Can skin histology be a useful tool for ancestry assessment in forensic settings? Ancestry assessment based on melanin pigment

Building the biological profile of a deceased person represents a pivotal step in order to achieve the victim’s identification. Specifically with regard to ancestry, the melanin distribution pattern in the dermal-epidermal layers has been poorly explored in the forensic field as a potential useful tool. In particular, nothing has been reported about the reliability of such method in bodies in active decay or in advanced state of decomposition. In this study fragments of skin sampled from bodies of known ancestry, both in good and in poor states of preservation, were subjected to histological analysis. We selected 15 subjects, which were divided into three groups: group A (5 white Europeans), group B (5 black Africans) and group C (5 Orientals). A double skin sample was performed on all the bodies, one from the abdomen and the other one from the right forearm. After histological processing and staining with hematoxylin and eosin (H&E) and Masson-Hamperl trichrome technique, the cutaneous melanin distribution pattern was assessed using a semi-quantitative score. The melanin distribution patterns observed both in fresh and in putrefied cadaveric skin were found to be in all cases consistent with the victims’ known ancestry. Moreover no differences were observed between abdominal and forearm skin samples and all the histological findings highlighted by H&E were confirmed by the Masson-Hamperl trichrome staining. We demonstrated that the histological analysis aimed at assessing the melanin distribution pattern may be a valuable useful tool in the assessment of ancestry.     

Interval growth of probably benign breast lesions on follow-up ultrasound: how can these be managed?

Objectives  

To investigate the malignancy rate in probably benign lesions with interval growth on follow-up ultrasound (US) and the cut-off values for predicting malignancy.     

Facing a disruptive threat: how can a nuclear medicine service be prepared for the coronavirus outbreak 2020?

European Journal of Nuclear Medicine and Molecular Imaging - The aim of this short communication is to outline our experience in policies and processes of a nuclear medicine service during the...     

Chest ultrasound in the assessment of patients in ICU: How can it help?

Background: Different imaging techniques can be used for assessment of chest problems in ICU patients, however ultrasound is a good diagnostic tool giving more information and at the same time without exposure to radiation and without risk of critical patient transfer.Aim of the work: The aim of this work was to study the role of thoracic ultrasound in assessment of ICU patients.Materials and methods: The study was carried out on 30 patients admitted to the ICU.B and M modes chest ultrasound was done for all patients using EsaoteMyLab?Alpha with eHD Technology.Results: The study included 19 males and 11 females with mean age of 42.6 ± 21.4 years. In this study ultrasound was able to diagnose Pneumothorax: 3 cases (10%). Pleural effusion: 20 cases (66.6%). Alveolar interstitial syndrome: 7 cases (23.3%). Lung consolidation: 20 cases (66.6%). Pulmonary infarcts: 1 case (3.3%). Neoplastic disease: 1 case (3.3%). Chest wall pathology: 1 case (3.3%).Conclusion: Ultrasound examination of the chest is a non- invasive, and promising bed side tool for examination of ICU patients.     

Vesicoureteral reflux: can the urethra be adequately assessed by using contrast-enhanced voiding US of the bladder?

PURPOSE: To prospectively evaluate contrast material-enhanced voiding ultrasonography (US) for assessment of the urethra by using voiding cystourethrography (VCUG) as the reference standard. MATERIALS AND METHODS: This study was approved by the ethics committee on human research. Written informed consent was obtained for all patients. A total of 146 pediatric patients suspected of having vesicoureteral reflux underwent US with a galactose-based contrast agent. The bladder was instilled with contrast agent and then filled with saline. US images of the urethra were videotaped before catheterization and during voiding. VCUG was subsequently performed in all patients. In female patients, the probe (a 3.5- or 5-MHz sector array or a 7.5-MHz linear transducer) was positioned longitudinally between the labia. In male patients, the transducer was placed longitudinally on the scrotum and then displaced distally toward the penile urethra. During voiding, attention was focused on the distention of the urethral walls and on the caliber of both the posterior and anterior urethra, which were measured with calipers. Sensitivity and specificity were estimated by using a confidence interval (CI) of 95%. RESULTS: All female patients and 75 male patients showed a normal urethra at both US and VCUG. Posterior urethral valves (PUV) were diagnosed in three patients at voiding US and were confirmed with findings from VCUG. Urethral stenosis was diagnosed in two male patients at voiding US and was confirmed with findings from VCUG. Seven male patients who had undergone surgery for PUV were adequately evaluated with both modalities. Sensitivity of voiding US was 100% (CI 95%: 96.5%, 100%); specificity was 100% (CI 95%: 69.9%, 100%). CONCLUSION: Voiding US is a reliable imaging modality for studying the urethra.     

