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  1. Article ; Online: Differing sizes of bullet entrance holes in skin of the anterior and posterior trunk.

    Geisenberger, D / Große Perdekamp, M / Pollak, S / Thierauf-Emberger, A / Thoma, V

    International journal of legal medicine

    2022  Volume 136, Issue 6, Page(s) 1597–1603

    Abstract: The aim of the present study was to establish whether the size (diameter and area) of bullet entrance holes in skin varies between distant shots to the anterior and posterior trunk, respectively, when using the same ammunition (in concreto pistol ... ...

    Abstract The aim of the present study was to establish whether the size (diameter and area) of bullet entrance holes in skin varies between distant shots to the anterior and posterior trunk, respectively, when using the same ammunition (in concreto pistol cartridges 9 mm Luger). For that purpose, specimens of porcine skin from the belly region and the back were taken (10 samples each) and shot at from a distance of 1.6 m. The entrance holes were photo-documented under standardised conditions. After image processing for contrast enhancement, the maximum diameter and the area of each skin defect were measured automatically by means of an image analysis system. Both size parameters differed significantly depending on the body region affected. On the back with its comparatively thick dermis, the skin defects were considerably smaller than those on the ventral trunk where the corium is less thick. This difference can be explained by the fact that the elastic properties of skin are strongly determined by the connective tissue which is especially rich in fibres. The study results were consistent with the authors' casework experience and support the assumption that the entrance site of gunshot wounds has a major influence on the size of the bullet hole in skin.
    MeSH term(s) Animals ; Firearms ; Forensic Ballistics/methods ; Skin/injuries ; Swine ; Wounds, Gunshot
    Language English
    Publishing date 2022-08-25
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1055109-8
    ISSN 1437-1596 ; 0937-9827
    ISSN (online) 1437-1596
    ISSN 0937-9827
    DOI 10.1007/s00414-022-02879-x
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  2. Article: Bing-Neel Syndrome: An Initial Manifestation of Waldenstrom Macroglobulinemia.

    Lee, Matthew S / Sathe, Sanjivani / Valasapalli, Srijan / Grosse Perdekamp, Maria

    Cureus

    2021  Volume 13, Issue 11, Page(s) e19402

    Abstract: Waldenstrom macroglobulinemia (WM) is a low-grade B-cell lymphoma characterized by bone marrow infiltration by monoclonal lymphoplasmacytic cells plus an IgM monoclonal gammopathy. Bing-Neel syndrome (BNS) is a rare manifestation of WM where malignant ... ...

    Abstract Waldenstrom macroglobulinemia (WM) is a low-grade B-cell lymphoma characterized by bone marrow infiltration by monoclonal lymphoplasmacytic cells plus an IgM monoclonal gammopathy. Bing-Neel syndrome (BNS) is a rare manifestation of WM where malignant lymphoplasmacytic cells infiltrate the central nervous system (CNS). Though only present in 0.8% of WM cases, it is likely underdiagnosed and may present before or during WM treatment. Here, we present a case of BNS as an initial sign of WM. A 75-year-old male presented with confusion, gait instability, and expressive aphasia. MRI demonstrated a 5.5-cm mass in the right frontal lobe, crossing midline. Brain biopsy showed CNS lymphoma and later tested positive for the MYD88L265P mutation suggesting WM (as is a mutation in 90-95% WM patients). Indeed, quantitative serum immunoglobulins showed elevated IgM. Initial treatment for WM was started with rituximab, methylprednisolone, carfilzomib, and ibrutinib. MRI two months after initiation showed good response, and the patient was transitioned to ibrutinib monotherapy. Surveillance MRI one year later showed patchy right frontal lobe enhancement indicating disease progression, and therefore the patient was placed back on his initial treatment regimen. However, ibrutinib later had to be held due to thrombocytopenia. Two months after re-starting chemotherapy, he presented with bizarre behavior, and MRI showed extensive disease progression. He was then transitioned to palliative chemotherapy with high-dose methotrexate and rituximab. He has responded well to this regimen, and MRI two years after diagnosis showed no recurrent disease. BNS is a rare but easily missed manifestation of WM. As per the recent National Comprehensive Cancer Network (NCCN) guidelines and the 8th International Workshop on WM (IWWM-8), no standardized diagnostic or management guidelines for BNS is available. Direct brain biopsy is the gold standard for diagnosis. Due to its low incidence, rarity, and limited prospective trial, there is a lack of a clear standard of care therapy. Specific treatment regimen depends on the patient factors and treatment tolerability. IWWM-8 suggests the use of a variety of cytotoxic chemotherapies or ibrutinib. A high-quality meta-analysis of existing reports is critical to characterize the diagnostic features and optimal treatment for BNS. The prognosis of BNS remains unclear, with an estimated three- and five-year survival rate at 59% and 71%, respectively. BNS is an infrequent complication of WM. Clinicians should suspect BNS with persistent, unexplained neurologic symptoms in WM.
    Language English
    Publishing date 2021-11-09
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.19402
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  3. Article ; Online: Cyclic GMP in Liver Cirrhosis-Role in Pathophysiology of Portal Hypertension and Therapeutic Implications.

