Living donor and split-liver transplantation techniques require the calculation of a standard liver volume (SLV) as a reference point for the minimal volume necessary for the recipient. We therefore examined whether a widely used formula developed on the basis of a Japanese population sample was also adequate for the Caucasian population. The documentation of volumes of 1332 autopsy livers from a German Forensic Medicine Department was used to create a formula for an SLV for the Caucasian population. The Japanese formula estimated the Caucasian liver volume to be on average 322.6 ؎ 335.8 g (SD) less than they actually were. The following new formula for the calculation of SLV for Caucasians was established by linear regression analysis:Liver volume (mL) ‫؍‬ 1072.8 ‫ء‬ body surface area (m 2 ) ؊ 345.7

We tested the diagnostic validity of carbohydrate-deficient transferrin (CDT) as an indicator for relapse into elevated alcohol consumption among patients who were examined under follow-up treatment before (n = 147) and after (n = 102) orthotopic liver transplantation (OLT) in the outpatient-department of the University Hospital Department of Surgery in Hamburg-Eppendorf. CDT measurements were performed with two commercial kits in parallel (CDTect-RIA and CDT%-RIA). Short-term parameters of alcohol consumption (ethanol, methanol) indicated relapses into elevated alcohol consumption in 11.4% of the evaluated patients with alcoholic liver disease (ALD) before transplantation. Before OLT, median CDT values were determined to be elevated among patients with alcoholic as well as nonalcoholic end-stage liver diseases (NALD). Among patients with ALD, we found elevated CDT medians even in those who were successfully scheduled for OLT after long-term evidence of abstinence proved by biochemical short-term parameters and psychological tests. Both CDTect and CDT% assays had comparable low specificities in selected patient groups before transplantation. CDT% and CDTect were negatively correlated with the albumin level. Before the study ended, CDT was no longer implemented in the evaluation of whether an OLT should be administered. This was due to inconsistent results of CDT in ALD as well as NALD. After OLT, patients with ALD, as well as NALD, had statistically significant lower CDT medians than before OLT, which ranged within reference levels. We determined, according to CDT, elevated alcohol consumption subsequent to OLT in 4 of 13 patients with ALD who underwent transplantation during the study (median observation period: 10 months). CDT does not appear to be useful in evaluating patients before OLT. With regained specificity and high sensitivity in patients after OLT, CDT could be recommended as a standard instrument for quality control in patients with ALD after liver transplantation.

SummaryDue to a lack of available size-matched liver grafts from children, most pediatric recipients are transplanted with technical variant grafts from adult donors. Size requirements for these grafts are not well defined, and consequences of mismatched graft sizes in pediatric liver transplantation are not known. Existing formulas for calculation of a standard liver volume are mostly derived from adults disregarding the age-related percentual liver weight changes in children. In this study, we aimed to establish a formula for general use in children to calculate the standard liver volume. In a second step, the formula was applied in pediatric patients undergoing liver transplantation at our institution between 2000 and 2010 (n = 377). Analysis of a large number (n = 388) of autopsy data from children by regression analysis revealed a best fit for two formulas: "Formula 1," children 0 to ≤1 year (n = 246): standard liver volume [ml] = À143.062973 + 4.274603051 * body length [cm] + 14.78817631 * body weight [kg]; "Formula 2," children >1 to <16 years (n = 142): standard liver volume [ml] = À20.2472281 + 3.339056437 * body length [cm] + 13.11312561 * body weight [kg]. In comparison with children receiving size-matched organs, we found an elevated risk of liver graft failure in children transplanted with a small-for-size graft, whereas large-for-size organs seem to have no negative impact.

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Compression of the Neck and Arterial ObstructionSummary. Literature dealing with the obstruction of neck arteries induced by strangulation is referred to. Two types Of strangulation are applied to ten human corpses, i.e., hanging and strangulation by ligature. The neck arteries are isolated at their origins from the thoracic vessels. After removal of the brain the arterial openings at the skull base are observed of their flow through. Tap water is perfused through the vessels under four pressures, i.e., 100 , 200, 300, and 170 mm Hg. By using strangulation tools of three different diameters, various strangulation experiments are performed under controlled conditions imitating strangulation by ligature as well as atypical hanging. The most relevant results were:(1) In ~trangulation by ligature with the rope running horizontally round the neck it is possible to bring about obstruction to the carotid arterie~ by the same forces as in experimental hanging. Depending on the tool and on the arterial pressure, these forces vary between 2.5 and 10 kg. There are relations between the necessary forces, the diameter of the strangulaiion tools and the arterial pressures. Even by applying tractive forces in the range between 30-40 kg or by enhancing with a manual draw we did not succeed in bringing about an obstruction of the vertebral arteries. With the rope running obliquely round the neck as it does in typical hanging it is possible by minor tensile forces (between 8 and 17 kg) to obstruct these vessels as well.(2) In experimental hanging using a typical position of the tool, obstructions of all arteries occur between 5 and 15 kg. In types of hanging with an anterior suspension point above the level of the chin it was possible to occlude at least two vessels by application of intermediate forces.(3) In strangulation by ligature, the site of the appliance seems to have some influence. Infralaryngeal strangulation need somewhat greater tensile forces than a supralaryngeal course of the rope. Extreme bending of the neck does not impede the free passage of water, whereas with rotation and lateral flexion there could very well result obstructions of the arterial passage of the neck if physiological move of the head is reached or slightly overstepped.Some individual parameters of the corpses used (neck girth, rigor mortis, arteriosclerosis) did not have any influence on the powers obstructive to the carotid arteries.

The central brain temperature was recorded in 53 human corpses, stored at constant ambient temperatures between 10 degrees and 30 degrees C. The measurements were started on average 1.6 h post mortem and continued for 8-50 h. The sigmoidal shape of the temperature curves fitted the mathematical model of Marshall and Hoare (1962). This model provides a precise description of the temperature curves. For 44 corpses, studied at temperatures between 10 degrees and 25 degrees C, the time of death was calculated using fixed values for the adaptation parameters of the model. The margins of error for the 95% tolerance limit were +/- 1.5 h up to 6.5 h post mortem, +/- 2.5 h between 6.5 and 10.5 h post mortem and +/- 3.5 h between 10.5 and 13.5 h post mortem. For the recommended practical application a "brain temperature--time of death" nomogram is presented. We found that the rate of cooling was influenced by the amount of hair. Furthermore, it has been argued that the study method could be improved further. In consequence, we expect the central brain temperature to be even more accurate in the calculation of the time of death than has been discussed and shown on the basis of the present material.

For 253 frequently used drugs therapeutic and, if data were available, toxic, and fatal plasma concentrations as well as elimination half-lives were compiled in a table. To assess the significance of drug levels for the therapeutic monitoring of patients, it is essential that a collection of data is readily available. In addition, this list can assist the diagnostic assessment in case of intoxications.

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