Zeitschrift für Rechtsmedizin. Journal of legal medicine
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The respirator lung is characterized histologically in the first exudative phase by capillary congestion, intra-alveolary edema, hyaline membranes and in most cases by concomitant inflammatory alterations. In the following irreversible phase, fibrous organization processes dominate and show a variable tendency towards pulmonary fibrosis. In 27 cases with long-term artificial respiration from 4 days to 12 weeks, mainly the proliferative alterations were investigated. ⋯ In cases of artificial respiration with pure oxygen, there is a special toxic component, which is illustrated by a young woman with polytraumatism who was administered artificial respiration for 5 weeks with pure oxygen. She died from respiratory insufficiency with severe pulmonary fibrosis. As different pathogenetic factors may cause irreversible pulmonary fibrosis, histomorphological classification is difficult later and, moreover, forensic problems result.
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The "Krönlein" shot (evisceration of the brain) is a very rare injury of the skull caused by a high-velocity bullet. The requirement for this type of low-range shot wound is a broad opening of the skull with laceration of the dura mater. In the past, several cases of this particular injury have been reported and all led to immediate death.
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Autopsy findings in 270 fatal head injuries from firearms are reported, including 243 suicides and 27 homicides. The most frequent weapon used for both groups were shot guns which are easily available in Norway. ⋯ Twenty-six percent of the victims from homicides had multiple wounds in their head. Suicide by firearms showed marked male predominance, whereas the sex ratio for homicide was rather equal between the two sexes.
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Despite many attempts it has so far not been possible to establish a uniform application of the term "whiplash injury" either for diagnostics, therapy, or medical reports. To obtain a clear, functionally based definition, the most frequently used formulations are compared, taking into account anatomic and mechanical aspects in addition. Whiplash injury is separated from hyperextension injury ("snap" trauma of the cervical spine), even though overlaps in the lesion picture are possible. ⋯ This second movement does not by any means proceed with low energy, but its determined by the mass contraction of the muscle group subject to primary abrupt overextension with their synergists. On the basis of the analysis of the mechanical course and the investigation of a actual accidents, the monosegmental cervical spine injury cannot, therefore, be seen as the characteristic type of damage due to a whiplash injury. Instead of this, the frequent occurrence of multiple injuries is pointed out.
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Thiamine deficiency leads to a moderate hyperlactacidemia. As a result of an acute alcohol exposure the hyperlactacidemia is increased. In addition metabolic and respiratory acidosis with a distinct low pH value occurs. These changes constitute vital risks and may be considered as basic arguments for the explanation of sudden death in chronic alcoholics.