Gas at postmortem computed tomography--an evaluation of 73 non-putrefied trauma and non-trauma cases.

Postmortem computed tomography (PMCT) has become an important complement in investigating forensic cases allowing an accurate detection of gas accumulations. The present study investigated the presence and distribution of gas in a large number of non-putrefied cases of traumatic and non-traumatic deaths. Furthermore the possibility of pneumobilia secondary to blunt abdominal trauma was studied. Retrospectively, 73 cases, underwent a whole-body PMCT prior to autopsy. These were divided into four groups: penetrating trauma (20 gunshot cases, 13 stabbing cases), blunt abdominal trauma (20 cases) and a control group of 20 non-trauma cases. Exclusion criteria were visible signs of decomposition. Each group was screened for gas accumulations in the vascular system, internal organs, soft tissues and body cavities. Gas accumulations were present in 98% of the trauma cases, compared to 80% of the control group. The most affected structures and/or organs in the trauma group were soft tissues, vessels and the liver. In most cases of the trauma group gas was associated with open injuries and lacerations of vessels. Furthermore, in the gunshot group gas was frequently seen in the intracranial cavity. Pneumobilia occurred in one case of the blunt trauma group; in that control group gas was also seen, but less frequently. Gas accumulation showed a strong association with traumatic events, but even the majority of non-trauma cases showed gas accumulations. Despite the exclusion of cases with visible decomposition signs, a putrefactive origin of gas was assumed in some cases. Gas accumulations are a frequent finding in PMCT with a higher incidence in (open) trauma cases. Even though a differentiation between putrefactive and traumatic gas accumulations is still difficult, knowledge of the circumstance surrounding the case may help identify the origin of gas.

Fingering a murderer: a successful anthropological and radiological collaboration.

We illustrate an interdisciplinary approach to identify a victim in a case with complex taphonomic and procedural issues. Burning, fragmentation, species commingling, and examination by multiple experts required anthropological preparation and analysis combined with radiographic adaptations to image and match trabecular patterns in unusually small, burned specimens. A missing person was last seen in the company of a reclusive female on a remote rural property. A warranted search found several burn sites containing human and animal bones. Fragment preparation, analysis, and development of a biological profile by anthropologists enabled examination by the odontologist, molecular biologist, and radiologist, and justified use of antemortem radiographs from one potential victim. Visual and radiological comparison resulted in a positive (later confirmed) identification of the victim by radiological matches of three carpal phalanges. Although some dimensional changes are expected with burning, morphological details were preserved, aided by selection of relatively intact, small bones for comparison.

Interaction between academic radiology and the news media: a potentially powerful and unpredictable process--five stories.

OBJECTIVE: Although articles have been published describing the relationship between news reports and the general medical literature, to our knowledge little has been published describing the relationship between radiology publications and news coverage. We present five instances of news stories centered on radiology publications or abstracts of presentations at national meetings and the effect of the media coverage within the medical community. CONCLUSION: The five examples show that news coverage can have a dramatic effect on advancing research findings and public health information published in radiology journals. Even when news coverage is inaccurate or sensationalized, the attention of the general public can drive change not only generally in medicine but also specifically in radiology.

Multifocal variant of heterotopic ossification.

In this case report, we present a 25 year follow-up of a single patient with a previously undescribed multifocal variant of heterotopic ossification. The patient presented with multiple occurrences of lesions similar to myositis ossificans atraumatica as well as some lesions resembling exostoses/osteochondromas. Several images and histological sections show the range of appearances and locations of her somewhat disparate lesions, including an exostosis with intraspinal extension. Until additional similar cases are brought forward, we consider this a unique variant of heterotopic ossification. The precise aetiology of this patient's condition is unknown.

Infant death due to air embolism from peripheral venous infusion.

An otherwise healthy male infant was brought to the hospital because the mother suspected superficial infection at the operative site 5 days after an inguinal hernia repair. He was admitted to the pediatric unit overnight to be evaluated by his surgeon the next morning. When a venous infusion of maintenance fluids was started, the patient immediately went into cardio-respiratory arrest and was pronounced dead after resuscitation efforts failed. Subsequently, air collections were found in both venous and arterial circulations, including the splenoportal system. Detailed review of the clinical presentation and course, laboratory results, radiological, and pathological findings, along with a review of pertinent literature provides an explanation for the death by air embolism. Apparent inconsistent findings both radiographically and at autopsy are resolved. The mechanism of distribution of air to both systemic and splenoportal circulation is discussed. We believe this to be only the eighth case reported in English-language literature of infantile death from peripheral venous infusion. In all age groups, we find only six other cases in the English-language literature of gas found concomitantly in both the systemic and portal venous systems.

A bullet-sired bone cyst.

