Homicide in Greenland 1985–2010

Purpose

Homicide in Greenland has not often been investigated. The latest published study documented a dramatic rise in the homicide rate from around 1/100,000 inhabitants to more than 23/100,000 inhabitants from 1946 to 1984. The aim of our study was to characterize homicides in Greenland from 1985 to 2010 and to compare trends during this period with those in previous studies and with homicide characteristics in Denmark, northern Europe, and other Arctic regions.

Methods

We identified a total of 281 homicides by legal definition and 194 by medical definition, the latter from the years 1990 to 2010. We procured case files for a total of 129 victims (71 male, 58 female) and 117 perpetrators (85 male, 32 female).

Results

We identified an overall decrease in the homicide rate during our study period. The decrease in the medical homicide rate was significant (p = 0.007). The homicide rate ranged from 25/100,000 inhabitants to 13/100,000 inhabitants when results were grouped within 5-year periods. There were significantly more male perpetrators (p < 0.001) and among female perpetrators there were significantly more male victims (p < 0.001). Sharp force and gunshot-related killings dominated homicide methods (41 and 29 % respectively), with sharp force deaths increasing throughout the investigation period. Altercations were the main motive (49 %). Alcohol-related homicides decreased in our study period.

Conclusions

While the Greenlandic homicide rate has decreased, it is markedly higher compared to that seen in Denmark and northern Europe. However, it resembles the rate seen in the rest of the Arctic. Liberal gun laws do not affect the proportion of gun-related killings. Despite the high homicide rate, women account for almost half the victims.

     

SPME–GC–MS analysis of α-pyrrolidinovaleorophenone in blood in a fatal poisoning case

We provided toxicological analytical support for a fatal case of abuse of α-pyrrolidinovaleorophenone (α-PVP). Solid-phase microextraction (SPME) and capillary gas chromatography coupled to mass spectrometry (GC–MS) was employed to quantify the drug in whole blood. The whole blood concentration of the drug in the heart was 486 ng/ml. This is the first report of α-PVP intoxication as ascertained by mass spectrometric identification of α-PVP in whole blood.     

Gunshot homicides in Denmark 1992–2016

International Journal of Legal Medicine - The majority of homicides in the world are caused by firearms and a good understanding of gunshot wounds is important for the forensic pathologist. We have...     

Pharmacomechanical Thrombectomy in Paget–Schroetter Syndrome

Purpose

The purpose of the study was to evaluate feasibility of pharmacomechanical thrombectomy (PMT) in the treatment of Paget–Schroetter syndrome (PSS) followed by thoracoscopic or open surgical decompression of the subclavian vein.

Methods

Twenty-two out of 27 consecutive patients with PSS received PMT using the Trellis-8 peripheral infusion system (Covidien) between 2010 and 2014. Subsequent surgery was performed in 18 of those patients, 9 patients were treated with thoracoscopic, 7 patients with subclavicular, and 2 patients with transaxillary first rib resection, 4 patients were treated with PMT and anticoagulation alone. Technical success, complications, and patency were registered.

Results

PMT was successful in 21 (95 %) patients; 1 patient with unsatisfactory lysis received further catheter-directed thrombolysis, which, however, did not improve the result. The mean endovascular procedure time was 105 ± 33 min (range 70–200 min), and the required median amount of thrombolytic agent was 500,000 international unit (IU; range 250,000–1,000,000 IU). Adjunctive balloon venoplasty and aspiration were used in 18 (82 %) and 7 (32 %) cases, respectively. One patient had an intimal tear of the subclavian vein that was discovered and repaired during surgery. There were no other complications related to the endovascular procedure. At follow-up, 18 of 21 patients (86 %) with follow-up imaging available had patent subclavian vein, and all except 1 of the 22 patients were asymptomatic. The mean follow-up time was 25 ± 17 months.

Conclusions

In experienced hands, PMT is effective for early thrombus removal in PSS. Surgical decompression must be considered after PMT.

     

PET–CT in oncological patients: analysis of informal care costs in cost–benefit assessment

Purpose

The authors analysed the impact of nonmedical costs (travel, loss of productivity) in an economic analysis of PET–CT (positron-emission tomography–computed tomography) performed with standard contrast-enhanced CT protocols (CECT).

