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Sample records for delayed post-mortem diagnosis

  1. Delayed Post Mortem Predation in Lightning Strike Carcasses ...

    African Journals Online (AJOL)

    Campbell Murn

    An adult giraffe was struck dead by lightning on a game farm outside. Phalaborwa, South Africa in March 2014. Interestingly, delayed post-mortem predation occurred on the carcass, which according to the farm owners was an atypical phenomenon for the region. Delayed post-mortem scavenging on lightning strike ...

  2. Diagnosis of drowning using post-mortem computed tomography - state of the art.

    Science.gov (United States)

    Raux, C; Saval, F; Rouge, D; Telmon, N; Dedouit, F

    Recent studies using post-mortem computed tomography (PMCT) have suggested this imaging modality is of value in the positive diagnosis of drowning. We summarize the data from the literature regarding the diagnostic value of CT in cases of drowning. We performed an all-language search of literature published from 1999 to 2013 with the key words "post-mortem CT scan", "drowning and CT scan", "near-drowning diagnosis", and "drowning diagnosis". Only 11 articles, whose data enabled complementary statistical analysis, were included. The presence of fluid and sediment in paranasal sinuses appear to be the determinants of the diagnosis of drowning. The presence of fluid in the sinuses had a sensitivity of 100%, and of 90% in the trachea and main bronchi. The results were completed by the high specificity of the presence of sediment in the paranasal sinuses, upper airways and stomach, which was 100% for all three. Haemodilution was present in cases of drowning (p drowning.

  3. Diagnosis of porcine enzootic pneumonia by post mortem sanitary inspection: comparison with other diagnostic methods

    OpenAIRE

    Kênia de Fátima Carrijo; Elmiro Rosendo do Nascimento; Virginia Léo de Almeida Pereira; Nelson Morés; Catia Silene Klein; Leonardo Muliterno Domingues; Rogerio Tortelly

    2014-01-01

    ABSTRACT. Carrijo K.F., Nascimento E.R., Pereira V.L.A., Morés N., Klein, C.S., Domingues L.M. & Tortelly R. [Diagnosis of porcine enzootic pneumonia by post mortem sanitary inspection: comparison with other diagnostic methods.] Diagnóstico da pneumonia enzoótica suína pela inspeção sanitária post mortem: comparação com outros métodos de diagnóstico. Revista Brasileira de Veterinária Brasileira 36(2):188-194, 2014. Faculdade de Medicina Veterinária, Universidade Federal de Uberlândia, Av. Par...

  4. Diagnosis of drowning using post-mortem computed tomography – state of the art

    Directory of Open Access Journals (Sweden)

    Catherine Raux

    2014-12-01

    Full Text Available Aim of the study: Recent studies using post-mortem computed tomography (PMCT have suggested this imaging modality is of value in the positive diagnosis of drowning. We summarize the data from the literature regarding the diagnostic value of CT in cases of drowning. Material and methods: We performed an all-language search of literature published from 1999 to 2013 with the key words “post-mortem CT scan”, “drowning and CT scan”, “near-drowning diagnosis”, and “drowning diagnosis”. Results : Only 11 articles, whose data enabled complementary statistical analysis, were included. The presence of fluid and sediment in paranasal sinuses appear to be the determinants of the diagnosis of drowning. The presence of fluid in the sinuses had a sensitivity of 100%, and of 90% in the trachea and main bronchi. The results were completed by the high specificity of the presence of sediment in the paranasal sinuses, upper airways and stomach, which was 100% for all three. Haemodilution was present in cases of drowning (p < 0.001. The values made it possible to formulate a decision algorithm for the diagnosis of drowning.

  5. Diagnosis of porcine enzootic pneumonia by post mortem sanitary inspection: comparison with other diagnostic methods

    Directory of Open Access Journals (Sweden)

    Kênia de Fátima Carrijo

    2014-06-01

    Full Text Available ABSTRACT. Carrijo K.F., Nascimento E.R., Pereira V.L.A., Morés N., Klein, C.S., Domingues L.M. & Tortelly R. [Diagnosis of porcine enzootic pneumonia by post mortem sanitary inspection: comparison with other diagnostic methods.] Diagnóstico da pneumonia enzoótica suína pela inspeção sanitária post mortem: comparação com outros métodos de diagnóstico. Revista Brasileira de Veterinária Brasileira 36(2:188-194, 2014. Faculdade de Medicina Veterinária, Universidade Federal de Uberlândia, Av. Pará, 1720, Bloco 2T, Jardim Umuarama, Uberlândia, MG 38400-902, Brasil. E-mail: keniacarrijo@ famev.ufu.br To compare the concordance of the diagnosis of porcine enzootic pneumonia (PEP by post-mortem Sanitary Inspection with other methods (histophatology and immunohistochemistry - IHC, were used lung tissue samples from 100 pigs slaughtered under sanitary inspection, and 50 of these had macroscopic lesions suggestive of PEP and 50 had no such lesions. These were fixed in 10% buffered formalin and processed by routine procedures for paraffin embedding and IHC technique for Mycoplasma hyopneumoniae using a monoespecific polyclonal antibody. The study demonstrating that there is concordance between the diagnosis of Sanitary Inspection with histophatology, between the diagnosis of Sanitary Inspection with IHC and histophatology with IHC. It can be conclude that when the lung has gross lesions of PEP, the probability the result is positive to M. hyopneumoniae by IHC and the presence of microscopic lesions increases. Thus, the microscopic diagnosis for PEP is feasible because it is associated to the other, so that the diagnosis given by the officials of Sanitary Inspection in slaughterhouses is not wrong; the macroscopic diagnosis is therefore a valid method for the diagnosis of PEP, it being understood this is not to say that the detection of M. hyopneumoniae.

  6. Post-mortem diagnosis of chronic Chagas's disease comparative evaluation of three serological tests on pericardial fluid.

    Science.gov (United States)

    Lopes, E R; Chapadeiro, E; Batista, S M; Cunha, J G; Rocha, A; Miziara, L; Ribeiro, J U; Patto, R J

    1978-01-01

    In an attempt to improve the post-mortem diagnosis of Chagas's disease the authors performed haemagglutination tests (HAT), fluorescent Trypanosoma cruzi antibody tests (FAT), and complement fixation tests (CFT) on the pericardial fluid obtained at autopsy of 50 individuals with Chagas's heart disease, and 93 patients in whom this disease was not thought to be present. The results demonstrate that all three tests are efficient for the post-mortem diagnosis of Chagas's disease but suggest that their combined use would detect more cases than would one isolated reaction only.

  7. Hypothermic death: Possibility of diagnosis by post-mortem computed tomography

    International Nuclear Information System (INIS)

    Kawasumi, Yusuke; Onozuka, Naoki; Kakizaki, Ayana; Usui, Akihito; Hosokai, Yoshiyuki; Sato, Miho; Saito, Haruo; Ishibashi, Tadashi; Hayashizaki, Yoshie; Funayama, Masato

    2013-01-01

    Referring to our experience with post-mortem computed tomography (CT), many hypothermic death cases presented a lack of increase in lung-field concentration, blood clotting in the heart, thoracic aorta or pulmonary artery, and urine retention in the bladder. Thus we evaluated the diagnostic performance of post-mortem CT on hypothermic death based on the above-mentioned three findings. Twenty-four hypothermic death subjects and 53 non-hypothermic death subjects were examined. Two radiologists assessed the presence or lack of an increase in lung-field concentration, blood clotting in the heart, thoracic aorta or pulmonary artery, and measured urine volume in the bladder. Pearson's chi-square test and Mann–Whitney U-test were used to assess the relationship between the three findings and hypothermic death. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the diagnosis were also calculated. Lack of an increase in lung-field concentration and blood clotting in the heart, thoracic aorta or pulmonary artery were significantly associated with hypothermic death (p = 0.0007, p < 0.0001, respectively). The hypothermic death cases had significantly more urine in the bladder than the non-hypothermic death cases (p = 0.0011). Regarding the diagnostic performance with all three findings, the sensitivity was 29.2% but the specificity was 100%. These three findings were more common in hypothermic death cases. Although the sensitivity was low, these findings will assist forensic physicians in diagnosing hypothermic death since the specificity was high

  8. Hypothermic death: possibility of diagnosis by post-mortem computed tomography.

    Science.gov (United States)

    Kawasumi, Yusuke; Onozuka, Naoki; Kakizaki, Ayana; Usui, Akihito; Hosokai, Yoshiyuki; Sato, Miho; Saito, Haruo; Ishibashi, Tadashi; Hayashizaki, Yoshie; Funayama, Masato

    2013-02-01

    Referring to our experience with post-mortem computed tomography (CT), many hypothermic death cases presented a lack of increase in lung-field concentration, blood clotting in the heart, thoracic aorta or pulmonary artery, and urine retention in the bladder. Thus we evaluated the diagnostic performance of post-mortem CT on hypothermic death based on the above-mentioned three findings. Twenty-four hypothermic death subjects and 53 non-hypothermic death subjects were examined. Two radiologists assessed the presence or lack of an increase in lung-field concentration, blood clotting in the heart, thoracic aorta or pulmonary artery, and measured urine volume in the bladder. Pearson's chi-square test and Mann-Whitney U-test were used to assess the relationship between the three findings and hypothermic death. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the diagnosis were also calculated. Lack of an increase in lung-field concentration and blood clotting in the heart, thoracic aorta or pulmonary artery were significantly associated with hypothermic death (p=0.0007, p<0.0001, respectively). The hypothermic death cases had significantly more urine in the bladder than the non-hypothermic death cases (p=0.0011). Regarding the diagnostic performance with all three findings, the sensitivity was 29.2% but the specificity was 100%. These three findings were more common in hypothermic death cases. Although the sensitivity was low, these findings will assist forensic physicians in diagnosing hypothermic death since the specificity was high. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  9. Hypothermic death: Possibility of diagnosis by post-mortem computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kawasumi, Yusuke, E-mail: ssu@rad.med.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Clinical Imaging, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575 (Japan); Onozuka, Naoki; Kakizaki, Ayana [Tohoku University Graduate School of Medicine, Department of Clinical Imaging, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575 (Japan); Usui, Akihito, E-mail: t7402r0506@med.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Diagnostic Image Analysis, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575 (Japan); Hosokai, Yoshiyuki, E-mail: hosokai@med.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Diagnostic Image Analysis, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575 (Japan); Sato, Miho, E-mail: meifan58@m.tains.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Clinical Imaging, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575 (Japan); Saito, Haruo, E-mail: hsaito@med.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Diagnostic Image Analysis, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575 (Japan); Ishibashi, Tadashi, E-mail: tisibasi@med.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Clinical Imaging, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575 (Japan); Hayashizaki, Yoshie, E-mail: yoshie@forensic.med.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Forensic Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575 (Japan); Funayama, Masato, E-mail: funayama@forensic.med.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Forensic Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575 (Japan)

    2013-02-15

    Referring to our experience with post-mortem computed tomography (CT), many hypothermic death cases presented a lack of increase in lung-field concentration, blood clotting in the heart, thoracic aorta or pulmonary artery, and urine retention in the bladder. Thus we evaluated the diagnostic performance of post-mortem CT on hypothermic death based on the above-mentioned three findings. Twenty-four hypothermic death subjects and 53 non-hypothermic death subjects were examined. Two radiologists assessed the presence or lack of an increase in lung-field concentration, blood clotting in the heart, thoracic aorta or pulmonary artery, and measured urine volume in the bladder. Pearson's chi-square test and Mann–Whitney U-test were used to assess the relationship between the three findings and hypothermic death. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the diagnosis were also calculated. Lack of an increase in lung-field concentration and blood clotting in the heart, thoracic aorta or pulmonary artery were significantly associated with hypothermic death (p = 0.0007, p < 0.0001, respectively). The hypothermic death cases had significantly more urine in the bladder than the non-hypothermic death cases (p = 0.0011). Regarding the diagnostic performance with all three findings, the sensitivity was 29.2% but the specificity was 100%. These three findings were more common in hypothermic death cases. Although the sensitivity was low, these findings will assist forensic physicians in diagnosing hypothermic death since the specificity was high.

  10. [Post-mortem microbiology analysis].

    Science.gov (United States)

    Fernández-Rodríguez, Amparo; Alberola, Juan; Cohen, Marta Cecilia

    2013-12-01

    Post-mortem microbiology is useful in both clinical and forensic autopsies, and allows a suspected infection to be confirmed. Indeed, it is routinely applied to donor studies in the clinical setting, as well as in sudden and unexpected death in the forensic field. Implementation of specific sampling techniques in autopsy can minimize the possibility of contamination, making interpretation of the results easier. Specific interpretation criteria for post-mortem cultures, the use of molecular diagnosis, and its fusion with molecular biology and histopathology have led to post-mortem microbiology playing a major role in autopsy. Multidisciplinary work involving microbiologists, pathologists, and forensic physicians will help to improve the achievements of post-mortem microbiology, prevent infectious diseases, and contribute to a healthier population. Crown Copyright © 2012. Published by Elsevier Espana. All rights reserved.

  11. Prevalence and concordance between the clinical and the post-mortem diagnosis of dementia in a psychogeriatric clinic.

    Science.gov (United States)

    Grandal Leiros, B; Pérez Méndez, L I; Zelaya Huerta, M V; Moreno Eguinoa, L; García-Bragado, F; Tuñón Álvarez, T; Roldán Larreta, J J

    The aim of our study is to describe the types of dementia found in a series of patients and to estimate the level of agreement between the clinical diagnosis and post-mortem diagnosis. We conducted a descriptive analysis of the prevalence of the types of dementia found in our series and we established the level of concordance between the clinical and the post-mortem diagnoses. The diagnosis was made based on current diagnostic criteria. 114 cases were included. The most common clinical diagnoses both at a clinical and autopsy level were Alzheimer disease and mixed dementia but the prevalence was quite different. While at a clinical level, prevalence was 39% for Alzheimer disease and 18% for mixed dementia, in the autopsy level, prevalence was 22% and 34%, respectively. The agreement between the clinical and the autopsy diagnoses was 62% (95% CI 53-72%). Almost a third of our patients were not correctly diagnosed in vivo. The most common mistake was the underdiagnosis of cerebrovascular pathology. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. An audit of the contribution to post-mortem examination diagnosis of individual analyte results obtained from biochemical analysis of the vitreous.

    Science.gov (United States)

    Mitchell, Rebecca; Charlwood, Cheryl; Thomas, Sunethra Devika; Bellis, Maria; Langlois, Neil E I

    2013-12-01

    Biochemical analysis of the vitreous humor from the eye is an accepted accessory test for post-mortem investigation of cause of death. Modern biochemical analyzers allow testing of a range of analytes from a sample. However, it is not clear which analytes should be requested in order to prevent unnecessary testing (and expense). The means and standard deviation of the values obtained from analysis of the vitreous humor for sodium, potassium, chloride, osmolality, glucose, ketones (β-hydroxybutyrate), creatinine, urea, calcium, lactate, and ammonia were calculated from which the contribution of each analyte was reviewed in the context of post-mortem findings and final cause of death. For sodium 32 cases were regarded as high (more than one standard deviation above the mean), from which 9 contributed to post-mortem diagnosis [drowning (4), heat related death (2), diabetic hyperglycemia (2), and dehydration (1)], but 25 low values (greater than one standard deviation below the mean) made no contribution. For chloride 29 high values contributed to 4 cases--3 drowning and 1 heat-related, but these were all previously identified by a high sodium level. There were 29 high and 35 low potassium values, none of which contributed to determining the final cause of death. Of 22 high values of creatinine, 12 contributed to a diagnosis of renal failure. From 32 high values of urea, 18 contributed to 16 cases of renal failure (2 associated with diabetic hyperglycemia), 1 heat-related death, and one case with dehydration. Osmolarity contributed to 12 cases (5 heat-related, 4 diabetes, 2 renal failure, and 1 dehydration) from 36 high values. There was no contribution from 32 high values and 19 low values of calcium and there was no contribution from 4 high and 2 low values of ammonia. There were 11 high values of glucose, which contributed to the diagnosis of 6 cases of diabetic hyperglycemia and 21 high ketone levels contributed to 8 cases: 4 diabetic ketosis, 3 hypothermia, 3

  13. The quantification of COMT mRNA in post mortem cerebellum tissue: diagnosis, genotype, methylation and expression

    Directory of Open Access Journals (Sweden)

    Craig Ian W

    2006-02-01

    Full Text Available Abstract Background The COMT gene is located on chromosome 22q11, a region strongly implicated in the aetiology of several psychiatric disorders, in particular schizophrenia. Previous research has suggested that activity and expression of COMT is altered in schizophrenia, and is mediated by one or more polymorphisms within the gene, including the functional Val158Met polymorphism. Method In this study we examined the expression levels of COMT mRNA using quantitative RT-PCR in 60 post mortem cerebellum samples derived from individuals with schizophrenia, bipolar disorder, depression, and no history of psychopathology. Furthermore, we have examined the methylation status of two CpG sites in the promoter region of the gene. Results We found no evidence of altered COMT expression or methylation in any of the psychiatric diagnoses examined. We did, however, find evidence to suggest that genotype is related to COMT gene expression, replicating the findings of two previous studies. Specifically, val158met (rs165688; Val allele rs737865 (G allele and rs165599 (G allele all showed reduced expression (P COMT expression, with females exhibiting significantly greater levels of COMT mRNA. Conclusion The expression of COMT does not appear to be altered in the cerebellum of individuals suffering from schizophrenia, bipolar disorder or depression, but does appear to be influenced by single nucleotide polymorphisms within the gene.

  14. Isolation of primary microglia from the human post-mortem brain: effects of ante- and post-mortem variables.

    Science.gov (United States)

    Mizee, Mark R; Miedema, Suzanne S M; van der Poel, Marlijn; Adelia; Schuurman, Karianne G; van Strien, Miriam E; Melief, Jeroen; Smolders, Joost; Hendrickx, Debbie A; Heutinck, Kirstin M; Hamann, Jörg; Huitinga, Inge

    2017-02-17

    Microglia are key players in the central nervous system in health and disease. Much pioneering research on microglia function has been carried out in vivo with the use of genetic animal models. However, to fully understand the role of microglia in neurological and psychiatric disorders, it is crucial to study primary human microglia from brain donors. We have developed a rapid procedure for the isolation of pure human microglia from autopsy tissue using density gradient centrifugation followed by CD11b-specific cell selection. The protocol can be completed in 4 h, with an average yield of 450,000 and 145,000 viable cells per gram of white and grey matter tissue respectively. This method allows for the immediate phenotyping of microglia in relation to brain donor clinical variables, and shows the microglia population to be distinguishable from autologous choroid plexus macrophages. This protocol has been applied to samples from over 100 brain donors from the Netherlands Brain Bank, providing a robust dataset to analyze the effects of age, post-mortem delay, brain acidity, and neurological diagnosis on microglia yield and phenotype. Our data show that cerebrospinal fluid pH is positively correlated to microglial cell yield, but donor age and post-mortem delay do not negatively affect viable microglia yield. Analysis of CD45 and CD11b expression showed that changes in microglia phenotype can be attributed to a neurological diagnosis, and are not influenced by variation in ante- and post-mortem parameters. Cryogenic storage of primary microglia was shown to be possible, albeit with variable levels of recovery and effects on phenotype and RNA quality. Microglial gene expression substantially changed due to culture, including the loss of the microglia-specific markers, showing the importance of immediate microglia phenotyping. We conclude that primary microglia can be isolated effectively and rapidly from human post-mortem brain tissue, allowing for the study of the

  15. Post-mortem CT evaluation of atlanto-occipital dissociation.

    Science.gov (United States)

    Madadin, Mohammed; Samaranayake, Ravindra Priyalal; O'Donnell, Chris; Cordner, Stephen

    2017-02-01

    Atlanto-occipital dissociation injury is an important injury in forensic pathology practice. Radiological diagnosis of atlanto-occipital dissociation clinically is assessed by direct measurement of occipito-vertebral skeletal relationships. Different measurements may be used to diagnose atlanto-occipital dissociation, including the basion-dens interval (BDI) and basion-axial interval (BAI). It is not known whether the normal ante-mortem measurements of BDI and BAI described in the literature are applicable to post-mortem CT images of the occipito-cervical junction (OCJ) or whether these measurements could be affected by early post-mortem changes. This study aims to compare post-mortem BDI and BAI measurements with ante-mortem values. Post-mortem CT scans of the cervical spines of 100 deceased adults were reviewed, and the BDI and BAI were measured. Different parameters were recorded in each case. The results from this study suggest that there are no effects of post-mortem changes on the measurement of BAI as relied upon clinically. There appear to be some effects of fully established rigor mortis on BDI measurement, shortening it. This may have consequences for the post mortem diagnosis of atlanto-occipital dissociation. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  16. Myocardial contrast defect associated with thrombotic coronary occlusion: Pre-autopsy diagnosis of a cardiac death with post-mortem CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Heon; Cha, Jang Gyu [Dept. of Radiology, Soonchunhyang University Hospital, Bucheon (Korea, Republic of); Park, Hye Jin; Lee, Soo Kyoung; Yang, Kyung Moo [Dept. of Forensic Medicine, National Forensic Service, Wonju (Korea, Republic of)

    2015-10-15

    We report the case of a female who died of suspected acute myocardial infarction. Post-mortem CT angiography (PMCTA) was performed with intravascular contrast infusion before the standard autopsy, and it successfully demonstrated the complete thrombotic occlusion of a coronary artery and also a corresponding perfusion defect on myocardium. We herein describe the PMCTA findings of a cardiac death with special emphasis on the potential benefits of this novel CT technique in forensic practice.

  17. Differences in sampling techniques on total post-mortem tryptase.

    Science.gov (United States)

    Tse, R; Garland, J; Kesha, K; Elstub, H; Cala, A D; Ahn, Y; Stables, S; Palmiere, C

    2017-11-20

    The measurement of mast cell tryptase is commonly used to support the diagnosis of anaphylaxis. In the post-mortem setting, the literature recommends sampling from peripheral blood sources (femoral blood) but does not specify the exact sampling technique. Sampling techniques vary between pathologists, and it is unclear whether different sampling techniques have any impact on post-mortem tryptase levels. The aim of this study is to compare the difference in femoral total post-mortem tryptase levels between two sampling techniques. A 6-month retrospective study comparing femoral total post-mortem tryptase levels between (1) aspirating femoral vessels with a needle and syringe prior to evisceration and (2) femoral vein cut down during evisceration. Twenty cases were identified, with three cases excluded from analysis. There was a statistically significant difference (paired t test, p sampling methods. The clinical significance of this finding and what factors may contribute to it are unclear. When requesting post-mortem tryptase, the pathologist should consider documenting the exact blood collection site and method used for collection. In addition, blood samples acquired by different techniques should not be mixed together and should be analyzed separately if possible.

  18. Post-mortem CT-coronary angiography

    DEFF Research Database (Denmark)

    Pøhlsgaard, Camilla; Leth, Peter Mygind

    2007-01-01

    post-mortem coronary angiography and computerized tomography.  We describe how to prepare and inject the contrast medium, and how to establish a CT-protocol that optimizes spatial resolution, low contrast resolution and noise level. Testing of the method on 6 hearts, showed that the lumen...

  19. Forensic radiology: The role of cross-sectional imaging in virtual post-mortem examinations

    International Nuclear Information System (INIS)

    Higginbotham-Jones, Joshua; Ward, Anthony

    2014-01-01

    Aim: The aim of this review is to assess the benefits and limitations of using Multi Slice Computed Tomography and Magnetic Resonance as non-invasive post-mortem imaging methods. Method: The author utilised SciVerse (Science Direct), Scopus, PubMed and Discover to search for relevant articles. The following search terms were used: virtopsy, minimally invasive post-mortem imaging, autopsy, Multi Slice Computed Tomography, Magnetic Resonance. Articles which discussed the use of non-invasive imaging techniques for post-mortem examinations were included in the review. Any articles published before 2003 were excluded with a few exceptions. Findings: The decline in use of the conventional post-mortem method has led to the need for an alternative method of investigation which increases both sensitivity and specificity, and also is more acceptable to the family of the deceased. Discussion/conclusion: There are numerous factors affecting the usability of these non-invasive post-mortem options including cost and availability. With the price of non-invasive post-mortem examinations often rising above £1000, it is considered to be less economically viable than the conventional method. Therefore, further research into this method and its implementation in hospitals has been delayed

  20. Evaluation of RT-PCR Assay for Routine Laboratory Diagnosis of Rabies in Post Mortem Brain Samples from Different Species of Animals

    OpenAIRE

    Aravindh Babu, R. P.; Manoharan, S.; Ramadass, P.; Chandran, N. D. J.

    2012-01-01

    Rabies in domestic and wild animals continues to be a major public health threat in India. Rapid and accurate diagnosis of rabies in animals is therefore of utmost importance as the individuals who were in contact with the rabid animals are at a greater risk. A significant amount of diagnostic tissue samples submitted to our laboratory are often autolysed and the WHO recommended direct fluorescent antibody test (FAT) for rabies diagnosis cannot be used in such samples. In this pilot study we ...

  1. Reviviendo la consulta post-mortem.

    OpenAIRE

    Armando Cortés

    2009-01-01

    Por estos días se inaugura el “Centro de consulta post-mortem del Hospital Universitario del Valle”, una denominación más apropiada para la autopsia «ver por sí mismo» o cualquiera de sus sinónimos necropsia, examen post-mortem, necroscopia, o tanatopsia; todos ellos no aceptados y condicionados por factores culturales, sociales o religiosos. Estos términos han alcanzado una connotación claramente negativa en el ambiente médico y en el público general. Quizás, el mejor término sea «consulta p...

  2. Post mortem examination report concerning Nadim Nuwwara

    DEFF Research Database (Denmark)

    Leth, Peter Mygind

    2014-01-01

    Post mortem examination report concerning Nadim Nuwawara, 17-years old, who was killed may 15 2014 in Beitunia near Rahmallah, Palestine. The examination was performed by an international team consisting of dr. Saber Al-Aloul, director of the Medico Legal Institute at Quds University, dr. Marc A....... Krouse, Deputy Chief Medical Examiner, Office of Chief Medical Examiner, Fort Worth, Texas, USA, dr. Chen Kugel, Chief Forensic Pathologist, Abu Kabir Institute of Forensic Medicine, Tel Aviv, dr. Ricardo Pablo Nachman, forensic expert at Abu Kabir Institute of Forensic Medicine, Tel Aviv and dr. Peter...

  3. Post-mortem fetal MRI: What do we learn from it?

    International Nuclear Information System (INIS)

    Whitby, E.H.; Paley, M.N.J.; Cohen, M.; Griffiths, P.D.

    2006-01-01

    Post-mortem magnetic resonance (MR) imaging is of increasing interest not only as an alternative to autopsy but as a research tool to aid the interpretation and diagnosis of in utero MR images. The information from the post-mortem MR has allowed the development of imaging sequences applicable to in utero imaging and neonatal imaging. It has established brain development during gestation and has provided data on this to which in utero MR can be compared. The detail available from the post-mortem images is such that brain development can be studied in a non-invasive manner, a permanent record on the normal and abnormal areas is available and a greater understanding of developmental abnormalities is possible

  4. Effects of post mortem temperature on rigor tension, shortening and ...

    African Journals Online (AJOL)

    Fully developed rigor mortis in muscle is characterised by maximum loss of extensibility. The course of post mortem changes in ostrich muscle was studied by following isometric tension, shortening and change in pH during the first 24 h post mortem within muscle strips from the muscularis gastrocnemius, pars interna at ...

  5. Blast furnace hearth lining: post mortem analysis

    Energy Technology Data Exchange (ETDEWEB)

    Almeida, Bruno Vidal de; Vernilli Junior, Fernando, E-mail: bva@usp.br [Universidade de Sao Paulo (USP), Lorena, SP (Brazil). Escola de Engenharia; Neves; Elton Silva; Silva, Sidiney Nascimento [Companhia Siderugica Nacional (CSN), Rio de Janeiro, RJ (Brazil)

    2017-05-15

    The main refractory lining of blast furnace hearth is composed by carbon blocks that operates in continuous contact with hot gases, liquid slag and hot metal, in temperatures above 1550 deg C for 24 hours a day. To fully understand the wear mechanism that acts in this refractory layer system it was performed a Post Mortem study during the last partial repair of this furnace. The samples were collected from different parts of the hearth lining and characterized using the following techniques: Bulk Density and Apparent Porosity, X-Ray Fluorescence, X-ray Diffraction, Scanning Electron Microscopy with Energy-dispersive X-Ray Spectroscopy. The results showed that the carbon blocks located at the opposite side of the blast furnace tap hole kept its main physicochemical characteristics preserved even after the production of 20x10{sup 6} ton of hot metal. However, the carbon blocks around the Tap Hole showed infiltration by hot metal and slag and it presents a severe deposition of zinc and sulfur over its carbon flakes. The presence of these elements is undesired because it reduces the physic-chemical stability of this refractory system. This deposition found in the carbon refractory is associated with impurities present in the both coke and the sinter feed used in this blast furnace in the last few years. (author)

  6. Blast furnace hearth lining: post mortem analysis

    International Nuclear Information System (INIS)

    Almeida, Bruno Vidal de; Vernilli Junior, Fernando

    2017-01-01

    The main refractory lining of blast furnace hearth is composed by carbon blocks that operates in continuous contact with hot gases, liquid slag and hot metal, in temperatures above 1550 deg C for 24 hours a day. To fully understand the wear mechanism that acts in this refractory layer system it was performed a Post Mortem study during the last partial repair of this furnace. The samples were collected from different parts of the hearth lining and characterized using the following techniques: Bulk Density and Apparent Porosity, X-Ray Fluorescence, X-ray Diffraction, Scanning Electron Microscopy with Energy-dispersive X-Ray Spectroscopy. The results showed that the carbon blocks located at the opposite side of the blast furnace tap hole kept its main physicochemical characteristics preserved even after the production of 20x10"6 ton of hot metal. However, the carbon blocks around the Tap Hole showed infiltration by hot metal and slag and it presents a severe deposition of zinc and sulfur over its carbon flakes. The presence of these elements is undesired because it reduces the physic-chemical stability of this refractory system. This deposition found in the carbon refractory is associated with impurities present in the both coke and the sinter feed used in this blast furnace in the last few years. (author)

  7. [Legal aspects of post-mortem radiology in the Netherlands].

    Science.gov (United States)

    Venderink, W; Dute, J C J

    2016-01-01

    In the Netherlands, the application of post-mortem radiology (virtual autopsy) is on the rise. Contrary to conventional autopsy, with post-mortem radiology the body remains intact. There is uncertainty concerning the legal admissibility of post-mortem radiology, since the Dutch Corpse Disposal Act does not contain any specific regulations for this technique. Autopsy and post-mortem radiology differ significantly from a technical aspect, but these differences do not have far-reaching legal consequences from a legal perspective. Even though the body remains intact during post-mortem radiology, the bodily integrity of a deceased person is breached if it would be applied without previously obtained consent. This permission can only be obtained after the relatives are fully informed about the proposed activity. In this respect, it is not relevant which technique is used, be it post-mortem radiology or autopsy. Therefore, the other legal conditions for post-mortem radiology are essentially identical to those for autopsy.

  8. Routine perinatal and paediatric post-mortem radiography: detection rates and implications for practice

    Energy Technology Data Exchange (ETDEWEB)

    Arthurs, Owen J. [NHS Foundation Trust, Department of Radiology Great Ormond Street Hospital for Children, London (United Kingdom); University College London, Institute of Child Health, London (United Kingdom); Calder, Alistair D. [NHS Foundation Trust, Department of Radiology Great Ormond Street Hospital for Children, London (United Kingdom); Kiho, Liina [Camelia Botnar Laboratories Great Ormond Street Hospital for Children, Department of Paediatric Pathology, London (United Kingdom); Taylor, Andrew M. [Great Ormond Street Hospital for Children, Cardiorespiratory Unit, London (United Kingdom); UCL Institute of Cardiovascular Science, London (United Kingdom); University College London, Institute of Child Health, London (United Kingdom); Sebire, Neil J. [Camelia Botnar Laboratories Great Ormond Street Hospital for Children, Department of Paediatric Pathology, London (United Kingdom); University College London, Institute of Child Health, London (United Kingdom)

    2014-03-15

    Routine perinatal and paediatric post-mortem plain radiography allows for the diagnosis and assessment of skeletal dysplasias, fractures and other bony abnormalities. The aim of this study was to review the diagnostic yield of this practice. We identified 1,027 cases performed in a single institution over a 21/2-year period, including babygrams (whole-body examinations) and full skeletal surveys. Images were reported prior to autopsy in all cases. Radiology findings were cross-referenced with the autopsy findings using an autopsy database. We scored each case from 0 to 4 according to the level of diagnostic usefulness. The overall abnormality rate was 126/1,027 (12.3%). There was a significantly higher rate of abnormality when a skeletal survey was performed (18%) rather than a babygram (10%; P < 0.01); 90% (665/739) of babygrams were normal. Of the 74 abnormal babygrams, we found 33 incidental non-contributory cases, 19 contributory, 20 diagnostic, and 2 false-positive cases. There were only 2 cases out of 739 (0.27%) in whom routine post-mortem imaging identified potentially significant abnormalities that would not have been detected if only selected imaging had been performed. A policy of performing selected, rather than routine, foetal post-mortem radiography could result in a significant cost saving. Routine post-mortem paediatric radiography in foetuses and neonates is neither diagnostically useful nor cost-effective. A more evidence-based, selective protocol should yield significant cost savings. (orig.)

  9. Routine perinatal and paediatric post-mortem radiography: detection rates and implications for practice

    International Nuclear Information System (INIS)

    Arthurs, Owen J.; Calder, Alistair D.; Kiho, Liina; Taylor, Andrew M.; Sebire, Neil J.

    2014-01-01

    Routine perinatal and paediatric post-mortem plain radiography allows for the diagnosis and assessment of skeletal dysplasias, fractures and other bony abnormalities. The aim of this study was to review the diagnostic yield of this practice. We identified 1,027 cases performed in a single institution over a 21/2-year period, including babygrams (whole-body examinations) and full skeletal surveys. Images were reported prior to autopsy in all cases. Radiology findings were cross-referenced with the autopsy findings using an autopsy database. We scored each case from 0 to 4 according to the level of diagnostic usefulness. The overall abnormality rate was 126/1,027 (12.3%). There was a significantly higher rate of abnormality when a skeletal survey was performed (18%) rather than a babygram (10%; P < 0.01); 90% (665/739) of babygrams were normal. Of the 74 abnormal babygrams, we found 33 incidental non-contributory cases, 19 contributory, 20 diagnostic, and 2 false-positive cases. There were only 2 cases out of 739 (0.27%) in whom routine post-mortem imaging identified potentially significant abnormalities that would not have been detected if only selected imaging had been performed. A policy of performing selected, rather than routine, foetal post-mortem radiography could result in a significant cost saving. Routine post-mortem paediatric radiography in foetuses and neonates is neither diagnostically useful nor cost-effective. A more evidence-based, selective protocol should yield significant cost savings. (orig.)

  10. Quality of coroner's post-mortems in a UK hospital.

    Science.gov (United States)

    Al Mahdy, Husayn

    2014-01-01

    The aim of this paper was, principally, to look at the coroner's post-mortem report quality regarding adult medical patients admitted to an English hospital; and to compare results with Royal College of Pathologists guidelines. Hospital clinical notes of adult medical patients dying in 2011 and who were referred to the coroner's office to determine the cause of death were scrutinised. Their clinical care was also reviewed. There needs to be a comprehensive approach to coroner's post-mortems such as routinely taking histological and microbiological specimens. Acute adult medical patient care needs to improve. Steps should be taken to ensure that comprehensive coroner's post-mortems are performed throughout the UK, including with routine histological and microbiological specimens examination. Additionally, closer collaboration between clinicians and pathologists needs to occur to improve emergency adult medical patient clinical care. The study highlights inadequacies in coroner's pathology services.

  11. Drowning - post-mortem imaging findings by computed tomography

    International Nuclear Information System (INIS)

    Christe, Andreas; Aghayev, Emin; Jackowski, Christian; Thali, Michael J.; Vock, Peter

    2008-01-01

    The aim of this study was to identify the classic autopsy signs of drowning in post-mortem multislice computed tomography (MSCT). Therefore, the post-mortem pre-autopsy MSCT- findings of ten drowning cases were correlated with autopsy and statistically compared with the post-mortem MSCT of 20 non-drowning cases. Fluid in the airways was present in all drowning cases. Central aspiration in either the trachea or the main bronchi was usually observed. Consecutive bronchospasm caused emphysema aquosum. Sixty percent of drowning cases showed a mosaic pattern of the lung parenchyma due to regions of hypo- and hyperperfused lung areas of aspiration. The resorption of fresh water in the lung resulted in hypodensity of the blood representing haemodilution and possible heart failure. Swallowed water distended the stomach and duodenum; and inflow of water filled the paranasal sinuses (100%). All the typical findings of drowning, except Paltau's spots, were detected using post-mortem MSCT, and a good correlation of MSCT and autopsy was found. The advantage of MSCT was the direct detection of bronchospasm, haemodilution and water in the paranasal sinus, which is rather complicated or impossible at the classical autopsy. (orig.)

  12. Post-mortem examination and sampling of African flamingos ...

    African Journals Online (AJOL)

    Recent largely unexplained deaths in African flamingos have prompted the need for standard, reproducible methods for the post-mortem examination of these birds, for the taking of samples and for the recording of findings. Here we describe suitable techniques and present three distinct protocols for field-based ...

  13. Post-mortem cytogenomic investigations in patients with congenital malformations.

    Science.gov (United States)

    Dias, Alexandre Torchio; Zanardo, Évelin Aline; Dutra, Roberta Lelis; Piazzon, Flavia Balbo; Novo-Filho, Gil Monteiro; Montenegro, Marilia Moreira; Nascimento, Amom Mendes; Rocha, Mariana; Madia, Fabricia Andreia Rosa; Costa, Thais Virgínia Moura Machado; Milani, Cintia; Schultz, Regina; Gonçalves, Fernanda Toledo; Fridman, Cintia; Yamamoto, Guilherme Lopes; Bertola, Débora Romeo; Kim, Chong Ae; Kulikowski, Leslie Domenici

    2016-08-01

    Congenital anomalies are the second highest cause of infant deaths, and, in most cases, diagnosis is a challenge. In this study, we characterize patterns of DNA copy number aberrations in different samples of post-mortem tissues from patients with congenital malformations. Twenty-eight patients undergoing autopsy were cytogenomically evaluated using several methods, specifically, Multiplex Ligation-dependent Probe Amplification (MLPA), microsatellite marker analysis with a MiniFiler kit, FISH, a cytogenomic array technique and bidirectional Sanger sequencing, which were performed on samples of different tissues (brain, heart, liver, skin and diaphragm) preserved in RNAlater, in formaldehyde or by paraffin-embedding. The results identified 13 patients with pathogenic copy number variations (CNVs). Of these, eight presented aneuploidies involving chromosomes 13, 18, 21, X and Y (two presented inter- and intra-tissue mosaicism). In addition, other abnormalities were found, including duplication of the TYMS gene (18p11.32); deletion of the CHL1 gene (3p26.3); deletion of the HIC1 gene (17p13.3); and deletion of the TOM1L2 gene (17p11.2). One patient had a pathogenic missense mutation of g.8535C>G (c.746C>G) in exon 7 of the FGFR3 gene consistent with Thanatophoric Dysplasia type I. Cytogenomic techniques were reliable for the analysis of autopsy material and allowed the identification of inter- and intra-tissue mosaicism and a better understanding of the pathogenesis of congenital malformations. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Post-mortem radiology-a new sub-speciality?

    International Nuclear Information System (INIS)

    O'Donnell, C.; Woodford, N.

    2008-01-01

    Computed tomography (CT) and magnetic resonance imaging (MRI) examinations of deceased individuals are increasingly being utilized in the field of forensic pathology. However, there are differences in the interpretation of post-mortem and clinical imaging. Radiologists with only occasional experience in post-mortem imaging are at risk of misinterpreting the findings if they rely solely on clinical experience. Radiological specialists working in a co-operative environment with pathologists are pivotal in the understanding of post-mortem CT and MRI, and its appropriate integration into the autopsy. This has spawned a novel subspecialty called post-mortem radiology or necro-radiology (radiology of the deceased). In the future it is likely that whole-body CT will be incorporated into the routine forensic autopsy due its ability to accurately detect and localise abnormalities commonly seen in forensic practice, such as haematoma, abnormal gas collections, fractures, and metallic foreign bodies. In the next 5-10 years most forensic institutes will seek regular access to such CT facilities or install machines into their own mortuaries. MRI is technically more problematic in the deceased but the improved tissue contrast over CT means that it is also very useful for investigation of pathology in the cranial, thoracic, and abdominal cavities, as well as the detection of haematoma in soft tissue. In order for radiologists to be an integral part of this important development in forensic investigation, radiological organizations must recognize the subspecialty of post-mortem radiology and provide a forum for radiologists to advance scientific knowledge in the field

  15. Corroboration of in utero MRI using post-mortem MRI and autopsy in foetuses with CNS abnormalities

    International Nuclear Information System (INIS)

    Whitby, E.H.; Variend, S.; Rutter, S.; Paley, M.N.J.; Wilkinson, I.D.; Davies, N.P.; Sparey, C.; Griffiths, P.D.

    2004-01-01

    AIMS: To corroborate the findings of in utero magnetic resonance imaging (MRI) with autopsy and post-mortem MRI in cases of known or suspected central nervous system (CNS) abnormalities on ultrasound and to compare the diagnostic accuracy of ante-natal ultrasound and in utero MRI. METHODS: Twelve pregnant women, whose foetuses had suspected central nervous system abnormalities underwent in utero MRI. The foetuses were imaged using MRi before autopsy. The data were used to evaluate the diagnostic accuracy of in utero MRI when compared with a reference standard of autopsy and post-mortem MRI in 10 cases and post-mortem MRI alone in two cases. RESULTS: The diagnostic accuracy of antenatal ultrasound and in utero MRI in correctly characterizing brain and spine abnormalities were 42 and 100%, respectively. CONCLUSION: In utero MRI provides a useful adjuvant to antenatal ultrasound when assessing CNS abnormalities by providing more accurate anatomical information. Post-mortem MRI assists the diagnosis of macroscopic structural abnormalities

  16. Diagnostic accuracy of post-mortem CT with targeted coronary angiography versus autopsy for coroner-requested post-mortem investigations: a prospective, masked, comparison study.

    Science.gov (United States)

    Rutty, Guy N; Morgan, Bruno; Robinson, Claire; Raj, Vimal; Pakkal, Mini; Amoroso, Jasmin; Visser, Theresa; Saunders, Sarah; Biggs, Mike; Hollingbury, Frances; McGregor, Angus; West, Kevin; Richards, Cathy; Brown, Laurence; Harrison, Rebecca; Hew, Roger

    2017-07-08

    England and Wales have one of the highest frequencies of autopsy in the world. Implementation of post-mortem CT (PMCT), enhanced with targeted coronary angiography (PMCTA), in adults to avoid invasive autopsy would have cultural, religious, and potential economic benefits. We aimed to assess the diagnostic accuracy of PMCTA as a first-line technique in post-mortem investigations. In this single-centre (Leicester, UK), prospective, controlled study, we selected cases of natural and non-suspicious unnatural death referred to Her Majesty's (HM) Coroners. We excluded cases younger than 18 years, known to have had a transmittable disease, or who weighed more than 125 kg. Each case was assessed by PMCTA, followed by autopsy. Pathologists were masked to the PMCTA findings, unless a potential risk was shown. The primary endpoint was the accuracy of the cause of death diagnosis from PMCTA against a gold standard of autopsy findings, modified by PMCTA findings only if additional substantially incontrovertible findings were identified. Between Jan 20, 2010, and Sept 13, 2012, we selected 241 cases, for which PMCTA was successful in 204 (85%). Seven cases were excluded from the analysis because of procedural unmasking or no autopsy data, as were 24 cases with a clear diagnosis of traumatic death before investigation; 210 cases were included. In 40 (19%) cases, predictable toxicology or histology testing accessible by PMCT informed the result. PMCTA provided a cause of death in 193 (92%) cases. A major discrepancy with the gold standard was noted in 12 (6%) cases identified by PMCTA, and in nine (5%) cases identified by autopsy (because of specific findings on PMCTA). The frequency of autopsy and PMCTA discrepancies were not significantly different (p=0·65 for major discrepancies and p=0·21 for minor discrepancies). Cause of death given by PMCTA did not overlook clinically significant trauma, occupational lung disease, or reportable disease, and did not significantly affect

  17. Delayed Post Mortem Predation in Lightning Strike Carcasses ...

    African Journals Online (AJOL)

    Campbell Murn

    Senior Specialist: Forensic Pathologist. Department of Forensic Medicine, University of Pretoria. E-mail: ryan.blumenthal@up.ac.za. Abstract. An adult giraffe was struck dead by ... meticulous and scientific observations in future case studies. Case History. An adult giraffe was found dead in the South African lowveld (broad-.

  18. Preliminary study of post mortem identification using lip prints.

    Science.gov (United States)

    Utsuno, Hajime; Kanoh, Takashi; Tadokoro, Osamu; Inoue, Katsuhiro

    2005-05-10

    Identification using lip prints was first performed in the 1950s and was the subject of much research in the 1960s and 70s, leading to the acceptance of this technique as evidence in the criminal justice system. Previous research has focused on identifying lip print types or on methods of obtaining hidden lip prints left at the crime scene. The present study aimed to clarify characteristics of lip prints from cadavers with various causes of death (including drowning and hanging) and to determine the effects of fixation on post mortem changes in lip impressions.

  19. Making post-mortem implantable cardioverter defibrillator explantation safe

    DEFF Research Database (Denmark)

    Räder, Sune B E W; Zeijlemaker, Volkert; Pehrson, Steen

    2009-01-01

    that the resting voltage over the operating person would not exceed 50 V. CONCLUSION: The use of intact medical gloves made of latex, neoprene, or plastic eliminates the potential electrical risk during explantation of an ICD. Two gloves on each hand offer sufficient protection. We will recommend the use......AIMS: The aim of this study is to investigate whether protection with rubber or plastic gloves during post-mortem explantation of an implantable cardioverter defibrillator (ICD) offers enough protection for the explanting operator during a worst-case scenario (i.e. ICD shock). METHODS AND RESULTS...

  20. Comparison of diagnostic performance for perinatal and paediatric post-mortem imaging: CT versus MRI

    International Nuclear Information System (INIS)

    Arthurs, Owen J.; Jacques, Thomas S.; Sebire, Neil J.; Guy, Anna; Chong, W.K.; Gunny, Roxanna; Saunders, Dawn; Olsen, Oystein E.; Thayyil, Sudhin; Wade, Angie; Jones, Rod; Norman, Wendy; Taylor, Andrew M.; Scott, Rosemary; Robertson, Nicola J.; Owens, Catherine M.; Offiah, Amaka C.; Chitty, Lyn S.

    2016-01-01

    To compare the diagnostic yield of whole-body post-mortem computed tomography (PMCT) imaging to post-mortem magnetic resonance (PMMR) imaging in a prospective study of fetuses and children. We compared PMCT and PMMR to conventional autopsy as the gold standard for the detection of (a) major pathological abnormalities related to the cause of death and (b) all diagnostic findings in five different body organ systems. Eighty two cases (53 fetuses and 29 children) underwent PMCT and PMMR prior to autopsy, at which 55 major abnormalities were identified. Significantly more PMCT than PMMR examinations were non-diagnostic (18/82 vs. 4/82; 21.9 % vs. 4.9 %, diff 17.1 % (95 % CI 6.7, 27.6; p < 0.05)). PMMR gave an accurate diagnosis in 24/55 (43.64 %; 95 % CI 31.37, 56.73 %) compared to 18/55 PMCT (32.73 %; 95 % CI 21.81, 45.90). PMCT was particularly poor in fetuses <24 weeks, with 28.6 % (8.1, 46.4 %) more non-diagnostic scans. Where both PMCT and PMMR were diagnostic, PMMR gave slightly higher diagnostic accuracy than PMCT (62.8 % vs. 59.4 %). Unenhanced PMCT has limited value in detection of major pathology primarily because of poor-quality, non-diagnostic fetal images. On this basis, PMMR should be the modality of choice for non-invasive PM imaging in fetuses and children. (orig.)

  1. Method for modeling post-mortem biometric 3D fingerprints

    Science.gov (United States)

    Rajeev, Srijith; Shreyas, Kamath K. M.; Agaian, Sos S.

    2016-05-01

    Despite the advancements of fingerprint recognition in 2-D and 3-D domain, authenticating deformed/post-mortem fingerprints continue to be an important challenge. Prior cleansing and reconditioning of the deceased finger is required before acquisition of the fingerprint. The victim's finger needs to be precisely and carefully operated by a medium to record the fingerprint impression. This process may damage the structure of the finger, which subsequently leads to higher false rejection rates. This paper proposes a non-invasive method to perform 3-D deformed/post-mortem finger modeling, which produces a 2-D rolled equivalent fingerprint for automated verification. The presented novel modeling method involves masking, filtering, and unrolling. Computer simulations were conducted on finger models with different depth variations obtained from Flashscan3D LLC. Results illustrate that the modeling scheme provides a viable 2-D fingerprint of deformed models for automated verification. The quality and adaptability of the obtained unrolled 2-D fingerprints were analyzed using NIST fingerprint software. Eventually, the presented method could be extended to other biometric traits such as palm, foot, tongue etc. for security and administrative applications.

  2. Multimodal imaging and in vivo/post mortem co-registration in rodents and non human primates

    International Nuclear Information System (INIS)

    Delzescaux, T.

    2006-01-01

    Within the framework of neuro-degenerative disease studies, animal models still remain essential for the improvement of our understanding of underlying pathological mechanisms and for the discovery and development of potential novel therapeutic approaches. The pre-clinical research especially requires the use of non-human primates models because of the similarities between their brain and Human's, whereas fundamental investigations in many areas of biology and medicine more widely involve the use of rodent models.The recent developments of in vivo imaging systems dedicated to small animals (μ-CT, μ-MRI and μ-PET) have made possible the study of brain anatomic alterations as well as the longitudinal follow-up of metabolism and neurotransmission impairments, which can be involved in neuro-degenerative diseases. In particular, μ-PET is becoming increasingly relevant to assess the efficiency of a potential candidate in the field of drug discovery and development and disease diagnosis. However, until today a few laboratories are equipped with them. Moreover, their limited spatial resolution and the lack of specific biological markers are still major limitations. As a consequence, the scientific community still needs comparative anatomical and/or functional analyses, in particular for studies concerning rodent brain. Hence, post mortem biological imaging remains the powerful, reference and predominantly technology used for small animal imaging and for the validation of in vivo imaging systems. Generally, anatomical and complementary functional information are, respectively, provided by histological staining and autoradiography of corresponding brain sections. The large variety of histological dyes (cresyl violet for Nissl bodies Congo red for amyloid plaques) and radioactive compounds ([ 14 C]Deoxyglucose for cerebral glucose metabolism, [ 14 C]leucine for cerebral protein synthesis [ 14 C]iodoantipyrine for cerebral blood flow), as well as the microscopic range of

  3. Multimodal imaging and in vivo/post mortem co-registration in rodents and non human primates

    Energy Technology Data Exchange (ETDEWEB)

    Delzescaux, T. [Service Hospitalier Frederic Joliot, Isotopic Imaging, 91 - Orsay (France)

    2006-07-01

    Within the framework of neuro-degenerative disease studies, animal models still remain essential for the improvement of our understanding of underlying pathological mechanisms and for the discovery and development of potential novel therapeutic approaches. The pre-clinical research especially requires the use of non-human primates models because of the similarities between their brain and Human's, whereas fundamental investigations in many areas of biology and medicine more widely involve the use of rodent models.The recent developments of in vivo imaging systems dedicated to small animals ({mu}-CT, {mu}-MRI and {mu}-PET) have made possible the study of brain anatomic alterations as well as the longitudinal follow-up of metabolism and neurotransmission impairments, which can be involved in neuro-degenerative diseases. In particular, {mu}-PET is becoming increasingly relevant to assess the efficiency of a potential candidate in the field of drug discovery and development and disease diagnosis. However, until today a few laboratories are equipped with them. Moreover, their limited spatial resolution and the lack of specific biological markers are still major limitations. As a consequence, the scientific community still needs comparative anatomical and/or functional analyses, in particular for studies concerning rodent brain. Hence, post mortem biological imaging remains the powerful, reference and predominantly technology used for small animal imaging and for the validation of in vivo imaging systems. Generally, anatomical and complementary functional information are, respectively, provided by histological staining and autoradiography of corresponding brain sections. The large variety of histological dyes (cresyl violet for Nissl bodies Congo red for amyloid plaques) and radioactive compounds ([{sup 14}C]Deoxyglucose for cerebral glucose metabolism, [{sup 14}C]leucine for cerebral protein synthesis [{sup 14}C]iodoantipyrine for cerebral blood flow), as well as

  4. Post-mortem MRI of the foetal spine and spinal cord

    International Nuclear Information System (INIS)

    Widjaja, E.; Whitby, E.H.; Cohen, M.; Paley, M.N.J.; Griffiths, P.D.

    2006-01-01

    Aims: To compare the findings of post-mortem magnetic resonance imaging (MRI) of the foetal spine with autopsy with a view to using post-mortem MRI as an alternative or adjunct to autopsy, particularly in foetal and neonatal cases. Materials and Methods: The brains and spines of 41 foetuses, with a gestational age range of 14-41 weeks, underwent post-mortem MRI before autopsy. Post-mortem MRI of the brain consisted of T2-weighted sequences in three orthogonal planes and MRI of the spine consisted of T2-weighted sequence in the sagittal and axial planes in all cases and coronal planes in selected cases. Results: Thirty of 41 (78%) foetal spines were found to be normal at autopsy and on post-mortem MRI. Eleven of 41 (22%) foetal spines were abnormal: eight foetuses had myelomeningocoeles and Chiari 2 deformities, one foetus had limited dorsal myeloschisis, one foetus had caudal regression syndrome, and one had diastematomyelia. The post-mortem MRI findings concurred with the autopsy findings in 10/11 of the abnormal cases, the disagreement being the case of diastematomyelia that was shown on post-mortem MRI but was not diagnosed at autopsy. Conclusions: In this series, post-mortem MRI findings agreed with the autopsy findings in 40/41(98%) cases and in one case the post-mortem MRI demonstrated an abnormality not demonstrated at autopsy

  5. Post mortem magnetic resonance imaging in the fetus, infant and child: A comparative study with conventional autopsy (MaRIAS Protocol

    Directory of Open Access Journals (Sweden)

    Thayyil Sudhin

    2011-12-01

    Full Text Available Abstract Background Minimally invasive autopsy by post mortem magnetic resonance (MR imaging has been suggested as an alternative for conventional autopsy in view of the declining consented autopsy rates. However, large prospective studies rigorously evaluating the accuracy of such an approach are lacking. We intend to compare the accuracy of a minimally invasive autopsy approach using post mortem MR imaging with that of conventional autopsy in fetuses, newborns and children for detection of the major pathological abnormalities and/or determination of the cause of death. Methods/Design We recruited 400 consecutive fetuses, newborns and children referred for conventional autopsy to one of the two participating hospitals over a three-year period. We acquired whole body post mortem MR imaging using a 1.5 T MR scanner (Avanto, Siemens Medical Solutions, Enlargen, Germany prior to autopsy. The total scan time varied between 90 to 120 minutes. Each MR image was reported by a team of four specialist radiologists (paediatric neuroradiology, paediatric cardiology, paediatric chest & abdominal imaging and musculoskeletal imaging, blinded to the autopsy data. Conventional autopsy was performed according to the guidelines set down by the Royal College of Pathologists (UK by experienced paediatric or perinatal pathologists, blinded to the MR data. The MR and autopsy data were recorded using predefined categorical variables by an independent person. Discussion Using conventional post mortem as the gold standard comparator, the MR images will be assessed for accuracy of the anatomical morphology, associated lesions, clinical usefulness of information and determination of the cause of death. The sensitivities, specificities and predictive values of post mortem MR alone and MR imaging along with other minimally invasive post mortem investigations will be presented for the final diagnosis, broad diagnostic categories and for specific diagnosis of each system

  6. Note sulla concezione del post mortem presso gli Ittiti

    DEFF Research Database (Denmark)

    Vigo, Matteo; Bellucci, Benedetta

    significato escatologico della morte; 2) la definizione dello status ultraterreno dei defunti (i.e. il diverso trattamento del defunto, ad esempio dal punto di vista cultuale, sulla base della sua condizione sociale); 3) il delineamento dei caratteri e delle funzioni delle divinità ultra-terrene; 4) la......Oggetto d’analisi di questo paper è la concezione della sfera del post-mortem presso la civiltà degli Ittiti. Lo studio delle tematiche che riguardano la concezione dell’“aldilà” nel mondo ittita, sia in senso fisico che metafisico, riveste una larga importanza nella letteratura ittitologica ed è...... stato, pertanto, diffusamente trattato. Nel presente contributo si è scelto quindi di approfondire solo alcuni aspetti della concezione dell’oltretomba, inteso come dimensione metafisica in cui il corpo del defunto giace, staziona o transita dopo la morte. I temi approfonditi saranno quindi: 1) il...

  7. Post-mortem virtual estimation of free abdominal blood volume

    International Nuclear Information System (INIS)

    Ampanozi, Garyfalia; Hatch, Gary M.; Ruder, Thomas D.; Flach, Patricia M.; Germerott, Tanja; Thali, Michael J.; Ebert, Lars C.

