The impact of economic progress and modernization in medicine on the ossification of hand and wrist

One of the main criteria used for age estimations of young living subjects is the developmental status of the ossification of hand bones. The impact of economic progress and modernization in medicine on ossification rates in a given population still requires further clarification. We selected 36 samples from literature for which the ossification status had been determined with the Greulich–Pyle method and analyzed specific economic data (per capita income) and demographic data (life expectancy at birth) as parameters of modernization. To describe the influence of these parameters on the rate of ossification, we performed a regression analysis and found that a relatively high level of economic progress and modernization in medicine coincides with high ossification rates, while relatively low modernization seems to delay ossification. When performing age estimations, the expert opinion should therefore pay attention to the issue of different modernization levels.     

Bland-White-Garland-Syndrom

This is a report on the sudden death of a 4-week-old female infant without external signs of violence. At autopsy the anomalous origin of the left coronary artery from the pulmonary trunk (Bland-White-Garland syndrome) was identified as the possible cause of death. Immunohistochemical investigations revealed fresh cardiac necrosis indicating an acute fatal event. Toxicological analyses were negative.     

Effects of ethnicity on skeletal maturation: consequences for forensic age estimations

An X-ray of the hand is an important method in forensic science for estimation of the age of juvenile suspects with uncertain date of birth. Relevant X-ray standards for evaluation of skeletal maturity are available for white US Americans as well as for North and Central Europeans. The applicability of these standards to members of ethnic groups different from the reference population has been the subject of controversial discussion. More than 80 publications were analysed with the view to finding out whether skeletal maturation is affected by ethnic identity. It was concluded that skeletal maturation takes place in phases which are identically defined for all ethnic groups. Time-related differences in passing those stages of skeletal maturation within the relevant age group appear to be unaffected by ethnic identity. It is the socio-economic status of a given population which is of decisive importance to the rate of ossification. The application of X-ray standards to individuals of a socio-economic status lower than that of the reference population usually leads to underestimation of that person’s age. In terms of criminal responsibility, this is of no adverse effect on the person concerned. Received: 25 February 1999 / Received in revised form: 6 August 1999     

Comparison of imaging planes during CT-based evaluation of clavicular ossification: a multi-center study

Determining the ossification stage of the medial clavicular epiphysis by computed tomography represents the currently recommended methodology for the question of whether a living individual has completed the 18th or 21st year of life. In the present study, thin-slice CT scans of 1078 sternoclavicular joints were reconstructed in axial and coronal image series and evaluated according to the two classification systems established for age diagnostics using the clavicle. Both image series (axial and coronal) were analyzed separately. When comparing the results of axial and coronal view, a different ossification stage was found in 35.6% of the clavicles. The results suggest an influence of the imaging plane on the process of stage determination. In order to further approximate the three-dimensional and asymmetrical structure of the epiphyseal ossification center, the usage of at least two different reformation types may be recommended. In practice, only those reference studies should be applied which exactly employed the same number and orientations of the reformation types that are going to be used in the respective routine case.

     

The Risser sign for forensic age estimation in living individuals: a study of 643 pelvic radiographs

Due to increasing international migratory movements, forensic age estimations of living individuals in criminal proceedings are gaining increasing significance for forensic physicians and radiologists involved in delivering expert opinions. The present study examines the suitability of the radiologically well-known Risser sign grading as a possible new criterion in forensic age diagnostics. For this purpose, anteroposterior pelvic radiographs of 643 patients aged between 10 and 30 years were retrospectively evaluated by means of two different Risser sign grading systems (US and French), each with 5 stages. The left and right sides of the pelvis were assessed separately. The data was analyzed with separation of the sexes. Reliable Risser sign determination was possible in 566 cases. In both sexes, stage 4 of both the US and the French grading systems was predominantly first noted at age 14 years. In the US grading system, stage 5 was also first achieved at age 14 years in the majority of both sexes. In the French grading system, females manifested stage 5 at a minimum of 16 years, whereas in males it was first observed at 17 years. As to the nature of iliac crest maturation, interesting deviations were observed at stages 1 and 5, raising doubts about Risser’s ossification process. To conclude, both Risser sign grading systems are suitable for forensic age diagnostics, especially to determine whether the 14th year of life has been completed or not. The French Risser sign system additionally allows for statements as to the completion of the 16th year of age.     

