real-life scenario exercises may reveal additional deficits, which cannot be easily disclosed in training sessions. Although the SARS-CoV-2 pandemic interfered with our activities the enhanced cooperation among German HLIU during the pandemic ensured constant readiness for the admission of HCID patients to our or to collaborating HLIU. This is a single centre’s experience, which may not be generalized to other centres. However, we believe that our work may address aspects that should be considered when preparing a unit for the admission of patients with HCID. These may then be adapted to the local situations.
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Affiliation(s)
- Frieder Pfäfflin
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- * E-mail:
| | - Miriam Songa Stegemann
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Katrin Moira Heim
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Stephan Achterberg
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ursula Pfitzner
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Louise Götze
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Lars Oesterhelweg
- Institute of Legal Medicine and Forensic Sciences, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Norbert Suttorp
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Christian Herzog
- Centre for Biological Threats, Strategy and Incident Response, Robert Koch-Institute, Berlin, Germany
| | - Benjamin Stadtmann
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Alexander Uhrig
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Meinhardt J, Radke J, Dittmayer C, Franz J, Thomas C, Mothes R, Laue M, Schneider J, Brünink S, Greuel S, Lehmann M, Hassan O, Aschman T, Schumann E, Chua RL, Conrad C, Eils R, Stenzel W, Windgassen M, Rößler L, Goebel HH, Gelderblom HR, Martin H, Nitsche A, Schulz-Schaeffer WJ, Hakroush S, Winkler MS, Tampe B, Scheibe F, Körtvélyessy P, Reinhold D, Siegmund B, Kühl AA, Elezkurtaj S, Horst D, Oesterhelweg L, Tsokos M, Ingold-Heppner B, Stadelmann C, Drosten C, Corman VM, Radbruch H, Heppner FL. Olfactory transmucosal SARS-CoV-2 invasion as a port of central nervous system entry in individuals with COVID-19. Nat Neurosci 2021; 24:168-175. [PMID: 33257876 DOI: 10.1038/s41593-020-00758-5] [Citation(s) in RCA: 806] [Impact Index Per Article: 268.7] [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: 06/13/2020] [Accepted: 11/12/2020] [Indexed: 02/07/2023]
Abstract
The newly identified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19, a pandemic respiratory disease. Moreover, thromboembolic events throughout the body, including in the CNS, have been described. Given the neurological symptoms observed in a large majority of individuals with COVID-19, SARS-CoV-2 penetrance of the CNS is likely. By various means, we demonstrate the presence of SARS-CoV-2 RNA and protein in anatomically distinct regions of the nasopharynx and brain. Furthermore, we describe the morphological changes associated with infection such as thromboembolic ischemic infarction of the CNS and present evidence of SARS-CoV-2 neurotropism. SARS-CoV-2 can enter the nervous system by crossing the neural-mucosal interface in olfactory mucosa, exploiting the close vicinity of olfactory mucosal, endothelial and nervous tissue, including delicate olfactory and sensory nerve endings. Subsequently, SARS-CoV-2 appears to follow neuroanatomical structures, penetrating defined neuroanatomical areas including the primary respiratory and cardiovascular control center in the medulla oblongata.
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Affiliation(s)
- Jenny Meinhardt
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Josefine Radke
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, CCCC (Campus Mitte), Berlin, Germany
| | - Carsten Dittmayer
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jonas Franz
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
- Campus Institute for Dynamics of Biological Networks, University of Göttingen, Göttingen, Germany
- Max Planck Institute for Experimental Medicine, Göttingen, Germany
| | - Carolina Thomas
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
- Max Planck Institute for Experimental Medicine, Göttingen, Germany
| | - Ronja Mothes
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Michael Laue
- Centre for Biological Threats and Special Pathogens (ZBS), Robert Koch Institute, Berlin, Germany
| | - Julia Schneider
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany
| | - Sebastian Brünink
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany
| | - Selina Greuel
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Malte Lehmann
- Division of Gastroenterology, Infectiology and Rheumatology, Medical Department, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Olga Hassan
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Tom Aschman
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Elisa Schumann
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, CCCC (Campus Mitte), Berlin, Germany
| | - Robert Lorenz Chua
- Center for Digital Health, Berlin Institute of Health (BIH) and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christian Conrad
- Center for Digital Health, Berlin Institute of Health (BIH) and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Roland Eils
- Center for Digital Health, Berlin Institute of Health (BIH) and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Health Data Science Unit, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Werner Stenzel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Marc Windgassen
- Institute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Larissa Rößler
- Institute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hans R Gelderblom
- Centre for Biological Threats and Special Pathogens (ZBS), Robert Koch Institute, Berlin, Germany
| | - Hubert Martin
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Andreas Nitsche
- Centre for Biological Threats and Special Pathogens (ZBS), Robert Koch Institute, Berlin, Germany
| | | | - Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Martin S Winkler
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Franziska Scheibe
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Cluster of Excellence, NeuroCure, Berlin, Germany
| | - Péter Körtvélyessy
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Dirk Reinhold
- Institute of Molecular and Clinical Immunology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Britta Siegmund
- Division of Gastroenterology, Infectiology and Rheumatology, Medical Department, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Anja A Kühl
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, and iPATH.Berlin, Berlin, Germany
| | - Sefer Elezkurtaj
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - David Horst
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Lars Oesterhelweg
- Institute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Michael Tsokos
- Institute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | | | | | - Christian Drosten
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany
| | - Victor Max Corman
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany
| | - Helena Radbruch
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Frank L Heppner
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
- Cluster of Excellence, NeuroCure, Berlin, Germany.
