The UN in crisis?

The United Nations (UN), the principal role of which is dealing with crises, has been in almost perpetual crisis since its foundation. The situation has become worse in the 1990s, a time when the need for an effective UN has been greater than ever, to cope with issues such as climate-change, pollution and the consequences of globalization. The current crisis has various aspects. Politically there have been widely publicized failures in peacekeeping, largely due to the Security Council being a body of compromise, while successes in peacekeeping have been largely ignored. In the economic and social field, influence has passed to the International Monetary Fund (IMF) and the World Bank. Development aid has plummeted, despite its key role in peace and security, and so an integrated approach to development and security is urgently needed. The UN has been constantly under-funded, with the failure of the United States (US) to pay its dues a key factor. Reform of the UN is vital, but the vested interests of member states make root-and-branch reform virtually impossible. Public pressure for reform can come from non-governmental organizations, perhaps coordinated through the Internet.     

Wie viel Regionalit?t steckt in K?rpergewebe?

The use of stable isotope methods to investigate unresolved criminal cases has become established practice in forensic science. It is mainly applied for determination of geographical origin of unknown corpses. Stable isotope ratios of the bioelements hydrogen (H), carbon (C), nitrogen (N), oxygen (O) and sulphur (S) and the geoelements strontium (Sr) and lead (Pb) in human body tissues contain information about individual dietary habits, climate and environmental influences within a geographical region. The evaluation of stable isotope results in human remains, such as teeth, bones, hair and nails reflects living conditions through a certain period of an individual??s life. Body tissues of a newborn child include information about the mother??s origin and whereabouts during pregnancy. Isotope signatures of hair samples collected worldwide serve as reference values. To cite an example, body tissue investigations of a dead newborn, which led to determination of the origin of the mother are outlined. For investigated corpses which were later identified by the police investigations, the geographical origin and location were in very good to good agreement with the interpretation of the stable isotope results in 40% of the cases.     

Intracartilaginous haemorrhagic lesions in strangulation?

This case control study was designed to investigate if laryngeal haemorrhages occur in cases of strangulation and whether these lesions are specific to strangulation. In the study 30 larynges from victims of fatal strangulation were examined (7 cases of manual strangulation, 12 cases of ligature strangulation, 11 cases of combined manual and ligature strangulation). The control group comprised 40 cases of death without any neck injuries and another group consisted of 5 cases of death caused by trauma with findings of non-strangulation neck injuries. In all the groups, only four solitary haemorrhages (two cases, one control, one non-strangulation neck injury) were observed that did not occur in the proximity of areas of blood accumulation. The results of our investigation suggest that histological evidence of blood accumulation or of haemorrhages in thyroid cartilage is not a reliable criterion to distinguish between haemorrhagic lesions due to strangulation and other types of blood accumulation or artefacts.     

Virtopsy?-Untersuchungsmethoden in der Strafverfolgung

Background

More than 10 years ago the institute of forensic medicine (IRM) in Bern launched the Virtopsy? project. Thereby methods from the fields of medicine, radiology and surveying technique, like for example three dimensional (3D) surface scanning, computer tomography (CT), magnet resonance imaging (MRI), post mortal biopsy and post mortal angiography are used to document cases of extraordinary deaths (agT), but also injuries of living people. As from 2006, the prosecuting authorities of the cantons Bern and Aargau fall back routinely on the imaging procedures.

Materials and methods

In this context the IRM Bern carried out an electronic poll with the investigate judges (UR).

Results

The results of that poll showed partly a big cantonal difference between both cantons. Above all the imaging procedures are not much known by the UR of the canton Aargau compared with the UR of the canton Bern. The UR of both cantons get an overvalue out of the imaging procedures opposite to the classic forensic procedures. The future of the Virtopsy?, also in a legal point of view (to new Swiss code of criminal procedure), is assessed in an optimistic way.

Conclusion

In future, there will not be any obstacles for the imaging procedures in criminal prosecution, except the currently minor level of awareness of the prosecuting authorities.     

Gruppierter Mikrokalk in der Mammographie?

Ohne Zusammenfassung     

Citrate in Pediatric CNS Tumors?

BACKGROUND AND PURPOSE: In a subset of in vivo MR spectra acquired from pediatric brain tumors, we have observed an unassigned peak. The goal of this study was to determine the molecule of origin, and the prevalence and concentration of this chemical in various pediatric brain tumors.MATERIALS AND METHODS: Single-voxel point-resolved spectroscopy (PRESS) spectra from 85 patients with brain tumors and 469 control subjects were analyzed. Citrate seemed to be a likely candidate, and model spectra of citrate were added to the basis set of metabolites for automated processing with use of LCModel software. Absolute “apparent” concentrations of citrate and the Cramer-Rao lower bounds (CRLB), indicators for the reliability of detection, were determined.RESULTS: “Apparent” citrate was detected in 26 of 85 patients with CRLB of less than 25%. Diffuse intrinsic brain stem glioma (DIBSG) had the highest mean concentration (4.0 ± 1.1 mmol/kg in all subjects), and 8 of 12 patients had CRLB less than 25%. A significant reduction of citrate (P < .01) was observed in 6 DIBSGs that had follow-up MR spectroscopy studies after radiation therapy. “Apparent” citrate with CRLB less than 25% was detected in 5 of 22 medulloblastomas (mean citrate, 2.9 ± 2.2 mmol/kg), in 5 of 14 ependymomas (2.6 ± 1.8 mmol/kg), 5 of 14 astrocytomas (1.9 ± 1.2 mmol/kg), and 3 of 23 pilocytic astrocytomas (1.4 ± 1.1 mmol/kg). In control subjects older than 6 months, CRLB less than 25% was not observed, whereas CRLB less than 25% was observed in 39 of 194 subjects younger than 6 months,.CONCLUSION: MR signal consistent with citrate was observed in pediatric brain tumors and in the developing brain of infants younger than 6 months.

