Radiographic evaluation of Gustafson’s criteria for the purpose of forensic age diagnostics

The main criteria used in dental age estimation in living young individuals are mineralisation and eruption of the third molars. In order to further diversify the spectrum of characteristics after completion of third molar development, tests were undertaken to determine whether the characteristics studied by Gustafson can be ascertained with the required forensic certainty with the aid of the orthopantomogram and whether the evaluation of these could render forensic odontological age diagnoses possible beyond the 18th year of life. For this purpose, 1,299 conventionally produced orthopantomograms of 650 female and 649 male Germans aged from 15 to 40?years were studied. The characteristics of secondary dentin formation, cementum apposition, periodontal recession and attrition were evaluated in all the mandibular premolars. The correlation of the individual characteristics with chronological age was studied with the aid of a multiple regression analysis in which chronological age formed the dependent variable. Depending on the tooth studied, the R values amounted to 0.65 to 0.73; the standard error of estimate was 5.3 to 5.7?years. Basically, the regression equations calculated can be recommended for age estimation in living individuals, although it should be borne in mind that the applicability of the new method presented is limited by the quality of the X-ray images.     

Intraoperative Komplikationen beim VKB-Ersatz

Arthroscopic anterior cruciate ligament (ACL) reconstruction is a highly standardized procedure. To minimize the risk of technical failures and intraoperative complications, special instruments, such as dedicated drill guides, have been developed. However, each surgical step still implies specific complications. Thus, it is of great importance to know the technique used and its instruments as well as solution algorithms in detail. This article explains intraoperative complications in ACL reconstruction. Furthermore, specific techniques to solve, and particularly to prevent these complications are discussed.     

The current state of forensic age estimation of live subjects for the purpose of criminal prosecution

In recent years, many countries have experienced a sharp increase in the demand for forensic age estimates of live persons. From a legal perspective, such age estimates are carried out to determine whether a suspect without valid identity documents has reached the age of criminal responsibility and whether general criminal law in force for adults applies. In many countries, the age thresholds of relevance to criminal prosecution lie between 14 and 21 years. In line with recommendations issued by the Study Group on Forensic Age Diagnostics for determining the age of live subjects in criminal proceedings, a forensic age estimate should combine the results of a physical examination, an x-ray of the hand, and a dental examination that records dentition status and evaluates an orthopantomogram. In addition, a radiological or computed tomographic examination of the clavicles is recommended to establish whether a person has attained 21 years of age. This article addresses the influence of ethnicity on the examined developmental systems. In so doing, the authors conclude that forensic age estimates should pay due heed to the proband’s socioeconomic status and ethnic origin.     

Partial attenuation of hemodynamic responses to rapid sequence induction and intubation with labetalol

The effectiveness of labetalol (a combination nonselective beta and alpha-1-adrenergic receptor antagonist) in modifying hemodynamic responses associated with rapid sequence induction and tracheal intubation was evaluated. In a double-blind study, 24 ASA physical status I or II male patients scheduled for elective surgery were given either IV labetalol, 0.25 mg/kg (n = 8) or 0.75 mg/kg (n = 8), or a saline placebo (n = 8). Five minutes later, patients were given oxygen by mask and IV vecuronium, 0.01 mglkg. Ten minutes after giving labetalol or placebo, cricoid pressure was applied and anesthesia was induced with IV sodium thiopental (4 mg/kg) and succinylcholine (1.5 mg/kg) 1 minute prior to intubation. The mean duration of laryngoscopy was 17 ± 3 seconds. Prior to induction, the 0.25 mg/kg and 0.75 mg/kg) doses of labetalol significantly (p < 0.05) reduced mean arterial pressure by 4.4 ± 1.9 and by 8.6 ± 2.0 mmHg, respectively, but did not significantly alter heart rate or cardiac output. The 0.75 mg/kg) dose of labetalol also significantly (p < 0.05) decreased total peripheral resistance by 10.1 ± 3.0%. Within 30 seconds after intubation, patients in all three groups exhibited increases in heart rate, mean arterial pressure, total peripheral resistance, and rate pressure product and a decrease in stroke volume. However, patients in the 0.25 and 0.75 mg/kg) labetalol groups, compared to those in the placebo group, had significantly lower increases in peak heart rate (33 ± 2 and 27 ± 3 vs. 44 ± 7 beats/minute), peak mean arterial pressure (38 ± 6 and 38 ± 7 vs. 58 ± 7 mmHg), and peak rate pressure product (7,726 ± 260 and 7,215 ± 300 vs. 14,023 ± 250 units). The results show that these doses of labetalol significantly blunt, but do not completely block, autonomic responses to rapid sequence induction and intubation.     

