John Hunsaker III for their time and passion invested over the past 15 years in the journal -they have not only read, reviewed, and edited thousands of papers, they have also published extensively themselves and thus contributed to the reputation of the journal, too.Together with the Editorial Board, they made the journal what it is today.Secondly, we would like to thank the whole team at Springer, who gave us three "newcomers" the opportunity to follow in these big footsteps.We will do our best.Now brought to the second-most important
Evaluation of the fitness of an accused person to participate in legal proceedings is a classic forensic activity. Before the trial, the forensic expert will already assess any preexisting somatic and psychological illnesses and give a written expert opinion describing the condition of the accused at the time of the examination and assessing whether he is fit to stand trial. Nevertheless, decompensation or aggravation of a disease may occur--especially in stress situations as they are to be expected for an accused in the courtroom--so that apart from the current evaluation of the state of health of the accused, emergency treatment may occasionally become necessary in the courtroom. The article tries to answer the question how the expert can meet this challenge.
The authors describe the case of a 27-year-old Vietnamese shoplifter who was caught by two shop detectives and suffered traumatic and mechanical asphyxia due to obstruction of the respiratory excursion and pressure against the neck. The man surprisingly survived the incident without any neurological damage, although the emergency doctor called to the scene diagnosed a score of 4 on the Glasgow Coma Scale. Whether the term burking applies to the described case depends on which of the various definitions in the literature is used.
Background: Fragmented QRS represents depolarization abnormality in myocardium and has a high prognostic value of arrhythmic events and mortality in various cardiac diseases.As another modality of evaluating myocardial fibrosis, late gadolinium enhancement (LGE) in cardiac magnetic resonance (cMR) imaging showed excellent agreement in histologic pattern of cardiac fibrosis.Also, patients with increased LGE were exposed to more frequent arrhythmic events and sudden cardiac attack in various cardiac disease.Objectives: The purpose is to evaluate whether fQRS was associated with presence of LGE in cMR, and to have clinical implication of fQRS as a predictor of ventricular arrhythmic events in dilated cardiomyopathy (DCMP) patients.Method: This study prospectively enrolled 307 patients with DCMP.With enrollment, all patients underwent cMR imaging, EKG monitoring and echocardiogram.All EKG were analyzed on the presence of qQRS, J wave at all 12 leads.And all patients were followed up and analyzed for the following outcomes: fatal arrhythmic events (Ventricular tachycardia, Ventricular fibrillation), hospitalization due to heart failure and sudden cardiac death (SCD).Result: Out of 307 patients, 14%(44) and 11.1%(33) patients showed inferior fQRS and inferior J wave, respectively.Patients with fQRS had longer QRS duration (109.8 vs. 123.8ms,p¼0.023), but there was no difference in age, sex, ejection fraction between two groups (p>0.05).The fQRS was associated with LGE ratio more than 3.5%(OR¼3.764,p¼0.001) quantitatively, and subendocardial pattern (OR¼3.67,p¼0.008) qualitatively, in multivariate analysis.Patients with inferior fQRS experienced more hospitalization due to heart failure (0.561.0 vs. 1.661.9times, p<0.001) and were more likely to have sustained ventricular tachycardia (4.1 vs. 13.9%,p¼0.011) and ventricular fibrilation(1.5 vs. 9.1%, p¼0.003) during mean 43.6637.3months.In Cox regression multivariate analysis, patients with more LGE (HR 1.042, p¼0.019) and inferior fQRS (HR 2.791, p¼0.024) showed significantly more fatal ventricular arrhythmia including SCD during mean 43.6637.3months.Conclusion: Inferior fQRS was associated with presence of LV-LGE, especially with subendocardial pattern.Furthermore, inferior fQRS was associated with higher incidence of fatal ventricular arrhythmia including SCD, heart failure hospitalization in patients with dilated cardiomyopathy.1300 Sudden cardiac death in patients with end stage renal disease on hemodialysis and the serial change of ECG.Multicenter prospective study
Unstable pelvic injuries are rare (3-8% of all fractures) but are associated with a mortality of up to 30%. An effective way to treat venous and cancellous sources of bleeding prehospital is to reduce intrapelvic volume with external noninvasive pelvic stabilizers. Scientifically reliable data regarding pelvic volume reduction and applicable pressure are lacking. Epidemiologic data were collected, and multiple post-mortem CT scans and biomechanical measurements were performed on real, unstable pelvic injuries. Unstable pelvic injury was shown to be the leading source of bleeding in only 19%. All external non-invasive pelvic stabilizers achieved intrapelvic volume reduction; the T-POD® succeeded best on average (333 ± 234 cm3), but with higher average peak traction (110 N). The reduction results of the VBM® pneumatic pelvic sling consistently showed significantly better results at a pressure of 200 mmHg than at 100 mmHg at similar peak traction forces. All pelvic stabilizers exhibited the highest peak tensile force shortly after application. Unstable pelvic injuries must be considered as an indicator of serious concomitant injuries. Stabilization should be performed prehospital with specific pelvic stabilizers, such as the T-POD® or the VBM® pneumatic pelvic sling. We recommend adjusting the pressure recommendation of the VBM® pneumatic pelvic sling to 200 mmHg.
Zusammenfassung Es wird der Todesfall eines 74-jährigen Mannes berichtet, bei dem nach Auffindung in der Wohnung bei der ärztlichen Leichenschau eine gastrointestinale Blutung als Todesursache dokumentiert wurde. Die Krematoriumsleichenschau ergab jedoch eine suspekte Verletzung am Kopf. Die gerichtliche Sektion ergab einen mittels eines selbstgebauten Schussapparates suizidal beigebrachten todesursächlichen Kopfsteckschuss. Der Fall betont einmal mehr die Notwendigkeit einer suffizienten ärztlichen Leichenschau.
Zusammenfassung Es wird der Todesfall einer 80-jährigen Patientin, die im Rahmen eines stationären Aufenthalts eine sturzbedingte Thoraxprellung mit Ruptur einer Emphysembulla erlitt, berichtet. Durch konsekutive Ausbildung eines Spannungspneumothorax wurde die Patientin innerhalb kurzer Zeit reanimationspflichtig. Bei den Wiederbelebungsversuchen kam es zunächst zu einer Ösophagusperforation durch den eingeführten Larynxtubus; nach „Korrektur“ dieser Lage fand sich der Larynxtubus bei der Obduktion im Kehlkopf einliegend. Eine Pleuradekompression war trotz eines massiv ausgeprägten Spannungspneumothorax mit ausgedehntem Weichteilemphysem nicht vorgenommen worden. Der dargestellte Fall betont einmal mehr die Notwendigkeit eines strukturierten Vorgehens im Rahmen des Atemwegsmanagements bei der kardiopulmonalen Reanimation. So hätte jedenfalls der Spannungspneumothorax adressiert werden können. Der Einsatz einer (sonst im klinischen Alltag nicht verwendeten) supraglottischen Atemwegshilfe sollte intensiv trainiert bzw. eventuell sogar überdacht werden.
