Radiology in forensic identification: the Mt Erebus disaster.

Although radiology has exceptional discriminatory power in the identification of individuals, it is not often used for this purpose. This under-utilization stems in part from insufficient appreciation of its potential, and in part from a lack of agreed operational protocols. Descriptions of criteria used for radiological identification are scattered in individual reports and have not been collated. The circumstances in which identification is required are various and pose different problems for which guidelines have not been established. The areas in which radiology has a high capacity for identification of age, sex or identity are reviewed and their strengths and limitations are discussed. A survey of the literature identified three different circumstances in which cadaver identification is needed, and a protocol is suggested to meet the differing requirements of these three situations. The use of these protocols and techniques in the identification of bodies recovered from the Mt Erebus disaster is described. Postmortem radiographs established the identity of 11 bodies not identified by other techniques. There is a need for greater awareness in police and forensic circles of the identifying power of radiology.

Complications of epilepsy and a ruptured pyonephrosis: radiology to the rescue in the Brooks murder case.

A woman and her lover were accused of murdering the woman's husband. Five weeks after fracture/dislocations of both shoulders and a central fracture/dislocation of the right hip were diagnosed the woman's husband died of septicaemia consequent on a ruptured infected hydronephrosis. The shoulder and hip injuries and the ruptured hydronephrosis were attributed to a beating with a blunt instrument. A review of the medical records of the deceased, particularly his radiological examinations, led the authors to conclude that his joint injuries and ruptured kidney were not due to the alleged assault. The joint injuries were the consequence of epileptic seizures and the ruptured kidney was also due to natural causes. These medical opinions provided evidence that led to acquittal of the accused.

High peripheral and axial bone densities in a postmenopausal woman with untreated hypoparathyroidism.

It has been reported that bone density is increased in patients with treated hypoparathyroidism, though it is unclear whether this increase is attributable to the condition itself or to its treatment. We have recently investigated a 70 year old woman with untreated hypoparathyroidism from the time of thyroid surgery at the age of 29 years. Bone mineral content of the non-dominant distal forearm was 3.7 standard deviations above the mean normal value found in 23 healthy volunteers of comparable menopausal age, and was also above the mean normal value found in premenopausal women. The vertebral mineral density of her lumbar spine (measured by quantitative computed tomography) was 3.0 standard deviations above the mean normal value. These findings suggest that high bone density is a feature of hypoparathyroidism per se and that postmenopausal bone loss may be significantly attenuated in this condition.

Efficacy and long term effects of antenatal prophylaxis with anti-D immunoglobulin.

OBJECTIVE: To measure the safety and efficacy of antenatal treatment with anti-D immunoglobulin. DESIGN: Open study with historical controls. SETTING: Multicentre study in 17 hospitals in West Yorkshire. PATIENTS: 1238 Rh negative women who delivered Rh positive infants after 34 weeks in their first pregnancy in 1980-1 (group 1) and 2000 similar primigravidas from 1978-9 (group 2). Obstetric data were collected for 616 women in group 1 who had a subsequent pregnancy, 536 similar women in group 2, and 410 Rh positive but otherwise similar primigravidas who delivered in the same hospitals in 1978-81 (group C). INTERVENTIONS: Anti-D immunoglobulin 100 micrograms intramuscularly was given at 28 and 34 weeks to the mothers in their first pregnancy who delivered in 1980-1. END POINTS: Detection of anti-D antibody in the first or any subsequent pregnancy in groups 1 and 2. For all three groups having subsequent pregnancies gestation at delivery, birth weight, fetal survival at one month, pre-eclampsia defined as blood pressure greater than 140/90 on two occasions more than 12 hours apart, and proteinuria greater than 0.25 milligram. MEASUREMENTS AND MAIN RESULTS: Antenatal immunisation to Rh(D) occurred in six mothers in group 1 and 32 group 2. Most immunisations occurred in the first or second pregnancy. The rates of abortion, gestation at delivery, birth weight, and fetal survival were not significantly different among the three groups. The incidence of pre-eclampsia was lower in mothers given antenatal anti-D immunoglobulin, but the difference was not significant. CONCLUSIONS: Antenatal prophylaxis with anti-D immunoglobulin is effective, and the effect of giving it in the first pregnancy persists into at least the second pregnancy. It seems to be safe for the fetus in the index and subsequent pregnancies.

