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Einleitung: Kopf-Hals Karzinome (head and neck squamous cell carcinoma, HNSCC) gehören zu den am häufigsten vorkommenden Tumoren weltweit. Tumorzellen verwenden diverse Mechanismen um der Immunantwort zu entkommen und sich zu etablieren. Für verschiedene Tumorentitäten wurde bereits[zum vollständigen Text gelangen Sie über die oben angegebene URL], 88. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

We studied the vertebral fracture prevalence on low-dose chest computed tomography (CT) in male lung cancer screening participants and the association of fractures and bone density with chronic obstructive pulmonary disease (COPD) and smoking. 1140 male current and former smokers with ≥ 16.5 packyears from the NELSON lung cancer screening trial were included. Age, body mass index, and smoking status were registered. CT scans and pulmonary function tests were obtained on the same day. On CT, vertebral fractures and bone density were measured. The cohort had a mean age of 62.5 years (standard deviation 5.2) old; 531 (46.6%) had quit smoking; and 437 (38.3%) had COPD. Of the group, 100 (8.8%) participants had a vertebral fracture. Fracture prevalence was higher in current compared to former smokers (11.3% versus 5.8%, p = 0.001), but similar in participants with COPD compared to those without (9.6% versus 8.3%, p = 0.430). The multivariable adjusted odds ratio for fracture presence was 1.79 (95% CI: 1.13-2.84) in current smokers and 1.08 (95% CI: 0.69-1.67) in COPD participants. Bone density was lower in current compared to former smokers (103.2 HU versus 108.7 HU, p = 0.006) and in participants with COPD compared to those without [100.7 Hounsfield Units (HU) versus 108.9 HU, p < 0.001]. In multivariate analysis, smoking status and COPD status were independently associated with bone density, corrected for age and body mass index. In conclusion, our study shows that lung cancer screening participants have a substantial vertebral fracture burden. Fractures are more common in current smokers, who also have lower bone density. We could not confirm that COPD is independently associated with vertebral fractures.

Esther Pompe,1 Pim A de Jong,2 Eva M van Rikxoort,3 Leticia Gallardo Estrella,3 Werner U de Jong,2 Rozemarijn Vliegenthart,4,5 Matthijs Oudkerk,5 Carlijn M van der Aalst,6 Bram van Ginneken,3 Jan-Willem J Lammers,1 Firdaus AA Mohamed Hoesein2 1Department of Pulmonology, 2Department of Radiology, University Medical Center Utrecht, Utrecht, 3Department of Radiology, Radboud University Medical Center, Nijmegen, 4Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 5Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, 6Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands Abstract: Osteoporosis is more common in patients with COPD and in smokers. The aim of this study was to assess whether measures of emphysema and airway disease on computed tomography (CT) were associated with lower bone density or vertebral fractures in smokers with and without COPD. For this purpose, we included participants from the NELSON lung cancer screening trial. Bone density was measured as Hounsfield Units in the first lumbar vertebra, and vertebral fractures were assessed semiquantitatively. The 15th percentile method (Perc15) was used to assess emphysema, and the airway lumen perimeter (Pi10) was used for airway wall thickness. Expiratory/inspiratory-ratiomean lung density (E/I-ratioMLD) was used as a measure for air trapping and tracheal index to assess tracheal deformity. Linear regression models and logistic regression models were used to assess associations between CT biomarkers, bone density, and presence of fractures. Exactly 1,093 male participants were eligible for analysis. Lower Perc15 and higher E/I-ratioMLD were significantly associated with lower bone density (b=-1.27, P=0.02 and b=-0.37, P=0.02, respectively). Pi10 and tracheal index were not associated with bone density changes. CT-derived biomarkers were not associated with fracture prevalence. Bone density is lower with increasing extent of emphysema and small airway disease but is not associated with large airway disease and tracheal deformity. This may indicate the necessity to measure bone density early in smokers with emphysema and air trapping to prevent vertebral fractures. Keywords: phenotyping, computed tomography, air trapping, emphysema, COPD, bone density