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany.
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Gauselmann H, Martin H, Oesterhelweg L. Häusliche Gewalt oder spontanes Ereignis? Fruchttod nach Gebärmutterriss in der 22. Schwangerschaftswoche. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00446-5] [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: 11/30/2022]
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Tattoli L, Gauselmann H, Oesterhelweg L. Fatal gas embolism in hospital: accident or suicide? Forensic Sci Med Pathol 2020; 16:528-530. [DOI: 10.1007/s12024-020-00222-7] [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] [Accepted: 01/13/2020] [Indexed: 10/24/2022]
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Buschmann C, Hartwig S, Tsokos M, Oesterhelweg L. Death scene investigation and autopsy proceedings in identifying the victims of the terror attack on the Breitscheidplatz in Berlin 19 th December 2016. Forensic Sci Med Pathol 2020; 16:510-514. [PMID: 32734590 PMCID: PMC7449987 DOI: 10.1007/s12024-020-00277-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 11/15/2022]
Abstract
We describe and discuss the forensic mission after the terrorist attack on the Breitscheidplatz in Berlin on 19th December 2016, focusing on co-operation with police authorities, and the injury patterns of the deceased. Even after massive blunt trauma, severe injury patterns are often unrecognizable by visual inspection of the body (“Casper’s sign”), which could instill false security among rescuers or, as happened on the Breitscheidplatz, may lead to distress or even trauma in rescue personnel when obviously primarily uninjured patients die suddenly.
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Affiliation(s)
- Claas Buschmann
- Institute of Legal Medicine and Forensic Sciences, Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Turmstr. 21, Haus N, 10559, Berlin, Germany.
| | - Sven Hartwig
- Institute of Legal Medicine and Forensic Sciences, Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Turmstr. 21, Haus N, 10559, Berlin, Germany
| | - Michael Tsokos
- Institute of Legal Medicine and Forensic Sciences, Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Turmstr. 21, Haus N, 10559, Berlin, Germany
| | - Lars Oesterhelweg
- Institute of Legal Medicine and Forensic Sciences, Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Turmstr. 21, Haus N, 10559, Berlin, Germany
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Bolz S, Gapert R, Hartwig S, Tsokos M, Oesterhelweg L. Evaluation of foramen magnum sexual dimorphism in a modern documented German population using post-mortem computed tomography. Forensic Imaging 2020. [DOI: 10.1016/j.fri.2020.200352] [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: 10/25/2022]
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Rutty GN, Alminyah A, Apostol M, Boel LWT, Brough A, Bouwer H, O'Donnell C, Fujimoto H, Iino M, Kroll J, Lee CT, Levey DS, Makino Y, Oesterhelweg L, Ong B, Ranson D, Robinson C, Singh MKC, Villa C, Viner M, Woodford N, Watkins T, Wozniak K. Positional Statement: Radiology Disaster Victim Identification Reporting Forms. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.jofri.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Middleton A, Alminyah A, Apostol MA, Boel LW, Brough A, Develter W, Heinze S, Makino Y, Mulcahy L, O'Donnell C, Gorincour G, Hofman PA, Iino M, Oesterhelweg L, Ranson D, Robinson C, Ruder T, Rutty GN, Singh MK, Villa C, Viner MD, Woźniak K, Yoshida M. Forensic odontology radiography and imaging in disaster victim identification. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jofri.2016.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ross SG, Bolliger SA, Ampanozi G, Oesterhelweg L, Thali MJ, Flach PM. Postmortem CT angiography: capabilities and limitations in traumatic and natural causes of death. Radiographics 2015; 34:830-46. [PMID: 24819799 DOI: 10.1148/rg.343115169] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Whole-body postmortem computed tomographic (CT) angiography is a promising new development in forensic radiology that has the potential to improve vascular and soft-tissue imaging beyond levels currently achievable with unenhanced postmortem CT. Postmortem access to the vascular system and injection of contrast medium are different from those steps in clinical (antemortem) radiology. Because there is no circulation in a corpse that could transport or dilute a contrast medium, the injection must be performed by using a roller pump to fill the vasculature (arterial and venous) with a mixture of a water-soluble iodized contrast medium and polyethylene glycol. In contrast to a classic autopsy, postmortem CT angiography is a minimally invasive procedure. It allows the diagnosis of vascular lesions without the disruption or destruction of anatomic structures, which could result in a loss of evidence in a criminal investigation. Furthermore, postmortem CT angiography facilitates the display of vascular pathologic conditions in areas that are not typically covered with autopsy alone, such as the craniocervical junction and the small pelvis. Therefore, postmortem CT angiography adds substantial value to the classic forensic autopsy; cross-sectional data can be reevaluated objectively at any time and are fully reproducible as counterexpertise, which is as useful in the fields of forensic medicine and pathology as in clinical research. Familiarity with the capabilities of postmortem CT angiography may help radiologists working with forensic cases improve their diagnostic performance.
