The presence of occipital hair in the pilonidal sinus cavity-a triple approach to proof

PURPOSE

Hair in the pilonidal sinus is not growing within the sinus cavity, as hair follicles are not present there. Not few pilonidal patients do not have intergluteal hair, which is said to be the causative agent of folliculitis and pilonidal genesis. So, what is the real source of the hair forming the typical pilonidal hair nest?

METHODS

A trifold approach was used: First, axial hair strength testing of pilonidal hair and body hair harvested from head, lower back (glabella sacralis), and cranial third of intergluteal fold. Hair strength match was compared clinically. Second, comparative morphological examination by expert forensic biologist of hair from sinus and dorsal body hair. Third, statistical Bayesian classification of every single sinus hair based on its strength was done to determine the most probable region of origin.

RESULTS

Using clinical hair strength comparison, in 13/20 patients, head hair is the stiffest hair, followed by intergluteal hair. Only in 6/20 patients, this is the case with hair from the glabella sacralis. According to comparative morphological comparison, a minimum of 5 of 13 hair nests with possible hair allocation examined contain hair from the occiput. In 5/18 nests, hair could not be determined to a specific location though. Statistical classification with correction for multiple testing shows that 2 nests have hair samples that are at least 100 times more probable to originate from head or lower back than from intergluteal fold.

CONCLUSION

We saw our null hypothesis that "hair in the sinus cavity is from the intergluteal region" rejected by each of three different approaches. There is strong evidence that occipital hair is present regularly in pilonidal sinus nests. We should start thinking of occipital hair as an important hair source for the development of the pilonidal hair nest.

Temperature based forensic death time estimation: The standard model in experimental test

The determination of the time since death is essential to forensic homicide investigations since the time of death represents the presumed time of the offence. Erroneous death time estimates may lead to false acquittal or conviction of suspects. Since its introduction 30years back, the nomogram method by Henßge has been established as the standard procedure of temperature-based death time determination in the early post-mortem period. The present study provides an independent investigation of the validity of its death time estimates and their corresponding 95%-confidence intervals. Comparison to post-mortem cooling curves recorded under controlled conditions of 84 suddenly deceased with known death times yielded the following results: Since in the light of our experiments the validity of the nomogram method seems to be problematic, death time estimates - and particularly their 95%-confidence interval limits - have to be interpreted carefully and should only be restrictively used as court evidence to support or refute alibis. Systematic overestimation of the post-mortem interval in bodies of high mass and large surface area must be taken into account.

Liver transplantation in the rat: single-center experience with technique, long-term survival, and functional and histologic findings

OBJECTIVE

Orthotopic liver transplantation (OLT) in rats is frequently used as an experimental model. Numerous surgical techniques have been developed that enable the investigator to conduct clinically relevant studies. The objective of this study was to develop a rat model of acute and chronic rejection, to explicitly study technical modifications of vascular anastomoses with precision, and to examine histopathologic and functional changes in the graft.

MATERIALS AND METHODS

With DA-(RT1av1) rats as donors and Lewis-(RT1) rats as recipients, arterialized OLT was performed using a combined suture, cuff, and splint method. Recipients were divided into 5 groups: syngeneic control rats (group 1), allogeneic control rats (group 2), allogeneic OLT rats with low-dose tacrolimus (FK506) immunosuppression (group 3), allogeneic OLT rats with high-dose tacrolimus immunosuppression (group 4), and allogeneic OLT rats with high-dose tacrolimus immunosuppression and retrograde reperfusion via the infrahepatic caval vein (group 5). After OLT, serum parameters were determined and hepatic biopsy specimens were sampled. We examined the effects of acute rejection with or without immunosuppression therapy at histopathologic evaluation.

RESULTS

Liver grafts in syngeneic and allogeneic rats (groups 1, 2, 4, and 5) demonstrated normal serum parameters and histopathologic findings at 10 days after OLT, and 93% survival at 3 months. The simplified technique using 1 suture and 2 cuff anastomoses provided the best short- and long-term survival after OLT in all groups. Retrograde perfusion via the infrahepatic caval vein resulted in lower postoperative liver enzyme values.

