Jagdgeschwader 27

Background

Assessment of bones, especially with respect to the question of species, individualization, gender and exposure time is an essential component of routine forensic work and involves recent as well as historical objects. Morphological and morphometric investigations allow at least a reasonable answer to these aspects; however, the identification of bones and skeletal findings often founders on a lack of knowledge of a presumed identity or methodological limitations. Findings can substantially contribute to an assessment of the historical context.

Objective

Based on the planned excavation of a Messerschmitt Bf 109, which according to contemporary witnesses crashed in 1945, the possibilities and limitations of forensic osteological expertise are illustrated.

Material and methods

The recovery of the aircraft wreck from earth contaminated by aviation fuel was carried by representatives of the German War Graves Commission (?Volksbund Deutsche Kriegsgräberfürsorge e. V.“). Subsequently, a forensic osteological assessment of skeletal fragments and evaluation of accompanying objects were carried out. Furthermore, chemical toxicological investigations of biological materials, accompanying objects and the surrounding environment as well as DNA analytical investigations on selected bones were carried out.

Results

The investigations showed these were parts of a young male skeleton with deformation of the ribs as well as fractures of the spine and extremities. The cause of death was consistent with a high speed trauma (aircraft crash) without recognizable heat damage. A complete DNA profile of a male person could be achieved, despite the skeletal parts being saturated with aviation fuel.

Conclusion

Despite many indications (e.g. identification tag, aircraft type, accompanying findings and DNA profile) and presumed identity, an identification could not be achieved due to a lack of reference materials. Noteworthy was the complete DNA profile despite, or perhaps because of, fuel-saturated bones.

     

Infrared pupillography in routine police traffic checks

Background

In order to evaluate the ability of traffic participants to drive, standardized and objective measurement methods are needed. In recent analyses it was shown that pupil function is a significant indicator of being under the influence of substances acting on the central nervous system.

Objective

The aim of this study was to answer the question whether it is possible to detect if a person is under the influence of drugs or medication based on pupil function.

Material and methods

In total 121 subjects were exposed to different light stimuli and an infrared pupillographic investigation of the eyes was carried out. The study cohort consisted of 41 healthy test subjects and 80 subjects under the influence of drugs or medication. Several neural network models with different network architectures were trained in a learning group, further analyzed in a verification sample and most importantly tested in an independent test sample. Specificity, sensitivity, negative and positive predictive values as well as the percentage of correctly predicted subjects were analyzed. A 95?% confidence interval (CI) was included for all performance measurements.

Results

A neural network model was found which performed with a specificity of 91?% (95% CI, 78–98?%), sensitivity 90?% (95% CI, 81–96?%), negative predictive value 85?% (95% CI, 72–94?%), positive predictive value 94?% (95% CI, 86–98?%) and a correct prediction was made for 90?% (95% CI, 83–95?%) of the subjects.

Conclusion

The results of this study clearly show that infrared pupillography provides excellent discrimination between healthy subjects and persons under the influence of drugs or medication in this specific setting.

     

Environmental Factors Predictive of No-Show Visits in Radiology: Observations of Three Million Outpatient Imaging Visits Over 16 Years

PurposeTo evaluate the impact of environmental and socioeconomic factors on outpatient cancellations and “no-show visits” (NSVs) in radiology.Materials and MethodsWe conducted a retrospective analysis by collecting environmental factor data related to outpatient radiology visits occurring between 2000 and 2015 at our multihospital academic institution. Appointment attendance records were joined with daily weather observations from the National Oceanic and Atmospheric Administration and estimated median income from the US Census American Community Survey. A multivariate logistic regression model was built to examine relationships between NSV rate and median income, commute distance, maximum daily temperature, and daily snowfall.ResultsThere were 270,574 (8.0%) cancellations and 87,407 (2.6%) NSVs among 3,379,947 scheduled outpatient radiology appointments and 575,206 unique patients from 2000 to 2015. Overall cancellation rates decreased from 14% to 8%, and NSV rates decreased from 6% to 1% as median income increased from $20,000 to $120,000 per year. In a multivariate model, the odds of NSV decreased 10.7% per $10,000 increase in median income (95% confidence interval [CI]: 10.3%-11.1%) and 2.0% per 10°F increase in maximum daily temperature (95% CI: 1.3%-1.6%). The odds of NSV increased 1.4% per 10-mile increase in commute distance (95% CI: 1.3%-1.6%) and 4.5% per 1-inch increase in daily snowfall (95% CI: 3.6%-5.3%). Commute distance was more strongly associated with NSV for those in the two lower tertiles of income than the highest tertile (P < .001).ConclusionEnvironmental factors are strongly associated with patients’ attendance at scheduled outpatient radiology examinations. Modeling of appointment failure risk based on environmental features can help increase the attendance of outpatient radiology appointments.     