    2012-01-01

    Purpose: The purpose of this retrospective study was to examine the reliability of virtually estimated abdominal blood volume using segmentation from postmortem computed tomography (PMCT) data. Materials and methods: Twenty-one cases with free abdominal blood were investigated by PMCT and autopsy. The volume of the blood was estimated using a manual segmentation technique (Amira, Visage Imaging, Germany) and the results were compared to autopsy data. Six of 21 cases had undergone additional post-mortem computed tomographic angiography (PMCTA). Results: The virtually estimated abdominal blood volumes did not differ significantly from those measured at autopsy. Additional PMCTA did not bias data significantly. Conclusion: Virtual estimation of abdominal blood volume is a reliable technique. The virtual blood volume estimation is a useful tool to deliver additional information in cases where autopsy is not performed or in cases where a postmortem angiography is performed

  8. The Elusive Universal Post-Mortem Interval Formula

    Energy Technology Data Exchange (ETDEWEB)

    Vass, Arpad Alexander [ORNL

    2011-01-01

    The following manuscript details our initial attempt at developing universal post-mortem interval formulas describing human decomposition. These formulas are empirically derived from data collected over the last 20 years from the University of Tennessee's Anthropology Research Facility, in Knoxville, Tennessee, USA. Two formulas were developed (surface decomposition and burial decomposition) based on temperature, moisture, and the partial pressure of oxygen, as being three of the four primary drivers for human decomposition. It is hoped that worldwide application of these formulas to environments and situations not readily studied in Tennessee will result in interdisciplinary cooperation between scientists and law enforcement personnel that will allow for future refinements of these models leading to increased accuracy.

  9. Post-mortem toxicology in young sudden cardiac death victims

    DEFF Research Database (Denmark)

    Bjune, Thea; Risgaard, Bjarke; Kruckow, Line

    2017-01-01

    Aims: Several drugs increase the risk of ventricular fibrillation and sudden cardiac death (SCD). We aimed to investigate in detail the toxicological findings of all young SCD throughout Denmark. Methods and results: Deaths in persons aged 1-49 years were included over a 10-year period. Death...... certificates and autopsy reports were retrieved and read to identify cases of sudden death and establish cause of death. All medico-legal autopsied SCD were included and toxicological reports collected. Positive toxicology was defined as the presence of any substance (licit and/or illicit). All toxicological...... findings had previously been evaluated not to have caused the death (i.e. lethal concentrations were excluded). We identified 620 medico-legal autopsied cases of SCD, of which 77% (n = 477) were toxicologically investigated post-mortem, and 57% (n = 270) had a positive toxicology profile. Sudden cardiac...

  10. Histopathological features of post-mortem pituitaries: A retrospective analysis

    Directory of Open Access Journals (Sweden)

    Francisco José Tortosa Vallecillos

    Full Text Available SUMMARY Objective: As a result of the use of neuroimaging techniques, silent pituitary lesions are diagnosed more and more frequently; however, there are few published post-mortem studies about this gland. Incidence data of pituitary lesions are rare and in Portugal they are outdated or even non-existent. The aim of this study is to determine the prevalence of normal patterns and incidental post-mortem pituitary pathology at Centro Hospitalar Lisboa Norte, analyzing the associations with clinical data and assessing the clinical relevance of the findings. Method: We reviewed retrospectively and histologically 167 pituitaries of a consecutive series of autopsies from the Department of Pathology of this centre. They were done between 2012 and 2014, and in all cases medical records were reviewed. The morphological patterns observed, were classified into three major groups: 1 Normal histological patterns and variants; 2 Infectious-inflammatory pathology, metabolic and vascular disorders; 3 Incidental primary proliferation and secondary to systemic diseases. Results: The subjects included in this study were of all age groups (from 1 day to 91 years old, 71 were female and 96 male. Fifty-seven of these glands didn’t show any alteration; 51 showed colloid cysts arising from Rathke cleft; 44 presented hyperplasia in adenohypophysis and we identified 20 adenomas in 19 glands (immunohistochemically, eight PRL-producing and five ACTH-producing tumors, ten of which associated with obesity, 11 to hypertension and six to diabetes mellitus. There were two cases with metastasis. Conclusion: Subclinical pathology in our country is similar to that seen in other parts of the world, but at older ages.

  11. Quantification of maceration changes using post mortem MRI in fetuses

    International Nuclear Information System (INIS)

    Montaldo, P.; Addison, S.; Oliveira, V.; Lally, P. J.; Taylor, A. M.; Sebire, N. J.; Thayyil, S.; Arthurs, O. J.

    2016-01-01

    Post mortem imaging is playing an increasingly important role in perinatal autopsy, and correct interpretation of imaging changes is paramount. This is particularly important following intra-uterine fetal death, where there may be fetal maceration. The aim of this study was to investigate whether any changes seen on a whole body fetal post mortem magnetic resonance imaging (PMMR) correspond to maceration at conventional autopsy. We performed pre-autopsy PMMR in 75 fetuses using a 1.5 Tesla Siemens Avanto MR scanner (Erlangen, Germany). PMMR images were reported blinded to the clinical history and autopsy data using a numerical severity scale (0 = no maceration changes to 2 = severe maceration changes) for 6 different visceral organs (total 12). The degree of maceration at autopsy was categorized according to severity on a numerical scale (1 = no maceration to 4 = severe maceration). We also generated quantitative maps to measure the liver and lung T 2 . The mean PMMR maceration score correlated well with the autopsy maceration score (R 2 = 0.93). A PMMR score of ≥4.5 had a sensitivity of 91 %, specificity of 64 %, for detecting moderate or severe maceration at autopsy. Liver and lung T 2 were increased in fetuses with maceration scores of 3–4 in comparison to those with 1–2 (liver p = 0.03, lung p = 0.02). There was a good correlation between PMMR maceration score and the extent of maceration seen at conventional autopsy. This score may be useful in interpretation of fetal PMMR

  12. Essentials of forensic post-mortem MR imaging in adults

    Science.gov (United States)

    Ruder, T D; Thali, M J; Hatch, G M

    2014-01-01

    Post-mortem MR (PMMR) imaging is a powerful diagnostic tool with a wide scope in forensic radiology. In the past 20 years, PMMR has been used as both an adjunct and an alternative to autopsy. The role of PMMR in forensic death investigations largely depends on the rules and habits of local jurisdictions, availability of experts, financial resources, and individual case circumstances. PMMR images are affected by post-mortem changes, including position-dependent sedimentation, variable body temperature and decomposition. Investigators must be familiar with the appearance of normal findings on PMMR to distinguish them from disease or injury. Coronal whole-body images provide a comprehensive overview. Notably, short tau inversion–recovery (STIR) images enable investigators to screen for pathological fluid accumulation, to which we refer as “forensic sentinel sign”. If scan time is short, subsequent PMMR imaging may be focussed on regions with a positive forensic sentinel sign. PMMR offers excellent anatomical detail and is especially useful to visualize pathologies of the brain, heart, subcutaneous fat tissue and abdominal organs. PMMR may also be used to document skeletal injury. Cardiovascular imaging is a core area of PMMR imaging and growing evidence indicates that PMMR is able to detect ischaemic injury at an earlier stage than traditional autopsy and routine histology. The aim of this review is to present an overview of normal findings on forensic PMMR, provide general advice on the application of PMMR and summarise the current literature on PMMR imaging of the head and neck, cardiovascular system, abdomen and musculoskeletal system. PMID:24191122

  13. Usefulness of post-mortem ophthalmological endoscopy during forensic autopsy: a case report.

    Science.gov (United States)

    Tsujinaka, Masatake; Akaza, Kayoko; Nagai, Atsushi; Nakamura, Isao; Bunai, Yasuo

    2005-01-01

    Post-mortem intraocular findings in two autopsy cases with traumatic intracranial haemorrhage were obtained using an ophthalmological endoscope. The endoscopy results clearly revealed the presence of intraocular haemorrhages and papilledema caused by intracranial haemorrhage. Post-mortem ophthalmological endoscopy offers several benefits. First, post-mortem intraocular findings can be directly observed in corpses with post-mortem clouding of the cornea. Secondly, the endoscopy only requires a 0.9 mm incision in the sclera and does not require the removal of the eye from the corpse, a procedure that should be avoided for ethical and cosmetic reasons. Thus, post-mortem opthalmological endoscopy is a useful method for obtaining intraocular findings in autopsies.

  14. Application of contrast media in post-mortem imaging (CT and MRI).

    Science.gov (United States)

    Grabherr, Silke; Grimm, Jochen; Baumann, Pia; Mangin, Patrice

    2015-09-01

    The application of contrast media in post-mortem radiology differs from clinical approaches in living patients. Post-mortem changes in the vascular system and the absence of blood flow lead to specific problems that have to be considered for the performance of post-mortem angiography. In addition, interpreting the images is challenging due to technique-related and post-mortem artefacts that have to be known and that are specific for each applied technique. Although the idea of injecting contrast media is old, classic methods are not simply transferable to modern radiological techniques in forensic medicine, as they are mostly dedicated to single-organ studies or applicable only shortly after death. With the introduction of modern imaging techniques, such as post-mortem computed tomography (PMCT) and post-mortem magnetic resonance (PMMR), to forensic death investigations, intensive research started to explore their advantages and limitations compared to conventional autopsy. PMCT has already become a routine investigation in several centres, and different techniques have been developed to better visualise the vascular system and organ parenchyma in PMCT. In contrast, the use of PMMR is still limited due to practical issues, and research is now starting in the field of PMMR angiography. This article gives an overview of the problems in post-mortem contrast media application, the various classic and modern techniques, and the issues to consider by using different media.

  15. Minimally invasive autopsy employing post-mortem CT and targeted coronary angiography: evaluation of its application to a routine Coronial service.

    Science.gov (United States)

    Roberts, Ian S D; Traill, Zoe C

    2014-01-01

    Post-mortem imaging is a potential alternative to traditional medicolegal autopsy. We investigate the reduction in number of invasive autopsies required by use of post-mortem CT ± coronary angiography. A total of 120 adult deaths referred to the Coroner were investigated by CT, with coronary angiography employed only for the second series of 60 cases, in order to determine the added value of angiography. The confidence of imaging cause of death was classified as definite (no autopsy), probable, possible or unascertained. Invasive autopsy was not required in 38% of cases without coronary angiography and 70% of cases with angiography. Full autopsy, including brain dissection, was required in only 9% of cases. There was complete agreement between autopsy and radiological causes of death in the cases with a 'probable' imaging cause of death, indicating that cases for which imaging provides an accurate cause of death without autopsy were identified correctly. In two patients, CT demonstrated unsuspected fractures, not detected at subsequent autopsy. A two-thirds reduction in the number of invasive coronial autopsies can be achieved by use of post-mortem CT plus coronary angiography. At the same time, use of post-mortem CT may improve accuracy of diagnosis, particularly for traumatic deaths. © 2013 John Wiley & Sons Ltd.

  16. Stomach: ultrasonography evaluation and post mortem inspection in adult horses

    Directory of Open Access Journals (Sweden)

    Cristiano Chaves Pessoa da Veiga

    2014-06-01

    Full Text Available ABSTRACT. Veiga C.C.P., Cascon C.M., Souza B.G., Braga L.S.M., Souza V.C., Ferreira A.M.R. & Leite J.S. [Stomach: ultrasonography evaluation and post mortem inspection in adult horses.] Avaliação ultrassonográfica e anatomopatológica macroscópica do estômago de equinos destinados ao abate comercial. Revista Brasileira de Medicina Veterinária, 36(2:125-130, 2014. Instituto de Veterinária, Universidade Federal Rural do Rio de Janeiro, BR 465, km 7, Seropédica, 23890-000, RJ, Brasil. E-mail: radiovet@ufrrj.br The equine gastric ulcer syndrome (EGUS includes all symptomatic or asymptomatic cases of erosions, ulcers, gastritis, gastric emptying disorders, duodenitis, duodenal ulcers and complications of these disorders. Occupies a prominent place in the equine clinic where you can go for the death of the animal. Ultrasonography of the stomach is indicated when the animals showed clinical signs of gastric disease. The aim of this study was to describe the sonographic evaluation and macroscopic pathological findings of the stomach of adult horses intended for commercial slaughter. To this 39 intended for commercial slaughter horses were evaluated. Sonographic evaluation before slaughter transabdominal via the left side of abdomen for evaluation of the stomach was performed. After the slaughter of these animals their stomachs were collected, evaluated and photographed. The study concluded that ultrasonography identified the stomach in all animals evaluated, but did not allow a careful evaluation of the entire length of the viscera, especially the aglandular region and pleated border. All animals evaluated had injury to the gastric mucosa in different degrees. In animals evaluated, the stomach region was most affected by injuries glandular region, although the most severe lesions have been found in the ruffled border adjacent to aglandular region.

  17. O líquido cefalorraqueano no post-mortem

    Directory of Open Access Journals (Sweden)

    A. Spina-França

    1969-12-01

    Full Text Available Foi estudado o LCR de 45 cadáveres, sendo os resultados considerados em função do tempo decorrido entre o momento da morte e a colheita do LCR (TOC. Obedecendo a esse critério os casos foram assim grupados: 1 aqueles com TOC até 4 horas; 2 aqueles com TOC de 4 a 8 horas; 3 aqueles com TOC de 8 horas ou mais. Com o aumento do TOC a presença de hemácias no LCR de cadáveres se torna mais freqüente e mais intensa. A mistura de sangue ao LCR prejudica a avaliação das modificações cadavéricas de outros componentes do LCR, conforme foi demonstrado para as concentrações de cloretos glicose e proteínas totais, para o perfil protêico e para a atividade de transaminases. Assim sendo, para avaliar as modificações da composição do LCR próprias ao post-mortem devem ser considerados apenas os casos com menos de 1000 hemácias/mm³. O número normal de leucócitos foi proporcionalmente mais comum nas amostras provenientes de cadáveres cujo TOC era igual ou superior a 8 horas. A pleocitose foi observada com mais freqüência que o número normal de leucócitos, sendo mais comumente ligeira ou discreta. Quantidades superiores a 50 leucócitos/mm³ foram observadas geralmente em casos relativos a pacientes que faleceram na vigência de processos infecciosos agudos. As concentrações de cloretos e de glicose no LCR tendem a cair no postmortem e as diminuições mostraram-se, em média, tanto mais intensas quanto maior o TOC. A hipoglicorraquia foi, em média mais acentuada nos casos com pleoeitose mais intensa. A concentração de uréia tende a elevar-se de modo precoce, não tendo sido encontradas médias significativamente diversas em função do TOC. A atividade de TGO tende a elevar-se no post-mortem sendo esta elevação, em média, mais nítida a partir do grupo de casos com TOC de 4 até 8 horas. Ocorre também tendência a aumento da atividade de TGP; esta se mostrou menos intensa que a de TGO e, em média, foi mais nítida a

  18. Clarke's Isolation and identification of drugs in pharmaceuticals, body fluids, and post-mortem material

    National Research Council Canada - National Science Library

    Clarke, E. G. C; Moffat, A. C; Jackson, J. V

    1986-01-01

    This book is intended for scientists faced with the difficult problem of identifying an unknown drug in a pharmaceutical product, in a sample of tissue or body fluid from a living patient, or in post-mortem material...

  19. Post-Mortem Projections: Medieval Mystical Resurrection and the Return of Tupac Shakur

    OpenAIRE

    Spencer-Hall, Alicia

    2012-01-01

    Medieval hagiographies abound with tales of post-mortem visits and miracles by saints. The saint was a powerful religious individual both in life and in death, a conduit of divine grace and lightning rod for Christian fervour. With her post-mortem presence, the presumptive boundary between living and dead, spirit and flesh, is rent apart: showing the reality of the hereafter and shattering the fantasies of the mortal world. The phenomenon of a glorified individual returning to a worshipful co...

  20. Post-Mortem Projections: Medieval Mystical Resurrection and the Return of Tupac Shakur

    OpenAIRE

    Spencer-Hall, A.

    2012-01-01

    Medieval hagiographies abound with tales of post-mortem visits and miracles by saints. The saint was a powerful religious individual both in life and in death, a conduit of divine grace and lightning rod for Christian fervour. With her post-mortem presence, the presumptive boundary between living and dead, spirit and flesh, is rent apart: showing the reality of the hereafter and shattering the fantasies of the mortal world. The phenomenon of a glorified individual returning to ...

  1. Value of systematic post mortem radiographic examinations of fetuses - 400 cases

    Energy Technology Data Exchange (ETDEWEB)

    Kalifa, G.; Sellier, N.; Barbet, J.P.; Labbe, F.; Houette, A.

    1989-01-01

    A retrospective study of 400 cases of fetal deaths has been carried out to assess the value of systematic post mortem radiological examination. Apart from general diagnosis purpose, special attention was given to the assessment of bone age and mineralization. The results were correlated with the clinical, U.S., chromosomal and pathological data. Computerized analysis of our information show the following results: (1) The radiological examination was valuable for the final diagnosis in 13.5% of cases. (2) It brings additional information in 34.5% of cases. (3) It had no diagnostic value in 52%. Furthermore several points deserve attention such as apparition of teeth (21 weeks), calcaneum (24 weeks). Major osteoporosis was always associated with a constitutional bone disease or an infectious process. An excessive length of the upper limbs (12) was seen in 11 cases of anencephaly. We suggest that a radiological examination should not be routinely performed, when the diagnosis is otherwise obvious, but should be considered in the presence of dwarfism, or other limb abnormalities and when the gestational age is uncertain. The films provide essential information especially for further genetic counselling.

  2. Value of systematic post mortem radiographic examinations of fetuses - 400 cases

    International Nuclear Information System (INIS)

    Kalifa, G.; Sellier, N.; Barbet, J.P.; Labbe, F.; Houette, A.

    1989-01-01

    A retrospective study of 400 cases of fetal deaths has been carried out to assess the value of systematic post mortem radiological examination. Apart from general diagnosis purpose, special attention was given to the assessment of bone age and mineralization. The results were correlated with the clinical, U.S., chromosomal and pathological data. Computerized analysis of our information show the following results: (1) The radiological examination was valuable for the final diagnosis in 13.5% of cases. (2) It brings additional information in 34.5% of cases. (3) It had no diagnostic value in 52%. Furthermore several points deserve attention such as apparition of teeth (21 weeks), calcaneum (24 weeks). Major osteoporosis was always associated with a constitutional bone disease or an infectious process. An excessive length of the upper limbs (12) was seen in 11 cases of anencephaly. We suggest that a radiological examination should not be routinely performed, when the diagnosis is otherwise obvious, but should be considered in the presence of dwarfism, or other limb abnormalities and when the gestational age is uncertain. The films provide essential information especially for further genetic counselling. (orig./MG)

  3. O líquido cefalorraqueano no post-mortem The cerebrospinal fluid in the post-mortem

    Directory of Open Access Journals (Sweden)

    A. Spina-França

    1969-12-01

    Full Text Available Foi estudado o LCR de 45 cadáveres, sendo os resultados considerados em função do tempo decorrido entre o momento da morte e a colheita do LCR (TOC. Obedecendo a esse critério os casos foram assim grupados: 1 aqueles com TOC até 4 horas; 2 aqueles com TOC de 4 a 8 horas; 3 aqueles com TOC de 8 horas ou mais. Com o aumento do TOC a presença de hemácias no LCR de cadáveres se torna mais freqüente e mais intensa. A mistura de sangue ao LCR prejudica a avaliação das modificações cadavéricas de outros componentes do LCR, conforme foi demonstrado para as concentrações de cloretos glicose e proteínas totais, para o perfil protêico e para a atividade de transaminases. Assim sendo, para avaliar as modificações da composição do LCR próprias ao post-mortem devem ser considerados apenas os casos com menos de 1000 hemácias/mm³. O número normal de leucócitos foi proporcionalmente mais comum nas amostras provenientes de cadáveres cujo TOC era igual ou superior a 8 horas. A pleocitose foi observada com mais freqüência que o número normal de leucócitos, sendo mais comumente ligeira ou discreta. Quantidades superiores a 50 leucócitos/mm³ foram observadas geralmente em casos relativos a pacientes que faleceram na vigência de processos infecciosos agudos. As concentrações de cloretos e de glicose no LCR tendem a cair no postmortem e as diminuições mostraram-se, em média, tanto mais intensas quanto maior o TOC. A hipoglicorraquia foi, em média mais acentuada nos casos com pleoeitose mais intensa. A concentração de uréia tende a elevar-se de modo precoce, não tendo sido encontradas médias significativamente diversas em função do TOC. A atividade de TGO tende a elevar-se no post-mortem sendo esta elevação, em média, mais nítida a partir do grupo de casos com TOC de 4 até 8 horas. Ocorre também tendência a aumento da atividade de TGP; esta se mostrou menos intensa que a de TGO e, em média, foi mais nítida a

  4. Post-mortem imaging compared with autopsy in trauma victims--A systematic review.

    Science.gov (United States)

    Jalalzadeh, Hamid; Giannakopoulos, Georgios F; Berger, Ferco H; Fronczek, Judith; van de Goot, Frank R W; Reijnders, Udo J; Zuidema, Wietse P

    2015-12-01

    Post-mortem imaging or virtual autopsy is a rapidly advancing field of post-mortem investigations of trauma victims. In this review we evaluate the feasibility of complementation or replacement of conventional autopsy by post-mortem imaging in trauma victims. A systematic review was performed in compliance with the PRISMA guidelines. MEDLINE, Embase and Cochrane databases were systematically searched for studies published between January 2008 and January 2014, in which post-mortem imaging was compared to conventional autopsy in trauma victims. Studies were included when two or more trauma victims were investigated. Twenty-six studies were included, with a total number of 563 trauma victims. Post-mortem computer tomography (PMCT) was performed in 22 studies, post-mortem magnetic resonance imaging (PMMRI) in five studies and conventional radiography in two studies. PMCT and PMMRI both demonstrate moderate to high-grade injuries and cause of death accurately. PMCT is more sensitive than conventional autopsy or PMMRI in detecting skeletal injuries. For detecting minor organ and soft tissue injuries, autopsy remains superior to imaging. Aortic injuries are missed frequently by PMCT and PMMRI and form their main limitation. PMCT should be considered as an essential supplement to conventional autopsy in trauma victims since it detects many additional injuries. Despite some major limitations, PMCT could be used as an alternative for conventional autopsy in situations where conventional autopsy is rejected or unavailable. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Dutch guideline for clinical foetal-neonatal and paediatric post-mortem radiology, including a review of literature.

    Science.gov (United States)

    Sonnemans, L J P; Vester, M E M; Kolsteren, E E M; Erwich, J J H M; Nikkels, P G J; Kint, P A M; van Rijn, R R; Klein, W M

    2018-06-01

    Clinical post-mortem radiology is a relatively new field of expertise and not common practice in most hospitals yet. With the declining numbers of autopsies and increasing demand for quality control of clinical care, post-mortem radiology can offer a solution, or at least be complementary. A working group consisting of radiologists, pathologists and other clinical medical specialists reviewed and evaluated the literature on the diagnostic value of post-mortem conventional radiography (CR), ultrasonography, computed tomography (PMCT), magnetic resonance imaging (PMMRI), and minimally invasive autopsy (MIA). Evidence tables were built and subsequently a Dutch national evidence-based guideline for post-mortem radiology was developed. We present this evaluation of the radiological modalities in a clinical post-mortem setting, including MIA, as well as the recently published Dutch guidelines for post-mortem radiology in foetuses, neonates, and children. In general, for post-mortem radiology modalities, PMMRI is the modality of choice in foetuses, neonates, and infants, whereas PMCT is advised in older children. There is a limited role for post-mortem CR and ultrasonography. In most cases, conventional autopsy will remain the diagnostic method of choice. Based on a literature review and clinical expertise, an evidence-based guideline was developed for post-mortem radiology of foetal, neonatal, and paediatric patients. What is Known: • Post-mortem investigations serve as a quality check for the provided health care and are important for reliable epidemiological registration. • Post-mortem radiology, sometimes combined with minimally invasive techniques, is considered as an adjunct or alternative to autopsy. What is New: • We present the Dutch guidelines for post-mortem radiology in foetuses, neonates and children. • Autopsy remains the reference standard, however minimal invasive autopsy with a skeletal survey, post-mortem computed tomography, or post-mortem

  6. Late stillbirth post mortem examination in New Zealand: Maternal decision-making.

    Science.gov (United States)

    Cronin, Robin S; Li, Minglan; Wise, Michelle; Bradford, Billie; Culling, Vicki; Zuccollo, Jane; Thompson, John M D; Mitchell, Edwin A; McCowan, Lesley M E

    2018-03-05

    For parents who experience stillbirth, knowing the cause of their baby's death is important. A post mortem examination is the gold standard investigation, but little is known about what may influence parents' decisions to accept or decline. We aimed to identify factors influencing maternal decision-making about post mortem examination after late stillbirth. In the New Zealand Multicentre Stillbirth Study, 169 women with singleton pregnancies, no known abnormality at recruitment, and late stillbirth (≥28weeks gestation), from seven health regions were interviewed within six weeks of birth. The purpose of this paper was to explore factors related to post mortem examination decision-making and the reasons for declining. We asked women if they would make the same decision again. Maternal decision to decline a post mortem (70/169, 41.4%) was more common among women of Māori (adjusted odds ratio (aOR) 4.99 95% confidence interval (CI) 1.70-14.64) and Pacific (aOR 3.94 95% CI 1.47-10.54) ethnicity compared to European, and parity two or more (aOR 2.95 95% CI 1.14-7.62) compared to primiparous. The main reason for declining was that women 'did not want baby to be cut'. Ten percent (7/70) who declined said they would not make this decision again. No woman who consented regretted her decision. Ethnic differences observed in women's post mortem decision-making should be further explored in future studies. Providing information of the effect of post mortem on the baby's body and the possible emotional benefits of a post mortem may assist women faced with this decision in the future. © 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  7. Rigor mortis at the myocardium investigated by post-mortem magnetic resonance imaging.

    Science.gov (United States)

    Bonzon, Jérôme; Schön, Corinna A; Schwendener, Nicole; Zech, Wolf-Dieter; Kara, Levent; Persson, Anders; Jackowski, Christian

    2015-12-01

    Post-mortem cardiac MR exams present with different contraction appearances of the left ventricle in cardiac short axis images. It was hypothesized that the grade of post-mortem contraction may be related to the post-mortem interval (PMI) or cause of death and a phenomenon caused by internal rigor mortis that may give further insights in the circumstances of death. The cardiac contraction grade was investigated in 71 post-mortem cardiac MR exams (mean age at death 52 y, range 12-89 y; 48 males, 23 females). In cardiac short axis images the left ventricular lumen volume as well as the left ventricular myocardial volume were assessed by manual segmentation. The quotient of both (LVQ) represents the grade of myocardial contraction. LVQ was correlated to the PMI, sex, age, cardiac weight, body mass and height, cause of death and pericardial tamponade when present. In cardiac causes of death a separate correlation was investigated for acute myocardial infarction cases and arrhythmic deaths. LVQ values ranged from 1.99 (maximum dilatation) to 42.91 (maximum contraction) with a mean of 15.13. LVQ decreased slightly with increasing PMI, however without significant correlation. Pericardial tamponade positively correlated with higher LVQ values. Variables such as sex, age, body mass and height, cardiac weight and cause of death did not correlate with LVQ values. There was no difference in LVQ values for myocardial infarction without tamponade and arrhythmic deaths. Based on the observation in our investigated cases, the phenomenon of post-mortem myocardial contraction cannot be explained by the influence of the investigated variables, except for pericardial tamponade cases. Further research addressing post-mortem myocardial contraction has to focus on other, less obvious factors, which may influence the early post-mortem phase too. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Deuterium inventory in Tore Supra: reconciling particle balance and post-mortem analysis

    International Nuclear Information System (INIS)

    Tsitrone, E.; Brosset, C.; Pegourie, B.; Gauthier, E.; Bouvet, J.; Bucalossi, J.; Carpentier, S.; Corre, Y.; Delchambre, E.; Dittmar, T.; Douai, D.; Ekedahl, A.; Ghendrih, Ph.; Grisolia, C.; Grosman, A.; Gunn, J.; Hong, S.H.; Desgranges, L.; Escarguel, A.; Jacob, W.

    2009-01-01

    Fuel retention, a crucial issue for next step devices, is assessed in present-day tokamaks using two methods: particle balance performed during shots and post-mortem analysis carried out during shutdowns between experimental campaigns. Post-mortem analysis generally gives lower estimates of fuel retention than integrated particle balance. In order to understand the discrepancy between these two methods, a dedicated experimental campaign has been performed in Tore Supra to load the vessel walls with deuterium (D) and monitor the trapped D inventory through particle balance. The campaign was followed by an extensive post-mortem analysis phase of the Tore Supra limiter. This paper presents the status of the analysis phase, including the assessment of the D content in the castellated tile structure of the limiter. Indeed, using combined surface analysis techniques, it was possible to derive the relative contributions of different zones of interest on the limiter (erosion, thick deposits, thin deposits), showing that the post-mortem inventory is mainly due to codeposition (90% of the total), in particular due to gap deposits. However, deuterium was also evidenced deep into the material in erosion zones (10% of the total). At the present stage of the analysis, 50% of the inventory deduced from particle balance has been found through post-mortem analysis, a significant progress with respect to previous studies (factor 8-10 discrepancy). This shows that post-mortem analysis can be consistent with particle balance provided specific procedures are implemented (dedicated campaign followed by extensive post-mortem analysis). Both techniques are needed for a reliable assessment of fuel retention in tokamaks, giving complementary information on how much and where fuel is retained in the vessel walls.

  9. Characterisation of the metabolome of ocular tissues and post-mortem changes in the rat retina.

    Science.gov (United States)

    Tan, Shi Z; Mullard, Graham; Hollywood, Katherine A; Dunn, Warwick B; Bishop, Paul N

    2016-08-01

    Time-dependent post-mortem biochemical changes have been demonstrated in donor cornea and vitreous, but there have been no published studies to date that objectively measure post-mortem changes in the retinal metabolome over time. The aim of the study was firstly, to investigate post-mortem, time-dependent changes in the rat retinal metabolome and secondly, to compare the metabolite composition of healthy rat ocular tissues. To study post-mortem changes in the rat retinal metabolome, globes were enucleated and stored at 4 °C and sampled at 0, 2, 4, 8, 24 and 48 h post-mortem. To study the metabolite composition of rat ocular tissues, eyes were dissected immediately after culling to isolate the cornea, lens, vitreous and retina, prior to storing at -80 °C. Tissue extracts were subjected to Gas Chromatograph Mass Spectrometry (GC-MS) and Ultra High Performance Liquid Chromatography Mass Spectrometry (UHPLC-MS). Generally, the metabolic composition of the retina was stable for 8 h post-mortem when eyes were stored at 4 °C, but showed increasing changes thereafter. However, some more rapid changes were observed such as increases in TCA cycle metabolites after 2 h post-mortem, whereas some metabolites such as fatty acids only showed decreases in concentration from 24 h. A total of 42 metabolites were identified across the ocular tissues by GC-MS (MSI level 1) and 2782 metabolites were annotated by UHPLC-MS (MSI level 2) according to MSI reporting standards. Many of the metabolites detected were common to all of the tissues but some metabolites showed partitioning between different ocular structures with 655, 297, 93 and 13 metabolites being uniquely detected in the retina, lens, cornea and vitreous respectively. Only a small percentage (1.6%) of metabolites found in the vitreous were only detected in the retina and not other tissues. In conclusion, mass spectrometry-based techniques have been used for the first time to compare the metabolic composition of

  10. Utility of Post-Mortem Genetic Testing in Cases of Sudden Arrhythmic Death Syndrome

    NARCIS (Netherlands)

    Lahrouchi, Najim; Raju, Hariharan; Lodder, Elisabeth M.; Papatheodorou, Efstathios; Ware, James S.; Papadakis, Michael; Tadros, Rafik; Cole, Della; Skinner, Jonathan R.; Crawford, Jackie; Love, Donald R.; Pua, Chee J.; Soh, Bee Y.; Bhalshankar, Jaydutt D.; Govind, Risha; Tfelt-Hansen, Jacob; Winkel, Bo G.; van der Werf, Christian; Wijeyeratne, Yanushi D.; Mellor, Greg; Till, Jan; Cohen, Marta C.; Tome-Esteban, Maria; Sharma, Sanjay; Wilde, Arthur A. M.; Cook, Stuart A.; Bezzina, Connie R.; Sheppard, Mary N.; Behr, Elijah R.

    2017-01-01

    Sudden arrhythmic death syndrome (SADS) describes a sudden death with negative autopsy and toxicological analysis. Cardiac genetic disease is a likely etiology. This study investigated the clinical utility and combined yield of post-mortem genetic testing (molecular autopsy) in cases of SADS and

  11. Post-mortem cardiac diffusion tensor imaging: detection of myocardial infarction and remodeling of myofiber architecture.

    Science.gov (United States)

    Winklhofer, Sebastian; Stoeck, Christian T; Berger, Nicole; Thali, Michael; Manka, Robert; Kozerke, Sebastian; Alkadhi, Hatem; Stolzmann, Paul

    2014-11-01

    To investigate the accuracy of post-mortem diffusion tensor imaging (DTI) for the detection of myocardial infarction (MI) and to demonstrate the feasibility of helix angle (HA) calculation to study remodelling of myofibre architecture. Cardiac DTI was performed in 26 deceased subjects prior to autopsy for medicolegal reasons. Fractional anisotropy (FA) and mean diffusivity (MD) were determined. Accuracy was calculated on per-segment (AHA classification), per-territory, and per-patient basis, with pathology as reference standard. HAs were calculated and compared between healthy segments and those with MI. Autopsy demonstrated MI in 61/440 segments (13.9 %) in 12/26 deceased subjects. Healthy myocardial segments had significantly higher FA (p Analysis of HA distribution demonstrated remodelling of myofibre architecture, with significant differences between healthy segments and segments with chronic (p  0.05). Post-mortem cardiac DTI enables differentiation between healthy and infarcted myocardial segments by means of FA and MD. HA assessment allows for the demonstration of remodelling of myofibre architecture following chronic MI. • DTI enables post-mortem detection of myocardial infarction with good accuracy. • A decrease in right-handed helical fibre indicates myofibre remodelling following chronic myocardial infarction. • DTI allows for ruling out myocardial infarction by means of FA. • Post-mortem DTI may represent a valuable screening tool in forensic investigations.

  12. Utility of Post-Mortem Genetic Testing in Cases of Sudden Arrhythmic Death Syndrome

    DEFF Research Database (Denmark)

    Lahrouchi, Najim; Raju, Hariharan; Lodder, Elisabeth M

    2017-01-01

    BACKGROUND: Sudden arrhythmic death syndrome (SADS) describes a sudden death with negative autopsy and toxicological analysis. Cardiac genetic disease is a likely etiology. OBJECTIVES: This study investigated the clinical utility and combined yield of post-mortem genetic testing (molecular autopsy...

  13. Experience with post-mortem computed tomography in Southern Denmark 2006-11

    DEFF Research Database (Denmark)

    Leth, Peter Mygind

    2013-01-01

    Objectives: (1) To explore the ability of post-mortem computed tomography (PMCT) to establish the cause of death. (2) To investigate the inter-method variation between autopsy and PMCT. (3) To investigate whether PMCT can select cases for autopsy. (4) To investigate the importance of histology...

  14. 42 CFR 35.16 - Autopsies and other post-mortem operations.

    Science.gov (United States)

    2010-10-01

    ... AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.16 Autopsies and other post-mortem... to in writing by a person authorized under the law of the State in which the station or hospital is... made a part of the clinical record. [25 FR 6331, July 6, 1960] ...

  15. Current status of paediatric post-mortem imaging: an ESPR questionnaire-based survey

    Energy Technology Data Exchange (ETDEWEB)

    Arthurs, Owen J. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Radiology, London (United Kingdom); University College London, Institute of Child Health, London (United Kingdom); Rijn, Rick R. van [Academic Medical Centre, Department of Radiology, Amsterdam (Netherlands); Sebire, Neil J. [Great Ormond Street Hospital for Children, Department of Pathology, London (United Kingdom); University College London, Institute of Child Health, London (United Kingdom)

    2014-03-15

    The use of post-mortem imaging, including skeletal radiography, CT and MRI, is increasing, providing a minimally invasive alternative to conventional autopsy techniques. The development of clinical guidelines and national standards is being encouraged, particularly for cross-sectional techniques. To outline the current practice of post-mortem imaging amongst members of the European Society of Paediatric Radiology (ESPR). We e-mailed an online questionnaire of current post-mortem service provisions to members of the ESPR in January 2013. The survey included direct questions about what services were offered, the population imaged, current techniques used, imaging protocols, reporting experience and intended future involvement. Seventy-one percent (47/66) of centres from which surveys were returned reported performing some form of post-mortem imaging in children, of which 81 % perform radiographs, 51% CT and 38% MRI. Eighty-seven percent of the imaging is performed within the radiology or imaging departments, usually by radiographers (75%), and 89% is reported by radiologists, of which 64% is reported by paediatric radiologists. Overall, 72% of positive respondents have a standardised protocol for radiographs, but only 32% have such a protocol for CT and 27% for MRI. Sixty-one percent of respondents wrote that this is an important area that needs to be developed. Overall, the majority of centres provide some post-mortem imaging service, most of which is performed within an imaging department and reported by a paediatric radiologist. However, the populations imaged as well as the details of the services offered are highly variable among institutions and lack standardisation. We have identified people who would be interested in taking this work forwards. (orig.)

  16. Diagnosis delay in Libyan female breast cancer

    Directory of Open Access Journals (Sweden)

    Ermiah Eramah

    2012-08-01

    Full Text Available Abstract Aims To study the diagnosis delay and its impact on stage of disease among women with breast cancer on Libya. Methods 200 women, aged 22 to 75 years with breast cancer diagnosed during 2008–2009 were interviewed about the period from the first symptoms to the final histological diagnosis of breast cancer. This period (diagnosis time was categorized into 3 periods: 6 months. If diagnosis time was longer than 3 months, the diagnosis was considered delayed (diagnosis delay. Consultation time was the time taken to visit the general practitioner after the first symptoms. Retrospective preclinical and clinical data were collected on a form (questionnaire during an interview with each patient and from medical records. Results The median of diagnosis time was 7.5 months. Only 30.0% of patients were diagnosed within 3 months after symptoms. 14% of patients were diagnosed within 3–6 months and 56% within a period longer than 6 months. A number of factors predicted diagnosis delay: Symptoms were not considered serious in 27% of patients. Alternative therapy (therapy not associated with cancer was applied in 13.0% of the patients. Fear and shame prevented the visit to the doctor in 10% and 4.5% of patients, respectively. Inappropriate reassurance that the lump was benign was an important reason for prolongation of the diagnosis time. Diagnosis delay was associated with initial breast symptom(s that did not include a lump (p  Diagnosis delay was associated with bigger tumour size (p Conclusions Diagnosis delay is very serious problem in Libya. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer awareness and training of general practitioners to reduce breast cancer mortality by promoting early detection. The treatment guidelines should pay more attention to the early phases of breast cancer. Especially, guidelines for good practices in managing

  17. Establishing post mortem criteria for the metabolic syndrome: an autopsy based cross-sectional study.

    Science.gov (United States)

    Christensen, Martin Roest; Bugge, Anne; Malik, Mariam Elmegaard; Thomsen, Jørgen Lange; Lynnerup, Niels; Rungby, Jørgen; Banner, Jytte

    2018-01-01

    Individuals who suffer from mental illness are more prone to obesity and related co-morbidities, including the metabolic syndrome. Autopsies provide an outstanding platform for the macroscopic, microscopic and molecular-biological investigation of diseases. Autopsy-based findings may assist in the investigation of the metabolic syndrome. To utilise the vast information that an autopsy encompasses to elucidate the pathophysiology behind the syndrome further, we aimed to both develop and evaluate a method for the post mortem definition of the metabolic syndrome. Based on the nationwide Danish SURVIVE study of deceased mentally ill, we established a set of post mortem criteria for each of the harmonized criteria of the metabolic syndrome. We based the post mortem (PM) evaluation on information from the police reports and the data collected at autopsy, such as anthropometric measurements and biochemical and toxicological analyses (PM information). We compared our PM evaluation with the data from the Danish health registries [ante mortem (AM) information, considered the gold standard] from each individual. The study included 443 deceased individuals (272 male and 171 female) with a mean age of 50.4 (± 15.5) years and a median (interquartile range) post mortem interval of 114 (84-156) hours. We found no significant difference when defining the metabolic syndrome from the PM information in comparison to the AM information ( P  = 0.175). The PM evaluation yielded a high specificity (0.93) and a moderate sensitivity (0.63) with a moderate level of agreement compared to the AM evaluation (Cohen's κ = 0.51). Neither age nor post mortem interval affected the final results. Our model of a PM definition of the metabolic syndrome proved reliable when compared to the AM information. We believe that an appropriate estimate of the prevalence of the metabolic syndrome can be established post mortem. However, while neither the PM nor the AM information is exhaustive in

  18. Effect of gamma irradiation on the microstructure and post-mortem anaerobic metabolism of bovine muscle

    International Nuclear Information System (INIS)

    Yook, H.-S.; Lee, J.-W.; Lee, K.-H.; Kim, M.-K.; Song, C.-W.; Byun, M.-W.

    2001-01-01

    Experiments were performed to study the effect of gamma irradiation on morphological properties and post-mortem metabolism in bovine M. sternomandibularis with special reference to ultrastructure, shear force, pH and ATP breakdown. The shortening of sarcomere was not observed in gamma-irradiated muscle, however, the disappearance of M-line and of A- and I-bands was perceptible. During cold storage, the destruction of muscle bundles was faster in the gamma-irradiated muscle than in the non-irradiated with a dose-dependent manner. The same is true for the post mortem pH drop and ATP breakdown. So, experimental results confirmed that the anaerobic metabolism and morphological properties are noticeably affected by gamma irradiation in beef

  19. Herpetic brainstem encephalitis: report of a post-mortem case studied electron microscopically and immunohisiochemically

    Directory of Open Access Journals (Sweden)

    José Eymard Homem Pitella

    1987-03-01

    Full Text Available A post-mortem examined case of herpetic brainstem encephalitis is presented. Clinically, the patient had cephalea followed by ataxia, drowsiness and multiple palsies of some cranial nerves, developing into death in eight days. The pathologic examination of the brain showed necrotizing encephalitis in multiple foci limited to the brainstem, more distinctly in the pons and medula oblongata. The technique of immunoperoxidase revealed rare glial cells with intranuclear immunoreactivity for herpes antigen. Rare viral particles with the morphological characteristics of the herpesvirus were identified in the nuclei of neurons in 10% formol fixed material. This is the second reported case of herpetic brainstem encephalitis confirmed by post-mortem examination. The pathway used by the virus to reach the central nervous system and its posterior dissemination to the oral cavity, the orbitofrontal region and the temporal lobes as well as to the brainstem, after a period of latency and reactivation, are discussed.

  20. Post-mortem cardiac diffusion tensor imaging: detection of myocardial infarction and remodeling of myofiber architecture

    International Nuclear Information System (INIS)

    Winklhofer, Sebastian; Berger, Nicole; Stolzmann, Paul; Stoeck, Christian T.; Kozerke, Sebastian; Thali, Michael; Manka, Robert; Alkadhi, Hatem

    2014-01-01

    To investigate the accuracy of post-mortem diffusion tensor imaging (DTI) for the detection of myocardial infarction (MI) and to demonstrate the feasibility of helix angle (HA) calculation to study remodelling of myofibre architecture. Cardiac DTI was performed in 26 deceased subjects prior to autopsy for medicolegal reasons. Fractional anisotropy (FA) and mean diffusivity (MD) were determined. Accuracy was calculated on per-segment (AHA classification), per-territory, and per-patient basis, with pathology as reference standard. HAs were calculated and compared between healthy segments and those with MI. Autopsy demonstrated MI in 61/440 segments (13.9 %) in 12/26 deceased subjects. Healthy myocardial segments had significantly higher FA (p 0.05). Post-mortem cardiac DTI enablesdifferentiation between healthy and infarcted myocardial segments by means of FA and MD. HA assessment allows for the demonstration of remodelling of myofibre architecture following chronic MI. (orig.)

  1. Various methods for the estimation of the post mortem interval from Calliphoridae: A review

    Directory of Open Access Journals (Sweden)

    Ruchi Sharma

    2015-03-01

    Forensic entomology is recognized in many countries as an important tool for legal investigations. Unfortunately, it has not received much attention in India as an important investigative tool. The maggots of the flies crawling on the dead bodies are widely considered to be just another disgusting element of decay and are not collected at the time of autopsy. They can aid in death investigations (time since death, manner of death, etc.. This paper reviews the various methods of post mortem interval estimation using Calliphoridae to make the investigators, law personnel and researchers aware of the importance of entomology in criminal investigations. The various problems confronted by forensic entomologists in estimating the time since death have also been discussed and there is a need for further research in the field as well as the laborator. Correct estimation of the post mortem interval is one of the most important aspects of legal medicine.

  2. Viability and infectivity of Ichthyophonus sp. in post-mortem Pacific herring, Clupea pallasii.

    Science.gov (United States)

    Kocan, Richard; Hart, Lucas; Lewandowski, Naomi; Hershberger, Paul

    2014-12-01

    Ichthyophonus-infected Pacific herring, Clupea pallasii , were allowed to decompose in ambient seawater then serially sampled for 29 days to evaluate parasite viability and infectivity for Pacific staghorn sculpin, Leptocottus armatus . Ichthyophonus sp. was viable in decomposing herring tissues for at least 29 days post-mortem and could be transmitted via ingestion to sculpin for up to 5 days. The parasite underwent morphologic changes during the first 48 hr following death of the host that were similar to those previously reported, but as host tissue decomposition progressed, several previously un-described forms of the parasite were observed. The significance of long-term survival and continued morphologic transformation in the post-mortem host is unknown, but it could represent a saprozoic phase of the parasite life cycle that has survival value for Ichthyophonus sp.

  3. Comparing different post-mortem human samples as DNA sources for downstream genotyping and identification.

    Science.gov (United States)

    Calacal, Gayvelline C; Apaga, Dame Loveliness T; Salvador, Jazelyn M; Jimenez, Joseph Andrew D; Lagat, Ludivino J; Villacorta, Renato Pio F; Lim, Maria Cecilia F; Fortun, Raquel D R; Datar, Francisco A; De Ungria, Maria Corazon A

    2015-11-01

    The capability of DNA laboratories to perform genotyping procedures from post-mortem remains, including those that had undergone putrefaction, continues to be a challenge in the Philippines, a country characterized by very humid and warm conditions all year round. These environmental conditions accelerate the decomposition of human remains that were recovered after a disaster and those that were left abandoned after a crime. When considerable tissue decomposition of human remains has taken place, there is no other option but to extract DNA from bone and/or teeth samples. Routinely, femur shafts are obtained from recovered bodies for human identification because the calcium matrix protects the DNA contained in the osteocytes. In the Philippines, there is difficulty in collecting femur samples after natural disasters or even human-made disasters, because these events are usually characterized by a large number of fatalities. Identification of casualties is further delayed by limitation in human and material resources. Hence, it is imperative to test other types of biological samples that are easier to collect, transport, process and store. We analyzed DNA that were obtained from body fluid, bone marrow, muscle tissue, clavicle, femur, metatarsal, patella, rib and vertebral samples from five recently deceased untreated male cadavers and seven male human remains that were embalmed, buried for ∼ 1 month and then exhumed. The bodies had undergone different environmental conditions and were in various stages of putrefaction. A DNA extraction method utilizing a detergent-washing step followed by an organic procedure was used. The utility of bone marrow and vitreous fluid including bone marrow and vitreous fluid that was transferred on FTA(®) cards and subjected to autosomal STR and Y-STR DNA typing were also evaluated. DNA yield was measured and the presence or absence of PCR inhibitors in DNA extracts was assessed using Plexor(®)HY. All samples were amplified using

  4. [Inheritance rights fo the child born from post-mortem fertilization].

    Science.gov (United States)

    Iniesta Delgado, Juan José

    2008-01-01

    Spanish Law allows in the possibility of post mortem fertilization, recognizing the paternity of the deceased male. The most prominent legal effects of this fact have to do with the succession of his father. The way of fixing the child's portion in the forced succession and its protection, the question of determining his share in the inheritance and the necessity of defending his rights until the verification of the birth are some of the issues that are discussed in this article.

  5. Post-mortem changes in the physical meat quality characteristics of ...

    African Journals Online (AJOL)

    ... apparatus) of the muscle generally improved with time. The quadratic equation y = -0.0817x2 + 0.4468x + 10.477 best described (R2 = 0.32) this improvement in tenderness. The implications of this result is that fresh game meat producers can de-bone carcasses after 24 hours post mortem and leave the primal cuts to age ...

  6. Forensic aspects of incised wounds and bruises in pigs established post-mortem

    DEFF Research Database (Denmark)

    Barington, Kristiane; Jensen, Henrik Elvang

    2017-01-01

    Recognizing post-mortem (PM) changes is of crucial importance in veterinary forensic pathology. In porcine wounds established PM contradicting observations regarding infiltration of leukocytes have been described. In the present study, skin, subcutis and muscle tissue sampled from experimental pigs...... of sampling. Moreover, it was found that AM bruises free of leukocyte infiltration cannot be distinguished from PM bruises, an observation which is of crucial importance when timing bruises in forensic cases....

  7. Uses and social meanings of post-mortem photography in Colombia

    OpenAIRE

    Ana María Henao Albarracín

    2013-01-01

    This research is intended to understand the social uses and meanings of post-mortem or funeral photography between the late nineteenth and mid-twentieth century in Colombia. The article seeks to contribute to the analysis of the relationship between photography and society, and more particularly, between photography and a social representation of death, identifying the conventions and rules of this photographic practice that determine aesthetic behaviors around death.

  8. DNA methylation results depend on DNA integrity – role of post mortem interval

    Directory of Open Access Journals (Sweden)

    Mathias eRhein

    2015-05-01

    Full Text Available Major questions of neurological and psychiatric mechanisms involve the brain functions on a molecular level and cannot be easily addressed due to limitations in access to tissue samples. Post mortem studies are able to partly bridge the gap between brain tissue research retrieved from animal trials and the information derived from peripheral analysis (e.g. measurements in blood cells in patients. Here, we wanted to know how fast DNA degradation is progressing under controlled conditions in order to define thresholds for tissue quality to be used in respective trials. Our focus was on the applicability of partly degraded samples for bisulfite sequencing and the determination of simple means to define cut-off values.After opening the brain cavity, we kept two consecutive pig skulls at ambient temperature (19-21°C and removed cortex tissue up to a post mortem interval (PMI of 120h. We calculated the percentage of degradation on DNA gel electrophoresis of brain DNA to estimate quality and relate this estimation spectrum to the quality of human post-mortem control samples. Functional DNA quality was investigated by bisulfite sequencing of two functionally relevant genes for either the serotonin receptor 5 (SLC6A4 or aldehyde dehydrogenase 2 (ALDH2.Testing our approach in a heterogeneous collective of human blood and brain samples, we demonstrate integrity of measurement quality below the threshold of 72h PMI.While sequencing technically worked for all timepoints irrespective of conceivable DNA degradation, there is a good correlation between variance of methylation to degradation levels documented in the gel (R2=0.4311, p=0.0392 for advancing post mortem intervals (PMI. This otherwise elusive phenomenon is an important prerequisite for the interpretation and evaluation of samples prior to in-depth processing via an affordable and easy assay to estimate identical sample quality and thereby comparable methylation measurements.

  9. Uses and social meanings of post-mortem photography in Colombia

    Directory of Open Access Journals (Sweden)

    Ana María Henao Albarracín

    2013-06-01

    Full Text Available This research is intended to understand the social uses and meanings of post-mortem or funeral photography between the late nineteenth and mid-twentieth century in Colombia. The article seeks to contribute to the analysis of the relationship between photography and society, and more particularly, between photography and a social representation of death, identifying the conventions and rules of this photographic practice that determine aesthetic behaviors around death.

  10. The use of contrast-enhanced post Mortem CT in the detection of cardiovascular deaths.

    Directory of Open Access Journals (Sweden)

    Jonas Christoph Apitzsch

    Full Text Available OBJECTIVES: To evaluate the diagnostic value of contrast enhanced post mortem computed tomography (PMCT in comparison to non-enhanced post mortem CT in the detection of cardiovascular causes of death (COD. BACKGROUND: As autopsy rates decline, new methods to determine CODs are necessary. So contrast enhanced PMCT shall be evaluated in comparison to established non-enhanced PMCT in order to further improve the method. METHODS: In a prospective study, 20 corpses were examined using a 64-row multisclice CT (MSCT before and after intraarterial perfusion with a newly developed, barium-bearing contrast agent and ventilation of the lungs. The cause of death was determined in enhanced and unenhanced scans and a level of confidence (LOC was given by three experienced radiologists on a scale between 0 and 4. Results were compared to autopsy results as gold standard. Autopsy was performed blinded to PMCT-findings. RESULTS: The method allowed visualization of different types of cause of death. There was a significant improvement in LOC in enhanced scans compared to unenhanced scans as well as an improvement in the detection of COD. The cause of death could be determined in 19 out of 20 patients. CONCLUSIONS: PMCT is feasible and appears to be robust for diagnosing cardiovascular causes of death. When compared with unenhanced post-mortem CT intraarterial perfusion and pulmonary ventilation significantly improve visualization and diagnostic accuracy. These promising results warrant further studies.

  11. A Case Study in Support of Multiple Post Mortem Assessments (Invited Paper

    Directory of Open Access Journals (Sweden)

    Jill Pable

    2015-02-01

    Full Text Available Creative projects in various fields are often subjected to afterthe- fact 'post-mortem' assessments to better understand their successes and failures. Names for these include project retrospectives or post occupancy evaluations (POEs depending on their field of origin. This case study from the architecture field will show the utility of engaging in multiple rounds of post-mortem activities in order to assess the solution from multiple stakeholder perspectives and in doing so, more fully recognize its strengths and weaknesses. The design of a homeless shelter bedroom was subjected to two POE analyses: a 'demand side' focused study that analyzed user accommodation, and a 'supply side' study that addressed issues including budget and funding. The two POEs yielded both corroborative and contrasting findings that sometimes worked at cross purposes. Three evaluation tactics emerged that could be extended to other fields' post mortem assessment activities: 1 conduct two or more POEs; 2 vary the POE criteria so that one is deep and focused 'demand side' user analysis and the other is 'supply side' operational and installation issues; and 3 conduct the POEs over a broad time period.

  12. Assessment of coronary artery disease by post-mortem cardiac MR

    International Nuclear Information System (INIS)

    Ruder, Thomas D.; Bauer-Kreutz, Regula; Ampanozi, Garyfalia; Rosskopf, Andrea B.; Pilgrim, Thomas M.; Weber, Oliver M.; Thali, Michael J.; Hatch, Gary M.

    2012-01-01

    Objectives: Minimally invasive or virtual autopsies are being advocated as alternative to traditional autopsy, but have limited abilities to detect coronary artery disease. It was the objective of this study to assess if the occurrence of chemical shift artifacts (CSA) along the coronary arteries on non-contrast, post-mortem cardiac MR may be used to investigate coronary artery disease. Methods: We retrospectively compared autopsy and CT findings of 30 cases with significant (≥75%), insignificant (<75%), or absent coronary artery stenosis to post-mortem cardiac MR findings. The chi-square test was used to investigate if the occurrence of CSA depends on the presence or absence of stenosis. Sensitivity, specificity and predictive values were calculated for each finding. Results: CSA indicates the absence of (significant) stenosis (p < 0.001). The occurrence of paired dark bands in lieu of CSA on post-mortem cardiac MR suggests (significant) coronary arteries stenosis (p < 0.001). Both findings have a high specificity but low sensitivity. Conclusions: CSA is a marker of vessel patency. The presence of paired dark bands indicates stenosis. These criteria improve the ability of minimally invasive or virtual autopsy to detect coronary artery disease related deaths

  13. Post-mortem cardiac diffusion tensor imaging: detection of myocardial infarction and remodeling of myofiber architecture

    Energy Technology Data Exchange (ETDEWEB)

    Winklhofer, Sebastian; Berger, Nicole; Stolzmann, Paul [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); Stoeck, Christian T.; Kozerke, Sebastian [Institute for Biomedical Engineering University and ETH Zurich, Zurich (Switzerland); Thali, Michael [University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); Manka, Robert [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Institute for Biomedical Engineering University and ETH Zurich, Zurich (Switzerland); University Hospital Zurich, Clinic for Cardiology, Zurich (Switzerland); Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland)

    2014-11-15

    To investigate the accuracy of post-mortem diffusion tensor imaging (DTI) for the detection of myocardial infarction (MI) and to demonstrate the feasibility of helix angle (HA) calculation to study remodelling of myofibre architecture. Cardiac DTI was performed in 26 deceased subjects prior to autopsy for medicolegal reasons. Fractional anisotropy (FA) and mean diffusivity (MD) were determined. Accuracy was calculated on per-segment (AHA classification), per-territory, and per-patient basis, with pathology as reference standard. HAs were calculated and compared between healthy segments and those with MI. Autopsy demonstrated MI in 61/440 segments (13.9 %) in 12/26 deceased subjects. Healthy myocardial segments had significantly higher FA (p < 0.01) and lower MD (p < 0.001) compared to segments with MI. Multivariate logistic regression demonstrated that FA (p < 0.10) and MD (p = 0.01) with the covariate post-mortem time (p < 0.01) predicted MI with an accuracy of 0.73. Analysis of HA distribution demonstrated remodelling of myofibre architecture, with significant differences between healthy segments and segments with chronic (p < 0.001) but not with acute MI (p > 0.05). Post-mortem cardiac DTI enablesdifferentiation between healthy and infarcted myocardial segments by means of FA and MD. HA assessment allows for the demonstration of remodelling of myofibre architecture following chronic MI. (orig.)

  14. Effects of post mortem interval and gender in DNA base excision repair activities in rat brains

    Energy Technology Data Exchange (ETDEWEB)

    Soltys, Daniela Tathiana; Pereira, Carolina Parga Martins; Ishibe, Gabriela Naomi; Souza-Pinto, Nadja Cristhina de, E-mail: nadja@iq.usp.br

    2015-06-15

    Most human tissues used in research are of post mortem origin. This is the case for all brain samples, and due to the difficulty in obtaining a good number of samples, especially in the case of neurodegenerative diseases, male and female samples are often included in the same experimental group. However, the effects of post mortem interval (PMI) and gender differences in the endpoints being analyzed are not always fully understood, as is the case for DNA repair activities. To investigate these effects, in a controlled genetic background, base excision repair (BER) activities were measured in protein extracts obtained from Wistar rat brains from different genders and defined PMI up to 24 hours, using a novel fluorescent-based in vitro incision assay. Uracil and AP-site incision activity in nuclear and mitochondrial extracts were similar in all groups included in this study. Our results show that gender and PMI up to 24 hours have no influence in the activities of the BER proteins UDG and APE1 in rat brains. These findings demonstrate that these variables do not interfere on the BER activities included in these study, and provide a security window to work with UDG and APE1 proteins in samples of post mortem origin.