Materials and methods

From October to November 2009, a total of 100 patients referred to our institute were administered a questionnaire to evaluate the nonmedical costs of PET–CT. In addition, the medical costs (equipment maintenance and depreciation, consumables and staff) related to PET–CT performed with CECT and PET–CT with low-dose nonenhanced CT and separate CECT were also estimated.

Results

The medical costs were 919.3 euro for PET–CT with separate CECT, and 801.3 euro for PET–CT with CECT. Therefore, savings of approximately 13 % are possible. Moreover, savings in nonmedical costs can be achieved by reducing the number of hospital visits required by patients undergoing diagnostic imaging.

Conclusions

Nonmedical costs heavily affect patients’ finances as well as having an indirect impact on national health expenditure. Our results show that PET–CT performed with standard dose CECT in a single session provides benefits in terms of both medical and nonmedical costs.     

Asphyxia homicides in Denmark 1992–2016

In this retrospective study , we present the findings in 250 homicides by asphyxia in Denmark in a 25-year period, with a particular focus on the autopsy findings in strangulation. Our intention is for the results to be used in future death investigations, where difficulties in interpretation of findings in potential asphyxial deaths arise. Asphyxia homicides showed a strong bias with respect to sex, age, and homicide type. The frequent female victim was typically an adult, whereas the rarer male victim was most often a child. Female offenders most often killed their children, and male offenders most often killed their female partner. Generally, most asphyxia homicides took place in a domestic setting. Manual strangulation and ligature strangulation were the most common mechanisms of asphyxia homicides (81.6%). A lack of petechial hemorrhages, especially in the conjunctiva, was rare in homicidal strangulation, but there were exceptions, especially when there was postmortem decomposition, making it impossible to verify them. Most victims of strangulation had skin lesions in the face (including the jawline) or on the neck, with accompanying hemorrhages in muscle and connective tissue, but the findings could be subtle or compounded by decomposition. Fractures of the laryngo-hyoid complex were common in strangulation, particularly in manual strangulation (chi-sq = 4.0993, df = 1, P < 0.05) and were clearly related to the age of the victim (chi-sq = 82.193, df = 4, P < 0.001). In children and young adults dying from homicidal strangulation, a lack of fractures is to be expected, while a lack of fractures is unusual, but not entirely unexpected, for adults and aged people.

     

Bilateral retinal detachment in a patient with Vogt–Koyanagi–Harada syndrome

We present a 38-year-old woman with bilateral serous retinal detachments and bilateral panuveitis on fundoscopic exam. CT of the orbits and MRI scans revealed bilateral ocular choroidal thickening and bilateral retinal detachments; however, no other CNS or meningeal lesion was detected. This patient met the clinical criteria for Vogt–Koyanagi–Harada (VKH) Syndrome. Review of VKH syndrome as well as the radiographic findings will be discussed.     

Altitude illness in Qinghai–Tibet railroad passengers

It takes ≈24 h to travel the ≈3000-km-long Qinghai–Tibet railroad of which 85% is situated above 4000 m with a pass at 5072 m. Each year about 2 million passengers are rapidly exposed to high altitude traveling on this train. The aim of this study was to quantify the occurrence of altitude illness on the train. Three subject groups were surveyed: 160 Han lowlanders, 62 Han immigrants living at 2200 to 2500 m, and 25 Tibetans living at 3700 to 4200 m. Passengers reached 4768 m from 2808 m in less than 1.5 h, after which 78% of the passengers reported symptoms, 24% reaching the Lake Louise criterion score for AMS. AMS incidence was 31% in nonacclimatized Han compared to 16% in Han altitude residents and 0% in Tibetans. Women and older subjects had a slightly greater risk for AMS. Most cases of AMS were mild and self-limiting, resolving within days upon arrival in Lhasa. Some cases of more severe AMS necessitated medical attention. To curb the health risk of rapid travel to altitude by train, prospective travelers should be better informed, medical train personnel should be well trained, and staged travel with 1 to 2 days at intermediate altitudes should be suggested to nonacclimatized subjects.     