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Affiliation(s)
- Steffen G Ross
- From the Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland (S.G.R., S.A.B., G.A., M.J.T., P.M.F.); the Institute of Forensic Medicine, University of Berne, Berne, Switzerland (S.G.R.); the Institute of Forensic Medicine, University of Berlin, Berlin, Germany (L.O.); and the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland (P.M.F.)
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Oertelt-Prigione S, Jenner S, Etzold S, Oesterhelweg L, Stickel A, Kurmeyer C, Reinemann D. Strategien und Hürden zur aktiven Nachfrage bei häuslicher Gewalt – Ergebnisse einer Befragung bei der ersten allgemeinen Pflichtfortbildung an einem Universitätsklinikum in Deutschland. Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1386980] [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: 10/24/2022]
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Kleine-Doepke L, Oesterhelweg L. Komplikationen religiös-ritueller Zirkumzisionen von Jungen im Neugeborenenalter. Rechtsmedizin (Berl) 2014. [DOI: 10.1007/s00194-014-0940-y] [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: 10/25/2022]
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Hayashi T, Hartwig S, Tsokos M, Oesterhelweg L. Postmortem multislice computed tomography (pmMSCT) imaging of hangman’s fracture. Forensic Sci Med Pathol 2013; 10:3-8. [DOI: 10.1007/s12024-013-9430-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2013] [Indexed: 11/28/2022]
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Bedford PJ, Oesterhelweg L. Different conditions and strategies to utilize forensic radiology in the cities of Melbourne, Australia and Berlin, Germany. Forensic Sci Med Pathol 2013; 9:321-6. [DOI: 10.1007/s12024-013-9424-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2013] [Indexed: 10/27/2022]
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Guddat SS, Gapert R, Tsokos M, Oesterhelweg L. Proof of live birth using postmortem multislice computed tomography (pmMSCT) in cases of suspected neonaticide: advantages of diagnostic imaging compared to conventional autopsy. Forensic Sci Med Pathol 2012; 9:3-12. [PMID: 22760696 DOI: 10.1007/s12024-012-9361-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2012] [Indexed: 11/28/2022]
Abstract
Proof of live birth is of major importance in suspected neonaticide cases. Although not without controversy the lung flotation test is the main method used to asses this in different jurisdictions worldwide. The present study examines the usefulness of postmortem multislice computed tomography (pmMSCT) in the detection of live birth signs. Body scans were conducted on four infants, one was stillborn, another died a day after birth and the other two were classified as neonaticides. The appearance of the lungs, gastrointestinal tract and vascular system of the liver was compared in these cases. Clear differences were discernable between the lungs of the stillborn and the 1 day old infant. The aerated lungs and air in the stomach and duodenum were clearly visible in the latter case while the stillborn infant lacked these signs. The two neonaticide cases demonstrated similarly aerated lung tissue to the 1 day old infant. The hepatic vessels did not show any putrefactive gas changes in any of the cases. The extent of aeration of the peripheral alveoli was easily observable on the pmMSCT, thus making it a useful tool in the possible differentiation between artificially and naturally aerated lungs. During the four autopsies the classic flotation tests were performed and similar positive aeration of the lungs in the two neonaticides was shown. The stillborn's tests, on the other hand were negative for aeration. The results of this study clearly demonstrate the advantages of using pmMSCT before commencing a conventional autopsy in cases of suspected neonaticide.
