Examination of invisible injuries: UV-induced fluorescence as a supplement to physical examination for blunt trauma injury

Die Untersuchung von Gewaltopfern und die Dokumentation von Verletzungen gehört zur Routinetätigkeit in der Klinischen Rechtsmedizin. Am häufigsten werden Folgen stumpfer Gewalteinwirkung festgestellt. Diese Untersuchungen geraten an ihre Grenzen, wenn z.B. Hautunterblutungen (noch) nicht oder bereits nicht mehr sichtbar sind. Die vorliegende Arbeit belegt den Nutzen von ultravioletter (UV) Strahlung zur Sichtbarmachung verblasster und mit bloßem Auge nicht erkennbare Hämatome. Die durch UV-Strahlung hervorgerufene Fluoreszenz von gesundem im Vergleich zu geschädigtem Gewebe kann teils noch bis zu Monate nach einer Verletzung Unterschiede aufweisen. Somit stellt das hier untersuchte Verfahren eine kostengünstige, schnelle und zuverlässige Alternative des Methodenspektrums rechtsmedizinischer Untersuchungstechniken dar.:1. Bibliographische Beschreibung 2. Introduction 3. Background 3.1. Hematoma 3.2. Electromagnetic radiation 3.3. Fluorescence 3.4. UV radiation 3.5. UV-induced fluorescence 3.6. Hematoma fluorescence 3.7. UV-photography 3.8. Alternative non-invasive 4. Motivation & Purpose of this Thesis 5. Publication 6. Summary & Conclusion 6.1. Background 6.2. Aim 6.3. Material and Method 6.4. Results 6.5. Thesis 6.6. Conclusion 7. Appendix 7.1. Bibliography 7.2. Core Data 7.3. Declaration of Independence 7.4. Curriculum vitae 7.5. Publications 7.6. AcknowledgementsIdentification and age determination of hematomas is daily work in forensic medicine. Following blunt trauma, a hematoma may be visible between a few hours and up to three weeks. Patients presenting their injuries outside of that timeframe usually miss visual signs. Various studies indicate that ultraviolet radiation (UVR) can aid the process of hematoma identification, when visible signs are vague or even absent. In this thesis hematoma identification using UV- induced fluorescence is discussed as simple, economic and convenient method.:1. Bibliographische Beschreibung 2. Introduction 3. Background 3.1. Hematoma 3.2. Electromagnetic radiation 3.3. Fluorescence 3.4. UV radiation 3.5. UV-induced fluorescence 3.6. Hematoma fluorescence 3.7. UV-photography 3.8. Alternative non-invasive 4. Motivation & Purpose of this Thesis 5. Publication 6. Summary & Conclusion 6.1. Background 6.2. Aim 6.3. Material and Method 6.4. Results 6.5. Thesis 6.6. Conclusion 7. Appendix 7.1. Bibliography 7.2. Core Data 7.3. Declaration of Independence 7.4. Curriculum vitae 7.5. Publications 7.6. Acknowledgement

PET and MRI for the evaluation of regional myocardial perfusion and wall thickening after myocardial infarction

Deterioration of left ventricular (LV) function after myocardial infarction (MI) is a major cause of heart failure. Myocardial perfusion performance may play an important role in deterioration or improvement in LV function after MI. The aim of this study was to evaluate the myocardial perfusion reserve (MPR) and stress perfusion in deteriorating and non-deteriorating LV segments in patients after MI by PET and MRI, respectively. Regional wall thickening of 352 segments in 22 patients was assessed at 4 and 24 months after MI by cardiac MRI. PET was performed to evaluate MPR and adenosine stress N-13-ammonia perfusion 24 months after MI. Segments were divided into four groups according to deterioration or improvement in wall thickening. Normal functional segments at 4 months after MI that remained stable had a significantly higher mean MPR and mean stress perfusion PET value than deteriorated segments (p < 0.001). Furthermore, dysfunctional segments that improved had a significantly higher mean stress perfusion PET value than dysfunctional segments that remained dysfunctional (p < 0.001). This study demonstrated the additional value of myocardial perfusion assessment in relation to the functional integrity of the injured myocardium. Segmental functional LV improvement after MI was associated with better regional myocardial perfusion characteristics. Furthermore, the amount of wall thickening reduction was associated with regional myocardial perfusion abnormalities in patients after MI

