Forensic age estimation of the knee by post-mortem DR, CT, and MR imaging: a comparative study.

It is believed by many that reference data for age estimation purposes must be imaging-modality specific. A study from our department has however proven otherwise. We therefore found it interesting to investigate this further by looking at the level of agreement between different imaging modalities. The aim of this study was to investigate the level of agreement between the three radiological modalities, computed tomography (CT), magnetic resonance imaging (MRI), and digital radiography (DR), in assessing the ossification of the epiphyses of the knee. A total of 34 deceased individuals of 10-25 years of age, brought in for a medicolegal autopsy at our department, were scanned by CT, MRI, and DR. The ossification stages of the three bones of the right knee, distal femoral, proximal tibial, and proximal fibular epiphysis were assessed using the established combined staging method by Schmeling et al. and Kellinghaus et al. Analysis of the results by Cohen's weighted kappa showed a good agreement between CT and DR (K = 0.61-0.70), and MRI and DR (K = 0.68-0.79) but only moderate agreement between CT and MRI (K = 0.55-0.57). This leads us to conclude that different radiological images cannot be used interchangeably for age estimation purposes, so reference material needs to be imaging-modality specific. However, to make a more general conclusion research on a larger population is needed.

Fractures of the neuro-cranium: sensitivity and specificity of post-mortem computed tomography compared with autopsy.

Post-mortem computed tomography (PMCT) is a routine tool in many forensic pathology departments as it is fast and non-destructive and allows less gruesome visualization than photographs, and the images are indefinitely storable. Several studies investigated congruence between PMCT and autopsy for skull fracture but registered only the presence or absence of fracture systems. The objective of this study was to determine location-specific sensitivity and specificity of PMCT for individual fracture lines in blunt force head trauma. Accurate 3D models based on PMCT data with all fracture lines visible are important for future studies on fractures, applying finite element analysis (FEA). We retrospectively sampled adult cases from 2013 to 2019 with skull fracture mentioned in the autopsy report. PMCT was on a Siemens 64-slice scanner and autopsy according to international guidelines. The location and direction of all fracture lines at autopsy and at de novo interpretation of scans were registered and compared. Ninety-nine cases with 4809 individual findings were included. Age ranged from 18 to 100 years. The overall sensitivity was 0.58, and specificity was 0.91. For individual locations, sensitivity ranged from 0.24 to 0.85, and specificity ranged from 0.73 to 1.00. Intra-observer agreement was 0.74, and inter-observer agreement ranged from 0.43 to 0.58. In conclusion, PMCT is suited for detection of fracture systems, but not for detection of all individual fracture lines. Our results differed from the existing literature due to the methodological choices of registering individual fracture lines. Future studies utilising FEA must supplement PMCT with autopsy data.

[Iatrogenic venous air embolism after unintentional injection of atmospheric air during computed tomography].

Venous air embolism (VAE) is a well-known complication to trauma and various surgical, diagnostic and therapeutically procedures. Small iatrogenic VAE during contrast-enhanced computed tomography (CeCT) are frequent and often asymptomatic. We present a case of iatrogenic VAE during CeCT, where the patient instead of contrast had 100 ml of atmospheric air injected intravenously. The patient developed symptoms of VAE with clinical cardiac arrest, but survived and was discharged without any clinical evidence of embolic sequelae five days after the tomography.

[Iatrogenic gas embolism]. / Iatrogen gasemboli

Gas embolism is the entry of air or medical gases into the blood circulation following invasive procedures, surgery, trauma or diving. The mortality of symptomatic gas embolism is high. Time is of the essence when initiating treatment, and gas embolism is often easily prevented. In this article, aetiology, frequency, pathophysiology, symptoms, diagnosis, treatment, outcome and prevention of both venous and arterial iatrogenic gas embolism are reviewed.

The economic impact of dengue hemorrhagic fever on family level in Southern Vietnam.

Dengue fever is a viral infection transmitted by mosquitoes (Aedes Aegypti). WHO estimates that 40% of the world's population live in areas endemic for dengue fever, and that there are approximately 50 million cases of dengue infection worldwide every year. This study aims to measure the economic consequences of dengue hemorrhagic fever in Southern Vietnam on family level. Estimating the economic impact of dengue fever/dengue hemorrhagic fever is important in order to prioritize resources for research, prevention, and control. So far no studies from Vietnam concerning this subject have been published. The study is based on standardized interviews. The study includes 175 children at the age 0-15 years, hospitalized in Children's Hospital No 1 in Ho Chi Minh City during a 10-week period in the fall of 2005. The children's parents/caretakers were interviewed on expenses related to the child's disease. The study shows that the average family cost of treating one child is approximately 61 USD including direct and indirect costs. On average, the largest expenses were those related to the initial visit at a local general practitioner, the hospital bill from Children's Hospital No1 and lost income for the parents. Dengue hemorrhagic fever is a large expense for a family and can rightly be considered as a substantial socio-economic burden in Southern Vietnam. Larger studies are needed for a more accurate estimate of the extent of the expenses related to both dengue fever and dengue hemorrhagic fever.