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Affiliation(s)
- Saskia S Guddat
- Institute of Legal Medicine and Forensic Sciences, Charité-University Medicine Berlin, Berlin, Germany
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Christe A, Oesterhelweg L, Ross S, Spendlove D, Bolliger S, Vock P, Thali MJ. Can MRI of the neck compete with clinical findings in assessing danger to life for survivors of manual strangulation? A statistical analysis. Leg Med (Tokyo) 2010; 12:228-32. [PMID: 20630784 DOI: 10.1016/j.legalmed.2010.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [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: 02/16/2010] [Revised: 04/09/2010] [Accepted: 05/13/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to examine the clinical forensic findings of strangulation according to their ability to differentiate between life-threatening and non-life-threatening strangulation, compare clinical and MRI findings of the neck and discuss a simple score for life-threatening strangulation (SLS). MATERIALS AND METHODS Forensic pathologists classified a continuous sample of 56 survivors of strangulation into life-threatening cases by clinical history and examination alone. Subjective, objective and radiological signs were evaluated for discriminating the two groups. RESULTS In 27% of the cases life was in danger. The most significant signs of danger to life were congestive petechial hemorrhage in the face (eyes); hematoma of the neck and loss of consciousness. The radiological score could compete with the clinical scores. CONCLUSION Clinical forensic findings differ significantly in non-life-threatening and life-threatening manual strangulation. Thanks to MRI a rather objective test for life-threatening strangulation can be added to a SLS.
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Affiliation(s)
- Andreas Christe
- Department of Radiology, Inselspital, University Hospital of Bern, Freiburgstrasse, 3010 Bern, Switzerland.
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Bolliger SA, Oesterhelweg L, Spendlove D, Ross S, Thali MJ. Is Differentiation of Frequently Encountered Foreign Bodies in Corpses Possible by Hounsfield Density Measurement? J Forensic Sci 2009; 54:1119-22. [DOI: 10.1111/j.1556-4029.2009.01100.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Oesterhelweg L, Bolliger SA, Thali MJ, Ross S. Virtopsy: Postmortem Imaging of Laryngeal Foreign Bodies. Arch Pathol Lab Med 2009; 133:806-10. [DOI: 10.5858/133.5.806] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2008] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Death from corpora aliena in the larynx is a well-known entity in forensic pathology. The correct diagnosis of this cause of death is difficult without an autopsy, and misdiagnoses by external examination alone are common.
Objective.—To determine the postmortem usefulness of modern imaging techniques in the diagnosis of foreign bodies in the larynx, multislice computed tomography, magnetic resonance imaging, and postmortem full-body computed tomography–angiography were performed.
Design.—Three decedents with a suspected foreign body in the larynx underwent the 3 different imaging techniques before medicolegal autopsy.
Results.—Multislice computed tomography has a high diagnostic value in the noninvasive localization of a foreign body and abnormalities in the larynx. The differentiation between neoplasm or soft foreign bodies (eg, food) is possible, but difficult, by unenhanced multislice computed tomography. By magnetic resonance imaging, the discrimination of the soft tissue structures and soft foreign bodies is much easier. In addition to the postmortem multislice computed tomography, the combination with postmortem angiography will increase the diagnostic value.
Conclusions.—Postmortem, cross-sectional imaging methods are highly valuable procedures for the noninvasive detection of corpora aliena in the larynx.
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Affiliation(s)
- Lars Oesterhelweg
- From the Center of Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Switzerland. Dr Oesterhelweg is now with the State Institute of Legal Medicine Berlin, Senate Administration for Health, Environment and Customer Protection, Berlin, Germany
| | - Stephan A. Bolliger
- From the Center of Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Switzerland. Dr Oesterhelweg is now with the State Institute of Legal Medicine Berlin, Senate Administration for Health, Environment and Customer Protection, Berlin, Germany
| | - Michael J. Thali
- From the Center of Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Switzerland. Dr Oesterhelweg is now with the State Institute of Legal Medicine Berlin, Senate Administration for Health, Environment and Customer Protection, Berlin, Germany
| | - Steffen Ross
- From the Center of Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Switzerland. Dr Oesterhelweg is now with the State Institute of Legal Medicine Berlin, Senate Administration for Health, Environment and Customer Protection, Berlin, Germany
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Christe A, Thoeny H, Ross S, Spendlove D, Tshering D, Bolliger S, Grabherr S, Thali MJ, Vock P, Oesterhelweg L. Life-threatening versus non-life-threatening manual strangulation: are there appropriate criteria for MR imaging of the neck? Eur Radiol 2009; 19:1882-9. [PMID: 19283386 DOI: 10.1007/s00330-009-1353-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 01/08/2009] [Accepted: 01/22/2009] [Indexed: 10/21/2022]
Abstract
The aim of the study was to determine objective radiological signs of danger to life in survivors of manual strangulation and to establish a radiological scoring system for the differentiation between life-threatening and non-life-threatening strangulation by dividing the cross section of the neck into three zones (superficial, middle and deep zone). Forensic pathologists classified 56 survivors of strangulation into life-threatening and non-life-threatening cases by history and clinical examination alone, and two blinded radiologists evaluated the MRIs of the neck. In 15 cases, strangulation was life-threatening (27%), compared with 41 cases in which strangulation was non-life-threatening (73%). The best radiological signs on MRI to differentiate between the two groups were intramuscular haemorrhage/oedema, swelling of platysma and intracutaneous bleeding (all p = 0.02) followed by subcutaneous bleeding (p = 0.034) and haemorrhagic lymph nodes (p = 0.04), all indicating life-threatening strangulation. The radiological scoring system showed a sensitivity and specificity of approximately 70% for life-threatening strangulation, when at least two neck zones were affected. MRI is not only helpful in assessing the severity of strangulation, but is also an excellent documentation tool that is even admissible in court.