  15. Effects of post mortem interval and gender in DNA base excision repair activities in rat brains

    International Nuclear Information System (INIS)

    Soltys, Daniela Tathiana; Pereira, Carolina Parga Martins; Ishibe, Gabriela Naomi; Souza-Pinto, Nadja Cristhina de

    2015-01-01

    Most human tissues used in research are of post mortem origin. This is the case for all brain samples, and due to the difficulty in obtaining a good number of samples, especially in the case of neurodegenerative diseases, male and female samples are often included in the same experimental group. However, the effects of post mortem interval (PMI) and gender differences in the endpoints being analyzed are not always fully understood, as is the case for DNA repair activities. To investigate these effects, in a controlled genetic background, base excision repair (BER) activities were measured in protein extracts obtained from Wistar rat brains from different genders and defined PMI up to 24 hours, using a novel fluorescent-based in vitro incision assay. Uracil and AP-site incision activity in nuclear and mitochondrial extracts were similar in all groups included in this study. Our results show that gender and PMI up to 24 hours have no influence in the activities of the BER proteins UDG and APE1 in rat brains. These findings demonstrate that these variables do not interfere on the BER activities included in these study, and provide a security window to work with UDG and APE1 proteins in samples of post mortem origin

  16. Diagnosis delay in tuberculosis and its consequences

    International Nuclear Information System (INIS)

    Habibullah, S.; Sheikh, M.A.; Sadiq, A.; Anwar, T.

    2004-01-01

    Objective: To find out the average duration from onset of symptoms to the diagnosis and treatment of tuberculosis, reasons for diagnostic delay, its consequences, association of variables and formulation of recommendations. Results: In this study it was found that average time from onset of initial symptoms to diagnosis and treatment of tuberculosis was 120 days. In 64% of the patients medical practitioners were responsible for delaying the diagnosis of tuberculosis. Loss of weight in 40% and haemoptysis is 21% were the consequences of diagnostic delay of tuberculosis. Delay in the diagnosis of tuberculosis was statistically significant in those patients who consulted private practitioners, and consequences of tuberculosis were severe in those patients who consulted late. (author)

  17. Diagnosis delay in Libyan female breast cancer.

    Science.gov (United States)

    Ermiah, Eramah; Abdalla, Fathi; Buhmeida, Abdelbaset; Larbesh, Entesar; Pyrhönen, Seppo; Collan, Yrjö

    2012-08-21

    To study the diagnosis delay and its impact on stage of disease among women with breast cancer on Libya. 200 women, aged 22 to 75 years with breast cancer diagnosed during 2008-2009 were interviewed about the period from the first symptoms to the final histological diagnosis of breast cancer. This period (diagnosis time) was categorized into 3 periods: 6 months. If diagnosis time was longer than 3 months, the diagnosis was considered delayed (diagnosis delay). Consultation time was the time taken to visit the general practitioner after the first symptoms. Retrospective preclinical and clinical data were collected on a form (questionnaire) during an interview with each patient and from medical records. The median of diagnosis time was 7.5 months. Only 30.0% of patients were diagnosed within 3 months after symptoms. 14% of patients were diagnosed within 3-6 months and 56% within a period longer than 6 months. A number of factors predicted diagnosis delay: Symptoms were not considered serious in 27% of patients. Alternative therapy (therapy not associated with cancer) was applied in 13.0% of the patients. Fear and shame prevented the visit to the doctor in 10% and 4.5% of patients, respectively. Inappropriate reassurance that the lump was benign was an important reason for prolongation of the diagnosis time. Diagnosis delay was associated with initial breast symptom(s) that did not include a lump (p diagnosis, the clinical stage distribution was as follows: 9.0% stage I, 25.5% stage II, 54.0% stage III and 11.5% stage IV.Diagnosis delay was associated with bigger tumour size (p Diagnosis delay is very serious problem in Libya. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer awareness and training of general practitioners to reduce breast cancer mortality by promoting early detection. The treatment guidelines should pay more attention to the early phases of breast

  18. [Research Progress of Carrion-breeding Phorid Flies for Post-mortem Interval Estimation in Forensic Medicine].

    Science.gov (United States)

    Li, L; Feng, D X; Wu, J

    2016-10-01

    It is a difficult problem of forensic medicine to accurately estimate the post-mortem interval. Entomological approach has been regarded as an effective way to estimate the post-mortem interval. The developmental biology of carrion-breeding flies has an important position at the post-mortem interval estimation. Phorid flies are tiny and occur as the main or even the only insect evidence in relatively enclosed environments. This paper reviews the research progress of carrion-breeding phorid flies for estimating post-mortem interval in forensic medicine which includes their roles, species identification and age determination of immatures. Copyright© by the Editorial Department of Journal of Forensic Medicine.

  19. Role of biogenic amines in the post-mortem migration of Anisakis pegreffii (Nematoda: Anisakidae Dujardin, 1845) larvae into fish fillets.

    Science.gov (United States)

    Šimat, Vida; Miletić, Jelena; Bogdanović, Tanja; Poljak, Vedran; Mladineo, Ivona

    2015-12-02

    Infective third-stage larvae (L3) of nematode Anisakis spp. have been recognized as one of the major food-borne threats in lightly processed fish products in Europe, particularly in the Mediterranean region. Therefore, the effect of different storage temperatures of fish on larval post-mortem migration from visceral cavity into fillets is an important parameter to take into account when evaluating the risk for consumer safety. The European anchovy (Engraulis encrasicolus) were caught during fishing season, a subsample of fillets was checked for the presence of Anisakis larvae at capture (mean abundance=0.07), and the rest was stored at four different temperatures (-18, 0, 4 and 22°C) in order to count migrating larvae and measure the production of biogenic amines over a period of time. Larvae were identified by morphological features and molecular tools. Post-mortem migration was observed in fillets stored at 0 and 4°C after three and five days, respectively, but not at 22 and -18°C. In case of storage at 22°C for two days, at the onset of putrefaction of the visceral organs, larvae migrated out of the visceral cavity towards the fish surface. Measured pH and biogenic amine profile during storage indicated that certain biochemical conditions trigger larval migration into fillets. Likewise, migration was observed at pH ~6.4 when sensory degradation of the fish was markedly visible. Although larval migration was delayed for approximately four days at a temperature of fillet was high and statistically significant at both 0 (r=0.998, p<0.01) and 4°C (r=0.946, p<0.05). Out of eight biogenic amines measured, cadaverine and putrescine levels correlated the most with the post-mortem migration at 4°C, while tyramine levels were significant at both temperatures. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. Post-mortem detection of gasoline residues in lung tissue and heart blood of fire victims.

    Science.gov (United States)

    Pahor, Kevin; Olson, Greg; Forbes, Shari L

    2013-09-01

    The purpose of this study was to determine whether gasoline residues could be detected post-mortem in lung tissue and heart blood of fire victims. The lungs and heart blood were investigated to determine whether they were suitable samples for collection and could be collected without contamination during an autopsy. Three sets of test subjects (pig carcasses) were investigated under two different fire scenarios. Test subjects 1 were anaesthetized following animal ethics approval, inhaled gasoline vapours for a short period and then euthanized. The carcasses were clothed and placed in a house where additional gasoline was poured onto the carcass post-mortem in one fire, but not in the other. Test subjects 2 did not inhale gasoline, were clothed and placed in the house and had gasoline poured onto them in both fires. Test subjects 3 were clothed but had no exposure to gasoline either ante- or post-mortem. Following controlled burns and suppression with water, the carcasses were collected, and their lungs and heart blood were excised at a necropsy. The headspace from the samples was analysed using thermal desorption-gas chromatography-mass spectroscopy. Gasoline was identified in the lungs and heart blood from the subjects that were exposed to gasoline vapours prior to death (test subjects 1). All other samples were negative for gasoline residues. These results suggest that it is useful to analyse for volatile ignitable liquids in lung tissue and blood as it may help to determine whether a victim was alive and inhaling gases at the time of a fire.

  1. Optimisation of post mortem cardiac computed tomography compared to optical coherence tomography and histopathology - Technical note

    DEFF Research Database (Denmark)

    Falk, Erling

    2014-01-01

    . Here, a new method for optimising cardiac coronary CT with optical coherence tomography (OCT) and histopathology is presented. Materials and methods: Twenty human hearts obtained from autopsies were used. A contrast agent that solidifies after cooling was injected into the coronary arteries. CT...... of the images was also developed. Results: We have succeeded in developing a new method for post-mortem coronary CT angiography in which an autopsy heart is placed in a chest phantom to simulate clinical CT. Conclusion: The new method permits comparison of CT with OCT and histopathology. This method can also...

  2. Characteristics of human infant primary fibroblast cultures from Achilles tendons removed post-mortem

    DEFF Research Database (Denmark)

    Rohde, Marianne Cathrine; Corydon, Thomas Juhl; Hansen, Jakob

    2014-01-01

    Primary cell cultures were investigated as a tool for molecular diagnostics in a forensic setting. Fibroblast cultures had been established from human Achilles tendon resected at autopsies, from cases of sudden infant death syndrome and control infants who died in traumatic events (n=41). After...... established from post-mortem tissue are renewable sources of biological material; they can be the foundation for genetic, metabolic and other functional studies and thus constitute a valuable tool for molecular and pathophysiological investigations in biomedical and forensic sciences....

  3. Microstructural analysis of geopolymer developed from wood fly ash, post-mortem doloma refractory and metakaolin

    International Nuclear Information System (INIS)

    Moura, Jailes de Santana; Mafra, Marcio Paulo de Araujo; Rabelo, Adriano Alves; Fagury, Renata Lilian Ribeiro Portugal; Fagury Neto, Elias

    2016-01-01

    Geopolymers are one of the widely discussed topics of materials science in recent times due to its vast potential as an alternative binder material to cement. This work aimed to evaluate the microstructure of geopolymers developed from wood fly ash, post-mortem doloma refractory and metakaolin. A preliminary study has been completed and achieved significant results compressive strength: the best formulation of geopolymer paste obtained approximately 25 MPa. Microstructural analysis by scanning electron microscopy, the geopolymer paste, allowed to verify the homogeneity, distribution of components, and providing evidence of raw materials that do not respond if there was crystalline phase, porosity and density of the structure. (author)

  4. Increased concentration of. cap alpha. - and. gamma. -endorphin in post mortem hypothalamic tissue of schizophrenic patients

    Energy Technology Data Exchange (ETDEWEB)

    Wiegant, V.M.; Verhoef, C.J.; Burbach, J.P.H.; de Wied, D.

    1988-01-01

    The concentrations of ..cap alpha..-, ..beta..- and ..gamma..-endorphin were determined by radioimmunoassay in HPLC fractionated extracts of post mortem hypothalamic tissue obtained from schizophrenic patients and controls. The hypothalamic concentration of ..cap alpha..- and ..gamma..-endorphin was significantly higher in patients than in controls. No difference was found in the concentration of ..beta..-endorphin, the putative precursor of ..cap alpha..- and ..gamma..-endorphins. These results suggest a deviant metabolism of ..beta..-endorphin in the brain of schizophrenic patients. Whether this phenomenon is related to the psychopathology, or is a consequence of ante mortem farmacotherapy, remains to be established.

  5. Intravital and post-mortem CT examinations of cerebral gunshot injuries

    International Nuclear Information System (INIS)

    Schumacher, M.; Oehmichen, M.; Koenig, H.G.; Einighammer, H.; Koeln Univ.; Tuebingen Univ.; Duesseldorf Univ.

    1983-01-01

    The value of CT was assessed in 24 patients who died of cerebral gun-shot injuries and in two patients with more recent injuries in order to reconstruct the mode of injury and for adding forensic information. The post-mortem and intravital appearances are described and are compared with ultrasound rotation compound scans of the isolated brains. CT showed good agreement with pathological findings. Ultrasound produced images with an accuracy between CT and photographs of the brain specimen. Both methods are regarded as valuable additions to the pathological and forensic information concerning gunshot injuries. (orig.) [de

  6. Usos y significados sociales de la fotografía post-mortem en Colombia

    OpenAIRE

    Henao Albarracín, Ana María; Universidad Paris Ouest Nanterre La Défense, Paris, Francia

    2013-01-01

    Esta investigación tiene como finalidad conocer los usos y significados sociales de la fotografía post-mortem o fúnebre entre finales del XIX y mediados del siglo XX en Colombia. De tal forma, busca contribuir al análisis de las relaciones entre fotografía y sociedad, y más particularmente, entre la fotografía y una representación social de la muerte, identificando las convenciones y reglas de esta práctica fotográfica que determinan comportamientos estéticos alrededor de la muerte. This r...

  7. Post-mortem re-cloning of a transgenic red fluorescent protein dog.

    Science.gov (United States)

    Hong, So Gun; Koo, Ok Jae; Oh, Hyun Ju; Park, Jung Eun; Kim, Minjung; Kim, Geon-A; Park, Eun Jung; Jang, Goo; Lee, Byeong-Chun

    2011-12-01

    Recently, the world's first transgenic dogs were produced by somatic cell nuclear transfer. However, cellular senescence is a major limiting factor for producing more advanced transgenic dogs. To overcome this obstacle, we rejuvenated transgenic cells using a re-cloning technique. Fibroblasts from post-mortem red fluorescent protein (RFP) dog were reconstructed with in vivo matured oocytes and transferred into 10 surrogate dogs. One puppy was produced and confirmed as a re-cloned dog. Although the puppy was lost during birth, we successfully established a rejuvenated fibroblast cell line from this animal. The cell line was found to stably express RFP and is ready for additional genetic modification.

  8. Investigations into the analysis of the rate of decay of the compound action potentials recorded from the rat sciatic nerve after death: significance for the prediction of the post-mortem period.

    Science.gov (United States)

    Nokes, L D; Daniel, D; Flint, T; Barasi, S

    1991-01-01

    There have been a number of papers that have reported the investigations of electrical stimulation of muscle groups in order to determine the post-mortem period. To the authors knowledge, no techniques have been described that analyse the compound action potentials (CAP) of various nerve fibre groups after death. This paper reports the monitoring of both the amplitude and latency changes of the CAP recorded from a stimulated rat sciatic nerve after death. Initial results suggest that the method my be useful in determining the early post-mortem period within 1 or 2 h after death. It may also be of use in measuring nerve conduction delay in various pathological conditions that can affect the neural network; for example diabetes.

  9. Distinction between saltwater drowning and freshwater drowning by assessment of sinus fluid on post-mortem computed tomography

    International Nuclear Information System (INIS)

    Kawasumi, Yusuke; Sato, Yuki; Sato, Yumi; Ishibashi, Tadashi; Usui, Akihito; Daigaku, Nami; Hosokai, Yoshiyuki; Hayashizaki, Yoshie; Funayama, Masato

    2016-01-01

    To evaluate the difference in sinus fluid volume and density between saltwater and freshwater drowning and diagnose saltwater drowning in distinction from freshwater drowning. Ninety-three drowning cases (22 saltwater and 71 freshwater) were retrospectively investigated; all had undergone post-mortem CT and forensic autopsy. Sinus fluid volume and density were calculated using a 3D-DICOM workstation, and differences were evaluated. Diagnostic performance of these indicators for saltwater drowning was evaluated using a cut-off value calculated by receiver operating characteristic (ROC) analysis. The median sinus fluid volume was 5.68 mL in cases of saltwater drowning (range 0.08 to 37.55) and 5.46 mL in cases of freshwater drowning (0.02 to 27.68), and the average densities were 47.28 (14.26 to 75.98) HU and 32.56 (-14.38 to 77.43) HU, respectively. While sinus volume did not differ significantly (p = 0.6000), sinus density was significantly higher in saltwater than freshwater drowning cases (p = 0.0002). ROC analysis for diagnosis of saltwater drowning determined the cut-off value as 37.77 HU, with a sensitivity of 77 %, specificity of 72 %, PPV of 46 % and NPV of 91 %. The average density of sinus fluid in cases of saltwater drowning was significantly higher than in freshwater drowning cases; there was no significant difference in the sinus fluid volume. (orig.)

  10. The benefits and pitfalls of post-mortem computed tomography in forensic external examination: A retrospective study of 145 cases.

    Science.gov (United States)

    Willaume, Thibault; Farrugia, Audrey; Kieffer, Estelle-Marie; Charton, Jeanne; Geraut, Annie; Berthelon, Laurent; Bierry, Guillaume; Raul, Jean-Sébastien

    2018-05-01

    Nowadays, post-mortem computed tomography (PMCT) has become an integral part of Forensic practice. The purpose of the study was to determine PMCT impact on diagnosis of the cause of death within the context of the external examination of the body, when autopsy has, at first, not been requested. We reviewed the records of 145 cases for which unenhanced PMCT was performed in addition to the external examination of the body from January 2014 to July 2015 at the Institute of Forensic medicine in Strasbourg (France). We confronted final reports from forensic pathologist to the corresponding PMCT reports. Data were collected in a contingency table and the impact of PMCT on the final conclusions of the forensic pathologist was evaluated via a Chi 2 test. PMCT results significantly impact the final conclusions of forensic pathologist (pforensic pathologist. In other cases (traumatic death), PMCT enables fast and exhaustive lesion assessment. Lastly, there are situations where PMCT may be ineffective (intoxication, hanging or some natural deaths). Performing PMCT within the context of the external examination of the body when autopsy has, at first, not been requested could bring significant benefits in diagnosing the cause of death. The impact of PMCT varies depending on the circumstances of death. Copyright © 2018 Elsevier B.V. All rights reserved.

  11. Distinction between saltwater drowning and freshwater drowning by assessment of sinus fluid on post-mortem computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kawasumi, Yusuke; Sato, Yuki; Sato, Yumi; Ishibashi, Tadashi [Tohoku University Graduate School of Medicine, Department of Clinical Imaging, Sendai, Miyagi (Japan); Usui, Akihito; Daigaku, Nami; Hosokai, Yoshiyuki [Tohoku University Graduate School of Medicine, Department of Diagnostic Image Analysis, Sendai, Miyagi (Japan); Hayashizaki, Yoshie; Funayama, Masato [Tohoku University Graduate School of Medicine, Department of Forensic Medicine, Sendai, Miyagi (Japan)

    2016-04-15

    To evaluate the difference in sinus fluid volume and density between saltwater and freshwater drowning and diagnose saltwater drowning in distinction from freshwater drowning. Ninety-three drowning cases (22 saltwater and 71 freshwater) were retrospectively investigated; all had undergone post-mortem CT and forensic autopsy. Sinus fluid volume and density were calculated using a 3D-DICOM workstation, and differences were evaluated. Diagnostic performance of these indicators for saltwater drowning was evaluated using a cut-off value calculated by receiver operating characteristic (ROC) analysis. The median sinus fluid volume was 5.68 mL in cases of saltwater drowning (range 0.08 to 37.55) and 5.46 mL in cases of freshwater drowning (0.02 to 27.68), and the average densities were 47.28 (14.26 to 75.98) HU and 32.56 (-14.38 to 77.43) HU, respectively. While sinus volume did not differ significantly (p = 0.6000), sinus density was significantly higher in saltwater than freshwater drowning cases (p = 0.0002). ROC analysis for diagnosis of saltwater drowning determined the cut-off value as 37.77 HU, with a sensitivity of 77 %, specificity of 72 %, PPV of 46 % and NPV of 91 %. The average density of sinus fluid in cases of saltwater drowning was significantly higher than in freshwater drowning cases; there was no significant difference in the sinus fluid volume. (orig.)

  12. Post-mortem 3H-thymidine incorporation in human epidermis and oral mucosa

    International Nuclear Information System (INIS)

    Schellmann, B.

    1981-01-01

    Using the 3H-thymidine labelling method, the authors studied post-mortem incorporation activity in the epidermis and oral mucosa of corpses which were stored with their clothes on under conditions of normal room temperature (+20 0 ) and of cooling (+4 0 C). Samples were taken in the form of skin punches at 2 h or 4 h intervals, respec.. Using histo-autoradiograms, the incorporation of 3H-thymidine in dependence from the time interval between the points of time of death and sampling were determined in situe and given as the ratio of labelled cells of the germinative layer per 100 μm length of basement membrane. A linear drop of post-mortem thymidine incorporation rates in epidermis and oral mucosa was found in human corpse skin correlating with increasing temporal distance from the point of time of death. Incorporation rates in the oral mucosa were markedly higher (by a factor of 3 to 5) than those of the epidermis which agrees well with in vivo conditions. No labelling of cell nuclei, i.e. no synthetic activity of the germinative layer, could be detected in the epidermis 35-40 h after individual death at the latest (in the oral mucosa after 45-50 h). However, clear incorporation activities could be observed in the germinative layer of epidermis and oral mucosa after more than 4 d in the case of storage at +4 0 C. (orig./MG) [de

  13. Optimising imaging parameters for post mortem MR imaging of the human brain

    Energy Technology Data Exchange (ETDEWEB)

    Blamire, A.M.; Rowe, J.G.; Styles, P. [MRC Magnetic Resonance Spectroscopy Unit, Dept. of Biochemistry, Univ. of Oxford (United Kingdom); McDonald, B. [MRC Schizophrenia Research Group, Dept. of Neuropathology, Radcliffe Infirmary, Oxford (United Kingdom)

    1999-11-01

    Purpose: MR imaging of post mortem brains has the potential to yield volumetric information and define the extent of structural changes prior to pathological examination. Although standard T2-weighted clinical imaging sequences have been used for the examination of formalin-fixed brains, these protocols may not yield optimum contrast. We examined the effect of varying durations of formalin fixation on the transverse relaxation time (T2) and the tissue spin density. Material and Methods: Three post mortem brains were examined weekly during formalin fixation from the unfixed state to 35 days fixation. Standard MR spin-echo imaging was used at 5 echo times (20-100 ms) to calculate transverse relaxation time (T2) and spin density. Results: T2 decreased significantly (ANOVA, p<0.001) in both grey and white matter by 7 days fixation and there was a further (but non-significant) trend towards lower values between7 and 35 days. Grey and white matter T2 times converged with fixation. Conversely, the grey to white matter spin density ratio increased from 1.19{+-}0.01 to 1.54{+-}0.06 over five weeks of fixation. Conclusion: Our results suggest that spin density-weighted imaging sequences would provide improved grey to white matter contrast over T2-weighted sequences. (orig.)

  14. Profiling of RNA degradation for estimation of post mortem [corrected] interval.

    Directory of Open Access Journals (Sweden)

    Fernanda Sampaio-Silva

    Full Text Available An estimation of the post mortem interval (PMI is frequently touted as the Holy Grail of forensic pathology. During the first hours after death, PMI estimation is dependent on the rate of physical observable modifications including algor, rigor and livor mortis. However, these assessment methods are still largely unreliable and inaccurate. Alternatively, RNA has been put forward as a valuable tool in forensic pathology, namely to identify body fluids, estimate the age of biological stains and to study the mechanism of death. Nevertheless, the attempts to find correlation between RNA degradation and PMI have been unsuccessful. The aim of this study was to characterize the RNA degradation in different post mortem tissues in order to develop a mathematical model that can be used as coadjuvant method for a more accurate PMI determination. For this purpose, we performed an eleven-hour kinetic analysis of total extracted RNA from murine's visceral and muscle tissues. The degradation profile of total RNA and the expression levels of several reference genes were analyzed by quantitative real-time PCR. A quantitative analysis of normalized transcript levels on the former tissues allowed the identification of four quadriceps muscle genes (Actb, Gapdh, Ppia and Srp72 that were found to significantly correlate with PMI. These results allowed us to develop a mathematical model with predictive value for estimation of the PMI (confidence interval of ±51 minutes at 95% that can become an important complementary tool for traditional methods.

  15. Burned bodies: post-mortem computed tomography, an essential tool for modern forensic medicine.

    Science.gov (United States)

    Coty, J-B; Nedelcu, C; Yahya, S; Dupont, V; Rougé-Maillart, C; Verschoore, M; Ridereau Zins, C; Aubé, C

    2018-06-07

    Currently, post-mortem computed tomography (PMCT) has become an accessible and contemporary tool for forensic investigations. In the case of burn victims, it provides specific semiologies requiring a prudent understanding to differentiate between the normal post-mortem changes from heat-related changes. The aim of this pictorial essay is to provide to the radiologist the keys to establish complete and focused reports in cases of PMCT of burn victims. Thus, the radiologist must discern all the contextual divergences with the forensic history, and must be able to report all the relevant elements to answer to the forensic pathologist the following questions: Are there tomographic features that could help to identify the victim? Is there evidence of remains of biological fluids in liquid form available for toxicological analysis and DNA sampling? Is there another obvious cause of death than heat-related lesions, especially metallic foreign bodies of ballistic origin? Finally, what are the characteristic burn-related injuries seen on the corpse that should be sought during the autopsy? • CT is highly useful to find features permitting the identification of a severely burned body. • PMCT is a major asset in gunshot injuries to depict ballistic foreign bodies in the burned cadavers. • CT is able to recognise accessible blood for tests versus heat clot (air-crescent sign). • Heat-related fractures are easily differentiated from traumatic fractures. • Epidural collections with a subdural appearance are typical heat-related head lesions.

  16. Diagnostic accuracy of post-mortem magnetic resonance imaging in fetuses, children and adults: A systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Thayyil, Sudhin, E-mail: s.thayyil@ucl.ac.u [Centre for Cardiovascular Imaging, UCL Institute of Child Health, London (United Kingdom); UCL Institute for Women' s Health, London (United Kingdom); Chandrasekaran, Manigandan [UCL Institute for Women' s Health, London (United Kingdom); Chitty, Lyn S. [UCL Institute for Women' s Health, London (United Kingdom); Clinical Molecular Genetics Unit, UCL Institute of Child Health, London (United Kingdom); Wade, Angie [Medical Statistics, UCL Institute of Child Health (United Kingdom); Skordis-Worrall, Jolene [Centre for International Health and Development, UCL Institute of Child Health (United Kingdom); Bennett-Britton, Ian [Centre for International Health and Development, UCL Institute of Child Health (United Kingdom); Health Economics and Financing Program, London School of Hygiene and Tropical Medicine, London (United Kingdom); Cohen, Marta [Department of Histopathology, Sheffield Children' s Hospital, Sheffield (United Kingdom); Withby, Elspeth [Department of Academic Radiology, Sheffield Children' s Hospital, Sheffield (United Kingdom); Sebire, Neil J. [Department of Histopathology, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London (United Kingdom); Robertson, Nicola J. [UCL Institute for Women' s Health, London (United Kingdom); Taylor, Andrew M. [Centre for Cardiovascular Imaging, UCL Institute of Child Health, London (United Kingdom)

    2010-07-15

    To determine, in a systematic review, the diagnostic accuracy, acceptability and cost-effectiveness of less invasive autopsy by post-mortem MR imaging, in fetuses, children and adults. We searched Medline, Embase, the Cochrane library and reference lists to identify all studies comparing post-mortem MR imaging with conventional autopsy, published between January 1990 and March 2009. 539 abstracts were identified; 15 papers met the inclusion criteria; data from 9 studies were extracted (total: 146 fetuses, 11 children and 24 adults). In accurately identifying the final cause of death or most clinically significant abnormality, post-mortem MR imaging had a sensitivity and specificity of 69% (95% CI-56%, 80%) and 95% (95% CI-88%, 98%) in fetuses, and 28% (95% CI-13%, 47%) and 64% (95% CI-23%, 94%) in children and adults, respectively; however the published data is limited to small, heterogenous and poorly designed studies. Insufficient data is available on acceptability and economic evaluation of post-mortem MR imaging. Well designed, large, prospective studies are required to evaluate the accuracy of post-mortem MR imaging, before it can be offered as a clinical tool.

  17. Diagnostic accuracy of post-mortem magnetic resonance imaging in fetuses, children and adults: A systematic review

    International Nuclear Information System (INIS)

    Thayyil, Sudhin; Chandrasekaran, Manigandan; Chitty, Lyn S.; Wade, Angie; Skordis-Worrall, Jolene; Bennett-Britton, Ian; Cohen, Marta; Withby, Elspeth; Sebire, Neil J.; Robertson, Nicola J.; Taylor, Andrew M.

    2010-01-01

    To determine, in a systematic review, the diagnostic accuracy, acceptability and cost-effectiveness of less invasive autopsy by post-mortem MR imaging, in fetuses, children and adults. We searched Medline, Embase, the Cochrane library and reference lists to identify all studies comparing post-mortem MR imaging with conventional autopsy, published between January 1990 and March 2009. 539 abstracts were identified; 15 papers met the inclusion criteria; data from 9 studies were extracted (total: 146 fetuses, 11 children and 24 adults). In accurately identifying the final cause of death or most clinically significant abnormality, post-mortem MR imaging had a sensitivity and specificity of 69% (95% CI-56%, 80%) and 95% (95% CI-88%, 98%) in fetuses, and 28% (95% CI-13%, 47%) and 64% (95% CI-23%, 94%) in children and adults, respectively; however the published data is limited to small, heterogenous and poorly designed studies. Insufficient data is available on acceptability and economic evaluation of post-mortem MR imaging. Well designed, large, prospective studies are required to evaluate the accuracy of post-mortem MR imaging, before it can be offered as a clinical tool.

  18. The social life of the dead: The role of post-mortem examinations in medical student socialisation.

    Science.gov (United States)

    Goodwin, Dawn; Machin, Laura; Taylor, Adam

    2016-07-01

    Dissection has held a privileged position in medical education although the professional values it inculcates have been subject to intense debate. Claims vary from it generating a dehumanising level of emotional detachment, to promotion of rational and dispassionate decision-making, even to being a positive vehicle for ethical education. Social scientists have positioned dissection as a critical experience in the emotional socialisation of medical students. However, curricular revision has provoked debate about the style and quantity of anatomy teaching thus threatening this 'rite of passage' of medical students. Consequently, some UK medical schools do not employ dissection at all. In its place, observation of post-mortem examinations - a long established, if underutilised, practice - has re-emerged in an attempt to recoup aspects of anatomical knowledge that are arguably lost when dissection is omitted. Bodies for post-mortem examinations and bodies for dissection, however, have striking differences, meaning that post-mortem examinations and dissection cannot be considered comparable opportunities to learn anatomy. In this article, we explore the distinctions between dissection and post-mortem examinations. In particular, we focus on the absence of a discourse of consent, concerns about bodily integrity, how the body's shifting ontology, between object and person, disrupts students' attempts to distance themselves, and how the observation of post-mortem examinations features in the emotional socialisation of medical students. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. The toxicological significance of post-mortem drug concentrations in bile.

    Science.gov (United States)

    Ferner, Robin E; Aronson, Jeffrey K

    2018-01-01

    Some authors have proposed that post-mortem drug concentrations in bile are useful in estimating concentrations in blood. Both The International Association of Forensic Toxicologists (TIAFT) and the US Federal Aviation Administration recommend that samples of bile should be obtained in some circumstances. Furthermore, standard toxicological texts compare blood and bile concentrations, implying that concentrations in bile are of forensic value. To review the evidence on simultaneous measurements of blood and bile drug concentrations reported in the medical literature. We made a systematic search of EMBASE 1980-2016 using the search terms ("bile/" OR "exp drug bile level/concentration/") AND "drug blood level/concentration/", PubMed 1975-2017 for ("bile[tw]" OR "biliary[tw]") AND ("concentration[tw]" OR "concentrations[tw]" OR "level[tw]" OR "levels[tw]") AND "post-mortem[tw]" and also MEDLINE 1990-2016 for information on drugs whose biliary concentrations were mentioned in standard textbooks. The search was limited to human studies without language restrictions. We also examined recent reviews, indexes of relevant journals and citations in Web of Science and Google Scholar. We calculated the bile:blood concentration ratio. The searches together yielded 1031 titles with abstracts. We scanned titles and abstracts for relevance and retrieved 230, of which 161 were considered further. We excluded 49 papers because: the paper reported only one case (30 references); the data referred only to a metabolite (1); the work was published before 1980 (3); the information concerned only samples taken during life (10); or the paper referred to a toxin or unusual recreational drug (5). The remaining 112 papers provided data for analysis, with at least two observations for each of 58 drugs. Bile:blood concentration ratios: Median bile:blood concentration ratios varied from 0.18 (range 0.058-0.32) for dextromoramide to 520 (range 0.62-43,000) for buprenorphine. Median bile

  20. Histological transformations of the dental pulp as possible indicator of post mortem interval: a pilot study.

    Science.gov (United States)

    Carrasco, Patricio A; Brizuela, Claudia I; Rodriguez, Ismael A; Muñoz, Samuel; Godoy, Marianela E; Inostroza, Carolina

    2017-10-01

    The correct estimation of the post mortem interval (PMI) can be crucial on the success of a forensic investigation. Diverse methods have been used to estimate PMI, considering physical changes that occur after death, such as mortis algor, livor mortis, among others. Degradation after death of dental pulp is a complex process that has not yet been studied thoroughly. It has been described that pulp RNA degradation could be an indicator of PMI, however this study is limited to 6 days. The tooth is the hardest organ of the human body, and within is confined dental pulp. The pulp morphology is defined as a lax conjunctive tissue with great sensory innervation, abundant microcirculation and great presence of groups of cell types. The aim of this study is to describe the potential use of pulp post mortem alterations to estimate PMI, using a new methodology that will allow obtainment of pulp tissue to be used for histomorphological analysis. The current study will identify potential histological indicators in dental pulp tissue to estimate PMI in time intervals of 24h, 1 month, 3 months and 6 months. This study used 26 teeth from individuals with known PMI of 24h, 1 month, 3 months or 6 months. All samples were manipulated with the new methodology (Carrasco, P. and Inostroza C. inventors; Universidad de los Andes, assignee. Forensic identification, post mortem interval estimation and cause of death determination by recovery of dental tissue. United State patent US 61/826,558 23.05.2013) to extract pulp tissue without the destruction of the tooth. The dental pulp tissues obtained were fixed in formalin for the subsequent generation of histological sections, stained with Hematoxylin Eosin and Masson's Trichrome. All sections were observed under an optical microscope using magnifications of 10× and 40×. The microscopic analysis of the samples showed a progressive transformation of the cellular components and fibers of dental pulp along PMI. These results allowed creating a

  1. Abnormal fetal cerebral laminar organization in cobblestone complex as seen on post-mortem MRI and DTI

    International Nuclear Information System (INIS)

    Widjaja, Elysa; Geibprasert, Sasikhan; Blaser, Susan; Rayner, Tammy; Shannon, Patrick

    2009-01-01

    We report a unique case of cobblestone complex using post-mortem MR and diffusion tensor imaging to assess the laminar organization of the fetal cerebrum. The imaging findings were correlated with autopsy findings. Abnormal cortical development in cobblestone complex resulted in disruption of normal laminar organization of the fetal brain, which was seen as interruption and nodularity of the high-signal T1 cortical band with increased anisotropy and medium diffusivity extending beyond the cortical band into the cerebral mantle on post-mortem MR and diffusion tensor imaging. (orig.)

  2. Abnormal fetal cerebral laminar organization in cobblestone complex as seen on post-mortem MRI and DTI

    Energy Technology Data Exchange (ETDEWEB)

    Widjaja, Elysa; Geibprasert, Sasikhan; Blaser, Susan; Rayner, Tammy [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto (Canada); Shannon, Patrick [University of Toronto, Department of Pathology, Mount Sinai Hospital, Toronto (Canada)

    2009-08-15

    We report a unique case of cobblestone complex using post-mortem MR and diffusion tensor imaging to assess the laminar organization of the fetal cerebrum. The imaging findings were correlated with autopsy findings. Abnormal cortical development in cobblestone complex resulted in disruption of normal laminar organization of the fetal brain, which was seen as interruption and nodularity of the high-signal T1 cortical band with increased anisotropy and medium diffusivity extending beyond the cortical band into the cerebral mantle on post-mortem MR and diffusion tensor imaging. (orig.)

  3. The effect of stress and exercise on post-mortem biochemistry of Atlantic salmon and rainbow trout

    DEFF Research Database (Denmark)

    Thomas, P.M.; Pankhurst, N.W.; Bremner, Allan

    1999-01-01

    Freshwater Atlantic salmon Salmo salar and rainbow trout Oncorhynchus mykiss responded similarly to increase in water flow (exercise), reduction in holding tank water level (stress), or 30 min chasing with water level reduction (stress and exercise). Stress generally resulted in elevated plasma c...... and exercise, results in mostly transient changes in post-mortem muscle biochemistry. These changes lead to an earlier onset and resolution of rigor, and lower post-mortem muscle pH in comparison to the control. (C) 1999 The Fisheries Society of the British Isles...

  4. [Acceptance of post-mortem organ donation in Germany : Representative cross-sectional study].

    Science.gov (United States)

    Tackmann, E; Dettmer, S

    2018-02-01

    The German post-mortem organ donation rate has dropped by one third since 2010. Furthermore, 958 patients died in 2015 in Germany while waiting for an organ. To decrease organ shortage, an amendment of the transplantation law was established in 2012. An information package including an organ donor card is sent to all German citizens via the postal service. A voluntary national transplantation register was introduced in 2016 to improve transparency in the organ donation process. The influence of several transplantation scandals starting in 2012 on organ donation rates is in question. Therefore, the objective of this article is to discuss approval and objections to post-mortem organ donation among the next of kin of potential donors and the general public in Germany. Binary logistic regression of data from the 2014 survey by the Federal Centre for Health Education on attitudes towards organ and tissue donation in Germany was conducted, aiming to identify influencing factors on the likelihood of organ donor card possession. Additionally, data of the German Organ Transplantation Foundation on post-mortem organ donations in Germany in 2014 were studied to highlight reasons for approval and objections by next of kin of potential and explanted post-mortem organ donors. Methods of documentation of the deceased's will according to data of the German Organ Transplantation Foundation were analyzed. Male gender and lack of knowledge about organ donation decrease the likelihood of having an organ donor card. Of the respondents in the survey of the Federal Centre for Health Education 71.0% would donate their own organs, whereas only one third possess an organ donor card. Health insurances and physicians are the most important providers of organ donor cards in Germany. An increase in the percentage of organ donor card possession following the amendment of the transplantation law could not be observed by 2016. Fear of organ trade and unjust organ allocation are the main reasons

  5. Lipoma of the midbrain: post-mortem finding in a patient with breast cancer

    Directory of Open Access Journals (Sweden)

    Verônica Maia Gouvea

    1989-09-01

    Full Text Available Intracranial lipomas are rare, usually do not have clinical expression and are located mare frequently in the corpus callosum. Other locations include the spinal cord, midbrain tectum, superior vermis, tuber cinereum, infundibulum and more rarely cerebellopontine angle, hypothalamus, superior medullary velum and insula. We report the case of a lipoma of the left inferior colliculus which was a post-mortem finding in a woman who died of breast cancer. Although there are reports of intracranial lipomas in patients with malignant tumors there is no explanation for the co-existence of the two tumors. The present tumor also includes a segment of a nerve which is not uncommon, but a less common finding was the presence of nests of Schwann cells within it, shown by immunohistochemistry.

  6. Fuel retention in JET ITER-Like Wall from post-mortem analysis

    Energy Technology Data Exchange (ETDEWEB)

    Heinola, K., E-mail: kalle.heinola@ccfe.ac.uk [Association EURATOM-TEKES, University of Helsinki, PO Box 64, 00560 Helsinki (Finland); EURATOM/CCFE Fusion Association, Culham Science Centre, Abingdon OX14 3DB (United Kingdom); Widdowson, A. [EURATOM/CCFE Fusion Association, Culham Science Centre, Abingdon OX14 3DB (United Kingdom); Likonen, J. [Association EURATOM-TEKES, VTT, PO Box 1000, 02044 VTT, Espoo (Finland); Alves, E. [Instituto Superior Tecnico, Instituto de Plasmas e Fusao Nuclear, Universidade de Lisboa, 1049-001 Lisboa (Portugal); Baron-Wiechec, A. [EURATOM/CCFE Fusion Association, Culham Science Centre, Abingdon OX14 3DB (United Kingdom); Barradas, N. [Instituto Superior Tecnico, Instituto de Plasmas e Fusao Nuclear, Universidade de Lisboa, 1049-001 Lisboa (Portugal); Brezinsek, S. [Forschungszentrum Julich GmbH, EURATOM Association, D-52425 Julich (Germany); Catarino, N. [Instituto Superior Tecnico, Instituto de Plasmas e Fusao Nuclear, Universidade de Lisboa, 1049-001 Lisboa (Portugal); Coad, P. [EURATOM/CCFE Fusion Association, Culham Science Centre, Abingdon OX14 3DB (United Kingdom); Koivuranta, S. [Association EURATOM-TEKES, VTT, PO Box 1000, 02044 VTT, Espoo (Finland); Matthews, G.F. [EURATOM/CCFE Fusion Association, Culham Science Centre, Abingdon OX14 3DB (United Kingdom); Mayer, M. [Max-Planck Institut fur Plasmaphysik, EURATOM Association, D-85748 Garching (Germany); Petersson, P. [Royal Institute of Technology, Association EURATOM-VR, SE-10044 Stockholm (Sweden)

    2015-08-15

    Selected Ion Beam Analysis techniques applicable for detecting deuterium and heavier impurities have been used in the post-mortem analyses of tiles removed after the first JET ITER-Like Wall (JET-ILW) campaign. Over half of the retained fuel was measured in the divertor region. The highest figures for fuel retention were obtained from regions with the thickest deposited layers, i.e. in the inner divertor on top of tile 1 and on the High Field Gap Closure tile, which resides deep in the plasma scrape-off layer. Least retention was found in the main chamber high erosion regions, i.e. in the mid-plane of Inner Wall Guard Limiter. The fuel retention values found typically varied with deposition layer thicknesses. The reported retention values support the observed decrease in fuel retention obtained with gas balance experiments of JET-ILW.

  7. Plug-in Based Analysis Framework for LHC Post-Mortem Analysis

    CERN Document Server

    Gorbonosov, R; Zerlauth, M; Baggiolini, V

    2014-01-01

    Plug-in based software architectures [1] are extensible, enforce modularity and allow several teams to work in parallel. But they have certain technical and organizational challenges, which we discuss in this paper. We gained our experience when developing the Post-Mortem Analysis (PMA) system, which is a mission critical system for the Large Hadron Collider (LHC). We used a plugin-based architecture with a general-purpose analysis engine, for which physicists and equipment experts code plugins containing the analysis algorithms. We have over 45 analysis plugins developed by a dozen of domain experts. This paper focuses on the design challenges we faced in order to mitigate the risks of executing third-party code: assurance that even a badly written plugin doesn't perturb the work of the overall application; plugin execution control which allows to detect plugin misbehaviour and react; robust communication mechanism between plugins, diagnostics facilitation in case of plugin failure; testing of the plugins be...

  8. Pregnant woman and road safety: experimental crash test with post mortem human subject.

    Science.gov (United States)

    Delotte, Jerome; Behr, Michel; Thollon, Lionel; Arnoux, Pierre-Jean; Baque, Patrick; Bongain, Andre; Brunet, Christian

    2008-05-01

    Trauma affect between 3 and 7% of all pregnancies in industrialized countries, and the leading cause of these traumas is car crashes. The difficulty to appreciate physiologic and anatomic changes occurring during pregnancy explain that majority of studies were not based on anatomical data. We present a protocol to create a realistic anatomical model of pregnant woman using a post mortem human subject (PMHS). We inserted a physical model of the gravid uterus into the pelvis of a PMHS. 3D acceleration sensors were placed on the subject to measure the acceleration on different body segments. We simulated three frontal impact situations at 20 km/h between two average European cars. Two main kinematics events were identified as possible causes of injuries: lap belt loading and backrest impact. Cadaver experiments provide one interesting complementary approach to study injury mechanisms related to road accidents involving pregnant women. This anatomical accuracy makes it possible to progress in the field of safety devices.

  9. Post-mortem diagnostics in cases of sepsis. Part 1. Aetiology, epidemiology and microbiological tests

    Directory of Open Access Journals (Sweden)

    Marta Rorat

    2015-03-01

    Full Text Available Clinical practice has an effective methodology of diagnostic procedures to be followed in cases of sepsis. However, there are as yet no corresponding standards of action in post-mortem diagnostics. The scope of examinations is limited to an autopsy and histopathological tests. This situation may lead to errors in medico-legal opinions on the cause of death and in the assessment of appropriateness of medical procedures. In cases of suspected sepsis, medico-legal investigations require obtaining detailed information about the circumstances of death (including symptoms and results of intravital examinations before autopsy is performed, as well as sterile collection of specimens for microbiological tests and interpretation of their results on the basis of knowledge of epidemiology, pathophysiology and clinical progression of sepsis.

  10. The influence of body temperature on image contrast in post mortem MRI

    International Nuclear Information System (INIS)

    Ruder, Thomas D.; Hatch, Gary M.; Siegenthaler, Lea; Ampanozi, Garyfalia; Mathier, Sandra; Thali, Michael J.; Weber, Oliver M.

    2012-01-01

    Objective: To assess the temperature dependency of tissue contrast on post mortem magnetic resonance (PMMR) images both objectively and subjectively; and to visually demonstrate the changes of image contrast at various temperatures. Materials and methods: The study was approved by the responsible justice department and the ethics committee. The contrast of water, fat, and muscle was measured using regions of interest (ROI) in the orbit of 41 human corpses to assess how body temperature (range 2.1–39.8 °C) relates to image contrast of T1-weighted (T1W) and T2-weighted (T2W) sequences on PMMR. Regressions were calculated using the method of least squares. Three readers judged visible changes of image contrast subjectively by consensus. Results: There was a positive relationship between temperature and contrast on T1-weighted (T1W) images and between temperature and the contrast of fat/muscle on T2-weighted (T2W) images. There was a negative relationship between temperature and the contrast of water/fat and water/muscle on T2W images. Subjectively, the influence of temperature became visible below 20 °C on T2W images, and below 10 °C on T1W images. Conclusion: Image contrast on PMMR depends on the temperature of a corpse. Radiologists involved in post mortem imaging must be aware of temperature-related changes in MR image contrast. To preserve technical quality, scanning corpses below 10 °C should be avoided.

  11. Post-mortem changes in chicken muscle : some key biochemical processes involved in the conversion of muscle to meat

    NARCIS (Netherlands)

    Schreurs, F.J.G.

    1999-01-01

    The post mortem changes taking place in poultry muscular tissue and the resulting meat quality, until the moment of consumption of the meat by the consumer are described. Modern broiler chickens grow 'at the edge of what is metabolically possible'. This hypothesis is derived from the fact

  12. Effect of cooling rate upon processing characteristics of pork meat of different glycolysis type during post mortem ageing.

    Science.gov (United States)

    Vada, M

    1977-10-01

    Rapid chilling was applied to porcine longissimus dorsi muscles at 1 h post mortem in order to observe its effect on the quality of canned products prepared from those of different pH(1) values. The muscle from one side of each animal was removed from the carcase 50 minutes post mortem and divided into two longitudinal strips. One was chilled immediately to 13-15°C (1 h post mortem): the other after a further hour (2 h post mortem) acted as control. After the centre temperature had reached 10°C the muscles were stored in a refrigerator at 3-5°C. Compared with the control samples (chilled at 2 h p.m.), rapid chilling from 1 h p.m. caused an improvement in the water-holding capacity and the texture of pork meat, which had higher pH(1) values and was processed at 2, 4 and 48 h p.m. There was minimum brine retention and texture score if samples-both rapidly chilled and control-were processed at 24 h p.m. Although brine retention of PSE pork meat could not be increased even by rapid chilling, the texture of heat treated PSE pork showed an improvement during storage, which was more pronounced after ageing for 48 h, if PSE samples were chilled at 1 h p.m. Copyright © 1977. Published by Elsevier Ltd.

  13. Identification of discrete vascular lesions in the extremities using post-mortem computed tomography angiography – Case reports

    NARCIS (Netherlands)

    Haakma, Wieke; Rohde, Marianne; Uhrenholt, Lars; Pedersen, Michael; Boel, Lene Warner Thorup

    2017-01-01

    In this case report, we introduced post-mortem computed tomography angiography (PMCTA) in three cases suffering from vascular lesions in the upper extremities. In each subject, the third part of the axillary arteries and veins were used to catheterize the arms. The vessels were filled with a barium

  14. Post-mortem computed tomography angiography utilizing barium sulfate to identify microvascular structures : a preliminary phantom model and case study

    NARCIS (Netherlands)

    Haakma, Wieke; Rohde, Marianne; Kuster, Lidy; Uhrenholt, Lars; Pedersen, Michael; Boel, Lene Warner Thorup

    2016-01-01

    We investigated the use of computer tomography angiography (CTA) to visualize microvascular structures in a vessel-mimicking phantom and post-mortem (PM) bodies. A contrast agent was used based on 22% barium sulfate, 20% polyethylene glycol and 58% distilled water. A vessel-mimicking phantom

  15. Variation in post mortem rate of glycolyis does not necessarily affect drip loss of non-stimulated veal

    NARCIS (Netherlands)

    Hertog-Meischke, den M.J.; Klont, R.E.; Smulders, F.J.M.; Logtestijn, van J.G.

    1997-01-01

    In this study the effect of the rate of post mortem pH fall on the water-holding capacity of meat from moderately chilled veal carcasses was investigated. Also the relationship between muscle protein denaturation and drip loss of veal was examined. Three groups of 10 Friesian Holstein male veal

  16. External foam and the post-mortem period in freshwater drowning; results from a retrospective study in Amsterdam, the Netherlands.

    Science.gov (United States)

    Reijnen, G; Buster, M C; Vos, P J E; Reijnders, U J L

    2017-11-01

    Determining the time of death of bodies recovered from water can be difficult. A feature of drowning is the presence of external foam. This study describes the presence of external foam in relation to the post-mortem period. The study utilizes a database of death reports dated between January 2011 and July 2016. For bodies recovered from fresh water, the presence or absence of external foam was noted. In this study, 112 death reports are included. Of these reports, 18 mentioned external foam, which account for 16.1% of the entire study population. In the population with a post-mortem period of less than 24 h, external foam was detected in 27.7% of cases. All 18 incidents with external foam had an estimated post-mortem period of less than 24 h. In our study, external foam was only present in freshwater drowning cases with a post-mortem period of less than 24 h. Based on this finding, the presence of external foam may be useful as an additional indicator when estimating the time of death in freshwater drowning. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  17. Can we infer post mortem interval on the basis of decomposition rate? A case from a Portuguese cemetery.

    Science.gov (United States)

    Ferreira, M Teresa; Cunha, Eugénia

    2013-03-10

    Post mortem interval estimation is crucial in forensic sciences for both positive identification and reconstruction of perimortem events. However, reliable dating of skeletonized remains poses a scientific challenge since human remains decomposition involves a set of complex and highly variable processes. Many of the difficulties in determining post mortem interval and/or the permanence of a body in a specific environment relates with the lack of systematic observations and research in human body decomposition modalities in different environments. In March 2006, in order to solve a problem of misidentification, a team of the South Branch of Portuguese National Institute of Legal Medicine carried out the exhumation of 25 identified individuals buried for almost five years in the same cemetery plot. Even though all individuals shared similar post mortem intervals, they presented different stages of decomposition. In order to analyze the post mortem factors associated with the different stages of decomposition displayed by the 25 exhumed individuals, the stages of decomposition were scored. Information regarding age at death and sex of the individuals were gathered and recorded as well as data in the cause of death and grave and coffin characteristics. Although the observed distinct decay stages may be explained by the burial conditions, namely by the micro taphonomic environments, individual endogenous factors also play an important role on differential decomposition as witnessed by the present case. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  18. Reducing Delay in Diagnosis: Multistage Recommendation Tracking.

    Science.gov (United States)

    Wandtke, Ben; Gallagher, Sarah

    2017-11-01

    The purpose of this study was to determine whether a multistage tracking system could improve communication between health care providers, reducing the risk of delay in diagnosis related to inconsistent communication and tracking of radiology follow-up recommendations. Unconditional recommendations for imaging follow-up of all diagnostic imaging modalities excluding mammography (n = 589) were entered into a database and tracked through a multistage tracking system for 13 months. Tracking interventions were performed for patients for whom completion of recommended follow-up imaging could not be identified 1 month after the recommendation due date. Postintervention compliance with the follow-up recommendation required examination completion or clinical closure (i.e., biopsy, limited life expectancy or death, or subspecialist referral). Baseline radiology information system checks performed 1 month after the recommendation due date revealed timely completion of 43.1% of recommended imaging studies at our institution before intervention. Three separate tracking interventions were studied, showing effectiveness between 29.0% and 57.8%. The multistage tracking system increased the examination completion rate to 70.5% (a 52% increase) and reduced the rate of unknown follow-up compliance and the associated risk of delay in diagnosis to 13.9% (a 74% decrease). Examinations completed after tracking intervention generated revenue of 4.1 times greater than the labor cost. Performing sequential radiology recommendation tracking interventions can substantially reduce the rate of unknown follow-up compliance and add value to the health system. Unknown follow-up compliance is a risk factor for delay in diagnosis, a form of preventable medical error commonly identified in malpractice claims involving radiologists and office-based practitioners.

  19. Delay in the diagnosis of cancer

    DEFF Research Database (Denmark)

    Hansen, Rikke Pilegaard

    for a detailed description of the patients' diagnostic pathways, allowing the researchers to draw the time line from symptom onset to treatment start, and to describe the characteristics of the patients and the GPs. Existing scales were used whenever possible; otherwise, ad hoc questions were constructed....... Chaper 1 introduces the concept of delay in the diagnosis of cancer. The chapter aims to provide insight into the time interval from symptom to treatment and into the patient and GP characteristics that potentially influence this interval. In addition, the chapter gives a brief overview of cancer...

  20. Causes of Stillbirth and Time of Death in Swedish Holstein Calves Examined Post Mortem

    Directory of Open Access Journals (Sweden)

    Elvander M

    2003-09-01

    Full Text Available This study was initiated due to the observation of increasing and rather high levels of stillbirths, especially in first-calving Swedish Holstein cows (10.3%, 2002. Seventy-six Swedish Holstein calves born to heifers at 41 different farms were post mortem examined in order to investigate possible reasons for stillbirth and at what time in relation to full-term gestation they had occurred. The definition of a stillborn calf was dead at birth or within 24 h after birth after at least 260 days of gestation. Eight calves were considered as having died already in uterus. Slightly less than half of the examined calves (46.1% were classified as having died due to a difficult calving. Four calves (5.3% had different kinds of malformations (heart defects, enlarged thymus, urine bladder defect. Approximately one third of the calves (31.6% were clinically normal at full-term with no signs of malformation and born with no indication of difficulties at parturition or any other reason that could explain the stillbirth. The numbers of male and female calves were rather equally distributed within the groups. A wide variation in post mortem weights was seen in all groups, although a number of the calves in the group of clinically normal calves with unexplained reason of death were rather small and, compared with e.g. those calves categorised as having died due to a difficult calving, their average birth weight was 6 kg lower (39.9 ± 1.7 kg vs. 45.9 ± 1.5 kg, p ≤ 0.01. It was concluded that the cause of stillbirth with a non-infectious aetiology is likely to be multifactorial and difficult calving may explain only about half of the stillbirths. As much as one third of the calves seemed clinically normal with no obvious reason for death. This is a target group of calves that warrants a more thorough investigation in further studies.

  1. Practical experience in post-mortem tissue donation in consideration of the European tissue law.

    Science.gov (United States)

    Karbe, Thomas; Braun, Christian; Wulff, Birgit; Schröder, Ann Sophie; Püschel, Klaus; Bratzke, Hansjürgen; Parzeller, Markus

    2010-03-01

    In consequence of the European guidelines of safety and quality standards for the donation, retrieval, storing and distribution of human tissues and cells the purpose of tissue transplantation was implemented into German legislation in May 2007. The law came into effect on August 1st 2007 considering of the European rules. The Institutes for Legal Medicine of the University of Frankfurt/Main and the University Medical Center Hamburg-Eppendorf developed a model for tissue retrieval. The Institute of Legal Medicine (I.f.R.) at the University Medical Center Hamburg cooperates with the German Institute of Cell and Tissue Replacement (Deutsches Institut für Zell--und Gewebeersatz DIZG). Potential post-mortem tissue donors (PMTD) among the deceased are selected by standardized sets of defined criteria. The procedure is guided by the intended exclusion criteria of the tissue regulation draft (German Transplant Law TPG GewV) in accordance with the European Guideline (2006/17/EC). Following the identification of the donor and subsequent removal of tissue, the retrieved samples were sent to the DIZG, a non-profit tissue bank according to the tissue regulation. Here the final processing into transplantable tissue grafts takes place, which then results in the allocation of tissue to hospitals in Germany and other European countries. The Center of Legal Medicine at the Johann Wolfgang Goethe-University Medical Center Frankfurt/Main cooperates since 2000 with Tutogen, a pharmaceutical company. Harvesting of musculoskeletal tissues follows corresponding regulations. To verify the outcome of PMTD at the I.f.R. Hamburg, two-statistic analysis over 12 and 4 months have been implemented. Our results have shown an increasing number of potential appropriate PMTD within the second inquiry interval but a relatively small and unvaryingly rate of successful post-mortem tissue retrievals similar to the first examination period. Thus, the aim of the model developed by the I.f.R. is to

  2. The post-mortem diagnosis of vasocclusive crisis in sickle cell disease

    Directory of Open Access Journals (Sweden)

    Varsha Bhatia

    2014-09-01

    Full Text Available Sickle cell disease (SCD comprises a group of genetic blood disorders that affect the hemoglobin molecular structure, and in some cases, the association with hemoglobin synthesis. In sickle cell anemia, the replacement of glutamic acid by valine at the 6th position on the beta chain from the N terminal results in the synthesis of the abnormal hemoglobin, called hemoglobin S (HbS.