Quality control of involved field radiotherapy in the HD 13 and HD 14 trials

Introduction

As part of the foundation of the German Hodgkin Study Group (GHSG) in 1978, a central radiotherapy (RT) reference centre was established to evaluate and to improve the quality of treatment. During the study generations, the quality assurance programs (QAP) were continued and adapted to the demands of each study. The purpose of this article is to demonstrate the results of the fifth study generation and to compare them to the previous findings.

Methods

With the start of the fourth GHSG study generation (HD10–12), a central prospective review of all diagnostic images was established to create an individual treatment plan for each early stage study patient. The quality of involved field RT was retrospectively evaluated by an expert panel of radiation oncologists. In the fifth study generation (HD13–15), the retrospective review of radiotherapy performed was refined and the results were compared with the findings of the fourth generation.

Results

The expert panel analyzed the RT planning and application of 1037 (28?%) patients (HD13 n = 465, HD14 n = 572). Simulation films were available in 85?% of cases and verification films in 87?%. RT was assessed as major violation in 46?% (HD13 = 38?%, HD14 = 52?%), minor violation in 9?% (HD13 = 9?%, HD14 = 9?%) and according to the protocol in 45?% (HD13 = 52?%, HD14 = 38?%).

Conclusion

The value for QAP of RT within the GHSG trials is well known. Still there were several protocol violations. In the future, the QAP program has to be adapted to the requirements of “modern RT” in malignant lymphoma.

     

A 20 × 20 m repeated sprint field test replicates the demands of wheelchair rugby

Objectives

To assess the physiological responses to, and the agreement between, a 20 × 20 m repeated sprint field test and wheelchair rugby game play, as well as the reliability of the test.

Autoimmunreaktionen und Paraneoplasien

Clinical issue

Autoimmune disorders of the central nervous system (CNS) are common but are also a heterogeneous group of diseases. The most common form is multiple sclerosis (MS), others are clinically isolated syndrome (CIS), acute demyelinating encephalomyelitis (ADEM) and neuromyelitis optica spectrum disorders (NMOSD). Paraneoplastic syndromes are rare and tumor-associated, they are not induced by direct invasion of tumor tissue but by tumor-associated autoantibodies mostly against specific CNS proteins, e.?g. limbic encephalitis and paraneoplastic cerebellar ataxia or degeneration.

Diagnostics, standard radiological methods, performance and achievements

The correct diagnosis of autoimmune and paraneoplastic syndromes can still be challenging. In addition to the patient history, clinical examination and blood as well as cerebrospinal fluid (CSF) tests, magnetic resonance imaging (MRI) is gaining importance in the diagnostics. It is important not only in primary diagnostics but also in follow-up and therapy monitoring, especially in MS with specific therapies to detect therapy complications, such as progressive multifocal leukoencephalopathy as early as possible. In paraneoplastic syndromes MRI can also be an important component in the diagnostics but can also initially be negative and typical signal changes become visible only in follow-up scans.

Practical recommendations

In paraneoplastic syndromes the correct diagnosis is based on laboratory tests for specific autoantibodies in serum and CSF.

Treatment

The treatment of autoimmune and paraneoplastic disorders of the CNS ranges from steroids and immunosuppressive agents to plasmapheresis, depending on the specific disorder.