Fatal intoxications in the age group 15–34 years in Denmark in 1984 and 1985

Summary This survey deals with the Danish part of a study on fatal intoxications conducted in the Nordic countries in 1984 and 1985 with special reference to drug addicts. There were 315 cases of fatal intoxications in people 15–34 years of age. These were examined at the Forensic Institutes in Denmark and described with reference to cause of death, sex, age and drug addiction. Of the deceased, 194 were drug addicts according to a specific definition of this term. Women accounted for 28% of all the fatalities investigated in the study and 24% of those in addicts. More than 90% of the deaths were caused by drugs, with ethanol as a contributory factor in approximately 40% of cases. Deaths caused by heroin/morphine predominated, causing 50% of the deaths among drug addicts, but legal drugs, such as dextropropoxyphene, methadone and ketobemidone were also frequent causes of death in this group. In half the cases the concentration of morphine in blood following injection of heroin/morphine was found to be equal to or less than 0.5 mol/ kg, and in only about one-tenth of cases was the blood concentration above 2.0 mol/kg.     

Left ventricular function in physiologic and pathologic hypertrophy in Sprague–Dawley rats

Objective

The aim of this study was to design a high intensity swimming training and two-kidney, one-clip (2K1C) hypertension protocol in Sprague–Dawley (SD) rats and to use current echocardiography techniques to examine the differential diagnosis between physiological and pathological left ventricular hypertrophy.

Methods

One group of SD rats performed swimming training at high intensive swimming training (HIGH) for eight weeks. In animals of the other arm of the study, a 2KIC hypertension was created and maintained for eight weeks.

Results

After eight weeks, all rats were studied by standard and tissue Doppler echocardiography. The heart weight/body weight ratio (HW/BW) of 2K1C and HIGH rats increased by 16% and 42%, respectively. Echocardiography showed increased septal and posterior wall thickness in both the 2K1C and HIGH rats. Left ventricular increased by 35 and 41% respectively. Left ventricular diameters, stroke volumes, cardiac output, and ejection fractions were unchanged in either group. Mitral inflow showed a decrease in late-wave velocity, thus increasing the E/A ratio in HIGH rats. However, mitral inflow showed an increase in late-wave velocity, thus decreasing the E/A ratio in 2K1C rats. There was a significant increase in Ea and early diastolic (Em)/late diastolic (Am) in HIGH rats in basal septum and lateral mitral valve annulus. And there was a significant increase in Am, which led to a significant decrease of Em/Am in 2K1C rats. No significant change occurred in pulmonary vein systolic velocity and diastolic velocity, in either of the three animal groups. However, there was significant increase in atrial reversal velocity in HIGH rats.

Conclusions

Doppler echocardiographic parameters of LV diastolic function can be of diagnostic importance for discrimination between pathologic and physiologic LV hypertrophy.     

Postural stabilization and balance assessment in Charcot–Marie–Tooth 1A subjects

The aim of the present study was to assess postural stabilization skill in adult subjects affected by Charcot–Marie–Tooth disease (CMT) type 1A. For this purpose ground reaction force (GRF) was measured by means of a piezoelectric force platform during the sit-to-stand (STS) movement, until a steady state erect posture was achieved. Specific indexes to quantify Centre of Mass acceleration, both during postural stabilization and during quiet standing, were computed using a mathematical model. Forty-seven CMT1A subjects were recruited for the study, and the control group was formed by forty-one age- and sex-matched healthy subjects.The results show that CMT1A subjects are less stable than controls during the quiet stance. Greater difficulty (high values of Y_inf, the final instability rate) to maintain erect posture appears to be mainly associated with plantar-flexor muscle weakness, rather than to damage of the proprioceptive system. The worst performances shown by CMT1A subjects in the stabilization phase (high values of I, the global index of postural stabilization performance) seem to be associated with reduced muscle strength and the loss of large sensory nerve fibres.Distal muscle weakness appears to affect both postural stabilization and quiet erect posture. The presented protocol and the analysis of postural stabilization parameters provide useful information on CMT1A balance disorders.     

