Some medicolegally important aspects of symphyseal injuries due to trauma.

A total of 58 cases of fatal trauma (forensic autopsies) were investigated for lesions of the pelvic girdle, the pubic symphysis, and for injuries distant from the pelvis. Traumata of the pubic symphysis were present in 30% (n = 17) of the cases. The symphyses were examined by x-ray and macroscopically related to the main violence (Abbreviated Injury Scale [AIS]). A correlation between the latter and the severity of the resulting injuries could be deducted. Characteristic patterns of symphyseal injuries included small hemorrhages, partial and complete ruptures, and also ruptures of the ligamentary insertions, which have not yet been described. The kind and severity of these lesions related to the intensity/direction of the violence are demonstrated and discussed.

Preoperative local MRI-staging of patients with a suspected pancreatic mass.

The aim of this study was to define the value of MRI of the pancreas for preoperative local staging of patients with a suspected pancreatic mass. Ninety-four patients (41 women, 53 men; age range 32-87 years) with a suspected pancreatic tumor underwent preoperative staging with MRI on a 1.5-T system. The MRI protocol included breath-hold MR cholangiopancreatography in turbo spin-echo technique, biphasic contrast-enhanced 3D MR angiography, and MRI of the upper abdomen with breath-hold T2-weighted half-Fourier acquired single-shot turbo spin-echo and T1-weighted fast-low-angle-shot (pre- and postcontrast) sequences. Data were collected prospectively and analyzed by two radiologists in agreement modality. Evaluation criteria were vascular involvement, resectability, and a characterization benign vs malignant. Results were compared to histopathology in 78 patients. Sixteen patients were followed-up. In 74 of 94 patients a solid tumor or an inflammation of the pancreas ( n=62) or the papilla ( n=12) was detected. In this group, MRI had a sensitivity of 98%, a specificity of 92%, and an accuracy of 96% in the characterization of malignant tumors. Regarding only the solid tumors, the positive predictive value of MRI was 87% with respect to resectability. Other pathologic findings included adenoma or inflammation of the duodenum ( n=5), carcinoma or benign stenosis of the choledochus duct ( n=7) and carcinoma of the gall bladder ( n=2). In 6 patients MRI did not depict any pathologic findings, and follow-up confirmed this interpretation. Magnetic resonance imaging allows a local preoperative staging in patients with suspected pancreatic tumor. Limitations, however, concern to the diagnostics of peritoneal and/or liver metastases.