Suicide by self-immolation in Berlin 1990 - 2000

Titel und Inhaltsverzeichnis 1 Einleitung 5 Fälle und Methoden 8 Ergebnisse 9 Diskussion 22 Fazit 43 Zusammenfassung 45 Bildmaterial 47 Literaturverzeichnis 53 Danksagung 59 Lebenslauf 60In der vorliegenden Arbeit wurde das rechtsmedizinische Obduktionsgut in Berlin der Jahre 1990 bis 2000 im Hinblick auf Suizide durch Verbrennen ausgewertet. Insgesamt fanden sich bei 6036 Suiziden 47 Fälle durch Selbstverbrennung (0,8 %). Bemerkenswert war, dass insbesondere religiöse oder kulturelle Motive keine wichtige Rolle in der Berliner Untersuchungsgruppe spielten, auch politische Motive fanden sich nur in wenigen Fällen. Allerdings wurden psychiatrische Störungen bei zwei Dritteln der Suizidenten gefunden, was sich mit den meisten anderen Studien in Einklang bringen ließ. Drei Viertel der Suizidenten waren Männer. Das mittlere Alter der Suizidenten betrug 44 Jahre. Üblicherweise erfolgte die Inbrandsetzung im Freien (66 %) nach Übergießen mit einem Brandbeschleuniger, zumeist mit Benzin. Nahezu alle Suizidenten wiesen dritt- oder viertgradige Brandverletzungen auf; durchschnittlich waren 78 % der Körperoberfläche verbrannt. Die höchsten Rauchgaskonzentrationen fanden sich bei Suizidenten, die sich in ihrem Pkw verbrannt hatten. 60 % der Suizidenten verstarben am Ort der Selbstverbrennung, 21 % überlebten länger als 24 Stunden. Als bedeutendste Todesursache wurden ausgedehnte Verbrennungen angegeben (34 %), gefolgt von kombinierten Todesursachen wie Verbrennung mit Rauchgasintoxikation (21 %) und Verbrennung mit Inhalationstrauma (15%). Bei den zunächst überlebenden Suizidenten stand ein Multiorganversagen als Todesursache im Vordergrund. Beeinflussung durch Alkohol oder Pharmaka spielte keine wesentliche Rolle, nur in Einzelfällen wurden bedeutsame Blutalkoholkonzentrationen festgestellt. Mehr als ein Drittel der Suizidenten hatte bereits zuvor Suizidversuche unternommen, jedoch in keinem Fall durch Selbstverbrennung. Eine enge Zusammenarbeit mit den Ermittlungsbehörden ist unabdingbar bei der Untersuchung von Verbrennungsopfern, denn dies ist die einzige Möglichkeit zwischen einem akzidentellen Geschehen, einem Suizid oder einer Fremdeinwirkung zu unterscheiden. Ganz besonderes Augenmerk sollte auf die Befunde einer Rußaspiration sowie die Bestimmung von COHb und Zyanid im Blut gelenkt werden, um ein vitales von einem postmortalen Geschehen differenzieren zu können. Eine rechtsmedizinische Untersuchung von Brandleichen am Fundort sollte ebenso obligat sein wie die gerichtliche Obduktion von Todesfällen nach thermischer Einwirkung.The forensic autopsy cases of suicide by self-immolation in Berlin from 1990 to 2000 have been investigated retrospectively. There were 47 cases, representing 0.78 % of all known suicides committed in Berlin during this period. As reported in some other studies, two thirds of these individuals had a history of mental distur-bances. In only two cases political reasons appeared to be the motives for the self-immolation. Three quarters of the individuals have been male. The mean age was 44 years. The location of the self-immolation was outdoors in 66 %, the rest was indoors, except for three victims, who committed suicide in their cars. In nearly all cases, the suicides had doused themselves with an inflammable liquid, usually petrol. The median body surface burnt was 78 %. 60 % of the victims died at the location of their self-immolation, 21 % survived for more than 24 hours. 34 % of the individuals died exclusively from their extensive burns, 21 % from a combination of severe burns and smoke intoxication or inhalation trauma (15 %). The initially surviving victims died of multiple organ failure or septic complications due to severe burns. Only a few victims have been under mentionable influence of alcohol or drugs. More than one third of the victims had a history of suicide attempts. For the distinction of suicide from homicide or accidental burning the investigation of soot in the airways and carboxyhemoglobin is most important. The cooperation of forensic scientists and investigation authorities is unalterable, and the forensic examination of fire victims at the scene should be as evident as the autopsy of these individuals

3D-MRCP for evaluation of intra- and extrahepatic bile ducts: comparison of different acquisition and reconstruction planes

