Missed fractures resulting from satisfaction of search effect

This study assessed whether subtle fractures are mised in multitrauma patients because other fractures are detected. Sixty-five simulated trauma patients were each depicted in series of radiographs that were assembled from radiographs of several actual patients. The radiographs were selected to look like they belonged to a single patient. Forty-six cases included a radiograph showing a subtle fracture (which we called the “target”). In one experimental condition, none of the other radiographs in the patient’s series contained a fracture. In a second experimental condition, a radiograph containing an additional fracture (called the “distracter”) was substituted for a radiograph that had no fracture in the first experimental condition. The accuracy of detecting the target fractures was significantly reduced for cases in which the distracter fracture was reported. Awareness of the nature of this type of miss may lead to realistic strategies to avoid it. Supported by U.S. Public Health Service Grant RO1 CA 42453 from the National Cancer Institute, Bethesda, MD.     

家族性颅骨锁骨发育不全的影像学表现(附6例分析)

目的探讨家族性锁骨颅骨发育不全的X线及CT表现特征。方法分析6例(2个家庭)锁骨颅骨发育不全的临床、X线及CT表现,并从遗传学角度进行探讨。结果家族性锁骨颅骨发育不全的X线及CT表现主要为颅顶膨隆或下陷、囟门未闭、颅缝增宽、多发缝间骨、颅底相对较窄,蝶骨短、蝶窦小,颅底骨明显增厚,并呈棉花团状改变,边缘模糊、牙齿发育不良、锁骨发育不全或缺如、全身骨骼发育不全。结论家族性锁骨颅骨发育不全的X线及CT表现具有特征性,能够作出正确的诊断。     

Searching for first-degree familial relationships in California's offender DNA database: validation of a likelihood ratio-based approach

A validation study was performed to measure the effectiveness of using a likelihood ratio-based approach to search for possible first-degree familial relationships (full-sibling and parent–child) by comparing an evidence autosomal short tandem repeat (STR) profile to California's ∼1,000,000-profile State DNA Index System (SDIS) database. Test searches used autosomal STR and Y-STR profiles generated for 100 artificial test families. When the test sample and the first-degree relative in the database were characterized at the 15 Identifiler^® (Applied Biosystems^®, Foster City, CA) STR loci, the search procedure included 96% of the fathers and 72% of the full-siblings. When the relative profile was limited to the 13 Combined DNA Index System (CODIS) core loci, the search procedure included 93% of the fathers and 61% of the full-siblings. These results, combined with those of functional tests using three real families, support the effectiveness of this tool. Based upon these results, the validated approach was implemented as a key, pragmatic and demonstrably practical component of the California Department of Justice's Familial Search Program. An investigative lead created through this process recently led to an arrest in the Los Angeles Grim Sleeper serial murders.     

Retroperitoneal desmoid tumor in a patient with familial adenomatous polyposis: A case report

Desmoid tumors are benign fibroblastic neoplasms, with locally invasive features and a tendency of recurrence. They are considered an aggressive non-metastatic fibromatosis. The retroperitoneal location is extremely rare. Their exact mechanism of occurrence is still controversial, but could be related to a genetic predisposition, hormonal factors or traumatic factors, including surgery. This entity faces management difficulties due to its rarity, the variable circumstances of its discovery, and the non-specific clinical manifestations. Their sensitivity to chemotherapy and radiotherapy is limited and surgery remains the only curative treatment in symptomatic cases, however observational waiting could consist the most appropriate management in selected asymptomatic patients, moreover it could avoid unnecessary morbidity from surgery or radiotherapy, which makes the management of this condition a multidisciplinary decision and should be adapted to fit the patients individually. We report a case of a retroperitoneal desmoid tumor in a 31-year-old woman with a history of familial adenomatous polyposis, through which we will discuss this extremely rare neoplastic entity.     