MR findings of the orbit in patients with Vogt–Koyanagi–Harada disease

Purpose

We aimed to evaluate the MR findings of the orbit in patients with Vogt–Koyanagi–Harada disease (VKHD).

Methods

We included 14 patients with clinically diagnosed VKHD, who underwent orbital MR imaging before treatment between May 2011 and August 2017. The mean duration from initial symptom onset to MR imaging was 16 days (range, 2–36 days). Fat-suppressed gadolinium-enhanced T1-weighted images were obtained in six patients. We retrospectively assessed the choroids and Tenon’s capsules for the presence of thickening on unenhanced images and abnormal enhancement on contrast-enhanced images.

Results

Bilateral choroidal thickening was observed in 14 patients (100%) on T1-weighted images and in 12 patients (85.7%) on T2-weighted images. Choroidal thickening showed posterior pole predominance in 11 patients (78.6%) and diffusely distributed in the remaining three patients (21.4%). Bilateral Tenon’s capsule thickening was observed in five patients (35.7%) on T1-weighted images and in 14 patients (100%) on T2-weighted images. On contrast-enhanced images, the choroids and Tenon’s capsules were abnormally enhanced in six patients (100%).

Conclusion

MR imaging sensitively detected abnormalities of the choroids and Tenon’s capsules in patients with VKHD. Bilaterality and predominant posterior pole distribution were characteristic of choroidal VKHD.

     

Quantitative determination of taxine B in body fluids by LC–MS–MS

A new specific and sensitive LC–MS–MS method for the detection of taxine B and isotaxine B, the main toxic pseudo-alkaloids from yew (Taxus sp.), in biological samples (blood, urine, gastric content) was developed. Biological samples were prepared for LC–MS–MS by means of solid-phase extraction (SPE) procedure and yielded a recovery of 86%. Chromatographic separation was achieved using an RP₁₈ column. Detection of taxine B and isotaxine B was performed using multiple reaction monitoring with m/z 584.2 as precursor ion, i.e. [M+H]⁺, of both isomers and m/z 194.3 and m/z 107.1 as product ions after collision-induced dissociation. Docetaxel was applied as internal standard. The method was fully validated for the analysis of blood samples. Linearity was proven in the range from 0.1–500 ng/g. The limit of detection and the limit of quantitation are 0.4 and 2 ng/g, respectively. The method was applied to the determination of taxine B and isotaxine B in four fatal cases (two humans, two horses) with suspected yew intoxication. Blood levels were 105, 168, 174 and 212 ng/g.     

Financial Toxicity in the Post–Health Reform Era

The Patient Protection and Affordable Care Act (ACA), enacted in March 2010, was comprehensive health care reform legislation aimed to improve health care access and quality of care and curb health care–related costs. This review focuses on key provisions of the ACA and their impact on financial toxicity. We will focus our review on cancer care, because this is the most commonly studied disease process in respect to financial toxicity. Patients with cancer face rising expenditures and financial burden, which in turn impact quality of life, compliance to treatment, and survival outcomes. Health insurance expansion include dependent-coverage expansion, Medicaid expansion, and establishment of the Marketplace. Coverage reform focused on reducing financial barriers by limiting cost sharing. Payment reforms included new innovative payment and delivery systems to focus on improving outcomes and reducing costs. Challenges remain as efforts to reduce costs have led to the expansion of insurance plans, such as high-deductible health plans, that may ultimately worsen financial toxicity in cancer and high out-of-pocket costs for further diagnostic testing and procedures. Further research is necessary to evaluate the long-term impacts of the ACA provisions—and threats to the ACA—on outcomes and the costs accrued by patients.     