CONCLUSION

The present model is feasible, enabling comprehensive preclinical experimental research on liver transplantation. Furthermore, we provide helpful instructions for learning this surgical technique.

Microsurgical technique of simultaneous pancreas/kidney transplantation in the rat: clinical experience and review of the literature

BACKGROUND

For experimental basic research, standardized transplantation models reflecting technical and immunologic aspects are necessary. This article describes an experimental model of combined pancreas/kidney transplantation (PKTx) in detail.

MATERIALS AND METHODS

Donor rats underwent en bloc pancreatectomy and nephrectomy. Revascularization was performed using the aorta with the superior mesenteric artery and the inferior vena cava with the portal vein. Exocrine drainage of the pancreas took place over a segment of the duodenum which was transplanted side-to-side to the jejunum. The kidney vessels were transplanted end-to-side. The ureter was anastomosed by patch technique. Postoperatively, serum parameters were monitored daily. Biopsies for histopathology were taken on days 5, 8 and 12.

RESULTS

All 12 recipients survived the combined PKTx without serious surgical complications. One thrombosis of the portal vein led to organ failure. Blood glucose levels were normal by the 3rd postoperative day. The transplanted duodenal segment showed slight villous atrophy, and the kidneys were well perfused without vascular complications. The anastomosis between ureter and bladder was leakproof.

CONCLUSIONS

Excellent graft function and survival rates can be achieved due to simplified operation technique and short operation time. It may thus have high clinical relevance to immunologic issues within the scope of basic research.

Nitric oxide inhibition and consecutive Aspisol application show a prolonged survival of orthotopic transplanted livers in a rat model

BACKGROUND

It is generally accepted that nitric oxide (NO) plays a crucial role in acute rejection caused by inflammatory responses. Therefore, the purpose of this study was to investigate the effect on survival following arterialized orthotopic rat liver transplantations (o-RLTx) of NO inhibition and consequent blockade of platelet aggregation by application of Aspisol.

MATERIALS AND METHODS

Inbred LEWIS-(RT(1)) rats underwent arterialized o-RLTx under ether anesthesia with DA-(RT1av1) rats as organ donors. After liver transplantation, serum parameters were determined and hepatic biopsy specimens were sampled on postoperative days 5, 8, 10, 30, and 90. Sixty-one rats were divided into 5 groups: syngenic controls (group I, n = 12); allogenic controls (group II, n = 11); allogenic with FK506 immunosuppression (group III, n = 12); allogenic with AGH-treatment (group IV, n = 13); and allogenic with AGH/low- dose Aspisol treatment for 5 days after liver transplantation (group V, n = 13) (Bayer, Leverkusen, Germany).

RESULTS

Rats of group V with AGH/low-dose Aspisol treatment showed significantly longer graft survival (18.2 days +/- 1.8 days) compared with group II rats with untreated grafts (11.3 days +/- 1.7 days) the allogenic group IV with AGH treatment (11.2 days +/- 1.8 days; P < .05). Histological examination revealed moderate graft rejection among the AGH-treated group IV; however, marked platelet aggregation in sinusoids was present, which was not observed in the AGH/low-dose Aspisol-treated animals (group V).

CONCLUSION

Our data suggested that simultaneous treatment with AGH/low-dose Aspisol leads to a significant increase in survival and inhibition of platelet aggregation in the graft after orthotopic liver transplantation.

CCL19 is constitutively expressed in the CNS, up-regulated in neuroinflammation, active and also inactive multiple sclerosis lesions

CCL19 and CCL21 bind to CCR7, which is crucial for both inducing an immune response and establishing immunological tolerance. We report that in the normal human brain CCL19, but not CCL21, is transcribed, and detectable as a protein in tissue lysates and in cerebrospinal fluid. In both active and inactive multiple sclerosis (MS) lesions CCL19 transcripts were elevated. In cerebrospinal fluid from MS and OIND patients CCL19 protein was increased. In relapsing-remitting and secondary progressive MS patients CCL19 correlated with intrathecal IgG production. This study suggests that CCL19 plays a role in both the physiological immunosurveillance of the healthy CNS and the pathological maintenance of immune cells in the CNS of MS patients.