    Kreisel, Wolfgang / Lazaro, Adhara / Trebicka, Jonel / Grosse Perdekamp, Markus / Schmitt-Graeff, Annette / Deibert, Peter

    International journal of molecular sciences

    2021  Volume 22, Issue 19

    Abstract: The NO-cGMP signal transduction pathway plays a crucial role in tone regulation in hepatic sinusoids and peripheral blood vessels. In a cirrhotic liver, the key enzymes endothelial NO synthase (eNOS), soluble guanylate cyclase (sGC), and ... ...

    Abstract The NO-cGMP signal transduction pathway plays a crucial role in tone regulation in hepatic sinusoids and peripheral blood vessels. In a cirrhotic liver, the key enzymes endothelial NO synthase (eNOS), soluble guanylate cyclase (sGC), and phosphodiesterase-5 (PDE-5) are overexpressed, leading to decreased cyclic guanosine-monophosphate (cGMP). This results in constriction of hepatic sinusoids, contributing about 30% of portal pressure. In contrast, in peripheral arteries, dilation prevails with excess cGMP due to low PDE-5. Both effects eventually lead to circulatory dysfunction in progressed liver cirrhosis. The conventional view of portal hypertension (PH) pathophysiology has been described using the "NO-paradox", referring to reduced NO availability inside the liver and elevated NO production in the peripheral systemic circulation. However, recent data suggest that an altered availability of cGMP could better elucidate the contrasting findings of intrahepatic vasoconstriction and peripheral systemic vasodilation than mere focus on NO availability. Preclinical and clinical data have demonstrated that targeting the NO-cGMP pathway in liver cirrhosis using PDE-5 inhibitors or sGC stimulators/activators decreases intrahepatic resistance through dilation of sinusoids, lowering portal pressure, and increasing portal venous blood flow. These results suggest further clinical applications in liver cirrhosis. Targeting the NO-cGMP system plays a role in possible reversal of liver fibrosis or cirrhosis. PDE-5 inhibitors may have therapeutic potential for hepatic encephalopathy. Serum/plasma levels of cGMP can be used as a non-invasive marker of clinically significant portal hypertension. This manuscript reviews new data about the role of the NO-cGMP signal transduction system in pathophysiology of cirrhotic portal hypertension and provides perspective for further studies.
    MeSH term(s) Animals ; Cyclic GMP/metabolism ; Cyclic Nucleotide Phosphodiesterases, Type 5/metabolism ; Humans ; Hypertension, Portal/metabolism ; Hypertension, Portal/pathology ; Hypertension, Portal/therapy ; Liver Cirrhosis/metabolism ; Liver Cirrhosis/pathology ; Liver Cirrhosis/therapy ; Nitric Oxide/metabolism ; Nitric Oxide Synthase Type III/metabolism ; Second Messenger Systems
    Chemical Substances Nitric Oxide (31C4KY9ESH) ; NOS3 protein, human (EC 1.14.13.39) ; Nitric Oxide Synthase Type III (EC 1.14.13.39) ; Cyclic Nucleotide Phosphodiesterases, Type 5 (EC 3.1.4.35) ; Cyclic GMP (H2D2X058MU)
    Language English
    Publishing date 2021-09-26
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2019364-6
    ISSN 1422-0067 ; 1422-0067 ; 1661-6596
    ISSN (online) 1422-0067
    ISSN 1422-0067 ; 1661-6596
    DOI 10.3390/ijms221910372
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  4. Article ; Online: The punched-out tissue complex (skin-bone "imprimatum") in shots from captive-bolt guns: does it act as a secondary projectile?

