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Based on the description of the findings of four cases of self-strangulation with multiple knotting of the strangling device examined by the authors general criminological and specific forensic criteria for differential diagnosis of suicide and commission of the offence by another person are discussed. Though multiple knotting of the strangling device, caught hair and parts of clothes and concomitant injuries may also be seen in cases of suicide, they primarily justify the suspicion that the death was caused by another person. If it is one of those rare cases of self-strangulation with multiple knotting, the presence of symptoms of congestion in the head area, which may occasionally be absent in other cases of strangulation, is necessary for pathophysiological reasons.

First clinical results of patients with diseases of the lungs. The previous experiences on patients with diseases of the lungs reveal that the regional function diagnostics of the lungs may be extended and improved by functional scintigraphic radiospirometry. Because of the determination of regional lung volumes restrictive lung diseases can be differentiated and analysed more exactly than it has been possible before by the examinations of perfusion and ventilation alone. A further advance of the determination of lung volume is that the question of functional operability can be cleared up exactly. In our opinion the routine use of the functional scintigraphic radiospirometry is justified. A contraindication for this kind of examination should only be pregnancy.

A foreign worker died after a compressed air injury. The insufflation of high pressure air into the anus caused multiple ruptures in the part anterior of the dilated sigmoid and colon descending. For the reconstruction of the case it was necessary to know the minimum distance between the nozzle and the gluteal region. Experimental work has shown that clothing does offer protection against the high pressure air and colon perforations can only be expected if there is a small distance between the jet of the compressed air and the anal region.

Radioiodine therapy and surgical enucleation as a functionally legitimate operation are adequate methods of treatment for the autonomous adenoma of the thyroid. With reference to a series of our own patients, the making of the indication, the operation technique and the carrying out of radioiodine therapy are commented on. The aim of the operation is the enucleation of the autonomous adenoma without traumatizing the healthy thyroid tissue and without ligature of the polar vessels. The aim of radioiodine therapy is the selective destruction of the adenoma. The indication for the operation should certainly be made more liberally to perform the low-risk enucleation.

Cyclic precordial variations of radiation after i.v. administration of 15 mCi 99mTc-HSA correspond to cyclic volume changes of ventricular volumes of the heart. The "gated blood pool procedure" yields reliable data. Extensive analysis of these data results in subsequent information concerning left ventricular myocardial behaviour: 1. extent of the regional myocardial contraction 2. homogeneity of the contraction 3. regional contraction velocity 4. regional relaxation velocity. Four parametric scans present the distribution of each one of those parameters within the heart. Gated blood pool data have been compared with angiographic data. Reliability of those parameters obtained by extensive analysis of the gated blood pool data could be proven.

The subjects of investigation were 13 dead thorotrast patients, 10 male, 3 female, with ages ranging from 45 to 79 years. Two thousand organ and tissue specimens were investigated by means of autopsy and by both microscopic-autoradiographic and neutron activation analysis in order to detect late effects and to determine on approximate mean concentration of 232Th (mg per g of tissue). A comparison between late effects and concentrations of the dye medium led to the following conclusions: 1. 232Th is, after intravascular injection, deposited in all organs and tissues of the human body. 2. The highest mean concentrations are shown in the spleen, liver, bone marrow, and lymph nodes. 3. The distribution of 232Th is inhomogeneous in all organs and tissues. The variations of maximum and minimum concentration lie around factor 2.2 X 10(0)-2.4 X 10(5). 4. Late effects occur only in spleen, liver, lymph nodes, and bone marrow, but not in organs and tissues that show a mean concentration of 232Th under 10(-1) mg per g tissue. 5. It is highly probable that tumors of thorotrast patients in organs other than spleen, liver lymph nodes, and bone marrow are not caused by deposition of 232Th or ThO2.

It is reported about a female patient with two lipomas of the liver. The special diagnosis and the differentiation against metastases and other malignant tumors of the liver are only possible by means of computertomography. Scintigraphy and sonography do not allow a differential diagnosis. On the one hand lipoma of the liver is a very rare and benign disease but on the other hand a correct diagnosis may be - like in this case - very important because of therapy and prognosis.

