Morphological evaluation of the mandibular lingula using cone-beam computed tomography.

BACKGROUND: Lingula is a tongue-like flap of bone that overlaps the mandibular foramen antero-medially and location is clinically significant in oral and maxillofacial surgeries. The aim of this study was to assess the shape and precise location of lingula using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: In this study, 3-dimensional images provided by CBCT of 63 patients (28 females, 35 males, age range 25-70 years) were retrospectively evaluated. All CBCT images were performed due to implant planning. From both sides of 63 mandibles were classified in the following shapes: triangular, truncated, nodular and assimilated. The location was determined by 5 distances from the lingula: the anterior and the posterior borders of the mandibular ramus, man-dibular notch and lover border of mandible. Height of the lingula was measured from the lingular tip to the mandibular foramen. RESULTS: Nodular shape of lingula was the most commonly found (32.5%). The mean distance of lingula from anterior and posterior borders of mandibular ramus was 18.5 ± 2.3 and 16.9 ± 3.5 mm, respectively. The lingula was located at 18.1 ± 3.6 mm from the mandibular notch and 38.3 mm from the lover border of mandible. The mean height of lingula was 7.8 ± 2.4 mm. CONCLUSIONS: The present study provides the morphological variation and localization of the lingula. The lingula is an important clinical landmark for mandibular osteotomy, and for determining the distance to mandibular foramen entrance.

Sudden death due to a rare brain tumor: an autopsy case.

UNLABELLED: Sudden death in persons with intracranial neoplasms is a rare mechanism of death detected in the forensic autopsies. 10 years-old girl was brought to a local clinic death shortly after analgesic therapy for headache. Autopsy findings showed a large, solid cerebellar mass. Histological diagnosis was pilomyxoid astrocytoma, low-grade tumor with features alike to pilocytic astrocytomas. In this case report we present and discuss rare autopsy case of pilomyxoid astrocytoma from medicolegal point of view. KEYWORDS: sudden death - brain - pilomyxoid astrocytoma - autopsy.

Suicidal electrocution using a homemade electrocution device.

Electrocutions deaths are mostly accidental, suicidal electrocutions are rarely reported. The records of Forensic Medicine Council of Turkey Bursa Morgue Department reveal second case of suicidal electrocution during the past 20 years. The presented case was a 61 year old man, found by his wife at his home bedroom, using a homemade suicidal electrocution device with bare copper wires. The mechanism of death and autopsy findings in suicidal electrocution is discussed.

A comparison of the diagnostic accuracy of in vivo and in vitro photostimulable phosphor digital images in the detection of occlusal caries lesions.

OBJECTIVES: The purpose of this study was to compare the accuracy of diagnoses of occlusal caries lesions from digital images captured using a photostimulable phosphor (PSP) sensor under in vivo and in vitro conditions and to present useful clinical data regarding the clinical application of the system. METHODS: The study sample comprised 60 mandibular third molars (30 sound and 30 with occlusal caries) requiring extraction. A pre-extraction and post-extraction image of each tooth were acquired using a PSP sensor. A stopwatch was used to record the time required for the clinical procedures. Patient comfort or discomfort during image acquisition was also recorded. Images were evaluated twice by three observers using a five-point scale. Kappa coefficients were calculated to assess intra- and interobserver agreement. Receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of each observer for both in vivo and in vitro images. The t-test was used to compare A(z) values, with a significance level set at 0.05 (alpha _ 0.05). The time required for clinical imaging procedures in patients who claimed discomfort and in those who did not was compared using the Mann-Whitney U-test. RESULTS: Intraobserver agreement was almost perfect, whereas interobserver agreement was fair to moderate. No statistically significant differences were found in the accuracy of diagnoses of occlusal caries lesions using in vivo and in vitro digital images. The median time needed for image exposure was 1.04 min and the median time needed to complete the image acquisition procedure was 1.45 min. CONCLUSIONS: The diagnosis of accuracy of occlusal caries lesions using in vivo and in vitro digital images yielded similar results.

Diagnostic accuracy of different imaging modalities in detection of proximal caries.

OBJECTIVE: The purpose of this study was to assess the in vitro diagnostic ability of visual inspection, film, charge-coupled device (CCD) sensor, photostimulable phosphor (PSP) sensor and cone beam CT in the detection of proximal caries in posterior teeth compared with the histological gold standard. METHODS: Visual inspection, film, CCD, PSP and cone beam CT images were used to detect proximal caries in the mesial and distal surfaces of 138 teeth (276 surfaces). Visual inspection and evaluation of all intraoral digital and conventional radiographs and cone beam CT images were performed twice by three oral radiologists. Weighted kappa coefficients were calculated to assess intra- and interobserver agreement for each image set, and scores were compared with the histological gold standard using receiver operating characteristic (ROC) analysis to evaluate diagnostic ability. RESULTS: Intraobserver kappa coefficients calculated for each observer for each method of detecting caries ranged from 0.739 to 0.928. Strong interobserver agreement ranging from 0.631 to 0.811 was found for all detection methods. The highest Az values for all three observers were obtained with the cone beam CT images; however, differences between detection methods were not statistically significant (P > 0.05). CONCLUSION: Visual inspection, film, CCD, PSP plates and cone beam CT performed similarly in the detection of proximal caries.

The roles of extracellular matrix proteins, apoptosis and c-kit positive cells in the pathogenesis of ureteropelvic junction obstruction.

AIM: To investigate histopathological changes in ureteropelvic junction obstruction (UPJO) from an etiological perspective. PATIENTS AND METHODS: Medical records of patients with UPJO were reviewed and pathological specimens collected. Nephrectomy materials from forensic autopsies were taken as controls. Specimens were assessed with light microscopy. Fibronectin, type 4 collagen, laminin, Bax and Bcl-2 expression for apoptosis, together with interstitial cells of Cajal determination with c-kit were determined immunohistochemically. Staining scores were evaluated semiquantitatively. Results were evaluated using Mann-Whitney U-test. RESULTS: Control group comprised 14 children (median age, 3.5 years; 6 months-17 years). Study group comprised 22 children with UPJO (median age, 9 months; 1 month-10 years). Light microscopy revealed non-specific inflammation, epithelial proliferation and atrophy with fibrosis in the smooth muscle of the UPJ in all patients. Fibronectin, type 4 collagen and laminin were found to be significantly increased in UPJO at the intrafascicular space of smooth muscle and the matrix of stroma. Bcl-2 expression was increased in UPJO. c-Kit was unable to stain interstitial cells of Cajal, but staining for mast cells was significant. CONCLUSIONS: High expression of fibronectin, laminin and type 4 collagen may indicate a relation to the pathogenesis of UPJO. Defective kidney morphogenesis, during branching and tubulogenesis of ureteric bud, may be responsible for this congenital pathology.

Sudden death due to single coronary artery.

Coronary artery anomalies that entail a risk of sudden death are frequently associated with complex cardiac malformations but may occasionally be solitary. A 31-year-old man became ill in the night and lost consciousness. He was taken to a hospital where he was treated. However, he died on the same day. The death was considered to be suspicious and an autopsy was mandated. On macroscopic examination, the heart weighed 410 g. A single coronary artery that originated from the right aortic sinus was found. The coronary artery ostium was 0.8 cm in diameter and had a hole-like shape. Demonstration of coronary artery pathologies in autopsies is vital for the elucidation of sudden death cases related to these lesions and for the development of new treatment approaches. The aims of this case report are to contribute to a better understanding of the coronary artery anomalies and emphasise their medicolegal importance.