     

Funktionelle MRT 2.0

In recent years the purely morphological magnetic resonance imaging (MRI) has been increasingly flanked by so-called functional imaging methods, such as diffusion-weighted imaging (DWI), to obtain additional information about tissue or pathological processes. This review article presents two MR techniques that can detect physiological processes in the human body. In contrast to all other functional MR imaging techniques, which are based on hydrogen protons, the first technique presented (X-nuclei imaging) uses the spin of other nuclei for imaging and consequently allows a completely different insight into the human body. In this article X?nuclei imaging is focused on sodium (²³Na) MRI because it currently represents the main focus of research in this field due to the favorable MR properties of sodium. The second MR technique presented is the relatively novel chemical exchange saturation transfer (CEST) imaging that can detect exchange processes between protons in metabolites and protons in free water. The first part of this article introduces the basic technical principles, problems, advantages and disadvantages of these two MR techniques, whereas the second part highlights the potential clinical applications. Examples illustrate several potential applications in neuroimaging (e.?g. stroke and tumors), musculoskeletal imaging (e.?g. osteoarthritis and degenerative processes) and abdominal imaging (e.?g. kidneys and hypertension). Both techniques inherently contain an incredible potential for future imaging but are still on the threshold of clinical use and are currently under evaluation in many university centers.     

How to improve femoral component rotational alignment in computer-assisted TKA

Purpose

Although several anatomical landmarks have been proposed to obtain adequate femoral component alignment in total knee arthroplasty (TKA), there is still no consensus regarding the best way to correctly position the prosthetic component on the horizontal plane. A previous computed tomography (CT)-based study has demonstrated anatomical transepicondylar axis (aTEA) to be externally rotated relative to surgical transepicondylar axis (sTEA) of approximately 4.5°. In this study, it is described a new methodological approach to femoral component rotational positioning through the use of previously reported CT scan information and navigation.

Methods

Eight consecutive patients scheduled for navigated TKA were selected. Rotational placement of the femoral component was performed using navigation system. The femoral component was implanted setting 4.5° of internal rotation relative to the aTEA. Within 1 week from surgery, all patients underwent a CT scan, and the posterior condylar angle (PCA) was measured. A PCA of 0.0°, meaning component placement parallel to sTEA, was set as femoral rotational alignment target. Clinical evaluation was performed at a mean 14.3 months of follow-up with KOOS questionnaire.

Results

The mean PCA measured on post-operative CT images was 0.4° (SD 1.3°), meaning that the femoral component was averagely implanted with 0.4° of internal rotation relative to the sTEA. Seven out of eight cases (87.5 %) resulted to have within 1° deviation from the rotational alignment target. All patients but one reported good clinical results.

Conclusions

Relevant finding of the present study was that the use of navigation and aTEA as a reference demonstrated to be accurate to set up femoral component rotational positioning on the horizontal plane in TKA. Further study should be performed to confirm this conclusion.

Level of evidence

III.     

Percutaneous Sclerotherapy for Giant Symptomatic Liver Hemangiomas: A Pilot Study

This single-center prospective trial evaluated the safety and efficacy of percutaneous sclerotherapy for liver hemangiomas in 5 patients (1 man, 4 women; mean age 41.2 y) between 2016 and 2017. All patients were symptomatic (4 abdominal pain; 1 early satiety) and refused surgery. A single session of sclerotherapy with 20 cc mixture of 45 IU. Bleomycin in 10 cc distilled water and 10 cc Lipiodol (Ultra Fluide, Guerbet, France) was performed in all patients, achieving a 45.6%–71.1% lesion volume reduction and a 12.9%–41% reduction in the largest diameter of the lesion. Symptoms subsided in all patients during the 5-month follow-up period. Adverse events included a self-limited intraperitoneal hemorrhage in 1 patient.     

Kompensationsstrategien älterer Kraftfahrer

Background

The increasing proportion of elderly people in populations means that an increasing number of drivers with reduced executive functions due to age-related reasons have to be expected. Thus, an important question is how elderly drivers compensate for deficits in executive functioning and how these drivers can be identified.