Einleitung: Die chronische Rhinosinusitis mit nasalen Polypen (CRSwNP) ist überwiegend charakterisiert durch eine chronische Entzündung der Schleimhaut im Nasen- und Nasennebenhöhlenbereich. Das Komplementsystem stellt einen zentralen Bereich des Immunsystems dar. Eine unkontrollierte[zum vollständigen Text gelangen Sie über die oben angegebene URL], 87. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Background: Osteoporosis is more common in patients with chronic obstructive pulmonary disease (COPD) and smokers. Bone density derived from computed tomography (CT) can be used to identify patients at risk for a vertebral fracture. Aims and objectives: We investigated whether COPD related measures on computed tomography (CT) scans were associated with lower bone density or vertebral fractures in smokers with and without COPD. Methods: We included participants from the NELSON lung cancer screening trial. Bone density was measured as the Hounsfield Unit (HU) in the first lumbar vertebra and vertebral fractures were assessed semi-quantitatively. The 15th Percentile method (Perc15) was used to assess emphysema and the airway lumen perimeter (Pi10) was used to measure airway wall thickness. The expiratory/inspiratory-ratioMeanLungDensity (E/I-ratioMLD) was used as a measure for air trapping and tracheal index (TI) was used to assess trachea deformity. Results: 1,093 male participants were included. Lower Perc15 and higher E/I-ratioMLD were significantly associated with lower bone density (b = -1.29, p = 0.03 and b = -0.48, p = 0.01, respectively). Pi10 and TI were not associated with bone density changes. 95 (8.7%) participants had a vertebral fracture. All CT-derived biomarkers were not associated with fracture prevalence. Conclusions: Bone density is lower with increasing extents of emphysema and small airway disease, but is not associated with large airway disease and trachea deformity. This may indicate the necessity to measure bone density early in the disease in COPD patients with emphysema and air trapping to prevent vertebral fractures.

Objective To determine inter-observer and inter-examination variability of manual attenuation measurements of the vertebrae in low-dose unenhanced chest computed tomography (CT). Methods Three hundred and sixty-seven lung cancer screening trial participants who underwent baseline and repeat unenhanced low-dose CT after 3 months because of an indeterminate lung nodule were included. The CT attenuation value of the first lumbar vertebrae (L1) was measured in all CTs by one observer to obtain inter-examination reliability. Six observers performed measurements in 100 randomly selected CTs to determine agreement with limits of agreement and Bland-Altman plots and reliability with intraclass correlation coefficients (ICCs). Reclassification analyses were performed using a threshold of 110 HU to define osteoporosis. Results Inter-examination reliability was excellent with an ICC of 0.92 (p

Einleitung: Chronische Rhinosinusitis mit nasalen Polypen ist eine mit chronischer Entzündung und Polypenwachstum einhergehende Erkrankung der nasalen und paranasalen Schleimhäute. Die zugrunde liegenden molekularen Mechanismen des gutartigen Zellwachstums von nasalen Polypen sind bislang[for full text, please go to the a.m. URL], 86. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Objective To assess the diagnostic value of nasal endoscopic findings in adults suspected of chronic rhinosinusitis.Data Sources PubMed, EMBASE, and the Cochrane Library.Review Methods A comprehensive search was performed up to March 5, 2013. Articles that assessed the diagnostic value of nasal endoscopy in adults suspected of chronic rhinosinusitis were included. For selected articles, the study design was assessed for directness of evidence and risk of bias. Prevalence, positive, and negative predictive values were extracted from reported data.Results Out of 3899 unique publications, we included 3 diagnostic studies with a high directness of evidence and a low or moderate risk of bias for data extraction. They showed a prevalence of chronic rhinosinusitis (diagnosed with computed tomography) of .40 to .56. Compared with posterior probabilities we found an added value for ruling in chronic rhinosinusitis by a positive nasal endoscopy of 25% to 28% and an added value for ruling out chronic rhinosinusitis by a negative nasal endoscopy of 5% to 30%.Conclusion and Recommendation Computed tomography is not considered necessary in case of a positive nasal endoscopy. While nasal endoscopy cannot rule out chronic rhinosinusitis, we advise computed tomography only for patients with a prolonged or complicated course of rhinosinusitis.