Der Einfluss der Ethnie auf die bei strafrechtlichen Alterssch?tzungen untersuchten Merkmale

Die Frage nach dem Einfluss der Ethnie auf die bei strafrechtlichen Alterssch?tzungen bei Lebenden untersuchten Merkmale ist von gro?er praktischer Bedeutung. Beim Vorliegen gravierender interethnischer Differenzen würde die Anwendung der gebr?ulichen Referenzstudien auf andere ethnische Gruppen zu Fehlsch?tzungen führen. Es wurden mehr als 500 Publikationen zu Ossifikation, Dentition und sexueller Reifeentwicklung bei zahlreichen Populationen ausgewertet. Danach ergab sich, dass definierte Entwicklungsstadien von allen ethnischen Hauptgruppen in derselben Reihenfolge durchlaufen werden. W?hrend die Ossifikation und die Weisheitszahnmineralisation in der betreffenden Altersgruppe offenbar nicht relevant von der ethnischen Zugeh?rigkeit beeinflusst werden, besteht bezüglich einer m?glichen vergleichsweisen Akzeleration von Afrikanern bei der Weisheitszahneruption und der sexuellen Reifeentwicklung weiterer Forschungsbedarf.     

Tibial fracture during removal of a tibial intramedullary nail.

SUMMARY: As tibial intramedullary nailing becomes the preferred treatment for tibial shaft fracture, removal of tibial nails will become more common. Removal of tibial intramedullary nails is not without complications, but a review of the literature found only one recent report of a fracture of the tibia during removal. A case report of a tibial fracture during removal of an Alta tibial nail is presented.     

Reference data for the Thiemann–Nitz method of assessing skeletal age for the purpose of forensic age estimation

The aim of this study was to determine the statistical parameters of deviation in the Thiemann–Nitz method for use in forensic age diagnostics. To this effect, 402 hand radiograms, originally taken in two large German cities between 1983 and 2002 for the purpose of diagnosing trauma, were analyzed. At the time of examination, the patients were aged between 10 and 18 years. The study presents the mean, standard deviation, and median, with lower and upper quartiles, for the skeletal ages of 11.0 through 18.0 years. The simple standard deviations range between 0.2 and 1.2 years. To increase the accuracy of age estimates and improve the identification of age-relevant developmental disorders in forensic age estimation practice, the methods for determining skeletal age should always be combined with a physical and dental examination. In addition, the expert opinion should pay attention to the issue of different modernization levels in relevant populations.     

A murine model of deep vein thrombosis: characterization and validation in transgenic mice

Deep vein thrombosis (DVT) occurs with high prevalence in association with a number of risk factors, including major surgery, trauma, obesity, bed rest (> 5 days), cancer, a previous history of DVT, and several predisposing prothrombotic mutations. A novel murine model of DVT was developed for applications to preclinical studies of transgenically constructed prothrombotic lines and evaluation of new antithrombotic therapies.A transient direct-current electrical injury was induced in the common femoral vein of adult C57BI/6 mice. A non-occlusive thrombus grew, peaking in size at 30 min, and regressing by 60 min, as revealed by histomorphometric volume reconstruction of the clot. Pre-heparinization greatly reduced clot formation at 10, 30, and 60 min (p < 0.01 versus non-heparinized). Homozygous FactorV Leiden mice (analogous to the clinical FactorV Leiden prothrombotic mutation) on a C57Bl/6 background had clot volumes more than twice those of wild-types at 30 min (0.121 +/- 0.018 mm3 vs. 0.052 +/- 0.008 mm3, respectively; p < 0.01). Scanning electron microscopy revealed a clot surface dominated by fibrin strands, in contrast to arterial thrombi which showed a platelet-dominated structure. This new model of DVT presents a quantifiable approach for evaluating thrombosis-related murine transgenic lines and for comparatively evaluating new pharmacologic approaches for prevention of DVT.