Metric approach for age assessment of children: an alternative to radiographs?

The objective of this study was to examine the use of metric assessment of the face and body height for age estimation of young children for legal proceedings. The sample consisted of 591 healthy children (317 boys and 274 girls) aged between 3 and 6 years from Germany, Italy and Lithuania. Multiple regression models for age estimation were developed using body height and selected craniofacial measurements and proportions. The accuracy of the models was assessed by the mean absolute error on a sample of 60 children. Sex-specific regression equations were established using five craniofacial indices (sestozyzy, zyzyeueu, tsetgn, seprnsegn, seprnsesto), associated absolute measurements, and body height. The standard deviations for a mean age estimate in a child of a given sex, body height and face dimensions ranged from 6 to 10 months. Mean absolute errors between real and estimated ages ranged from 4 to 9 months. It is concluded that facial measurements and body height may be used for age estimation in young children either as a complementary method to dental and skeletal assessment or as an alternative method for radiological evaluation when this cannot be applied due to lack of access or legislative restrictions for unaccompanied minors or adopted children     

Bone age assessment: comparison of children from two different regions with the Greulich–Pyle method In Turkey

The aim of this study was to identify and compare bone age assessments of Turkish children in regions of Central Anatolia and Eastern Anatolia using the Greulich-Pyle (GP) method. Evaluation was made of 849 (375 boys, 514 girls) adolescents aged between 9 and 17 years, who lived in two geographically different regions of Turkey. The selection criteria included normal growth and development, a state of good physical and mental health with no previous history of chronic or acute illnesses, no past trauma or injury to the hand-wrist region, no congenital or acquired malformations of the hand-wrist area, no hormonal disorders, and good quality hand-wrist radiographs. Bone age (BA) was evaluated using the GP method from definitive radiographs of the left hand-wrist. The total mean differences between BA and chronological age (CA) for girls and boys were found to be 1.19 ± 1.2 (p < 0.05) and 0.90 ± 1.2 (p < 0.05) years in the Eastern Anatolia region and 0.28 ± 0.6 (p > 0.05) and –0.10 ± 0.3 (p > 0.05) years in the Central Anatolia region. There were significant differences between BA and CA in all age groups for girls and boys in Malatya (a city in the Eastern Anatolia region) and in 10 and 13 year olds for girls and 12, 13, 15, and 16 year olds for boys in Sivas (a city in the Central Anatolia region). Statistically significant differences were determined between the BA and CA of the subjects living in Malatya and Sivas (p < 0.05). The results of this study using the Greulich–Pyle atlas indicate that bone development is completed earlier in adolescents living in Malatya compared with those in Sivas.     

Are antimicrobial peptides an alternative for conventional antibiotics?

Antimicrobial peptides are widespread in living organisms and constitute an important component of innate immunity to microbial infections. By the early 1980s, more than 800 different antimicrobial peptides had been isolated from mammals, amphibians, fish, insects, plants and bacterial species. In humans, they are produced by granulocytes, macrophages and most epithelial and endothelial cells. Newly discovered antibiotics have antibacterial, antifungal, antiviral and even antiprotozoal activity. Occasionally, a single antibiotic may have a very wide spectrum of activity and may show activity towards various kinds of microorganisms. Although antimicrobial activity is the most typical function of peptides, they are also characterized by numerous other properties. They stimulate the immune system, have anti-neoplastic properties and participate in cell signalling and proliferation regulation. As antimicrobial peptides from higher eukaryotes differ structurally from conventional antibiotics produced by bacteria and fungi, they offer novel templates for pharmaceutical compounds, which could be used effectively against the increasing number of resistant microbes.     

The digital atlas of skeletal maturity by Gilsanz and Ratib: a suitable alternative for age estimation of living individuals in criminal proceedings?

As a collection of radiographic standards of the normal hand development with a homogenous degree of maturity of all skeletal elements, the digital atlas of skeletal maturity by Gilsanz and Ratib combines the possibilities of digital imaging with the principle of a conventional atlas method. The present paper analyses the forensic applicability of skeletal age assessment according to Gilsanz and Ratib to age estimation in criminal proceedings. For this, the hand X-rays of 180 children and adolescents aged 10–18 years old were examined retrospectively. For the entire age range, the minima and maxima, the mean values and standard deviations as well as the medians with upper and lower quartiles are specified by sex. For the legally relevant age groups from 14 to 18 years, there is a risk of overestimation of the chronological age of up to 7.2 months in females. The method of Gilsanz and Ratib is therefore only suitable to forensic age estimation in criminal proceedings to a limited extent.     

Evaluation of deep myometrial invasion in endometrial cancer patients: is dual-energy CT an option?

Objectives

Assessment of deep (>50%) myometrial invasion by dual-energy CT (DECT) and Trans-Vaginal US (TVUS) in patients with endometrial cancer.