Contrast–enhanced ultrasonography in Crohn’s disease

PURPOSE: The purpose of this study was to demonstrate the diagnostic efficacy of contrast-enhanced power Doppler (CEPD) after ultrasound (US) with colour power Doppler (CPD) in defining disease activity in patients with ileal Crohn's disease in the acute phase and during treatment follow-up. MATERIALS AND METHODS: The study included 15 patients with ileal Crohn's disease, 12 of whom were examined in the acute phase of their illness and then 30-60 days after treatment. Three patients were studied during clinical quiescence. All patients were examined prior to treatment with US-CPD study and then with contrast-enhanced power Doppler (CEPD) examination (CEPD) with the use of US contrast agent (SonoVue, Bracco), together with clinical assessment and laboratory tests. Disease activity was defined by the Crohn's Disease Activity Index (CDAI) and some of the most sensitive biohumoural markers. After initial US, CPD and CEPD were performed to assess enhancement of the thickened bowel wall with the use of a reference box and a semiquantitative scoring system. RESULTS: The CEPD study is more reliable then US-CPD in the diagnosis of Crohn's disease and statistically agrees significantly with clinical and laboratory indices for disease activity. CONCLUSIONS: This study demonstrates the importance of US-CPD in the follow-up of patients with Crohn's disease and suggests systematic use of the US contrast agent, which can improve diagnostic performance of abdominal US study. It also provides more information about patients both in the acute phase and during follow-up, thus improving treatment planning and better monitoring of treatment efficacy.     

Reliable determination of cyanide,thiocyanate and azide in human whole blood by GC–MS,and its application in NAGINATA–GC–MS screening

Purpose

Cyanide, its metabolite thiocyanate and azide in human biological fluids are commonly analyzed by gas chromatography–mass spectrometry (GC–MS) after derivatization with pentafluorobenzyl bromide using extractive alkylation. However, the reported methods have some drawbacks. We examined each step of these reported methods and attempted to establish a more reliable method to determine the levels of the above compounds in human whole blood. We also examined the applicability of the established method to NAGINATA–GC–MS screening.

Methods

The deproteinization method, internal standard (IS), the cause of column damage, and the effect of the addition of ascorbic acid were examined, and the best procedure was selected. The obtained data, including mass specta, retention times and calibration curves were registered to the database of NAGINATA software.

Results

The analysis of cyanide in whole blood was possible only when the blood was deproteinized with trichloroacetic acid. A high recovery of thiocyanate and azide was obtained without the deproteinization step. K¹³C¹⁵N (for cyanide) and tribromobenzene (for thiocyanate and azide) were selected as ISs. The column damage caused by the phase transfer catalyst was successfully eliminated by passing the catalyst containing solution through an ethyl benzoic sulfonic silica gel column. By these improvements, a more reliable determination method was established. All anions were rapidly identified using NAGINATA software, and the approximate concentration of each compound in whole blood was obtained at the same time.

Conclusions

Because NAGINATA–GC–MS screening can rapidly identify these poisons without using toxic compounds as reference standards, it should be useful in forensic and emergency medicine laboratories.

     

The Policy of Co–First Authorship and Co–Senior Authorship in Radiology Journals

ObjectiveIncreasingly, medical journals are recognizing “equally credited authors” (ECA) in the primary and senior authorship of articles. The aim of this study was to assess the policies of co–first authorship, co–senior authorship, and designation of a corresponding author in the radiology literature.MethodsWe identified 29 radiology journals based on impact factor ranking. Journal offices were contacted by phone and e-mail to ascertain their practices on first and senior authorship ECA designations. We surveyed the March, June, and December 2018 issues of each journal (when available) to assess the utilization of the co-designations in articles.ResultsTwenty-five of 29 journals responded to our survey (response rate: 86.2%). Of 25 journals, 20 (80%) allowed co–first authorship. Among these, 4 of 25 journals (16%) allowed more than two co–first authors. Among the 25 responses, 14 journals (56%) allowed co–senior authorship. Among the 24 journals who responded to this specific question, 23 (96%) approved designation of a corresponding author, different from the first or senior author. The review of March, June, December 2018 editions found co–first authorship and co–senior authorship ECA rates of 8.6% (range 0.0%-22.7%) and 1.8% (range 0.0%-13.3%), respectively. A corresponding author other than first or senior author was noted in 13.3% (range 0.0%-34.7%).DiscussionThere has been widespread acceptance of the concept of ECA in the policies of the top cited imaging journals particularly for first authors (80%). However, the utilization of these designations is uncommon for first authorship (8.6%) and rare (1.8%) for senior authorship based on our 2018 sampling.