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Affiliation(s)
- Andreas Christe
- Department of Radiology, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
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Hollinger A, Christe A, Thali M, Kneubuehl B, Oesterhelweg L, Ross S, Spendlove D, Bolliger S. Incidence of auditory ossicle luxation and petrous bone fractures detected in post-mortem multislice computed tomography (MSCT). Forensic Sci Int 2009; 183:60-6. [DOI: 10.1016/j.forsciint.2008.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 10/09/2008] [Accepted: 10/15/2008] [Indexed: 11/25/2022]
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21
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Andenmatten MA, Thali MJ, Kneubuehl BP, Oesterhelweg L, Ross S, Spendlove D, Bolliger SA. Gunshot injuries detected by post-mortem multislice computed tomography (MSCT): a feasibility study. Leg Med (Tokyo) 2008; 10:287-92. [PMID: 18485787 DOI: 10.1016/j.legalmed.2008.03.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 03/13/2008] [Accepted: 03/14/2008] [Indexed: 10/22/2022]
Abstract
Modern cross-sectional imaging techniques are being increasingly implemented in forensic pathology. These methods may serve as an adjuvant to classic forensic autopsies or even replace them altogether in the future. In order to assess the practicability of such a method, namely post-mortem multislice computed tomography (MSCT) in fatal gunshot injuries, 22 corpses underwent such an examination prior to forensic autopsy. The cardinal questions of the location of entrance and exit wounds, the detection of bullets and bullet fragments in the body, the bullet course, inflicted injuries and cause of death were addressed at MSCT and autopsy. The results of the two techniques revealed that post-mortem MSCT can answer these questions reliably and is therefore a useful tool in the assessment of such injuries.
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Affiliation(s)
- M A Andenmatten
- Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, IRM, Buehlstrasse 20, CH3012 Bern, Switzerland
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Pohlenz P, Blessmann M, Oesterhelweg L, Habermann CR, Begemann PGC, Schmidgunst C, Blake F, Schulze D, Püschel K, Schmelzle R, Heiland M. 3D C-arm as an alternative modality to CT in postmortem imaging: Technical feasibility. Forensic Sci Int 2008; 175:134-9. [PMID: 17640838 DOI: 10.1016/j.forsciint.2007.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 08/28/2006] [Revised: 11/04/2006] [Accepted: 06/02/2007] [Indexed: 12/28/2022]
Abstract
OBJECT The aim of our study was to demonstrate the image quality of the new device using human cadavers, extending the horizon of available imaging modalities in forensic medicine. MATERIALS AND METHODS Six human cadavers were examined, revealing C-arm data sets of the head, neck thorax, abdomen and pelvis. High-resolution mode was performed with 500 fluoroscopy shots during a 190 degrees orbital movement with a constant tube voltage of 100 kV and a current of 4.6 mA. Based on these data sets subsequent three-dimensional reconstructions were generated. RESULTS Reconstructed data sets revealed high-resolution images of all skeletal structures in a near-CT quality. The same image quality was available in all reconstruction planes. Artefacts caused by restorative dental materials are less accentuated in CBCT data sets. The system configuration was not powerful enough to generate sufficient images of intracranial structures. CONCLUSION After the here-demonstrated encouraging preliminary results, the forensic indications that would be suitable for imaging with a 3D C-arm have to be defined. Promising seems the visualization local limited region of interest as the cervical spine or the facial skeleton.
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Affiliation(s)
- Philipp Pohlenz
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Oesterhelweg L, Ross S, Spendlove D, Schoen CA, Christe A, Thali MJ, Bolliger SA. Virtopsy: Fatal stab wounds to the skull – The relevance of ante-mortem and post-mortem radiological data in case reconstructions. Leg Med (Tokyo) 2007; 9:314-7. [PMID: 17567525 DOI: 10.1016/j.legalmed.2007.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 03/06/2007] [Revised: 04/10/2007] [Accepted: 04/11/2007] [Indexed: 10/23/2022]
Abstract
Homicides with a survival of several days are not uncommon in forensic routine work. Reconstructions of these cases by autopsy alone are very difficult and may occasionally lead to unsatisfying results. For the medico-legal reconstruction of these cases, ante-mortem and post-mortem radiological imaging should always be included in the expertise. We report on a case of fatal penetrating stab wounds to the skull in which a case reconstruction was only possible by combining the radiological ante- and post-mortem data with the autopsy findings.
