Age estimation in adults by dental imaging assessment systematic review.

IMPORTANCE: The need to rely on proper, simple, and accurate methods for age estimation in adults is still a world-wide issue. It has been well documented that teeth are more resistant than bones to the taphonomic processes, and that the use of methods for age estimation based on dental imaging assessment are not only less invasive than those based on osseous analysis, but also have shown similar or superior accuracy in adults. OBJECTIVES: To summarise the results of some of the recently most recently cited methods for dental age estimation in adults, based on odontometric dental imaging analysis, to establish which is more accurate, accessible, and simple. EVIDENCE REVIEW: A literature search from several databases was conducted from January 1995 to July 2016 with previously defined inclusion criteria. CONCLUSION: Based on the findings of this review, it could be possible to suggest pulp/tooth area ratio calculation from first, upper canines and other single rooted teeth (lower premolars, upper central incisors), and a specific statistical analysis that considers the non-linear production of secondary dentine with age, as a reliable, easy, faster, and predictable method for dental age estimation in adults. The second recommended method is the pulp/tooth width-length ratio calculation. The use of specific population formulae is recommended, but to include data of individuals from different groups of population in the same analysis is not discouraged. A minimum sample size of at least 120 participants is recommended to obtain more reliable results. Methods based on volume calculation are time consuming and still need improvement.

Comparison of preoperative CT-based imaging parameters to predict postoperative pancreatic fistula.

AIM: To review all reported methods of preoperative computed tomography (CT) in one patient cohort and to identify which were the strongest to predict postoperative pancreatic fistula (POPF) after pancreatoduodenectomy. MATERIALS AND METHODS: Consecutive patients undergoing pancreatoduodenectomy were included if they had unenhanced CT images for review. Eighteen variables and two scores were tested. Receiver operator characteristics (ROC) were explored. RESULTS: POPF affected 26 of 107 patients (24.3%). Nine variables were significantly related to POPF with pancreatic duct width having the largest area under the ROC curve (AUROC; 0.808, p<0.001). An obese body habitus was associated with POPF with six of nine related variables using data from CT images associated with POPF; of these intra-abdominal wall thickness yielded the largest AUROC (0.713, p=0.001). This corresponded to the finding that body mass index (BMI) was related to POPF (AUROC 0.705, p=0.002). The largest AUROC of all was associated with one of the predictive scores (0.828, p<0.001). Substituting BMI for intra-abdominal wall thickness in this score yielded a non-significant increase to predict POPF (AUROC 0.840, p=0.676). None of the assessments of organ density (in Hounsfield Units) were associated with POPF. CONCLUSION: Data from preoperative CT imaging provides valuable information regarding a patient's risk of POPF. Obesity as assessed by CT images strongly relates to POPF, but the largest single risk factor for POPF is a narrow pancreatic duct.

Reliability and repeatability of pulp volume reconstruction through three different volume calculations.

OBJECTIVE: To test the variability of the volume measurements when different segmentation methods are applied in pulp volume reconstruction. MATERIALS AND METHODS: Osirix® and ITK-SNAP software were used. Different segmentation methods (Part A) and volume approaches (Part B) were tested in a sample of 21 dental CBCT's from upper canines. Different combinations of the data set were also tested on one lower molar and one upper canine (Part C) to determine the variability of the results when automatic segmentation is performed. RESULTS: Although the obtained results show correlation among them(r > 0.75), there is no evidence that these methods are sensitive enough to detect small volume changes in structures such as the dental pulp canal (Part A and Part B). Automatic segmentation is highly susceptible to be affected by small variations in the setting parameters (Part C). CONCLUSIONS: Although the volumetric reconstruction and pulp/tooth volume ratio has not shown better results than methods based on dental radiographs, it is worth to persevere with the research in this area with new development in imaging techniques.

Functional management of Achilles tendon rupture: A viable option for non-operative management.

BACKGROUND: Functional management of the ruptured Achilles tendon can be effective using orthoses like the removable walker boot (Foam Walker Boot, Air Cast UK Limited, Lincolnshire, United Kingdom). We conducted this study to look at the outcome of our protocol using this orthosis. MATERIALS AND METHODS: We retrospectively reviewed 107 non-operatively managed Achilles tendon ruptures over the last 5 years. Case notes were analyzed for demographics and immediate outcomes. Long term outcomes were assessed by a postal questionnaire using the Achilles Tendon Total Rupture Score (ATRS). RESULTS: Of the 107 tendons (male:female=71:36, mean age=50 years), 105 tendons (98%) healed with an average discharge time of 22 weeks. Six patients reported major complications and 6 reported minor complications. We received 56 questionnaires with a mean ATRS score of 21. Seventy-seven percent returned to pre-injury level of activity. CONCLUSION: Functional management of Achilles tendon rupture, under appropriate supervision, provides a viable option for non-operative management.

