Morphological study of the labial grooves’ pattern in an Italian population

ABSTRACT

Cheiloscopy is the branch of forensic dentistry studying the patterns and the systems of the lips’ grooves for identification purposes. Different authors have studied different ethnic population but no research has been carried out specific to the Italian population. This study aimed to describe the pattern and the system of lip grooves in an Italian population composed of 96 subjects. The lip prints were taken as follows: a thin film of lipstick was applied onto cleaned and dried inferior and superior lips. The impressions of the lips were taken using a transparent adhesive tape. The grooves were identified and classified according to the classification of Suzuki and Tsuchihashi and a pattern was assigned. Sixty-eight different patterns were detected in the superior lips and 53 different patterns in the inferior lips. The most frequent pattern was the III-IV-IV-III and II-I-I-II for superior and inferior lips respectively. Within the limit of the sample size, the morphological analysis of the lip-prints confirmed their potential uniqueness in an Italian population.     

Direct magnetic resonance arthrography of the knee: utility of axial traction

The purpose of this study was to determine the impact of axial traction during acquisition of direct magnetic resonance (MR) arthrography examination of the knee in terms of joint space width and amount of contrast material between the cartilage surfaces. Direct knee MR arthrography was performed in 11 patients on a 3-T MR imaging unit using a T1-weighted isotropic gradient echo sequence in a coronal plane with and without axial traction of 15 kg. Joint space widths were measured at the level of the medial and the lateral femorotibial joint with and without traction. The amount of contrast material in the medial and lateral femorotibial joint was assessed independently by two musculoskeletal radiologists in a semiquantitative manner using three grades (‘absence of surface visualization, ‘partial surface visualization or ‘complete surface visualization’). With traction, joint space width increased significantly at the lateral femorotibial compartment (mean = 0.55 mm, p = 0.0105) and at the medial femorotibial compartment (mean = 0.4 mm, p = 0.0124). There was a trend towards an increased amount of contrast material in the femorotibial compartment with axial traction. Direct MR arthrography of the knee with axial traction showed a slight and significant increase of the width of the femorotibial compartment with a trend towards more contrast material between the articular cartilage surfaces.     

Clinical implication of myocardial FDG uptake pattern in oncologic PET: retrospective comparison study with stress myocardial perfusion imaging as the reference standard

The purpose of this study was to determine the clinical implication of the myocardial FDG uptake patterns by comparing with the results of stress myocardial perfusion imaging (MPI) as the reference standard. By reviewing the medical records, 86 pairs of stress MPI and FDG PET/CT of 84 patients who underwent stress MPI and oncologic FDG PET/CT in 1 month were included in this study. The patterns of the myocardial FDG uptake were classified into five patterns such as ‘low’, ‘diffuse’, ‘basal ring’, ‘focal high’, and ‘focal defect on diffuse high’. MPI was evaluated using a 5-point scoring model ranging from 0 (normal uptake) to 4 (uptake absent) based on the 17-segment model. The summed stress score of 4 or higher was defined as ‘abnormal MPI’. Factors predictive of abnormal MPI were analyzed using a log-rank multivariate test and p < 0.05 was set as significant. Abnormal MPI was observed in only 16 of 36 (44%) patients with ‘low’ pattern, 10 of 23 (43%) patients with ‘diffuse high’ pattern, and 1 of 9 (11%) patients with ‘basal ring’ pattern, but in 8 of 9 (89%) patients with ‘focal high’ pattern, and 8 of 9 (89%) patients with ‘focal defect on diffuse high’ pattern. The log-rank multivariate test revealed that ‘focal high’ and ‘focal defect on diffuse high’ pattern were correlated with an abnormal MPI. These results indicate that further cardiac work-up might be helpful in the patients with ‘focal high’ pattern or ‘focal defect on diffuse high’ pattern of myocardial FDG at oncologic PET. A prospective study should be needed to further support this conclusion.     