The natural history of familial cerebral cavernomas: a retrospective MRI study of 40 patients

Our objective was to determine the natural history and prognostic factors of familial forms of cerebral cavernous malformations (CCM). Cavernomas are one of the most common central nervous system vascular malformations. Familial CCM is increasingly diagnosed, but little is known about its natural history. In a national survey, we analysed clinical and MRI features of 173 patients from 57 unrelated French families. Of these 40 had undergone at least two clinical and MRI examinations. Occurrence of haemorrhage, new lesions, change in signal intensity and size of lesions have been studied by comparison between first and last MRI studies. The CCM were classified according to Zabramski et al. Mean follow-up was 3.2 years (range 0.5–6.5 years). We followed 232 cavernomas (mean 5.9 per patient, range 1–17). Serial MRI demonstrated changes in 28 patients (70 %). Bleeding occurred in 21 lesions (9.1 %) in 14 patients (35 %). The haemorrhagic risk was 2.5 % per lesion-year, higher in type I and brain-stem CCM. We saw 23 new lesions appear in 11 patients (27.5 %), with an incidence of 0.2 lesions per patient year. Signal change was observed in 11 patients (27.5 %), in 14 lesions (6 %), while 9 lesions (3.9 %) in 9 patients (22.5 %) changed significantly in size. Received: 20 May 1999/Accepted: 1 September 1999     

A more straightforward derivation of the LR for a database search

Matching DNA profiles of an accused person and a crime scene trace are one of the most common forms of forensic evidence. A number of years ago the so-called ‘DNA controversy’ was concerned with how to quantify the value of such evidence. Given its importance, the lack of understanding of such a basic issue was quite surprising and concerning. Deriving the equation for the likelihood ratio of a DNA database match in a much more direct and simple way is the topic of this paper. As it is much easier to follow it is hoped that this derivation will contribute to the understanding.     

The effect of FBI CODIS Core STR Loci expansion on familial DNA database searching

1000 profiles chosen randomly from an in-house database of 6000 profiles were searched against the database for matches with at least one shared allele per locus. The database contains profiles that have been analyzed with Identifiler Plus (15 markers) for biological relationship and DNA identification purposes and both true and false matches are expected to be obtained. 100 pairs of at least one true paternity match and one false match were selected and were initially supplemented with 5 additional STRs representing the new Core CODIS set. Study of the LR value showed that when false matches were treated as paternity matches, the expansion of the marker set severely diminished the LR values obtained compared to true matches and the false positive ratio of familial database searching. When false matches were treated as full-sibling matches, the expansion to 20 STRs also diminished the number of false matches and the corresponding LR values compared to true full-sibling cases, but the effect was less dramatic. Addition of the SE33 marker, further promoted distinction between true and false matches both in paternity and full-sibling cases. Counting the number of shared alleles presented improved distinction efficiency between true and false matches after STR expansion to20 and 21 STRs but remains a less valuable method of familial DNA database searching compared to LR.     

Sudden, unexpected death resulting from a giant coronary artery aneurysm

Aneurysms of the coronary arteries are rare and most cases develop in vessels with severe atherosclerosis. However, coronary aneurysms of other etiological origins may occur in younger people. These cases often remain undetected until a sudden and sometimes fatal complication occurs. Therefore, knowledge of the disease is important not only for the clinician, but also for the forensic pathologist. We report the case of a young man who died suddenly and unexpectedly and in whom autopsy revealed a giant coronary artery aneurysm complicated by fresh, obliterating thrombosis.     

Delay in ED arrival resulting from a remote helipad at a trauma center

Introduction: Ground transport from a remote helipad at a trauma center may delay patient arrival in the ED and affect patient morbidity and mortality. Prehospital care providers must be aware of the magnitude of any delay when selecting the most expedient means of transport for trauma patients. This study quantities the time required for a 0.6-mile ground transport from a remote trauma center helipad to an ED through two traffic signals along one city street.