Macroscopic and microscopic changes in incinerated deciduous teeth.

Teeth are amongst the most resilient elements of the human skeleton and are thus often utilized in routine forensic investigation involving the identification of unknown remains. Teeth exposed to thermal stress have the potential to not only aid in identification, but also in understanding the circumstances surrounding the fire. Children are twice as likely to become victims of house fire because of an inability to safely evacuate from areas of danger. The literature demonstrates, however, that research on the effects of incineration on teeth is mostly restricted to the permanent dentition. The apparent lack of knowledge on the effects of incineration on deciduous teeth thus necessitates further research in this area. To this end, this study aimed to relate colour changes that occur post heating with fragility to aid in proper handling of samples in a forensic scenario and to determine the possibility of identifying incineration temperature based on tooth condition. Teeth are amongst the most resilient elements of the human skeleton and are thus often utilized in routine forensic investigation involving the identification of unknown remains. Teeth exposed to thermal stress have the potential to not only aid in identification, but also in understanding the circumstances surrounding the fire. Children are twice as likely to become victims of house fire because of an inability to safely evacuate from areas of danger. The literature demonstrates, however, that research on the effects of incineration on teeth is mostly restricted to the permanent dentition. The apparent lack of knowledge on the effects of incineration on deciduous teeth thus necessitates further research in this area. To this end, this study aimed to relate colour changes that occur post heating with fragility to aid in proper handling of samples in a forensic scenario and to determine the possibility of identifying incineration temperature based on tooth condition. A total of 90 deciduous teeth, extracted as a part of routine clinical treatment, were exposed to temperatures ranging from 100°C to 1100°C for 30 minutes using a laboratory Gallenkamp oven. Unheated deciduous teeth were used as controls for the project. Post-incineration the teeth were analyzed under a stereomicroscope and SEM to assess the morphological changes. A colorimetric assessment was also undertaken to evaluate colour changes due to thermal stress. It was possible to identify incineration temperature based on tooth condition when the colour changes, stereomicroscopic findings and SEM images were utilized collectively. It was concluded that thermally induced changes in primary teeth occur at lower temperatures in comparison to the permanent teeth. It was also established that post-incineration deciduous teeth are fragile and show a tendency to fragment after minimal exposure to thermal stress.

Quantitative light microscopic detection of Enterocytozoon bieneusi in stool specimens: a longitudinal study of human immunodeficiency virus-infected microsporidiosis patients.

The clinical course of microsporidiosis caused by Enterocytozoon bieneusi and the pattern of intestinal shedding of spores have not been correlated, at least in part because detection of E. bieneusi in stools is more difficult than detection of other protozoa because of its smaller size and less intense staining. We examined with a modified trichrome stain 124 stool specimens collected over a 2-year follow-up period from 23 human immunodeficiency virus-infected patients with electron microscopic-proven E. bieneusi infection and correlated the results with electron microscopic observations from duodenal biopsy specimens taken at the beginning of the study period. E. bieneusi was detected in the stool at least once in 74% (17 of 23) of all patients, in 100% (9 of 9) of patients in whose tissue moderate or abundant numbers of parasites were seen, and in 57% (8 of 14) of patients in whose tissue few parasites were seen. In two patients with abundant tissue parasites, many microsporidia were detected in every stool specimen (13 of 13) during the follow-up period, whereas among the patients with few tissue parasites, only 23% (15 of 64) of stool specimens were positive. Furthermore, if spore stages as well as plasmodial stages were detected in tissue, stool specimens were more likely to be positive. Although most of the heavily infected stools were from patients with chronic diarrhea, microsporidia were detected in 33, 28, and 42% of stool specimens from patients with nil, intermittent, and chronic diarrhea patterns, respectively. Although quantitation of E. bieneusi spores in stool specimens was closely correlated with quantitation in tissue, it was not correlated with reported patterns of diarrhea.

Postexposure rabies prophylaxis: when the guidelines are not respected.

Fifteen spontaneously reported cases of alleged lack of drug effect of postexposure antirabies prophylaxis using PCEC vaccine were analysed. The most striking finding was that in no case were the WHO guidelines for postexposure treatment of injuries caused by rabid animals respected. Therefore nothing points to insufficient vaccine efficacy. Better information for both the medical profession and the public about the treatment of exposed patients is needed.