Alterations of alpha 1 and alpha 2 adrenoceptor-mediated pressor responses by halothane and isoflurane anesthesia

The mechanism by which halothane and isoflurane interfere with catecholamine-mediated vasoconstriction was investigated, utilizing selective agonists of postjunctional alpha1 and alpha2 adrenoceptors in chronically instrumented dogs. After ganglionic, cholinergic, and beta adrenergic blockade, dose responses to phenylephrine (0.3-1.2 micrograms/kg, iv), a selective alpha1 adrenoceptor agonist, and azepexole [B-HT 933] (5-20 micrograms/kg, iv), a selective alpha2 adrenoceptor agonist, were obtained in conscious dogs. Each dog was subsequently anesthetized with either halothane (1.7%) or isoflurane (2%) in oxygen in equihypotensive concentrations. After a 1 h equilibration period, the dose response curves were repeated. Twenty experiments in ten chronically instrumented dogs were completed. Halothane and isoflurane produced significant (P less than 0.05) attenuation of both the increase in systolic and diastolic arterial pressure after bolus administration of all doses of phenylephrine and azepexole. No specific selectivity of either volatile anesthetic for alpha1 or alpha2 mediated pressor responses was found. Therefore, in chronically instrumented dogs, alpha1- and alpha2-mediated pressor responses were similarly influenced by halothane and isoflurane. The present results suggest that both halothane and isoflurane act as functional antagonists to alpha adrenergic mediated vasoconstriction.     

DNA single strand breakage, DNA adducts, and sister chromatid exchange in lymphocytes and phenanthrene and pyrene metabolites in urine of coke oven workers.

OBJECTIVES: To investigate the specificity of biological monitoring variables (excretion of phenanthrene and pyrene metabolites in urine) and the usefulness of some biomarkers of effect (alkaline filter elution, 32P postlabelling assay, measurement of sister chromatid exchange) in workers exposed to polycyclic aromatic hydrocarbons (PAHs). METHODS: 29 coke oven workers and a standardised control group were investigated for frequencies of DNA single strand breakage, DNA protein cross links (alkaline filter elution assay), sister chromatid exchange, and DNA adducts (32P postlabelling assay) in lymphocytes. Phenanthrene and pyrene metabolites were measured in 24 hour urine samples. 19 different PAHs (including benzo(a)pyrene, pyrene, and phenanthrene) were measured at the workplace by personal air monitoring. The GSTT1 activity in erythrocytes and lymphocyte subpopulations in blood was also measured. RESULTS: Concentrations of phenanthrene, pyrene, and benzo(a)pyrene in air correlated well with the concentration of total PAHs in air; they could be used for comparisons of different workplaces if the emission compositions were known. The measurement of phenanthrene metabolites in urine proved to be a better biological monitoring variable than the measurement of 1-hydroxypyrene. Significantly more DNA strand breaks in lymphocytes of coke oven workers were found (alkaline filter elution assay); the DNA adduct rate was not significantly increased in workers, but correlated with exposure to PAHs in a semiquantitative manner. The number of sister chromatid exchanges was lower in coke oven workers but this was not significant; thus counting sister chromatid exchanges was not a good variable for biomonitoring of coke oven workers. Also, indications for immunotoxic influences (changes in lymphocyte subpopulations) were found. CONCLUSIONS: The measurement of phenanthrene metabolites in urine seems to be a better biological monitoring variable for exposure to PAHs than measurement of hydroxypyrene. The alkaline filter elution assay proved to be the most sensitive biomarker for genotoxic damage, whereas the postlabelling assay was the only one with some specificity for DNA alterations caused by known compounds.     

Exertional intensities and energy requirements of technical mountaineering at moderate altitude

The purpose of this study was to determine the exertional energy requirements of technical mountaineering at moderate altitude. Six subjects completed maximum graded exercise tests (MGXT) prior to a 7-day ice climbing seminar conducted in the North Cascade Range of the United States. Mean weight, percent body fat, and maximum oxygen uptake (VO2max) were 71.3 (+/- 15.1) kg, 11.7 (+/- 4.2) %, and 53.7 (+/- 5.4) ml.kg-1.min-1 respectively. Heartrates (HR) were recorded and averaged over 5-second to 1-minute intervals during selected mountaineering activities of the ice climbing seminar. Average and peak estimated VO2 (EstVO2) and estimated energy expenditure (EstEE) were calculated from HR utilizing regression equations generated from the MGXT results. Trail hiking with loads averaging 45% of individual body weight required an average EstVO2 of 21.8 (+/- 3.0) ml.kg-1.min-1 and average EstEE of 7.5 (+/- 1.9) kcal.min-1 over a 2.2 hr period. Mean peak EstVO2 was 37.4 (+/- 3.4) ml.kg-1.min-1 and mean peak EstEE was 13.4 (+/- 3.0) kcal.min-1 during this period. Technical ice climbing involving movement up and down a 12 m vertical height for a mean time of 14.3 (+/- 2.6) min required an average EstVO2 and EstEE of 25.7 (+/- 7.6) ml.kg-1.min-1 and 9.5 (+/- 3.4) kcal.min-1 respectively. Peak EstVO2 and EstEE means were 38.4 (+/- 7.7) ml.kg-1.min-1 and 14.6 (+/- 3.5) kcal.min-1. Two subjects were monitored during a 6-hour summit ascent on snow and ice from 1636 m to 3266 m. Means for average EstVO2 and EstEE were 21.6 (+/- 3.3) ml.kg-1.min-1 and 7.2 (+/- 0.8) kcal.min-1 respectively while peak EstVO2 and EstEE means were 38.0 (+/- 6.1) ml.kg-1.min-1 and 13.3 (+/- 1.6) kcal.min-1. The total EstEE was 3096.8 and 2485.4 kcal for these two subjects over the 6-hour ascent. The most experienced climber averaged 0.078 kcal.kg-1.min-1 and the least experienced subject averaged 0.105 kcal.kg-1.min-1 while climbing at identical paces over the same terrain. This indicates a possible experience factor which may increase climbing efficiency.     