MR-guided liver biopsy within a short, wide-bore 1.5 Tesla MR system

The purpose of this study was to evaluate the diagnostic efficacy of magnetic resonance (MR)-guided biopsy of focal liver lesions within a short, wide-bore 1.5-T MR system and to determine the duration and accuracy of needle placement using MR fluoroscopy guidance in 25 patients. Accuracy of needle placement was evaluated in two orthogonal planes, and the out-of-plane angle of needle deflection was measured. Needle positioning was characterised subjectively as centred, peripheral, or exterior relative to the lesion. Exterior positioning was corrected by a step-by-step procedure. Surgical resection (n = 6), previous histologies (n = 8), or clinical/radiological follow-up (n = 11) served as the ‘gold standard’. The guidance needle could be placed successfully using MR fluoroscopy in 20 of 25 patients (80%). Needle placement was rated as ‘centred’ in 11 and as ‘peripheral’ in nine patients. Median needle deflection was 2.6 degrees, with a median deviation of 3.4 mm. In five patients, the direct approach failed or was rated as ‘exterior’; therefore, repositioning after needle stabilisation with a stainless-steel stylet was necessary. The diagnostic yield of all biopsies was: sensitivity 95.5%, specificity 100.0% and accuracy 96.0%. In conclusion, MR-guided biopsies in a short, wide-bore MR system yielded highly reliable biopsy results, and in most cases the direct approach with MR fluoroscopy guidance proved to be fast and accurate.     

Treatment of articular cartilage lesions of the knee joint using a modified AMIC technique

This study describes a modified AMIC technique consisting of perforations according to Pridie, rather than microfractures, and the covering of the focus of the lesion with a biological collagen patch enriched with bone marrow blood drawn through the knee itself. This technique allows advantages of both the Pridie technique and the in situ proliferation of mesenchymal cells beneath a biological collagen membrane, ‘augmented’, with bone marrow blood. The collagen membrane forms the roof of a ‘biological chamber’, and serves to protect and contains the stem cells as they differentiate into chondrocytes, which will form a healthy regenerative cartilage.     

Differentiation of serrated and non-serrated blades from stab marks in bone

Although evidence of sharp-force trauma on the human body, particularly the skeleton, can be extremely useful in providing information regarding the manner and context of death, there is still a lack of necessary detail available to the investigator. Using ribs, radii, scapulae, vertebrae and carpal bones, this study demonstrated that distinctions could be made between the stab marks left by serrated blades and those of non-serrated blades. Low power and scanning electron microscopy were used to record distinctive ‘T’-shaped stab marks from non-serrated blades and ‘Y’-shaped stab marks from serrated blades. In addition, elemental evidence of the presence of the blade in the stab-mark kerf was recoverable even when no metal fragment was visible.     

Diuretic renography in hydronephrosis: renal tissue tracer transit predicts functional course and thereby need for surgery

Purpose  

The recognition of those hydronephrotic kidneys which require therapy to preserve renal function remains difficult. We retrospectively compared the ‘tissue tracer transit’ (TTT) of ^99mTc-mercaptoacetyltriglycine (^99mTc-MAG₃) with ‘response to furosemide stimulation’ (RFS) and with ‘single kidney function < 40%’ (SKF < 40%) to predict functional course and thereby need for surgery.     

Evaluation of computer-aided detection and dual energy software in detection of peripheral pulmonary embolism on dual-energy pulmonary CT angiography

Purpose  

To evaluate the sensitivity of computer-aided detection(CAD) and dual-energy software(‘Lung PBV’, ‘Lung Vessels’) for detecting peripheral pulmonary embolism(PE).     

Frequency and intensity of pulmonary bone marrow and fat embolism due to manual or automated chest compressions during cardiopulmonary resuscitation

Iatrogenic consequences of cardiopulmonary resuscitation (CPR) include sternal or rib fractures, pulmonary bone marrow embolisms (BME) and fat embolisms (FE). This report aimed to analyze the frequency and intensity of pulmonary BME and FE in fatal cases receiving final CPR efforts with the use of automated chest compression devices (ACCD) or manual chest compressions (mCC). The study cohort (all cardiac causes of death, no ante-mortem fractures) consisted of 15 cases for each group ‘ACCD’, ‘mCC’ and ‘no CPR’. Lung tissue samples were retrieved and stained with hematoxylin eosin (n = 4 each) and Sudan III (n = 2 each). Evaluation was conducted microscopically for any existence of BME or FE, the frequency of BME-positive vessels, vessel size for BME and the graduation according to Falzi for FE. The data were compared statistically using non-parametric analyses. All groups were matched except for CPR duration (ACCD > mCC) but this time interval was linked to the existence of pulmonary BME (p = 0.031). Both entities occur in less than 25% of all cases following unsuccessful CPR. BME was only detectable in CPR cases, but was similar between ACCD and mCC cases for BME frequency (p = 0.666), BME intensity (p = 0.857) and the size of BME-affected pulmonary vessels (p = 0.075). If any, only mild pulmonary FE (grade I) was diagnosed without differences in the CPR method (p = 0.624). There was a significant correlation between existence of BME and FE (p = 0.043). Given the frequency, intensity and size of pulmonary BME and FE following CPR, these conditions may unlikely be considered as causative for death in case of initial survival but can be found in lower frequencies in autopsy histology.     