  3. Diagnostic accuracy of post-mortem MRI for thoracic abnormalities in fetuses and children

    International Nuclear Information System (INIS)

    Arthurs, Owen J.; Thayyil, Sudhin; Addison, Shea; Olsen, Oystein E.; Wade, Angie; Jones, Rod; Norman, Wendy; Taylor, Andrew M.; Scott, Rosemary J.; Robertson, Nicola J.; Chitty, Lyn S.; Sebire, Neil J.; Owens, Catherine M.

    2014-01-01

    To compare the diagnostic accuracy of post-mortem magnetic resonance imaging (PMMR) specifically for non-cardiac thoracic pathology in fetuses and children, compared with conventional autopsy. Institutional ethics approval and parental consent was obtained. A total of 400 unselected fetuses and children underwent PMMR before conventional autopsy, reported blinded to the other dataset. Of 400 non-cardiac thoracic abnormalities, 113 (28 %) were found at autopsy. Overall sensitivity and specificity (95 % confidence interval) of PMMR for any thoracic pathology was poor at 39.6 % (31.0, 48.9) and 85.5 % (80.7, 89.2) respectively, with positive predictive value (PPV) 53.7 % (42.9, 64.0) and negative predictive value (NPV) 77.0 % (71.8, 81.4). Overall agreement was 71.8 % (67.1, 76.2). PMMR was most sensitive at detecting anatomical abnormalities, including pleural effusions and lung or thoracic hypoplasia, but particularly poor at detecting infection. PMMR currently has relatively poor diagnostic detection rates for the commonest intra-thoracic pathologies identified at autopsy in fetuses and children, including respiratory tract infection and diffuse alveolar haemorrhage. The reasonable NPV suggests that normal thoracic appearances at PMMR exclude the majority of important thoracic lesions at autopsy, and so could be useful in the context of minimally invasive autopsy for detecting non-cardiac thoracic abnormalities. (orig.)

  4. Partial autolysis of μ/m-calpain during post mortem aging of chicken muscle.

    Science.gov (United States)

    Zhao, Liang; Jiang, Nanqi; Li, Miaozhen; Huang, Ming; Zhou, Guanghong

    2016-12-01

    The objective of this study was to investigate changes occurring in μ/m-calpain in post mortem chicken muscles and to determine the origin of the unknown bands found in calpain casein zymography. The unknown bands were reported with slightly greater mobility compared to conventional μ/m-calpain bands in casein zymography. Identification of these bands was accomplished using native polyacrylamide gel electrophoresis, liquid chromatography tandem mass spectrometry and with protein phosphatase treatment. Results showed that the unknown bands were corresponding to μ/m-calpain, and dephosphorylation by protein phosphatase did not change their appearance. The calpain samples were then incubated with various concentrations of Ca 2+ to determine the relationship between changes in μ/m-calpain and the appearance of the unknown bands. The products of μ/m-calpain partial autolysis were found to be consistent with the appearance of the unknown bands. Therefore, the appearance of these bands did not result from phosphorylation of μ/m-calpain as previously hypothesized, but from partial autolysis of μ/m-calpain. Also their presence suggests that μ/m-calpain undergoes partial autolysis during aging which may play certain roles in meat quality improvement. © 2016 Japanese Society of Animal Science.

  5. Audit of practice in sudden unexpected death in epilepsy (SUDEP) post mortems and neuropathological findings.

    Science.gov (United States)

    Thom, Maria; Michalak, Zuzanna; Wright, Gabriella; Dawson, Timothy; Hilton, David; Joshi, Abhijit; Diehl, Beate; Koepp, Matthias; Lhatoo, Samden; Sander, Josemir W; Sisodiya, Sanjay M

    2016-08-01

    Sudden unexpected death in epilepsy (SUDEP) is one of the leading causes of death in people with epilepsy. For classification of definite SUDEP, a post mortem (PM), including anatomical and toxicological examination, is mandatory to exclude other causes of death. We audited PM practice as well as the value of brain examination in SUDEP. We reviewed 145 PM reports in SUDEP cases from four UK neuropathology centres. Data were extracted for clinical epilepsy details, circumstances of death and neuropathological findings. Macroscopic brain abnormalities were identified in 52% of cases. Mild brain swelling was present in 28%, and microscopic pathologies relevant to cause or effect of seizures were seen in 89%. Examination based on whole fixed brains (76.6% of all PMs), and systematic regional sampling was associated with higher detection rates of underlying pathology (P detection of relevant pathology. Availability of full clinical epilepsy-related information at the time of PM could potentially further improve detection through targeted tissue sampling. Apart from confirmation of SUDEP, complete neuropathological examination contributes to evaluation of risk factors as well as helping to direct future research into underlying causes. © 2015 The Authors. Neuropathology and Applied Neurobiology published by John Wiley & Sons Ltd on behalf of British Neuropathological Society.

  6. Re-establishment of rigor mortis: evidence for a considerably longer post-mortem time span.

    Science.gov (United States)

    Crostack, Chiara; Sehner, Susanne; Raupach, Tobias; Anders, Sven

    2017-07-01

    Re-establishment of rigor mortis following mechanical loosening is used as part of the complex method for the forensic estimation of the time since death in human bodies and has formerly been reported to occur up to 8-12 h post-mortem (hpm). We recently described our observation of the phenomenon in up to 19 hpm in cases with in-hospital death. Due to the case selection (preceding illness, immobilisation), transfer of these results to forensic cases might be limited. We therefore examined 67 out-of-hospital cases of sudden death with known time points of death. Re-establishment of rigor mortis was positive in 52.2% of cases and was observed up to 20 hpm. In contrast to the current doctrine that a recurrence of rigor mortis is always of a lesser degree than its first manifestation in a given patient, muscular rigidity at re-establishment equalled or even exceeded the degree observed before dissolving in 21 joints. Furthermore, this is the first study to describe that the phenomenon appears to be independent of body or ambient temperature.

  7. Diagnostic accuracy of post-mortem MRI for thoracic abnormalities in fetuses and children

    Energy Technology Data Exchange (ETDEWEB)

    Arthurs, Owen J. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Radiology, London (United Kingdom); UCL Institute of Child Health, London (United Kingdom); Thayyil, Sudhin; Addison, Shea [Imperial College London, Perinatal Neurology and Neonatology, London (United Kingdom); Olsen, Oystein E. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Radiology, London (United Kingdom); Wade, Angie [UCL Institute of Child Health, Paediatric Epidemiology and Biostatistics Unit, London (United Kingdom); Jones, Rod; Norman, Wendy; Taylor, Andrew M. [UCL Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, London (United Kingdom); Great Ormond Street Hospital for Children NHS Foundation Trust, Cardiorespiratory Division, London (United Kingdom); Scott, Rosemary J. [University College London Hospital NHS Trust, Department of Histopathology, London (United Kingdom); Robertson, Nicola J. [UCL Institute for Women' s Health, Academic Neonatology, London (United Kingdom); Chitty, Lyn S. [UCL Institute of Child Health, Genetics and Genomic Medicine, London (United Kingdom); UCLH NHS Foundation Trusts, London (United Kingdom); Sebire, Neil J. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Histopathology, London (United Kingdom); UCL Institute of Child Health, London (United Kingdom); Owens, Catherine M. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Radiology, London (United Kingdom); UCL Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, London (United Kingdom); Great Ormond Street Hospital for Children NHS Foundation Trust, Cardiorespiratory Division, London (United Kingdom); Collaboration: Magnetic Resonance Imaging Autopsy Study (MaRIAS) Collaborative Group

    2014-11-15

    To compare the diagnostic accuracy of post-mortem magnetic resonance imaging (PMMR) specifically for non-cardiac thoracic pathology in fetuses and children, compared with conventional autopsy. Institutional ethics approval and parental consent was obtained. A total of 400 unselected fetuses and children underwent PMMR before conventional autopsy, reported blinded to the other dataset. Of 400 non-cardiac thoracic abnormalities, 113 (28 %) were found at autopsy. Overall sensitivity and specificity (95 % confidence interval) of PMMR for any thoracic pathology was poor at 39.6 % (31.0, 48.9) and 85.5 % (80.7, 89.2) respectively, with positive predictive value (PPV) 53.7 % (42.9, 64.0) and negative predictive value (NPV) 77.0 % (71.8, 81.4). Overall agreement was 71.8 % (67.1, 76.2). PMMR was most sensitive at detecting anatomical abnormalities, including pleural effusions and lung or thoracic hypoplasia, but particularly poor at detecting infection. PMMR currently has relatively poor diagnostic detection rates for the commonest intra-thoracic pathologies identified at autopsy in fetuses and children, including respiratory tract infection and diffuse alveolar haemorrhage. The reasonable NPV suggests that normal thoracic appearances at PMMR exclude the majority of important thoracic lesions at autopsy, and so could be useful in the context of minimally invasive autopsy for detecting non-cardiac thoracic abnormalities. (orig.)

  8. Breast density quantification with cone-beam CT: a post-mortem study

    International Nuclear Information System (INIS)

    Johnson, Travis; Ding, Huanjun; Le, Huy Q; Ducote, Justin L; Molloi, Sabee

    2013-01-01

    Forty post-mortem breasts were imaged with a flat-panel based cone-beam x-ray CT system at 50 kVp. The feasibility of breast density quantification has been investigated using standard histogram thresholding and an automatic segmentation method based on the fuzzy c-means algorithm (FCM). The breasts were chemically decomposed into water, lipid, and protein immediately after image acquisition was completed. The per cent fibroglandular volume (%FGV) from chemical analysis was used as the gold standard for breast density comparison. Both image-based segmentation techniques showed good precision in breast density quantification with high linear coefficients between the right and left breast of each pair. When comparing with the gold standard using %FGV from chemical analysis, Pearson's r-values were estimated to be 0.983 and 0.968 for the FCM clustering and the histogram thresholding techniques, respectively. The standard error of the estimate was also reduced from 3.92% to 2.45% by applying the automatic clustering technique. The results of the postmortem study suggested that breast tissue can be characterized in terms of water, lipid and protein contents with high accuracy by using chemical analysis, which offers a gold standard for breast density studies comparing different techniques. In the investigated image segmentation techniques, the FCM algorithm had high precision and accuracy in breast density quantification. In comparison to conventional histogram thresholding, it was more efficient and reduced inter-observer variation. (paper)

  9. Cochlear neuropathy in human presbycusis: Confocal analysis of hidden hearing loss in post-mortem tissue.

    Science.gov (United States)

    Viana, Lucas M; O'Malley, Jennifer T; Burgess, Barbara J; Jones, Dianne D; Oliveira, Carlos A C P; Santos, Felipe; Merchant, Saumil N; Liberman, Leslie D; Liberman, M Charles

    2015-09-01

    Recent animal work has suggested that cochlear synapses are more vulnerable than hair cells in both noise-induced and age-related hearing loss. This synaptopathy is invisible in conventional histopathological analysis, because cochlear nerve cell bodies in the spiral ganglion survive for years, and synaptic analysis requires special immunostaining or serial-section electron microscopy. Here, we show that the same quadruple-immunostaining protocols that allow synaptic counts, hair cell counts, neuronal counts and differentiation of afferent and efferent fibers in mouse can be applied to human temporal bones, when harvested within 9 h post-mortem and prepared as dissected whole mounts of the sensory epithelium and osseous spiral lamina. Quantitative analysis of five "normal" ears, aged 54-89 yrs, without any history of otologic disease, suggests that cochlear synaptopathy and the degeneration of cochlear nerve peripheral axons, despite a near-normal hair cell population, may be an important component of human presbycusis. Although primary cochlear nerve degeneration is not expected to affect audiometric thresholds, it may be key to problems with hearing in noise that are characteristic of declining hearing abilities in the aging ear. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Audit of practice in sudden unexpected death in epilepsy (SUDEP) post mortems and neuropathological findings

    Science.gov (United States)

    Michalak, Zuzanna; Wright, Gabriella; Dawson, Timothy; Hilton, David; Joshi, Abhijit; Diehl, Beate; Koepp, Matthias; Lhatoo, Samden; Sander, Josemir W.; Sisodiya, Sanjay M.

    2015-01-01

    Aims Sudden unexpected death in epilepsy (SUDEP) is one of the leading causes of death in people with epilepsy. For classification of definite SUDEP, a post mortem (PM), including anatomical and toxicological examination, is mandatory to exclude other causes of death. We audited PM practice as well as the value of brain examination in SUDEP. Methods We reviewed 145 PM reports in SUDEP cases from four UK neuropathology centres. Data were extracted for clinical epilepsy details, circumstances of death and neuropathological findings. Results Macroscopic brain abnormalities were identified in 52% of cases. Mild brain swelling was present in 28%, and microscopic pathologies relevant to cause or effect of seizures were seen in 89%. Examination based on whole fixed brains (76.6% of all PMs), and systematic regional sampling was associated with higher detection rates of underlying pathology (P epilepsy history and investigations. Conclusion Our findings support the contribution of examination of the whole fixed brain in SUDEP, with high rates of detection of relevant pathology. Availability of full clinical epilepsy‐related information at the time of PM could potentially further improve detection through targeted tissue sampling. Apart from confirmation of SUDEP, complete neuropathological examination contributes to evaluation of risk factors as well as helping to direct future research into underlying causes. PMID:26300477

  11. Intermittent fasting modulation of the diabetic syndrome in sand rats. III. Post-mortem investigations.

    Science.gov (United States)

    Belkacemi, Louiza; Selselet-Attou, Ghalem; Bulur, Nurdan; Louchami, Karim; Sener, Abdullah; Malaisse, Willy J

    2011-01-01

    The present report concerns several post-mortem variables examined in sand rats that were either maintained on a vegetal diet (control animals) or exposed first during a 20-day transition period to a mixed diet consisting of a fixed amount of a hypercaloric food and decreasing amounts of the vegetal food and then to a 30-day experimental period of exposure to the hypercaloric food. During the latter period, all animals were either given free access to food or fasting daily for 15 h, i.e. from 5.00 p.m. to 8.00 a.m. The body weight, liver wet weight, pancreas wet weight, plasma glucose and haemoglobin A1c concentration, plasma insulin concentration, insulinogenic index, insulin resistance HOMA, plasma cholesterol and triglyceride concentration, liver triglyceride and phospholipid content were all measured. Pancreatic islet (insulin, GLUT2) and liver (lipid droplets) histology were also examined. The main findings consisted in a lower body weight of fasting than non-fasting animals, a higher liver weight in non-diabetic and diabetic rats than in control non-fasting (but not so in fasting) animals, a decrease of pancreas weight in non-diabetic and diabetic as distinct from control animals, a fasting-induced decrease in plasma glucose, plasma insulin and insulin resistance HOMA, plasma cholesterol and triglyceride concentration and triglyceride liver content.

  12. Unusually extensive head trauma in a hydraulic elevator accident: post-mortem MSCT findings, autopsy results and scene reconstruction.

    Science.gov (United States)

    Jacobsen, Christina; Schön, Corinna A; Kneubuehl, Beat; Thali, Michael J; Aghayev, Emin

    2008-10-01

    Accidental or intentional falls from a height are a form of blunt trauma and occur frequently in forensic medicine. Reports describing elevator accidents as a small subcategory of falls from heights are rare in the medical literature and no report on injury patterns or scene reconstruction of such an accident was found. A case of an accident in a hydraulic elevator with a man falling 3m was examined using post-mortem multi-slice computed tomography (MSCT) and autopsy. The man suffered an unusually extensive trauma and died at the scene. Post-mortem MSCT examination showed a comminute fracture of the skull, the right femur and the first lumbar vertebra. Severe lacerations of the brain with epidural, subdural and subarachnoidal haemorrhages over both hemispheres were diagnosed. Autopsy confirmed these findings. To reconstruct the accident we used radiological and autopsy results as well as findings at the scene.

  13. Experimental evaluation of rigor mortis. VII. Effect of ante- and post-mortem electrocution on the evolution of rigor mortis.

    Science.gov (United States)

    Krompecher, T; Bergerioux, C

    1988-01-01

    The influence of electrocution on the evolution of rigor mortis was studied on rats. Our experiments showed that: (1) Electrocution hastens the onset of rigor mortis. After an electrocution of 90 s, a complete rigor develops already 1 h post-mortem (p.m.) compared to 5 h p.m. for the controls. (2) Electrocution hastens the passing of rigor mortis. After an electrocution of 90 s, the first significant decrease occurs at 3 h p.m. (8 h p.m. in the controls). (3) These modifications in rigor mortis evolution are less pronounced in the limbs not directly touched by the electric current. (4) In case of post-mortem electrocution, the changes are slightly less pronounced, the resistance is higher and the absorbed energy is lower as compared with the ante-mortem electrocution cases. The results are completed by two practical observations on human electrocution cases.

  14. Feather retention force in broilers ante-, peri-, and post-mortem as influenced by electrical and carbon dioxide stunning.

    Science.gov (United States)

    Buhr, R J; Cason, J A; Rowland, G N

    1997-11-01

    Stunning and slaughter trials were conducted to evaluate the influence of stunning method (electrical 50 V alternating current, CO2 gas: 0 to 40% for 90 s or 40 to 60% for 30 s) on feather retention force (FRF) in commercial broilers. Feathers from the pectoral, sternal, and femoral feather tracts were sampled with a force gauge before stunning (ante-mortem) and contralaterally either after stunning (peri-mortem from 0.5 to 4 min) or after stunning and bleeding (post-mortem from 2 to 6 min). Prior to stunning, ante-mortem FRF values varied among assigned stunning methods only for the pectoral (7%) feather tract. After stunning, peri-mortem FRF values were higher only for the sternal tract (11% for 40 to 60% CO2 for 30 s); whereas after stunning and bleeding, post-mortem FRF values were lower than ante- or peri-mortem only for the sternal tract (10% lower for 40 to 60% CO2 for 30 s). Peri- and post-mortem FRF values did not differ among stunning methods for the pectoral and femoral feather tracts. Small changes in FRF values occurred from ante-mortem to peri-mortem (-1 to +12%), and from ante-mortem to post-mortem (-2 to +8%) across stunning methods. A significant increase was determined for only the pectoral tract (7%) from ante- to peri-mortem across stunning methods. Electrically stunned broilers that were not bled gained weight in excess of the 36 feathers removed (0.16%), apparently due to body surface water pickup during the brine-stunning process, whereas CO2-stunned broilers lost weight due to excretion of cloacal contents (-0.31 to -0.98%). The change in body weight among stunning methods was significant (P defeathering efficiency may not differ after scalding.

  15. Influence of Post-Mortem Sperm Recovery Method and Extender on Unstored and Refrigerated Rooster Sperm Variables.

    Science.gov (United States)

    Villaverde-Morcillo, S; Esteso, M C; Castaño, C; Santiago-Moreno, J

    2016-02-01

    Many post-mortem sperm collection techniques have been described for mammalian species, but their use in birds is scarce. This paper compares the efficacy of two post-mortem sperm retrieval techniques - the flushing and float-out methods - in the collection of rooster sperm, in conjunction with the use of two extenders, i.e., L&R-84 medium and Lake 7.1 medium. To determine whether the protective effects of these extenders against refrigeration are different for post-mortem and ejaculated sperm, pooled ejaculated samples (procured via the massage technique) were also diluted in the above extenders. Post-mortem and ejaculated sperm variables were assessed immediately at room temperature (0 h), and after refrigeration at 5°C for 24 and 48 h. The flushing method retrieved more sperm than the float-out method (596.5 ± 75.4 million sperm vs 341.0 ± 87.6 million sperm; p < 0.05); indeed, the number retrieved by the former method was similar to that obtained by massage-induced ejaculation (630.3 ± 78.2 million sperm). For sperm collected by all methods, the L&R-84 medium provided an advantage in terms of sperm motility variables at 0 h. In the refrigerated sperm samples, however, the Lake 7.1 medium was associated with higher percentages of viable sperm, and had a greater protective effect (p < 0.05) with respect to most motility variables. In conclusion, the flushing method is recommended for collecting sperm from dead birds. If this sperm needs to be refrigerated at 5°C until analysis, Lake 7.1 medium is recommended as an extender. © 2015 Blackwell Verlag GmbH.

  16. Estimating the Post-Mortem Interval of skeletonized remains: The use of Infrared spectroscopy and Raman spectro-microscopy

    Science.gov (United States)

    Creagh, Dudley; Cameron, Alyce

    2017-08-01

    When skeletonized remains are found it becomes a police task to determine to identify the body and establish the cause of death. It assists investigators if the Post-Mortem Interval (PMI) can be established. Hitherto no reliable qualitative method of estimating the PMI has been found. A quantitative method has yet to be developed. This paper shows that IR spectroscopy and Raman microscopy have the potential to form the basis of a quantitative method.

  17. Quantification of ante-mortem hypoxic ischemic brain injury by post-mortem cerebral magnetic resonance imaging in neonatal encephalopathy.

    Science.gov (United States)

    Montaldo, Paolo; Chaban, Badr; Lally, Peter J; Sebire, Neil J; Taylor, Andrew M; Thayyil, Sudhin

    2015-11-01

    Post-mortem (PM) magnetic resonance imaging (MRI) is increasingly used as an alternative to conventional autopsy in babies dying from neonatal encephalopathy. However, the confounding effect of post-mortem changes on the detection of ante-mortem ischemic injury is unclear. We examined whether quantitative MR measurements can accurately distinguish ante-mortem ischemic brain injury from artifacts using post-mortem MRI. We compared PM brain MRI (1.5 T Siemens, Avanto) in 7 infants who died with neonatal encephalopathy (NE) of presumed hypoxic-ischemic origin with 7 newborn infants who had sudden unexplained neonatal death (SUND controls) without evidence of hypoxic-ischemic brain injury at autopsy. We measured apparent diffusion coefficients (ADCs), T1-weighted signal intensity ratios (SIRs) compared to vitreous humor and T2 relaxation times from 19 predefined brain areas typically involved in neonatal encephalopathy. There were no differences in mean ADC values, SIRs on T1-weighted images or T2 relaxation times in any of the 19 predefined brain areas between NE and SUND infants. All MRI images showed loss of cortical gray/white matter differentiation, loss of the normal high signal intensity (SI) in the posterior limb of the internal capsule on T1-weighted images, and high white matter SI on T2-weighted images. Normal post-mortem changes may be easily mistaken for ante-mortem ischemic injury, and current PM MRI quantitative assessment cannot reliably distinguish these. These findings may have important implications for appropriate interpretation of PM imaging findings, especially in medico-legal practice. Copyright © 2015 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  18. Joint analysis of three-dimensional anatomical and functional data considering the cerebral post mortem imaging in rodents

    International Nuclear Information System (INIS)

    Dubois, Albertine

    2008-01-01

    The recent development of dedicated small animal anatomical (MRI) and functional (micro-PET) scanners has opened up the possibility of performing repeated functional in vivo studies in the same animal as the longitudinal follow-up of cerebral glucose metabolism. However, these systems still suffer technical limitations including a limited sensitivity and a reduced spatial resolution. Hence, autoradiography and histological studies remain the reference and widely used techniques for biological studies in small animals. The major disadvantage of these post mortem imaging techniques is that they require brain tissue sectioning, entailing the production of large numbers (up to several hundreds) of serial sections and the inherent loss of three-dimensional (3D) spatial consistency. The first step towards improving the analysis of this post mortem information was the development of reliable, automated procedures for the 3D reconstruction of the whole brain sections. We first developed an optimized data acquisition from large numbers of post mortem data (2D sections and block-face photographs). Then, we proposed different strategies of 3D reconstruction of the corresponding volumes. We also addressed the histological to autoradiographic sections and to block-face photographs co-registration problem (the photographic volume is intrinsically spatially consistent). These developments were essential for the 3D reconstruction but also enabled the evaluation of different methods of functional data analysis, from the most straightforward (manual delineation of regions of interest) to the most automated (Statistical Parametric Mapping-like approaches for group analysis). Two biological applications were carried out: visual stimulation in rats and cerebral metabolism in a transgenic mouse model of Alzheimer's disease. One perspective of this work is to match reconstructed post mortem data with in vivo images of the same animal. (author) [fr

  19. Towards muscle-specific meat color stability of Chinese Luxi yellow cattle: A proteomic insight into post-mortem storage.

    Science.gov (United States)

    Wu, Wei; Yu, Qian-Qian; Fu, Yu; Tian, Xiao-Jing; Jia, Fei; Li, Xing-Min; Dai, Rui-Tong

    2016-09-16

    Searching for potential predictors of meat color is a challenging task for the meat industry. In this study, the relationship between meat color parameters and the sarcoplasmic proteome of M. longissimuss lumborum (LL) and M. psoas major (PM) from Chinese Luxi yellow cattle during post-mortem storage (0, 5, 10 and 15days) were explored with the aid of the integrated proteomics and bioinformatics approaches. Meat color attributes revealed that LL displayed better color stability than PM during storage. Furthermore, sarcoplasmic proteins of these two muscles were compared between days 5, 10, 15 and day 0. Several proteins were closely correlated with meat color attributes and they were muscle-specific and responsible for the meat color stability at different storage periods. Glycerol-3-phosphate dehydrogenase, fructose-bisphosphate aldolase A isoform, glycogen phosphorylase, peroxiredoxin-2, phosphoglucomutase-1, superoxide dismutase [Cu-Zn], heat shock cognate protein (71kDa) might serve as the candidate predictors of meat color stability during post-mortem storage. In addition, bioinformatics analyses indicated that more proteins were involved in glycolytic metabolism of LL, which contributed to better meat color stability of LL than PM. The present results could provide a proteomic insight into muscle-specific meat color stability of Chinese Luxi yellow cattle during post-mortem storage. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. Changes of microbial spoilage, lipid-protein oxidation and physicochemical properties during post mortem refrigerated storage of goat meat.

    Science.gov (United States)

    Sabow, Azad Behnan; Sazili, Awis Qurni; Aghwan, Zeiad Amjad; Zulkifli, Idrus; Goh, Yong Meng; Ab Kadir, Mohd Zainal Abidin; Nakyinsige, Khadijah; Kaka, Ubedullah; Adeyemi, Kazeem Dauda

    2016-06-01

    Examined was the effect of post mortem refrigerated storage on microbial spoilage, lipid-protein oxidation and physicochemical traits of goat meat. Seven Boer bucks were slaughtered, eviscerated and aged for 24 h. The Longissimus lumborum (LL) and Semitendinosus (ST) muscles were excised and subjected to 13 days post mortem refrigerated storage. The pH, lipid and protein oxidation, tenderness, color and drip loss were determined in LL while microbiological analysis was performed on ST. Bacterial counts generally increased with increasing aging time and the limit for fresh meat was reached at day 14 post mortem. Significant differences were observed in malondialdehyde (MDA) content at day 7 of storage. The thiol concentration significantly reduced as aging time increased. The band intensities of myosin heavy chain (MHC) and troponin-T significantly decreased as storage progressed, while actin remained relatively stable. After 14 days of aging, tenderness showed significant improvement while muscle pH and drip loss reduced with increase in storage time. Samples aged for 14 days had higher lightness (P goat meat. © 2016 Japanese Society of Animal Science.

  1. Usefulness of post mortem computed tomography versus conventional forensic autopsy of road accident victims (drivers and passengers).

    Science.gov (United States)

    Moskała, Artur; Woźniak, Krzysztof; Kluza, Piotr; Romaszko, Karol; Lopatin, Oleksiy

    2017-01-01

    Aim of the study: Deaths of in-vehicle victims (drivers and passengers) of road accidents represent a significant group of issues addressed by forensic medicine. Expressing opinions in this regard involves first of all the determination of the cause of death and the forensic pathologist's participation in the process of road accident reconstruction through defining the mechanism of bodily harm. The scope of the opinion as well as its accuracy and degree of detail largely depend on the scope of forensic autopsy. In this context, techniques that broaden the capabilities of standard autopsy are of particular importance. This paper compares the results of post mortem computed tomography (PMCT) of road accident victims (drivers and passengers) against the results of standard examination in order to determine the scope to which PMCT significantly enhances autopsy capabilities. Material and methods: The analysis covers 118 in-vehicle victims (drivers and passengers) examined from 2012 to 2014. In each case, post-mortem examination was preceded by PMCT examination using Somatom Emotion 16 (Siemens AG, Germany). Results: The results are presented in a tabular form. Conclusions: In most road accident victims (drivers and passengers), post mortem computed tomography significantly increases the results' degree of detail, particularly with regard to injuries of bones and gas collections.

  2. Laboratory experimental infection of sheep to Ornithobilharzia turkestanicum and its confirmation using post-mortem examination and histopathology

    Directory of Open Access Journals (Sweden)

    gholamreza karimi

    2014-11-01

    Full Text Available Ornithobilharzia turkestanicum from genus Ornithobilharzia genus and family Schistosomatidae is an important agent of parasitological infection in sheep. This parasite has been reported from Russia, China, Turkestan (Kazakhstan, Kyrgyzstan, Turkmenistan and Uzbekistan, Pakistan, Iraq, Turkey and Iran. Parasitological infection due to this agent could be one of the important factors of decreasing the production rate of livestock in Iran. The purpose of this study, was to experimentally infect sheep with this parasite and confirm the infection by post-mortem examination and Histopathology which was done successfully. Twenty five sheep were used in the study of which 10 sheep were experimentally infected by Ornithobilharzia turkestanikum using subcutaneous injection and 10 sheep by skin contact method and the other 5 sheep were kept as control. Result of post-mortem and Histopathology during a one year period confirmed that all of sheep were infected and adult worm, were seen in their mesentery. Mean number of cercaria used for inducing the infection was 6425 and 462 adult worms were collected post-mortem. There was no significant relationship between the number of cercaria and adult worms collected. Male sheep were more infected than female.

  3. The capability of high field MRI in demonstrating post-mortem fetal brains at different gestational age

    International Nuclear Information System (INIS)

    Zhang Zhonghe; Liu Shuwei; Lin Xiangtao; Gen Hequn; Teng Gaojun; Fang Fang; Zang Fengchao; Yu Taifei; Zhao Bin

    2009-01-01

    Objective: To study the capability of high field MRI in demonstrating the post-mortem fetal brains at different gestational age (GA). Methods: One hundred and eight post-mortem fetal brains of 14-40 weeks GA were evaluated by 3.0 T MRI. Eleven brains of 14 to 27 weeks GA with good 3.0 T MRI images were chosen and scanned by 7.0 T MRI. The developing sulci, layered structures of fetal cerebral cortex and basal nuclei were evaluated on MRI of different Tesla (3.0 T and 7.0 T) and their results analyzed. Results: On T 1 WI of 3.0 T MRI, the layered structures of fetal cerebral cortex were present at 14 weeks GA, the sulci were more accurately identified after 16 weeks GA. The basal nuclei were clearly distinguishable after 20 weeks CA, and these structures were better visualized as the GA increased. On T 2 WI of 7.0 T MRI, the sulci, layered structures of fetal cerebral cortex and basal nuclei were shown more clearly at the same GA when compared to 3.0 T, especially the sulci at the early developmental stages. Conclusions: T 1 WI of 3.0 T MRI could show the developing structures of post-mortem fetal brain well, but the T 2 WI of 7.0 T MRI were comparatively better. (authors)

  4. Small vessel disease, neurovascular regulation and cognitive impairment: post-mortem studies reveal a complex relationship, still poorly understood.

    Science.gov (United States)

    Love, Seth; Miners, J Scott

    2017-07-15

    The contribution of vascular disease to cognitive impairment is under-recognized and the pathogenesis is poorly understood. This information gap has multiple causes, including a lack of post-mortem validation of clinical diagnoses of vascular cognitive impairment (VCI) or vascular dementia (VaD), the exclusion of cases with concomitant neurodegenerative disease when diagnosing VCI/VaD, and a lack of standardization of neuropathological assessment protocols for vascular disease. Other contributors include a focus on end-stage destructive lesions to the exclusion of more subtle types of diffuse brain injury, on structural abnormalities of arteries and arterioles to the exclusion of non-structural abnormalities and capillary damage, and the use of post-mortem sampling strategies that are biased towards the identification of neurodegenerative pathologies. Recent studies have demonstrated the value of detailed neuropathology in characterizing vascular contributions to cognitive impairment (e.g. in diabetes), and highlight the importance of diffuse white matter changes, capillary damage and vasoregulatory abnormalities in VCI/VaD. The use of standardized, evidence-based post-mortem assessment protocols and the inclusion of biochemical as well as morphological methods in neuropathological studies should improve the accuracy of determination of the contribution of vascular disease to cognitive impairment and clarify the relative contribution of different pathogenic processes to the tissue damage. © 2017 The Author(s). published by Portland Press Limited on behalf of the Biochemical Society.

  5. Diagnostic accuracy of post mortem MRI for abdominal abnormalities in foetuses and children

    International Nuclear Information System (INIS)

    Arthurs, Owen J.; Thayyil, Sudhin; Owens, Catherine M.; Olsen, Oystein E.; Wade, Angie; Addison, Shea; Jones, Rod; Norman, Wendy; Scott, Rosemary J.

    2015-01-01

    Highlights: •Postmortem MR imaging (PMMR) has high overall accuracy for abdominal pathology in foetuses, newborns and children. •PMMR is particularly good at detecting renal abnormalities, and relatively poor at detecting intestinal abnormalities. •In clinical practice, PMMR may be a useful alternative or adjunct to conventional autopsy in foetuses and children for detecting abdominal abnormalities. -- Abstract: Background: To compare the diagnostic accuracy of post-mortem magnetic resonance imaging (PMMR) specifically for abdominal pathology in foetuses and children, compared to conventional autopsy. Methods: Institutional ethics approval and parental consent was obtained. 400 unselected foetuses and children underwent PMMR using a 1.5 T Siemens Avanto MR scanner before conventional autopsy. PMMR images and autopsy findings were reported blinded to the other data respectively. Results: Abdominal abnormalities were found in 70/400 (12%) autopsies. Overall sensitivity and specificity (95% confidence interval) of PMMR for abdominal pathology was 72.5% (61.0, 81.6) and 90.8% (87.0, 93.6), with positive (PPV) and negative predictive values (NPV) of 64.1% (53.0, 73.9) and 93.6% (90.2, 95.8) respectively. PMMR was good at detecting renal abnormalities (sensitivity 80%), particularly in foetuses, and relatively poor at detecting intestinal abnormalities (sensitivity 50%). Overall accuracy was 87.4% (83.6, 90.4). Conclusions: PMMR has high overall accuracy for abdominal pathology in foetuses, newborns and children. PMMR is particularly good at detecting renal abnormalities, and relatively poor at detecting intestinal abnormalities. In clinical practice, PMMR may be a useful alternative or adjunct to conventional autopsy in foetuses and children for detecting abdominal abnormalities

  6. Automatic entry point planning for robotic post-mortem CT-based needle placement.

    Science.gov (United States)

    Ebert, Lars C; Fürst, Martin; Ptacek, Wolfgang; Ruder, Thomas D; Gascho, Dominic; Schweitzer, Wolf; Thali, Michael J; Flach, Patricia M

    2016-09-01

    Post-mortem computed tomography guided placement of co-axial introducer needles allows for the extraction of tissue and liquid samples for histological and toxicological analyses. Automation of this process can increase the accuracy and speed of the needle placement, thereby making it more feasible for routine examinations. To speed up the planning process and increase safety, we developed an algorithm that calculates an optimal entry point and end-effector orientation for a given target point, while taking constraints such as accessibility or bone collisions into account. The algorithm identifies the best entry point for needle trajectories in three steps. First, the source CT data is prepared and bone as well as surface data are extracted and optimized. All vertices of the generated surface polygon are considered to be potential entry points. Second, all surface points are tested for validity within the defined hard constraints (reachability, bone collision as well as collision with other needles) and removed if invalid. All remaining vertices are reachable entry points and are rated with respect to needle insertion angle. Third, the vertex with the highest rating is selected as the final entry point, and the best end-effector rotation is calculated to avoid collisions with the body and already set needles. In most cases, the algorithm is sufficiently fast with approximately 5-6 s per entry point. This is the case if there is no collision between the end-effector and the body. If the end-effector has to be rotated to avoid collision, calculation times can increase up to 24 s due to the inefficient collision detection used here. In conclusion, the algorithm allows for fast and facilitated trajectory planning in forensic imaging.

  7. Quantitative susceptibility mapping (QSM) as a means to measure brain iron? A post mortem validation study

    Science.gov (United States)

    Langkammer, Christian; Schweser, Ferdinand; Krebs, Nikolaus; Deistung, Andreas; Goessler, Walter; Scheurer, Eva; Sommer, Karsten; Reishofer, Gernot; Yen, Kathrin; Fazekas, Franz; Ropele, Stefan; Reichenbach, Jürgen R.

    2012-01-01

    Quantitative susceptibility mapping (QSM) is a novel technique which allows determining the bulk magnetic susceptibility distribution of tissue in vivo from gradient echo magnetic resonance phase images. It is commonly assumed that paramagnetic iron is the predominant source of susceptibility variations in gray matter as many studies have reported a reasonable correlation of magnetic susceptibility with brain iron concentrations in vivo. Instead of performing direct comparisons, however, all these studies used the putative iron concentrations reported in the hallmark study by Hallgren and Sourander (1958) for their analysis. Consequently, the extent to which QSM can serve to reliably assess brain iron levels is not yet fully clear. To provide such information we investigated the relation between bulk tissue magnetic susceptibility and brain iron concentration in unfixed (in situ) post mortem brains of 13 subjects using MRI and inductively coupled plasma mass spectrometry. A strong linear correlation between chemically determined iron concentration and bulk magnetic susceptibility was found in gray matter structures (r = 0.84, p < 0.001), whereas the correlation coefficient was much lower in white matter (r = 0.27, p < 0.001). The slope of the overall linear correlation was consistent with theoretical considerations of the magnetism of ferritin supporting that most of the iron in the brain is bound to ferritin proteins. In conclusion, iron is the dominant source of magnetic susceptibility in deep gray matter and can be assessed with QSM. In white matter regions the estimation of iron concentrations by QSM is less accurate and more complex because the counteracting contribution from diamagnetic myelinated neuronal fibers confounds the interpretation. PMID:22634862

  8. Diagnostic accuracy of post mortem MRI for abdominal abnormalities in foetuses and children

    Energy Technology Data Exchange (ETDEWEB)

    Arthurs, Owen J., E-mail: owen.arthurs@gosh.nhs.uk [Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London (United Kingdom); Institute of Child Health, UCL, London (United Kingdom); Thayyil, Sudhin, E-mail: s.thayyil@imperial.ac.uk [Perinatal Neurology and Neonatology, Imperial College London, London (United Kingdom); Owens, Catherine M., E-mail: Catherine.owens@gosh.nhs.uk [Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London (United Kingdom); Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London (United Kingdom); Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London (United Kingdom); Olsen, Oystein E., E-mail: oystein.olsen@gosh.nhs.uk [Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London (United Kingdom); Institute of Child Health, UCL, London (United Kingdom); Wade, Angie, E-mail: a.wade@ucl.ac.uk [Clinical Epidemiology, Nutrition and Biostatistics Section, UCL Institute of Child health, London (United Kingdom); Addison, Shea, E-mail: shea.addison@imperial.ac.uk [Perinatal Neurology and Neonatology, Imperial College London, London (United Kingdom); Jones, Rod, E-mail: rod.jones@gosh.nhs.uk [Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London (United Kingdom); Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London (United Kingdom); Norman, Wendy, E-mail: wendy.norman@gosh.nhs.uk [Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London (United Kingdom); Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London (United Kingdom); Scott, Rosemary J., E-mail: rosemary.scott@uclh.nhs.uk [Department of Histopathology, University College London Hospital NHS Trust, London (United Kingdom); and others

    2015-03-15

    Highlights: •Postmortem MR imaging (PMMR) has high overall accuracy for abdominal pathology in foetuses, newborns and children. •PMMR is particularly good at detecting renal abnormalities, and relatively poor at detecting intestinal abnormalities. •In clinical practice, PMMR may be a useful alternative or adjunct to conventional autopsy in foetuses and children for detecting abdominal abnormalities. -- Abstract: Background: To compare the diagnostic accuracy of post-mortem magnetic resonance imaging (PMMR) specifically for abdominal pathology in foetuses and children, compared to conventional autopsy. Methods: Institutional ethics approval and parental consent was obtained. 400 unselected foetuses and children underwent PMMR using a 1.5 T Siemens Avanto MR scanner before conventional autopsy. PMMR images and autopsy findings were reported blinded to the other data respectively. Results: Abdominal abnormalities were found in 70/400 (12%) autopsies. Overall sensitivity and specificity (95% confidence interval) of PMMR for abdominal pathology was 72.5% (61.0, 81.6) and 90.8% (87.0, 93.6), with positive (PPV) and negative predictive values (NPV) of 64.1% (53.0, 73.9) and 93.6% (90.2, 95.8) respectively. PMMR was good at detecting renal abnormalities (sensitivity 80%), particularly in foetuses, and relatively poor at detecting intestinal abnormalities (sensitivity 50%). Overall accuracy was 87.4% (83.6, 90.4). Conclusions: PMMR has high overall accuracy for abdominal pathology in foetuses, newborns and children. PMMR is particularly good at detecting renal abnormalities, and relatively poor at detecting intestinal abnormalities. In clinical practice, PMMR may be a useful alternative or adjunct to conventional autopsy in foetuses and children for detecting abdominal abnormalities.

  9. Performance of post-mortem CT compared to autopsy in children.

    Science.gov (United States)

    Krentz, Beatriz V; Alamo, Leonor; Grimm, Jochen; Dédouit, Fabrice; Bruguier, Christine; Chevallier, Christine; Egger, Coraline; Da Silva, Luiz F F; Grabherr, Silke

    2016-07-01

    Radiological techniques such as non-enhanced post-mortem computed tomography (PMCT) play an increasingly important role in death investigations, especially in cases of non-medicolegal context of death, where the consent of the next of kin is required to perform autopsy. Such consent is often difficult to obtain for deceased children, and radiological methods may be an acceptable alternative. The aim of our study was to evaluate the performance of PMCT explorations compared to medicolegal conventional autopsies in children and its potential usefulness in non-medicolegal situations. We retrospectively reviewed a group of 26 children aged 0-12 years who died of different causes, which were investigated by both conventional autopsy and PMCT. We compared the findings extracted from radiological and autopsy reports. All findings were grouped according to their importance with respect to cause of death and to the anatomical structure they covered: organs, vascular system, soft tissue, and skeletal system. A significantly larger number of findings were detected by autopsy compared to PMCT. Autopsy proved to be superior to PMCT, notably at detecting organ, soft tissue, and vascular findings, while PMCT was superior at detecting bone findings. However, no statistically significant differences were found between the methods concerning the essential findings used to define the cause of death. In children, PMCT was less sensitive than conventional autopsy for detecting general findings. However, most essential findings were detected by both methods. PMCT was superior to autopsy for the detection of bone lesions in children. Up to today, very rare literature exists concerning PMCT in children, especially in a forensic setting. This article investigates the advantages and limitations of PMCT compared to autopsy in a unique study group and discusses possibilities for future developments.

  10. SU-E-T-481: In Vivo and Post Mortem Animal Irradiation: Measured Vs. Calculated Doses

    Energy Technology Data Exchange (ETDEWEB)

    Heintz, P [Univ New Mexico Radiology Dept., Albuquerque, NM (United States); Heintz, B [Texas Oncology, PA, Southlake, TX (United States); Sandoval, D [University of New Mexico, Albuquerque, NM (United States); Weber, W; Melo, D; Guilmette, R [Lovelace Respiratory Research Institute, Albuquerque, NM (United States)

    2015-06-15

    Purpose: Computerized radiation therapy treatment planning is performed on almost all patients today. However it is seldom used for laboratory irradiations. The first objective is to assess whether modern radiation therapy treatment planning (RTP) systems accurately predict the subject dose by comparing in vivo and decedent dose measurements to calculated doses. The other objective is determine the importance of using a RTP system for laboratory irradiations. Methods: 5 MOSFET radiation dosimeters were placed enterically in each subject (2 sedated Rhesus Macaques) to measure the absorbed dose at 5 levels (carina, lung, heart, liver and rectum) during whole body irradiation. The subjects were treated with large opposed lateral fields and extended distances to cover the entire subject using a Varian 600C linac. CT simulation was performed ante-mortem (AM) and post-mortem (PM). To compare AM and PM doses, calculation points were placed at the location of each dosimeter in the treatment plan. The measured results were compared to the results using Varian Eclipse and Prowess Panther RTP systems. Results: The Varian and Prowess treatment planning system agreed to within in +1.5% for both subjects. However there were significant differences between the measured and calculated doses. For both animals the calculated central axis dose was higher than prescribed by 3–5%. This was caused in part by inaccurate measurement of animal thickness at the time of irradiation. For one subject the doses ranged from 4% to 7% high and the other subject the doses ranged 7% to 14% high when compared to the RTP doses. Conclusions: Our results suggest that using proper CT RTP system can more accurately deliver the prescribed dose to laboratory subjects. It also shows that there is significant dose variation in such subjects when inhomogeneities are not considered in the planning process.

  11. Skeletal abnormalities in fetuses with Down's syndrome: a radiographic post-mortem study

    International Nuclear Information System (INIS)

    Stempfle, N.; Brisse, H.; Huten, Y.; Fredouille, C.; Nessmann, C.

    1999-01-01

    Objective. To evaluate skeletal abnormalities on post-mortem radiographs of fetuses with Down's syndrome. Materials and methods. Biometrical and morphological criteria, which are used for US prenatal detection of trisomy 21, were assessed. Limb long bones, biparietal diameter (BPD)/occipito-frontal diameter (OFD) ratio, ossification of nasal bones and appearance of the middle phalanx of the fifth digit (P2) in 60 fetuses with Down's syndrome were analysed and compared with 82 normal fetuses matched for gestational age (GA) from 15 to 40 weeks' gestation (WG). Results. We observed reduced growth velocity of limb long bones during the third trimester in both groups, but the reduction was more pronounced in the trisomic group. Brachycephaly was found as early as 15 WG in Down's syndrome and continued throughout gestation (sensitivity 0.28, specificity 1). Ossification of the nasal bones, which can be detected in normal fetuses from 14 WG, was absent in one quarter of trisomic fetuses, regardless of GA. The middle phalanx of the fifth digit was evaluated by comparison with the distal phalanx (P3) of the same digit. We found that P2 was not ossified in 11/31 trisomic fetuses before 23 WG, and was either not ossified or hypoplastic in 17/29 cases after 24 WG (sensitivity 0.56, specificity 1). Conclusions. Three key skeletal signs were present in trisomic fetuses: brachycephaly, absence of nasal bone ossification, and hypoplasia of the middle phalanx of the fifth digit. All these signs are appropriate to prenatal US screening. When present, they fully justify determination of the fetal karyotype by amniocentesis. (orig.)

  12. [REASONS OF DELAYED DIAGNOSIS OF BLADDER TUBERCULOSIS].

    Science.gov (United States)

    Kul'chavenja, E V; Holtobin, D P

    2015-01-01

    The fourth, terminal, stage of bladder tuberculosis (BT) manifests itself in irreversible changes and requires surgical treatment. To identify the reasons for delayed diagnosis of this urogenital tuberculosis complication. Medical history of 26 urogenital tuberculosis patients with a complicated form of stage 4 BT, referred to the Novosibirsk TB Research Institute for reconstructive surgery were analysed. In 22 patients, bladder volume ranged from 55 to 100 ml, 4 patients previously underwent cystostomy due to extremely small bladder volume. Average duration of BT hidden in the guise of "urogenital infection" was 6.2 years. Patients were treated with norfloxacin (a total of 104 courses), ciprofloxacin (86 courses), amikacin (43 courses), nitroxoline (27 courses), third generation cephalosporins (32 courses), lomefloxacin (17 courses), levofloxacin (11 courses), Amoxicillin clavulanate (4 courses), ampicillin (2 courses). It was demonstrated that all cases of BT stage 4 were iatrogenic. Irreversible debilitating complications occurred due to suboptimal therapy, primarily due to administration of amikacin and fluoroquinolones for urogenital infections, which was tuberculosis in disguise. Absence of M. tuberculosis growth does not exclude tuberculosis; pathological specimens must be further examined at least by PCR. Interventional material must be mandatory examined histologically and stained by Ziehl-Neelsen method to identify M. tuberculosis. Effective and not masking tuberculosis, optimal therapy for urogenital infections includes fosfomycin, furazidin (nitrofurantoin), gentamicin, III generation cephalosporins (in outpatient settings dispersible form of efixime should be preferable).

  13. Post mortem investigations of the NPP Greifswald WWER-440 reactor pressure vessels

    Energy Technology Data Exchange (ETDEWEB)

    Schuhknecht, Jan; Viehrig, Hans-Werner; Weiss, Frank-Peter; Rindelhardt, Udo [Forschungszentrum Dresden-Rossendorf e.V., Dresden (Germany). Inst. for Safety Research; Keller, Werner [Studsvik GmbH und Co. KG, Stutensee (Germany)

    2008-07-01

    The paper presents first results of the post mortem investigations performed at the reactor pressure vessels (RPV) of the Russian WWER-440 type reactors. Trepans were taken from the core weld SN0.1.4 and base metal of the unit 1 RPV. This RPV was annealed after 15 years of operation and operated for two more years. At first the trepan of the core welding seam was investigated by Master Curve (MC) testing. Specimens from 5 locations through the thickness of the welding seam were tested according to ASTM E1921-05. The reference temperature T{sub 0} was calculated with the measured fracture toughness values, K{sub Jc}, at brittle failure of the specimen. Generally the K{sub Jc} values measured on pre-cracked and side-grooved Charpy size SE(B) specimens of the investigated weld metal follow the course of the Master Curve. The K{sub Jc} values show a remarkable scatter. More values than expected lie below the 5% fractile. In addition the MC SINTAP procedure was applied to determine T{sub 0}{sup SINTAP} of the brittle fraction of the data set. There are remarkable differences between T{sub 0} and T{sub 0}{sup SINTAP} indicating macroscopic inhomogeneous weld metal. The highest T{sub 0} was about 50 C at a distance of 22 mm from the inner surface of the weld. It is 40 K higher compared with T{sub 0} at the inner surface. This is important for the assessment of ductile-to-brittle temperatures measured with sub size Charpy specimens made of weld metal from the inner RPV wall. This material may not represent the most conservative condition. The results presented in this paper show that the Master Curve approach as adopted in the test standard ASTM E1921-05 is applicable to the investigated WWER-440 multilayer weld metal. The results are of direct importance for an advanced WWER-440 RPV integrity assessment. On the other hand the data pool is broadened for a general introduction of the MC based RPV integrity assessment in the national codes. Furthermore general experiences in

  14. Compressive rib fracture: peri-mortem and post-mortem trauma patterns in a pig model.

    Science.gov (United States)

    Kieser, Jules A; Weller, Sarah; Swain, Michael V; Neil Waddell, J; Das, Raj

    2013-07-01

    Despite numerous studies on high impact fractures of ribs, little is known about compressive rib injuries. We studied rib fractures from a biomechanical and morphological perspective using 15, 5th ribs of domestic pigs Sus scrofa, divided into two groups, desiccated (representing post-mortem trauma) and fresh ribs with intact periosteum (representing peri-mortem trauma). Ribs were axially compressed and subjected to four-point bending in an Instron 3339 fitted with custom jigs. Morphoscopic analysis of resultant fractures consisted of standard optical methods, micro-CT (μCT) and scanning electron microscopy (SEM). During axial compression, fresh ribs had slightly higher strength because of energy absorption capabilities of their soft and fluidic components. In flexure tests, dry ribs showed typical elastic-brittle behaviour with long linear load-extension curves, followed by relatively short non-linear elastic (hyperelastic) behaviour and brittle fracture. Fresh ribs showed initial linear-elastic behaviour, followed by strain softening, visco-plastic responses. During the course of loading, dry bone showed minimal observable damage prior to the onset of unstable fracture. In contrast, fresh bone showed buckling-like damage features on the compressive surface and cracking parallel to the axis of the bone. Morphologically, all dry ribs fractured precipitously, whereas all but one of the fresh ribs showed incomplete fracture. The mode of fracture, however, was remarkably similar for both groups, with butterfly fractures predominating (7/15, 46.6% dry and wet). Our study highlights the fact that under controlled loading, despite seemingly similar butterfly fracture morphology, fresh ribs (representing perimortem trauma) show a non-catastrophic response. While extensive strain softening observed for the fresh bone does show some additional micro-cracking damage, it appears that the periosteum may play a key role in imparting the observed pseudo-ductility to the ribs

  15. Post mortem investigations of the NPP Greifswald WWER-440 reactor pressure vessels

    International Nuclear Information System (INIS)

    Schuhknecht, Jan; Viehrig, Hans-Werner; Weiss, Frank-Peter; Rindelhardt, Udo

    2008-01-01

    The paper presents first results of the post mortem investigations performed at the reactor pressure vessels (RPV) of the Russian WWER-440 type reactors. Trepans were taken from the core weld SN0.1.4 and base metal of the unit 1 RPV. This RPV was annealed after 15 years of operation and operated for two more years. At first the trepan of the core welding seam was investigated by Master Curve (MC) testing. Specimens from 5 locations through the thickness of the welding seam were tested according to ASTM E1921-05. The reference temperature T 0 was calculated with the measured fracture toughness values, K Jc , at brittle failure of the specimen. Generally the K Jc values measured on pre-cracked and side-grooved Charpy size SE(B) specimens of the investigated weld metal follow the course of the Master Curve. The K Jc values show a remarkable scatter. More values than expected lie below the 5% fractile. In addition the MC SINTAP procedure was applied to determine T 0 SINTAP of the brittle fraction of the data set. There are remarkable differences between T 0 and T 0 SINTAP indicating macroscopic inhomogeneous weld metal. The highest T 0 was about 50 C at a distance of 22 mm from the inner surface of the weld. It is 40 K higher compared with T 0 at the inner surface. This is important for the assessment of ductile-to-brittle temperatures measured with sub size Charpy specimens made of weld metal from the inner RPV wall. This material may not represent the most conservative condition. The results presented in this paper show that the Master Curve approach as adopted in the test standard ASTM E1921-05 is applicable to the investigated WWER-440 multilayer weld metal. The results are of direct importance for an advanced WWER-440 RPV integrity assessment. On the other hand the data pool is broadened for a general introduction of the MC based RPV integrity assessment in the national codes. Furthermore general experiences in the cutting of irradiated RPV steels are collected

  16. Human decomposition and the reliability of a 'Universal' model for post mortem interval estimations.

    Science.gov (United States)

    Cockle, Diane L; Bell, Lynne S

    2015-08-01

    Human decomposition is a complex biological process driven by an array of variables which are not clearly understood. The medico-legal community have long been searching for a reliable method to establish the post-mortem interval (PMI) for those whose deaths have either been hidden, or gone un-noticed. To date, attempts to develop a PMI estimation method based on the state of the body either at the scene or at autopsy have been unsuccessful. One recent study has proposed that two simple formulae, based on the level of decomposition humidity and temperature, could be used to accurately calculate the PMI for bodies outside, on or under the surface worldwide. This study attempted to validate 'Formula I' [1] (for bodies on the surface) using 42 Canadian cases with known PMIs. The results indicated that bodies exposed to warm temperatures consistently overestimated the known PMI by a large and inconsistent margin for Formula I estimations. And for bodies exposed to cold and freezing temperatures (less than 4°C), then the PMI was dramatically under estimated. The ability of 'Formulae II' to estimate the PMI for buried bodies was also examined using a set of 22 known Canadian burial cases. As these cases used in this study are retrospective, some of the data needed for Formula II was not available. The 4.6 value used in Formula II to represent the standard ratio of time that burial decelerates the rate of decomposition was examined. The average time taken to achieve each stage of decomposition both on, and under the surface was compared for the 118 known cases. It was found that the rate of decomposition was not consistent throughout all stages of decomposition. The rates of autolysis above and below the ground were equivalent with the buried cases staying in a state of putrefaction for a prolonged period of time. It is suggested that differences in temperature extremes and humidity levels between geographic regions may make it impractical to apply formulas developed in

  17. Microstructural analysis of geopolymer developed from wood fly ash, post-mortem doloma refractory and metakaolin; Analise microestrutural de geopolimero desenvolvido a partir de cinza de olaria, tijolo refratario dolomitico post-mortem e metacaulim

    Energy Technology Data Exchange (ETDEWEB)

    Moura, Jailes de Santana; Mafra, Marcio Paulo de Araujo; Rabelo, Adriano Alves; Fagury, Renata Lilian Ribeiro Portugal; Fagury Neto, Elias, E-mail: jailesmoura@hotmail.com, E-mail: fagury@unifesspa.edu.br [Universidade Federal do Sul e Sudeste do Para (UNIFESSPA), PA (Brazil). Faculdade de Engenharia de Materiais

    2016-07-01

    Geopolymers are one of the widely discussed topics of materials science in recent times due to its vast potential as an alternative binder material to cement. This work aimed to evaluate the microstructure of geopolymers developed from wood fly ash, post-mortem doloma refractory and metakaolin. A preliminary study has been completed and achieved significant results compressive strength: the best formulation of geopolymer paste obtained approximately 25 MPa. Microstructural analysis by scanning electron microscopy, the geopolymer paste, allowed to verify the homogeneity, distribution of components, and providing evidence of raw materials that do not respond if there was crystalline phase, porosity and density of the structure. (author)

  18. Efeito do resfriamento sobre a textura post-mortem da carne do peixe matrinxã Brycon cephalus Chilling effect on the post-mortem texture of the matrinxã fish muscle Brycon cephalus

    Directory of Open Access Journals (Sweden)

    H. Suárez-Mahecha

    2007-08-01

    Full Text Available Os mecanismos que causam o amolecimento e a perda na textura post-mortem da carne de matrinxã foram determinados por meio das mudanças na microestrutura do músculo, imediatamente após a morte e depois de 12 horas de estocagem a -3°C. As observações na microestrutura, realizadas com microscópio eletrônico de transmissão, foram semelhantes aos resultados obtidos na força de ruptura do músculo medidos com o texturômetro. Os valores da força da ruptura foram menores para a carne após o resfriamento. Observou-se que as fibras do colágeno do tecido conectivo pericelular se desintegraram e que as do colágeno do tecido conectivo do miocommata conservaram sua arquitetura e integridade. Houve pouca degradação da linha Z. Isso sugere que o amolecimento post-mortem da carne de mantrinxã, durante a estocagem a -3°C, é causado pela degradação do tecido conectivo pericelular.In order to determine the mechanisms that cause the post mortem muscle softness of the matrinxã Brycon cephalus, changes in the micro structure of the muscle were observed immediately after death and after 12 hours of storage at -3º C, measuring the firmness of the flesh with test instruments. Observations by the transmission electron microscope were similar to the results obtained in the breaking strength of the muscle measured with a texturometer. The values of the breaking strength of the fish muscle were smaller after chilling. At the same time, it was observed that the collagen fibers of the pericellular connective tissue had disintegrated, while the collagen fibers of the miocommata connective tissue maintained their organization and integrity. No evident breakdown of Z-discs was observed. It is suggested that the post-mortem tenderization of the matrinxã muscle during chilled storage was due to the disintegration of the collagen fibers in the pericellular connective tissue and, in a smaller extent, to the weakening of Z-disk.