Methods

We retrospectively enrolled patients with endometrial cancer who underwent DECT and TVUS for pre-surgical staging. Three sets of images were evaluated: 70 keV (routine CT images), 50 keV, and iodine-water reconstructions. The gold standard was pathology after surgery. The agreement between the different imaging modalities and the gold standard was estimated. Sensitivity, specificity and accuracy for each imaging modality were evaluated with 95% confidence intervals (CI).

Results

Thirty-nine patients were included. Median time from CT and TVUS to surgery was 23 and 18 days, respectively. The best agreement between evaluation of myometrial infiltration and the gold standard was 0.88 (0.72, 1.00) for the 50 keV images; the worst agreement was 0.43 (0.00, 0.88) for the 70 keV images. CT iodine reconstructions and US agreement were comparable. Specificity, sensitivity and accuracy were 0.91, 1.00, 0.94; 0.57, 0.86, 0.71; 0.82, 1.00, 0.87; 0.91, 0.77, 0.86 for 50 keV, 70 keV, iodine reconstructions and ultrasound, respectively.

Conclusions

DECT is a promising tool for assessment of myometrial invasion in endometrial cancer patients, with a special focus on 50 keV images.

     

Computed tomography perfusion imaging for therapeutic assessment: has it come of age as a biomarker in oncology?

With the emergence of novel targeted therapies, imaging techniques that assess tumor vascular support have gained credence for response assessment alongside standard response criteria. Computed tomography (CT) perfusion techniques that quantify regional tumor blood flow, blood volume, flow-extraction product, and permeability-surface area product through standard kinetic models are attractive, but the level of evidence for CT perfusion to be a truly mature biomarker remains insufficient. Studies to date have not been powered to assess this. Future studies that include good quality prospective validation correlating perfusion CT to outcome end points in the trial setting are needed to take CT perfusion forward as a biomarker in oncology.     

How reliable are the risk estimates for X-ray examinations in forensic age estimations? A safety update

Possible biological side effects of exposure to X-rays are stochastic effects such as carcinogenesis and genetic alterations. In recent years, a number of new studies have been published about the special cancer risk that children may suffer from diagnostic X-rays. Children and adolescents who constitute many of the probands in forensic age-estimation proceedings are considerably more sensitive to the carcinogenic risks of ionizing radiation than adults. Established doses for X-ray examinations in forensic age estimations vary from less than 0.1 μSv (left hand X-ray) up to more than 800 μSv (computed tomography). Computed tomography in children, as a relatively high-dose procedure, is of particular interest because the doses involved are near to the lower limit of the doses observed and analyzed in A-bombing survivor studies. From these studies, direct epidemiological data exist concerning the lifetime cancer risk. Since there is no medical indication for forensic age examinations, it should be stressed that only safe methods are generally acceptable. This paper reviews current knowledge on cancer risks associated with diagnostic radiation and aims to help forensic experts, dentists, and pediatricians evaluate the risk from radiation when using X-rays in age-estimation procedures.     

Magnetic resonance fistulography for the demonstration of anovaginal fistula: an alternative imaging technique?

Anovaginal fistulae (AVF) are frequently seen in patients with inflammatory bowel disease, especially in Crohn disease with active colonic inflammation. Herein, we report a 21-year-old woman with Crohn disease suffering from vaginal discharge and anal pain. Although clinical presentation was very suggestive of AVF, physical examination and colonoscopy were inconclusive. We used an alternative technique and performed magnetic resonance fistulography by applying rectal contrast for the demonstration of AVF.     

Is intra-articular pethidine an alternative to local anaesthetics in arthroscopy?

We investigated the per- and postoperative pain-reducing effect of pethidine given intra-articularly (i. art.). Thirty patients subjected to knee joint arthroscopy, diagnostic and surgical procedures, were randomly assigned to one of three groups. Group A consisted of ten patients who received 250 mg prilocaine +200 g adrenaline (i. art.) in a volume of 50 ml, group B of ten patients who received 200 mg pethidine (i. art.) in 50 ml saline, and group C of ten patients who received 200 mg pethidine +200 g adrenaline (i. art.) in 50 ml saline. During arthroscopy the patients reported on pain intensity and discomfort using visual analogue scales. Ratings were low and did not differ significantly between the three groups. Two of three patients in each group requested additional analgesics or sedatives due to pain and discomfort, but again with no difference between the three groups. Postoperatively all patients rated their pain intensity at rest and during movement (at 0, 1, 2, 3, 4, 5, 6, 12 and 24 h). The patients receiving pethidine (group B) reported significantly less pain at rest and movement than group A patients, in general at 1–4 h postoperatively. A significant difference was detected between groups B and C at 4 h postoperatively. Calculating the total sum of pain scores, patients receiving pethidine (group B) reported significantly less pain both at rest and during movement than those receiving prilocaine (group A). Furthermore, patients in group B used significantly less analgesics than those in group A. Adrenaline did not potentiate the effect of pethidine. Reported side effects were mild and did not require clinical action. The present study provides evidence for pethidine as a potential alternative to prilocaine in arthroscopy using local anaesthetic techniques.     