Methods: The trauma registry was queried for all patients transported directly from the scene to the regional trauma center by helicopter between January 1993 and October 1996. Prehospital records were used to supplement missing time data; patients with incomplete data were excluded. Ground transport time was calculated by subtracting the time that the helicopter arrived at the remote helipad from the time the ambulance arrived at the ED. Mean ground transport time and standard deviation were calculated.

Results: Three-hundred-eighty-nine trauma patients were transported directly from the scene to the regional trauma center by helicopter. Complete data were available for 345 patients (89%). Mean ground transport time was 5.2 ± 2.3 minutes.

Conclusion: The need for ground ambulance transport from this remotely located trauma center helipad adds more than 5 minutes to total prehospital time. This delay in ED arrival may be significant for some patients and should be taken into account when selecting the most appropriate mechanism of patient transport and planning helipad construction.     

Epidural abscess resulting from traumatic esophageal rupture secondary to a flexion-extension injury

An epidural abscess developed several weeks after a traumatic esophageal rupture secondary to a reported flexion-extension injury in a restrained back seat passenger in a motor vehicle accident. Chest radiograph and an Indium study suggested the possibility of a posterior mediastinal abscess. Chest computed tomography (CT) also noted epidural abscess and osteomyelitis, which were confirmed by magnetic resonance imaging (MRI). Diagnosis was delayed significantly by underinterpretation of both chest and CT findings. Obvious positive findings (lower lobe infiltrate on chest radiograph and posterior mediastinal abscess on CT) were noted, but more subtle and very important findings of superior mediastinal widening and extra pulmonary gas bubbles on the chest radiograph and extradural disease displacing the spinal cord on CT were not described. We can find no previously reported case of esophageal rupture associated with flexion-extension injury of the neck. It is also extremely rare for esophageal rupture to remain asymptomatic for more than several hours.     

急性期脑梗死引起的运动性失语的功能磁共振研究

目的:探讨急性脑梗死引起的运动性失语脑内代偿情况。方法:急性脑梗死患者8例,男女比例1.3:1,平均44.5岁;正常健康志愿者20人,男10例,女10例,平均38.5岁,均为右利手。检查者均完成图片命名任务。AFNI软件处理实验数据。统计分析采用SPSS12.0分析软件。同一感兴奋区(ROI)比较采用两样本t检验或非参数统计:Mann-Whitney test。结果:患者组因病灶位置不同分为两组:①病灶位于左侧岛叶及左侧脑室旁白质5例。激活脑区如下:右侧Broca区,右侧BA10区,左侧角回,左侧顶上小叶,辅助运动区等。其中右侧Broca区激活强度和体素具有统计学意义,P0.05;②病灶位于左侧额下回(Broca区)3例。激活脑区如下:左侧BA46区,右侧顶上小叶,右侧额中回,左侧角回,辅助运动区等。正常对照组激活脑区:双侧岛叶,双侧额下回(Broca区,以左侧为著);双侧额中回,双侧额叶背外侧区,双侧顶上小叶,双侧颞上回,辅助运动区,双侧梭状回等激活。结论:急性脑梗死所致运动性失语,脑内代偿方式因位置不同而有差异。     

Australian forensic scientists: a view from the witness box

Forensic scientists occupy an important position in courts of law as expert witnesses. Despite a wealth of knowledge and experience about how scientific evidence is presented, Australian forensic scientists have not, until now, been asked for their perspective on how their evidence is used in the legal system. This paper highlights some of the results of a survey of Australian forensic scientists across a broad range of disciplines, which investigated their views on pre-trial processes, trial presentation of scientific evidence, their interaction with the judge, jury and other forensic experts, and finally, their comments on forensic science and expert evidence in general.     

A case of a serial sexual offender: The first ever report from Turkey

There have been cases of serial sexual offenders and studies dealing with such cases in the literature. However, no serial sexual offender case was reported in Turkey, to the best of our knowledge. In this article, as the first report from Turkey, we present a serial sexual offender who assaulted 27 women. The assailant entered a total of 29 houses, and assaulted victims in 27 of them, and he failed to assault two individuals. The 'modus operandi' of the offender was identical in all assault cases and led the police towards a hypothesis that these assaults were all committed by the same individual. The offender did not admit the assaults and strictly refused a forensic psychiatric examination. Being an individual with a high level of education, having a respected position and profession, choosing women aged older than 18 years as victims were among distinctive features of the presented offender.     