Objective

This article is based on the hierarchical model of Michon and focuses on the analyses of characteristic behavior, attitudes and personality traits of elderly drivers who try to enhance their driving abilities based on individual compensation and coping strategies, compared to drivers who do not.

Material and methods

A sample of 42 drivers conducted driving exercises, as well as psychometric tests and a semi-structured interview, in order to obtain as broad a database as possible.

Results

The results of this study provide evidence that age per se is not a good predictor for fitness to drive.

Conclusion

The best predictor for the use of compensation strategies is the ability of elderly drivers to perceive and identify subjective mental stress and limitations of driving skills.

     

Laparoscopic Sleeve Gastrectomy: A Radiological Guide to Common Postsurgical Failure

Laparoscopic sleeve gastrectomy is one of the most common bariatric procedures worldwide. It has recently gained in popularity because of a low complication rate, satisfactory resolution of comorbidities, and excellent weight loss outcome. This article reviews the surgical technique, expected postsurgical imaging appearance, and imaging findings of common complications after laparoscopic sleeve gastrectomy. Understanding of the surgical technique of laparoscopic sleeve gastrectomy and of the normal postsurgical anatomy allows accurate interpretation of imaging findings in cases of insufficient weight loss, weight regain, and postsurgical complications.     

Treatment of astrocytoma grade III with Photofrin II as a radiosensitizer

Introduction

Astrocytomas are neoplasms that originate from glial cells. Anaplastic astrocytoma is classified as WHO III, with 27?% of the individuals with grade III astrocytoma living for at least 5 years even after treatment (radiation and chemotherapy). Photofrin II has been demonstrated to serve as a specific and selective radiosensitizing agent in both in vitro and in vivo tumor models.

Material and methods

This case report presents a woman suffering from an inoperable astrocytoma WHO III since 2004. The patient was treated with radiation therapy and Photofrin II as a radiosensitiser. The patient underwent irradiation with 40?+?20 Gy boost. The patient was given a single intravenous dose of 1 mg/kg Photofrin II 24 h prior to the initiation of radiation therapy.

Results

The patient is still alive without any significant side effect with a follow up of 106 months. MRI shows no evidence of disease.

Conclusion

The follow-up results are encouraging regarding the application of Photofrin II as an effective radiosensitizing agent in the treatment of inoperable WHO III astrocytoma.     

Mechanische Thrombektomie – Technik

Mechanical thrombectomy with stent retrievers in acute stroke has emerged as the technique with the highest recanalization rate of therapeutic procedures available so far. Recently it was demonstrated that compared to intravenous rTPA alone, mechanical thrombectomy improves outcomes of patients with acute occlusions of intracranial arteries of the anterior circulation in several randomized clinical trials. In this article we will give an overview of the steps required for the thrombectomy procedure.     

Intra-individual comparison of different contrast media concentrations (300 mg, 370 mg and 400 mg iodine) in MDCT

Objective  

To compare intra-individual contrast enhancement in multi-detector-row computed tomography (MDCT) using contrast media (CM) containing 300, 370 and 400 mg iodine per ml (mgI/ml).     

Comparison of 4 cm Z-axis and 16 cm Z-axis multidetector CT perfusion

Objective  

The aim of the study was to compare 4 cm with 16 cm Z-axis coverage in the assessment of brain CT perfusion (CTP) using. 320 slice multidetector CT     

DAXX Mutation Status of Embolization-Treated Neuroendocrine Tumors Predicts Shorter Time to Hepatic Progression

Purpose

To identify common gene mutations in patients with neuroendocrine liver metastases (NLM) undergoing transarterial embolization (TAE) and establish relationship between these mutations and response to TAE.

Potential Mechanisms of Vascular Thrombosis after Microwave Ablation in an in Vivo Liver

Purpose

To evaluate potential biologic and thermal mechanisms of the observed differences in thrombosis rates between hepatic vessels during microwave (MW) ablation procedures.