Correlation of the cross-over ratio of the cross-over sign on conventional pelvic radiographs with computed tomography retroversion measurements

Objective  

To find a correlation between the cross-over ratio of the cross-over sign on conventional anteroposterior (AP) pelvic radiographs and retroversion measurements (‘roof-edge angle’ and ‘equatorial-edge angle) on computed tomography (CT) scans. This would facilitate the interpretation of the cross-over sign regarding the amount of acetabular retroversion.     

Supplement

The 20th International Symposium on the Forensic Sciences (ANZFSS) was held in Sydney, Australia, between September 5 and 9, 2010. The theme was ‘forensic science on trial’. Abstracts are provided here for all oral presentations given at the conference.     

Assessment of the spatial pattern of colorectal tumour perfusion estimated at perfusion CT using two-dimensional fractal analysis

The aim was to evaluate the feasibility of fractal analysis for assessing the spatial pattern of colorectal tumour perfusion at dynamic contrast-enhanced CT (perfusion CT). Twenty patients with colorectal adenocarcinoma underwent a 65-s perfusion CT study from which a perfusion parametric map was generated using validated commercial software. The tumour was identified by an experienced radiologist, segmented via thresholding and fractal analysis applied using in-house software: fractal dimension, abundance and lacunarity were assessed for the entire outlined tumour and for selected representative areas within the tumour of low and high perfusion. Comparison was made with ten patients with normal colons, processed in a similar manner, using two-way mixed analysis of variance with statistical significance at the 5% level. Fractal values were higher in cancer than normal colon (p ≤ 0.001): mean (SD) 1.71 (0.07) versus 1.61 (0.07) for fractal dimension and 7.82 (0.62) and 6.89 (0.47) for fractal abundance. Fractal values were lower in ‘high’ than ‘low’ perfusion areas. Lacunarity curves were shifted to the right for cancer compared with normal colon. In conclusion, colorectal cancer mapped by perfusion CT demonstrates fractal properties. Fractal analysis is feasible, potentially providing a quantitative measure of the spatial pattern of tumour perfusion.     

Combined hyperextension and supination of the elbow joint induces lateral ligament lesions An experimental study of the pathoanatomy and kinematics in elbow ligament injuries

An epidemiological study suggested that the injury mechanism of ‘handball goalie’s elbow’ may be hyperextension. The pathomechanics of hyperextension combined with supination was studied in ten macroscopically normal, male, cadaveric elbow joint specimens. The age of the donors was 28.8 years (range 18– 45 years). Extension loading of the elbow was performed in an experimental three-dimensional (3D)-kinematic loading apparatus. The degree of extension increased by 16.7°± 8.7° after loading. Hyperextension loads induced significant joint laxity in joint flexion (< 50°) during forced valgus, external and internal rotation, respectively, but not during forced varus. The hyperextension trauma produced three lesions: (1) anterior capsule rupture, (2) avulsion of the proximal insertion of both the medial and the lateral collateral ligaments, and (3) occasional single rupture of the lateral collateral ligament. The lesions indicate that combined hyperextension and supination represent a possible mechanism leading to ‘handball goalie’s elbow’. Received: 28 January 1997 Accepted: 27 April 1997     

False homozygosities at CSF1PO loci revealed by discrepancies between two kits in Chinese population

During the course of paternity test, three samples in two cases were apparently homozygous at the CSF1PO locus using AmpFlSTRs Identifiler PCR Amplification kits, but using the PowerPlexs 16 kit, the three individuals were found to be heterozygous. This puzzling problem was solved by using multiple analytical approaches, including the use of different primer pairs and the characterization of the mutation causing the ‘‘null allele.’’ Dropout was caused by a single mutation event in the presumptive binding site of the forward primer. While the frequency of these silent alleles remains low (0.5% in our study), it is suggested that appropriate measures should be taken for database comparisons and that allelic dropout should be further investigated by sequence analysis and be reported to the forensic community.     

Correlated regions of cerebral blood flow with clinical parameters in Parkinson’s disease; comparison using ‘Anatomy’ and ‘Talairach Daemon’ software

Objectives  

We assign the anatomical names of functional activation regions in the brain, based on the probabilistic cyto-architectonic atlas by Anatomy 1.7 from an analysis of correlations between regional cerebral blood flow (rCBF) and clinical parameters of the non-demented Parkinson’s disease (PD) patients by SPM8. We evaluated Anatomy 1.7 of SPM toolbox compared to ‘Talairach Daemon’ (TD) Client 2.4.2 software.     