AIMS/HYPOTHESIS: Lack of insulin and infection/inflammation are the two most common causes of diabetic ketoacidosis (DKA). We used insulin withdrawal followed by insulin administration as a clinical model to define effects on substrate metabolism and to test whether increased levels of counter-regulatory hormones and cytokines and altered adipose tissue signalling participate in the early phases of DKA.METHODS: Nine individuals with type 1 diabetes, without complications, were randomly studied twice, in a crossover design, for 5 h followed by 2.5 h high-dose insulin clamp: (1) insulin-controlled euglycaemia (control) and (2) after 14 h of insulin withdrawal in a university hospital setting.RESULTS: Insulin withdrawal increased levels of glucose (6.1 ± 0.5 vs 18.6 ± 0.5 mmol/l), NEFA, 3-OHB (127 ± 18 vs 1837 ± 298 μmol/l), glucagon, cortisol and growth hormone and decreased HCO3- and pH, without affecting catecholamine or cytokine levels. Whole-body energy expenditure, endogenous glucose production (1.55 ± 0.13 vs 2.70 ± 0.31 mg kg-1 min-1), glucose turnover, non-oxidative glucose disposal, lipid oxidation, palmitate flux (73 [range 39-104] vs 239 [151-474] μmol/min), protein oxidation and phenylalanine flux all increased, whereas glucose oxidation decreased. In adipose tissue, Ser473 phosphorylation of Akt and mRNA levels of G0S2 decreased, whereas CGI-58 (also known as ABHD5) mRNA increased. Protein levels of adipose triglyceride lipase (ATGL) and hormone-sensitive lipase phosphorylations were unaltered. Insulin therapy decreased plasma glucose concentrations dramatically after insulin withdrawal, without any detectable effect on net forearm glucose uptake.CONCLUSIONS/INTERPRETATION: Release of counter-regulatory hormones and overall increased catabolism, including lipolysis, are prominent features of preacidotic ketosis induced by insulin withdrawal, and dampening of Akt insulin signalling and transcriptional modulation of ATGL activity are involved. The lack of any increase in net forearm glucose uptake during insulin therapy after insulin withdrawal indicates muscle insulin resistance.TRIAL REGISTRATION: ClinicalTrials.gov NCT02077348 FUNDING: This study was supported by Aarhus University and the KETO Study Group/Danish Agency for Science Technology and Innovation.

BACKGROUND: Renal denervation (RDN), treating resistant hypertension, has, in open trial design, been shown to lower blood pressure (BP) dramatically, but this was primarily with respect to office BP.METHOD: We conducted a SHAM-controlled, double-blind, randomized, single-center trial to establish efficacy data based on 24-h ambulatory BP measurements (ABPM). Inclusion criteria were daytime systolic ABPM at least 145 mmHg following 1 month of stable medication and 2 weeks of compliance registration. All RDN procedures were carried out by an experienced operator using the unipolar Medtronic Flex catheter (Medtronic, Santa Rosa, California, USA).RESULTS: We randomized 69 patients with treatment-resistant hypertension to RDN (n = 36) or SHAM (n = 33). Groups were well balanced at baseline. Mean baseline daytime systolic ABPM was 159 ± 12 mmHg (RDN) and 159 ± 14 mmHg (SHAM). Groups had similar reductions in daytime systolic ABPM compared with baseline at 3 months [-6.2 ± 18.8 mmHg (RDN) vs. -6.0 ± 13.5 mmHg (SHAM)] and at 6 months [-6.1 ± 18.9 mmHg (RDN) vs. -4.3 ± 15.1 mmHg (SHAM)]. Mean usage of antihypertensive medication (daily defined doses) at 3 months was equal [6.8 ± 2.7 (RDN) vs. 7.0 ± 2.5 (SHAM)].RDN performed at a single center and by a high-volume operator reduced ABPM to the same level as SHAM treatment and thus confirms the result of the HTN3 trial.CONCLUSION: Further, clinical use of RDN for treatment of resistant hypertension should await positive results from double-blinded, SHAM-controlled trials with multipolar ablation catheters or novel denervation techniques.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0.