    Geisenberger, Dorothee / Giorgetti, Arianna / Glardon, Matthieu / Große Perdekamp, Markus / Pollak, Stefan / Pircher, Rebecca

    International journal of legal medicine

    2020  Volume 134, Issue 3, Page(s) 1095–1102

    Abstract: From the first half of the twentieth century to the present day, injuries and fatalities from captive-bolt livestock stunners are a major topic in forensic medicine. The vast majority of cases account for suicides with the frontal, temporal, parietal, ... ...

    Abstract From the first half of the twentieth century to the present day, injuries and fatalities from captive-bolt livestock stunners are a major topic in forensic medicine. The vast majority of cases account for suicides with the frontal, temporal, parietal, and occipital regions being the most common sites of entrance (in descending order of frequency). Due to the limited length of the bolt, the corresponding wound channel within the braincase is only several centimeters long. It has been a controversial subject for a long time, whether the skin-bone complex punched out by the conically grooved end of the steel rod may act as a "secondary projectile" being propelled beyond the actual path of the bolt. To answer this question, experimental shots from various types of captive bolt-guns were fired to simulants. Video-documentation employing a high-speed motion camera showed that the punched-out pieces of skin and bone did not move further than the bolt. Thus, a secondary extension of the total wound channel could not be observed. However, the suction effect caused by the bolt's rearward movement may induce a slight retrograde displacement of the skin-bone complex.
    MeSH term(s) Animals ; Firearms/classification ; Forensic Ballistics ; Forensic Medicine ; Head Injuries, Penetrating/pathology ; Humans ; Models, Biological ; Wounds, Gunshot/pathology
    Language English
    Publishing date 2020-02-14
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1055109-8
    ISSN 1437-1596 ; 0937-9827
    ISSN (online) 1437-1596
    ISSN 0937-9827
    DOI 10.1007/s00414-020-02262-8
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  5. Article ; Online: Non-traumatic subdural hematoma secondary to septic brain embolism: A rare cause of unexpected death in a drug addict suffering from undiagnosed bacterial endocarditis.

    Geisenberger, D / Huppertz, L M / Büchsel, M / Kramer, L / Pollak, S / Grosse Perdekamp, M

    Forensic science international

    2015  Volume 257, Page(s) e1–5

    Abstract: Acute subdural hematomas are mostly due to blunt traumatization of the head. In rare instances, subdural bleeding occurs without evidence of a previous trauma following spontaneous hemorrhage, e.g. from a ruptured aneurysm or an intracerebral hematoma ... ...

    Abstract Acute subdural hematomas are mostly due to blunt traumatization of the head. In rare instances, subdural bleeding occurs without evidence of a previous trauma following spontaneous hemorrhage, e.g. from a ruptured aneurysm or an intracerebral hematoma perforating the brain surface and the arachnoid. The paper presents the morphological, microbiological and toxicological findings in a 38-year-old drug addict who was found by his partner in a dazed state. When brought to a hospital, he underwent trepanation to empty a right-sided subdural hematoma, but he died already 4h after admission. Autopsy revealed previously undiagnosed infective endocarditis of the aortic valve as well as multiple infarctions of brain, spleen and kidneys obviously caused by septic emboli. The subdural hematoma originated from a subcortical brain hemorrhage which had perforated into the subdural space. Microbiological investigation of the polypous vegetations adhering to the aortic valve revealed colonization by Streptococcus mitis and Klebsiella oxytoca. According to the toxicological analysis, no psychotropic substances had contributed to the lethal outcome. The case reported underlines that all deaths of drug addicts should be subjected to complete forensic autopsy, as apart from intoxications also natural and traumatic causes of death have to be taken into consideration.
    MeSH term(s) Adult ; Aortic Valve/microbiology ; Aortic Valve/pathology ; Brain Infarction/etiology ; Brain Infarction/pathology ; Drug Users ; Endocarditis, Bacterial/complications ; Endocarditis, Bacterial/pathology ; Fatal Outcome ; Hematoma, Subdural, Acute/etiology ; Hematoma, Subdural, Acute/pathology ; Humans ; Infarction/etiology ; Infarction/pathology ; Intracranial Embolism/complications ; Intracranial Embolism/microbiology ; Intracranial Embolism/pathology ; Intracranial Hemorrhages/complications ; Intracranial Hemorrhages/pathology ; Kidney/blood supply ; Kidney/pathology ; Klebsiella Infections/complications ; Klebsiella oxytoca/isolation & purification ; Male ; Splenic Infarction/etiology ; Splenic Infarction/pathology ; Streptococcal Infections/complications ; Streptococcus mitis/isolation & purification
    Language English
    Publishing date 2015-12
    Publishing country Ireland
    Document type Case Reports ; Journal Article
    ZDB-ID 424042-x
    ISSN 1872-6283 ; 0379-0738
    ISSN (online) 1872-6283
    ISSN 0379-0738
    DOI 10.1016/j.forsciint.2015.07.055
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  6. Article ; Online: Pattern injuries from blows with the muzzle end of a handgun.