Health screening for Gurkha families in UK by chest X-ray, Heaf and blood testing: is it worthwhile?

This paper reports the chest X-rays, Heaf tests and haematology findings on a population of Gurkha wives and their children who arrived in the UK to accompany their husbands on an army base in 1997-8. The conclusions from this study are that there is no benefit from performing chest X-rays, but that screening for rubella and iron deficiency anaemia should continue.     

Diagnostic neuroradiology: Ready for the neuro-interventional age?

Acute cerebral ischemia or stroke is currently considered an emergency for which therapeutic options are available if the therapeutic window of 4.5 h is respected.Imaging modalities have progressed greatly over the last few decades,rendering ischemia detectable in the first hours after the event.However,in order for treatment to be efficacious it is necessary to speed up all the processes before the start of therapy.Thus,one must decrease the time to arrival at the hospital and to the radiological method that is to be employed(be it computed tomography or magnetic resonance imaging);only then will the medical or interventional techniques available fulfill their potential.     

Is ancestry,not natron,an explanation for fair haired children in Greco-Roman Egypt?

In an examination of three unwrapped mummified children from the Graeco-Roman Period of ancient Egypt there was an unexpected finding of fair hair. In the     

Elimination of hand–wrist radiographs for maturity assessment in children needing orthodontic therapy

Our aim was to evaluate the validity of the cervical vertebra maturation (CVM) method as an indicator of skeletal age during the circumpubertal period by correlating the CVM method with the hand–wrist maturation (HWM) method in an attempt to eliminate the need for hand–wrist radiographs for maturity assessment. Hand–wrist and lateral cephalometric radiographs of 400 Chinese were randomly selected. The age for girls was between 10 years and 15 years and for boys it was between 12 years and 17 years, so that they were within the circumpubertal period. The CVM was assessed by a method developed by Baccetti and co-workers, whereas hand–wrist maturation was assessed by Fishman’s method. The CVM was significantly correlated with HWM skeletal age. (Spearman’s r boys = 0.9206, girls = 0.9363). All the patients in cervical vertebra stage 3 (CVS3) of CVM corresponded to skeletal maturation indicator 2 (SMI2) or SMI3 stages of HWM (around the peak of the growth spurt). The method error was insignificant. CVM is a valid indicator of skeletal growth during the circumpubertal period. This work will provide dental practitioners with information on jaw growth modification therapy.     

Difference in fitness for duty among soldiers on a mission: can these be explained by a difference in the preemployment assessment?

In 1998, the Royal Netherlands Army introduced a new examination system (abbreviated as BMEKL), which was based on the "workload-capability" model, to replace the old system (abbreviated as PULHEEMS), which focused on diagnosis and was based solely on the detection of diseases and infirmities. To discern differences under operational conditions between soldiers examined with one of the two medical examination systems, we performed a prospective cohort study. In the study, soldiers who had been declared fit for duty with one of the two medical assessment systems (randomized) and sent on a mission were monitored for 2 years. We used the two operational measures of availability and health care costs. In addition, the candidates were given a questionnaire twice per year during the study period. The study revealed that the soldiers assessed using the function-based BMEKL system displayed greater fitness for duty than did those assessed using the diagnosis-based PULHEEMS system. The BMEKL assessment system is a better predictor of the ability to function as a soldier in general, and with regard to deployment, health, and the locomotor apparatus specifically, than is the PULHEEMS system.     

Femoral torsion assessment with MRI in children: Should we use the bony or cartilaginous contours?

ObjectiveTo assess whether the use of cartilaginous contours at the femoral condyles instead of bony contours significantly changes femoral torsion measurements in children.Materials and MethodsFemoral torsion was measured in 32 girls (mean age 10.1 years ± 2.3 standard deviation) and 42 boys (10.9 years ± 2.5) on axial magnetic resonance (MR) images by two independent readers (R1,R2). The femoral condyle angle was measured using each the cartilaginous and bony contours of the distal femur. Cartilage thickness at femoral condyles was assessed. Intraclass-correlation-coefficient (ICC) and Pearson's correlation were used for statistical analysis.ResultsMean difference between cartilaginous and bony femoral torsion in girls was −1.1° ± 1.75 (range, −5.4° to 3.1°) for R1 and −1.64° ± 1.67 (−6.3° to 2.1°) for R2, in boys −1.5° ± 1.87 (−8.4° to 1.1°) for R1 and −2.28° ± 1.48 (−4.3° to 9.7°) for R2. Weak-to-moderate correlations between difference of cartilaginous-versus-bony measurements and cartilage thickness (r = −0.15 to −0.55, P < 0.001–0.46) or age (r = −0.33 to 0.46, P < 0.001–0.006) were found for both genders. Intermethod-ICC for cartilaginous versus bony femoral torsion measurements was 0.99/0.99 for R1/R2 in girls, and 0.99/0.98 in boys.ConclusionThere is only a small difference when measuring femoral torsion through cartilaginous versus bony contours, and no major difference in this between boys and girls.