  19. Post-mortem magnetic resonance foetal imaging: a study of morphological correlation with conventional autopsy and histopathological findings.

    Science.gov (United States)

    Vullo, Annamaria; Panebianco, Valeria; Cannavale, Giuseppe; Aromatario, Mariarosaria; Cipolloni, Luigi; Frati, Paola; Santurro, Alessandro; Vullo, Francesco; Catalano, Carlo; Fineschi, Vittorio

    2016-11-01

    The aim of the present study is to offer our experience concerning post-mortem magnetic resonance (PMMR) in foetal death cases and an evaluation of the differences between the findings acquired by PMMR and by forensic autopsy. Fifteen foetuses were recruited from July 2014 to December 2015. These had suffered intrauterine death in women in the 21st to 38th week of gestation who were treated in the emergency department for non-perception of foetal movements. We performed a PMMR on foetuses, 3 ± 1 days on average from the time of death, and then a complete forensic autopsy was performed. All 15 foetuses were examined with a whole-body study protocol, starting from the skull, down to and including the lower limbs. The total time of examination ranged from 20 to 30 min in each case. The external evaluation and description of post-mortem phenomena (maceration), record of the weight and detection and the various measurements of foetal diameters were evaluated before performing autopsy. A complete histopathological study was performed in each case. Out of 15 cases examined, eight were negative for structural anatomical abnormalities and/or diseases, both in the preliminary radiological examination and the traditional autopsy. In the remaining seven cases, pathological findings were detected by PMMR with corresponding results at autopsy. PMMR can provide useful information on foetal medical conditions and result in improved diagnostic classification. It may enable the planning of a more suitable technique before proceeding to autopsy, including focusing on certain aspects of organ pathology otherwise not detectable. The association between PMMR, post-mortem examination and related histological study of the foetus-placenta unit could help reduce the percentage of cases in which the cause of foetal death remains unexplained. Lastly, it may allow a selective sampling of the organ in order to target histological investigations.

  20. Severe malaria - a case of fatal Plasmodium knowlesi infection with post-mortem findings: a case report

    Directory of Open Access Journals (Sweden)

    Adem Patricia

    2010-01-01

    Full Text Available Abstract Background Zoonotic malaria caused by Plasmodium knowlesi is an important, but newly recognized, human pathogen. For the first time, post-mortem findings from a fatal case of knowlesi malaria are reported here. Case presentation A formerly healthy 40 year-old male became symptomatic 10 days after spending time in the jungle of North Borneo. Four days later, he presented to hospital in a state of collapse and died within two hours. He was hyponatraemic and had elevated blood urea, potassium, lactate dehydrogenase and amino transferase values; he was also thrombocytopenic and eosinophilic. Dengue haemorrhagic shock was suspected and a post-mortem examination performed. Investigations for dengue virus were negative. Blood for malaria parasites indicated hyperparasitaemia and single species P. knowlesi infection was confirmed by nested-PCR. Macroscopic pathology of the brain and endocardium showed multiple petechial haemorrhages, the liver and spleen were enlarged and lungs had features consistent with ARDS. Microscopic pathology showed sequestration of pigmented parasitized red blood cells in the vessels of the cerebrum, cerebellum, heart and kidney without evidence of chronic inflammatory reaction in the brain or any other organ examined. Brain sections were negative for intracellular adhesion molecule-1. The spleen and liver had abundant pigment containing macrophages and parasitized red blood cells. The kidney had evidence of acute tubular necrosis and endothelial cells in heart sections were prominent. Conclusions The overall picture in this case was one of systemic malaria infection that fit the WHO classification for severe malaria. Post-mortem findings in this case were unexpectedly similar to those that define fatal falciparum malaria, including cerebral pathology. There were important differences including the absence of coma despite petechial haemorrhages and parasite sequestration in the brain. These results suggest that further

  1. Differential Nuclear and Mitochondrial DNA Preservation in Post-Mortem Teeth with Implications for Forensic and Ancient DNA Studies

    Science.gov (United States)

    Higgins, Denice; Rohrlach, Adam B.; Kaidonis, John; Townsend, Grant; Austin, Jeremy J.

    2015-01-01

    Major advances in genetic analysis of skeletal remains have been made over the last decade, primarily due to improvements in post-DNA-extraction techniques. Despite this, a key challenge for DNA analysis of skeletal remains is the limited yield of DNA recovered from these poorly preserved samples. Enhanced DNA recovery by improved sampling and extraction techniques would allow further advancements. However, little is known about the post-mortem kinetics of DNA degradation and whether the rate of degradation varies between nuclear and mitochondrial DNA or across different skeletal tissues. This knowledge, along with information regarding ante-mortem DNA distribution within skeletal elements, would inform sampling protocols facilitating development of improved extraction processes. Here we present a combined genetic and histological examination of DNA content and rates of DNA degradation in the different tooth tissues of 150 human molars over short-medium post-mortem intervals. DNA was extracted from coronal dentine, root dentine, cementum and pulp of 114 teeth via a silica column method and the remaining 36 teeth were examined histologically. Real time quantification assays based on two nuclear DNA fragments (67 bp and 156 bp) and one mitochondrial DNA fragment (77 bp) showed nuclear and mitochondrial DNA degraded exponentially, but at different rates, depending on post-mortem interval and soil temperature. In contrast to previous studies, we identified differential survival of nuclear and mtDNA in different tooth tissues. Futhermore histological examination showed pulp and dentine were rapidly affected by loss of structural integrity, and pulp was completely destroyed in a relatively short time period. Conversely, cementum showed little structural change over the same time period. Finally, we confirm that targeted sampling of cementum from teeth buried for up to 16 months can provide a reliable source of nuclear DNA for STR-based genotyping using standard

  2. Prevalence of Atherosclerotic Coronary Stenosis in Asymptomatic North Indian Population: A Post-mortem Coronary Angiography Study.

    Science.gov (United States)

    Bansal, Yogender Singh; Mandal, Shatrugan Prasad; Kumar, Senthil; Setia, Puneet

    2015-09-01

    A preliminary study of coronaries using post-mortem angiography was undertaken to see the prevalence of atherosclerotic coronary stenosis in non-cardiac unnatural deaths. This study was conducted in a tertiary care centre located in Chandigarh. A total of 128 medico-legal cases were studied comprising 88 males and 40 females. Post-mortem examinations of these MLC cases were conducted in the Department of Forensic Medicine, PGIMER, Chandigarh. All hearts were visually screened by post-mortem coronary angiography first and then grossly examined using serial transverse incision technique in positive screening cases to find the degree of narrowing. Of the study group, 34% males and 20% females showed evidence of narrowing on angiography. Of the males showing coronary stenosis, 83% had single vessel disease and 13% had double vessel disease, while only one individual had triple vessel disease. In cases of female, all the cases of coronary stenosis were single vessel disease. Left anterior descending coronary artery (LAD) was the most common vessel involved, followed by right coronary artery (RCA) & Left circumflex artery (LCX) and in cases of double vessel disease, LAD in combination with LCX was responsible for 75% of the cases. Remarkably 23.6% of study population in the age group of less than 40 years showed appreciable narrowing in at least one of the coronaries. In general, the prevalence of CAD is on the rise, particularly in younger population owing to the changes in their lifestyle and food habits. This preliminary study revealed evidence of narrowing of at least one coronary in 34% male and 20% female population and 23.6% subjects were less than 40 years old. Further detailed studies are needed especially in younger age group and to support the need for preventive cardiology in the early years of life.

  3. Hippocampal Microbleed on a Post-Mortem T2*-Weighted Gradient-Echo 7.0-Tesla Magnetic Resonance Imaging

    Directory of Open Access Journals (Sweden)

    J. De Reuck

    2011-09-01

    Full Text Available The present post-mortem study of a brain from an Alzheimer patient showed on a T2*-weighted gradient-echo 7.0-T MRI of a coronal brain section a hyposignal in the hippocampus, suggesting a microbleed. On the corresponding histological examination, only iron deposits around the granular cellular layer and in blood vessel walls of the hippocampus were observed without evidence of a bleeding. This case report illustrates that the detection of microbleeds on MRI has to be interpreted with caution.

  4. Post-mortem assessment of hypoperfusion of cerebral cortex in Alzheimer's disease and vascular dementia.

    Science.gov (United States)

    Thomas, Taya; Miners, Scott; Love, Seth

    2015-04-01

    Perfusion is reduced in the cerebral neocortex in Alzheimer's disease. We have explored some of the mechanisms, by measurement of perfusion-sensitive and disease-related proteins in post-mortem tissue from Alzheimer's disease, vascular dementia and age-matched control brains. To distinguish physiological from pathological reduction in perfusion (i.e. reduction exceeding the decline in metabolic demand), we measured the concentration of vascular endothelial growth factor (VEGF), a protein induced under conditions of tissue hypoxia through the actions of hypoxia-inducible factors, and the myelin associated glycoprotein to proteolipid protein 1 (MAG:PLP1) ratio, which declines in chronically hypoperfused brain tissue. To evaluate possible mechanisms of hypoperfusion, we also measured the levels of amyloid-β40, amyloid-β42, von Willebrand factor (VWF; a measure of microvascular density) and the potent vasoconstrictor endothelin 1 (EDN1); we assayed the activity of angiotensin I converting enzyme (ACE), which catalyses the production of another potent vasoconstrictor, angiotensin II; and we scored the severity of arteriolosclerotic small vessel disease and cerebral amyloid angiopathy, and determined the Braak tangle stage. VEGF was markedly increased in frontal and parahippocampal cortex in Alzheimer's disease but only slightly and not significantly in vascular dementia. In frontal cortex the MAG:PLP1 ratio was significantly reduced in Alzheimer's disease and even more so in vascular dementia. VEGF but not MAG:PLP1 increased with Alzheimer's disease severity, as measured by Braak tangle stage, and correlated with amyloid-β42 and amyloid-β42: amyloid-β40 but not amyloid-β40. Although MAG:PLP1 tended to be lowest in cortex from patients with severe small vessel disease or cerebral amyloid angiopathy, neither VEGF nor MAG:PLP1 correlated significantly with the severity of structural vascular pathology (small vessel disease, cerebral amyloid angiopathy or VWF

  5. Post mortem rigor development in the Egyptian goose (Alopochen aegyptiacus) breast muscle (pectoralis): factors which may affect the tenderness.

    Science.gov (United States)

    Geldenhuys, Greta; Muller, Nina; Frylinck, Lorinda; Hoffman, Louwrens C

    2016-01-15

    Baseline research on the toughness of Egyptian goose meat is required. This study therefore investigates the post mortem pH and temperature decline (15 min-4 h 15 min post mortem) in the pectoralis muscle (breast portion) of this gamebird species. It also explores the enzyme activity of the Ca(2+)-dependent protease (calpain system) and the lysosomal cathepsins during the rigor mortis period. No differences were found for any of the variables between genders. The pH decline in the pectoralis muscle occurs quite rapidly (c = -0.806; ultimate pH ∼ 5.86) compared with other species and it is speculated that the high rigor temperature (>20 °C) may contribute to the increased toughness. No calpain I was found in Egyptian goose meat and the µ/m-calpain activity remained constant during the rigor period, while a decrease in calpastatin activity was observed. The cathepsin B, B & L and H activity increased over the rigor period. Further research into the connective tissue content and myofibrillar breakdown during aging is required in order to know if the proteolytic enzymes do in actual fact contribute to tenderisation. © 2015 Society of Chemical Industry.

  6. Ethical considerations in forensic genetics research on tissue samples collected post-mortem in Cape Town, South Africa.

    Science.gov (United States)

    Heathfield, Laura J; Maistry, Sairita; Martin, Lorna J; Ramesar, Raj; de Vries, Jantina

    2017-11-29

    The use of tissue collected at a forensic post-mortem for forensic genetics research purposes remains of ethical concern as the process involves obtaining informed consent from grieving family members. Two forensic genetics research studies using tissue collected from a forensic post-mortem were recently initiated at our institution and were the first of their kind to be conducted in Cape Town, South Africa. This article discusses some of the ethical challenges that were encountered in these research projects. Among these challenges was the adaptation of research workflows to fit in with an exceptionally busy service delivery that is operating with limited resources. Whilst seeking guidance from the literature regarding research on deceased populations, it was noted that next of kin of decedents are not formally recognised as a vulnerable group in the existing ethical and legal frameworks in South Africa. The authors recommend that research in the forensic mortuary setting is approached using guidance for vulnerable groups, and the benefit to risk standard needs to be strongly justified. Lastly, when planning forensic genetics research, consideration must be given to the potential of uncovering incidental findings, funding to validate these findings and the feedback of results to family members; the latter of which is recommended to occur through a genetic counsellor. It is hoped that these experiences will contribute towards a formal framework for conducting forensic genetic research in medico-legal mortuaries in South Africa.

  7. The importance of post-mortem computed tomography (PMCT) in confrontation with conventional forensic autopsy of victims of motorcycle accidents.

    Science.gov (United States)

    Moskała, Artur; Woźniak, Krzysztof; Kluza, Piotr; Romaszko, Karol; Lopatin, Oleksij

    2016-01-01

    Since traffic accidents are an important problem in forensic medicine, there is a constant search for new solutions to help with an investigation process in such cases. In recent years there was a rapid development of post-mortem imaging techniques, especially post-mortem computed tomography (PMCT). In our work we concentrated on a potential advantage of PMCT in cases of motorcycle accident fatalities. The results of forensic autopsy were compared with combined results of the autopsy and PMCT to check in which areas use of these two techniques gives statistically important increase in number of findings. The hypothesis was confirmed in case of pneumothorax and fractures of skull, spine, clavicle, scapula, lower leg bones. As for majority of other bone fractures locations and brain injures there were single cases with pathologies visible only in PMCT, but too few to reach expected level of p-value. In case of injuries of solid organs and soft tissues statistical analysis did not confirmed any advantage of unenhanced PMCT use. On the whole it has been shown that PMCT used as an adjunct to forensic autopsy can cause an increase in information about vitally important regions in case of motorcycle accident fatalities. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Post-mortem hemoparasite detection in free-living Brazilian brown brocket deer (Mazama gouazoubira, Fischer 1814).

    Science.gov (United States)

    Silveira, Júlia Angélica Gonçalves da; Rabelo, Elida Mara Leite; Lima, Paula Cristina Senra; Chaves, Bárbara Neves; Ribeiro, Múcio Flávio Barbosa

    2014-01-01

    Tick-borne infections can result in serious health problems for wild ruminants, and some of these infectious agents can be considered zoonosis. The aim of the present study was the post-mortem detection of hemoparasites in free-living Mazama gouazoubira from Minas Gerais state, Brazil. The deer samples consisted of free-living M. gouazoubira (n = 9) individuals that died after capture. Necropsy examinations of the carcasses were performed to search for macroscopic alterations. Organ samples were collected for subsequent imprint slides, and nested PCR assays were performed to detect hemoparasite species. Imprint slide assays from four deer showed erythrocytes infected with Piroplasmida small trophozoites, and A. marginale corpuscles were observed in erythrocytes from two animals. A. marginale and trophozoite co-infections occurred in two deer. A nested PCR analysis of the organs showed that six of the nine samples were positive for Theileria sp., five were positive for A. phagocytophilum and three were positive for A. marginale, with co-infection occurring in four deer. The results of the present study demonstrate that post-mortem diagnostics using imprint slides and molecular assays are an effective method for detecting hemoparasites in organs.

  9. Delayed puberty and hypogonadotropic hypogonadism. Differential diagnosis and treatment

    NARCIS (Netherlands)

    Snoep, Marinus Cornelis

    1978-01-01

    This thesis describes a method enabling a prospecrive differential diagnosis to be made berween delayed puberty (DP) and hypogonadotropic hypogonadism (HH). The influence of androgen administration on the gonadal feedback sysrem of patients with delayed puberty was also studied. ... Zie: Summary

  10. Delayed diagnosis in a sight-threatening lesion.

    LENUS (Irish Health Repository)

    O'Neill, E

    2009-06-01

    Acute chiasmal compression has several aetiologies including pituitary apoplexy, a medical emergency caused by acute haemorrhagic or ischemic infarction in pituitary macroadenomas. Clinical diagnosis can often be difficult as the patient is frequently unaware of an existing adenoma. Delayed diagnosis may lead to increased morbidity and mortality.

  11. Delayed diagnosis of sarcoidosis is common in Brazil

    Directory of Open Access Journals (Sweden)

    Mauri Monteiro Rodrigues

    2013-09-01

    Full Text Available OBJECTIVE: To determine the frequency of and the factors related to delayed diagnosis of sarcoidosis in Brazil. METHODS: We evaluated patients with a biopsy-proven diagnosis of sarcoidosis, using a questionnaire that addressed the following: time since symptom onset and since the first medical visit; and the number and specialty of the physicians visited. We divided the patients by the timeliness of the diagnosis-timely (< 6 months and delayed (≥ 6 months-comparing the two groups in terms of systemic and pulmonary symptoms; extrathoracic involvement; spirometric data; radiological staging; level of education; income; and tuberculosis (diagnosis and treatment. RESULTS: We evaluated 100 patients. The median number of physicians consulted was 3 (range, 1-14. In 11 cases, sarcoidosis was diagnosed at the first visit. In 54, the first physician seen was a general practitioner. The diagnosis of sarcoidosis was timely in 41 patients and delayed in 59. The groups did not differ in terms of gender; race; type of health insurance; level of education; income; respiratory/systemic symptoms; extrathoracic involvement; and radiological staging. In the delayed diagnosis group, FVC was lower (80.3 ± 20.4% vs. 90.5 ± 17.1%; p = 0.010, as was FEV1 (77.3 ± 19.9% vs. 86.4 ± 19.5%; p = 0.024, misdiagnosis with and treatment for tuberculosis (≥ 3 months also being more common (24% vs. 7%, p = 0.032, and 20% vs. 0%; p = 0.002, respectively. CONCLUSIONS: The diagnosis of sarcoidosis is often delayed, even when the imaging is suggestive of sarcoidosis. Delayed diagnosis is associated with impaired lung function at the time of diagnosis. Many sarcoidosis patients are misdiagnosed with and treated for tuberculosis.

  12. Factors Associated with Delayed Cancer Diagnosis in Egyptian Children

    Directory of Open Access Journals (Sweden)

    E.R. Abdelkhalek

    2014-01-01

    Full Text Available Background Despite tremendous importance of early cancer diagnosis in children, few studies on this topic have been conducted in Egypt. Early stage diagnosis can have a positive effect on prognoses and the quality of life of children with cancer. We investigated delays in the diagnosis of childhood cancers in Egypt and determined the factors associated with these delays. Methods This retrospective study included 172 children with cancer from two pediatric oncology units. The interval between symptoms onset and final diagnosis for each child was estimated and examined by univariate and multivariate analyses to determine correlations with the child's sex, age at diagnosis, type and site of malignancy, family residence, socioeconomic status, and parental educational level. Findings The median total diagnosis delay period was 47 days caused by patients and/or parents (8 days and diagnosis (28 days. Statistically significant patient factors associated with delayed diagnosis were age (<5 years, lower parental education, and socioeconomic status. Sex residence and family size were not significant. Malignancy type and tumor site significantly affected the time for diagnosis. The lowest median value was associated with germ cell tumors (GCTs and leukemia, and the highest value was in children with brain tumor. Missed diagnoses were initially recorded in 39.5% of the patients and were associated with patient and tumor factors. Interpretation Delayed diagnosis of childhood cancer is related to age, family, socioeconomic status and parental education, and cancer type and site. Efforts should be made to promote awareness, develop effective steps to eliminate possible contributing factors, and determine the best intervention method.

  13. Relationship between clinical and postmortem evaluation in repeat breeder beef cows Relação entre características clínicas e post-mortem em vacas de corte repetidoras de serviço

    Directory of Open Access Journals (Sweden)

    Rogério Ferreira

    2008-08-01

    Full Text Available The objective of this study was to investigate the causes of the repeat breeder syndrome comparing clinical signs and postmortem findings in beef cows. The identification of factors affecting the reproductive tract can support decisions as to whether treatment of repeat breeder cows is justifiable than culling. Since all animals were submitted to clinical examination before being slaughtered, this study has a differential approach when compared with others, where genital tracts from abattoir were examined. In this study, 130 crossbred cows and heifers that have failed to conceive after three or more services were identified, submitted to a clinical examination and blood collection for karyotyping and sent to an abattoir. postmortem examinations included macroscopic evaluation of the genital tracts, bacteriology and histopathology of the uterus. Uterine alterations were predominant followed by oviduct and ovarian pathologies. Histopathological examination was more sensitive as a diagnostic tool than clinical examination. Repeat breeder cows had a predominance of uterine abnormalities (95%, such as inflammatory (42.9% and degenerative (59.7% conditions. Oviduct abnormalities were found in 29.8 % of animals. Furthermore, 1 out 10 karyotyped cows showed aneuploidy. Thus, this study stressed the importance of laboratory exams in the diagnosis of the causes of infertility of repeat breeder cows.O objetivo deste estudo foi avaliar as causas de infertilidade em vacas de corte repetidoras de serviço, relacionando sinais clínicos com características laboratoriais post-mortem. A identificação dos fatores que afetam o desempenho reprodutivo pode fornecer uma fundamentação científica para auxiliar na decisão quanto ao destino de vacas repetidoras de serviço; tratamento ou descarte. Este estudo tem abordagem diferencial dos trabalhos que contemplam somente a ocorrência de alterações post-mortem do trato genital. A correlação das altera

  14. Delay in the Diagnosis of Stable Slipped Capital Femoral Epiphysis.

    Science.gov (United States)

    Hosseinzadeh, Pooya; Iwinski, Henry J; Salava, Jonathon; Oeffinger, Donna

    2017-01-01

    Delays in the diagnosis of stable slipped capital femoral epiphysis (SCFE) is common due to the vague symptomatology and the lack of awareness of this entity by healthcare providers. Delays in the diagnosis of this condition can lead to poor outcomes for the patients. This study was designed to identify factors that contributed to delays in the diagnosis or the treatment of patients with SCFE seen at our institution. A retrospective chart review of patients with the diagnosis of a stable SCFE who had undergone screw stabilization between 1989 and 2010 at our hospital was performed. For each patient, demographic data, the date of initial onset of symptoms, the date of the first visit to the medical provider, the type of provider seen initially (orthopaedic surgeon or not), the date of diagnosis of SCFE, the type of physician who made the diagnosis (orthopaedic surgeon or not), and the date of surgery were recorded. For each patient, the presenting symptom was recorded as hip, thigh, or knee pain. The effect of demographic data, presenting symptoms, and the type of initial provider seen on the delay to diagnosis was studied using 2 Cox models. A total of 149 patients with 196 stable SCFE were included. The average time from the first physician visit to diagnosis was 94 days in the group seen by a nonorthopaedic provider compared with an average of 2.9 days in the group seen by an orthopaedist (Pprovider versus 97% in the group seen by orthopaedic surgeons. It took significantly longer to be diagnosed with SCFE in patients who presented with initial knee pain (P=0.0097) compared with those who presented with hip pain at the initial visit. This study shows a significant delay in the diagnosis of SCFE in the United States, particularly in patients seen by nonorthopaedic providers initially. Level III-prognostic.

  15. Plain radiographic findings of lung cancer with delayed diagnosis

    International Nuclear Information System (INIS)

    Choe, Kyu Ok; Chung, Jin Ill

    1994-01-01

    In Korea, Lung cancer is the Second most common prevailing malignancy among male population next to stomach cancer. Although CT scan and MRI is widely used in the staging of lung cancer, plain chest x-ray still plays an important role in screening and diagnosis. Our intention was to review the confusing radiographic features which result in delayed diagnosis of lung cancer. Of the 160 patients with lung cancer evaluated by us, 62 patients(39%) with delayed diagnosis and average diagnostic duration of 5.1 months compared with 2.1 months for those without delay. We reviewed the plain chest x-ray findings of those 62 patients. The diagnosis of lung cancer was delayed more than half of the cases under the impression of intrathoracic tuberculosis. Upon reviewing the roentgenologic findings in patients with diagnostic delay, central type appeared as a small hilar or mediastinal mass with or without obstructive pneumonia. Peripheral type appeared as an ill-defined pulmonary module, a nodule hidden by overlapping structures, or as a lung cancer associated with pulmonary tuberculosis. Some cases were misinterpreted as extranodal spread of malignancy. To solve above mentioned problems, we recommend proper understanding of natural history of lung cancer, incorporation of high kVp technique in chest radiographs, routine acquisition of lateral chest radiograph to increase diagnostic accuracy, and appropriate use of CT scan in cases of difficult diagnosis

  16. Back to the Future - Part 2. Post-mortem assessment and evolutionary role of the bio-medicolegal sciences.

    Science.gov (United States)

    Ferrara, Santo Davide; Cecchetto, Giovanni; Cecchi, Rossana; Favretto, Donata; Grabherr, Silke; Ishikawa, Takaki; Kondo, Toshikazu; Montisci, Massimo; Pfeiffer, Heidi; Bonati, Maurizio Rippa; Shokry, Dina; Vennemann, Marielle; Bajanowski, Thomas

    2017-07-01

    Part 2 of the review "Back to the Future" is dedicated to the evolutionary role of the bio-medicolegal sciences, reporting the historical profiles, the state of the art, and prospects for future development of the main related techniques and methods of the ancillary disciplines that have risen to the role of "autonomous" sciences, namely, Genetics and Genomics, Toxicology, Radiology, and Imaging, involved in historic synergy in the "post-mortem assessment," together with the mother discipline Legal Medicine, by way of its primary fundament, universally denominated as Forensic Pathology. The evolution of the scientific research and the increased accuracy of the various disciplines will be oriented towards the elaboration of an "algorithm," able to weigh the value of "evidence" placed at the disposal of the "justice system" as real truth and proof.

  17. Preliminary approach on early post mortem stress and quality indexes changes in large size bluefin tuna (Thunnus thynnus

    Directory of Open Access Journals (Sweden)

    R. Ugolini

    2010-01-01

    Full Text Available Bluefin tuna (Thunnus thynnus is very appreciated on Japan and USA market for the preparation of sushi and sahimi. The market price of the fresh product can vary from 8 to 33 Euro/kg (gate farm/producers prices according to size, shape, fat level, meat colour, consistency and freshness (absence of “hyake”, all parameters strictly connected to feeding quality and quantity, rearing and killing stress factors and refrigeration times and conditions after death. Excessive levels of stress during the slaughtering can affect meat quality, contributing to significantly decrease of tuna’s price. The present trial was carried out to evaluate the possible harvesting/slaughtering stress effect on reared bluefin tuna meat quality, starting from the examination of the most important stress and quality parameters changes during the early post mortem period.

  18. Rapid determination of quetiapine in blood by gas chromatography-mass spectrometry. Application to post-mortem cases.

    Science.gov (United States)

    López-Guarnido, Olga; Tabernero, María Jesús; Hernández, Antonio F; Rodrigo, Lourdes; Bermejo, Ana M

    2014-10-01

    A simple, fast and sensitive method for the determination of quetiapine in human blood has been developed and validated. The method involved a basic liquid-liquid extraction procedure and subsequent analysis by gas chromatography-mass spectrometry, previous derivatization with bis(trimethylsilyl)-trifluoro-acetamide and chorotrimethylsilane (99 : 1). The methods of validation included linearity with a correlation coefficient > 0.99 over the range 0.02-1 µg ml(-1), intra- and interday precision (always < 12%) and accuracy (mean relative error always < 12%) to meet the bioanalytical acceptance criteria. The limit of detection was 0.005 µg ml(-1). The procedure was further applied to post mortems from the Institute of Legal Medicine, University of Santiago de Compostela. Copyright © 2013 John Wiley & Sons, Ltd.

  19. Overview of JET post-mortem results following the 2007-9 operational period, and comparisons with previous campaigns

    International Nuclear Information System (INIS)

    Coad, J P; Gruenhagen, S; Widdowson, A; Hole, D E; Hakola, A; Koivuranta, S; Likonen, J; Rubel, M

    2011-01-01

    In 2010, all the plasma-facing components were removed from JET so that the carbon-based surfaces could be replaced with beryllium (Be) or tungsten as part of the ITER-like wall (ILW) project. This gives unprecedented opportunities for post-mortem analyses of these plasma-facing surfaces; this paper reviews the data obtained so far and relates the information to studies of tiles removed during previous JET shutdowns. The general pattern of erosion/deposition at the JET divertor has been maintained, with deposition of impurities in the scrape-off layer (SOL) at the inner divertor and preferential removal of carbon and transport into the corner. However, the remaining films in the SOL contain very high Be/C ratios at the surface. The first measurements of erosion using a tile profiler have been completed, with up to 200 microns erosion being recorded at points on the inner wall guard limiters.

  20. Post mortem concentrations of endogenous gamma hydroxybutyric acid (GHB) and in vitro formation in stored blood and urine samples.

    Science.gov (United States)

    Busardò, Francesco Paolo; Bertol, Elisabetta; Vaiano, Fabio; Baglio, Giovanni; Montana, Angelo; Barbera, Nunziata; Zaami, Simona; Romano, Guido

    2014-10-01

    Gamma-hydroxybutyrate (GHB) is a central nervous system depressant, primarily used as a recreational drug of abuse with numerous names. It has also been involved in various instances of drug-facilitated sexual assault due to its potential incapacitating effects. The first aim of this paper is to measure the post-mortem concentration of endogenous GHB in whole blood and urine samples of 30 GHB free-users, who have been divided according to the post-mortem interval (PMI) in three groups (first group: 24-36h; second group: 37-72h; third group: 73-192h), trying to evaluate the role of PMI in affecting post mortem levels. Second, the Authors have evaluated the new formation of GHB in vitro in blood and urine samples of the three groups, which have been stored at -20°C, 4°C and 20°C over a period of one month. The concentrations were measured by GC-MS after liquid-liquid extraction according to the method validated and published by Elliot (For. Sci. Int., 2003). For urine samples, GHB concentrations were creatinine-normalized. In the first group the GHB mean concentration measured after autopsy was: 2.14mg/L (range 0.54-3.21mg/L) in blood and 3.90mg/g (range 0.60-4.81mg/g) in urine; in the second group it was: 5.13mg/L (range 1.11-9.60mg/L) in blood and 3.93mg/g (range 0.91-7.25mg/g) in urine; in the third group it was: 11.8mg/L (range 3.95-24.12mg/L) in blood and 9.83mg/g (range 3.67-21.90mg/g) in urine. The results obtained in blood and urine samples showed a statistically significant difference among groups (pblood and urine samples a mean difference at 20°C compared to -20°C not statistically significant at the 10% level. These findings allow us to affirm that the PMI strongly affects the post mortem production of GHB in blood and urine samples. Regarding the new formation of GHB in vitro both in blood and urine samples of the three groups, which have been stored at -20°C, 4°C and 20°C over a period of one month, although there was no significant increases of

  1. Post-Mortem Analysis after High-Power Operation of the TD24_R05 Tested in Xbox_1

    CERN Document Server

    Degiovanni, Alberto; Mouriz Irazabal, Nerea; Aicheler, Markus

    2016-01-01

    The CLIC prototype structure TD24_R05 has been high power tested in Xbox_1 in 2013. This report summarizes all examinations conducted after the high power test including bead-pull measurements, structure cutting, metrology and SEM observations. A synthesis of the various results is then made. The structure developed a hot cell progressively during operation and detuning was observed after the test was complete. The post mortem examination clearly showed a developed standing wave pattern which was explained by the physical deformation of one of the coupler iris. An elevated breakdown count through SEM imaging in the suspected hot cell however could not be confirmed. Neither any particular feature offering an explanation for the observed longitudinal breakdown distribution could be detected.

  2. Partitioning the proteome: phase separation for targeted analysis of membrane proteins in human post-mortem brain.

    Directory of Open Access Journals (Sweden)

    Jane A English

    Full Text Available Neuroproteomics is a powerful platform for targeted and hypothesis driven research, providing comprehensive insights into cellular and sub-cellular disease states, Gene × Environmental effects, and cellular response to medication effects in human, animal, and cell culture models. Analysis of sub-proteomes is becoming increasingly important in clinical proteomics, enriching for otherwise undetectable proteins that are possible markers for disease. Membrane proteins are one such sub-proteome class that merit in-depth targeted analysis, particularly in psychiatric disorders. As membrane proteins are notoriously difficult to analyse using traditional proteomics methods, we evaluate a paradigm to enrich for and study membrane proteins from human post-mortem brain tissue. This is the first study to extensively characterise the integral trans-membrane spanning proteins present in human brain. Using Triton X-114 phase separation and LC-MS/MS analysis, we enriched for and identified 494 membrane proteins, with 194 trans-membrane helices present, ranging from 1 to 21 helices per protein. Isolated proteins included glutamate receptors, G proteins, voltage gated and calcium channels, synaptic proteins, and myelin proteins, all of which warrant quantitative proteomic investigation in psychiatric and neurological disorders. Overall, our sub-proteome analysis reduced sample complexity and enriched for integral membrane proteins by 2.3 fold, thus allowing for more manageable, reproducible, and targeted proteomics in case vs. control biomarker studies. This study provides a valuable reference for future neuroproteomic investigations of membrane proteins, and validates the use Triton X-114 detergent phase extraction on human post mortem brain.

  3. Development of fetal brain of 20 weeks gestational age: Assessment with post-mortem Magnetic Resonance Imaging

    International Nuclear Information System (INIS)

    Zhang Zhonghe; Liu Shuwei; Lin Xiangtao; Teng Gaojun; Yu Taifei; Fang Fang; Zang Fengchao

    2011-01-01

    Background: The 20th week gestational age (GA) is at mid-gestation and corresponds to the age at which the termination of pregnancy in several countries and the first Magnetic Resonance Imaging (MRI) can be performed, and at which the premature babies may survive. However, at present, very little is known about the exact anatomical character at this GA. Objective: To delineate the developing fetal brain of 20 weeks GA and obtain the three dimensional visualization model. Materials and methods: 20 fetal specimens were scanned by 3.0 T and 7.0 T post-mortem MRI, and the three dimensional visualization model was obtained with Amira 4.1. Results: Most of the sulci or their anlage, except the postcentral sulcus and intraparietal sulcus, were present. The laminar organization, described as layers with different signal intensities, was most clearly distinguished at the parieto-occipital lobe and peripheral regions of the hippocampus. The basal nuclei could be clearly visualized, and the brain stem and cerebellum had formed their common shape. On the visualization model, the shape and relative relationship of the structures could be appropriately delineated. The ranges of normal values of the brain structures were obtained, but no sexual dimorphisms or cerebral asymmetries were found. Conclusions: The developing fetal brain of 20 weeks GA can be clearly delineated on 3.0 T and 7.0 T post-mortem MRIs, and the three dimensional visualization model supplies great help in precise cognition of the immature brain. These results may have positive influences on the evaluation of the fetal brain in the uterus.

  4. Microperforated hymen: a case of delayed diagnosis

    Directory of Open Access Journals (Sweden)

    Olívia Maria Ferraz Ferrarini

    2014-09-01

    Full Text Available Although the incidence of microperforated hymen (MH is unclear, this hymenal subocclusive anomaly is considered a rare entity. Differently from imperforated hymen, MH may be asymptomatic until puberty when the women’s quality of life is jeopardized. Depending on the size of the microperforation, MH’s clinical features me be very similar to those found in imperforated hymen cases. However, MH may present infectious complications since the accumulated secretion retained in the vaginal canal has contact with the external environment and therefore represents a source of entry for infectious agents. The authors report a case of a 28-year-old woman who sought the gynecologist complaining of inability to have vaginal intercourse. She referred normal menses, but in fact, although regular, bleeding was filiform and was exteriorized only through the right side of the vagina. Physical examination and imaging disclosed a microperforation of the hymenal membrane at 10 o’clock position. Hymenotomy under general anesthesia was undertaken. Outcome was favorable and the patient could thenceforth have a normal life. We conclude that this anomaly may be overlooked, interfering on its incidence determination. The delayed onset of symptoms and psychological embarrassing aspects, which postpone gynecological consultation, may contribute for misdiagnoses. We call attention to a mandatory detailed anamnesis and thorough physical examination to diagnose this anomaly before the puberty, when complications are less frequent and treatment is advisable.

  5. [Factors linked to delayed diagnosis of tuberculosis in Conakry (Guinea)].

    Science.gov (United States)

    Camara, A; Diallo, A; Camara, L M; Fielding, K; Sow, O Y; Chaperon, J

    2006-03-01

    Untreated smear-positive pulmonary tuberculosis constitutes a reservoir of infection which is highly contagious. The present study was conducted in Conakry, Guinea, to determine the different options which are available when seeking treatment or care, and to ascertain the average delay in diagnosis of pulmonary tuberculosis and the main factors linked to the delay in diagnosis after the initial onset of symptoms. Through a cross-sectional study, 113 consecutive patients with smear-positive pulmonary tuberculosis were interviewed through the use of a questionnaire. The median total delay from the onset of symptoms of pulmonary tuberculosis until the diagnosis was 11 weeks. This delay period exceeded 4 weeks for 90 of the patients (80%). The average delay linked to the conventional health care system was double that of the one at the fault of the patient (6 weeks versus 3 weeks, respectively). 54% of the patients had initially resorted to non-conventional care. To shorten this mean delay period, it is necessary to both strengthen the professional abilities and skills which train for one to better to detect tuberculosis and to sensitize the population to the subject matter and information on the illness and its symptoms.

  6. Delayed radiographic diagnosis of osteoid osteoma in the lumbar spine

    International Nuclear Information System (INIS)

    Louis-Ugbo, J.; Reddy, A.S.; Heller, J.G.

    1998-01-01

    Study design: Case report and literature review. Objectives: Describe a case of delayed diagnosis of osteoid osteoma of the spine due to misinterpretation of initial imaging studies within two months of onset of pain, and discuss the relevant imaging characteristics and their pitfalls. Summary of background data. Several cases of delayed diagnosis have been previously reported. Only one false negative bone scan has been reported; however other imaging modalities established the diagnosis. In our patient, all of the imaging modalities were initially interpreted as negative hence the delay in diagnosis. Methods: History, physical examination and imaging studies (x-rays, bone scan, MRI) of the patient were employed to evaluate the differential diagnosis of low back pain and sciatica in a 16 yr old. Repeat bone scan and CT scan were done six months after onset of symptoms because of persistent clinical suspicion of osteoid osteoma. Results: The repeat bone scan and CT scan confirmed-the diagnosis missed, during the first round of imaging. An osteoid osteoma of the L5 pedicle was removed without incident. Conclusion: Technetium bone scans remain the main stay of early diagnosis of osteoid osteoma when plain films and other imaging modalities are normal. However, when faced with persistent unexplained musculoskeletal pain in an adolescent, further follow-up and diagnostic efforts are indicated; possibly repeating a bone scan if initially interpreted as negative. (author)

  7. Delay in the histopathologic diagnosis of mycosis fungoides

    DEFF Research Database (Denmark)

    Guldhammer Skov, Anne; Gniadecki, Robert

    2015-01-01

    The diagnosis of mycosis fungoides (MF) is difficult in early stages and is based on a combination of clinical findings and histopathologic criteria. The aim of this study was to assess the diagnostic delay in MF and to investigate the rationale for multiple biopsies in a single-centre, retrospec......The diagnosis of mycosis fungoides (MF) is difficult in early stages and is based on a combination of clinical findings and histopathologic criteria. The aim of this study was to assess the diagnostic delay in MF and to investigate the rationale for multiple biopsies in a single...

  8. Hereditary spherocytosis: Consequences of delayed diagnosis

    Directory of Open Access Journals (Sweden)

    Sarah C Steward

    2014-08-01

    Full Text Available Objective: To determine whether patients with undiagnosed hereditary spherocytosis hospitalized for transfusions might have avoided hospitalization via earlier diagnosis. Study design: Charts of all (N = 30 patients with hereditary spherocytosis seen in pediatric hematology at West Virginia University-Charleston were reviewed. Family and transfusion history and presence of neonatal jaundice were recorded. Complete blood count and reticulocyte values during infancy were available for 20 of 30 patients, while baseline steady-state values were available for all 30. Results: Transfusions were given to 22 patients; 12 of 14 with an aplastic crisis were undiagnosed. In 10 of 12, the severity of anemia led to hospitalization (3 to intensive care. All 10 had prior mean corpuscular hemoglobin concentration and/or red cell distribution width elevations and a history of neonatal jaundice; 7 of 10 had a positive family history. Conclusions: Undiagnosed hereditary spherocytosis may lead to inpatient transfusions for severe anemia. Earlier detection of hereditary spherocytosis is easily achievable and may reduce hospitalizations via closer monitoring.

  9. Post-mortem whole-body magnetic resonance imaging of human fetuses: a comparison of 3-T vs. 1.5-T MR imaging with classical autopsy

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Xin; Bevilacqua, Elisa; Cos Sanchez, Teresa; Jani, Jacques C. [University Hospital Brugmann, Universite Libre de Bruxelles, Department of Obstetrics and Gynecology, Fetal Medicine Unit, Brussels (Belgium); Cannie, Mieke M. [University Hospital Brugmann, Universite Libre de Bruxelles, Department of Radiology, Brussels (Belgium); Vrije Universiteit Brussel, Department of Radiology, UZ Brussel, Brussels (Belgium); Arthurs, Owen J.; Sebire, Neil J. [Great Ormond Street Hospital for Children NHS Foundation Trust, London (United Kingdom); UCL Institute of Child Health, London (United Kingdom); Segers, Valerie; Fourneau, Catherine [University Hospital Brugmann, Universite Libre de Bruxelles, Department of Fetopathology, Brussels (Belgium)

    2017-08-15

    To prospectively compare diagnostic accuracy of fetal post-mortem whole-body MRI at 3-T vs. 1.5-T. Between 2012 and 2015, post-mortem MRI at 1.5-T and 3-T was performed in fetuses after miscarriage/stillbirth or termination. Clinical MRI diagnoses were assessed using a confidence diagnostic score and compared with classical autopsy to derive a diagnostic error score. The relation of diagnostic error for each organ group with gestational age was calculated and 1.5-T with 3-T was compared with accuracy analysis. 135 fetuses at 12-41 weeks underwent post-mortem MRI (followed by conventional autopsy in 92 fetuses). For all organ groups except the brain, and for both modalities, the diagnostic error decreased with gestation (P < 0.0001). 3-T MRI diagnostic error was significantly lower than that of 1.5-T for all anatomic structures and organ groups, except the orbits and brain. This difference was maintained for fetuses <20 weeks gestation. Moreover, 3-T was associated with fewer non-diagnostic scans and greater concordance with classical autopsy than 1.5-T MRI, especially for the thorax, heart and abdomen in fetuses <20 weeks. Post-mortem fetal 3-T MRI improves confidence scores and overall accuracy compared with 1.5-T, mainly for the thorax, heart and abdomen of fetuses <20 weeks of gestation. (orig.)

  10. Delays in diagnosis, referral and management of head and neck ...

    African Journals Online (AJOL)

    Delays in diagnosis, referral and management of head and neck cancer presenting at Kenyatta National Hospital, Nairobi. ... Vol 83, No 4 (2006) >. Log in or Register to get access to full text downloads. ... Background: The most important prognostic factor in head and neck cancer is the stage of the disease at presentation.

  11. Potentially Treatable Disorder Diagnosed Post Mortem by Exome Analysis in a Boy with Respiratory Distress

    Directory of Open Access Journals (Sweden)

    Valentina Imperatore

    2016-02-01

    Full Text Available We highlight the importance of exome sequencing in solving a clinical case of a child who died at 14 months after a series of respiratory crises. He was the half-brother of a girl diagnosed at 7 years with the early-onset seizure variant of Rett syndrome due to CDKL5 mutation. We performed a test for CDKL5 in the boy, which came back negative. Driven by the mother’s compelling need for a diagnosis, we moved forward performing whole exome sequencing analysis. Surprisingly, two missense mutations in compound heterozygosity were identified in the RAPSN gene encoding a receptor-associated protein with a key role in clustering and anchoring nicotinic acetylcholine receptors at synaptic sites. This gene is responsible for a congenital form of myasthenic syndrome, a disease potentially treatable with cholinesterase inhibitors. Therefore, an earlier diagnosis in this boy would have led to a better clinical management and prognosis. Our study supports the key role of exome sequencing in achieving a definite diagnosis in severe perinatal diseases, an essential step especially when a specific therapy is available.

  12. Diagnostic accuracy and limitations of post-mortem MRI for neurological abnormalities in fetuses and children

    International Nuclear Information System (INIS)

    Arthurs, O.J.; Thayyil, S.; Pauliah, S.S.; Jacques, T.S.; Chong, W.K.; Gunny, R.; Saunders, D.; Addison, S.; Lally, P.; Cady, E.; Jones, R.; Norman, W.; Scott, R.; Robertson, N.J.; Wade, A.; Chitty, L.; Taylor, A.M.

    2015-01-01

    Aim: To compare the diagnostic accuracy of non-invasive cerebral post-mortem magnetic resonance imaging (PMMRI) specifically for cerebral and neurological abnormalities in a series of fetuses and children, compared to conventional autopsy. Materials and methods: Institutional ethics approval and parental consent was obtained. Pre-autopsy cerebral PMMRI was performed in a sequential prospective cohort (n = 400) of fetuses (n = 277; 185 ≤ 24 weeks and 92 > 24 weeks gestation) and children <16 years (n = 123) of age. PMMRI and conventional autopsy findings were reported blinded and independently of each other. Results: Cerebral PMMRI had sensitivities and specificities (95% confidence interval) of 88.4% (75.5 to 94.9), and 95.2% (92.1 to 97.1), respectively, for cerebral malformations; 100% (83.9 to 100), and 99.1% (97.2 to 99.7) for major intracranial bleeds; and 87.5% (80.1 to 92.4) and 74.1% (68 to 79.4) for overall brain pathology. Formal neuropathological examination was non-diagnostic due to maceration/autolysis in 43/277 (16%) fetuses; of these, cerebral PMMRI imaging provided clinically important information in 23 (53%). The sensitivity of PMMRI for detecting significant ante-mortem ischaemic injury was only 68% (48.4 to 82.8) overall. Conclusions: PMMRI is an accurate investigational technique for identifying significant neuropathology in fetuses and children, and may provide important information even in cases where autolysis prevents formal neuropathological examination; however, PMMRI is less sensitive at detecting hypoxic–ischaemic brain injury, and may not detect rarer disorders not encountered in this study. -- Highlights: •Post mortem MRI (PMMRI) has a sensitivity of >87% for detecting cerebral malformations, intracranial bleeds and neurological cause of death. •PMMRI provides important diagnostic information in >50% of fetuses where conventional brain autopsy is non-diagnostic. •PMMRI is currently poor at reliably identifying

  13. Assessing various Infrared (IR) microscopic imaging techniques for post-mortem interval evaluation of human skeletal remains

    Science.gov (United States)

    Roider, Clemens; Ritsch-Marte, Monika; Pemberger, Nadin; Cemper-Kiesslich, Jan; Hatzer-Grubwieser, Petra; Parson, Walther; Pallua, Johannes Dominikus

    2017-01-01

    Due to the influence of many environmental processes, a precise determination of the post-mortem interval (PMI) of skeletal remains is known to be very complicated. Although methods for the investigation of the PMI exist, there still remains much room for improvement. In this study the applicability of infrared (IR) microscopic imaging techniques such as reflection-, ATR- and Raman- microscopic imaging for the estimation of the PMI of human skeletal remains was tested. PMI specific features were identified and visualized by overlaying IR imaging data with morphological tissue structures obtained using light microscopy to differentiate between forensic and archaeological bone samples. ATR and reflection spectra revealed that a more prominent peak at 1042 cm-1 (an indicator for bone mineralization) was observable in archeological bone material when compared with forensic samples. Moreover, in the case of the archaeological bone material, a reduction in the levels of phospholipids, proteins, nucleic acid sugars, complex carbohydrates as well as amorphous or fully hydrated sugars was detectable at (reciprocal wavelengths/energies) between 3000 cm-1 to 2800 cm-1. Raman spectra illustrated a similar picture with less ν2PO43−at 450 cm-1 and ν4PO43− from 590 cm-1 to 584 cm-1, amide III at 1272 cm-1 and protein CH2 deformation at 1446 cm-1 in archeological bone material/samples/sources. A semi-quantitative determination of various distributions of biomolecules by chemi-maps of reflection- and ATR- methods revealed that there were less carbohydrates and complex carbohydrates as well as amorphous or fully hydrated sugars in archaeological samples compared with forensic bone samples. Raman- microscopic imaging data showed a reduction in B-type carbonate and protein α-helices after a PMI of 3 years. The calculated mineral content ratio and the organic to mineral ratio displayed that the mineral content ratio increases, while the organic to mineral ratio decreases with

  14. Post-mortem computed tomography findings of the lungs: Retrospective review and comparison with autopsy results of 30 infant cases

    Energy Technology Data Exchange (ETDEWEB)

    Kawasumi, Yusuke, E-mail: ssu@rad.med.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Clinical Imaging, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 (Japan); Usui, Akihito, E-mail: t7402r0506@med.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Diagnostic Image Analysis, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 (Japan); Hosokai, Yoshiyuki, E-mail: hosokai@med.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Diagnostic Image Analysis, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 (Japan); Igari, Yui, E-mail: igari@forensic.med.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Forensic Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 (Japan); Hosoya, Tadashi [Tohoku University Graduate School of Medicine, Department of Forensic Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 (Japan); Hayashizaki, Yoshie, E-mail: yoshie@forensic.med.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Forensic Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 (Japan); Saito, Haruo, E-mail: hsaito@med.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Diagnostic Image Analysis, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 (Japan); Ishibashi, Tadashi, E-mail: tisibasi@med.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Clinical Imaging, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 (Japan); Funayama, Masato, E-mail: funayama@forensic.med.tohoku.ac.jp [Tohoku University Graduate School of Medicine, Department of Forensic Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 (Japan)

    2015-04-15

    Highlights: •Infant cases frequently show a diffuse increase in the concentration of lung fields on post-mortem computed tomography (PMCT). •In this study, twenty-two of the thirty sudden infant death cases showed increasing concentration in the entire lung field. •Based on the autopsy results, the lungs simply collapsed and no other abnormal lung findings were identified. •The radiologist should not consider increasing concentration in all lung fields as simply a pulmonary disorder when diagnosing the cause of infant death using PMCT. -- Abstract: Objectives: Infant cases frequently show a diffuse increase in the concentration of lung fields on post-mortem computed tomography (PMCT). However, the lungs often show simply atelectasis at autopsy in the absence of any other abnormal changes. Thus, we retrospectively reviewed the PMCT findings of lungs following sudden infant death and correlated them with the autopsy results. Materials and methods: We retrospectively reviewed infant cases (0 year) who had undergone PMCT and a forensic autopsy at our institution between May 2009 and June 2013. Lung opacities were classified according to their type; consolidation, ground-glass opacity and mixed, as well as distribution; bilateral diffuse and areas of sparing. Statistical analysis was performed to assess the relationships among lung opacities, causes of death and resuscitation attempt. Results: Thirty infant cases were selected, which included 22 sudden and unexplained deaths and 8 other causes of death. Resuscitation was attempted in 22 of 30 cases. Bilateral diffuse opacities were observed in 21 of the 30 cases. Of the 21 cases, 18 were sudden and unexplained deaths. Areas of sparing were observed in 4 sudden and unexplained deaths and 5 other causes of death. Distribution of opacities was not significantly associated with causes of death or resuscitation attempt. The 21 cases with bilateral diffuse opacities included 6 consolidations (4 sudden and unexplained

  15. Assessing various Infrared (IR microscopic imaging techniques for post-mortem interval evaluation of human skeletal remains.

    Directory of Open Access Journals (Sweden)

    Claudia Woess

    Full Text Available Due to the influence of many environmental processes, a precise determination of the post-mortem interval (PMI of skeletal remains is known to be very complicated. Although methods for the investigation of the PMI exist, there still remains much room for improvement. In this study the applicability of infrared (IR microscopic imaging techniques such as reflection-, ATR- and Raman- microscopic imaging for the estimation of the PMI of human skeletal remains was tested. PMI specific features were identified and visualized by overlaying IR imaging data with morphological tissue structures obtained using light microscopy to differentiate between forensic and archaeological bone samples. ATR and reflection spectra revealed that a more prominent peak at 1042 cm-1 (an indicator for bone mineralization was observable in archeological bone material when compared with forensic samples. Moreover, in the case of the archaeological bone material, a reduction in the levels of phospholipids, proteins, nucleic acid sugars, complex carbohydrates as well as amorphous or fully hydrated sugars was detectable at (reciprocal wavelengths/energies between 3000 cm-1 to 2800 cm-1. Raman spectra illustrated a similar picture with less ν2PO43-at 450 cm-1 and ν4PO43- from 590 cm-1 to 584 cm-1, amide III at 1272 cm-1 and protein CH2 deformation at 1446 cm-1 in archeological bone material/samples/sources. A semi-quantitative determination of various distributions of biomolecules by chemi-maps of reflection- and ATR- methods revealed that there were less carbohydrates and complex carbohydrates as well as amorphous or fully hydrated sugars in archaeological samples compared with forensic bone samples. Raman- microscopic imaging data showed a reduction in B-type carbonate and protein α-helices after a PMI of 3 years. The calculated mineral content ratio and the organic to mineral ratio displayed that the mineral content ratio increases, while the organic to mineral ratio

  16. Assessing various Infrared (IR) microscopic imaging techniques for post-mortem interval evaluation of human skeletal remains.

    Science.gov (United States)

    Woess, Claudia; Unterberger, Seraphin Hubert; Roider, Clemens; Ritsch-Marte, Monika; Pemberger, Nadin; Cemper-Kiesslich, Jan; Hatzer-Grubwieser, Petra; Parson, Walther; Pallua, Johannes Dominikus

    2017-01-01

    Due to the influence of many environmental processes, a precise determination of the post-mortem interval (PMI) of skeletal remains is known to be very complicated. Although methods for the investigation of the PMI exist, there still remains much room for improvement. In this study the applicability of infrared (IR) microscopic imaging techniques such as reflection-, ATR- and Raman- microscopic imaging for the estimation of the PMI of human skeletal remains was tested. PMI specific features were identified and visualized by overlaying IR imaging data with morphological tissue structures obtained using light microscopy to differentiate between forensic and archaeological bone samples. ATR and reflection spectra revealed that a more prominent peak at 1042 cm-1 (an indicator for bone mineralization) was observable in archeological bone material when compared with forensic samples. Moreover, in the case of the archaeological bone material, a reduction in the levels of phospholipids, proteins, nucleic acid sugars, complex carbohydrates as well as amorphous or fully hydrated sugars was detectable at (reciprocal wavelengths/energies) between 3000 cm-1 to 2800 cm-1. Raman spectra illustrated a similar picture with less ν2PO43-at 450 cm-1 and ν4PO43- from 590 cm-1 to 584 cm-1, amide III at 1272 cm-1 and protein CH2 deformation at 1446 cm-1 in archeological bone material/samples/sources. A semi-quantitative determination of various distributions of biomolecules by chemi-maps of reflection- and ATR- methods revealed that there were less carbohydrates and complex carbohydrates as well as amorphous or fully hydrated sugars in archaeological samples compared with forensic bone samples. Raman- microscopic imaging data showed a reduction in B-type carbonate and protein α-helices after a PMI of 3 years. The calculated mineral content ratio and the organic to mineral ratio displayed that the mineral content ratio increases, while the organic to mineral ratio decreases with time

  17. Using bacterial and necrophagous insect dynamics for post-mortem interval estimation during cold season: Novel case study in Romania.