Recent advances in hardware and the use of sophisticated processing software such as LCModel (Stephen Provencher, Oakville, Ontario, Canada) or the MRUI^1,2 have significantly improved automatic assignment and quantitation of metabolites of in vivo MR spectra of human brain tissue. Processing of spectra is accomplished by fitting in vivo spectra to linear combinations of typically 15 to 20 measured or simulated model spectra of metabolites. This list of metabolites includes the major metabolites N-acetylaspartate (NAA), creatine (Cr), choline-containing compounds (tCho), myo-inositol (mIns), lactate (Lac), glutamate (Glu), and glutamine (Gln). Also included are less prominent metabolites, such as glucose (Glc), scyllo-inositol (sI), taurine (Tau), γ-aminobutyric acid (GABA), aspartate (Asp), and others that are known to be present in measurable concentrations in healthy or diseased brain tissue. After the fitting of the data is completed, in most cases the remaining difference between the original in vivo spectrum and the linear combination comprises only random noise. It needs to be acknowledged that the quantitation of less prominent or complex partially overlapping peaks is less accurate and reliable than the quantitation of a metabolite with a prominent singlet. Still, residual random noise is an indicator that no metabolites at detectable concentrations have systematically been overlooked.However, in a subset of in vivo MR spectra acquired from pediatric brain tumors, we have observed a residual, nonrandom signal that cannot be attributed to any of the metabolites included in the basis set used for LCModel processing in this institution or that have been reported in the literature for brain tissue. Thus, the goals of this study were to determine the molecule of origin, the prevalence and concentration of this chemical in various pediatric brain tumors, and to review MR spectra of nontumorous tissue for the presence of the signal.     

Is the nasopharynx warmer in children than in adults?

Recent studies on the aetiology of the Sudden Infant Death Syndrome (SIDS) have suggested that some of these deaths are the consequence of an overwhelming inflammatory response to the production of pyrogenic toxins from bacteria colonizing the upper respiratory tract, particularly the nasopharynx. The pyrogenic toxins of Staphlococcus aureus, one of the likelier bacterial candidates, are only produced in temperatures of over 37 degrees C. This study examined nasopharyngeal temperatures in children. It is a preliminary study to develop an accurate means to measure how close to 37 degrees C the nasopharyngeal temperature lies in infants at the age when SIDS deaths occur. Following a pilot study and power calculation, measurements of nasopharyngeal temperature were made on 30 apyrexial children aged 4-10 years and 30 adults with no nasal pathology, undergoing surgery under general anaesthesia, using an accurately sited thermocouple probe. The mean temperature in children (35.64 degrees C) was significantly higher than in adults (34.01 degrees C). Comparable measurements attempted with the same subjects awake gave similar results.     

Angeh?rigenkontakt in der Rechtsmedizin

Background

This study is the first investigation of contact between family members of deceased and forensic pathologists from a doctor??s point of view, because in Switzerland it is a part of the daily routine.

Method

An anonymous questionnaire was sent to all forensic pathologists in medico-legal Institutions in the German-speaking area of Switzerland.

Results

The survey was able to confirm that it is mostly family members (53%) who get in touch by telephone (43%) to learn about the circumstances of the death of a relative. For them (73%) extensive and understandable information is very important as described in other publications but in forensic cases this might not be possible because of the judicial background. Most of the doctors feel restricted (64%) and perhaps therefore recommend professional help (64%). Another important finding is that there is a lack of mandatory courses (82%) during the specialist training and only a few (27%) took some courses on a voluntary basis. The special situation of being in contact with people, who have suddenly and unexpectedly lost a beloved person, maybe violently, has so far not been considered by the responsible training associations.

Conclusion

As more than two thirds (67%) of the respondents requested a specific advanced training, a pilot project with a psychologist (Univ.-Prof. Dr. Gernot Brauchle) was run in Zurich in summer 2010 in which doctors from all medico-legal institutions in Switzerland participated.     

CT-Kolonographie in der t?glichen Praxis

CLINICAL/METHODICAL ISSUE: Colorectal cancer is a major public health challenge in Austria and Germany. As the participation in dedicated colonoscopy screening programs is rather low, the question of alternative methods is raised again and computed tomography (CT) colonography seems to be a gentle alternative with a very high patient acceptance. STANDARD RADIOLOGICAL METHODS: In recent years CT colonography (CTC) has been established besides conventional colonoscopy as a radiological method for the investigation of the entire colon. From axial two-dimensional images three-dimensional images can be generated, allowing a virtual flight through the colon which is why this technique is also known as virtual colonoscopy. METHODICAL INNOVATIONS: The technique of CTC has been improved continuously during recent years. On the one hand the steady decrease in the layer thickness (currently ≤?1?mm) has improved the resolution of volume data sets and on the other hand there has been significant progress in postprocessing. PERFORMANCE: Numerous studies have recently shown that the significance of CTC in the detection of advanced adenomas is similar to conventional colonoscopy. ACHIEVEMENTS: Meanwhile CT colonography is now a routine investigation method established in both symptomatic and asymptomatic patients (screening). PRACTICAL RECOMMENDATIONS: Study data now clearly show that CTC, as an alternative to conventional colonoscopy, is a powerful method for investigation of colorectal cancer. To achieve good results adequate preparation including fecal tagging, standardized technical procedures during the investigation and expertise in both 2D and 3D reading are essential.