Death resulting from a mesenteric hemorrhage due to acute myeloid leukemia: An autopsy case

Acute leukemia causes hemorrhage in various sites throughout the body, such as the brain parenchyma, resulting in serious complications. Here, we present an autopsy case where the patient succumbed to a ruptured mesenteric hematoma caused by acute leukemia.A 58-year-old man, without a significant past medical history, was found dead at his workplace. An external examination showed subcutaneous hemorrhage on the left upper extremity. Macroscopic autopsy findings revealed a massive hemoperitoneum (1000 mL) and extensive hematoma in the mesentery. Histopathological findings showed monotonous cell proliferation not only in the mesentery, but in many organs, such as the liver, spleen, and kidney; aggregates of the infiltrating cells were also observed in the microvessels of various organs. Immunohistochemical staining indicated that the infiltrating cells showed variable myeloperoxidase positivity, and the cells were strongly positive for CD68 (PG-M1). From the autopsy findings and the immunohistochemical staining, we concluded that the underlying cause of death was acute myeloid leukemia (M5).This case was not only a rare presentation of acute leukemia, but provides a lesson to forensic pathologists regarding noting underlying hematological disease, particularly when a case of massive hemorrhage of unknown etiology is encountered.     

An analysis of injuries resulting from professional horse racing in France during 1991-2001: a comparison with injuries resulting from professional horse racing in Great Britain during 1992-2001

Background

It has been previously shown that professional jockeys suffer high rates of fatal and non‐fatal injuries in the pursuit of their occupation. Little is known, however, about differences in injury rates between countries.

Aim

To determine the rate of fatal and non‐fatal injuries in flat and jump jockeys in France and to compare the injury rates with those in Great Britain and Ireland

Method

Prospectively collected injury data on professional jockeys were used as the basis of the analysis.

Results

Limb fractures occur four times more often in both flat and jump racing in France than in Great Britain. Similarly dislocations are diagnosed 20 times more often in flat and three times more often in jump racing. This difference is surprising given that French jockeys have fewer falls per ride than their British counterparts in flat racing, although they do have more falls than the British in jump racing. Similarly concussion rates seem to be higher in French jockeys, although there may be a difference in the diagnostic methods used in the different countries. By contrast, soft tissue injuries account for a far smaller percentage of injuries than in Great Britain.

Conclusion

There are striking differences in injury rates between countries which may be explained in part by a difference in track conditions—for example, harder tracks in France—or different styles of racing—for example, larger fields of horses per race in France.     

Marfan syndrome: clinical consequences resulting from a medicolegal autopsy of a case of sudden death due to aortic rupture

To investigate the sudden death of a 31-year-old man, a medicolegal autopsy was performed. Major findings were a dilated aortic root with a longitudinal rupture of the intima and dissection of aorta and right coronary artery and consequent tamponade of the pericardial sac. Moreover, arachnodactyly and other skeletal deformities in combination with the histological finding of a pseudocystic medionecrosis of the aortic wall were noted. By sequencing of the FBN1 gene, a mutation (1622G>A) leading to the diagnosis of Marfan syndrome was found. Genetic counseling was recommended to the relatives who reported that the father of the deceased had died at the same age from aortic rupture. While fortunately the child of the deceased lacked this mutation, it was found in his younger sister. The results of the autopsy thus enabled early diagnosis and beginning of treatment in the sister and thus a considerable statistical increase in lifespan. With this report, we want to show that medicolegal autopsies can also have medical consequences for relatives. We argue that in all sudden and unexpected deaths in young persons up to 35 years an autopsy should be performed, not only to detect unnatural causes of death but also to identify heritable diseases and thus aid the relatives.     