False positive results of tests for syphilis and outcome of pregnancy: a retrospective case-control study.

In a retrospective case-control study 64 women yielding a false positive result to a test for syphilis in pregnancy were compared with 128 controls individually matched for age, parity, hospital of delivery, and year of delivery. There were significantly more unsuccessful pregnancies, mainly spontaneous abortions during the first and second trimesters, among women with persistent false positive results. There was no significant difference between groups in the mean birth weights of liveborn infants. The antibodies responsible for the false positive result may indicate the presence of an immunological disturbance. Women who give a false positive result should be carefully managed throughout their pregnancy.

The treatment of advanced recurrent carcinoma of the uterine cervix with platinum based cytotoxic chemotherapy.

Nineteen patients with advanced recurrent carcinoma of the uterine cervix received platinum based chemotherapy between February 1982 and April 1984. All patients had received prior pelvic irradiation. Eleven patients received combination chemotherapy with platinum, vinblastine and bleomycin (PVB), and 8 patients received a regimen of platinum and 5-fluorouracil (PF). Two patients achieved a complete response and 4 patients achieved a partial response, a total response rate of 33%. Five out of 6 responders received PVB. The median survival (MS) was 8 months (1-38) months from the first treatment with cytotoxic chemotherapy. In those patients achieving a response, MS was 13.5 months (6-38+ months) with 1 patient alive at 38 months, compared to an MS of 5 months (1-15 months) in those patients without response. Toxicity was significant with nausea and vomiting in the majority of patients. Two patients refused treatment after the first course because of toxicity. The morbidity of treatment was such that despite an encouraging response rate, particularly to PVB (45%), the routine use of such treatment must be questioned.

The silhouette sign and the inferior vena cava.

Pulmonary lesions causing obliteration of the normal inferior vena cava (IVC) shadow on the lateral radiograph are described. Retrocardiac mediastinal mass lesions and subpulmonic pleural effusions may also obliterate the IVC contour. Loss of the IVC shadow is an additional radiographic sign of right lower lobe collapse and frequently of disease involving the medial basal segment of the right lower lobe. This finding should be an indication that further investigation is needed to explain the loss of normal aeration.

Double contrast arthrography of the knee.

The author's experience with 280 double contrast knee arthrograms is presented. The accuracy of the procedure in 101 operated cases was 100 percent for normal menisci and 88 percent for abnormal. It is suggested that arthrography can be regarded as an integral part of the investigation of any knee in which a serious meniscal abnormality is suspected.

Posterior lymphadenopathy in sarcoidosis.

Chest radiographs were reviewed in 30 cases of biopsy proven sarcoidosis; posterior mediastinal or para-aortic lymph node enlargement was found in 6 patients (20%) who also had symmetrical hilar and/or paratracheal lymph node enlargement. The radiographic behavior of the hilar, mid- and posterior mediastinal lymph nodes was the same. Posterior mediastinal lymph node enlargement in otherwise typical sarcoidosis is not unusual.

Perinatal post-mortem radiography--experience with 2500 cases.

A review of 2500 routine post-mortem radiographic examinations of perinates is presented. It is concluded that the procedure is of value in the detection of abnormalities which may have contributed to the death of the perinate and which may have escaped detection at autopsy. The use of contrast agents may assist in the evaluation of congenital abnormalities, especially of the cardiovascular system. Post-mortem radiographic examination may be especially helpful in the evaluation of perinates for whom permission for autopsy is denied. Post-mortem radiography may assist in the gathering of statistical data and may provide useful material for teaching and research.