    Science.gov (United States)

    Iancu, Lavinia; Carter, David O; Junkins, Emily N; Purcarea, Cristina

    2015-09-01

    Considering the biogeographical characteristics of forensic entomology, and the recent development of forensic microbiology as a complementary approach for post-mortem interval estimation, the current study focused on characterizing the succession of necrophagous insect species and bacterial communities inhabiting the rectum and mouth cavities of swine (Sus scrofa domesticus) carcasses during a cold season outdoor experiment in an urban natural environment of Bucharest, Romania. We monitored the decomposition process of three swine carcasses during a 7 month period (November 2012-May 2013) corresponding to winter and spring periods of a temperate climate region. The carcasses, protected by wire cages, were placed on the ground in a park type environment, while the meteorological parameters were constantly recorded. The succession of necrophagous Diptera and Coleoptera taxa was monitored weekly, both the adult and larval stages, and the species were identified both by morphological and genetic characterization. The structure of bacterial communities from swine rectum and mouth tissues was characterized during the same time intervals by denaturing gradient gel electrophoresis (DGGE) and sequencing of 16S rRNA gene fragments. We observed a shift in the structure of both insect and bacterial communities, primarily due to seasonal effects and the depletion of the carcass. A total of 14 Diptera and 6 Coleoptera species were recorded on the swine carcasses, from which Calliphora vomitoria and C. vicina (Diptera: Calliphoridae), Necrobia violacea (Coleoptera: Cleridae) and Thanatophilus rugosus (Coleoptera: Silphidae) were observed as predominant species. The first colonizing wave, primarily Calliphoridae, was observed after 15 weeks when the temperature increased to 13°C. This was followed by Muscidae, Fanniidae, Anthomyiidae, Sepsidae and Piophilidae. Families belonging to Coleoptera Order were observed at week 18 when temperatures raised above 18°C, starting with

  18. Post-mortem computed tomography findings of the lungs: Retrospective review and comparison with autopsy results of 30 infant cases

    International Nuclear Information System (INIS)

    Kawasumi, Yusuke; Usui, Akihito; Hosokai, Yoshiyuki; Igari, Yui; Hosoya, Tadashi; Hayashizaki, Yoshie; Saito, Haruo; Ishibashi, Tadashi; Funayama, Masato

    2015-01-01

    Highlights: •Infant cases frequently show a diffuse increase in the concentration of lung fields on post-mortem computed tomography (PMCT). •In this study, twenty-two of the thirty sudden infant death cases showed increasing concentration in the entire lung field. •Based on the autopsy results, the lungs simply collapsed and no other abnormal lung findings were identified. •The radiologist should not consider increasing concentration in all lung fields as simply a pulmonary disorder when diagnosing the cause of infant death using PMCT. -- Abstract: Objectives: Infant cases frequently show a diffuse increase in the concentration of lung fields on post-mortem computed tomography (PMCT). However, the lungs often show simply atelectasis at autopsy in the absence of any other abnormal changes. Thus, we retrospectively reviewed the PMCT findings of lungs following sudden infant death and correlated them with the autopsy results. Materials and methods: We retrospectively reviewed infant cases (0 year) who had undergone PMCT and a forensic autopsy at our institution between May 2009 and June 2013. Lung opacities were classified according to their type; consolidation, ground-glass opacity and mixed, as well as distribution; bilateral diffuse and areas of sparing. Statistical analysis was performed to assess the relationships among lung opacities, causes of death and resuscitation attempt. Results: Thirty infant cases were selected, which included 22 sudden and unexplained deaths and 8 other causes of death. Resuscitation was attempted in 22 of 30 cases. Bilateral diffuse opacities were observed in 21 of the 30 cases. Of the 21 cases, 18 were sudden and unexplained deaths. Areas of sparing were observed in 4 sudden and unexplained deaths and 5 other causes of death. Distribution of opacities was not significantly associated with causes of death or resuscitation attempt. The 21 cases with bilateral diffuse opacities included 6 consolidations (4 sudden and unexplained

  19. DNA quality and quantity from up to 16 years old post-mortem blood stored on FTA cards.

    Science.gov (United States)

    Rahikainen, Anna-Liina; Palo, Jukka U; de Leeuw, Wiljo; Budowle, Bruce; Sajantila, Antti

    2016-04-01

    Blood samples preserved on FTA cards offer unique opportunities for genetic research. DNA recovered from these cards should be stable for long periods of time. However, it is not well established as how well the DNA stored on FTA card for substantial time periods meets the demands of forensic or genomic DNA analyses and especially so for from post-mortem (PM) samples in which the quality can vary upon initial collection. The aim of this study was to evaluate the time-dependent degradation on DNA quality and quantity extracted from up to 16 years old post-mortem bloodstained FTA cards. Four random FTA samples from eight time points spanning 1998 to 2013 (n=32) were collected and extracted in triplicate. The quantity and quality of the extracted DNA samples were determined with Quantifiler(®) Human Plus (HP) Quantification kit. Internal sample and sample-to-sample variation were evaluated by comparing recovered DNA yields. The DNA from the triplicate samplings were subsequently combined and normalized for further analysis. The practical effect of degradation on DNA quality was evaluated from normalized samples both with forensic and pharmacogenetic target markers. Our results suggest that (1) a PM change, e.g. blood clotting prior to sampling, affects the recovered DNA yield, creating both internal and sample-to-sample variation; (2) a negative correlation between the FTA card storage time and DNA quantity (r=-0.836 at the 0.01 level) was observed; (3) a positive correlation (r=0.738 at the level 0.01) was found between FTA card storage time and degradation levels. However, no inhibition was observed with the method used. The effect of degradation was manifested clearly with functional applications. Although complete STR-profiles were obtained for all samples, there was evidence of degradation manifested as decreased peak heights in the larger-sized amplicons. Lower amplification success was notable with the large 5.1 kb CYP2D6 gene fragment which strongly supports

  20. Delayed hepatobiliary imaging in the diagnosis of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Chen, S.; Ma, Z.; Tang, Z.

    2000-01-01

    In recent years, the use of ultrasonography (US), X-CT and MRI has reduced the employment of isotopic explorations in the detection of hepatocellular carcinoma (HCC). But sometime the results of US, X-CT or MRI were different and diagnosis was very difficult. This present investigation was aimed to assess the usefulness of delayed hepatobiliary imaging in the diagnosis of HCC in these patients. Forty-eight patients consisting of 33 males and 15 females were entered into the research protocol. The mean age was 46 yr old (range 12-71 yr old). All of the patients were performed by surgery and verified histologically after nuclear examination. The subject was in a supine position under a gamma camera (Elscint, Apex Ap-6) and 555 MBq of Tc-99m-PMT were injected intravenously. The initial scinphotos obtained within 1 min after injection were used to image the blood pool phase. Subsequently, hepatic scans were obtained at 5 min, 1,2 and 5 hr. Anterior, right lateral and posterior hepatic images were recorded. According to the radioactive uptake by the lesion in delayed phase, the negative (no or minor uptake), positive (equal or greater uptake) or very strong positive (almost equal to the activity, of gallbladder) were judged. The positive were considered as diagnostic of HCC. And the very strong positive, were considered as diagnostic of benign hepatoma, such as adenoma or FNH. Thirty-seven of the forty-eight patients were HCC based on histology. Delayed imaging revealed increased or equilibrated uptake of radioactivity by the tumors in 22 of 37 patients with hepatocellular carcinoma. The sensitivity was 59.5%. One patient final diagnosis based on histology was focal nodular regenerative hyperplasia, and only the diagnosis with delayed hepatobiliary imaging before surgery was correct. Compared with US, X-CT and MRI, delayed hepatobiliary imaging had the highest specificity for diagnosis of hepatocellular carcinoma. In recent group, the specificity of Tc-99m-PMT delayed

  1. Autoradiographic analysis of tritiated imipramine binding in the human brain post mortem: effects of suicide

    International Nuclear Information System (INIS)

    Gross-Isseroff, R.; Israeli, M.; Biegon, A.

    1989-01-01

    In vitro quantitative autoradiography of high-affinity tritiated imipramine binding sites was performed on brains of 12 suicide victims and 12 matched controls. Region-specific differences in imipramine binding were found between the two groups. Thus, the pyramidal and molecular layers of the cornu ammoni hippocampal fields and the hilus of the dentate gyrus exhibited 80%, 60%, and 90% increases in binding in the suicide group, respectively. The postcentral cortical gyrus, insular cortex, and claustrum had 45%, 28%, and 75% decreases in binding in the suicide group, respectively. No difference in imipramine binding was observed in prefrontal cortical regions, in the basal ganglia, and in mesencephalic nuclei. No sex and postmortem delay effects on imipramine binding were found. Imipramine binding was positively correlated with age, the effect of age being most pronounced in portions of the basal ganglia and temporal cortex

  2. Delays in the diagnosis of pulmonary tuberculosis in Coahuila, Mexico.

    Science.gov (United States)

    Salinas, J; Calvillo, S; Caylà, J; Nedel, F B; Martín, M; Navarro, A

    2012-09-01

    To determine diagnostic delay in pulmonary tuberculosis (PTB) cases and analyse associated factors. New PTB cases were studied in Coahuila, Northern Mexico, between 2008 and 2009. We obtained census data and data on residential address, symptoms and diagnosis from the national patient database; sociodemographic variables were obtained during home visits. Bivariate analyses used the Kaplan-Meier method; multivariate analysis consisted of modelling survival. We studied 458 subjects (median age 48 years), who were predominantly males (56.1%); the median years of schooling was 6.0 years, 83.4% were urban residents, 50.3% were unemployed, and 87.7% suffered from food poverty. The median delay between the onset of symptoms and the first medical consultation was 53.5 days. Lack of formal education (P = 0.050) and living ≥5 km from a health unit (P = 0.034) were associated with longer delays and consequently with severe symptoms (cough ≥2 weeks, P = 0.001; chest pain, P = 0.032; malnutrition, P = 0.003). Mean health system delay (between first consultation and smear test result) was 18.5 days, and was significantly longer when the first consultation was with a private physician (P < 0.001) and when patient age was ≥46 years (P = 0.001). In Coahuila, lack of formal education, living ≥5 km from a health unit, first consultation with a private physician, and being aged ≥46 years contributed to delays in PTB diagnosis.

  3. Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: frequent findings and comparison to autopsy

    Energy Technology Data Exchange (ETDEWEB)

    Winklhofer, Sebastian; Stolzmann, Paul [University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Surer, Eddie; Ampanozi, Garyfalia; Thali, Michael; Schweitzer, Wolf [University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); Ruder, Thomas [University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); University Hospital Bern, Institute of Diagnostic, Interventional and Pediatric Radiology, Bern (Switzerland); Elliott, Marina [Simon Fraser University, Department of Archaeology, Burnaby, BC (Canada); Oestreich, Andrea; Kraemer, Thomas [University of Zurich, Department of Forensic Pharmacology and Toxicology, Institute of Forensic Medicine, Zurich (Switzerland); Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland)

    2014-06-15

    To investigate frequent findings in cases of fatal opioid intoxication in whole-body post-mortem computed tomography (PMCT). PMCT of 55 cases in which heroin and/or methadone had been found responsible for death were retrospectively evaluated (study group), and were compared with PMCT images of an age- and sex-matched control group. Imaging results were compared with conventional autopsy. The most common findings in the study group were: pulmonary oedema (95 %), aspiration (66 %), distended urinary bladder (42 %), cerebral oedema (49 %), pulmonary emphysema (38 %) and fatty liver disease (36 %). These PMCT findings occurred significantly more often in the study group than in the control group (p < 0.05). The combination of lung oedema, brain oedema and distended urinary bladder was seen in 26 % of the cases in the study group but never in the control group (0 %). This triad, as indicator of opioid-related deaths, had a specificity of 100 %, as confirmed by autopsy and toxicological analysis. Frequent findings in cases of fatal opioid intoxication were demonstrated. The triad of brain oedema, lung oedema and a distended urinary bladder on PMCT was highly specific for drug-associated cases of death. (orig.)

  4. Properties of raw meat and meat curry from spent goat in relation with post-mortem handling conditions.

    Science.gov (United States)

    Narayan, Raj; Mendiratta, S K; Mane, B G

    2013-04-01

    The properties of raw meat and meat curry from spent goat meat in relation with post-mortem handling conditions were evaluated. The conditions evaluated were: cooking of meat within 1-2 h post-slaughter (condition 1); deboning meat storage at 25 ± 2 °C for 5-6 h and cooking (condition 2); post-slaughter storage of carcass at room temperature for 5-6 h, then deboning followed by storage of meat at refrigeration temperature for 5-6 h and cooking (condition 3); deboning and storage of meat at 25 ± 2 °C for 10-12 h and cooking (condition 4). Significant difference was observed in pH values in condition 1 (p meat as compared to the conditions 2, 3 and 4. However, the moisture content of cooked meat was significantly higher (p meat chunks, that is, the mean value was significantly higher (p < 0.01) for condition 2 and significantly lower for condition 1. Sensory scores were significantly higher in condition 1 and significantly lower in condition 2. However, sensory scores for condition 4 were almost similar to the condition 1.

  5. Distribution of 5HT2A receptors in the human brain: Comparison of data in vivo and post mortem

    International Nuclear Information System (INIS)

    Forutan, F.; Estalji, S.; Beu, M.; Nikolaus, S.; Vosberg, H.; Mueller-Gaertner, H.W.; Larisch, R.; Hamacher, K.; Coenen, H.H.

    2002-01-01

    Aim: The study presented here firstly compars the distribution of the binding potential of the serotonin-5HT 2A receptor as measured in vivo with data of receptor density taken from literature. Secondly, the sensitivity of the method to detect gradual differences in receptor densities is evaluated. Methods: Positron emission tomography (PET) studies were carried out in 6 healthy volunteers using the selective serotonin-5HT 2A ligand 18 F-altanserin. The binding potential was quantified in 12 regions using Logan's graphical method and the equilibrium method. These data were compared to the distribution of receptor density as taken from literature. Results: The binding data in vivo correlated to autoradiography data (post mortem) with r = 0.83 (Pearson regression coefficient; p 18 F-altanserin and PET in healthy volunteers and the true autoradiographically determined distribution of 5HT 2A receptors in human brains. The in vivo method seems to be sensitive enough to detect changes in receptor density of more than 18%. (orig.)

  6. Influence of carcass weight on meat quality of commercial feedlot steers with similar feedlot, slaughter and post-mortem management.

    Science.gov (United States)

    Agbeniga, Babatunde; Webb, Edward C

    2018-03-01

    The effects of beef carcass weight on muscle pH/temperature profile and selected meat quality attributes were evaluated. Twenty-six carcasses from light (≤260kg, n=15) and heavy (≥290kg, n=11) feedlot steers were randomly allocated and stimulated with low voltage electrical stimulation (LVES) for 30s at 7min post-mortem (pm). Quality evaluations were carried out on samples from the Longissimus et lumborum (LL) muscle from the left side of each carcass. Heavier carcasses showed faster pH decline and slower (P35°C) but there was no sign of sarcomere shortening in any carcass. Significantly lower (P0.05) drip loss at 3 and 14days pm as well as higher L* (meat lightness) (P<0.05) and C* (chroma) (P<0.05) values early (2days) pm. However, at 14days pm, there were no significant differences between the light and heavy carcasses in terms of L* and C*. No significant difference was observed between heavy and light carcasses in terms of H* at 2 and 14days pm. The study showed that heavier carcasses which favor slaughter house pricing can be produced and processed alongside lighter carcasses without significant detrimental effects on meat quality by using low voltage electrical stimulation (LVES). Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: frequent findings and comparison to autopsy

    International Nuclear Information System (INIS)

    Winklhofer, Sebastian; Stolzmann, Paul; Surer, Eddie; Ampanozi, Garyfalia; Thali, Michael; Schweitzer, Wolf; Ruder, Thomas; Elliott, Marina; Oestreich, Andrea; Kraemer, Thomas; Alkadhi, Hatem

    2014-01-01

    To investigate frequent findings in cases of fatal opioid intoxication in whole-body post-mortem computed tomography (PMCT). PMCT of 55 cases in which heroin and/or methadone had been found responsible for death were retrospectively evaluated (study group), and were compared with PMCT images of an age- and sex-matched control group. Imaging results were compared with conventional autopsy. The most common findings in the study group were: pulmonary oedema (95 %), aspiration (66 %), distended urinary bladder (42 %), cerebral oedema (49 %), pulmonary emphysema (38 %) and fatty liver disease (36 %). These PMCT findings occurred significantly more often in the study group than in the control group (p < 0.05). The combination of lung oedema, brain oedema and distended urinary bladder was seen in 26 % of the cases in the study group but never in the control group (0 %). This triad, as indicator of opioid-related deaths, had a specificity of 100 %, as confirmed by autopsy and toxicological analysis. Frequent findings in cases of fatal opioid intoxication were demonstrated. The triad of brain oedema, lung oedema and a distended urinary bladder on PMCT was highly specific for drug-associated cases of death. (orig.)

  8. [Post mortem temperature equilibration of the structures of the head. I. Thermometric techniques and principal investigations (author's transl)].

    Science.gov (United States)

    Brinkmann, B; May, D; Riemann, U

    1976-06-30

    Special thin and flexible thermometric probes showing a diameter of 1 mm and a sharp end were used for post mortem (p.m.) thermometric studies in several tissues. Brain temperatures were measured by inserting a double probe through the superior orbital fissura thus allowing to record the central and the peripheral brain regions separately. Another probe was inserted into the galea and a fourth into the liver. Temperature changes were recorded simultaneously. Many variables of the human head were measured. Sixteen corpses were investigated. The results were as follows: 1. Of all temperature curves registered those of the central brain regions showed the smallest variance. 2. The p.m. temperature curve of the brain shows a sigmoid shape with a rather short "plateau" in the beginning. 3. In the early p.m. phase there is an increasing difference of temperatures between central and peripheral brain regions amounting to 2-4, 6 degrees C in the time period between 78th and 128th minute. 4. The insertion of the thin probes does not cause visible damages. Thus it should be considered for use in forensic practice. 5. Some artificial "head models" were constructed and temperature decrease recorded after warming. The curves showed the same type of sigmoid shape as those obtained from the corpses. 6. Of the possible variables measured that could influence the temperature decrease only the density of the hair seems to be of interest.

  9. Virtual forensic entomology: improving estimates of minimum post-mortem interval with 3D micro-computed tomography.

    Science.gov (United States)

    Richards, Cameron S; Simonsen, Thomas J; Abel, Richard L; Hall, Martin J R; Schwyn, Daniel A; Wicklein, Martina

    2012-07-10

    We demonstrate how micro-computed tomography (micro-CT) can be a powerful tool for describing internal and external morphological changes in Calliphora vicina (Diptera: Calliphoridae) during metamorphosis. Pupae were sampled during the 1st, 2nd, 3rd and 4th quarter of development after the onset of pupariation at 23 °C, and placed directly into 80% ethanol for preservation. In order to find the optimal contrast, four batches of pupae were treated differently: batch one was stained in 0.5M aqueous iodine for 1 day; two for 7 days; three was tagged with a radiopaque dye; four was left unstained (control). Pupae stained for 7d in iodine resulted in the best contrast micro-CT scans. The scans were of sufficiently high spatial resolution (17.2 μm) to visualise the internal morphology of developing pharate adults at all four ages. A combination of external and internal morphological characters was shown to have the potential to estimate the age of blowfly pupae with a higher degree of accuracy and precision than using external morphological characters alone. Age specific developmental characters are described. The technique could be used as a measure to estimate a minimum post-mortem interval in cases of suspicious death where pupae are the oldest stages of insect evidence collected. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  10. Post-mortem prediction of primal and selected retail cut weights of New Zealand lamb from carcass and animal characteristics.

    Science.gov (United States)

    Ngo, L; Ho, H; Hunter, P; Quinn, K; Thomson, A; Pearson, G

    2016-02-01

    Post-mortem measurements (cold weight, grade and external carcass linear dimensions) as well as live animal data (age, breed, sex) were used to predict ovine primal and retail cut weights for 792 lamb carcases. Significant levels of variance could be explained using these predictors. The predictive power of those measurements on primal and retail cut weights was studied by using the results from principal component analysis and the absolute value of the t-statistics of the linear regression model. High prediction accuracy for primal cut weight was achieved (adjusted R(2) up to 0.95), as well as moderate accuracy for key retail cut weight: tenderloins (adj-R(2)=0.60), loin (adj-R(2)=0.62), French rack (adj-R(2)=0.76) and rump (adj-R(2)=0.75). The carcass cold weight had the best predictive power, with the accuracy increasing by around 10% after including the next three most significant variables. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Deuterium Inventory in Tore Supra (DITS): 2nd post-mortem analysis campaign and fuel retention in the gaps

    International Nuclear Information System (INIS)

    Dittmar, T.; Tsitrone, E.; Pegourie, B.; Cadez, I.; Pelicon, P.; Gauthier, E.; Languille, P.; Likonen, J.; Litnovsky, A.; Markelj, S.; Martin, C.; Mayer, M.; Pascal, J.-Y.; Pardanaud, C.; Philipps, V.; Roth, J.; Roubin, P.; Vavpetic, P.

    2011-01-01

    A dedicated study on fuel retention has been launched in Tore Supra, which includes a D wall-loading campaign and the dismantling of the main limiter (Deuterium Inventory in Tore Supra, DITS project). This paper presents new results from a second post-mortem analysis campaign on 40 tiles with special emphasis on the D retention in the gaps. SIMS analysis reveals that only 1/3 of the thickness of deposits in the plasma shadowed zones are due to the DITS wall-loading campaign. As pre-DITS deposits contain less D than DITS deposits, the contribution of DITS to the D inventory is about 30-50%. The new estimate for the total amount of D retained in the Tore Supra limiter is 1.7 x 10 24 atoms, close to the previous estimate, with the gap surfaces contributing about 33%. NRA measurements show a stepped decrease of D along the gap with strong asymmetries between different gap orientations.

  12. Outdoor post-mortem bite injuries by Tapinoma nigerrimum (Hymenoptera, Formicidae) on a human corpse: Case report.

    Science.gov (United States)

    Bonacci, Teresa; Vercillo, Vannio

    2015-07-01

    Ants are among the insects that colonize exposed human and animal corpses during the early stage of decomposition. In Calabria, Italy (as well as in other countries), Formicidae have been observed preying on immature stages of Diptera and other insects, as well as causing irregular scalloped areas of superficial skin loss on human corpses and animal carcasses. We present a case of injuries on a human corpse caused by ant feeding. The macroscopic appearance is described and the results of a histochemical investigation of the skin lesions caused by worker ants are reported for the first time. The investigation was carried out on the fresh corpse of a 53-year-old man discovered in a rural area of Cosenza province (Calabria, southern Italy). Numerous irregular areas of superficial skin loss caused by the ant Tapinoma nigerrimum (Nylander 1856) (Hymenoptera, Formicidae) were observed on the body surface, inflicted very early in the post-mortem period. Because the classification of lesions is of crucial importance for forensic investigations, the macroscopic appearance and distribution pattern of the lesions on the corpse are illustrated. The histochemical investigation of the damaged skin explains, for the first time, the mechanism of production of the lesions. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  13. Post-mortem hemoparasite detection in free-living Brazilian brown brocket deer (Mazama gouazoubira, Fischer 1814

    Directory of Open Access Journals (Sweden)

    Júlia Angélica Gonçalves da Silveira

    Full Text Available Tick-borne infections can result in serious health problems for wild ruminants, and some of these infectious agents can be considered zoonosis. The aim of the present study was the post-mortem detection of hemoparasites in free-living Mazama gouazoubira from Minas Gerais state, Brazil. The deer samples consisted of free-living M. gouazoubira (n = 9 individuals that died after capture. Necropsy examinations of the carcasses were performed to search for macroscopic alterations. Organ samples were collected for subsequent imprint slides, and nested PCR assays were performed to detect hemoparasite species. Imprint slide assays from four deer showed erythrocytes infected with Piroplasmida small trophozoites, and A. marginale corpuscles were observed in erythrocytes from two animals. A. marginale and trophozoite co-infections occurred in two deer. A nested PCR analysis of the organs showed that six of the nine samples were positive for Theileria sp., five were positive for A. phagocytophilum and three were positive for A. marginale, with co-infection occurring in four deer. The results of the present study demonstrate that post-mortemdiagnostics using imprint slides and molecular assays are an effective method for detecting hemoparasites in organs.

  14. Specific diagnosis of hepatocellular carcinoma by delayed hepatobiliary imaging

    International Nuclear Information System (INIS)

    Hasegawa, Y.; Nakano, S.; Ibuka, K.

    1986-01-01

    For assessment of the value of delayed hepatobiliary imaging with technetium 99m (/sup 99m/Tc)-(Sn)-N-pyridoxyl-5-methyltryptophan (/sup 99m/Tc-PMT) for specific diagnosis of hepatocellular carcinoma, 88 patients with various malignant and benign liver diseases (49 with hepatocellular carcinoma, 4 with cholangiocellular carcinoma, 10 with metastatic liver carcinoma, 2 with liver cysts, 2 with liver hemangioma, 1 with liver abscess, 2 with intrahepatic lithiasis, 12 with liver cirrhosis, and 6 with chronic hepatitis) were studied. In 20 (41%) of the 49 patients with hepatocellular carcinoma, greater uptake of /sup 99m/Tc-PMT by the tumor than by the surrounding liver tissue was seen in delayed hepatobiliary images, whereas in eight patients (16%), equilibrated uptake was seen. No increased uptake of the radioisotope by hepatic lesions was seen in 21 patients with localized liver diseases other than hepatoma. Moreover, in 18 patients with diffuse liver diseases, no focal accumulation of the radioisotope was seen in delayed /sup 99m/Tc-PMT images. In addition, of 28 patients with hepatocellular carcinoma in whom the serum alpha-fetoprotein level showed little or no increase, 12 showed increased uptake of /sup 99m/Tc-PMT by the tumor. In assessing delayed /sup 99m/Tc-PMT images, however, it was necessary to consider following complications: accumulation of tracer in obstructed and dilated biliary trees; retention of radioactivity in nonneoplastic liver tissues; difficulties in evaluating /sup 99m/Tc-PMT uptake by small hepatic tumors; overlapping of radioactivity in the gut and gallbladder in delayed /sup 99m/Tc-PMT images of tumors. This study indicates that delayed /sup 99m/Tc-PMT images can be useful in the diagnosis of hepatocellular carcinoma

  15. Post-mortem radiography of the lungs: Experiments to compare various methods of examination and descriptions of their usefulness in actual practice

    International Nuclear Information System (INIS)

    Pankow, W.

    1986-01-01

    Described is the post-mortem examination of the isolated lung using radiologic-morphologic and histologic methods. Comparisons are made ragarding practical value of the conservation techniques chosen, which were the method of Markaria and Heitzmann that is based on fixing in alcohol and air drying and the nitrogen freezing method developed by Rau and colleagues. Both methods ensure adequate visualition of the pulmonary ultrastructure by X-rays, even though this observation should be qualified by the fact that pulmonary tissue fixed in alcohol tends to shrink and that intraalveolar edema are thus artificially reduced. Either of the methods under investigation permits angiographic and bronchographic examinations to be carried out without difficulty. In macroscopic evaluations better results are obtained for lungs fixed in alcohol. Freeze-dried samples offer advantages in the histological assessment of the pulmonary ultrastructure. Post-mortem radiography of the lungs is particularly valuable in the analysis of pathological changes in the pulmonary structure. (MBC) [de

  16. Studies on time of death estimation in the early post mortem period -- application of a method based on eyeball temperature measurement to human bodies.

    Science.gov (United States)

    Kaliszan, Michał

    2013-09-01

    This paper presents a verification of the thermodynamic model allowing an estimation of the time of death (TOD) by calculating the post mortem interval (PMI) based on a single eyeball temperature measurement at the death scene. The study was performed on 30 cases with known PMI, ranging from 1h 35min to 5h 15min, using pin probes connected to a high precision electronic thermometer (Dostmann-electronic). The measured eye temperatures ranged from 20.2 to 33.1°C. Rectal temperature was measured at the same time and ranged from 32.8 to 37.4°C. Ambient temperatures which ranged from -1 to 24°C, environmental conditions (still air to light wind) and the amount of hair on the head were also recorded every time. PMI was calculated using a formula based on Newton's law of cooling, previously derived and successfully tested in comprehensive studies on pigs and a few human cases. Thanks to both the significantly faster post mortem decrease of eye temperature and a residual or nonexistent plateau effect in the eye, as well as practically no influence of body mass, TOD in the human death cases could be estimated with good accuracy. The highest TOD estimation error during the post mortem intervals up to around 5h was 1h 16min, 1h 14min and 1h 03min, respectively in three cases among 30, while for the remaining 27 cases it was not more than 47min. The mean error for all 30 cases was ±31min. All that indicates that the proposed method is of quite good precision in the early post mortem period, with an accuracy of ±1h for a 95% confidence interval. On the basis of the presented method, TOD can be also calculated at the death scene with the use of a proposed portable electronic device (TOD-meter). Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  17. Is survival improved by the use of NIV and PEG in amyotrophic lateral sclerosis (ALS)? A post-mortem study of 80 ALS patients

    OpenAIRE

    Burkhardt, Christian; Neuwirth, Christoph; Sommacal, Andreas; Andersen, Peter M.; Weber, Markus

    2017-01-01

    Background: Non-invasive ventilation (NIV) and percutaneous gastrostomy (PEG) are guideline-recommended interventions for symptom management in amyotrophic lateral sclerosis (ALS). Their effect on survival is controversial and the impact on causes of death is unknown. Objective: To investigate the effect of NIV and PEG on survival and causes of death in ALS patients. Methods: Eighty deceased ALS patients underwent a complete post mortem analysis for causes of death between 2003 and 2015. Fort...

  18. Post-mortem whole-body magnetic resonance imaging of human fetuses: a comparison of 3-T vs. 1.5-T MR imaging with classical autopsy.

    Science.gov (United States)

    Kang, Xin; Cannie, Mieke M; Arthurs, Owen J; Segers, Valerie; Fourneau, Catherine; Bevilacqua, Elisa; Cos Sanchez, Teresa; Sebire, Neil J; Jani, Jacques C

    2017-08-01

    To prospectively compare diagnostic accuracy of fetal post-mortem whole-body MRI at 3-T vs. 1.5-T. Between 2012 and 2015, post-mortem MRI at 1.5-T and 3-T was performed in fetuses after miscarriage/stillbirth or termination. Clinical MRI diagnoses were assessed using a confidence diagnostic score and compared with classical autopsy to derive a diagnostic error score. The relation of diagnostic error for each organ group with gestational age was calculated and 1.5-T with 3-T was compared with accuracy analysis. 135 fetuses at 12-41 weeks underwent post-mortem MRI (followed by conventional autopsy in 92 fetuses). For all organ groups except the brain, and for both modalities, the diagnostic error decreased with gestation (P autopsy than 1.5-T MRI, especially for the thorax, heart and abdomen in fetuses autopsy increases with 3-T. • PM-MRI using 3-T is particularly interesting for thoracic and abdominal organs. • PM-MRI using 3-T is particularly interesting for fetuses < 20 weeks' gestation.

  19. [18F]FDDNP PET in Tauopathies: Correlation to post mortem Pathology in a Case of Progressive Supranuclear Palsy (PSP)

    Science.gov (United States)

    Villegas, Brendon Josef

    This investigation of [18F]FDDNP was conducted in an effort to confirm the presence of disease in a patient with Progressive Supranuclear Palsy (PSP) and to correlate the ante mortem PET scan results to the post mortem pathology. The immunohistochemical and immunofluorescent staining of Paired Helical Filamentous (PHF) tau (AT8) and Amyloid Beta (6F/3D) misfolded proteins demonstrated a widespread deposition in the cortical and subcortical nuclei, the white matter, cerebellar white matter and the medulla oblongata. The in vitro autoradiography demonstrated a neocortical signal comprised of well-delineated amyloid beta in the nucleated layers I/II and hyperphosphorylated tau in the deeper layers III through VI. The autoradiography was well correlated with the immunohistochemical staining in adjacent tissue slides. The binding of the parametric [ 18F]FDDNP distribution volume ratio (DVR) correlated well (Spearman's rho = 0.962, p = .004) with the deposition of tau but not with the presence of amyloid beta (Spearman's rho = -0.829, p = .041). The [ 18F]FDDNP DVR signal appears to be primarily due to the large amount of bound hyperphosphorylated tau (p-tau) and the amyloid beta negligibly contributes to the total signal. Unlabeled FDDNP was shown to bind to tau in the form of globose tangles in the rostral ventromedial medulla as confirmed with both Thioflavin S and PHF-tau Immunofluorescence. The binding of [18F]FDDNP to the human neuroanatomy was investigated in two cohorts of distinct tauopathies and compared to the binding in two tau-negative cohorts against control patients. A cohort of PSP patients (n = 12) with a mean age of 63.8 years and a cohort of Chronic Traumatic Encephalopathy (CTE) patients (n = 14) with a mean age of 58.1 years are both characterized by the presence of various degrees of tau pathology in their brains. The cohort of Parkinson's Disease (PD) patients (n = 16) with a mean age of 63.2 years is initially characterized by clinical symptoms

  20. A comparison between rib fracture patterns in peri- and post-mortem compressive injury in a piglet model.

    Science.gov (United States)

    Bradley, Amanda L; Swain, Michael V; Neil Waddell, J; Das, Raj; Athens, Josie; Kieser, Jules A

    2014-05-01

    Forensic biomechanics is increasingly being used to explain how observed injuries occur. We studied infant rib fractures from a biomechanical and morphological perspective using a porcine model. We used 24, 6th ribs of one day old domestic pigs Sus scrofa, divided into three groups, desiccated (representing post-mortem trauma), fresh ribs with intact periosteum (representing peri-mortem trauma) and those stored at -20°C. Two experiments were designed to study their biomechanical behaviour fracture morphology: ribs were axially compressed and subjected to four-point bending in an Instron 3339 fitted with custom jigs. Morphoscopic analysis of resultant fractures consisted of standard optical methods, micro-CT (μCT) and Scanning Electron Microscopy (SEM). During axial compression fresh ribs did not fracture because of energy absorption capabilities of their soft and fluidic components. In flexure tests, dry ribs showed typical elastic-brittle behaviour with long linear load-extension curves, followed by short non-linear elastic (hyperelastic) behaviour and brittle fracture. Fresh ribs showed initial linear-elastic behaviour, followed by strain softening and visco-plastic responses. During the course of loading, dry bone showed minimal observable damage prior to the onset of unstable fracture. Frozen then thawed bone showed similar patterns to fresh bone. Morphologically, fresh ribs showed extensive periosteal damage to the tensile surface with areas of collagen fibre pull-out along the tensile surface. While all dry ribs fractured precipitously, with associated fibre pull-out, the latter feature was absent in thawed ribs. Our study highlights the fact that under controlled loading, fresh piglet ribs (representing perimortem trauma) did not fracture through bone, but was associated with periosteal tearing. These results suggest firstly, that complete lateral rib fracture in infants may in fact not result from pure compression as has been previously assumed; and

  1. Markers of microglia in post-mortem brain samples from patients with Alzheimer's disease: a systematic review.

    Science.gov (United States)

    Hopperton, K E; Mohammad, D; Trépanier, M O; Giuliano, V; Bazinet, R P

    2018-02-01

    Neuroinflammation is proposed as one of the mechanisms by which Alzheimer's disease pathology, including amyloid-β plaques, leads to neuronal death and dysfunction. Increases in the expression of markers of microglia, the main neuroinmmune cell, are widely reported in brains from patients with Alzheimer's disease, but the literature has not yet been systematically reviewed to determine whether this is a consistent pathological feature. A systematic search was conducted in Medline, Embase and PsychINFO for articles published up to 23 February 2017. Papers were included if they quantitatively compared microglia markers in post-mortem brain samples from patients with Alzheimer's disease and aged controls without neurological disease. A total of 113 relevant articles were identified. Consistent increases in markers related to activation, such as major histocompatibility complex II (36/43 studies) and cluster of differentiation 68 (17/21 studies), were identified relative to nonneurological aged controls, whereas other common markers that stain both resting and activated microglia, such as ionized calcium-binding adaptor molecule 1 (10/20 studies) and cluster of differentiation 11b (2/5 studies), were not consistently elevated. Studies of ionized calcium-binding adaptor molecule 1 that used cell counts almost uniformly identified no difference relative to control, indicating that increases in activation occurred without an expansion of the total number of microglia. White matter and cerebellum appeared to be more resistant to these increases than other brain regions. Nine studies were identified that included high pathology controls, patients who remained free of dementia despite Alzheimer's disease pathology. The majority (5/9) of these studies reported higher levels of microglial markers in Alzheimer's disease relative to controls, suggesting that these increases are not solely a consequence of Alzheimer's disease pathology. These results show that increased markers

  2. Layering of stomach contents in drowning cases in post-mortem computed tomography compared to forensic autopsy.

    Science.gov (United States)

    Gotsmy, Walther; Lombardo, Paolo; Jackowski, Christian; Brencicova, Eva; Zech, Wolf-Dieter

    2018-04-24

    In forensic autopsy, the analysis of stomach contents is important when investigating drowning cases. Three-layering of stomach contents may be interpreted as a diagnostic hint to drowning due to swallowing of larger amounts of water or other drowning media. The authors experienced frequent discrepancies of numbers of stomach content layering in drowning cases between post-mortem computed tomography (PMCT) and autopsy in forensic casework. Therefore, the goal of this study was to compare layering of stomach contents in drowning cases between PMCT and forensic autopsy. Drowning cases (n = 55; 40 male, 15 female, mean age 45.3 years; mean amount of stomach content 223 ml) that received PMCT prior to forensic autopsy were retrospectively analyzed by a forensic pathologist and a radiologist. Number of layers of stomach content in PMCT were compared to number of layers at forensic autopsy. In 28 of the 55 evaluated drowning cases, a discrepancy between layering of stomach contents at autopsy compared to PMCT was observed: 1 layer at autopsy (n = 28): 50% discrepancy to PMCT, 2 layers (n = 20): 45% discrepancy, and 3 layers (n = 7): 71.4% discrepancy. Sensitivity of correctly determining layering (as observed at forensic autopsy) in PMCT was 52% (positive predictive value 44.8%). Specificity was 46.6% (negative predictive value 53.8%). In a control group (n = 35) of non-drowning cases, three-layering of stomach contents was not observed. Discrepancies of observed numbers of stomach content layers between PMCT and forensic autopsy are a frequent finding possibly due to stomach content sampling technique at autopsy and movement of the corpse prior to PMCT and autopsy. Three-layering in PMCT, if indeed present, may be interpreted as a hint to drowning.

  3. GABAergic system impairment in the hippocampus and superior temporal gyrus of patients with paranoid schizophrenia: A post-mortem study.

    Science.gov (United States)

    Steiner, Johann; Brisch, Ralf; Schiltz, Kolja; Dobrowolny, Henrik; Mawrin, Christian; Krzyżanowska, Marta; Bernstein, Hans-Gert; Jankowski, Zbigniew; Braun, Katharina; Schmitt, Andrea; Bogerts, Bernhard; Gos, Tomasz

    2016-11-01

    Glutamic acid decarboxylase (GAD) is a key enzyme in GABA synthesis and alterations in GABAergic neurotransmission related to glial abnormalities are thought to play a crucial role in the pathophysiology of schizophrenia. This study aimed to identify potential differences regarding the neuropil expression of GAD between paranoid and residual schizophrenia. GAD65/67 immunostained histological sections were evaluated by quantitative densitometric analysis of GAD-immunoreactive (ir) neuropil. Regions of interest were the hippocampal formation (CA1 field and dentate gyrus [DG]), superior temporal gyrus (STG), and laterodorsal thalamic nucleus (LD). Data from 16 post-mortem schizophrenia patient samples (10 paranoid and 6 residual schizophrenia cases) were compared with those from 16 matched controls. Overall, schizophrenia patients showed a lower GAD-ir neuropil density (P=0.014), particularly in the right CA1 (P=0.033). However, the diagnostic subgroups differed significantly (Pparanoid versus residual patients (P=0.036) and controls (Pparanoid versus residual schizophrenia cases (P=0.042). GAD-ir neuropil density correlated positively with antipsychotic dosage, particularly in CA1 (right: r=0.850, P=0.004; left: r=0.800, P=0.010). Our finding of decreased relative density of GAD-ir neuropil suggests hypofunction of the GABAergic system, particularly in hippocampal CA1 field and STG layer V of patients with paranoid schizophrenia. The finding that antipsychotic medication seems to counterbalance GABAergic hypofunction in schizophrenia patients suggests the possibility of exploring new treatment avenues which target this system. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. Quantitative evaluation of volatile hydrocarbons in post-mortem blood in forensic autopsy cases of fire-related deaths.

    Science.gov (United States)

    Yonemitsu, Kosei; Sasao, Ako; Oshima, Toru; Mimasaka, Sohtaro; Ohtsu, Yuki; Nishitani, Yoko

    2012-04-10

    Volatile hydrocarbons in post-mortem blood from victims of fires were analyzed quantitatively by headspace gas chromatography mass spectrometry. The benzene and styrene concentrations in the blood were positively correlated with the carboxyhemoglobin (CO-Hb) concentration, which is evidence that the deceased inhaled the hydrocarbons and carbon monoxide simultaneously. By contrast, the concentrations of toluene and CO-Hb in the blood were not significantly correlated. This lack of correlation could be explained by two different sources of toluene, with low blood concentrations of toluene arising when the deceased inhaled smoke and high blood concentrations of toluene arising when the deceased inhaled petroleum vapor or other unknown vapors. The quantity of soot deposited in the respiratory tract was classified into four grades (-, 1+, 2+, 3+). The mean CO-Hb concentration in the 1+ soot group was significantly lower than those in the 2+ (ptypes of smoke produced by different materials. For example, petroleum combustion with a limited supply of oxygen, like in a compartment fire, may produce a large volume of dense black smoke that contains a large quantity of soot. Soot deposits in the airways and the blood CO-Hb concentration are basic and essential autopsy findings that are used to investigate fire-related deaths. The quantitative GC-MS analysis of blood volatile hydrocarbons can provide additional useful information on the cause of the fire and the circumstances surrounding the death. In combination, these three findings are useful for the reconstruction of cases. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  5. Delayed diagnosis in pediatric headache: an outpatient Italian survey.

    Science.gov (United States)

    Colombo, Bruno; Dalla Libera, Dacia; De Feo, Donatella; Pavan, Giulia; Annovazzi, Pietro Osvaldo; Comi, Giancarlo

    2011-09-01

    The aim of this prospective study is to assess the time lapse between the onset of recurring headache and the correct diagnosis in a cohort of pediatric patients attending an Italian children's headache center for the first time. One hundred and one patients and parents, referred to the Pediatric Headache Centre of San Raffaele Hospital in Milan, Italy, underwent a semi-structured interview to ascertain features of headache since onset (clinical and family history, presence of childhood periodic syndromes, previously undergone instrumental exams and specialists' examinations before the correct diagnosis, past and current treatment). All patients were evaluated by expert neurologists and their headache was classified according to the International Classification of Headache Disorders II (2004). The median time delay from the onset of the first episode of recurrent headache to definite diagnosis was 20 months (interquartile range 12 to 36 months). A correlation with younger age and a more delayed headache diagnosis was found (r Spearman = 0.25; P = .039). An association between diagnostic delay and positive family history (median 24 months [12 to 48] vs 12 [6 to 24]; P = .014) or female gender (median 18 months [12 to 42] vs. 12 [5 to 30]; P trend = .070) was also evident. Notably, 76 out of 101 patients referred to our Center received an appropriate diagnosis according to International Classification of Headache Disorders II at the time of our visit only. Of note, up to 21% of this group were previously misdiagnosed (for epilepsy 43%, sinusitis 38%, or other diseases 19%), a fact that contributed to a longer time of clinical assessment (median 39 months) before reaching a correct diagnosis. The other group of 80 patients (79%) did not receive a specific diagnosis and treatment, and were not studied until their symptom became chronic and disabling. Pediatric headache is still under-diagnosed and not adequately considered as a health problem in the

  6. A Comparison of Sacroiliac and Pubic Rami Fracture Occurrences in Oblique Side Impact Tests on Nine Post Mortem Human Subjects.

    Science.gov (United States)

    Petit, Philippe; Trosseille, Xavier; Lebarbé, Mathieu; Baudrit, Pascal; Potier, Pascal; Compigne, Sabine; Masuda, Mitsutoshi; Yamaoka, Akira; Yasuki, Tsuyoshi; Douard, Richard

    2015-11-01

    The WorldSID dummy can be equipped with both a pubic and a sacroiliac joint (S-I joint) loadcell. Although a pubic force criterion and the associated injury risk curve are currently available and used in regulation (ECE95, FMVSS214), as of today injury mechanisms, injury criteria, and injury assessment reference values are not available for the sacroiliac joint itself. The aim of this study was to investigate the sacroiliac joint injury mechanism. Three configurations were identified from full-scale car crashes conducted with the WorldSID 50th percentile male where the force passing through the pubis in all three tests was approximately 1500 N while the sacroiliac Fy/Mx peak values were 4500 N/50 Nm, 2400 N/130 Nm, and 5300 N/150 Nm, respectively. These tests were reproduced using a 150 kg guided probe impacting Post Mortem Human Subjects (PMHS) at 8 m/s, 5.4 m/s and 7.5 m/s. The shape and the orientation of the impacting face of the probe were selected to match the WorldSID pubic Fy and sacroiliac Fy/Mx loads of the three vehicle test configurations. Three PMHS were tested in each of the three configurations (nine PMHS in total). In the first PMHS configuration, one specimen sustained an AIS 3 injury and one sustained an AIS 4 injury (an unstable pelvis with complete disruption of the posterior arch, a sacroiliac joint disruption associated with an iliac fracture, and a pubic symphysis separation). In the second configuration, all specimens sustained a fracture of the superior lateral iliac wing (AIS 2). In the third configuration, one specimen sustained a partial disruption of the anterior arch (AIS 2). Based on the data from strain gauges located on the pubic rami and near the sacroiliac joint, the pubic rami fractures were identified as occurring prior to the sacroiliac fractures. Out of nine impactor tests performed, the PMHS S-I joint injuries were observed to consistently be associated with pelvic anterior arch fractures. In addition, from the injury

  7. Markers of microglia in post-mortem brain samples from patients with Alzheimer’s disease: a systematic review

    Science.gov (United States)

    Hopperton, K E; Mohammad, D; Trépanier, M O; Giuliano, V; Bazinet, R P

    2018-01-01

    Neuroinflammation is proposed as one of the mechanisms by which Alzheimer’s disease pathology, including amyloid-β plaques, leads to neuronal death and dysfunction. Increases in the expression of markers of microglia, the main neuroinmmune cell, are widely reported in brains from patients with Alzheimer’s disease, but the literature has not yet been systematically reviewed to determine whether this is a consistent pathological feature. A systematic search was conducted in Medline, Embase and PsychINFO for articles published up to 23 February 2017. Papers were included if they quantitatively compared microglia markers in post-mortem brain samples from patients with Alzheimer’s disease and aged controls without neurological disease. A total of 113 relevant articles were identified. Consistent increases in markers related to activation, such as major histocompatibility complex II (36/43 studies) and cluster of differentiation 68 (17/21 studies), were identified relative to nonneurological aged controls, whereas other common markers that stain both resting and activated microglia, such as ionized calcium-binding adaptor molecule 1 (10/20 studies) and cluster of differentiation 11b (2/5 studies), were not consistently elevated. Studies of ionized calcium-binding adaptor molecule 1 that used cell counts almost uniformly identified no difference relative to control, indicating that increases in activation occurred without an expansion of the total number of microglia. White matter and cerebellum appeared to be more resistant to these increases than other brain regions. Nine studies were identified that included high pathology controls, patients who remained free of dementia despite Alzheimer’s disease pathology. The majority (5/9) of these studies reported higher levels of microglial markers in Alzheimer’s disease relative to controls, suggesting that these increases are not solely a consequence of Alzheimer’s disease pathology. These results show that

  8. Conductometric titration to determine total volatile basic nitrogen (TVB-N) for post-mortem interval (PMI).

    Science.gov (United States)

    Xia, Zhiyuan; Zhai, Xiandun; Liu, Beibei; Mo, Yaonan

    2016-11-01

    Precise measurement of cadaver decomposition rate is the basis to accurate post-mortem interval (PMI) estimation. There are many approaches explored in recent years, however, it is still unsolved completely. Total volatile basic nitrogen (TVB-N), which is an important index to predict meat freshness and shelf life in food science, could serve as an indicator for measuring PMI associated decomposition rate of cadavers. The aim of this work was to establish a practical method to determine TVB-N in cadaver soft tissues (mainly skeletal muscle) for measuring decomposition rate. Determination of TVB-N in the simulation and animal experiments was conducted by steam distillation and conductometric titration using Kjeldahl distillation unit and conductivity meter. In simulation, standard concentrations of ammonium were used as TVB analogies, TVB-N contents were determined and the recovery rates of nitrogen were calculated. In animal experiment, TVB-N in skeletal muscle of forty-two rats was determined at different PMIs for 312 h at 24 °C ± 1 °C. The relationship between PMI and TVB-N was investigated also. The method showed high precision with 99%-100% recovery rates. TVB-N in skeletal muscle changed significantly with PMI especially after 24 h, and the data fit well to y = 3.35 E -5 x 3 -2.17 E -2 x 2 +6.13x-85.82 (adj. R 2  = 0.985). EC i (initial electrical conductivity in the samples just before titration) had positive linear relationship to final measured TVB-N values, y = 1.98x+16.16 (adj. R 2  = 0.985). The overall results demonstrated that the method is accurate, rapid and flexible, which could be expected as a basic technique for measuring decomposition rate in later PMI-estimation researches. Further studies are needed to validate our findings. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  9. Clinical and post mortem analysis of combat neck injury used to inform a novel coverage of armour tool.

    Science.gov (United States)

    Breeze, J; Fryer, R; Hare, J; Delaney, R; Hunt, N C; Lewis, E A; Clasper, J C

    2015-04-01

    There is a requirement in the Ministry of Defence for an objective method of comparing the area of coverage of different body armour designs for future applications. Existing comparisons derived from surface wound mapping are limited in that they can only demonstrate the skin entry wound location. The Coverage of Armour Tool (COAT) is a novel three-dimensional model capable of comparing the coverage provided by body armour designs, but limited information exists as to which anatomical structures require inclusion. The aim of this study was to assess the utility of COAT, in the assessment of neck protection, using clinically relevant injury data. Hospital notes and post mortem records of all UK soldiers injured by an explosive fragment to the neck between 01 Jan 2006 and 31 December 2012 from Iraq and Afghanistan were analysed to determine which anatomical structures were responsible for death or functional disability at one year post injury. Using COAT a comparison of three ballistic neck collar designs was undertaken with reference to the percentage of these anatomical structures left exposed. 13/81 (16%) survivors demonstrated complications at one year, most commonly upper limb weakness from brachial plexus injury or a weak voice from laryngeal trauma. In 14/94 (15%) soldiers the neck wound was believed to have been the sole cause of death, primarily from carotid artery damage, spinal cord transection or rupture of the larynx. COAT objectively demonstrated that despite the larger OSPREY collar having almost double the surface area than the two-piece prototype collar, the percentage area of vulnerable cervical structures left exposed only reduced from 16.3% to 14.4%. COAT demonstrated its ability to objectively quantify the potential effectiveness of different body armour designs in providing coverage of vulnerable anatomical structures from different shot line orientations. To improve its utility, it is recommended that COAT be further developed to enable weapon

  10. Factors influencing diagnosis delay of advanced breast cancer in Moroccan women

    OpenAIRE

    Maghous, A.; Rais, F.; Ahid, S.; Benhmidou, N.; Bellahamou, K.; Loughlimi, H.; Marnouche, E.; Elmajjaoui, S.; Elkacemi, H.; Kebdani, T.; Benjaafar, N.

    2016-01-01

    Background Delay in the diagnosis of breast cancer in symptomatic women of 3?months or more is associated with advanced stage and low survival. We conducted this study to learn more about the extent and reasons behind diagnosis delay of advanced breast cancer in Moroccan women. Methods A group of patients with advanced breast cancer were interviewed at the National Institute of Oncology in Rabat during the period from February to December 2014. Diagnosis delay was devised into patient delay a...

  11. Patient Delay, Diagnosis Delay and Treatment Delay for Breast Cancer: Comparison of the Pattern between Patients in Public and Private Health Sectors

    Directory of Open Access Journals (Sweden)

    Iraj Harirchi

    2015-05-01

    Full Text Available Background: The purpose of this study was to compare patient delay, diagnosis delay and treatment delay in breast cancer patients of selected public and private health centers in Tehran, Iran.Methods: In this cross-sectional study, female patients with newly diagnosed breast cancer in a public medical complex and a private breast clinic within one year were included. Patient delay was considered positive, if the interval between the detection of the first symptom by the patient and the first visit to a health care provider took longer than one month. Delay in diagnosis was defined as the period of more than one week between the first medical visit for the symptoms and the diagnosis of breast cancer. Following the confirmed diagnosis of breast malignancy, if the medical treatment was initiated later than one week, treatment delay had occurred. The potential reasons for patient, diagnosis and treatment delay according to the patients’ reports were also recorded.Results: Overall, 385 patients were included of whom 52.7% were recruited from the public hospitals and 47.3% from a private clinic. The prevalence of patient delay, diagnosis delay and treatment delay were 31.7%, 17.9% and 28.3%, respectively. Patient delay was significantly more common among patients with lower socio-economic status and those recruited from the public hospitals. All the patients with diagnosis delay were in the group recruited from the public hospitals.Conclusions: Gaps between women of different socio-economic levels of the society need to be addressed in order to decrease patient, diagnosis and treatment delay.

  12. Phosphatidylcholine 36:1 concentration decreases along with demyelination in the cuprizone animal model and post-mortem of multiple sclerosis brain tissue.

    Science.gov (United States)

    Trépanier, Marc-Olivier; Hildebrand, Kayla D; Nyamoya, Stella D; Amor, Sandra; Bazinet, Richard P; Kipp, Markus

    2018-03-25

    Multiple sclerosis (MS) is a demyelinating and inflammatory disease. Myelin is enriched in lipids, and more specifically, oleic acid. The goal of this study was to evaluate the concentration of oleic acid following demyelination and remyelination in the cuprizone model, test if these changes occurred in specific lipid species, and whether differences in the cuprizone model correlate with changes observed in post-mortem human brains. Eight-week-old C57Bl/6 mice were fed a 0.2% cuprizone diet for 5 weeks and some animals allowed to recover for 11 days. Demyelination, inflammation, and lipid concentrations were measured in the corpus callosum. Standard fatty acid techniques and liquid chromatography combined with tandem mass spectrometry were performed to measure concentrations of fatty acids in total brain lipids and a panel of lipid species within the phosphatidylcholine (PC). Similar measurements were conducted in post-mortem brain tissues of MS patients and were compared to healthy controls. Five weeks of cuprizone administration resulted in demyelination followed by significant remyelination after 11 days of recovery. Compared to control, oleic acid was decreased after 5 weeks of cuprizone treatment and increased during the recovery phase. This decrease in oleic acid was associated with a specific decrease in the PC 36:1 pool. Similar results were observed in human post-mortem brains. Decreases in myelin content in the cuprizone model was accompanied with decreases in oleic acid concentration and is associated with PC 36:1 suggesting that specific lipids could be a potential biomarker for myelin degeneration. The biological relevance of oleic acid for disease progression remains to be verified. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  13. An evaluation of the DRI-ETG EIA method for the determination of ethyl glucuronide concentrations in clinical and post-mortem urine.

    Science.gov (United States)

    Turfus, Sophie C; Vo, Tu; Niehaus, Nadia; Gerostamoulos, Dimitri; Beyer, Jochen

    2013-06-01

    A commercial enzyme immunoassay for the qualitative and semi-quantitative measurement of ethyl glucuronide (EtG) in urine was evaluated. Post-mortem (n=800), and clinical urine (n=200) samples were assayed using a Hitachi 902 analyzer. The determined concentrations were compared with those obtained using a previously published liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the quantification of EtG and ethyl sulfate. Using a cut-off of 0.5 µg/ml and LC-MS/MS limit of reporting of 0.1 µg/ml, there was a sensitivity of 60.8% and a specificity of 100% for clinical samples. For post-mortem samples, sensitivity and specificity were 82.4% and 97.1%, respectively. When reducing the cut-off to 0.1 µg/ml, the sensitivity and specificity were 83.3% and 100% for clinical samples whereas for post-mortem samples the sensitivity and specificity were 90.3 % and 88.3 %, respectively. The best trade-offs between sensitivity and specificity for LC-MS/MS limits of reporting of 0.5 and 0.1 µg/ml were achieved when using immunoassay cut-offs of 0.3 and 0.092 µg/ml, respectively. There was good correlation between quantitative results obtained by both methods but analysis of samples by LC-MS/MS gave higher concentrations than by enzyme immunoassay (EIA), with a statistically significant proportional bias (P<0.0001, Deming regression) for both sample types. The immunoassay is reliable for the qualitative and semi-quantitative presumptive detection of ethyl glucuronide in urine. Copyright © 2012 John Wiley & Sons, Ltd.

  14. Tissues from equine cadaver ligaments up to 72 hours of post-mortem: a promising reservoir of stem cells.

    Science.gov (United States)

    Shikh Alsook, Mohamad Khir; Gabriel, Annick; Piret, Joëlle; Waroux, Olivier; Tonus, Céline; Connan, Delphine; Baise, Etienne; Antoine, Nadine

    2015-12-18

    Mesenchymal stem cells (MSCs) harvested from cadaveric tissues represent a promising approach for regenerative medicine. To date, no study has investigated whether viable MSCs could survive in cadaveric tissues from tendon or ligament up to 72 hours of post-mortem. The purpose of the present work was to find out if viable MSCs could survive in cadaveric tissues from adult equine ligaments up to 72 hours of post-mortem, and to assess their ability (i) to remain in an undifferentiated state and (ii) to divide and proliferate in the absence of any specific stimulus. MSCs were isolated from equine cadaver (EC) suspensory ligaments within 48-72 hours of post-mortem. They were evaluated for viability, proliferation, capacity for tri-lineage differentiation, expression of cell surface markers (CD90, CD105, CD73, CD45), pluripotent transcription factor (OCT-4), stage-specific embryonic antigen-1 (SSEA-1), neuron-specific class III beta-tubulin (TUJ-1), and glial fibrillary acidic protein (GFAP). As well, they were characterized by transmission electron microscope (TEM). EC-MSCs were successfully isolated and maintained for 20 passages with high cell viability and proliferation. Phase contrast microscopy revealed that cells with fibroblast-like appearance were predominant in the culture. Differentiation assays proved that EC-MSCs are able to differentiate towards mesodermal lineages (osteogenic, adipogenic, chondrogenic). Flow cytometry analysis demonstrated that EC-MSCs expressed CD90, CD105, and CD73, while being negative for the leukocyte common antigen CD45. Immunofluorescence analysis showed a high percentage of positive cells for OCT-4 and SSEA-1. Surprisingly, in absence of any stimuli, some adherent cells closely resembling neuronal and glial morphology were also observed. Interestingly, our results revealed that approximately 15 % of the cell populations were TUJ-1 positive, whereas GFAP expression was detected in only a few cells. Furthermore, TEM analysis

  15. Delayed diagnosis of Addison's disease: an approach to management.

    Science.gov (United States)

    Mascarenhas, Janice V; Jude, Edward B

    2014-07-18

    Addison's disease accounts for the majority of cases of adrenal failure that are detected during hospital admissions. Unfortunately, prompt diagnosis of this condition is often delayed due to varied atypical manifestations and inadequate assessment at the time of presentation. We report a case of a 52-year-old woman who was detected to have hypotension during routine colonoscopy for evaluation of anaemia and progressive weight loss. During admission for evaluation of hypotension, she was also detected to have hyponatremia. Hyponatremia and hypotension failed to improve despite fluid resuscitation. Our endocrinological opinion was sought for and on further evaluation she was diagnosed with primary adrenal insufficiency. Glucocorticoid and mineralocorticoid replacement therapy were eventually instituted, which was followed by restoration of blood pressure and normalisation of serum sodium levels. 2014 BMJ Publishing Group Ltd.