BACKGROUND: Magnetic resonance cholangiopancreatography (MRCP) is an established technique for the evaluation of intra- and extrahepatic bile ducts in patients with known or suspected hepatobiliary disease. However, the ideal acquisition and reconstruction plane for optimal bile duct evaluation with 3D technique has not been evaluated. The purpose of our study was to compare different acquisition and reconstruction planes of 3D-MRCP for bile duct assessment. METHODS: 34 patients (17f/17 m, mean age 41y) referred for MRCP were included in this prospective IRB-approved study. Respiratory-triggered 3D-T2w-MRCP sequences were acquired in coronal and axial plane. Coronal and axial MIP were reconstructed based on each dataset (resulting in two coronal and two axial MIP, respectively). Three readers in two sessions independently assessed the MIP, regarding visualization of bile ducts and image quality. Results were compared (Wilcoxon test). Intra- and interobserver variability were calculated (kappa-statistic). RESULTS: In case of coronal data acquisition, visualization of bile duct segments was significantly better on coronal reconstructed MIP images as compared to axial reconstructed MIP (p < 0.05). Regarding visualization, coronal MIP of the coronal acquisition were equal to coronal MIP of the axial acquisition (p > 0.05). Image quality of coronal and axial datasets did not differ significantly. Intra- and interobserver agreement regarding bile duct visualization were moderate to excellent (κ-range 0.55-1.00 and 0.42-0.85, respectively). CONCLUSIONS: The results of our study suggest that for visualization and evaluation of intra- and extrahepatic bile duct segments reconstructed images in coronal orientation are preferable. The orientation of the primary dataset (coronal or axial) is negligible

Evaluation of transient respiratory motion artifact at gadoxetate disodium-enhanced MRI-Influence of different contrast agent application protocols.

PURPOSE:To evaluate transient severe respiratory motion artifacts (TSM) at gadoxetate disodium-enhanced MRI dependent on the mode of contrast agent application. METHODS:200 patients (71f, 129m; mean 51y) were included in this retrospective IRB-approved study. Contrast application protocols (n = 4) differed with regards to injection rate (2ml or 1ml/sec), dose (weight-based or fixed 10ml) and supplemental oxygen administration (yes/no). SNR measurements were performed in the aorta and portal vein. Qualitatively, three readers assessed arterial phase image quality and TSM independently (4- and 5-point scale, respectively). Quantitative and qualitative results were compared (Kruskal-Wallis test, Dunn's multiple comparison test). The influence of different contrast agent application parameters on the occurrence of respiratory motion artifacts was assessed (univariate analysis). Interrater agreement and reliability were calculated (intraclass correlation coefficient, ICC)). RESULTS:Use of a lower contrast injection rate resulted in significantly higher arterial SNR in the aorta and portal vein (p<0.05). TSM was observed in 12% of examinations. Neither injection rate, contrast dose, nor oxygen had a significant influence. Interrater agreement and reliability for evaluation of image quality and respiratory motion were substantial/ almost perfect (ICC = 0.640-0.915). CONCLUSIONS:Technical factors regarding the specific mode of contrast application do not seem to significantly reduce the incidence of severe transient respiratory motion artifacts

Finite element modeling of the Fatih Sultan Mehmet Suspension Bridge

This study presents the 3D finite element model of the Fatih Sultan Mehmet Suspension Bridge located In Istanbul, Turkey. All the towers and the deck are modeled with four node thin shell finite elements with the inclusion of internal diaphragms. The main suspension cable, the back-stay cable, and the hanger cables are modeled with two node beam finite elements. An initial nonlinear static analysis utilizing the geometric stiffness is performed in order to obtain the correct pre-stressing forces in the cables. An eigenvalue analysis of the bridge is performed once a converged solution is obtained by the non-linear static analysis. The results of the eigenvalue analysis are compared with the available ambient vibration test measurements and the results of the finite element model of the bridge with only beam elements. The results show that the 3D numerical model utilizing thin shell finite elements can accurately represent the modal periods of the suspension bridge

Grading of motion-related artifacts after gadoxetate disodium injection on a 5-point scale, exemplarily arterial phase datasets.

<p>A: Rated as grade 1 by all three readers; B: rated as grade 3 by all three readers; C: rated as grade 5 by all three readers.</p

Mean motion scores in different phases of the contrast dynamic after injection of gadoxetate disodium, comparison of different contrast agent application protocols (#1–4).

<p>Mean motion score as assessed on a 5-point scale by three readers, in the pre-contrast (pre), arterial (art), portalvenous (pv) and delayed (del) phase, respectively.</p

27 year old male patient with diagnosis of primary sclerosing cholangitis.

<p>Gadoxetate disodium-enhanced liver MRI in the arterial (A) and portalvenous phase (B). Self-limiting severe transient motion can be appreciated in the arterial phase, causing significant degradation of image quality, which is resolved in the portalvenous phase.</p

Arterial phase SNR in the aorta (left) and in the portal vein (right), comparison of different contrast agent application protocols (#1–4).

<p>SNR in the aorta and portal vein were significantly higher in protocol groups using the slower injection rate of 1 ml/sec, as compared to an injection rate of 2 ml/sec (p<0.0001 and p = 0.0016). * indicates a statistical significance.</p