Publisher Summary This chapter focuses on the various forensic considerations that need to be taken into account while performing blood alcohol evaluation. Blood drawn from a decomposing body may yield a flawed alcohol concentration since decomposition involves fermentation, and blood sugar will allow fermentation to occur. Blood alcohol level, in fresh water drowning, may be reduced by dilution, since inhaled water enters the blood circulation. By the same token, transfusions and administration of intravenous fluids in hospitals also dilute blood alcohol concentrations. Therefore, it is advisable that in hospital cases, admission blood specimens drawn prior to fluid administration should be obtained from the emergency room and analyzed. Embalming fluids may contain methanol and/or other alcohols, however, ethanol is not a standard component. Therefore, any ethanol present in an embalmed body suggests that it was ingested prior to death. Blood, which is shed on the floor, the road, inside a vehicle, or anywhere outside the body. may be contaminated, and should not be used for alcohol testing.

Einleitung: MICA und MICB Allele gehören zu den MHC Klasse I Molekülen im Bereich der HLA-B Region. MICA und MICB Moleküle werden durch gamma/delta T-Lymphozyten und NK-Zellen erkannt, binden an NKG2D Rezeptoren und vermitteln Antitumor-Immunität durch Aktivierung von NK-Zellen[for full text, please go to the a.m. URL], 126. Kongress der Deutschen Gesellschaft für Chirurgie

With the lengthening of the human life span, cancer has become an increasingly important medical problem for the aged. It is not uncommon to find multiple primary neoplasms in elderly individuals. We recently investigated the death of an elderly man who had died suddenly and had three incidental malignant neoplasms, including a pleural mesothelioma, first diagnosed at autopsy. The importance of performing a complete medicolegal autopsy for epidemiological and statistical purposes is emphasized.

The usual death of a long-time heroin user is described. The significance of this case is that death occurred suddenly and unexpectedly during incarceration. In the United States, such deaths are frequently followed by lawsuits against the prison authorities. Drug abuse can cause death in many varied ways.

Drug deaths attributed to propoxyphene have been reported to be on the increase throughout the country. This trend has been observed in the greater Detroit (Wayne County) area as well. Analysis of the toxicological data, however, reveals that in the majority of instances propoxyphene is not the sole offending agent. An observation which should be brought to the attention of the clinician is that very often alcohol and /or other drugs are found in combination with propoxyphene, thereby increasing the potential danger of the drug. An evaluation of the propoxyphene deaths which occurred in Wayne County from 1973 through 1975 revealed that ethanol alone was found in 22% of the cases, ethanol and other drugs were found in 16% of the cases, and other drugs were found in 40% of the cases. Drugs most frequently found in deaths involving propoxyphene were diazepam (Valium), chlordiazepoxide (Librium), and barbiturates. This observation is consistent with the frequency of prescription of these drugs.

We show that postmortem cerebrospinal fluid (CSF) pleocytosis is a common event. Postmortem cerebrospinal or ventricular fluid was obtained from children and adults. The cells were counted and morphologically characterized using several histochemical markers. Infants exhibit a brisk postmortem CSF pleocytosis. Sudden infant death cases have relatively high CSF counts. Typeable cells are mononuclear and consist of approximately 60%-70% lymphocytes and 20%-40% macrophages. When postmortem duration is greater than 12 h, the cells become vacuolated and cannot be identified. The etiology of these findings requires further study.

Sixteen accidental deaths of infants occurred in Wayne County (Detroit) during 1974-1975 as a result of unsafe sleeping environments. Thirteen of these deaths resulted from different modes of asphyxia, two were due to falls, and one drowned. Differential diagnoses are pointed out. It is estimated that over 600 infants die each year in the United States due to unsafe sleeping conditions. Despite the magnitude and importance of this problem, little has been provided to the public in the form of preventive education. Federal regulations, passed in 1974, control the manufacture of new cribs but do not affect the existing unsafe cribs. Suggestions for the prevention of such fatal accidents are outlined, in cluding a safety check list for infant beds. The cooperation of all health professionals is required to educate the public of these dangers to their infants.