What can be identified by three-phase bone scintigraphy in patients with chronic osteomyelitis of the mandible?

Objective  

Three-phase bone scintigraphy has been used for the diagnosis of osteomyelitis in some regions of the body. However, its utility in patients with chronic osteomyelitis of the mandible (COM) has been reported only occasionally and the significance has not been fully examined. The aim of this study was to investigate what can be identified from each phase of the three-phase bone scintigraphy in patients with COM.     

Cardiac injury markers and a failed algorithm: can accurate assessment of acute myocardial infarction be cost effective?

CONTEXT: Most studies assessing the use of cardiac injury markers, such as cardiac troponin I (cTnI), total creatine kinase (CK Total), and the cardiac isoenzyme of CK (CK-MB), agree that cTnI is the most specific test for diagnosing acute myocardial infarction (AMI). However, throughout the literature, there are ambiguities and contradictions on assay-ordering criteria. Inconsistent ways of viewing biochemical assessment of acute chest pain leads to cardiac injury marker assay-ordering patterns that can be nonspecific, ambiguous, and costly. OBJECTIVE: This study set out to design a cost-effective strategy and to outline criteria for ordering cardiac injury marker assays. This is accomplished by comparing Madigan Army Medical Center (MAMC) testing patterns to guidelines described in recently published prospective hospital studies investigating the markers. DESIGN: This was a retrospective study analyzing the patterns of 34,412 cardiac marker assays performed on 4,861 patients during 1999 and 2000 at MAMC. A total of 5,850 assays were run from 1,223 patients during the first 6 months of 2001. RESULTS: The MAMC chemistry section spent more than $100,000 during 1999 for the measurement of cardiac injury markers. During 2000, an algorithm was implemented to place controls on ordering; however, the same dollar amount was spent. CK Total, CK-MB, and cTnI testing represent 3.5% of the tests performed in the chemistry section, but they consumed about 20% of the supply budget. This disproportionate expenditure is attributable to numerous, dissimilar, and voluminous ordering patterns. CONCLUSIONS: Proper use of cardiac marker assays can lead to rapid and accurate diagnosis of AMI and subsequently save lives. This study demonstrates that cTnI is the only marker needed for accurate and more cost-effective assessment of AMI.     

Bone age assessment by dual-energy X-ray absorptiometry in children: an alternative for X-ray?

Objective

The aim of the study was to validate dual-energy X-ray absorptiometry (DXA) as a method to assess bone age in children.

Methods

Paired dual-energy X-ray absorptiometry (DXA) scans and X-rays of the left hand were performed in 95 children who attended the paediatric endocrinology outpatient clinic of University Hospital Rotterdam, the Netherlands. We compared bone age assessments by DXA scan with those performed by X-ray. Bone age assessment was performed by two blinded observers according to the reference method of Greulich and Pyle. Intra-observer and interobserver reproducibility were investigated using the intraclass correlation coefficient (ICC), and agreement was tested using Bland and Altman plots.

Results

The intra-observer ICCs for both observers were 0.997 and 0.991 for X-ray and 0.993 and 0.987 for DXA assessments. The interobserver ICC was 0.993 and 0.991 for X-ray and DXA assessments, respectively. The mean difference between bone age assessed by X-ray and DXA was 0.11 years. The limits of agreement ranged from −0.82 to 1.05 years, which means that 95% of all differences between the methods were covered by this range.

Conclusions

Results of bone age assessment by DXA scan are similar to those obtained by X-ray. The DXA method seems to be an alternative for assessing bone age in a paediatric hospital-based population.Children with the same chronological age often have a different bone maturation as a consequence of various genetic and social factors [1-3]. Bone age is a useful indicator of children’s growth and biological maturation and is frequently assessed in paediatric endocrinology to determine delayed or advanced growth [4-7]. In children with growth disorders, regular hand X-rays are needed to follow skeletal development at an interval of once or twice per year [8-10]. The classical method to assess bone age is based on the recognition of changes in the maturity indicators in hand–wrist X-rays by comparison with a reference atlas (Greulich and Pyle method) [11].The main problem with this method is the exposure to a certain amount of irradiation involved in X-ray procedures [12-14]. Although the precise risk estimate of paediatric cancers due to diagnostic X-ray exposure is not known [15-17], we know that the lifetime attributable risk of cancer due to one single X-ray exposure in childhood approximates 15% per sievert [18]. To avoid detrimental effects in later life as a result of cumulative radiation exposure, dose reduction is therefore particularly important in childhood [18,19]. Consequently, methods involving less radiation would be preferable to assess bone age in children. Dual-energy X-ray absorptiometry (DXA) has been suggested as a safer method to assess bone age [20]. In both children and adults, DXA is currently widely used to measure bone mineral density for the assessment of osteoporosis [21]. When applied to assess bone age, a hand–wrist scan by DXA (0.0001 mSv) produces a 10-fold lower effective dose than a hand–wrist X-ray (0.001 mSv) [22].One previous study in a paediatric population of 60 Polish subjects (5–20 years old) suggested that results for bone age assessment by DXA are similar to those produced by X-ray [20]. However, their results were presented as correlation coefficients and t-test analysis. For methods of comparison, Bland and Altman analysis is a more appropriate analysis, since it investigates agreement [23,24]. Also, they used a reference method that applied to the Polish population [25], whereas the Greulich and Pyle method would be more generalisable [3].Thus far, the accuracy of the assessment of bone age in children using DXA scans has not been properly validated. Therefore, the aim of this study was to investigate whether hand–wrist bone age assessment by DXA produces similar results to the classical X-ray method.     