The petrified heart in sepsis

We report the case of a 33-year-old transsexual man who developed severe sepsis after an accidental intravenous injection of urine (3-5 ml) instead of methadone. He died unexpectedly 28 days after the onset of sepsis. On postmortem examination, the outstanding findings were restricted to the heart with an unusual macroscopic presentation. On histological examination extensive calcifications of the heart muscle, particularly of the left ventricle were found. The pattern of calcifications on the right ventricle was also striking. In contrast, the entire cardial conduction system was unaffected. Furthermore, there were no calcium deposits in other organs and tissues. The advanced widespread cardial calcifications in the present case can be attributed to endotoxin-related myocarditis in severe long-term sepsis. The only treatment would have been an urgent heart transplantation. Without prior knowledge of such a condition, it is impossible for clinicians to correctly recognize, diagnose and treat or prevent in due time such a complication.

[Upper gastrointestinal bleeding after long term, high dose NSAID medication: a wolf in sheep's clothing?]

A 71-year-old patient with melena, abdominal and lower back pain was admitted to hospital under suspicion of upper gastrointestinal bleeding. He had mild anemia and an elevated C-reactive protein. Endoscopy and ultrasound failed to localize the source of bleeding. The patient died 2 1/2 days after admission on an exsanguinating hemorrhage. On pathologic examination a fistula between the small aortic aneurysm and duodenum and periaortic inflammation in contact with a spondylitis were found. When clinical presentation is subtle, with a herald bleeding followed by a period of grace, the diagnosis of aortoenteric fistula may be extremely difficult.

Death due to neurogenic shock following gastric rupture in an anorexia nervosa patient

We report a case of fatal gastric rupture discovered after death, which developed due to a bulimic attack of a 19-year-old woman suffering from anorexia nervosa. An autopsy revealed an acute gastric dilatation and rupture without commonly observed ischemic damage of gastric wall structures. However, it may be difficult to determine the cause of death despite the marked findings. The death as a consequence of neurogenic shock accounts for all the results of gross examination and histologic analysis. This case is the first reported case of fatal gastric rupture of an anorectic patient discovered after death.

[Extensive bilateral lower leg muscle necrosis after nasal application of heroin. Macroscopic and histologic findings in a 23-year-old man]

Rhabdomyolysis is one of the less known complications of heroin abuse. A case of lower leg muscle necrosis after nasal application of heroin is reported with repeated resection of the necrotic muscles. Superinfection with a methicillin-resistant Staphylococcus aureus (MRSA) strain was present. After 4 weeks, bilateral amputation could not be avoided. We regard a direct toxic effect of the heroin as the most probable mechanism of the muscular damage, with possible influence of the reduced oxygen delivery due to central respiratory and circulatory depression.

[Extreme cardiomegaly]

We report the case of 65 year old male patient with extreme heart enlargement. The patient was admitted to the hospital due to acute bleeding from varicose veins of the cardia. The endoscopic treatment by means of hemostatic clips and fibrine was successful. However the patient died two weeks later without having any complaints. The heart of the patient weighed 1350 g. Multiple coronary bypasses were found. There was also a recent myocardial infarction. The adoptive pathophysiologic changes accompanying extreme cardiomegaly are discussed. Numerous cases have been recorded of unusually large hearts, which in a few instances have even exceeded the one reported here. The analysis of observations reported in the literature reveals that rheumatic myocarditis and syphilitic aortitis were responsible for the majority of cases with extreme cardiac hypertrophy. Valvular deformities were also frequent findings. The occurrence of extreme cardiac enlargement in an elderly patient associated with multiple coronary bypasses has been not described so far.