    Geisenberger, D / Vogt, S / Pircher, R / Kramer, L / Pollak, S / Grosse Perdekamp, M

    Forensic science international

    2015  Volume 257, Page(s) 341–346

    Abstract: Pistols, revolvers and blank guns are not only used to discharge cartridges, but also for hits to the victim. In such cases, the blows preferably affect the head and/or the interposed hands protecting the body. The impact is mostly exerted either by the ... ...

    Abstract Pistols, revolvers and blank guns are not only used to discharge cartridges, but also for hits to the victim. In such cases, the blows preferably affect the head and/or the interposed hands protecting the body. The impact is mostly exerted either by the grip of a pistol or the butt of a revolver. In vigorous thrusts inflicted with the muzzle end of the weapon, the edge of the barrel may produce circular punch lesions with central skin flaps roughly corresponding to the bore. As in other kinds of pistol-whipping, the scalp wounds may be associated with fractures of the skull and even with brain contusions. Using the example of a homicide committed by pistol-whipping, the morphological features of blunt injuries from a handgun's muzzle are presented. The characteristic wound pattern found on the victim's head could be reproduced experimentally by forceful blows to the forehead of a slaughtered pig. In the case presented, the dominant hand of the perpetrator showed friction blisters due to prolonged striking with an unhandy tool in the form of a pistol.
    MeSH term(s) Animals ; Brain Injuries/etiology ; Brain Injuries/pathology ; Facial Injuries/etiology ; Facial Injuries/pathology ; Firearms ; Forehead/injuries ; Forensic Pathology ; Humans ; Lacerations/etiology ; Lacerations/pathology ; Male ; Models, Animal ; Scalp/injuries ; Swine ; Young Adult
    Language English
    Publishing date 2015-12
    Publishing country Ireland
    Document type Case Reports ; Journal Article
    ZDB-ID 424042-x
    ISSN 1872-6283 ; 0379-0738
    ISSN (online) 1872-6283
    ISSN 0379-0738
    DOI 10.1016/j.forsciint.2015.09.018
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  7. Article ; Online: Bullet wipe on the uppermost textile layer of gunshot entrance sites: may it be absent due to pre-existing blood staining?

    Pircher, Rebecca / Große Perdekamp, Markus / Mierdel, Katrin / Pollak, Stefan / Thierauf-Emberger, Annette / Geisenberger, Dorothee

    International journal of legal medicine

    2019  Volume 133, Issue 5, Page(s) 1437–1442

    Abstract: Most gunshot entrance sites on human victims are localized in clothed body regions. Except for the use of lead-free ammunition, a positive color reaction of the sodium rhodizonate test indicates a primary target hit by the bullet. Any lead residue ... ...

    Abstract Most gunshot entrance sites on human victims are localized in clothed body regions. Except for the use of lead-free ammunition, a positive color reaction of the sodium rhodizonate test indicates a primary target hit by the bullet. Any lead residue pattern in the area around the entrance hole allows approximate conclusions as to the firing distance in close and intermediate range shots, whereas the presence of a bullet wipe denotes an entrance site. A criminal case gave rise to an experimental study to clarify whether a blood-soaked garment being shot at as a primary target may lack a bullet wipe around the entrance hole. Distant-range shots were fired with a semi-automatic pistol (Heckler & Koch, Mod. USP Compact, cal. 9-mm Luger) using cartridges with jacketed round-nose bullets and a Sinoxid primer containing lead styphnate. In fabrics saturated with fluid blood, a wide area around the bullet entrance was densely covered with rhodizonate-positive microparticles simulating gunshot residues (GSR) from a close-range shot. In shots to fabrics oversaturated with blood, a typical bullet wipe was lacking, whereas lead-containing particles were spotted in the periphery. The results are discussed with respect to the aberrant appearance of bullet entrance sites in blood-soaked fabrics.
    MeSH term(s) Blood Stains ; Cyclohexanones/blood ; Cyclohexanones/chemistry ; Firearms ; Forensic Ballistics ; Textiles/analysis ; Wounds, Gunshot/blood
    Chemical Substances Cyclohexanones ; rhodizonic acid (118-76-3)
    Language English
    Publishing date 2019-05-31
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1055109-8
    ISSN 1437-1596 ; 0937-9827
    ISSN (online) 1437-1596
    ISSN 0937-9827
    DOI 10.1007/s00414-019-02087-0
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  8. Article: Elucidation of a strange gunshot injury.