  16. Male and female WorldSID and post mortem human subject responses in full-scale vehicle tests.

    Science.gov (United States)

    Yoganandan, Narayan; Humm, John; Pintar, Frank; Rhule, Heather; Moorhouse, Kevin; Suntay, Brian; Stricklin, Jim; Rudd, Rodney; Craig, Matthew

    2017-05-29

    This study compares the responses of male and female WorldSID dummies with post mortem human subject (PMHS) responses in full-scale vehicle tests. Tests were conducted according to the FMVSS-214 protocols and using the U.S. Side Impact New Car Assessment Program change in velocity to match PMHS experiments, published earlier. Moving deformable barrier (MDB) tests were conducted with the male and female surrogates in the left front and left rear seats. Pole tests were performed with the male surrogate in the left front seat. Three-point belt restraints were used. Sedan-type vehicles were used from the same manufacturer with side airbags. The PMHS head was instrumented with a pyramid-shaped nine-axis accelerometer package, with angular velocity transducers on the head. Accelerometers and angular velocity transducers were secured to T1, T6, and T12 spinous processes and sacrum. Three chest bands were secured around the upper, middle, and lower thoraces. Dummy instrumentation included five infrared telescoping rods for assessment of chest compression (IR-TRACC) and a chest band at the first abdomen rib, head angular velocity transducer, and head, T1, T4, T12, and pelvis accelerometers. Morphological responses of the kinematics of the head, thoracic spine, and pelvis matched in both surrogates for each pair. The peak magnitudes of the torso accelerations were lower for the dummy than for the biological surrogate. The brain rotational injury criterion (BrIC) response was the highest in the male dummy for the MDB test and PMHS. The probability of AIS3+ injuries, based on the head injury criterion, ranged from 3% to 13% for the PMHS and from 3% to 21% for the dummy from all tests. The BrIC-based metrics ranged from 0 to 21% for the biological and 0 to 48% for the dummy surrogates. The deflection profiles from the IR-TRACC sensors were unimodal. The maximum deflections from the chest band placed on the first abdominal rib were 31.7 mm and 25.4 mm for the male and female

  17. Longitudinal assessment of short-term memory deterioration in a logopenic variant primary progressive aphasia with post-mortem confirmed Alzheimer's Disease pathology.

    Science.gov (United States)

    Tree, Jeremy; Kay, Janice

    2015-09-01

    In the field of dementia research, there are reports of neurodegenerative cases with a focal loss of language, termed primary progressive aphasia (PPA). Currently, this condition has been further sub-classified, with the most recent sub-type dubbed logopenic variant (PPA-LV). As yet, there remains somewhat limited evaluation of the characteristics of this condition, with no studies providing longitudinal assessment accompanied by post-mortem examination. Moreover, a key characteristic of the PPA-LV case is a deterioration of phonological short-term memory, but again little work has scrutinized the nature of this impairment over time. The current study seeks to redress these oversights and presents detailed longitudinal examination of language and memory function in a case of PPA-LV, with special focus on tests linked to components of phonological short-term memory function. Our findings are then considered with reference to a contemporary model of the neuropsychology of phonological short-term memory. Additionally, post-mortem examinations indicated Alzheimer's disease type pathology, providing further evidence that the PPA-LV presentation may reflect an atypical presentation of this condition. © 2014 The British Psychological Society.

  18. Gamma-hydroxybutyric acid endogenous production and post-mortem behaviour - the importance of different biological matrices, cut-off reference values, sample collection and storage conditions.

    Science.gov (United States)

    Castro, André L; Dias, Mário; Reis, Flávio; Teixeira, Helena M

    2014-10-01

    Gamma-Hydroxybutyric Acid (GHB) is an endogenous compound with a story of clinical use, since the 1960's. However, due to its secondary effects, it has become a controlled substance, entering the illicit market for recreational and "dance club scene" use, muscle enhancement purposes and drug-facilitated sexual assaults. Its endogenous context can bring some difficulties when interpreting, in a forensic context, the analytical values achieved in biological samples. This manuscript reviewed several crucial aspects related to GHB forensic toxicology evaluation, such as its post-mortem behaviour in biological samples; endogenous production values, whether in in vivo and in post-mortem samples; sampling and storage conditions (including stability tests); and cut-off reference values evaluation for different biological samples, such as whole blood, plasma, serum, urine, saliva, bile, vitreous humour and hair. This revision highlights the need of specific sampling care, storage conditions, and cut-off reference values interpretation in different biological samples, essential for proper practical application in forensic toxicology. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  19. Reflexiones Acerca del Papel de la Mujer en la Reproducción Artificial Post Mortem (Analysis of the Role of Women in the Posthumous Reproduction

    Directory of Open Access Journals (Sweden)

    Alma Marìa Rodrìguez Guitián

    2017-03-01

    Full Text Available This contribution focuses on the analysis of the role of women in the posthumous reproduction. In the first place, it studies whether the woman's right to have children should be subject to limits and, if so, to which ones. Second, it explores if the posthumous reproduction extends to lesbian couples, married or not, and finally it focuses on the relevance of the mother's will to decide the deceased to be registered as the parent of the child. Este trabajo tiene por objeto el análisis del papel de la mujer en la hipótesis de la reproducción artificial post mortem. En primer lugar, aborda si el derecho a procrear de la mujer está sujeto a límites y, si es así, cuáles son. En segundo lugar, si la reproducción artificial post mortem se extiende desde el punto de vista subjetivo al matrimonio y parejas de mujeres y, por último, cuál es la relevancia de la voluntad de la madre gestante a la hora de decidir la determinación de la paternidad o maternidad de la persona fallecida. DOWNLOAD THIS PAPER FROM SSRN: https://ssrn.com/abstract=2921870

  20. Degradation of Kidney and Psoas Muscle Proteins as Indicators of Post-Mortem Interval in a Rat Model, with Use of Lateral Flow Technology.

    Directory of Open Access Journals (Sweden)

    Dong-Gi Lee

    Full Text Available We investigated potential protein markers of post-mortem interval (PMI using rat kidney and psoas muscle. Tissue samples were taken at 12 h intervals for up to 96 h after death by suffocation. Expression levels of eight soluble proteins were analyzed by Western blotting. Degradation patterns of selected proteins were clearly divided into three groups: short-term, mid-term, and long-term PMI markers based on the half maximum intensity of intact protein expression. In kidney, glycogen synthase (GS and glycogen synthase kinase-3β were degraded completely within 48 h making them short-term PMI markers. AMP-activated protein kinase α, caspase 3 and GS were short-term PMI markers in psoas muscle. Glyceraldehyde 3-phosphate dehydrogenase (GAPDH was a mid-term PMI marker in both tissues. Expression levels of the typical long-term PMI markers, p53 and β-catenin, were constant for at least 96 h post-mortem in both tissues. The degradation patterns of GS and caspase-3 were verified by immunohistochemistry in both tissues. GAPDH was chosen as a test PMI protein to perform a lateral flow assay (LFA. The presence of recombinant GAPDH was clearly detected in LFA and quantified in a concentration-dependent manner. These results suggest that LFA might be used to estimate PMI at a crime scene.

  1. Ablation of fast-spiking interneurons in the dorsal striatum, recapitulating abnormalities seen post-mortem in Tourette syndrome, produces anxiety and elevated grooming.

    Science.gov (United States)

    Xu, M; Li, L; Pittenger, C

    2016-06-02

    Tic disorders, including Tourette syndrome (TS), are thought to involve pathology of cortico-basal ganglia loops, but their pathology is not well understood. Post-mortem studies have shown a reduced number of several populations of striatal interneurons, including the parvalbumin-expressing fast-spiking interneurons (FSIs), in individuals with severe, refractory TS. We tested the causal role of this interneuronal deficit by recapitulating it in an otherwise normal adult mouse using a combination transgenic-viral cell ablation approach. FSIs were reduced bilaterally by ∼40%, paralleling the deficit found post-mortem. This did not produce spontaneous stereotypies or tic-like movements, but there was increased stereotypic grooming after acute stress in two validated paradigms. Stereotypy after amphetamine, in contrast, was not elevated. FSI ablation also led to increased anxiety-like behavior in the elevated plus maze, but not to alterations in motor learning on the rotorod or to alterations in prepulse inhibition, a measure of sensorimotor gating. These findings indicate that a striatal FSI deficit can produce stress-triggered repetitive movements and anxiety. These repetitive movements may recapitulate aspects of the pathophysiology of tic disorders. Copyright © 2016 IBRO. Published by Elsevier Ltd. All rights reserved.

  2. Delay in Presentation, Diagnosis, and Treatment for Breast Cancer Patients in Jordan.

    Science.gov (United States)

    Abu-Helalah, Ahmad Munir; Alshraideh, Hussam Ahmad; Al-Hanaqtah, Mo'tasem; Da'na, Moh'd; Al-Omari, Asim; Mubaidin, Rasmi

    2016-01-01

    Breast cancer is the most common cancer, and one of the leading causes of death for females in Jordan and many countries in the world. Studies have shown that delay in symptoms presentation, diagnosis or treatment would result in poor prognosis. There has been no published study from Jordan on delays in patient presentation, delays in diagnosis, or delays in treatment. Therefore, we conducted this study to assess these important quality indicators aiming to improve prognosis for breast cancer patients in Jordan. This project was a cross-sectional study on female breast cancer patients in Jordan. The total number of participants was 327. The proportion of patients with presentation delay, diagnosis delay, and treatment delay was 32.2%, 49.1%, or 32.4%, respectively. The main reported reasons for delay in presentation were ignorance of the nature of the problem (65.6%), limited/lack of knowledge that symptoms were suggestive of cancer diagnosis (16.7%), and misdiagnosis (16.7%). Predictors of delay and mean time for presentation, diagnosis, and treatment were identified. Our results reveal that breast cancer patients in Jordan are experiencing delays in presentation, diagnosis, and treatment. This could justify the advanced stages at diagnosis and poor outcomes for breast cancer patients in Jordan. We recommend revising the current early detection and down-staging programs in Jordan. © 2015 Wiley Periodicals, Inc.

  3. Delayed Diagnosis of Pharyngeal Perforation following Exploding Tyre Blast Barotrauma

    Directory of Open Access Journals (Sweden)

    Samantha M. Field

    2014-01-01

    Full Text Available Introduction. Pharyngoesophageal perforation secondary to barotrauma is a rare phenomenon that can have serious complications if identified late. It is challenging to detect due to nonspecific symptoms. We present a case in which detection proved difficult leading to delayed diagnosis. Case Report. A 27-year-old mechanic presented with haemoptysis, dysphonia, and odynophagia after a car tyre exploded in his face. Flexible nasoendoscopy (FNE revealed blood in the pharynx, thought to represent mucosal haemorrhage. Initial treatment consisted of IV dexamethasone and antibiotics. After 3 days, odynophagia persisted prompting a CT scan. This revealed a defect in the posterior hypopharynx and surgical emphysema in the deep neck tissues. Contrast swallow confirmed posterior hypopharyngeal leak. NG feeding was commenced until repeated contrast swallow confirmed resolution of the defect. Discussion. Prompt nonsurgical management of pharyngoesophageal perforation has good outcomes but untreated perforation can have serious complications. FNE should be performed routinely, but only a contrast swallow can diagnose a functional perforation. Clinicians should have a high index of clinical suspicion when patients present with barotrauma and odynophagia. Patients should be kept nil by mouth until perforation has been excluded. Conclusion. When faced with cases of facial barotrauma, clinicians should have a low threshold for further imaging to exclude pharyngoesophageal perforation.

  4. Measurements using 7.0 T post-mortem magnetic resonance imaging of the scalar dimensions of the fetal brain between 12 and 20 weeks gestational age.

    Science.gov (United States)

    Lin, Xiangtao; Zhang, Zhonghe; Teng, Gaojun; Meng, Haiwei; Yu, Taifei; Hou, Zhongyu; Fang, Fang; Zang, Fengchao; Liu, Shuwei

    2011-12-01

    In this study, scalar values for the fetal brain from 12 to 20 weeks gestational age were obtained. Fifty-two fetal specimens of 12-20 weeks gestational age with an anatomically normal and developmentally appropriate central nervous system (CNS) were scanned using a 7.0 T magnetic resonance imaging (MRI) scanner. The linear biometric measurements of the brain were then determined. All the measurements (except for the interhemispheric distance) were found to increase linearly with gestational age, although each increased at a different growth rates. The 95% confidence interval for each value was obtained. These data may be considered to be a valuable reference for the assessment of normal fetal brain development in clinical settings and as a supplement to post-mortem MRI or anatomical investigations. Copyright © 2011 ISDN. Published by Elsevier Ltd. All rights reserved.

  5. Influence of supplemental maslinic acid (olive-derived triterpene) on the post-mortem muscle properties and quality traits of gilthead seabream

    DEFF Research Database (Denmark)

    Matos, E.; Silva, Tomé Santos; Wulff, Tune

    2013-01-01

    , enzymatic activities and protein expression in the muscle were assessed. Supplementing gilthead seabream diets with maslinic acid mainly resulted in hypertrophy of muscle fibres and inhibition of cathepsin B activity, with no observed differences in terms of glycogen and ATP content of the muscle, as well...... as glycogen phosphorylase activity. Proteomic analysis showed a low impact of maslinic acid supplementation on muscle metabolism, with most changes reflecting increased stress coping capacity and muscle hypertrophy in maslinic acid-fed fish. As a finishing strategy to improve the muscle's energetic status......Maslinic acid, a natural triterpene, was evaluated as a dietary supplement to modulate glycogen post-mortem mobilization in gilthead seabream muscle. For this purpose, a multidisciplinary trial was undertaken, where flesh quality criteria, as well as biochemical and histological parameters...

  6. Post-mortem MRI as an alternative to non-forensic autopsy in foetuses and children: from research into clinical practice

    Science.gov (United States)

    Addison, S; Arthurs, O J

    2014-01-01

    Although post-mortem MRI (PMMR) was proposed as an alternative to conventional autopsy more than a decade ago, the lack of systematic validation has limited its clinical uptake. Minimally invasive autopsy (MIA) using PMMR together with ancillary investigations has now been shown to be as accurate as conventional autopsy in foetuses, newborns and infants and is particularly useful for cerebral, cardiac and genitourinary imaging. Unlike conventional autopsy, PMMR provides a permanent three-dimensional auditable record, with accurate estimation of internal organ volumes. MIA is becoming highly acceptable to parents and professionals, and there is widespread political support and public interest in its clinical implementation in the UK. In the short to medium term, it is desirable that a supraregional network of specialist centres should be established to provide this service within the current National Health Service framework. PMID:24288400

  7. Evaluation of hypostasis using a colorimeter measuring system and its application to assessment of the post-mortem interval (time of death).

    Science.gov (United States)

    Vanezis, P; Trujillo, O

    1996-03-05

    Hypostasis was measured in 93 cadavers using a tristimulus colorimeter in order to investigate its relationship with the time of death. The intensity (lightness) of the hypostasis in each case was measured over a period of 4 h and the rate of change in lightness derived. When examined against the time of death, it was found that there was a good correlation between the two. Namely, that the rate of change of lightness (and it can be inferred that this represents displaceability) decreases as the post-mortem period increases. The shift in hypostasis was particularly marked in the first 12 h and decreased thereafter. However, hypostasis could be useful for time of death estimation for up to 48 h. After this time, the degree of change was small or non-existent and by 72 h hypostasis had become fixed in the majority of cases, within our measuring period of 4 h.

  8. Time to address the problem of post-mortem procurement of organs for transplantation occurring without proper pre-mortem consent.

    Science.gov (United States)

    Garwood-Gowers, Austen

    2013-09-01

    Current cadaveric organ transplant systems allow individuals to be classified as donors after death where they registered wishes in favour of this prior to death. However, systems for registering wishes pertaining to donation fall woefully short of securing proper consent. Furthermore, even jurisdictions which technically require consent to be obtained in order to treat an individual as a donor, allow that consent to be given by next of kin after death in circumstances where there is no evidence of the individual having refused prior to death. This article explores these and related issues with current systems from the perspectives of health law norms, ethics and human rights. It concludes that proper pre-mortem consent ought to be a pre-requisite for post-mortem organ transplantation.

  9. Microstructural parcellation of the human cerebral cortex – from Brodmann's post-mortem map to in vivo mapping with high-field magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Stefan Geyer

    2011-02-01

    Full Text Available The year 2009 marked the 100th anniversary of the publication of the famous brain map of Korbinian Brodmann. Although a "classic" guide to microanatomical parcellation of the cerebral cortex, it is – from today's state-of-the-art neuroimaging perspective – problematic to use Brodmann's map as a structural guide to functional units in the cortex. In this article we discuss some of the reasons, especially the problematic compatibility of the "post-mortem world" of microstructural brain maps with the "in vivo world" of neuroimaging. We conclude with some prospects for the future of in vivo structural brain mapping: a new approach which has the enormous potential to make direct correlations between microstructure and function in living human brains: "in vivo Brodmann mapping" with high-field magnetic resonance imaging.

  10. PMICALC: an R code-based software for estimating post-mortem interval (PMI) compatible with Windows, Mac and Linux operating systems.

    Science.gov (United States)

    Muñoz-Barús, José I; Rodríguez-Calvo, María Sol; Suárez-Peñaranda, José M; Vieira, Duarte N; Cadarso-Suárez, Carmen; Febrero-Bande, Manuel

    2010-01-30

    In legal medicine the correct determination of the time of death is of utmost importance. Recent advances in estimating post-mortem interval (PMI) have made use of vitreous humour chemistry in conjunction with Linear Regression, but the results are questionable. In this paper we present PMICALC, an R code-based freeware package which estimates PMI in cadavers of recent death by measuring the concentrations of potassium ([K+]), hypoxanthine ([Hx]) and urea ([U]) in the vitreous humor using two different regression models: Additive Models (AM) and Support Vector Machine (SVM), which offer more flexibility than the previously used Linear Regression. The results from both models are better than those published to date and can give numerical expression of PMI with confidence intervals and graphic support within 20 min. The program also takes into account the cause of death. 2009 Elsevier Ireland Ltd. All rights reserved.

  11. Post mortem scientific sampling and the search for causes of death in intensive care: what information should be given and what consent should be obtained?

    Science.gov (United States)

    Rigaud, J P; Quenot, J P; Borel, M; Plu, I; Hervé, C; Moutel, G

    2011-03-01

    The search for cause of death is important to improve knowledge and provide answers for the relatives of the deceased. Medical autopsy following unexplained death in hospital is one way to identify cause of death but is difficult to carry out routinely. Post mortem sampling (PMS) of tissues via thin biopsy needle or 'mini incisions' in the skin may be a useful alternative. A study was undertaken to assess how this approach is perceived by intensive care doctors and also to evaluate how this practice is considered in ethical terms in France. A study of PMS practices immediately after death in 10 intensive care departments was performed. The medical director of each centre was interviewed by telephone and asked to describe practices in their unit and to outline the questions raised by this practice. PMS is routinely performed in 70% of the units which responded, without systematically obtaining formal consent and without precise rules for communicating results. Approaches to PMS differed between centres, but all physicians felt that PMS is useful for the scientific information it gives and also for the information it provides for relatives. All physicians regret the lack of standards to structure PMS practices. Information from post mortem examinations is important for society to inform about causes of death, for doctors to improve practices and for decision-makers responsible for organising care. Debate persists regarding the balance between individual rights and community interests. It is suggested that an approach for identifying cause of death could easily be integrated into the relationship between carers and relatives, provided full transparency is maintained.

  12. HIF1α protein and mRNA expression as a new marker for post mortem interval estimation in human gingival tissue.

    Science.gov (United States)

    Fais, Paolo; Mazzotti, Maria Carla; Teti, Gabriella; Boscolo-Berto, Rafael; Pelotti, Susi; Falconi, Mirella

    2018-06-01

    Estimating the post mortem interval (PMI) is still a crucial step in Forensic Pathology. Although several methods are available for assessing the PMI, a precise estimation is still quite unreliable and can be inaccurate. The present study aimed to investigate the immunohistochemical distribution and mRNA expression of hypoxia inducible factor (HIF-1α) in post mortem gingival tissues to establish a correlation between the presence of HIF-1α and the time since death, with the final goal of achieving a more accurate PMI estimation. Samples of gingival tissues were obtained from 10 cadavers at different PMIs (1-3 days, 4-5 days and 8-9 days), and were processed for immunohistochemistry and quantitative reverse transcription-polymerase chain reaction. The results showed a time-dependent correlation of HIF-1α protein and its mRNA with different times since death, which suggests that HIF-1α is a potential marker for PMI estimation. The results showed a high HIF-1α protein signal that was mainly localized in the stratum basale of the oral mucosa in samples collected at a short PMI (1-3 days). It gradually decreased in samples collected at a medium PMI (4-5 days), but it was not detected in samples collected at a long PMI (8-9 days). These results are in agreement with the mRNA data. These data indicate an interesting potential utility of Forensic Anatomy-based techniques, such as immunohistochemistry, as important complementary tools to be used in forensic investigations. © 2018 The Authors. Journal of Anatomy published by John Wiley & Sons Ltd on behalf of Anatomical Society.

  13. A semi-automated method for non-invasive internal organ weight estimation by post-mortem magnetic resonance imaging in fetuses, newborns and children

    International Nuclear Information System (INIS)

    Thayyil, Sudhin; Schievano, Silvia; Robertson, Nicola J.; Jones, Rodney; Chitty, Lyn S.; Sebire, Neil J.; Taylor, Andrew M.

    2009-01-01

    Magnetic resonance (MR) imaging allows minimally invasive autopsy, especially when consent is declined for traditional autopsy. Estimation of individual visceral organ weights is an important component of traditional autopsy. Objective: To examine whether a semi-automated can be used for non-invasive internal organ weight measurement using post-mortem MR imaging in fetuses, newborns and children. Methods: Phase 1: In vitro scanning of 36 animal organs (heart, liver, kidneys) was performed to check the accuracy of volume reconstruction methodology. Real volumes were measured by water displacement method. Phase 2: Sixty-five whole body post-mortem MR scans were performed in fetuses (n = 30), newborns (n = 5) and children (n = 30) at 1.5 T using a 3D TSE T2-weighted sequence. These data were analysed offline using the image processing software Mimics 11.0. Results: Phase 1: Mean difference (S.D.) between estimated and actual volumes were -0.3 (1.5) ml for kidney, -0.7 (1.3) ml for heart, -1.7 (3.6) ml for liver in animal experiments. Phase 2: In fetuses, newborns and children mean differences between estimated and actual weights (S.D.) were -0.6 (4.9) g for liver, -5.1 (1.2) g for spleen, -0.3 (0.6) g for adrenals, 0.4 (1.6) g for thymus, 0.9 (2.5) g for heart, -0.7 (2.4) g for kidneys and 2.7 (14) g for lungs. Excellent co-correlation was noted for estimated and actual weights (r 2 = 0.99, p < 0.001). Accuracy was lower when fetuses were less than 20 weeks or less than 300 g. Conclusion: Rapid, accurate and reproducible estimation of solid internal organ weights is feasible using the semi-automated 3D volume reconstruction method.

  14. Detection and differentiation of early acute and following age stages of myocardial infarction with quantitative post-mortem cardiac 1.5T MR.

    Science.gov (United States)

    Schwendener, Nicole; Jackowski, Christian; Persson, Anders; Warntjes, Marcel J; Schuster, Frederick; Riva, Fabiano; Zech, Wolf-Dieter

    2017-01-01

    Recently, quantitative MR sequences have started being used in post-mortem imaging. The goal of the present study was to evaluate if early acute and following age stages of myocardial infarction can be detected and discerned by quantitative 1.5T post-mortem cardiac magnetic resonance (PMCMR) based on quantitative T1, T2 and PD values. In 80 deceased individuals (25 female, 55 male), a cardiac MR quantification sequence was performed prior to cardiac dissection at autopsy in a prospective study. Focal myocardial signal alterations detected in synthetically generated MR images were MR quantified for their T1, T2 and PD values. The locations of signal alteration measurements in PMCMR were targeted at autopsy heart dissection and cardiac tissue specimens were taken for histologic examinations. Quantified signal alterations in PMCMR were correlated to their according histologic age stage of myocardial infarction. In PMCMR seventy-three focal myocardial signal alterations were detected in 49 of 80 investigated hearts. These signal alterations were diagnosed histologically as early acute (n=39), acute (n=14), subacute (n=10) and chronic (n=10) age stages of myocardial infarction. Statistical analysis revealed that based on their quantitative T1, T2 and PD values, a significant difference between all defined age groups of myocardial infarction can be determined. It can be concluded that quantitative 1.5T PMCMR quantification based on quantitative T1, T2 and PD values is feasible for characterization and differentiation of early acute and following age stages of myocardial infarction. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. "What happens behind the curtains?" An exploration of ICU nurses' experiences of post mortem care on patients who have died in intensive care.

    Science.gov (United States)

    de Swardt, Carien; Fouché, Nicola

    2017-12-01

    The aim of this study was to explore the experiences of intensive care nurses performing post mortem care on patients who had died in an intensive care unit at a private hospital in Cape Town. The study further sets out to identify educational needs and to offer recommendations that may address these needs for this sample of nurses. A qualitative research design using a descriptive method was used to explore the experiences of a purposive heterogeneous sample of six nurses who were working in an intensive care unit in a private hospital in Cape Town. A semi-structured interview which was audio-taped and transcribed verbatim was employed to collect data. Colaizzi's (1978) seven step inductive method was used to formulate naïve themes. Following participant feedback, three main themes emerged: care of the dead body, detachment and thanatophobia. Safeguarding the integrity and physical appearance of the dead body was the major finding and of the utmost priority for the participants in this study. Regardless of how the nurses felt about death, providing professional and quality care to the dead body and the family was seen as significantly important. The nurses, whilst performing post mortem care, experienced detachment from various relationships. This comprised of the nurse detaching him/herself professionally and emotionally from the dead patient, the family and him/herself from the death experience. This 'unspoken' experience of thanatophobia became apparent when the nurses were confronted by the reality of their own deaths. In a technological society, where answers to many questions can be pursued through science, understanding the experience of death, as opposed to dying, may be logically incomprehensible. Death remains one of the most traumatic events experienced by the patient and their family, and in some instances nurses themselves. The study has drawn attention to the nurses' experiences and in doing so; the emotional and educational needs have been

  16. Prevalence and determinants of delay in diagnosis of pulmonary tuberculosis in Darjeeling district of West Bengal

    Directory of Open Access Journals (Sweden)

    Sibasis Das

    2017-01-01

    Full Text Available Background: Delayed diagnosis of tuberculosis (TB is a significant problem both in individual as well as community level. Different studies around globe revealed that these diagnostic delays are attributed to both patient delay and health system-related delay. Aims: This study aims to assess the magnitude of delay in diagnosis and the association with sociodemographic profile among new sputum-positive pulmonary TB patients in Darjeeling district. Materials and Methods: A cross-sectional study was conducted among 374 TB patients from October 2011 to March 2012 using a predesigned pretested schedule by face-to-face interview. Statistical Analysis: Logistic regression analysis, odds ratios (OR, adjusted ORs. Results: Patient delay, health system delay and total diagnostic delay were 27 days, 20.1 days, and 20.6 days; mean delays were 23.64, 5.71, and 29.46 days, and median delays were 25, 5, and 32 days, respectively. Risk factors associated with patient delay were female gender, rural residence, illiteracy, smoking, alcohol consumption, taking two, or more alternate treatments; for health system delay were female sex, rural residence, time to reach health facility, time spent per visit; and for total diagnostic delay were female sex, alcoholism, and seeking more than two alternate treatment. Conclusions: The risk factors for delay identified may be the subject of future interventions.

  17. Factors influencing diagnosis delay of advanced breast cancer in Moroccan women.

    Science.gov (United States)

    Maghous, A; Rais, F; Ahid, S; Benhmidou, N; Bellahamou, K; Loughlimi, H; Marnouche, E; Elmajjaoui, S; Elkacemi, H; Kebdani, T; Benjaafar, N

    2016-06-07

    Delay in the diagnosis of breast cancer in symptomatic women of 3 months or more is associated with advanced stage and low survival. We conducted this study to learn more about the extent and reasons behind diagnosis delay of advanced breast cancer in Moroccan women. A group of patients with advanced breast cancer were interviewed at the National Institute of Oncology in Rabat during the period from February to December 2014. Diagnosis delay was devised into patient delay and system delay. Patient delay was defined as time from first symptoms until first medical consultation. System delay was defined as time from first presentation to a health care provider until definite diagnosis or treatment. Prospective information and clinical data were collected on a form during an interview with each patient and from medical records. In all, 137 patients were interviewed. The mean age of women was 48.3 ± 10.4 years. The median of consultation time was 6[4,12] months and the median of diagnosis time was 1[1,3] months. Diagnosis delay was associated to a personal reason in 96 (70.1 %) patients and to a medical reason in 19 (13.9 %) patients. A number of factors predicted diagnosis delay: symptoms were not considered serious in 66 (55.9 %) patients; traditional therapy was applied in 15 (12.7 %) patients and fear of cancer diagnosis and/or treatment in 14 (11.9 %) patients. A use of traditional methods was significantly associated with rural residence and far away from basic health center (p = 0.000). Paradoxically, a family history of breast cancer was significantly higher in who report a fear of cancer diagnosis and/or treatment to diagnosis delay (p Diagnosis delay is very serious problem in Morocco. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer information in our populations and training of general practitioners to reduce advanced breast cancer by

  18. Axial osteitis of the proximal sesamoid bones and desmitis of the intersesamoidean ligament in the hindlimb of Friesian horses: review of 12 cases (2002-2012) and post-mortem analysis of the bone-ligament interface.

    Science.gov (United States)

    Brommer, Harold; Voermans, Margreet; Veraa, Stefanie; van den Belt, Antoon J M; van der Toorn, Annette; Ploeg, Margreet; Gröne, Andrea; Back, Willem

    2014-11-19

    Axial osteitis of the proximal sesamoid bones and desmitis of the intersesamoidean ligament has been described in Friesian horses as well as in other breeds. The objectives of this study were to review the outcome of clinical cases of this disease in Friesian horses and analyse the pathology of the bone-ligament interface. Case records of Friesian horses diagnosed with axial osteitis of the proximal sesamoid bones and desmitis of the intersesamoidean ligament in the period 2002-2012 were retrospectively evaluated. Post-mortem examination was performed on horses that were euthanized (n = 3) and included macroscopic necropsy (n = 3), high-field (9.4 Tesla) magnetic resonance imaging (n = 1) and histopathology (n = 2). Twelve horses were included, aged 6.8 ± 2.7 years. The hindlimb was involved in all cases. Lameness was acute in onset and severe, with a mean duration of 1.9 ± 1.0 months. Three horses were euthanized after diagnosis; 9 horses underwent treatment. Two horses (22%) became sound for light riding purposes, 2 horses (22%) became pasture sound (comfortable at pasture, but not suitable for riding), 5 horses (56%) remained lame. In addition to bone resorption at the proximo-axial margin of the proximal sesamoid bones, magnetic resonance imaging and histopathology showed osteoporosis of the peripheral compact bone and spongious bone of the proximal sesamoid bones and chronic inflammation of the intersesamoidean ligament. Axial osteitis of the proximal sesamoid bones and desmitis of the intersesamoidean ligament in the hindlimb of Friesian horses carries a poor prognosis. Pathological characterization (inflammation, proximo-axial bone resorption and remodelling of the peripheral compact bone and spongious bone of the proximal sesamoid bones) may help in unravelling the aetiology of this disease.

  19. Understanding Early Post-Mortem Biochemical Processes Underlying Meat Color and pH Decline in the Longissimus thoracis Muscle of Young Blond d'Aquitaine Bulls Using Protein Biomarkers.

    Science.gov (United States)

    Gagaoua, Mohammed; Terlouw, E M Claudia; Micol, Didier; Boudjellal, Abdelghani; Hocquette, Jean-François; Picard, Brigitte

    2015-08-05

    Many studies on color biochemistry and protein biomarkers were undertaken in post-mortem beef muscles after ≥24 hours. The present study was conducted on Longissimus thoracis muscles of 21 Blond d'Aquitaine young bulls to evaluate the relationships between protein biomarkers present during the early post-mortem and known to be related to tenderness and pH decline and color development. pH values at 45 min, 3 h, and 30 h post-mortem were correlated with three, seven, and six biomarkers, respectively. L*a*b* color coordinates 24 h post-mortem were correlated with nine, five, and eight protein biomarkers, respectively. Regression models included Hsp proteins and explained between 47 and 59% of the variability between individuals in pH and between 47 and 65% of the variability in L*a*b* color coordinates. Proteins correlated with pH and/or color coordinates were involved in apoptosis or had antioxidative or chaperone activities. The main results include the negative correlations between pH45 min, pH3 h, and pHu and Prdx6, which may be explained by the antioxidative and phospholipase activities of this biomarker. Similarly, inducible Hsp70-1A/B and μ-calpain were correlated with L*a*b* coordinates, due to the protective action of Hsp70-1A/B on the proteolytic activities of μ-calpain on structural proteins. Correlations existed further between MDH1, ENO3, and LDH-B and pH decline and color stability probably due to the involvement of these enzymes in the glycolytic pathway and, thus, the energy status of the cell. The present results show that research using protein indicators may increase the understanding of early post-mortem biological mechanisms involved in pH and beef color development.

  20. Delays in early neuropsychic development: Approaches to diagnosis

    Directory of Open Access Journals (Sweden)

    N. N. Zavadenko

    2015-01-01

    Full Text Available The population frequency of neuropsychic developmental delays in infants is estimated at nearly 10%; that of global intellectual disability (mental retardation is at 1-3%. Delayed development is denned as a substantial retardation as compared to the standard indicators in any of the basic spheres: motor, communicative, cognitive, adaptive-behavioral, and socioemotional ones. Global developmental delay is characterized by a significant lag in two or more spheres. The use of current diagnostic techniques, such as the Bayley or Griffiths scales, can provide an objective quantitative assessment of both an infant's overall development and indicators in individual spheres. At the preliminary examination stage, it is expedient to carry out a Denver developmental screening test that may be directly used in a doctor's consulting room. The causes of global developmental delay/intellectual disability in infants may be perinatal central nervous system (CNS lesions; brain malformations; intrauterine infections; intrauterine intoxications; early-onset psychoneurological diseases (neuroinfections, CNS injuries, epilepsies, autism spectrum disorders, etc.; congenital hypothyroidism; genetic diseases. Among all genetic causes of global developmental delay/intellectual disability, there are chromosomal anomalies (25-30%, monogenic diseases (metabolic diseases, neuroectodermal syndromes, diseases with predominant grey and white matter involvement. The diagnostic possibilities of current genetic methods are considered.

  1. Delayed diagnosis of imperforate anus: an unacceptable morbidity.

    LENUS (Irish Health Repository)

    Turowski, Carmen

    2010-11-01

    Diagnosis of imperforate anus is usually made shortly after birth with physical examination. Nonetheless, a significant number of patients have presented beyond the neonatal period without recognition of anorectal malformation. We reviewed our experience of anorectal malformations, with particular emphasis on the timing of diagnosis.

  2. Determinants of delay in tuberculosis diagnosis in Hamadan province, 2006−2014

    Directory of Open Access Journals (Sweden)

    Salman Khazaei

    2016-10-01

    Conclusion: A high proportion of patients had delays in diagnosis exceeding three months. Our findings suggest that male gender, new cases, positive and extra pulmonary cases might increase the risk for delayeddiagnosis among TB patients.

  3. The discourse of health managers on aspects related to the delay in tuberculosis diagnosis

    Directory of Open Access Journals (Sweden)

    Lenilde Duarte de Sa

    2013-10-01

    Full Text Available The aim of this study was to analyze the discourse of health managers on aspects related to delay in tuberculosis diagnosis. This was a qualitative research study, conducted with 16 Family Health Unit managers. The empirical data were obtained through semi-structured interviews. The analysis was based on the theoretical framework of the French school of discourse analysis. According to the managers’ statements, the delay in tuberculosis diagnosis is related to patient and health service aspects. As for patient aspects, managers report fear, prejudice and lack of information as factors that may promote a delayed diagnosis. Regarding health service aspects, structural problems and lack of professional skills were reported. The discourse of managers should be considered to qualify tuberculosis control actions and to prevent delays in diagnosis.

  4. Causes of delay in diagnosis of pulmonary tuberCulosis in patients ...

    African Journals Online (AJOL)

    2008-06-01

    Jun 1, 2008 ... significant difference between males and females, the mean system delay was 3 ± 5 weeks (range: 0-39 weeks). the median patient, health systems and total delays were 42, 2, and 44 days respectively for all the patients. ... and management are done according to the national protocols; diagnosis by ...

  5. Considerable delay in diagnosis and acute management of subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Larsen, Carl Christian; Eskesen, Vagn; Hauerberg, John

    2010-01-01

    Rebleeding from subarachnoid haemorrhage (SAH) usually occurs within the first six hours after the initial bleeding. Rebleeding can be prevented effectively with tranexamic acid (TXA). Although a broad consensus has evolved that SAH should be treated as an emergency, it is likely that delays do...

  6. Influence of operational condition on lithium plating for commercial lithium-ion batteries – Electrochemical experiments and post-mortem-analysis

    International Nuclear Information System (INIS)

    Ecker, Madeleine; Shafiei Sabet, Pouyan; Sauer, Dirk Uwe

    2017-01-01

    Highlights: •Investigation of lithium plating to support reliable system integration. •Influence of operational conditions at low temperature on lithium plating. •Comparison of different lithium-ion battery technologies. •Large differences in low-temperature behaviour for different technologies. •Post-mortem analysis reveals inhomogeneous deposition of metallic lithium. -- Abstract: The lifetime and safety of lithium-ion batteries are key requirements for successful market introduction of electro mobility. Especially charging at low temperature and fast charging, known to provoke lithium plating, is an important issue for automotive engineers. Lithium plating, leading both to ageing as well as safety risks, is known to play a crucial role in system design of the application. To gain knowledge of different influence factors on lithium plating, low-temperature ageing tests are performed in this work. Commercial lithium-ion batteries of various types are tested under various operational conditions such as temperature, current, state of charge, charging strategy as well as state of health. To analyse the ageing behaviour, capacity fade and resistance increase are tracked over lifetime. The results of this large experimental survey on lithium plating provide support for the design of operation strategies for the implementation in battery management systems. To further investigate the underlying degradation mechanisms, differential voltage curves and impedance spectra are analysed and a post-mortem analysis of anode degradation is performed for a selected technology. The results confirm the deposition of metallic lithium or lithium compounds in the porous structure and suggest a strongly inhomogeneous deposition over the electrode thickness with a dense deposition layer close to the separator for the considered cell. It is shown that this inhomogeneous deposition can even lead to loss of active material. The plurality of the investigated technologies

  7. Test and Diagnosis for Small-Delay Defects

    CERN Document Server

    Tehranipoor, Mohammad; Chakrabarty, Krishnendu

    2012-01-01

    This book introduces new techniques for detecting and diagnosing small-delay defects (SDD) in integrated circuits. Although this sort of timing defect is commonly found in integrated circuits manufactured with nanometer technology, this will be the first book to introduce effective and scalable methodologies for screening and diagnosing small-delay defects, including important parameters such as process variations, crosstalk, and power supply noise. This book presents new techniques and methodologies to improve overall SDD detection with very small pattern sets. These methods can result in pattern counts as low as a traditional 1-detect pattern set and long path sensitization and SDD detection similar to or even better than n-detect or timing-aware pattern sets. The important design parameters and pattern-induced noises such as process variations,power supply noise (PSN) and crosstalk are taken into account in the methodologies presented. A diagnostic flow is also presented to identify whether the failure is ...

  8. Delay in diagnosis of pulmonary tuberculosis: a survey in the Lazio region, Italy

    Directory of Open Access Journals (Sweden)

    Patrizio Pezzotti

    2014-11-01

    Full Text Available OBJECTIVE: To estimate patient and health care delays in the diagnosis of PTB and to evaluate associated factors.METHODS: PTB incident cases ≥18 years diagnosed between September 2010 and September 2011 in the Lazio region; information on symptoms and date of onset, health professionals contacts, diagnostic exams performed, and drugs prescribed before diagnosis were collected through a standardized questionnaire. The total delay (TD was divided into patient delay (PD: from symptoms onset to first contact with healthcare services and health system delay (HSD: from first contact to diagnosis.RESULTS: 278 cases were evaluated. Median PD,HSD, and TD, were 31, 15, and 77.5 days, respectively. The median PD, HSD, and TD were significantly lower in foreign born patients (26, 10.5, 63.5, vs. 45, 36, 100 days, respectively. Other factors independently associated with longer delay were: absence of fever and presence of weight loss for PD; prior unspecific treatment, absence of cough, consult with a general practitioner, visit to an outpatient clinic, and a PD <30 days for HSD.CONCLUSIONS: In Italy, the delay in TB diagnosis is similar to that estimated in other European countries. Results indicate that actions aimed to reduce diagnostic delay should be primarily addressed to Italian patients.

  9. Time Delay and Associated Factors in Diagnosis and Treatment of Pulmonary Tuberculosis in Markazi Province

    Directory of Open Access Journals (Sweden)

    Aliasghar Farazi

    2012-07-01

    Full Text Available Introduction: Delay in the diagnosis of tuberculosis increases the risk of death and enhances the transmission of disease in the community. This study aims to determine the patient and health service delay and factors affecting it in tuberculosis diagnosis. Materials & Methods: A cross-sectional survey that included all the public health centers was conducted in Markazi province from March 2009 till June 2011. Patients were interviewed after diagnosis by using a structured questionnaire. Results: One hundred and sixty-six patients aged between 9 and 87 (median; 66 years were included in the study. They comprised 87 (52.4% females and 79 (47.6% males. The median and mean of patient delay was 35 and 62 days, respectively; the median and mean of health system diagnosis delay was 34 and 53 days, respectively; the median and mean of health system treatment delay was 5 and 6 days, respectively; The median and mean of total delays were 86 and 121 days, respectively for all patients. The main determinants of delay were non education, poor economic, private sector, female gender and age≥55. Conclusion: The results of this review suggest that there is a need for revising case-finding strategies and reduction of infectious cases for better control of tuberculosis.

  10. Simple spectrophotometric methods for determination of fluoxetine and clomipramine hydrochlorides in dosage forms and in some post-mortem biological fluids samples

    Directory of Open Access Journals (Sweden)

    Emam A. Ali

    2016-12-01

    Full Text Available Sensitive, simple and rapid spectrophotometric methods for micro determination of fluoxetine hydrochloride (FLU and clomipramine hydrochloride (CLO. The methods are based on the reaction between the examined drugs and acid dyes, namely; bromocresol green (BCG, phenol red (PhR and metanil yellow (MY producing yellow ion-pair complexes followed by their extraction with methylene chloride and measured at 412, 407 and 409 nm for FLU with BCG, PhR and MY, respectively; whereas for CLO at 409, 406 and 407 nm, respectively. All variables that affect the performance of the proposed methods were carefully studied and optimized. Beer’s law was obeyed in the concentration ranges 0.86–24.32 μg/mL, 8.64–41.30 μg/mL, 0.86–34.76 μg/mL for FLU and 1.75–24.55 μg/mL, 7.0–50 μg/mL, 1.65–34.78 μg/mL for CLO using BCG, PhR and MY respectively. The methods were validated in terms of accuracy and precision. The proposed methods were successfully applied to the determination of fluoxetine hydrochloride and clomipramine hydrochloride in pure samples, pharmaceutical formulations, spiked post-mortem urine and blood samples.

  11. A morphometric study of measurements of heart in adults and its relation with age and height of the individual: A post-mortem study

    Directory of Open Access Journals (Sweden)

    Chandni Gupta

    2014-01-01

    Full Text Available Objective: Reconstructive and replacement operations of diseased cardiac valves are commonly practiced these days. It may be noted that the choice of proper reconstructive intervention and prosthetic replacement might require the normal morphometric measurements of heart in relation with general body parameters, like age and height. So, this study was undertaken to measure various measurements of heart and its relation with age and height of the individual. Materials and Methods: Sixty five normal post-mortem hearts of adults were taken from the mortuary of Department of Forensic Medicine. Age of the individual was noted. Length of the deceased was measured with a measuring tape from the level of vertex to the outer border of heel. Length (from apex to base, breadth (at broadest diameter and thickness of the heart were measured with slide callipers. Weight was measured with weighing machine. Results: The mean length, breadth, thickness of heart in males and females are 11.25, 8.78, 3.97 cm and 10.60, 8.31, 3.63 cm. The mean weight of heart in males and females was 323 and 276 gms. There was significant correlation with weight of individual and weight of heart in males. There was significant correlation with age of individual and length of heart in females. Conclusion: This study will be helpful for cardiothoracic surgeons while doing surgery on hearts.

  12. High resolution post-mortem MRI of non-fixed in situ foetal brain in the second trimester of gestation. Normal foetal brain development

    Energy Technology Data Exchange (ETDEWEB)

    Scola, Elisa; Palumbo, Giovanni; Avignone, Sabrina; Cinnante, Claudia Maria [Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan (Italy); Conte, Giorgio [Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan (Italy); Universita degli Studi di Milano, Postgraduation School in Radiodiagnostics, Milan (Italy); Boito, Simona; Persico, Nicola [Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Department of Obstetrics and Gynaecology ' L. Mangiagalli' , Milan (Italy); Rizzuti, Tommaso [Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Pathology Unit, Milan (Italy); Triulzi, Fabio [Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan (Italy); Universita degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan (Italy)

    2018-01-15

    To describe normal foetal brain development with high resolution post-mortem MRI (PMMRI) of non-fixed foetal brains. We retrospectively collected PMMRIs of foetuses without intracranial abnormalities and chromosomal aberrations studied after a termination of pregnancy due to extracranial abnormalities or after a spontaneous intrauterine death. PMMRIs were performed on a 3-T scanner without any fixation and without removing the brain from the skull. All PMMRIs were evaluated in consensus by two neuroradiologists. Our analysis included ten PMMRIs (median gestational age (GA): 21 weeks; range: 17-28 weeks). At 19 and 20 weeks of GA, the corticospinal tracts are recognisable in the medulla oblongata, becoming less visible from 21 weeks. Prior to 20 weeks the posterior limb of the internal capsule (PLIC) is more hypointense than surrounding deep grey nuclei; starting from 21 weeks the PLIC becomes isointense, and is hyperintense at 28 weeks. From 19-22 weeks, the cerebral hemispheres show transient layers: marginal zone, cortical plate, subplate, and intermediate, subventricular and germinal zones. PMMRI of non-fixed in situ foetal brains preserves the natural tissue contrast and skull integrity. We assessed foetal brain development in a small cohort of foetuses, focusing on 19-22 weeks of gestation. (orig.)

  13. Entomología forense: el ciclo de vida de la mosca verde Phaenicia eximia (Wiedemann (Diptera: Calliphoridae, como herramienta para estimar el intervalo post-mortem

    Directory of Open Access Journals (Sweden)

    Enio B. Cano

    2017-03-01

    Full Text Available Se estudió el ciclo de vida de la mosca verde Phaenicia eximia (Wiedemann en condiciones controladas de laboratorio a 26 o C, con una humedad relativa de 75% y un período de iluminación de 12 h de luz y 12 h de oscuridad. El tiempo promedio de desarrollo estimado desde la oviposición hasta la salida de los adultos fue de 306 h (una media de casi 13 días. Bajo estas condiciones de temperatura y humedad, los huevos duran cerca de 19 h (0.8 días, las larvas duran unas 170 h (7.1 días y las pupas unas 116 h (4.8 días. En los meses secos y fríos de noviembre y diciembre en condiciones naturales, el ciclo de vida empírico fue de 25 días, implicando que las bajas temperaturas ralentizan el crecimiento y las altas lo aceleran. Se discute acerca de la importancia del ciclo de vida en la estimación del intervalo post-mortem en casos de muertes violentas en Guatemala.

  14. Is survival improved by the use of NIV and PEG in amyotrophic lateral sclerosis (ALS)? A post-mortem study of 80 ALS patients.

    Science.gov (United States)

    Burkhardt, Christian; Neuwirth, Christoph; Sommacal, Andreas; Andersen, Peter M; Weber, Markus

    2017-01-01

    Non-invasive ventilation (NIV) and percutaneous gastrostomy (PEG) are guideline-recommended interventions for symptom management in amyotrophic lateral sclerosis (ALS). Their effect on survival is controversial and the impact on causes of death is unknown. To investigate the effect of NIV and PEG on survival and causes of death in ALS patients. Eighty deceased ALS patients underwent a complete post mortem analysis for causes of death between 2003 and 2015. Forty-two of these patients consented for genetic testing. Effects of NIV and PEG on survival and causes of death were analyzed in a multivariable Cox proportional hazard regression. Six patients, who requested assisted suicide causing drug-induced hypoxia, were excluded from final analysis. Respiratory failure was the main cause of death in 72 out of 74 patients. Fifteen out of 74 died of aspiration pneumonia 23/74 of bronchopneumonia and 8/74 of a combination of aspiration pneumonia and bronchopneumonia. Twenty died of hypoxia without concomitant infection, and six patients had pulmonary embolism alone or in combination with pneumonia. NIV (p = 0.01) and PEG (pNIV bronchopneumonia was significantly more frequent (p NIV patients. This effect was even more pronounced in limb onset patients (pNIV and PEG prolongs survival in ALS. This study supports current AAN and EFNS guidelines which recommend NIV and PEG as a treatment option in ALS. The risk of bronchopneumonia as cause of death may be increased by NIV.

  15. Metabolomic Profiling of Post-Mortem Brain Reveals Changes in Amino Acid and Glucose Metabolism in Mental Illness Compared with Controls

    Directory of Open Access Journals (Sweden)

    Rong Zhang

    2016-01-01

    Full Text Available Metabolomic profiling was carried out on 53 post-mortem brain samples from subjects diagnosed with schizophrenia, depression, bipolar disorder (SDB, diabetes, and controls. Chromatography on a ZICpHILIC column was used with detection by Orbitrap mass spectrometry. Data extraction was carried out with m/z Mine 2.14 with metabolite searching against an in-house database. There was no clear discrimination between the controls and the SDB samples on the basis of a principal components analysis (PCA model of 755 identified or putatively identified metabolites. Orthogonal partial least square discriminant analysis (OPLSDA produced clear separation between 17 of the controls and 19 of the SDB samples (R2CUM 0.976, Q2 0.671, p-value of the cross-validated ANOVA score 0.0024. The most important metabolites producing discrimination were the lipophilic amino acids leucine/isoleucine, proline, methionine, phenylalanine, and tyrosine; the neurotransmitters GABA and NAAG and sugar metabolites sorbitol, gluconic acid, xylitol, ribitol, arabinotol, and erythritol. Eight samples from diabetic brains were analysed, six of which grouped with the SDB samples without compromising the model (R2 CUM 0.850, Q2 CUM 0.534, p-value for cross-validated ANOVA score 0.00087. There appears on the basis of this small sample set to be some commonality between metabolic perturbations resulting from diabetes and from SDB.

  16. The potential of non-invasive pre- and post-mortem carcass measurements to predict the contribution of carcass components to slaughter yield of guinea pigs.

    Science.gov (United States)

    Barba, Lida; Sánchez-Macías, Davinia; Barba, Iván; Rodríguez, Nibaldo

    2018-06-01

    Guinea pig meat consumption is increasing exponentially worldwide. The evaluation of the contribution of carcass components to carcass quality potentially can allow for the estimation of the value added to food animal origin and make research in guinea pigs more practicable. The aim of this study was to propose a methodology for modelling the contribution of different carcass components to the overall carcass quality of guinea pigs by using non-invasive pre- and post mortem carcass measurements. The selection of predictors was developed through correlation analysis and statistical significance; whereas the prediction models were based on Multiple Linear Regression. The prediction results showed higher accuracy in the prediction of carcass component contribution expressed in grams, compared to when expressed as a percentage of carcass quality components. The proposed prediction models can be useful for the guinea pig meat industry and research institutions by using non-invasive and time- and cost-efficient carcass component measuring techniques. Copyright © 2018 Elsevier Ltd. All rights reserved.

  17. Comparative analysis of bones, mites, soil chemistry, nematodes and soil micro-eukaryotes from a suspected homicide to estimate the post-mortem interval.

    Science.gov (United States)

    Szelecz, Ildikó; Lösch, Sandra; Seppey, Christophe V W; Lara, Enrique; Singer, David; Sorge, Franziska; Tschui, Joelle; Perotti, M Alejandra; Mitchell, Edward A D

    2018-01-08

    Criminal investigations of suspected murder cases require estimating the post-mortem interval (PMI, or time after death) which is challenging for long PMIs. Here we present the case of human remains found in a Swiss forest. We have used a multidisciplinary approach involving the analysis of bones and soil samples collected beneath the remains of the head, upper and lower body and "control" samples taken a few meters away. We analysed soil chemical characteristics, mites and nematodes (by microscopy) and micro-eukaryotes (by Illumina high throughput sequencing). The PMI estimate on hair 14 C-data via bomb peak radiocarbon dating gave a time range of 1 to 3 years before the discovery of the remains. Cluster analyses for soil chemical constituents, nematodes, mites and micro-eukaryotes revealed two clusters 1) head and upper body and 2) lower body and controls. From mite evidence, we conclude that the body was probably brought to the site after death. However, chemical analyses, nematode community analyses and the analyses of micro-eukaryotes indicate that decomposition took place at least partly on site. This study illustrates the usefulness of combining several lines of evidence for the study of homicide cases to better calibrate PMI inference tools.

  18. High resolution post-mortem MRI of non-fixed in situ foetal brain in the second trimester of gestation. Normal foetal brain development

    International Nuclear Information System (INIS)

    Scola, Elisa; Palumbo, Giovanni; Avignone, Sabrina; Cinnante, Claudia Maria; Conte, Giorgio; Boito, Simona; Persico, Nicola; Rizzuti, Tommaso; Triulzi, Fabio

    2018-01-01

    To describe normal foetal brain development with high resolution post-mortem MRI (PMMRI) of non-fixed foetal brains. We retrospectively collected PMMRIs of foetuses without intracranial abnormalities and chromosomal aberrations studied after a termination of pregnancy due to extracranial abnormalities or after a spontaneous intrauterine death. PMMRIs were performed on a 3-T scanner without any fixation and without removing the brain from the skull. All PMMRIs were evaluated in consensus by two neuroradiologists. Our analysis included ten PMMRIs (median gestational age (GA): 21 weeks; range: 17-28 weeks). At 19 and 20 weeks of GA, the corticospinal tracts are recognisable in the medulla oblongata, becoming less visible from 21 weeks. Prior to 20 weeks the posterior limb of the internal capsule (PLIC) is more hypointense than surrounding deep grey nuclei; starting from 21 weeks the PLIC becomes isointense, and is hyperintense at 28 weeks. From 19-22 weeks, the cerebral hemispheres show transient layers: marginal zone, cortical plate, subplate, and intermediate, subventricular and germinal zones. PMMRI of non-fixed in situ foetal brains preserves the natural tissue contrast and skull integrity. We assessed foetal brain development in a small cohort of foetuses, focusing on 19-22 weeks of gestation. (orig.)

  19. Post-mortem analysis on LiFePO4|Graphite cells describing the evolution & composition of covering layer on anode and their impact on cell performance

    Science.gov (United States)

    Lewerenz, Meinert; Warnecke, Alexander; Sauer, Dirk Uwe

    2017-11-01

    During cyclic aging of lithium-ion batteries the formation of a μm-thick covering layer on top of the anode facing the separator is found on top of the anode. In this work several post-mortem analyses of cyclic aged cylindrical LFP|Graphite cells are evaluated to give a detailed characterization of the covering layer and to find possible causes for the evolution of such a layer. The analyses of the layer with different methods return that it consists to high percentage of plated active lithium, deposited Fe and products of a solid electrolyte interphase (SEI). The deposition is located mainly in the center of the cell symmetrical to the coating direction. The origin of these depositions is assumed in locally overcharged particles, Fe deposition or inhomogeneous distribution of capacity density. As a secondary effect the deposition on one side increases the thickness locally; thereafter a pressure-induced overcharging due to charge agglomeration of the back side of the anode occurs. Finally a compact and dense covering layer in a late state of aging leads to deactivation of the covered parts of the anode and cathode due to suppressed lithium-ion conductivity. This leads to increasing slope of capacity fade and increase of internal resistance.

  20. Toward Identification of the Sexual Killer: A Comparison of Sexual Killers Engaging in Post-Mortem Sexual Interference and Non-Homicide Sexual Aggressors.

    Science.gov (United States)

    Higgs, Tamsin; Carter, Adam J; Stefanska, Ewa B; Glorney, Emily

    2017-08-01

    Establishing a model of sexual assault reflecting psychosocial and behavioral characteristics of perpetrators of sexual killing and rape is necessary for development in risk assessment and intervention. Methodological variations in defining sexual killing have amalgamated serial and non-serial offenders and perpetrators with direct and indirect associations between killing and sexual arousal. This study defined sexual killing specifying that killing should be directly linked to sexual arousal, and sampled 48 sexual killers, operationalized to include only those engaging in post-mortem sexual interference, with one or two known female victims (non-serial), from prison service national (England and Wales) databases. These sexual killers were compared with 48 non-homicide, life or indeterminately sentenced sexual aggressors on psychological and crime scene characteristics. Contrary to previous research, fatal outcomes were associated with neither stranger victims nor weapon presence; sexual killing was characterized by severity of violence less so than non-fatal assault. Sexual killers more often reported problems with emotional loneliness, empathic concern, and sexual entitlement than the sexual aggressors. Theoretical and applied implications are discussed.