The hormonal and metabolic response to stress in the neonate

Conclusions It is apparent that adult patients demonstrate a catabolic response to the stresses induced by operative or accidental trauma. It seems that the degree of this catabolic response may be quantitatively related to the extent of the trauma or the magnitude of associated complications such as infection. The host response to infection, traumatic injury, or major operative stress is characterized by such events as fever, pituitary and stress hormone elaboration, mineral redistribution, and increased acute-phase protein synthesis [21].The beneficial effects of this stress response consist in providing alternate energy sources to meet metabolic demands and essential building blocks for synthetic activities occuring in the postoperative period. It has been suggested that the hyperglycemic response is essential for supplying the increased glucose requirements of injured tissue [81]. In addition, the proteolytic component of the stress response provides the necessary amino acid elements for reparative protein synthesis and production of acute-phase reactants by the liver. The changes in metabolic patterns induced by the stress response are satisfied in part by increased lipolysis and ketogenesis to provide an alternate source of metabolic fuel for tissues such as the brain and skeletal muscle. Additionally, the observed gluconeogenesis may aid in maintaining the glucose supply for vital organs principally dependent on glucose [52, 160].This metabolic response has also been shown to potentiate many adverse conditions in the postoperative period and to further exacerbate the stress response. Examples include a hypermetabolic state with attendant increased VO₂, increased energy requirements, increased temperature, elevated cardiac output, and altered or impaired inflammatory or immune-responsiveness. Numerous investigators have demonstrated that adult patients exposed to severe degrees of traumatic stress are subjected to greatly increased rates of complications such as cardiac or pulmonary insufficiency, myocardial infarction, impaired hepatic and/or renal function, gastric stress ulcers, and sepsis. Furthermore, evidence exists to suggest that this response may be life-threatening if the induced catabolic activity remains excessive or unchecked for a prolonged period. Moyer et al. were able to identify with a great degree of certainty the patients who were likely to die based on a single analysis of a variety of plasma-borne substrates obtained up to 9 days prior to death [103].It is apparent that modulating or blunting the catabolic response induced by the stress state may have beneficial effects. In studies of postoperative pain management, improved pain control resulted in reduction of postoperative nitrogen loss and shortened periods of convalescence following operation [28, 88].It is evident from this review that human newborns, even those born prematurely, are capable of mounting an endocrine and metabolic response to operative stress. Unfortunately, many of the areas for which a relatively well-characterized response exists in adults are poorly documented in neonates. As is the case in adults, the response seems to be primarily catabolic in nature because the combined hormonal changes include an increased release of catabolic hormones such as catecholamines, glucagon, and corticosteroids coupled with suppression of and peripheral resistance to the effects of the primary anabolic hormone, insulin.The catecholamines may be the agents of primary importance in this response, and thus may modulate the remaining components of the hormonal response to stress as well as the metabolic changes, including inhibition of insulin release, marked hyperglycemia, and breakdown of the neonate's stores of nutrients (carbohydrate, protein, and fat). These reactions ultimately result in the release of glucose, NEFA, ketone bodies, and amino acids. Although these metabolic by-products are necessary to meet the body's altered energy needs in a time of increased metabolic demands, it is not difficult to imagine that a severe or prolonged response would be very detrimental to a previously ill neonate with limited reserves of nutrients and already high metabolic demands imposed by rapid growth, organ maturation, and adaptation to the postnatal environment. Preliminary investigations by Anand et al. outlined in this review indicate that alterations in anesthetic technique with the addition of agents such as halothane and fentanyl may be able to significantly blunt this catabolic response. In addition, it appears that modulation of the immune response may also greatly affect the postoperative catabolic response. It is hopeful that future developments and the acquisition of more detailed knowledge o the response will allow us to modify the stress response in neonates in order to further decrease their mortality and morbidity.From the Section of Pediatric Surgery, C. S. Mott Children's Hospital and University of Michigan Medical School Offprint requests to: A. G. Coran