A probability model for assessing age relative to the 18-year old threshold based on magnetic resonance imaging of the knee combined with radiography of third molars in the lower jaw.

OBJECTIVE: This study aims to generate a statistical model based on magnetic resonance imaging of the knee and radiography of third molars in the lower jaw, for assessing age relative to the 18-year old threshold. METHODS: In total, 58 studies correlating knee or tooth development to age were assessed, 5 studies for knee and 7 studies for tooth were included in the statistical model. The relation between the development of the anatomical site, based on a binary system, and age were estimated using logistic regression. Separate meta-populations for knee and tooth were generated from the individual based data for men and women. A weighted estimate of probabilities was made by combining the probability densities for knee and tooth. Margin of errors for males and females in different age groups and knee and tooth maturity were calculated within the larger framework of transition analysis using a logit model as a base. Evidentiary values for combinations of knee and tooth maturity were evaluated with likelihood ratios. RESULTS: For males, the sensitivity for the method was calculated to 0.78 (probability of correctly classifying adults), the specificity 0.90 (probability of correctly classifying minors), the negative predictive value 0.80 (proportion identified minors are minors) and the positive predictive value 0.89 (proportion identified adults are adults) indicating a model better at identifying minors than adults. The point at which half the female population has reached closed knee lies before the 18-year threshold, adding the knee as an indicator lowers specificity and increases sensitivity. The sensitivity when using tooth as an indicator for females is 0.24 and specificity 0.97, signifying few minors misclassified as adults but also a low probability of identifying adults. The negative predictive value for women when using tooth as the sole indicator is 0.56 and positive predictive value 0.88. Probabilities were calculated for males and females assuming a uniform age distribution between 15 and 21years. The calculated margin of error of minors classified as adults in a population between 15 and 21 years with the model was 11% for males and 12% for females. Further, the evidentiary value as well as margin of error vary for different combinations of knee and tooth maturity. CONCLUSION: The statistical model based on the combination of MRI knee and radiography of mandibular third molars is a valid method to assess age relative to the 18-year old threshold when applied on males and of limited value in females.

Sudden infant death syndrome (SIDS)--standardised investigations and classification: recommendations.

Sudden infant death syndrome (SIDS) still accounts for considerable numbers of unexpected infant deaths in many countries. While numerous theories have been advanced to explain these events, it is increasingly clear that this group of infant deaths results from the complex interaction of a variety of heritable and idiosyncratic endogenous factors interacting with exogenous factors. This has been elegantly summarised in the "three hit" or "triple risk" model. Contradictions and lack of consistencies in the literature have arisen from diverse autopsy approaches, variable applications of diagnostic criteria and inconsistent use of definitions. An approach to sudden infant death is outlined with discussion of appropriate tissue sampling, ancillary investigations and the use of controls in research projects. Standardisation of infant death investigations with the application of uniform definitions and protocols will ensure optimal investigation of individual cases and enable international comparisons of trends.

Fatal Fat Embolism After Penis Enlargement by Autologous Fat Transfer: A Case Report and Review of the Literature.

Fat embolism is an incidental finding in cases of long bone fractures or other trauma, but it is also associated with liposuction and autologous fat transfer, a procedure where fat from liposuction is injected back into the same patient's face, breast, buttocks or penis. We here present a case of sudden death by fat embolism in a healthy young male, caused by a simple penis enlargement procedure, in which fat was injected into the penis shaft. We suggest that the risk of fat embolization might be higher when pretraumatized tissue is subjected to fat injection, like in this case, where a penis elongation was performed before the fat injection.

Myocarditis and sudden infant death syndrome.

This is a retrospective survey of findings of myocarditis in 437 infants under the age of 1 year who died suddenly and unexpectedly between 1982 and 1999, and were investigated at the Department of Forensic Medicine in Stockholm, Sweden. Myocarditis was diagnosed in 69/410 infants who died naturally (16.8%) and in 2/27 violent deaths (7.4%). In 43/410 natural deaths (10.5%) the myocarditis was an isolated finding and the only explanation for cause of death and in 26 (6.3%) there were additional possible causes of death. The myocarditis was acute in 45/69 and chronic in 24/69 natural deaths, and was found to occur as early as at a few weeks of age. No specific risk factors were found when reviewing critical time of year, age, gender, previous symptoms, sleeping position, aspiration of gastric contents and environmental factors in infant deaths with finding of myocarditis compared to 313 deaths due to sudden infant death syndrome. Myocarditis was found in 13 of 37 deaths where cultures for cytomegalovirus were positive. More than 50% of the foci of the isolated myocarditis were located in the upper part of the interventricular septum and the adjacent part of the right atrium, areas including parts of the conduction system. This localisation is significant for the cause of death when comparing deaths with myocarditis as an isolated finding to deaths with other possible causes.

Cardiovascular malformations and sudden death in infancy.

BACKGROUND: We survey the postmortem findings of cardiovascular malformations in infants under the age of 1 year who died suddenly and unexpectedly, in a way that mimicked sudden infant death syndrome (SIDS), and evaluate the importance of the malformation for the fatal outcome. METHODS: Four hundred fifty-seven infants under the age of 1 year, who died between 1982 and 2001, were investigated at the Department of Forensic Medicine in Stockholm, Sweden. RESULTS: Cardiovascular malformations were found in 18 infants (3.9%). Only 6 of 18 malformations, mostly severe, were clinically diagnosed before death. In the other 12 infants, cardiovascular malformations were found, such as atrial or ventricular septal defects, coarctation of aorta, stenosis of the aortic or pulmonary artery orifice, and aneurysm of the membranous portion of the interventricular septum. In all instances, the heart weight was increased. CONCLUSIONS: The observation of undiagnosed cardiovascular malformations as the only explanation for the cause of sudden and unexpected death in apparently healthy infants may advocate more examinations of the infant during early life. It is also important to enlarge the debate of the cause of death in infants with cardiovascular malformations. Should they be included in borderline SIDS?