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Affiliation(s)
- L Oesterhelweg
- Center Forensic Imaging and Virtopsy at the University of Bern, Institute of Forensic Medicine, Bern, Switzerland.
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Heiland M, Pohlenz P, Blessmann M, Habermann CR, Oesterhelweg L, Begemann PC, Schmidgunst C, Blake FAS, Püschel K, Schmelzle R, Schulze D. Cervical soft tissue imaging using a mobile CBCT scanner with a flat panel detector in comparison with corresponding CT and MRI data sets. ACTA ACUST UNITED AC 2007; 104:814-20. [PMID: 17900944 DOI: 10.1016/j.tripleo.2007.04.031] [Citation(s) in RCA: 23] [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: 10/18/2006] [Revised: 03/26/2007] [Accepted: 04/25/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate soft tissue image quality of a mobile cone-beam computed tomography (CBCT) scanner with an integrated flat-panel detector. STUDY DESIGN Eight fresh human cadavers were used in this study. For evaluation of soft tissue visualization, CBCT data sets and corresponding computed tomography (CT) and magnetic resonance imaging (MRI) data sets were acquired. Evaluation was performed with the help of 10 defined cervical anatomical structures. RESULTS The statistical analysis of the scoring results of 3 examiners revealed the CBCT images to be of inferior quality regarding the visualization of most of the predefined structures. Visualization without a significant difference was found regarding the demarcation of the vertebral bodies and the pyramidal cartilages, the arteriosclerosis of the carotids (compared with CT), and the laryngeal skeleton (compared with MRI). Regarding arteriosclerosis of the carotids compared with MRI, CBCT proved to be superior. CONCLUSIONS The integration of a flat-panel detector improves soft tissue visualization using a mobile CBCT scanner.
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Affiliation(s)
- Max Heiland
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Verhoff MA, Ramsthaler F, Krähahn J, Gille RJ, Kage S, Kage P, Oesterhelweg L, Ross S, Thali MJ, Kreutz K. Digital forensic osteology. Forensic Sci Int 2007. [DOI: 10.1016/j.forsciint.2007.04.211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Oesterhelweg L, Püschel K. "Death may come on like a stroke of lightening": phenomenological and morphological aspects of fatalities caused by manure gas. Int J Legal Med 2007; 122:101-7. [PMID: 17486359 DOI: 10.1007/s00414-007-0172-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [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: 11/13/2006] [Accepted: 03/30/2007] [Indexed: 10/23/2022]
Abstract
Due to the decomposition of biological material, hydrogen sulphide (H2S) is produced. In low concentrations, the well-known smell of "rotten eggs" is associated with H2S. In higher concentrations, H2S is an odourless and colourless gas that may cause rapid loss of consciousness, neurological and respiratory depression and imminent death--"... like a stroke of lightening". Hydrogen sulphide poisoning is an un-common incident that is often associated with colleague fatalities. In this study, 4 fatal accidents with 10 deceased victims are reported and the morphological and phenomenological aspects are presented. In these cases, the morphological findings, namely, discolouration of the livores, pulmonary pathologies and sub-mucosal or sub-serosal congestion bleeding were found in nearly all cases. Also the impending threat for colleagues, first aid helpers and professional rescue teams is demonstrated. The suspicion of a fatal H2S intoxication should be based on a precise scene analysis with respect to the possibility of life-threatening H2S intoxication for the helpers, the typical scent of rotten eggs, which may be noted on the corpses and the abovementioned morphological findings. The diagnosis should be confirmed by a qualitative and, if possible, quantitative analysis of H2S.
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Affiliation(s)
- L Oesterhelweg
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Oesterhelweg L, Kröber S, Rottmann K, Willhöft J, Braun C, Thies N, Püschel K, Silkenath J, Gehl A. Cadaver dogs--a study on detection of contaminated carpet squares. Forensic Sci Int 2007; 174:35-9. [PMID: 17403590 DOI: 10.1016/j.forsciint.2007.02.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [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: 10/03/2006] [Revised: 01/24/2007] [Accepted: 02/28/2007] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Cadaver dogs are known as valuable forensic tools in crime scene investigations. Scientific research attempting to verify their value is largely lacking, specifically for scents associated with the early postmortem interval. The aim of our investigation was the comparative evaluation of the reliability, accuracy, and specificity of three cadaver dogs belonging to the Hamburg State Police in the detection of scents during the early postmortem interval. MATERIAL AND METHODS Carpet squares were used as an odor transporting media after they had been contaminated with the scent of two recently deceased bodies (PMI<3h). The contamination occurred for 2 min as well as 10 min without any direct contact between the carpet and the corpse. Comparative searches by the dogs were performed over a time period of 65 days (10 min contamination) and 35 days (2 min contamination). RESULTS The results of this study indicate that the well-trained cadaver dog is an outstanding tool for crime scene investigation displaying excellent sensitivity (75-100), specificity (91-100), and having a positive predictive value (90-100), negative predictive value (90-100) as well as accuracy (92-100).
