Kidney Cadmium Concentrations in an Urban Sri Lankan Population: an Autopsy Study.

Contamination and bioaccumulation of toxic heavy metals in our geo-environment is a growing public health concern. Human biomonitoring is an essential step in assessing the population risk of chronic exposure to environmental contaminants. Whole kidneys collected from a cohort of 92 deceased individuals undergoing forensic autopsies in Colombo, Sri Lanka, were analysed for cadmium (Cd) bioaccumulation using ICP-MS. Mean age of the population was 55.4 ± 15.4 years. Mean and median renal Cd concentrations of the total population were 4.38 and 2.60 µg g-1 w/w, respectively, which were below estimated toxic ranges. Males accumulated higher levels of Cd than females (p = 0.377). Cd concentrations were higher in the < 60 age group than the > 60 age group (p = 0.92), while the highest levels were reported in 51-60 age group. However, no significant correlation was found between renal Cd concentration and age (Æ®b = - 0.005, p = 0.94). Individuals who smoked, chewed betel or consumed alcohol were found to have elevated renal Cd concentrations in comparison to those who did not use these substances. This is the largest autopsy study on renal Cd bioaccumulation in Sri Lanka, and the findings do not indicate a high exposure risk to environmental Cd contamination at present.

Forensic age estimation in anti-piracy trials in Seychelles: Experiences and challenges faced.

Forensic age estimation (FAE) was conducted using a multifactorial method on thirteen Somali detainees claiming juvenile status during the anti-piracy trials of the Seychelles Supreme Court in 2014/2015. A multidisciplinary team, comprising of four of the authors covering specialties in forensic medicine, forensic odontology and radiology, conducted the FAE using a five-stage protocol. Each detainee was interviewed with an interpreter and examined for disorders affecting dental/skeletal development and for assessment of genital development through Tanner staging. Dental maturity was assessed clinically and radiologically. Eruption stage was assessed using Olze et al. and mandibular third-molar maturity was assessed using Demirjian's classification. Skeletal maturity was assessed from hand-wrist X-rays according to Greulich & Pyle and from CT-clavicle according to Kellinghaus et al. and Schultz et al. Interpretation of findings was done using reference population data from similar ethnic and social backgrounds wherever possible. Final age-ranges were calculated by combining dental and clavicle maturity stages using the regression formula developed by Bassed et al. followed by a 10% correction factor. The team later testified on their findings under cross-examination. The protocol adopted by the authors increased the scientific validity of the findings and was useful in addressing cross-examination queries on exclusion of developmental disorders, ethnic/socioeconomic variability and maintaining chain of custody. Unforeseen jurisdictional and practical limitations were experienced but did not affect the outcome. Combining dental and clavicle developmental data provided the court with a much clearer picture on the likelihood of the detainees' juvenile status which emphasizes the importance of conducting more population studies using combinations of different developmental sites. The authors note that available reference data is mostly from affluent populations whereas FAE is mostly required in individuals from less-developed regions. Regional networks that collate and share population-specific data need to be established to overcome these limitations.

Large-cell calcifying sertoli cell tumour of the testis detected at screening of a family with Carney syndrome.

We report the detection of a large-cell calcifying Sertoli cell tumour (LCCSCT) in a 34-year-old male during screening of a family with Carney syndrome. The patient had ignored the testicular swelling for 7 years. He also had a cardiac myxoma. The LCCSCT in this patient had prognostically unfavourable features such as large size (>6 cm) and a high mitotic rate. There is only one previous report of a malignant LCCSCT in a patient with Carney syndrome.

Primary endodermal sinus (yolk sac) tumour of the liver.

Primary endodermal sinus tumour of the liver is an extremely rare neoplasm. A 37-year-old man presented with a mass in the left lobe of the liver and a raised serum alpha-fetoprotein concentration. A left hepatic lobectomy was performed. Histological examination revealed an endodermal sinus tumour of the liver. There was no evidence of an extrahepatic primary source.