Added value of postmortem mri in sudden unexpected infant death cases.

We aimed to investigate the potential added value of postmortem MRI (PMMRI) in sudden unexpected infant death (SUID) cases referred to our center between September 2020 and June 2023. Ultimately, 19 SUID cases underwent PMMRI alongside standard autopsy procedures, which included technical examinations such as postmortem CT (PMCT). Four radiologists, two with prior PMMRI experience, provided structured reports following consensus. For each case, the responsible forensic medicine specialist documented the cause of death before and after reviewing the PMMRI report. Additionally, they assessed the overall impact of the PMMRI report and had the opportunity to provide written comments. The results of our study indicate that none of the PMMRI reports altered the prior determined cause of death, which included cases of infection, asphyxia, and sudden infant death syndrome (SIDS). However, we observed a moderate impact in one case and a low impact in 10 cases. The moderate impact arose from the PMMRI report identifying hypoxic-ischemic changes, where histologic examination of the brain was perceived as normal. Conversely, in the 10 cases with a low impact, the PMMRI reports supported the autopsy findings, specifically indicating brain injury and intra-alveolar cellular infiltrates. In conclusion, our study suggests that while PMMRI may not be pivotal in determining the cause of death in SUID cases, it could aid in detecting hypoxic-ischemic changes and reinforcing brain and lung observations. However, distinguishing genuine lung pathology from postmortem changes using PMMRI remains challenging. Further research is warranted to clarify the role of PMMRI in forensic SUID investigations.

Air bubble artifact: why postmortem brain MRI should always be combined with postmortem CT.

Forensic pathology increasingly uses postmortem magnetic resonance imaging (PMMRI), particularly in pediatric cases. It should be noted that each (sudden and unexpected) death of an infant or child should have a forensic approach as well. Current postmortem imaging protocols do not focus adequately on forensic queries. First, it is important to demonstrate or rule out bleeding, especially in the brain. Thus, when incorporating PMMRI, a blood sensitive sequence (T2* and/or susceptibility weighted imaging (SWI)) should always be included. Secondly, as intracranial air might mimic small focal intracerebral hemorrhages, PMMRI should be preceded by postmortem CT (PMCT) since air is easily recognizable on CT. This will be illustrated by a case of a deceased 3-week-old baby. Finally, note that postmortem scans will often be interpreted by clinical radiologists, sometimes with no specific training, which makes this case report relevant for a broader audience.

Deep posterior gluteal compartment block for regional anaesthesia of the posterior hip: a proof-of-concept pilot study.

Background: Various regional anaesthesia approaches to branches of the anterior lumbar plexus have been proved effective in providing analgesia in hip surgery. However, some patients still experience significant residual posterior hip pain attributed to the posterior nerve supply of the hip. This not only suggests that anterior approaches may not always provide sufficient pain relief, but also that the blocking of major nerves supplying the posterior pericapsular region is needed. Methods: We present an ultrasound-guided technique to block all major nerves supplying the posterior capsule of the hip joint. The optimal target area was determined by ultrasound imaging, cross-sectional digitised anatomy, and cadaver research, and was found in the deep gluteal compartment. Furthermore, this posterior pericapsular deep-gluteal block was evaluated in two patients. Results: The spread of dye in the cadaver was observed deep to the gluteus maximus and in between the quadratus femoris and piriformis muscles, and conformed to the presumed location during the ultrasound procedure. It included all major supplying nerves to the posterior hip capsule, that is the superior gluteal nerve, nerve to quadratus femoris and sciatic nerve. In both patients where this posterior pericapsular deep-gluteal block was applied the pain was substantially reduced (numeric rating scale: 4 to 1 and 7 to 1). Conclusion: We present a successful ultrasound-guided technique targeting the deep gluteal compartment to block all major nerves supplying the hip joint's posterior capsule. This posterior pericapsular deep-gluteal block can be applied as an additional block in hip surgery, with also a possible role in chronic hip pathology.

The influence of integrative lighting on sleep and cognitive functioning of shift workers during the morning shift in an assembly plant.

It is well known that exposure to light at the right time of the day is important to synchronise our circadian rhythm and enhance cognitive functioning. There is, however, a lack of field studies investigating which lighting characteristics are necessary to improve sleep and cognitive functioning. A controlled field study with 80 shift workers was set up, in which the impact of an integrative lighting (IL) scenario was investigated during the morning shift. Two groups were compared: a control group (no change in lighting settings) and a IL-group (exposed to a melanopic Equivalent Daylight Illuminance of 192 lux, i.e., bright light with a high fraction of short-wavelengths). Pre-post measurement of visual comfort, cognitive functioning (D2 task, go-nogo reaction time task) and sleep (MotionWatch8) were performed. The IL-settings ameliorated sleep efficiency and sleep latency during morning shift and enhanced alertness (not inhibition) compared to standard lighting conditions. Changing lighting settings in an industrial setting should be considered as it seems worthwhile for employees' sleep and cognitive performance.

Comment Concerning the Effects of Light Intensity on Melatonin Suppression in the Review "Light Modulation of Human Clocks, Wake, and Sleep" by A. Prayag et al.

Dose-response curves for circadian phase shift and melatonin suppression in relation to white or monochromatic nighttime illumination can be scaled to melanopic weighed illumination for normally constricted pupils, which makes them easier to interpret and compare. This is helpful for a practical applications.

Acute Cytomegalovirus Infection as a Rare Cause of Portal Vein Thrombosis with Small Bowel Infarction in an Immunocompetent Patient.

Portal vein thrombosis (PVT) refers to thrombosis that develops in the trunk of the portal vein including its right and left intrahepatic branches and may even extend to the splenic or superior mesenteric veins. PVT due to Cytomegalovirus (CMV) infection is a rare complication, scarcely described in English literature. We present a case of a 58-year-old immunocompetent patient with PVT and small bowel ischemia.