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Affiliation(s)
- L Oesterhelweg
- Institute of Legal Medicine, University Medical Center Hamburg, Germany.
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Grabherr S, Stephan BA, Buck U, Näther S, Christe A, Oesterhelweg L, Ross S, Dirnhofer R, Thali MJ. Virtopsy ? Radiology in Forensic Medicine. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1617-0830.2007.00086.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Verhoff MA, Ramsthaler F, Krähahn J, Gille RJ, Kage P, Kage S, Durschnabel M, Strunk J, Deml U, Grabherr S, Jackowski C, Ross S, Oesterhelweg L, Thali M, Kreutz K. Digitale forensische Osteologie. Rechtsmedizin (Berl) 2007. [DOI: 10.1007/s00194-006-0407-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
The aim of the VIRTOPSY project () is utilizing radiological scanning to push low-tech documentation and autopsy procedures in a world of high-tech medicine in order to improve scientific value, to increase significance and quality in the forensic field. The term VIRTOPSY was created from the terms virtual and autopsy: Virtual is derived from the Latin word 'virtus', which means 'useful, efficient and good'. Autopsy is a combination of the old Greek terms 'autos' (=self) and 'opsomei' (=I will see). Thus autopsy means 'to see with ones own eyes'. Because our goal was to eliminate the subjectivity of "autos", we merged the two terms virtual and autopsy - deleting "autos" - to create VIRTOPSY. Today the project VIRTOPSY combining the research topics under one scientific umbrella, is characterized by a trans-disciplinary research approach that combines Forensic Medicine, Pathology, Radiology, Image Processing, Physics, and Biomechanics to an international scientific network. The paper will give an overview of the Virtopsy change process in forensic medicine.
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Affiliation(s)
- Michael J Thali
- Institute of Forensic Medicine, Center of Forensic Imaging/Virtopsy, University of Berne, Switzerland.
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Oesterhelweg L. Atmosphere of departure in forensic medicine? Rechtsmedizin (Berl) 2007. [DOI: 10.1007/s00194-006-0425-8] [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: 10/23/2022]
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Uchigasaki S, Oesterhelweg L, Sperhake JP, Püschel K, Oshida S. Application of ultrasonography to postmortem examination. Diagnosis of pericardial tamponade. Forensic Sci Int 2006; 162:167-9. [PMID: 16860956 DOI: 10.1016/j.forsciint.2006.06.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 10/24/2022]
Abstract
In postmortem examination, it is difficult to diagnose pericardial tamponade in a dead body from the findings of conventional external examination alone. However, ultrasonography is a common diagnostic tool for pericardial tamponade in clinical practice. We studied the postmortem diagnosis of pericardial tamponade at external examination level by applying an ultrasonographic device. The ultrasonographic findings were compared with the conventional autopsy findings. Among 455 cases of forensic autopsy in Hamburg and Tokyo conducted within 5 days after death, we successfully diagnosed 11 cases of pericardial tamponade by ultrasound imaging prior to autopsy, and failed to diagnose pericardial tamponade in only two cases. In addition, 79 cases of external examination conducted at the Tokyo Medicinal Examiner's Office were also examined with ultrasonography, and we diagnosed three cases of pericardial tamponade and five cases of pericardial effusion. The differences in ultrasonographic findings between tamponade and effusion were relatively clear. Although autopsy provides definitive evidence for the cause of death, sometimes autopsy cannot be performed due to some social factors. In such cases, conventional external examination alone cannot establish a cause of death by pericardial tamponade, and application of diagnostic imaging technique will be helpful. While CT and/or MRI may provide more detailed information than ultrasound imaging, these techniques require special equipment, room and specialist, and most of all involves high cost, which is perhaps the most important consideration in the present atmosphere of medical cost containment. On the other hand, the ultrasonographic devices we use are compact, and can be used directly at the scene of death. Postmortem application of ultrasonography may be a valuable adjunct in the work of medical examiners and forensic pathologists.