Interpreting urgent brain CT scans: Does review by a radiology trainee make a difference in accuracy?

An urgent brain CT scan is now commonly performed on patients presenting to hospital emergency departments for a wide variety of indications. At most institutions in Australia, such scans are reviewed immediately by an on-call radiologist, who is usually an accredited registrar. The value of the trainee radiologist in such a setting is unclear. In the present study, the rate of abnormal findings in a random sample of 100 brain CT scans performed on hospital patients is reviewed and the accuracy of detection of potentially urgent lesions is compared between three junior clinicians, an accredited radiology registrar and a junior radiographer, using the final radiological report as the standard of reference. At least one potentially urgent abnormality in 25% of the patients scanned was found. The RANZCR trainee recorded a significantly higher sensitivity compared to the other readers. It is concluded that an urgent brain CT is of greater value as a screening test if a contemporaneous radiological review is made available, and the implications this may have on current imaging practices are briefly considered.     

Evaluation of the agonal stress: can immunohistochemical detection of ubiquitin in the locus coeruleus be useful?

The determination of the survival time after a crime as well as the concomitant physical and mental load of the victim is an important task for the forensic pathologist. The heat shock protein, ubiquitin, exerts an essential role in the cellular response to stress. We aimed to investigate the usefulness of the ubiquitin expression in the locus coeruleus as a marker for the evaluation of agonal stress. Is the amount of ubiquitin in this brain locus an indication of the length and/or intensity of the agonal period following various causes of death? The immunohistochemical (IHC) expression of ubiquitin is examined in formalin-fixed, paraffin-embedded slides of the human locus coeruleus (n?=?48). The evaluation of the IHC staining is blindly performed, prior to the study of the medico-legal files. According to the length of agony, a division into subgroups is made. Three possible IHC staining patterns are observed: a staining of the neuronal nucleus or the cytoplasm or both. In addition, the number of neurons with ubiquitin expression per μm² is calculated in each locus coeruleus. Significant differences in the number of ubiquitin-immunoreactive neurons are noticed with respect to the length of the agony: A higher density of positive neurons is seen in case of a pronounced and extended death struggle.     

3D CT protocol in the assessment of the esophageal neoplastic lesions: can it improve TNM staging?

The purpose of this prospective observational study was the evaluation of the usefulness of MPR reconstructions and virtual endoscopy in the study of the esophageal carcinoma. Thirty-nine patients with esophageal cancer proved by means of endoscopy, underwent preoperative TNM staging with dynamic CT of the chest and abdomen with the aid of 3D rendering. Twenty-six patients underwent surgery, and the CT results were compared with histopathologic findings. In staging the T parameter, the CT with 3D reconstructions and virtual endoscopy, showed a sensitivity of 92% and an accuracy of 88%. In staging lymph nodes, the sensitivity in our study was 85%, the specificity 58%, and the accuracy 69%. Our protocol of the study of the esophageal cancer with 3D CT and virtual endoscopy, demonstrated a high concordance with the surgical and pathologic findings. The 3D reconstructed images were very helpful to the surgeons regarding preoperative planning. We performed an observational enquiry, and although this was a small study, it has, however, confirmed that the 3D imaging of the esophagus represents a valuable advantage to conventional imaging. Further studies with a larger number of patients are needed to prove its superiority to traditional CT imaging of the esophagus.     

Does the measurement of the difference of resistive indexes in spleen and kidney allow a selective assessment of chronic kidney injury?