Anterior cruciate ligament rupture secondary to a ‘heel hook’: a dangerous martial arts technique

The ‘heel hook’ is a type of knee lock used in some forms of martial arts to stress the knee and cause opponent to concede defeat. While the knee is in a flexed and valgus disposition, an internal rotation force is applied to the tibia. Reports are lacking on serious knee trauma as a result of this technique. We report the case of a 32-year-old Mixed Martial Arts exponent who sustained complete anterior cruciate ligament rupture and an medial collateral ligament injury from the use of a ‘heel hook’.     

Use of dynamic CT in acute respiratory distress syndrome (ARDS) with comparison of positive and negative pressure ventilation

Negative pressure ventilation via an external device (‘iron lung’) has the potential to provide better oxygenation with reduced barotrauma in patients with ARDS. This study was designed to see if oxygenation differences between positive and negative ventilation could be explained by CT. Six anaesthetized rabbits had ARDS induced by repeated saline lavage. Rabbits were ventilated with positive pressure ventilation (PPV) and negative pressure ventilation (NPV) in turn. Dynamic CT images were acquired over the respiratory cycle. A computer-aided method was used to segment the lung and calculate the range of CT densities within each slice. Volumes of ventilated lung and atelectatic lung were measured over the respiratory cycle. NPV was associated with an increased percentage of ventilated lung and decreased percentage of atelectatic lung. The most significant differences in ventilation and atelectasis were seen at mid-inspiration and mid-expiration (ventilated lung NPV = 61%, ventilated lung PPV = 47%, p < 0.001; atelectatic lung NPV = 10%, atelectatic lung PPV 19%, p < 0.001). Aeration differences were not significant at end-inspiration. Dynamic CT can show differences in lung aeration between positive and negative ventilation in ARDS. These differences would not be appreciated if only static breath-hold CT was used.     

Radiologist experience and CT examination quality determine metastasis detection in patients with esophageal or gastric cardia cancer

We aimed to separate the influence of radiologist experience from that of CT quality in the evaluation of CT examinations of patients with esophageal or gastric cardia cancer. Two radiologists from referral centers (‘expert radiologists’) and six radiologists from regional non-referral centers (‘non-expert radiologists’) performed 240 evaluations of 72 CT examinations of patients diagnosed with esophageal or gastric cardia cancer between 1994 and 2003. We used conditional logistic regression analysis to calculate odds ratios (OR) for the likelihood of a correct diagnosis. Expert radiologists made a correct diagnosis of the presence or absence of distant metastases according to the gold standard almost three times more frequently (OR 2.9; 95% CI 1.4–6.3) than non-expert radiologists. For the subgroup of CT examinations showing distant metastases, a statistically significant correlation (OR 3.5; 95% CI 1.4–9.1) was found between CT quality as judged by the radiologists and a correct diagnosis. Both radiologist experience and quality of the CT examination play a role in the detection of distant metastases in esophageal or gastric cardia cancer patients. Therefore, we suggest that staging procedures for esophageal and gastric cardia cancer should preferably be performed in centers with technically advanced equipment and experienced radiologists.     

The hidden sentinel node and SPECT/CT in breast cancer patients

Purpose  In a minority of breast cancer patients, lymphoscintigraphy shows no lymphatic drainage and ‘hidden’ sentinel nodes may remain undiscovered. The purpose of this study was to explore the additional value of the recently introduced hybrid SPECT/CT in breast cancer patients with axillary non-visualisation on planar images. The role of blue dye and careful palpation of the axilla was evaluated in patients in whom axillary sentinel nodes remained hidden after SPECT/CT. Methods  Fifteen breast cancer patients with non-visualisation on planar lymphoscintigraphy and 13 women with only extra-axillary sentinel nodes underwent SPECT/CT following late planar imaging without re-injection of the radiopharmaceutical. Results  SPECT/CT visualised lymphatic drainage in eight of the 15 patients (53%) with non-visualisation on planar imaging, depicted nine of the 14 harvested sentinel nodes (64%) and three of five tumour-positive sentinel nodes. In two of the 13 patients (15%) with only extra-axillary sentinel nodes on their planar lymphoscintigram, SPECT/CT showed an axillary sentinel node that appeared to be uninvolved. Careful exploration of the axilla with the combined use of blue dye, a gamma probe and intra-operative palpation revealed an axillary sentinel node in the remaining 18 patients. SPECT/CT showed the exact anatomical location of all visualised sentinel nodes. Conclusion  SPECT/CT discovered ‘hidden’ sentinel nodes in the majority of patients with non-visualisation, but was less valuable in patients with only extra-axillary lymphatic drainage on the planar images. Exploration of the axilla in patients with persistent non-visualisation improved the identification of axillary (involved) sentinel nodes.