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Affiliation(s)
- S Uchigasaki
- Department of Legal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
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Uchigasaki S, Oesterhelweg L, Gehl A, Sperhake JP, Püschel K, Oshida S, Nemoto N. Application of compact ultrasound imaging device to postmortem diagnosis. Forensic Sci Int 2004; 140:33-41. [PMID: 15013164 DOI: 10.1016/j.forsciint.2003.11.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [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: 02/24/2003] [Accepted: 11/12/2003] [Indexed: 11/22/2022]
Abstract
In regions with low autopsy rates, forensic examiners often have to rely on external findings. Imaging techniques can assist the external examination and provide a more objective diagnosis. The SonoSite 180, a portable ultrasound device, was used for the examination of dead bodies. The influence of different degrees of decomposition was estimated. Even in cases with intestinal gas formation images of internal organs could be obtained with special techniques. Various pathological findings were detected by ultrasound and verified by autopsy (e.g. pericardial tamponade, cardiac hypertrophy, fatty liver, aortic aneurysm, metastatic liver, etc.). The experiences with the SonoSite 180 are promising. The device can be carried to the death scene or to the morgue and therefore serve as a valuable tool for medicolegal applications.
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Affiliation(s)
- S Uchigasaki
- Institute of Legal Medicine, University Hospital Hamburg-Eppendorf Butenfeld 34, 22529 Hamburg, Germany.
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Schroeder H, Klotzbach H, Oesterhelweg L, Püschel K. Larder beetles (Coleoptera, Dermestidae) as an accelerating factor for decomposition of a human corpse. Forensic Sci Int 2002; 127:231-6. [PMID: 12175954 DOI: 10.1016/s0379-0738(02)00131-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [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: 10/27/2022]
Abstract
Larder beetles are known to feed directly upon decomposing carrion, with a preference for dried carrion. Under optimal environmental conditions (dry and warm), they can appear in large numbers. In our case, the mummified corpse of a human male was nearly skeletonized in less than 5 months in his apartment with windows closed and a room temperature between 25 degrees C (near the radiator) and 19.4 degrees C (near the body). There were very few empty fly pupae in the apartment, but a lot of adult hide beetles, their larvae and larval cast skins (exuviae) (Dermestes maculatus DEG.) belonging to the family of the larder beetles (Dermestidae). The beetles skeletonized the human corpse in such a short time because of ideal conditions for them in the apartment (dry and warm) making the body an optimal feeding ground because of his mummification.
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Affiliation(s)
- H Schroeder
- Institute for Forensic Medicine, University of Hamburg, Butenfeld 34, D-22529 Hamburg, Germany
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Brand B, Oesterhelweg L, Binmoeller KF, Sriram PVJ, Bohnacker S, Seewald S, De Weerth A, Soehendra N. Impact of endoscopic ultrasound for evaluation of submucosal lesions in gastrointestinal tract. Dig Liver Dis 2002; 34:290-7. [PMID: 12038814 DOI: 10.1016/s1590-8658(02)80150-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic ultrasound is widely used following endoscopy for evaluation of suspected submucosal lesions and may guide further management of patients. PATIENTS AND METHOD A total of 181 consecutive patients with suspected submucosal lesion in the upper gastrointestinal tract were diagnosed by endoscopic ultrasound between 1990-97. We evaluated: 1) the potential of endoscopic ultrasound criteria to predict histological type of submucosal lesions in 69 patients with available histology, 2) the ability of endoscopic ultrasound alone or with clinical presentation, to predict malignancy in 86 patients with available histology or follow-up of >12 months. RESULTS Sensitivity and specificity for diagnosing 44 gastrointestinal stromal tumours were 95 and 72%, respectively, while 25 miscellaneous lesions were diagnosed correctly in only 56% by endoscopic ultrasound. Diagnosis of malignancy, using any two of three endoscopic ultrasound criteria (heterogeneous echotexture, size >3 cm, irregular margins) showed a sensitivity of 80% and specificity of 77%, giving accurate endoscopic ultrasound diagnosis in 16/20 malignant and 51/66 benign submucosal lesion. Heterogeneous echotexture, size >3 cm, and irregular margins showed a relative risk of 7.2, 5.4 and 4.6, respectively, for presence of malignancy. The presence of symptoms, potentially suggesting malignancy (dysphagia, gastrointestinal bleeding, pain and weight loss), had a relative risk of 4.2, however this did not increase the accuracy of diagnosing malignancy based on endoscopic ultrasound criteria alone. CONCLUSION The accuracy of endoultrasound is high in diagnosing gastrointestinal stromal tumours, which show a significant potential of malignancy. Endoscopic ultrasound morphology appears to be helpful in selection of patients for surgical or conservative treatment. The accuracy of endoscopic ultrasound in differential diagnosis of non-gastrointestinal stromal tumour lesions is limited.
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Affiliation(s)
- B Brand
- Department of Interdisciplinary Endoscopy, University Hospital Eppendorf, Hamburg, Germany.
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Schröder H, Klotzbach H, Oesterhelweg L, Gehl A, Püschel K. Artenspektrum und zeitliches Auftreten von Insekten an Wohnungsleichen im Großraum Hamburg. Rechtsmedizin (Berl) 2001. [DOI: 10.1007/s001940100087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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