Examination of invisible injuries: UV-induced fluorescence as a supplement to physical examination for blunt trauma injury

Die Untersuchung von Gewaltopfern und die Dokumentation von Verletzungen gehört zur Routinetätigkeit in der Klinischen Rechtsmedizin. Am häufigsten werden Folgen stumpfer Gewalteinwirkung festgestellt. Diese Untersuchungen geraten an ihre Grenzen, wenn z.B. Hautunterblutungen (noch) nicht oder bereits nicht mehr sichtbar sind. Die vorliegende Arbeit belegt den Nutzen von ultravioletter (UV) Strahlung zur Sichtbarmachung verblasster und mit bloßem Auge nicht erkennbare Hämatome. Die durch UV-Strahlung hervorgerufene Fluoreszenz von gesundem im Vergleich zu geschädigtem Gewebe kann teils noch bis zu Monate nach einer Verletzung Unterschiede aufweisen. Somit stellt das hier untersuchte Verfahren eine kostengünstige, schnelle und zuverlässige Alternative des Methodenspektrums rechtsmedizinischer Untersuchungstechniken dar.:1. Bibliographische Beschreibung 2. Introduction 3. Background 3.1. Hematoma 3.2. Electromagnetic radiation 3.3. Fluorescence 3.4. UV radiation 3.5. UV-induced fluorescence 3.6. Hematoma fluorescence 3.7. UV-photography 3.8. Alternative non-invasive 4. Motivation & Purpose of this Thesis 5. Publication 6. Summary & Conclusion 6.1. Background 6.2. Aim 6.3. Material and Method 6.4. Results 6.5. Thesis 6.6. Conclusion 7. Appendix 7.1. Bibliography 7.2. Core Data 7.3. Declaration of Independence 7.4. Curriculum vitae 7.5. Publications 7.6. AcknowledgementsIdentification and age determination of hematomas is daily work in forensic medicine. Following blunt trauma, a hematoma may be visible between a few hours and up to three weeks. Patients presenting their injuries outside of that timeframe usually miss visual signs. Various studies indicate that ultraviolet radiation (UVR) can aid the process of hematoma identification, when visible signs are vague or even absent. In this thesis hematoma identification using UV- induced fluorescence is discussed as simple, economic and convenient method.:1. Bibliographische Beschreibung 2. Introduction 3. Background 3.1. Hematoma 3.2. Electromagnetic radiation 3.3. Fluorescence 3.4. UV radiation 3.5. UV-induced fluorescence 3.6. Hematoma fluorescence 3.7. UV-photography 3.8. Alternative non-invasive 4. Motivation & Purpose of this Thesis 5. Publication 6. Summary & Conclusion 6.1. Background 6.2. Aim 6.3. Material and Method 6.4. Results 6.5. Thesis 6.6. Conclusion 7. Appendix 7.1. Bibliography 7.2. Core Data 7.3. Declaration of Independence 7.4. Curriculum vitae 7.5. Publications 7.6. Acknowledgement

Examination of invisible injuries: UV-induced fluorescence as a supplement to physical examination for blunt trauma injury