Purpose: To determine whether the difference of resistive indexes (RIs) in spleen and kidney (DI-RISK) is a more specific ultrasonographic (US) marker of intrarenal parenchymal damage than intrarenal RI alone. Materials and Methods: The study was approved by the local ethics committee. All study participants provided informed consent. The authors defined standard values for renal RI, splenic RI, and DI-RISK in 152 healthy subjects; carotid intima media thickness (IMT) was assessed as a marker of systemic vascular disease. Next, the authors measured these US parameters and collected echocardiographic data in 290 patients with chronic kidney disease (stage 2-4) recruited between September 2008 and February 2011 to evaluate the DI-RISK across the spectrum of stages of kidney function. Correlation coefficients were calculated with the Spearman test, and multivariate linear regression was used to analyze independent predictors of renal RI, splenic RI, and DI-RISK. Results: Healthy subjects had a mean age of 34.3 years ± 8.7, and patients with chronic kidney disease had a mean age of 65.0 years ± 12.3 (P < .001). In healthy subjects, both renal and splenic RIs were associated with IMT (renal RI: r = 0.19, P = .022; splenic RI: r = 0.23, P = .005); there was no correlation between DI-RISK and IMT (r = -0.10, P = .215). Similarly, in patients with chronic kidney disease, renal and splenic RIs correlated with IMT (renal RI: r = 0.33, P < .001; splenic RI: r = 0.30, P = .001). DI-RISK was associated with the estimated glomerular filtration rate (eGFR; r = -0.19, P = .001) but not with IMT (r = 0.08, P = .174). At multivariate regression analysis, DI-RISK was independently associated with eGFR but not with extrarenal factors. Conclusion: In patients with chronic kidney disease, renal RIs do not selectively indicate organ damage, but also mirror systemic vascular disease. The authors introduced DI-RISK as a potential US marker that may more specifically reflect kidney damage. ? RSNA, 2012.     

Urine protein as a rapid screen for renal function in the ED: can it replace serum creatinine in selected patients?

Many radiology departments are unwilling to perform studies that require contrast administration to adult emergency department patients over the age of 35 without having a documented serum creatinine concentration of less than 2.0 mg/dl within a week of the study. Significant diagnostic delays may ensue waiting for this serum test. The present study was performed to determine whether a negative urine protein test, obtained by dip testing, will serve as a marker for a serum creatinine concentration below 2.0 mg/dl in emergency department patients who give no history of a disease which potentially could cause renal insufficiency. Emergency patients aged 35 years or more presenting to a university hospital who did not volunteer a history of hypertension, diabetes mellitus, multiple myeloma, or systemic lupus erythematosus in triage were enrolled. Only patients with a negative urine protein test whose serum creatinine was tested for other reasons were included. Of the 310 patients who had no protein in their urine and no history of disease which potentially could cause renal insufficiency, none had a serum creatinine concentration greater than 2.0 mg/dl (mean=0.82 mg/dl, SD 0.28). Ages ranged from 35 to 96 years (mean=59.7 years, SD=17.5). All patients would have qualified for a contrast load for contrast computed tomography studies or for intravenous pyelogram. In patients who do not have a known history of hypertension, multiple myeloma, systemic lupus erythematosus, diabetes mellitus, or specific renal disease, urine dip testing for protein in the emergency department may be a rapid and safe screen for imaging studies requiring contrast without having to await serum creatinine testing.     

Acute spontaneous aortic pathologies associated with intramural hematoma: can a differential diagnosis be made by imaging techniques?

Acute intramural aortic hematoma may result from ruptured vasa vasorum without intimal disruption (IMH hereafter) but can also be found in association with processes in which an intimal lesion is present, such as aortic dissections (AD), where the hematoma represents the acute thrombosis of the false lumen, or in penetrating atherosclerotic ulcers (PAU), where blood collects beyond the disrupted internal elastic lamina. As the clinical presentation of these conditions is very similar, imaging techniques should aim both to diagnose the hematoma and to characterize the underlying pathology. This review critically analyzes the diagnostic potential of several imaging methods based on personal experience and literature reports. Although intramural hematoma can be easily diagnosed unrespective of the tomographic imaging modality, it is usually difficult to distinguish between IMH and hematomas associated either to AD or to PAU. Indeed, only PAU related hematomas can be consistently diagnosed due to the high probability of unveiling the causative wall ulceration; conversely, the differential diagnosis between IMH and AD - associated hematomas is still matter of controversy. According to the literature, the two conditions cannot be differentiated by transesophageal echocardiography, though some reports state that a distinction might be made by MR imaging. As regards CT, only a small percentage of AD - associated hematomas exhibit clear evidence of a typical intimal flap, allowing for a safe diagnosis to be made: often, unfortunately, the intimal lesion subsequently found at surgery cannot be detected, yielding a picture of IMH. Therefore, the radiological report should give the same diagnostic probability to both conditions.