Cyclohexamine (PCE), a drug related to phencyclidine (PCP), has recently appeared on the illicit drug market with no legal restrictions. Two deaths directly related to PCE are described together with its chemical and clinical properties. Specific clinical aspects of PCP ingestion are discussed in consideration of the likelihood that PCE would have similar effects. The need for legislation restricting the use of PCE is demonstrated by the serious and possibly fatal complications resulting from the illicit administration of this drug.

The files of 874 fatal traumatic accident victims, aged 12-25 years, examined at the Wayne County Medical Examiner's Office during the period 1978-1988 were reviewed. Postmortem blood alcohol results of individuals who died after less than 15 min of hospitalization were utilized to approximate alcohol levels at the time of the fatal injury. Relationships between types of accidents, sex, age, race, and time of accident were examined. White victims were far more likely to have been drinking than blacks, and the data indicated that underaged drinkers were involved in fatal accidents at lower levels of blood alcohol than their counterparts of legal drinking age. Consistent racial differences in average alcohol levels were not observed, however. Unlike female and black victims, who much less frequently tested positive for alcohol when underage, white male victims 16-21 years of age were just as likely to have been drinking as those aged 21-25. The results of the study show that postmortem blood alcohol level can be used to identify differences in alcohol consumption among groups of accident victims in a major metropolitan area. Language: en

Summary 1 The interaction of angiotensin and several inhibitors of the uptake of noradrenaline across the neuronal membrane (cocaine, desipramine, protriptyline, and pronethalol) on the output of noradrenaline produced by sympathetic nerve stimulation has been studied in the isolated perfused rabbit heart. 2 Most of these drugs increased noradrenaline outflow—angiotensin, for example, by 175%. Cocaine (10−4m) did not change the amine overflow, probably because this very high concentration inhibited not only the re-uptake but also the liberation of noradrenaline. 3 Desipramine, protriptyline, and pronethalol, although infused in concentrations which enhanced the noradrenaline output, were not able to impair the angiotensin-induced increase of transmitter overflow. In the presence of cocaine (10−4m) the increase elicited by angiotensin was slightly reduced, though lower concentrations of cocaine, as previously described, do not interfere with the effect of angiotensin. 4 In contrast to the interaction between uptake inhibitors and angiotensin, the augmented output of noradrenaline caused by an uptake inhibitor could not be increased further by infusion of a second uptake inhibitor. 5 It is concluded that the increase of the outflow of noradrenaline during sympathetic nerve stimulation by small doses of angiotensin is not caused by an inhibition of re-uptake. On the contrary, the transmitter liberation seems to be facilitated. This is a novel principle of drug action on the sympathetic nerve terminals.

Die erhobenen Befunde verdeutlichen, das das Vorkommen von Diatomeen in der Luft keine ortlich bedingte Besonderheit darstellt. Dabei ist hervorzuheben, das es sich bei dem zur Untersuchung gelangten Material lediglich um zeitlich begrenzte Stichproben aus Luft-filtrationsstreifen aus 13 verschiedenen Stadten der Bundesrepublik gehandelt hat. Trotzdem glauben wir jedoch mit dem vorliegenden Beitrag weitgehend die Frage, ob die seinerzeit in Berlin festgestellten Luftverhaltnisse in bezug auf den Diatomeengehalt auch fur andere Gebiete der Bundesrepublik gelten, beantwortet zu haben. Die Gultigkeit von Diatomeen in den Organen fur die Diagnose des Ertrinkungstodes wird diskutiert.

In the isolated rabbit heart, the effects of angiotensin, vasopressin and mechanical reduction of coronary flow on the output of noradrenaline caused by sympathetic nerve stimulation were investigated. Both mechanical diminution of flow by 25–75% and infusion of Arg 8 -or Lys 8 -vasopressin (1–25 mU/min) decreased the output of noradrenaline. However, angiotensin (10 – 100 ng/min) augmented the output of transmitter. The regression equations relating changes of coronary flow to those of noradrenaline output were calculated for the three groups of hearts. Positive correlations with similar slopes were found for vasopressin and mechanical reduction of flow, while there was a negative correlation for angiotensin. - If coronary flow was diminished then the percentage of infused noradrenaline eliminated from the perfusion medium by the heart was significantly augmented. Vasopressin probably decreases the output of noradrenaline by reducing the coronary flow and consequently favouring the retention of the transmitter. Although the same mechanism may contribute to the effect of angiotensin, the output of noradrenaline is not reduced, but is enhanced by some specific interaction with adrenergic nerve function.