Random gunfire deposited a bullet in the proximal tibial metaphysis of a 9-year-old girl. The wound was not incapacitating and was treated conservatively. Within 17 months, soreness developed in the proximal leg, and radiography revealed a large unicameral cyst within which the bullet freely tumbled. Eventually, fear of impending fracture prompted further radiography, computed tomography, surgical intervention and pathological examination of the cyst wall. We believe this is only the second description in the English-language literature of this rare sequence of events.

Survey of physician members of the American Academy of Forensic Sciences.

There are approximately 1000 physician members of the American Academy of Forensic Sciences (AAFS) dispersed into all but one of the ten AAFS Sections. Section membership does not necessarily define their disciplines, specialties, interests or activities. A survey was performed to explore the demographics of the physician members and their views on their Sections and the Academy as a whole. The responses were predominantly favorable but some areas of improvement were suggested. The detailed results also indicate the increasing globalization of the physician membership and the catholicity of medicolegal interests.

Human identification from the ankle with pre- and postsurgical radiographs.

Fifty-four sets of presurgical ("premortem") and postsurgical ("postmortem") foot and ankle radiographs were retrospectively evaluated to simulate a postmortem identification. The entire foot and ankle was examined in a previous study. The present study evaluates only the ankle for positive identification. Results are consistent with our earlier investigation of pre- and postsurgical foot and ankle radiographic comparisons and indicate that surgical intervention with subsequent healing does not preclude positive identification. However, the ankle contains fewer skeletal features unique to an individual than does the entire foot. Hence, the ankle may be less useful than the foot for establishing positive identification from radiographic comparisons.

Using pre- and post-surgical foot and ankle radiographs for identification.

An evaluation of the effect of surgical intervention on foot and ankle radiographic comparisons was performed. In this study, 34 sets of pre-surgical ("premortem") and post-surgical ("postmortem") foot and ankle radiographs were retrospectively evaluated simulating a postmortem identification. In each radiographic set, the films were separated by a surgical event to reproduce the effects of an alteration in the anatomy. The radiographs included both matches and mismatches. This study also presents a numerical representation of the reliability of a radiographic match following a surgical procedure. Results indicate that surgical intervention with subsequent healing does not preclude positive identification in foot and ankle radiographic comparisons.

Use of CT scan in the diagnosis of pediatric acute appendicitis.

BACKGROUND: The efficacy of CT scan in the diagnosis of pediatric appendicitis has hot been established. METHODS: Every patient under the age of 18 who was diagnosed and treated for acute appendicitis in the 1 year period from March 1998-March 1999 at Lakeland Regional Medical Center were included. The presentation, laboratory evaluation, imaging evaluation, hospital course, and pathologic evaluation were reviewed. Selected imaging studies were reviewed by an independent radiologist. RESULTS: Forty-six patients were treated for appendicitis; 17 of them received CT scans (37%). The CT scans predicted appendicitis in 9 of 17 cases (sensitivity = 53%). False-negative studies resulted in some morbidity but no mortality. The radiology review indicated that three cases clearly did not demonstrate appendicitis. The other false-negative studies were secondary to either technical or professional factors. CONCLUSION: The efficacy of CT imaging in the diagnosis of acute appendicitis in children has still not been demonstrated. This limited series indicates that if CT scanning is to be used in pediatric patients, more attention to technical and professional factors may be required. Some of these factors, particularly the ingestion of oral contrast, are particularly problematic in small children and may limit the effectiveness of this modality.

Direct plasma sample injection in multiple-component LC-MS-MS assays for high-throughput pharmacokinetic screening.

The simultaneous dosing of numerous compounds followed by multiple-component analysis using LC-MS-MS (the N-in-1 approach) has significantly improved the throughput of the drug-screening process. However, plasma samples still need to be extracted before LC-MS-MS analysis, which frequently limits the throughput of the assay. In this work, a high-throughput on-line extraction technique has been developed for multiple-component LC-MS-MS assays using a high-flow column-switching technique. In N-in-1 LC-MS-MS assays, high sensitivity is required since the dose level is generally reduced to minimize drug-drug interactions. In addition, good chromatographic separation is essential to minimize interference and suppression effects. The direct plasma sample injection method developed in this work has successfully met the two requirements for multiple-component LC-MS-MS assays in high-throughput pharmacokinetic screening. Plasma samples containing a large number of potential drug candidates were directly injected onto an extraction column operated under a flow rate sufficiently high to exhibit a turbulent-flow profile. The extracted analytes were then eluted onto an analytical column via column switching for LC-MS-MS analysis. The use of turbulent flow resulted in a faster and more rugged extraction with reduced carryover compared with results obtained under laminar-flow conditions. Meanwhile, the use of a column-switching method maintained the chromatographic resolving power and high sensitivity of the LC-MS-MS assay. Separation efficiency, dynamic range, accuracy, and precision comparable with those of solid-phase extraction have been achieved with the turbulent-flow column-switching technique. As a result, this technique has been successfully and routinely used for high-throughput pharmacokinetic screening.