The circumstances and characteristics of fatal falls in Victoria,Australia: a descriptive study

Falls are the 18th major cause of death in Australia. The intention of this study was to provide a comprehensive understanding of fatal falls in an Australian context through documenting the circumstances of fall-related deaths and investigating the characteristics surrounding those falls. A retrospective review of fatal falls in the state of Victoria from 2005 to 2014 was undertaken using the National Coronial Information System online database. Details recorded for each fatal fall case comprised the circumstances of the fall (year and month of fall, fall type, and manner and cause of death) and characteristics of the deceased (sex, age, body mass index, pre-existing conditions and psychoactive drug use). There were 2743 fatal falls, encompassing falls from a bed, chair, height (>3 m), horse, ladder, low height (≤3 m), motor vehicle, stair(s), standing, toilet, wheelchair and unspecified. The majority of falls were accidental (95.5%), indirectly contributed to the fatality (66.4%), were female (53.2%), elderly (61+years) (92.3%) and of a healthy weight (33.3%). Many had pre-existing conditions (86.8%) and several (19%) had psychoactive drug use. Findings are anticipated to contribute to prevention policy improvements and assist medico-legal death investigations.     

Estimating height from the first and second cervical vertebrae in a Spanish population

One of the roles of forensic anthropology is the identification of skeletal remains and over the years many methods have been developed to obtain specific details of a corpse such as an estimation of age and height. The femur and tibia are ideal for this purpose but unfortunately they are often missing or badly fragmented. For this reason, in this present study, we used the smaller bones of the first and second cervical vertebrae, which are often better preserved than the long bones. Direct measurement of these bones has been found to be misleading, largely due to the remains of a covering of soft tissue, and to overcome this all measurements were taken from tomographic images. The aim of this study is to provide an auxiliary diagnostic method to evaluate the association of different anthropometric measurements taken with tomographic imagery of both the first cervical and second cervical vertebra with body height within a sample of the Spanish population.Measurements were taken from tomographic images taken with a dental CT of 203 healthy individuals from a Spanish population. The best correlation was obtained in the case of unknown sex using four measurements: two of the first cervical vertebra and two of the second vertebra using the following regression formula S = 49.02 + 1.02O + 1.58DO + 0.49V + 0.67I.All formulae provided statistically significant results and can be applied to any skeletal remains belonging to a Spanish population.     

The Australian Institute of Sport framework for rebooting sport in a COVID-19 environment

Sport makes an important contribution to the physical, psychological and emotional well-being of Australians. The economic contribution of sport is equivalent to 2–3% of Gross Domestic Product (GDP). The COVID-19 pandemic has had devastating effects on communities globally, leading to significant restrictions on all sectors of society, including sport. Resumption of sport can significantly contribute to the re-establishment of normality in Australian society.The Australian Institute of Sport (AIS), in consultation with sport partners (National Institute Network (NIN) Directors, NIN Chief Medical Officers (CMOs), National Sporting Organisation (NSO) Presidents, NSO Performance Directors and NSO CMOs), has developed a framework to inform the resumption of sport. National Principles for Resumption of Sport were used as a guide in the development of ‘the AIS Framework for Rebooting Sport in a COVID-19 Environment’ (the AIS Framework); and based on current best evidence, and guidelines from the Australian Federal Government, extrapolated into the sporting context by specialists in sport and exercise medicine, infectious diseases and public health.The principles outlined in this document apply to high performance/professional, community and individual passive (non-contact) sport. The AIS Framework is a timely tool of minimum baseline of standards, for ‘how’ reintroduction of sport activity will occur in a cautious and methodical manner, based on the best available evidence to optimise athlete and community safety. Decisions regarding the timing of resumption (the ‘when’) of sporting activity must be made in close consultation with Federal, State/Territory and/or Local Public Health Authorities. The priority at all times must be to preserve public health, minimising the risk of community transmission.