    Grosse Perdekamp, M / Pollak, S

    International journal of legal medicine

    2005  Volume 119, Issue 2, Page(s) 91–93

    Abstract: A 50-year-old obese man sought medical treatment for bleeding injuries in the abdomen and thigh. According to his statement he felt a dull blow on the front of the trunk while he was feeding swans at a lake. The forensic wound findings and the ... ...

    Abstract A 50-year-old obese man sought medical treatment for bleeding injuries in the abdomen and thigh. According to his statement he felt a dull blow on the front of the trunk while he was feeding swans at a lake. The forensic wound findings and the examination of the clothing suggested that the injuries were caused by a single close-range gunshot with the bullet path running nearly vertically downwards and having a total length of 38 cm. The bullet primarily entered in the right mesogastrium, left the body in the right inguinal region, re-entered and ultimately lodged in the right thigh. After confronting the man with the results of the forensic examination he admitted that he himself had caused the gunshot injury accidentally when cleaning his small-bore revolver.
    MeSH term(s) Abdominal Injuries/pathology ; Accidents ; Foreign-Body Migration/pathology ; Humans ; Male ; Middle Aged ; Obesity/pathology ; Thigh ; Wounds, Gunshot/pathology
    Language English
    Publishing date 2005-03
    Publishing country Germany
    Document type Case Reports ; Journal Article
    ZDB-ID 1055109-8
    ISSN 1437-1596 ; 0937-9827
    ISSN (online) 1437-1596
    ISSN 0937-9827
    DOI 10.1007/s00414-004-0502-z
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  9. Article ; Online: Muzzle imprint mark: a patterned injury which may be constituted of intradermal blood extravasations.

    Pircher, R / Bielefeld, L / Geisenberger, D / Große Perdekamp, M / Pollak, S / Thierauf-Emberger, A

    Forensic science international

    2014  Volume 244, Page(s) 166–169

    Abstract: The muzzle imprint mark in contact shots is usually regarded as a patterned pressure abrasion depicting the barrel end as well as adjacent constructional components of the weapon. Due to parching after exposure to air, the affected skin assumes a brown ... ...

    Abstract The muzzle imprint mark in contact shots is usually regarded as a patterned pressure abrasion depicting the barrel end as well as adjacent constructional components of the weapon. Due to parching after exposure to air, the affected skin assumes a brown color, especially along the contours of the impacting structures. Apart from this well-known type of epidermal damage, the imprint mark may also be formed by intradermal hemorrhages. In some cases, these intracutaneous bleedings manifest themselves as circular, curved or straight reddish lines mirroring the surface relief of the weapon's muzzle end. To estimate the frequency of skin hematomas in muzzle imprints, 35 consecutive contact shots to the head (temple, forehead, submental and occipital region) were evaluated. In 3 cases, the muzzle imprint mark exclusively consisted of intracutaneous bruises surrounding the bullet entrance hole. In 14 cases, the muzzle imprint was composed of both excoriations and intradermal hematomas.
    MeSH term(s) Female ; Forensic Pathology ; Head Injuries, Penetrating/pathology ; Hematoma/pathology ; Homicide ; Humans ; Male ; Skin/injuries ; Skin/pathology ; Suicide ; Wounds, Gunshot/pathology
    Language English
    Publishing date 2014-11
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 424042-x
    ISSN 1872-6283 ; 0379-0738
    ISSN (online) 1872-6283
    ISSN 0379-0738
    DOI 10.1016/j.forsciint.2014.08.029
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  10. Article: Maximale Blutalkoholkonzentration nach forciertem Konsum von alkoholfreiem Bier. Maximum blood ethanol concentration after forced consumption of non-alcoholic beer

    Thierauf, A. / Große Perdekamp, M. / Auwärter, V.

    Rechtsmedizin

    2012  Volume 22, Issue 4, Page(s) 244

    Language German
    Document type Article
    ZDB-ID 1064911-6
    ISSN 0937-9819
    Database Current Contents Medicine

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