1. Experimente, die an Hunden durchgefuhrt wurden, zeigten, da\ Diatomeen und Latexpartikel bis zu einem Durchmesser von 90 Μ bereits 10 min nach peroraler Verabreichung im arteriellen und venosen Blut nachzuweisen sind. Zunahme der Partikel an Menge und Gro\e bis zu 2 Std. Nach Trinken eines Suspensionengemisches von Latexpartikeln verschiedener Gro\e, konnte das gleiche Ergebnis auch im Selbstversuch festgestellt werden. 2. In Blutproben von Hunden, die mit Suspensionen von Latexpartikeln uber Tracheotomie „ertrAnkt“ wurden, konnten die Modellkorper bis zu einer Gro\e von 12, vereinzelt auch 14 Μ nachgewiesen werden. 2. Die Ergebnisse vorliegender Untersuchungen scheinen die Gultigkeit eines Diatomeenbefundes zur Diagnose des Ertrinkungstodes zu widerlegen, da hAufig Wasser wAhrend eines Todes im Wasser geschluckt wird. Der Mechanismus mit welchem rigide, inerte Partikel der angegebenen Gro\en nach oraler Gabe ins Blut und in den Urin gelangen, ohne dabei sichtbare GefA\verletzungen zu verursachen, bedarf weiterer Untersuchungen. Es mag dabei vielleicht der lymphatische Apparat des Darmes eine Rolle spielen.

Assessment of the hazard associated with sudden natural death of drivers suggests that the magnitude of the problem does not warrant costly and restrictive control efforts. Investigation o...

Es wurden Schiesversuche mit einer 9 mm Luger-Pistole und entsprechender Munition durchgefuhrt, um den Entstehungsmechanismus einer todlichen atypischen Einschuswunde in der Stirn einer jungen Frau zu erklaren. Die fragliehe Verletzung wies einerseits die Charakteristika eines Kontaktschusses (Schus mit aufgesetzter Mundung) auf, lies andererseits aber Pulverschmauch, beziehungsweise Pulvereinsprengungen auch im Schuskanal vermissen. Der Angeklagte verneinte, jemals in Richtung seiner Frau geschossen zu haben. KOntaktschus, Fernschusse, sowie Schusse abgegeben im spitzen Winkel zur Haut wiesen gegenuber der fraglichen Einschuswunde abweichende Befunde auf. Es wurde die Moglichkeit erortert, das es sich bei dem todlichen Geschos um ein deformiertes gehandelt haben konnte. Daraufhin wurden in der letzten Versuchsreihe, zwecks Nachahmung eines Rikoschettgeschosses, Geschosse der Luger-Munition aus ihren Hulsen extrahiert und umgekehrt wieder in dieselben eingefugt. Bei einer Entfernung von 2 1/2–3 m konnte eine Verletzung produziert werden, die der todlichen ahnlich war. Die Versuchsergebnisse waren ausreichend, bei dem Gericht angemessene Zweifel aufzuwerfen hinsichtlich des vorher angenommenen „Vorsatzes“ des Angeklagten, seine Frau zu toten.

The influence of angiotensin on the removal of noradrenaline (10 ng/ml) from the perfusion medium and on the net-uptake of noradrenaline (5 and 20 μg/ml) was examined in the rabbit isolated heart. Concentrations of angiotensin, known to augment the output of noradrenaline from rabbit heart during sympathetic nerve stimulation, did not inhibit the removal of infused noradrenaline from the perfusion fluid. Only very high concentrations of angiotensin (13 μg/ml) significantly diminished the loss of noradrenaline. The positive inotropic effect of noradrenaline was not potentiated by angiotensin. On the other hand, cocaine, in doses which enhance the output of noradrenaline during sympathetic stimulation greatly reduced the loss of noradrenaline from the perfusion fluid. Neither angiotensin (130 ng/ml) nor metanephrine (5 and 20 μg/ml) significantly influenced the net-uptake of noradrenaline from high concentrations. The observations made support the assumption that an increase of transmitter liberation rather than inhibition of transmitter inactivation is responsible for the increase caused by angiotensin in the output of noradrenaline during stimulation of sympathetic nerves.