Die Untersuchung von Gewaltopfern und die Dokumentation von Verletzungen gehört zur Routinetätigkeit in der Klinischen Rechtsmedizin. Am häufigsten werden Folgen stumpfer Gewalteinwirkung festgestellt. Diese Untersuchungen geraten an ihre Grenzen, wenn z.B. Hautunterblutungen (noch) nicht oder bereits nicht mehr sichtbar sind. Die vorliegende Arbeit belegt den Nutzen von ultravioletter (UV) Strahlung zur Sichtbarmachung verblasster und mit bloßem Auge nicht erkennbare Hämatome. Die durch UV-Strahlung hervorgerufene Fluoreszenz von gesundem im Vergleich zu geschädigtem Gewebe kann teils noch bis zu Monate nach einer Verletzung Unterschiede aufweisen. Somit stellt das hier untersuchte Verfahren eine kostengünstige, schnelle und zuverlässige Alternative des Methodenspektrums rechtsmedizinischer Untersuchungstechniken dar.:1. Bibliographische Beschreibung 2. Introduction 3. Background 3.1. Hematoma 3.2. Electromagnetic radiation 3.3. Fluorescence 3.4. UV radiation 3.5. UV-induced fluorescence 3.6. Hematoma fluorescence 3.7. UV-photography 3.8. Alternative non-invasive 4. Motivation & Purpose of this Thesis 5. Publication 6. Summary & Conclusion 6.1. Background 6.2. Aim 6.3. Material and Method 6.4. Results 6.5. Thesis 6.6. Conclusion 7. Appendix 7.1. Bibliography 7.2. Core Data 7.3. Declaration of Independence 7.4. Curriculum vitae 7.5. Publications 7.6. AcknowledgementsIdentification and age determination of hematomas is daily work in forensic medicine. Following blunt trauma, a hematoma may be visible between a few hours and up to three weeks. Patients presenting their injuries outside of that timeframe usually miss visual signs. Various studies indicate that ultraviolet radiation (UVR) can aid the process of hematoma identification, when visible signs are vague or even absent. In this thesis hematoma identification using UV- induced fluorescence is discussed as simple, economic and convenient method.:1. Bibliographische Beschreibung 2. Introduction 3. Background 3.1. Hematoma 3.2. Electromagnetic radiation 3.3. Fluorescence 3.4. UV radiation 3.5. UV-induced fluorescence 3.6. Hematoma fluorescence 3.7. UV-photography 3.8. Alternative non-invasive 4. Motivation & Purpose of this Thesis 5. Publication 6. Summary & Conclusion 6.1. Background 6.2. Aim 6.3. Material and Method 6.4. Results 6.5. Thesis 6.6. Conclusion 7. Appendix 7.1. Bibliography 7.2. Core Data 7.3. Declaration of Independence 7.4. Curriculum vitae 7.5. Publications 7.6. Acknowledgement

Myocardial perfusion reserve in spared myocardium:correlation with infarct size and left ventricular ejection fraction

PURPOSE: Left ventricular ejection fraction (LVEF) after myocardial infarction is considered to be determined by the size of the infarction and residual function of the spared myocardium. Myocardial perfusion reserve (MPR) has been shown to be a strong prognostic factor in patients with ischaemic heart failure, even stronger than LVEF. In the present study, the interrelationship between MPR, LVEF and infarct size was investigated. METHODS: In total, 102 patients with a prior history of myocardial infarction were included. All underwent rest and stress (13)N-ammonia and gated (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) for evaluation of myocardial ischaemia and viability. FDG polar maps were used to determine the size of the infarction. The LVEF was obtained by gated (18)F-FDG PET or another available method within 3 months of the PET scan. MPR was obtained per segment in the spared myocardium. RESULTS: The mean age of the subjects was 68 ± 12 years. Global MPR was 1.63 ± 0.51. The mean LVEF was 36 ± 10 % and mean infarct size 23.72 ± 14.8 %. A linear regression model was applied for the analysis considering the LVEF as a dependent variable. All risk factors, mean stress flow, infarct size and MPR were entered as variables. The infarct size (p < 0.001) and MPR (p = 0.04) reached statistical significance. In a multivariate model MPR had a stronger correlation with LVEF than infarct size. CONCLUSION: In patients with a prior history of myocardial infarction, LVEF is not just related to infarct size but also to MPR in the spared myocardium