The death of a young healthy man, 11 days after he sustained minor trauma, illustrates the potential disaster of undiagnosed necrotizing fasciitis. Difficulty in early diagnosis often arises because the skin is initially spared and only later becomes secondarily involved. In this case, because of the lack of external manifestations, the diagnosis of necrotizing fasciitis was not considered until the postmortem examination. Necrotizing fasciitis should be considered a potentially serious problem that can follow minor trauma and eventually lead to death. The need for a high index of suspicion to make this diagnosis, along with the medicolegal implication of a diagnosis of necrotizing fasciitis, are both addressed in this report. Also of note is the fact that this patient was treated with nonsteroidal antiinflammatory drugs for pain and inflammation, which has recently been reported to be associated with an increased incidence of fulminant evolution of necrotizing fasciitis.

Graves' disease is a form of hyperthyroidism. A rare complication of Graves' disease is thyrotoxic crisis. Although the crisis is frequently fatal, it is a distinctly unusual cause of sudden death. We investigated the case of a young woman with Graves' disease who died suddenly. Radioimmunoassay tests of thyroid function were used to establish the diagnosis.

Two adults experienced syncopal episodes before dying suddenly. The autopsies revealed mitral valve myxomas. Mitral valve myxomas producing syncope and sudden death are discussed.

Penetrating injuries of the chest are uncommon in the work-place. We report an unusual case of a machinist who was killed when a drill press broke and a flying metallic fragment penetrated his thorax. Language: en

A previously healthy heroin addict died suddenly and unexpectedly of hemothorax due to rupture of a subclavian artery aneurysm. He had been using the neck veins for mainlining. The pathogenesis of the aneurysm is discussed.

Considerable disparity exists from area to area in the United States in the quality of medicolegal investigation. Much of this type of investigation in this country is still conducted by physicians in general practice, who possess neither specialized medicolegal training nor experience. Forensic autopsies are being performed mostly by hospital pathologists without forensic expertise, who conduct these autopsies in their spare time or as a paid hobby. This article provides guidelines for improved medicolegal investigation and formulation of autopsy reports, including opinions, which have been found to be advantageous in a medicolegal setting of a major metropolitan area and are, in my opinion, also applicable to smaller, even rural, types of jurisdiction.

A case of suicidal hanging inside an automobile is presented. To our knowledge, hanging has not been previously reported as a cause of death in a motor vehicle driver. The causes of death in automobile-related suicides are discussed.

A case of suicidal electrocution in a filled bathtub is presented with a discussion of the mechanism of electrocution in water. A modern safety device, the Ground Fault Interruptor Circuit, is also described.

Discussed are the unusual position of a body at a death scene and plausible mechanisms responsible for this positioning. Language: en

Scald burns are the most common type of thermal injury in child abuse. Death associated with nonaccidental burns, however, is uncommon. We recently investigated the case of a 4-year-old child who died from extensive body burns due to scalding. A contributory cause of death was isopropyl alcohol intoxication resulting from application of this chemical to the burns.

Sudden death caused by foreign-body perforation of the esophagus is distinctly uncommon. We report the death of an elderly patient in a nursing home who exsanguinated after she swallowed a chicken bone that perforated her esophagus and right common carotid artery.

An intrapleural free floating golf ball size body was an incidental finding at autopsy. The pathogenesis and clinical significance of this lesion are discussed.

A misleading dental chart can lead to a conflict in identification of a corpse. Such a conflict arose when it was necessary to identify the body of a man so severely mutilated in a bomb explosion in a car that identification appeared problematic. Eventually, the finding of fingernail fragments led to positive identification despite discrepancies between the dental chart and actual condition of the tooth remains.

Scene investigation is an important part of the medicolegal autopsy. In many cases the cause of death cannot be determined without knowledge of the circumstances. A case is presented in which the diagnosis of compression asphyxia and smothering was made only after analysis of the scene findings.