  1. Preventing gatekeeping delays in the diagnosis of rare diseases

    NARCIS (Netherlands)

    de Vries, E.; Fransen, L.; van den Aker, M.; Meijboom, B.R.

    2018-01-01

    GPs acting as gatekeepers render a healthcare system easily accessible as well as affordable. However, gatekeeping can have an important drawback: it may hamper timely diagnosis and treatment of patients suffering from a rare disease (incidence <1:2000),1 especially if patients present with common

  2. Sociodemographic factors and delay in the diagnosis of cervical ...

    African Journals Online (AJOL)

    Background: In Morocco, cervical cancer is the second most common cancer in women. The cases of cervical cancer are diagnosed at a late stage: 43.7% presented at stage II of diagnosis (FIGO) and 38.1% in advanced stage (stage III and IV). The main objective of this study is to investigate factors associated to late the ...

  3. Fox Den Disease: An Interesting Case Following Delayed Diagnosis.

    Science.gov (United States)

    Stehr, Ryan C; Kim, Nicholas; LoGiudice, John A; Ludwig, Kirk

    2015-06-01

    Pyoderma fistulans sinifica, also known as fox den disease, is a rare and poorly understood inflammatory disorder of the skin and subcutaneous tissues. This disorder is often mistaken for other inflammatory skin disorders and treated inappropriately. The authors describe the case of a 53-year-old male who presented to the colorectal surgery service with a longstanding diagnosis of perirectal Crohn's disease. Despite aggressive immunosuppression and numerous surgical procedures, the patient continued to have unrelenting purulent drainage from the skin of his buttocks. Following wide excision of the affected skin and subcutaneous tissues by the colorectal surgeon, the plastic surgery team reconstructed the 30 cm x 55 cm wound using a combination of local flaps and skin grafts. The initial pathology report of the excised specimen confirmed the presence of nonspecific abscesses and inflammation. Upon special request by the plastic surgery team, the sample was resectioned with the specific intent of establishing a diagnosis of fox den disease. The additional slides met the criteria for an unequivocal diagnosis of fox den disease. Immunosuppression was discontinued and the patient healed his wounds without complication. Fox den disease is often overlooked because of the obscurity of the disease and the special histological sectioning needed to establish a diagnosis. In this case, the patient was unnecessarily treated with immunosuppressive drugs for more than 3 decades because of a misdiagnosis. With increased awareness of fox den disease, perhaps its pathophysiology can be better elucidated as more patients are appropriately diagnosed and treated.

  4. Factors associated with delays in treatment initiation after tuberculosis diagnosis in two districts of India.

    Directory of Open Access Journals (Sweden)

    Durba Paul

    Full Text Available BACKGROUND: Excessive time between diagnosis and initiation of tuberculosis (TB treatment contributes to ongoing TB transmission and should be minimized. In India, Revised National TB Control Programme (RNTCP focuses on indicator start of treatment within 7 days of diagnosis for patients with sputum smear-positive PTB for monitoring DOTS implementation. OBJECTIVES: To determine length of time between diagnosis and initiation of treatment and factors associated with delays of more than 7 days in smear-positive pulmonary TB. METHODS: Using existing programme records such as the TB Register, treatment cards, and the laboratory register, we conducted a retrospective cohort study of all patients with smear-positive pulmonary TB registered from July-September 2010 in two districts in India. A random sample of patients with pulmonary TB who experienced treatment delay of more than 7 days was interviewed using structured questionnaire. RESULTS: 2027 of 3411 patients registered with pulmonary TB were smear-positive. 711(35% patients had >7 days between diagnosis and treatment and 262(13% had delays >15 days. Mean duration between TB diagnosis and treatment initiation was 8 days (range = 0-128 days. Odds of treatment delay >7 days was 1.8 times more likely among those who had been previously treated (95% confidence interval [CI] 1.5-2.3 and 1.6 (95% CI 1.3-1.8 times more likely among those diagnosed in health facilities without microscopy centers. The main factors associated with a delay >7 days were: patient reluctance to start a re-treatment regimen, patients seeking second opinions, delay in transportation of drugs to the DOT centers and delay in initial home visits. To conclude, treatment delay >7 days was associated with a number of factors that included history of previous treatment and absence of TB diagnostic services in the local health facility. Decentralized diagnostic facilities and improved referral procedures may reduce such treatment

  5. Preventing delayed diagnosis of cancer: clinicians’ views on main problems and solutions

    Science.gov (United States)

    Car, Lorainne Tudor; Papachristou, Nikolaos; Urch, Catherine; Majeed, Azeem; El–Khatib, Mona; Aylin, Paul; Atun, Rifat; Car, Josip; Vincent, Charles

    2016-01-01

    Background Delayed diagnosis is a major contributing factor to the UK’s lower cancer survival compared to many European countries. In the UK, there is a significant national variation in early cancer diagnosis. Healthcare providers can offer an insight into local priorities for timely cancer diagnosis. In this study, we aimed to identify the main problems and solutions relating to delay cancer diagnosis according to cancer care clinicians. Methods We developed and implemented a new priority–setting approach called PRIORITIZE and invited North West London cancer care clinicians to identify and prioritize main causes for and solutions to delayed diagnosis of cancer care. Results Clinicians identified a number of concrete problems and solutions relating to delayed diagnosis of cancer. Raising public awareness, patient education as well as better access to specialist care and diagnostic testing were seen as the highest priorities. The identified suggestions focused mostly on the delays during referrals from primary to secondary care. Conclusions Many identified priorities were feasible, affordable and converged around common themes such as public awareness, care continuity and length of consultation. As a timely, proactive and scalable priority–setting approach, PRIORITZE could be implemented as a routine preventative system for determining patient safety issues by frontline staff. PMID:28028437

  6. Factors affecting professional delay in diagnosis and treatment of oral cancer in Iran.

    Science.gov (United States)

    Esmaelbeigi, Farhad; Hadji, Maryam; Harirchi, Iraj; Omranipour, Ramesh; vand Rajabpour, Mojtaba; Zendehdel, Kazem

    2014-04-01

    Oral cancer is the most common malignant tumor among head and neck cancers. Delay in diagnosis affects the treatment and prognosis of oral cancer. We measured the professional delay in the diagnosis and its attributes in the Cancer Institute of Iran, the largest referral center for oral cancer patients in the country.  We interviewed oral cancer patients to measure the delay and used case-control approach to study association of various prognostic factors with professional delay and tumor stage. Out of 206 patients, 71.4% were diagnosed at the advanced stage. The median of the patient, professional and total delays were 45, 86 and 140 day, receptively. In the univariate model, prescription of medicines like analgesics (OR = 5.3, 95% CI 2.2-12.9) and history of dental procedure (OR=6.8, 95% CI 1.7-26.9) were associated with higher risk of delay compared to patient who were biopsied from the beginning. History of loose teeth increased risk of delay 4 times (OR = 4.0, 95% CI 1.6-9.8). Patients with primary education had 70% lower risk of delay compared to the illiterate patients (OR = 0.3, 95% CI 0.1-0.7) and the risk was lower among patients who had diploma (OR = 0.04, 95% CI 0-0.7) and college education (OR = 0.1, 95% CI 0-0.4). The delayed patients were diagnosed in more advanced stage compared to the patients without delay (OR = 2.1, 95% CI 1.0-4.4). Development of a national guideline for follow-up of oral lesions, training and awareness of health care professionals about oral cancer diagnosis may decrease the delay and improve the oral cancer outcome in Iran.

  7. Diagnosis delay of breast cancer and its associated factors in Malaysian women

    Directory of Open Access Journals (Sweden)

    Naing Nyi N

    2011-04-01

    Full Text Available Abstract Background Breast cancer is the leading cause of cancer mortality among women in Malaysia. Delayed diagnosis is preventable and has major effects on patients' prognosis and survival. The objectives of our study were to identify the magnitude of delayed diagnosis and its associated factors in women with breast cancer in Malaysia. Methods This study had a cross-sectional design. Respondents had histologically confirmed breast cancer and were registered at five medical centres between 2005 and 2007. All breast cancer patients who attended hospital clinics at the East Coast were included. Patients at Kuala Lumpur hospitals were selected by systematic sampling. A standardised questionnaire was developed to interview respondents. We measured the time from the first recognition of symptoms to the first general practitioners' consultation and to the histological diagnosis of breast cancer. Diagnosis delay was defined when there was more than 6 months from the recognition of symptoms to the histological diagnosis. Multiple logistic regression was used for analysis. Results In total, 328 respondents were included. The mean (standard deviation age was 47.9 (9.4 years. Most respondents were of Malay ethnicity, were married housewives with a median family income of RM1500 a month. Most respondents had ductal carcinoma (89.3% and the stage distribution was as follows: 5.2% stage I, 38.7% stage II, 44.8% stage III and 11.3% stage IV. The median time to consultation was 2 months and the median time to diagnosis was 5.5 months. The frequency of diagnosis delay of more than 3 months was 72.6% and delay of more than 6 months occurred in 45.5% of the cases. The factors associated with diagnosis delay included the use of alternative therapy (odds ratio (OR 1.77; 95% confidence interval (CI: 1.06, 2.94, breast ulcer (OR 5.71; 95% CI: 1.59, 20.47, palpable axillary lymph nodes (OR 2.19; 95% CI: 1.23, 3.90, false-negative diagnostic test (OR 5.32; 95% CI: 2

  8. Diagnosis delay of breast cancer and its associated factors in Malaysian women

    International Nuclear Information System (INIS)

    Norsa'adah, Bachok; Rampal, Krishna G; Rahmah, Mohd A; Naing, Nyi N; Biswal, Biswa M

    2011-01-01

    Breast cancer is the leading cause of cancer mortality among women in Malaysia. Delayed diagnosis is preventable and has major effects on patients' prognosis and survival. The objectives of our study were to identify the magnitude of delayed diagnosis and its associated factors in women with breast cancer in Malaysia. This study had a cross-sectional design. Respondents had histologically confirmed breast cancer and were registered at five medical centres between 2005 and 2007. All breast cancer patients who attended hospital clinics at the East Coast were included. Patients at Kuala Lumpur hospitals were selected by systematic sampling. A standardised questionnaire was developed to interview respondents. We measured the time from the first recognition of symptoms to the first general practitioners' consultation and to the histological diagnosis of breast cancer. Diagnosis delay was defined when there was more than 6 months from the recognition of symptoms to the histological diagnosis. Multiple logistic regression was used for analysis. In total, 328 respondents were included. The mean (standard deviation) age was 47.9 (9.4) years. Most respondents were of Malay ethnicity, were married housewives with a median family income of RM1500 a month. Most respondents had ductal carcinoma (89.3%) and the stage distribution was as follows: 5.2% stage I, 38.7% stage II, 44.8% stage III and 11.3% stage IV. The median time to consultation was 2 months and the median time to diagnosis was 5.5 months. The frequency of diagnosis delay of more than 3 months was 72.6% and delay of more than 6 months occurred in 45.5% of the cases. The factors associated with diagnosis delay included the use of alternative therapy (odds ratio (OR) 1.77; 95% confidence interval (CI): 1.06, 2.94), breast ulcer (OR 5.71; 95% CI: 1.59, 20.47), palpable axillary lymph nodes (OR 2.19; 95% CI: 1.23, 3.90), false-negative diagnostic test (OR 5.32; 95% CI: 2.32, 12.21), non-cancer interpretation

  9. Delayed Diagnosis: Giant Basal Cell Carcinoma of Scalp

    Directory of Open Access Journals (Sweden)

    Didem Didar Balcı,

    2008-07-01

    Full Text Available Although basal cell carcinoma (BCC is the most common form of skin cancer, the scalp lesions of BCC have been rarely reported. Giant BCC is defined as a tumor larger than 5 cm in diameter and only 0.5-1 % of all BCCs achieve this size. We report a case of giant BCC on the scalp that was treated with topical coticosteroids and antifungal shampoo for five years. BCC should be considered in the differential diagnosis in erythematous plaque type lesions resistant to therapy with long duration localized on the scalp.

  10. Delays in diagnosis and treatment of extrapulmonary tuberculosis in Guatemala.

    Science.gov (United States)

    Shah, Pooja Ajay; Coj, Merida; Rohloff, Peter

    2017-10-09

    A 23-year-old indigenous Guatemalan man presented in 2016 to our clinic in Sololá, Guatemala, with 10 months of recurrent neck swelling, fevers, night sweats and weight loss. Previously, he had sought care in three different medical settings, including a private physician-run clinic, a tertiary private cancer treatment centre and, finally, a rural government health post. With assistance from our institution's accompaniment staff, the patient was admitted to a public tertiary care hospital for work-up. Rifampin-susceptible tuberculosis was diagnosed, and appropriate treatment was begun. The case illustrates how low tuberculosis recognition among community health workers and health system segmentation creates obstacles to appropriate care, especially for patients with limited means. As a result, significant diagnostic and treatment delays can occur, increasing the public health burden of tuberculosis. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Delays in the diagnosis and treatment of tuberculosis patients in Vietnam: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Khanh Vu T

    2007-06-01

    Full Text Available Abstract Background Treatment delay is an important indicator of access to tuberculosis diagnosis and treatment. Analyses of patient delay (i.e. time interval between onset of symptoms and first consultation of a health care provider and health care delay (i.e. time interval between first consultation and start of treatment can inform policies to improve access. This study assesses the patient, health care provider and total delay in diagnosis and treatment of new smear-positive pulmonary tuberculosis patients, and the risk factors for long delay, in Vietnam. Methods A cross-sectional survey of new patients treated by the National Tuberculosis Control Programme was conducted in 70 randomly selected districts in Vietnam. All consecutively registered patients in one quarter of 2002 were interviewed using a pre-coded structured questionnaire. Results Median (range delay was 4 weeks (1–48 for total, 3 (1–48 weeks for patient and 1 (0–25 week for health care delay. Patients with long total delay (≥ 12 weeks, 15% accounted for 49% of the cumulative number of delay-weeks. Independent risk factors (p 5 km distance from a health facility or in the northern area. For long health care delay (≥ 6 weeks this was urban setting, residence in the central area and initial visit to a communal health post, TB hospital or the private sector. Conclusion Analyses of patient and treatment delays can indicate target groups and areas for health education and strengthening of the referral system, in particular between the private sector and the NTP.

  12. Association of Protein Distribution and Gene Expression Revealed by PET and Post-Mortem Quantification in the Serotonergic System of the Human Brain.

    Science.gov (United States)

    Komorowski, A; James, G M; Philippe, C; Gryglewski, G; Bauer, A; Hienert, M; Spies, M; Kautzky, A; Vanicek, T; Hahn, A; Traub-Weidinger, T; Winkler, D; Wadsak, W; Mitterhauser, M; Hacker, M; Kasper, S; Lanzenberger, R

    2017-01-01

    Regional differences in posttranscriptional mechanisms may influence in vivo protein densities. The association of positron emission tomography (PET) imaging data from 112 healthy controls and gene expression values from the Allen Human Brain Atlas, based on post-mortem brains, was investigated for key serotonergic proteins. PET binding values and gene expression intensities were correlated for the main inhibitory (5-HT1A) and excitatory (5-HT2A) serotonin receptor, the serotonin transporter (SERT) as well as monoamine oxidase-A (MAO-A), using Spearman's correlation coefficients (rs) in a voxel-wise and region-wise analysis. Correlations indicated a strong linear relationship between gene and protein expression for both the 5-HT1A (voxel-wise rs = 0.71; region-wise rs = 0.93) and the 5-HT2A receptor (rs = 0.66; 0.75), but only a weak association for MAO-A (rs = 0.26; 0.66) and no clear correlation for SERT (rs = 0.17; 0.29). Additionally, region-wise correlations were performed using mRNA expression from the HBT, yielding comparable results (5-HT1Ars = 0.82; 5-HT2Ars = 0.88; MAO-A rs = 0.50; SERT rs = -0.01). The SERT and MAO-A appear to be regulated in a region-specific manner across the whole brain. In contrast, the serotonin-1A and -2A receptors are presumably targeted by common posttranscriptional processes similar in all brain areas suggesting the applicability of mRNA expression as surrogate parameter for density of these proteins. © The Author 2016. Published by Oxford University Press.

  13. Impacts of post-mortem ageing prior to freezing on technological and oxidative properties of coarse ground lamb sausage in a model system.

    Science.gov (United States)

    Choe, Juhui; Kim, Hyun-Wook; Farouk, Mustafa M; Brad Kim, Yuan H

    2017-07-01

    The objective of this study was to evaluate the effects of ageing time of lamb loins prior to freezing on technological characteristics and oxidation stability of coarse ground lamb loin sausage using in a model system. Lamb loins ( M. longissimus lumborum , n = 25) were aged at -1.5°C for 0, 1, 2, 3, and 8 wk and then frozen for the remaining days (a total of 30 wk). The aged/frozen/thawed lamb loins were ground, and model sausages were formulated with 75% aged/frozen/thawed lamb loin, 25% water, 1.5% sodium chloride (NaCl) and 0.3% sodium tripolyphosphate. The pH and thaw/purge loss of aged/frozen/thawed lamb loins were evaluated, and protein functionality (protein solubility and emulsifying capacity), water-holding capacity and textural properties of model sausages were determined. Cooked model sausages were vacuum-packaged in a plastic bag and displayed under continuous fluorescent natural white light (3°C±1°C). Colour and lipid oxidation of the cooked model sausages were evaluated on 0 and 21 d of display storage. Ageing prior to freezing had no impact on pH and purge/thaw loss of lamb loins and the colour of cooked sausages (p>0.05) made from the loins. Lamb loins aged for at least 3 wk prior to freezing numerically improved total and myofibrillar protein solubilities (p>0.05) and emulsion activity index (p = 0.009) of meat batter, but decreased cooking loss (p = 0.003) and lipid oxidation (p<0.05) of model sausages. This study suggests that post-mortem ageing of raw meat prior to freezing could improve water-holding capacity and lipid oxidative stability of sausage made from the meat.

  14. The impact of body mass index in gene expression of reelin pathway mediators in individuals with schizophrenia and mood disorders: A post-mortem study.

    Science.gov (United States)

    Brietzke, Elisa; Trevizol, Alisson P; Fries, Gabriel R; Subramaniapillai, Mehala; Kapczinski, Flavio; McIntyre, Roger S; Mansur, Rodrigo B

    2018-04-13

    The objective of this study was to compare the expression of genes involved in the reelin pathway, in the post-mortem brain of individuals with schizophrenia (SZ) and mood disorders (MD) with a healthy control (HC) group; and to investigate the role f body mass index (BMI) as a potential mediator. The "Gene Expression in Postmortem dlPFC and Hippocampus from Schizophrenia and Mood Disorders" study holds microarray data on individuals with SZ, MD and HCs (from whom 849 specimens are from the dlPFC and 579 from the hippocampus). mRNA data was obtained using HumanHT-12 v4 BeadChip arrays (Illumina). Multivariate analysis of covariance were used to investigate the main effects of group and relevant covariates on RELNm, NOTCH1, GRIN1m, GRIN3A, CAMK2Gm, CAMK2A, CAMK2Bm, CAMK2N2, GRIN2Bm, GRIN2A, CREBBPm, APOE, LDLR and DAB1 gene expression. In the dlPFC, individuals with SZ had higher expression, relative to HCs, of APOE. Individuals with MD had higher expression, relative to HCs, of CAMK2A, CAMK2N2, and GRIN2Bm. Moreover, individuals with MD had higher expression, relative to SZ patients, of CAMK2N2. There were significant group by BMI effects for expression of RELN, CAMK2A, CAMK2N2, and GRIN2A. In the hippocampus, individuals with MD had lower expression, relative to HCs, of APOE. The results of this study suggest that the expression of genes related to the reelin pathway could be different between individuals with SZ and MD and healthy controls, with a greater vulnerability associated with greater BMI. Copyright © 2018 Elsevier Ltd. All rights reserved.

  15. Metabolomics of Neurotransmitters and Related Metabolites in Post-Mortem Tissue from the Dorsal and Ventral Striatum of Alcoholic Human Brain.

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    Kashem, Mohammed Abul; Ahmed, Selina; Sultana, Nilufa; Ahmed, Eakhlas U; Pickford, Russell; Rae, Caroline; Šerý, Omar; McGregor, Iain S; Balcar, Vladimir J

    2016-02-01

    We report on changes in neurotransmitter metabolome and protein expression in the striatum of humans exposed to heavy long-term consumption of alcohol. Extracts from post mortem striatal tissue (dorsal striatum; DS comprising caudate nucleus; CN and putamen; P and ventral striatum; VS constituted by nucleus accumbens; NAc) were analysed by high performance liquid chromatography coupled with tandem mass spectrometry. Proteomics was studied in CN by two-dimensional gel electrophoresis followed by mass-spectrometry. Proteomics identified 25 unique molecules expressed differently by the alcohol-affected tissue. Two were dopamine-related proteins and one a GABA-synthesizing enzyme GAD65. Two proteins that are related to apoptosis and/or neuronal loss (BiD and amyloid-β A4 precursor protein-binding family B member 3) were increased. There were no differences in the levels of dopamine (DA), 3,4-dihydrophenylacetic acid (DOPAC), serotonin (5HT), homovanillic acid (HVA), 5-hydroxyindoleacetic acid (HIAA), histamine, L-glutamate (Glu), γ-aminobutyric acid (GABA), tyrosine (Tyr) and tryptophan (Tryp) between the DS (CN and P) and VS (NAc) in control brains. Choline (Ch) and acetylcholine (Ach) were higher and norepinephrine (NE) lower, in the VS. Alcoholic striata had lower levels of neurotransmitters except for Glu (30 % higher in the alcoholic ventral striatum). Ratios of DOPAC/DA and HIAA/5HT were higher in alcoholic striatum indicating an increase in the DA and 5HT turnover. Glutathione was significantly reduced in all three regions of alcohol-affected striatum. We conclude that neurotransmitter systems in both the DS (CN and P) and the VS (NAc) were significantly influenced by long-term heavy alcohol intake associated with alcoholism.

  16. The Effect of Upper Body Mass and Initial Knee Flexion on the Injury Outcome of Post Mortem Human Subject Pedestrian Isolated Legs.

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    Petit, Philippe; Trosseille, Xavier; Dufaure, Nicolas; Dubois, Denis; Potier, Pascal; Vallancien, Guy

    2014-11-01

    In the ECE 127 Regulation on pedestrian leg protection, as well as in the Euro NCAP test protocol, a legform impactor hits the vehicle at the speed of 40 kph. In these tests, the knee is fully extended and the leg is not coupled to the upper body. However, the typical configuration of a pedestrian impact differs since the knee is flexed during most of the gait cycle and the hip joint applies an unknown force to the femur. This study aimed at investigating the influence of the inertia of the upper body (modelled using an upper body mass fixed at the proximal end of the femur) and the initial knee flexion angle on the lower limb injury outcome. In total, 18 tests were conducted on 18 legs from 9 Post Mortem Human Subjects (PMHS). The principle of these tests was to impact the leg at 40 kph using a sled equipped with 3 crushing steel tubes, the stiffness of which were representative of the front face of a European sedan (bonnet leading edge, bumper and spoiler). The mass of the equipped sled was 74.5 kg. The test matrix was designed to perform 4 tests in 4 configurations combining two upper body masses (either 0 or 3 kg) and two knee angles (0 or 20 degrees) at 40 kph (11 m/s) plus 2 tests at 9 m/s. Autopsies were performed on the lower limbs and an injury assessment was established. The findings of this study were first that the increase of the upper body mass resulted in more severe injuries, second that an initial flexion of the knee, corresponding to its natural position during the gait cycle, decreased the severity of the injuries, and third that based on the injury outcome, a test conducted with no upper body mass and the knee fully extended was as severe as a test conducted with a 3 kg upper body mass and an initial knee flexion of 20°.

  17. Development, appraisal, validation and implementation of a consensus protocol for the assessment of cerebral amyloid angiopathy in post-mortem brain tissue

    Science.gov (United States)

    Love, Seth; Chalmers, Katy; Ince, Paul; Esiri, Margaret; Attems, Johannes; Jellinger, Kurt; Yamada, Masahito; McCarron, Mark; Minett, Thais; Matthews, Fiona; Greenberg, Steven; Mann, David; Kehoe, Patrick Gavin

    2014-01-01

    In a collaboration involving 11 groups with research interests in cerebral amyloid angiopathy (CAA), we used a two-stage process to develop and in turn validate a new consensus protocol and scoring scheme for the assessment of CAA and associated vasculopathic abnormalities in post-mortem brain tissue. Stage one used an iterative Delphi-style survey to develop the consensus protocol. The resultant scoring scheme was tested on a series of digital images and paraffin sections that were circulated blind to a number of scorers. The scoring scheme and choice of staining methods were refined by open-forum discussion. The agreed protocol scored parenchymal and meningeal CAA on a 0-3 scale, capillary CAA as present/absent and vasculopathy on 0-2 scale, in the 4 cortical lobes that were scored separately. A further assessment involving three centres was then undertaken. Neuropathologists in three centres (Bristol, Oxford and Sheffield) independently scored sections from 75 cases (25 from each centre) and high inter-rater reliability was demonstrated. Stage two used the results of the three-centre assessment to validate the protocol by investigating previously described associations between APOE genotype (previously determined), and both CAA and vasculopathy. Association of capillary CAA with or without arteriolar CAA with APOE ε4 was confirmed. However APOE ε2 was also found to be a strong risk factor for the development of CAA, not only in AD but also in elderly non-demented controls. Further validation of this protocol and scoring scheme is encouraged, to aid its wider adoption to facilitate collaborative and replication studies of CAA. PMID:24754000

  18. Erratum: Development, appraisal, validation and implementation of a consensus protocol for the assessment of cerebral amyloid angiopathy in post-mortem brain tissue.

    Science.gov (United States)

    Love, Seth; Chalmers, Katy; Ince, Paul; Esiri, Margaret; Attems, Johannes; Kalaria, Raj; Jellinger, Kurt; Yamada, Masahito; McCarron, Mark; Minett, Thais; Matthews, Fiona; Greenberg, Steven; Mann, David; Kehoe, Patrick Gavin

    2015-01-01

    In a collaboration involving 11 groups with research interests in cerebral amyloid angiopathy (CAA), we used a two-stage process to develop and in turn validate a new consensus protocol and scoring scheme for the assessment of CAA and associated vasculopathic abnormalities in post-mortem brain tissue. Stage one used an iterative Delphi-style survey to develop the consensus protocol. The resultant scoring scheme was tested on a series of digital images and paraffin sections that were circulated blind to a number of scorers. The scoring scheme and choice of staining methods were refined by open-forum discussion. The agreed protocol scored parenchymal and meningeal CAA on a 0-3 scale, capillary CAA as present/absent and vasculopathy on 0-2 scale, in the 4 cortical lobes that were scored separately. A further assessment involving three centres was then undertaken. Neuropathologists in three centres (Bristol, Oxford and Sheffield) independently scored sections from 75 cases (25 from each centre) and high inter-rater reliability was demonstrated. Stage two used the results of the three-centre assessment to validate the protocol by investigating previously described associations between APOE genotype (previously determined), and both CAA and vasculopathy. Association of capillary CAA with or without arteriolar CAA with APOE ε4 was confirmed. However APOE ε2 was also found to be a strong risk factor for the development of CAA, not only in AD but also in elderly non-demented controls. Further validation of this protocol and scoring scheme is encouraged, to aid its wider adoption to facilitate collaborative and replication studies of CAA.[This corrects the article on p. 19 in vol. 3, PMID: 24754000.].

  19. Post-Mortem Evaluation of Pathological Lesions in European Bison (Bison Bonasus in the Białowieża Primeval Forest Between 2008 and 2013

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    K. Krzysiak Michał

    2014-10-01

    Full Text Available The study presents the analysis of the findings of 234 post-mortem examinations on free-ranging and captive European bison selectively culled or having fallen between 2008 and 2013 in Białowieża Primeval Forest. Pneumonia, emphysema, nephritis, bodily traumas, and intestinal lesions were observed in 106 (45.3%, 77 (32.9%, 82 (35.0%, 68 (29.1%, and 56 (23.9% animals respectively and were the most common pathological changes. Almost half of all males (66 out of 140; 47.1% tested showed some pathological changes of prepuce and penis, described as posthitis or balanoposthitis. Infection with liver fluke (Fasciola hepatica and lungworm (Dictyocaulus viviparus was observed macroscopically in 114 (48.7% and 80 (32.9% bison respectively. F. hepatica prevalence was associated with the emergence of other liver changes such as hepatitis and cirrhosis (P < 0.001. Similarly, the prevalence of D. viviparus coincided with pneumonia (P = 0.001, changes in the upper respiratory tract (P = 0.04, and emphysema (P < 0.001. Hepatitis, infection with F. hepatica, and pathological lesions in the male and female reproductive tracts were associated with the animals’ age. Mechanical injuries, caused by other bison or less commonly by traffic accidents, were the most common cause of death of bison below six months of age. Most pathological changes were significantly more frequent in the selectively culled animals in comparison with the ones having fallen, which confirms the desirability of elimination as a tool to improve the health and welfare of the bison population and limit the number of reservoirs of invasive and possibly infectious diseases.

  20. Impacts of post-mortem ageing prior to freezing on technological and oxidative properties of coarse ground lamb sausage in a model system

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    Juhui Choe

    2017-07-01

    Full Text Available Objective The objective of this study was to evaluate the effects of ageing time of lamb loins prior to freezing on technological characteristics and oxidation stability of coarse ground lamb loin sausage using in a model system. Methods Lamb loins (M. longissimus lumborum, n = 25 were aged at −1.5°C for 0, 1, 2, 3, and 8 wk and then frozen for the remaining days (a total of 30 wk. The aged/frozen/thawed lamb loins were ground, and model sausages were formulated with 75% aged/frozen/thawed lamb loin, 25% water, 1.5% sodium chloride (NaCl and 0.3% sodium tripolyphosphate. The pH and thaw/purge loss of aged/frozen/thawed lamb loins were evaluated, and protein functionality (protein solubility and emulsifying capacity, water-holding capacity and textural properties of model sausages were determined. Cooked model sausages were vacuum-packaged in a plastic bag and displayed under continuous fluorescent natural white light (3°C±1°C. Colour and lipid oxidation of the cooked model sausages were evaluated on 0 and 21 d of display storage. Results Ageing prior to freezing had no impact on pH and purge/thaw loss of lamb loins and the colour of cooked sausages (p>0.05 made from the loins. Lamb loins aged for at least 3 wk prior to freezing numerically improved total and myofibrillar protein solubilities (p>0.05 and emulsion activity index (p = 0.009 of meat batter, but decreased cooking loss (p = 0.003 and lipid oxidation (p<0.05 of model sausages. Conclusion This study suggests that post-mortem ageing of raw meat prior to freezing could improve water-holding capacity and lipid oxidative stability of sausage made from the meat.

  1. Dating Pupae of the Blow Fly Calliphora vicina Robineau–Desvoidy 1830 (Diptera: Calliphoridae for Post Mortem Interval—Estimation: Validation of Molecular Age Markers

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    Barbara K. Zajac

    2018-03-01

    Full Text Available Determining the age of juvenile blow flies is one of the key tasks of forensic entomology when providing evidence for the minimum post mortem interval. While the age determination of blow fly larvae is well established using morphological parameters, the current study focuses on molecular methods for estimating the age of blow flies during the metamorphosis in the pupal stage, which lasts about half the total juvenile development. It has already been demonstrated in several studies that the intraspecific variance in expression of so far used genes in blow flies is often too high to assign a certain expression level to a distinct age, leading to an inaccurate prediction. To overcome this problem, we previously identified new markers, which show a very sharp age dependent expression course during pupal development of the forensically-important blow fly Calliphora vicina Robineau–Desvoidy 1830 (Diptera: Calliphoridae by analyzing massive parallel sequencing (MPS generated transcriptome data. We initially designed and validated two quantitative polymerase chain reaction (qPCR assays for each of 15 defined pupal ages representing a daily progress during the total pupal development if grown at 17 °C. We also investigated whether the performance of these assays is affected by the ambient temperature, when rearing pupae of C. vicina at three different constant temperatures—namely 17 °C, 20 °C and 25 °C. A temperature dependency of the performance could not be observed, except for one marker. Hence, for each of the defined development landmarks, we can present gene expression profiles of one to two markers defining the mentioned progress in development.

  2. Is survival improved by the use of NIV and PEG in amyotrophic lateral sclerosis (ALS? A post-mortem study of 80 ALS patients.

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    Christian Burkhardt

    Full Text Available Non-invasive ventilation (NIV and percutaneous gastrostomy (PEG are guideline-recommended interventions for symptom management in amyotrophic lateral sclerosis (ALS. Their effect on survival is controversial and the impact on causes of death is unknown.To investigate the effect of NIV and PEG on survival and causes of death in ALS patients.Eighty deceased ALS patients underwent a complete post mortem analysis for causes of death between 2003 and 2015. Forty-two of these patients consented for genetic testing. Effects of NIV and PEG on survival and causes of death were analyzed in a multivariable Cox proportional hazard regression.Six patients, who requested assisted suicide causing drug-induced hypoxia, were excluded from final analysis. Respiratory failure was the main cause of death in 72 out of 74 patients. Fifteen out of 74 died of aspiration pneumonia 23/74 of bronchopneumonia and 8/74 of a combination of aspiration pneumonia and bronchopneumonia. Twenty died of hypoxia without concomitant infection, and six patients had pulmonary embolism alone or in combination with pneumonia. NIV (p = 0.01 and PEG (p<0.01 had a significant impact on survival. In patients using NIV bronchopneumonia was significantly more frequent (p <0.04 compared to non-NIV patients. This effect was even more pronounced in limb onset patients (p<0.002. Patients with C9orf72 hexanucleotide repeat expansions showed faster disease progression and shorter survival (p = 0.01.The use of NIV and PEG prolongs survival in ALS. This study supports current AAN and EFNS guidelines which recommend NIV and PEG as a treatment option in ALS. The risk of bronchopneumonia as cause of death may be increased by NIV.

  3. Cerebellar oxidative DNA damage and altered DNA methylation in the BTBR T+tf/J mouse model of autism and similarities with human post mortem cerebellum.

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    Svitlana Shpyleva

    Full Text Available The molecular pathogenesis of autism is complex and involves numerous genomic, epigenomic, proteomic, metabolic, and physiological alterations. Elucidating and understanding the molecular processes underlying the pathogenesis of autism is critical for effective clinical management and prevention of this disorder. The goal of this study is to investigate key molecular alterations postulated to play a role in autism and their role in the pathophysiology of autism. In this study we demonstrate that DNA isolated from the cerebellum of BTBR T+tf/J mice, a relevant mouse model of autism, and from human post-mortem cerebellum of individuals with autism, are both characterized by an increased levels of 8-oxo-7-hydrodeoxyguanosine (8-oxodG, 5-methylcytosine (5mC, and 5-hydroxymethylcytosine (5hmC. The increase in 8-oxodG and 5mC content was associated with a markedly reduced expression of the 8-oxoguanine DNA-glycosylase 1 (Ogg1 and increased expression of de novo DNA methyltransferases 3a and 3b (Dnmt3a and Dnmt3b. Interestingly, a rise in the level of 5hmC occurred without changes in the expression of ten-eleven translocation expression 1 (Tet1 and Tet2 genes, but significantly correlated with the presence of 8-oxodG in DNA. This finding and similar elevation in 8-oxodG in cerebellum of individuals with autism and in the BTBR T+tf/J mouse model warrant future large-scale studies to specifically address the role of OGG1 alterations in pathogenesis of autism.

  4. Trace elements distribution and post-mortem intake in human bones from Middle Age by total reflection X-ray fluorescence

    International Nuclear Information System (INIS)

    Carvalho, M.L.; Marques, A.F.; Lima, M.T.; Reus, U.

    2004-01-01

    The purpose of the present work is to investigate the suitability of TXRF technique to study the distribution of trace elements along human bones of the 13th century, to conclude about environmental conditions and dietary habits of old populations and to study the uptake of some elements from the surrounding soil. In this work, we used TXRF to quantify and to make profiles of the elements through long bones. Two femur bones, one from a man and another from a woman, buried in the same grave were cross-sectioned in four different points at a distance of 1 cm. Microsamples of each section were taken at a distance of 1 mm from each other. Quantitative analysis was performed for Ca, Mn, Fe, Cu, Zn, Sr, Ba and Pb. Very high concentrations of Mn and Fe were obtained in the whole analysed samples, reaching values higher than 2% in some samples of trabecular tissue, very much alike to the concentrations in the burial soil. A sharp decrease for both elements was observed in cortical tissue. Zn and Sr present steady concentration levels in both kinds of bone tissues. Pb and Cu show very low concentrations in the inner tissue of cortical bone. However, these concentrations increase in the regions in contact to trabecular tissue and external surface in contact with the soil, where high levels of both elements were found. We suggest that contamination from the surrounding soil exists for Mn and Fe in the whole bone tissue. Pb can be both from post-mortem and ante-mortem origin. Inner compact tissue might represent in vivo accumulation and trabecular one corresponds to uptake during burial. The steady levels of Sr and Zn together with soil concentration lower levels for these elements may allow us to conclude that they are originated from in vivo incorporation in the hydroxyapatite bone matrix

  5. Percutaneous drainage of Morel-Lavallée lesions when the diagnosis is delayed.

    Science.gov (United States)

    Zhong, Biao; Zhang, Chi; Luo, Cong-feng

    2014-10-01

    Morel-Lavallée lesions are a closed internal degloving, and open débridement can damage the only remaining blood supply to the skin. We performed percutaneous draining and débridement to treat 8 patients in whom the diagnosis of Morel-Lavallée lesions was delayed more than 1 week. Here we discuss our treatment procedures and the outcomes in these 8 patients. We consider percutaneous drainage to be an effective treatment for patients with delayed diagnosis of Morel-Lavallée lesions.

  6. Hereditary angioedema with C1 inhibitor deficiency: delay in diagnosis in Europe.

    Science.gov (United States)

    Zanichelli, Andrea; Magerl, Markus; Longhurst, Hilary; Fabien, Vincent; Maurer, Marcus

    2013-08-12

    Hereditary angioedema (HAE) is a rare, debilitating, and potentially life-threatening disease characterized by recurrent edema attacks. Important advances in HAE treatment have been made, including the development of new therapies for treating or preventing attacks. Nevertheless, the disease is still frequently misdiagnosed and inappropriately treated, potentially exposing patients with laryngeal attacks to the risk of asphyxiation. The Icatibant Outcome Survey (IOS) is an international, observational study that documents the clinical outcome of HAE patients eligible for treatment with icatibant. Patient ages at first symptoms and at diagnosis were recorded at enrolment, and the delay between first symptoms and diagnosis was calculated. The median [range] diagnostic delay in HAE type I and II patients across eight countries was 8.5 years [0-62.0]. The median delay in diagnosis was longer for HAE type II versus type I (21 versus 8 years, respectively), although this did not quite reach statistical significance. Although it can be difficult to differentiate HAE symptoms from those of more common angioedema sub-types (e.g. idiopathic or acquired angioedema), our results show that HAE type I and II patients have an unacceptable delay in diagnosis, even those with a family history of the disease. Raising physician awareness of this disabling and potentially fatal disease may lead to a more accurate diagnosis and timely treatment.

  7. Premature Birth with Complicated Perinatal Course Delaying Diagnosis of Prader-Willi Syndrome

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    G. Ciana

    2011-01-01

    Full Text Available Prader-Willi syndrome in the newborn is essentially characterized by marked hypotonia, feeding difficulties, hypogonadism, and possible characteristic facial features. However, diagnosis at this age may be particularly difficult, and dysmorphic features may be subtle or absent. Prematurity can furthermore delay clinical features recognition and typical complications due to preterm birth may contribute to divert the diagnosis. We describe a preterm baby with a complicated perinatal course later diagnosed as PWS.

  8. Clinical Impacts of Delayed Diagnosis of Hirschsprung’s Disease in Newborn Infants

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    Chien-Chung Lee

    2012-04-01

    Conclusion: In our study, we found that delayed diagnosis of HD beyond 1 week after birth significantly increases the risk of serious complications in neonatal patients. Patients with long-segment or total colonic aganglionosis have higher risk of postoperative HAEC and failure to thrive. Patients with preoperative HAEC are more likely to have adhesive bowel obstruction and failure to thrive.

  9. Social support and delays seeking care after HIV diagnosis, North Carolina, 2000-2006.

    Science.gov (United States)

    McCoy, Sandra I; Strauss, Ronald P; MacDonald, Pia D M; Leone, Peter A; Eron, Joseph J; Miller, William C

    2009-09-01

    Many adults in the USA enter primary care late in the course of HIV infection, countering the clinical benefits of timely HIV services and missing opportunities for risk reduction. Our objective was to determine if perceived social support was associated with delay entering care after an HIV diagnosis. Two hundred and sixteen patients receiving primary care at a large, university-based HIV outpatient clinic in North Carolina were included in the study. Dimensions of functional social support (emotional/informational, tangible, affectionate, and positive social interaction) were quantified with a modified Medical Outcomes Study Social Support Scale and included in proportional hazards models to determine their effect on delays seeking care. The median delay between diagnosis and entry to primary care was 5.9 months. Levels of social support were high but only positive social interaction was moderately associated with delayed presentation in adjusted models. The effect of low perceived positive social interaction on the time to initiation of primary care differed by history of alcoholism (no history of alcoholism, hazard ratio (HR): 1.43, 95% confidence interval (CI): 0.88, 2.34; history of alcoholism, HR: 0.71, 95% CI: 0.40, 1.28). Ensuring timely access to HIV care remains a challenge in the southeastern USA. Affectionate, tangible, and emotional/informational social support were not associated with the time from diagnosis to care. The presence of positive social interaction may be an important factor influencing care-seeking behavior after diagnosis.

  10. Alterações bioquímicas post-mortem de matrinxã Brycon cephalus (Günther, 1869 procedente da piscicultura, mantido em gelo Post-mortem biochemical alterations in aquacultured matrinxã fish Brycon cephalus (Günther, 1869 when stored on ice

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    Gilvan Machado Batista

    2004-12-01

    Full Text Available No presente trabalho, foram estudadas as alterações bioquímicas post-mortem que ocorreram em matrinxã Brycon cephalus (Günther, 1869 procedente da piscicultura e mantido em gelo em Manaus - AM. Foi determinado o tempo de estocagem em gelo por meio das avaliações sensoriais físicas e gustativas, das análises de pH, Nitrogênio das Bases Voláteis Totais (N-BVT e bacteriológicas durante 29 dias. Foram determinados os índices de rigor-mortis, as concentrações de ATP e seus produtos de degradações e o valor K. De acordo com a composição química, o peixe foi classificado como "semi-gordo". Os peixes entraram em rigor-mortis aos 75 minutos após a morte por hipotermia, tendo permanecido durante 10 dias. As avaliações sensoriais (físicas e gustativas mostraram que os peixes apresentaram condição de consumo até 26 dias. As análises de ATP e de seus produtos de degradação mostraram que a referida espécie foi considerada formadora de inosina (HxR, nas condições de experimento. O valor K mostrou que os exemplares de matrinxãs permaneceram "muito frescos" até 16 dias de estocagem em gelo, concordante com a avaliação sensorial gustativa.Post-mortem biochemical alterations in aquacultured matrinxã fish Brycon cephalus (Günther, 1869 when stored on ice in Manaus-AM, were studied in this paper. The storage time on ice was determined through tasting and physical sensory evaluations, pH, total volatile bases nitrogen (TVB-N and bacteriological analyses during 29 days. Rigor-mortis index, ATP-related compounds and K value were also determined. Chemical composition demonstrated that fish was classified as "semi-fat". The specimens presented rigor-mortis 75 minutes after death caused by hypothermia and remained that way for 10 days. Shelf life time on ice was 26 days, according to sensory evaluations, pH, TVBN determinations and bacteriological analyses. ATP-related compounds pointed out that the referred species was considered to

  11. Diagnosis of drowning using post-mortem computed tomography based on the volume and density of fluid accumulation in the maxillary and sphenoid sinuses.

    Science.gov (United States)

    Kawasumi, Yusuke; Kawabata, Tomoyoshi; Sugai, Yusuke; Usui, Akihito; Hosokai, Yoshiyuki; Sato, Miho; Saito, Haruo; Ishibashi, Tadashi; Hayashizaki, Yoshie; Funayama, Masato

    2013-10-01

    Recent studies have reported that drowning victims frequently have fluid accumulation in the paranasal sinuses, most notably the maxillary and sphenoid sinuses. However, in our previous study, many non-drowning victims also had fluid accumulation in the sinuses. Therefore, we evaluated the qualitative difference in fluid accumulation between drowning and non-drowning cases in the present study. Thirty-eight drowning and 73 non-drowning cases were investigated retrospectively. The fluid volume and density of each case were calculated using a DICOM workstation. The drowning cases were compared with the non-drowning cases using the Mann-Whitney U-test because the data showed non-normal distribution. The median fluid volume was 1.82 (range 0.02-11.7) ml in the drowning cases and 0.49 (0.03-8.7) ml in the non-drowning cases, and the median fluid density was 22 (-14 to 66) and 39 (-65 to 77) HU, respectively. Both volume and density differed significantly between the drowning and non-drowning cases (p=0.001, p=0.0007). Regarding cut-off levels in the ROC analysis, the points on the ROC curve closest (0, 1) were 1.03ml (sensitivity 68%, specificity 68%, PPV 53%, NPV 81%) and 27.5 HU (61%, 70%, 51%, 77%). The Youden indices were 1.03ml and 37.8 HU (84%, 51%, 47%, 86%). When the cut-off level was set at 1.03ml and 27.5HU, the sensitivity was 42%, specificity 45%, PPV 29% and NPV 60%. When the cut-off level was set at 1.03ml and 37.8HU, sensitivity was 58%, specificity 32%, PPV 31% and NPV 59%. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  12. Delay in the diagnosis and treatment of pulmonary tuberculosis in Uzbekistan: a cross-sectional study.

    Science.gov (United States)

    Belkina, Tatiana V; Khojiev, Doniyor S; Tillyashaykhov, Mirzagaleb N; Tigay, Zinaida N; Kudenov, Marat U; Tebbens, Jurjen Duintjer; Vlcek, Jiri

    2014-11-25

    Early diagnosis and prompt effective therapy are crucial for the prevention of tuberculosis (TB) transmission, particularly in regions with high levels of multi-drug resistant TB. This study aimed to evaluate the extent of delay in diagnosis and treatment of TB in Uzbekistan and identify associated risk factors. A cross-sectional study was performed on hospital patients with newly diagnosed TB. The time between the onset of respiratory symptoms and initiation of anti-TB treatment was assessed and delays were divided into patient, health system and total delays. Univariable and multivariable logistic regression analysis was used to evaluate determinants of diagnostic and treatment delay. Among 538 patients enrolled, the median delay from onset of symptoms until treatment with anti-TB drugs was 50 days. Analysis of the factors affecting health-seeking behaviour and timely treatment showed the presence of the patient factor. Self-medication was the first health-seeking action for 231 (43%) patients and proved to be a significant predictor of delay (p = 0.005), as well as coughing (p = 0.009), loss of weight (p = 0.001), and visiting private and primary healthcare facilities (p = 0.03 and p = 0.02, respectively). TB diagnostic and treatment delay was mainly contributed to by patient delay and should be reduced through increasing public awareness of TB symptoms and improving public health-seeking behaviour for timely initiation of anti-TB treatment. Efforts should be made to minimise irrational use of antibiotics and support interventions to restrict over-the-counter availability of antibiotics.

  13. Comparison of whole-body post mortem 3D CT and autopsy evaluation in accidental blunt force traumatic death using the abbreviated injury scale classification.

    Science.gov (United States)

    Daly, Barry; Abboud, Samir; Ali, Zabiullah; Sliker, Clint; Fowler, David

    2013-02-10

    Although 3D CT imaging data are available on survivors of accidental blunt trauma, little similar data has been collected and classified on major injuries in victims of fatal injuries. This study compared the sensitivity of post mortem computed tomography (PMCT) with that of conventional autopsy for major trauma findings classified according to the trauma Abbreviated Injury Scale (AIS). Whole-body 3D PMCT imaging data and full autopsy findings were analyzed on 21 victims of accidental blunt force trauma death. All major injuries were classified on the AIS scale with ratings from 3 (serious) to 6 (unsurvivable). Agreement between sensitivity of autopsy and PMCT for major injuries was determined. A total of 195 major injuries were detected (mean per fatality, 9.3; range, 1-14). Skeletal injuries by AIS grade included 37 grade 3, 45 grade 4, 12 grade 5, and 2 grade 6 major findings. Soft tissue injuries included 10 grade 3, 68 grade 4, 16 grade 5, and 5 grade 6 major findings. Of these, PMCT detected 165 (88 skeletal, 77 soft tissue), and autopsy detected 127 (59 skeletal, 68 soft tissue). PMCT agreed with autopsy in 86% and 76% of skeletal and soft tissue injuries, respectively. PMCT detected an additional 37 skeletal and 31 soft tissue injuries that were not identified at autopsy. Autopsy detected 8 skeletal and 22 soft tissue injuries that were not detected by PMCT. PMCT was more sensitive for skeletal (P=0.05) and head and neck region injury (P=0.043) detection. PMCT showed a trend for greater sensitivity than autopsy, but this did not reach statistical significance (P=0.083). 3D PMCT detected significantly more skeletal injuries than autopsy and a similar number of soft tissue injuries to autopsy and promises to be a sensitive tool for detection and classification of skeletal injuries in fatal blunt force accidental trauma. Use of the AIS scale allows standardized categorization and quantification of injuries that contribute to death in such cases and allows more

  14. Neurofibrillary tangle pathology and Braak staging in chronic epilepsy in relation to traumatic brain injury and hippocampal sclerosis: a post-mortem study.

    Science.gov (United States)

    Thom, Maria; Liu, Joan Y W; Thompson, Pam; Phadke, Rahul; Narkiewicz, Marta; Martinian, Lillian; Marsdon, Derek; Koepp, Matthias; Caboclo, Luis; Catarino, Claudia B; Sisodiya, Sanjay M

    2011-10-01

    The long-term pathological effects of chronic epilepsy on normal brain ageing are unknown. Previous clinical and epidemiological studies show progressive cognitive decline in subsets of patients and an increased prevalence of Alzheimer's disease in epilepsy. In a post-mortem series of 138 patients with long-term, mainly drug-resistant epilepsy, we carried out Braak staging for Alzheimer's disease neurofibrillary pathology using tau protein immunohistochemistry. The stages were compared with clinicopathological factors, including seizure history and presence of old traumatic brain injury. Overall, 31% of cases were Braak Stage 0, 36% Stage I/II, 31% Stage III/IV and 2% Stage V/VI. The mean age at death was 56.5 years and correlated with Braak stage (P < 0.001). Analysis of Braak stages within age groups showed a significant increase in mid-Braak stages (III/IV), in middle age (40-65 years) compared with data from an ageing non-epilepsy series (P < 0.01). There was no clear relationship between seizure type (generalized or complex partial), seizure frequency, age of onset and duration of epilepsy with Braak stage although higher Braak stages were noted with focal more than with generalized epilepsy syndromes (P < 0.01). In 30% of patients, there was pathological evidence of traumatic brain injury that was significantly associated with higher Braak stages (P < 0.001). Cerebrovascular disease present in 40.3% and cortical malformations in 11.3% were not significantly associated with Braak stage. Astrocytic-tau protein correlated with the presence of both traumatic brain injury (P < 0.01) and high Braak stage (P < 0.001). Hippocampal sclerosis, identified in 40% (bilateral in 48%), was not associated with higher Braak stages, but asymmetrical patterns of tau protein accumulation within the sclerotic hippocampus were noted. In over half of patients with cognitive decline, the Braak stage was low indicating causes other than Alzheimer's disease pathology. In summary

  15. Analysis of death in major trauma: value of prompt post mortem computed tomography (pmCT) in comparison to office hour autopsy.

    Science.gov (United States)

    Schmitt-Sody, Markus; Kurz, Stefanie; Reiser, Maximilian; Kanz, Karl Georg; Kirchhoff, Chlodwig; Peschel, Oliver; Kirchhoff, Sonja

    2016-03-29

    To analyze diagnostic accuracy of prompt post mortem Computed Tomography (pmCT) in determining causes of death in patients who died during trauma room management and to compare the results to gold standard autopsy during office hours. Multiple injured patients who died during trauma room care were enrolled. PmCT was performed immediately followed by autopsy during office hours. PmCT and autopsy were analyzed primarily regarding pmCT ability to find causes of death and secondarily to define exact causes of death including accurate anatomic localizations. For the secondary analysis data was divided in group-I with equal results of pmCT and autopsy, group-II with autopsy providing superior results and group-III with pmCT providing superior information contributing to but not majorly causing death. Seventeen multiple trauma patients were enrolled. Since multiple trauma patients were enrolled more injuries than patients are provided. Eight patients sustained deadly head injuries (47.1%), 11 chest (64.7%), 4 skeletal system (23.5%) injuries and one patient drowned (5.8%). Primary analysis revealed in 16/17 patients (94.1%) causes of death in accordance with autopsy. Secondary analysis revealed in 9/17 cases (group-I) good agreement of autopsy and pmCT. In seven cases autopsy provided superior results (group-II) whereas in 1 case pmCT found more information (group-III). The presented work studied the diagnostic value of pmCT in defining causes of death in comparison to standard autopsy. Primary analysis revealed that in 94.1% of cases pmCT was able to define causes of death even if only indirect signs were present. Secondary analysis showed that pmCT and autopsy showed equal results regarding causes of death in 52.9%. PmCT is useful in traumatic death allowing for an immediate identification of causes of death and providing detailed information on bony lesions, brain injuries and gas formations. It is advisable to conduct pmCT especially in cases without consent to

  16. Regional correlations between [11C]PIB PET and post-mortem burden of amyloid-beta pathology in a diverse neuropathological cohort

    Directory of Open Access Journals (Sweden)

    Sang Won Seo

    2017-01-01

    Full Text Available Imaging-pathological correlation studies show that in vivo amyloid-β (Aβ positron emission tomography (PET strongly predicts the presence of significant Aβ pathology at autopsy. We sought to determine whether regional PiB-PET uptake would improve sensitivity for amyloid detection in comparison with global measures (experiment 1, and to estimate the relative contributions of different Aβ aggregates to in vivo PET signal (experiment 2. In experiment 1, 54 subjects with [11C] PiB-PET during life and postmortem neuropathologic examination (85.2% with dementia, interval from PET to autopsy 3.1 ± 1.9 years were included. We assessed Thal amyloid phase (N = 36 and CERAD score (N = 54 versus both global and regional PiB SUVRs. In experiment 2 (N = 42, PiB SUVR and post-mortem amyloid β burden was analyzed in five customized regions of interest matching regions sampled at autopsy. We assessed the relative contribution of neuritic plaques (NPs, diffuse plaques (DPs and cerebral amyloid angiopathy (CAA to regional PIB SUVR using multi-linear regression. In experiment 1, there were no differences in Area Under the Curve for amyloid phase ≥ A2 and CERAD score ≥ C2 between global and highest regional PiB SUVR (p = 0.186 and 0.230. In experiment 2, when NPs, DPs, and/or CAA were included in the same model, moderate to severe NPs were independently correlated with PiB SUVR in all regions except for the inferior temporal and calcarine ROI (β = 0.414–0.804, p < 0.05, whereas DPs were independently correlated with PiB SUVR in the angular gyrus ROI (β = 0.446, p = 0.010. CAA was also associated with PiB SUVR in the inferior temporal and calcarine ROI (β = 0.222–0.355, p < 0.05. In conclusion, global PiB-PET SUVR performed as well as regional values for amyloid detection in our cohort. The substrate-specific binding of PiB might differ among the brain specific regions.

  17. Paper-based microfluidic devices on the crime scene: A simple tool for rapid estimation of post-mortem interval using vitreous humour.

    Science.gov (United States)

    Garcia, Paulo T; Gabriel, Ellen F M; Pessôa, Gustavo S; Santos Júnior, Júlio C; Mollo Filho, Pedro C; Guidugli, Ruggero B F; Höehr, Nelci F; Arruda, Marco A Z; Coltro, Wendell K T

    2017-06-29

    This paper describes for the first time the use of paper-based analytical devices at crime scenes to estimate the post-mortem interval (PMI), based on the colorimetric determination of Fe 2+ in vitreous humour (VH) samples. Experimental parameters such as the paper substrate, the microzone diameter, the sample volume and the 1,10-phenanthroline (o-phen) concentration were optimised in order to ensure the best analytical performance. Grade 1 CHR paper, microzone with diameter of 5 mm, a sample volume of 4 μL and an o-phen concentration of 0.05 mol/L were chosen as the optimum experimental conditions. A good linear response was observed for a concentration range of Fe 2+ between 2 and 10 mg/L and the calculated values for the limit of detection (LOD) and limit of quantification (LOQ) were 0.3 and 0.9 mg/L, respectively. The specificity of the Fe 2+ colorimetric response was tested in the presence of the main interfering agents and no significant differences were found. After selecting the ideal experimental conditions, four HV samples were investigated on paper-based devices. The concentration levels of Fe 2+ achieved for samples #1, #2, #3 and #4 were 0.5 ± 0.1, 0.7 ± 0.1, 1.2 ± 0.1 and 15.1 ± 0.1 mg/L, respectively. These values are in good agreement with those calculated by ICP-MS. It important to note that the concentration levels measured using both techniques are proportional to the PMI. The limitation of the proposed analytical device is that it is restricted to a PMI greater than 1 day. The capability of providing an immediate answer about the PMI on the crime scene without any sophisticated instrumentation is a great achievement in modern instrumentation for forensic chemistry. The strategy proposed in this study could be helpful in many criminal investigations. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Os conflitos do consentimento acerca da doação de órgãos post mortem no Brasil

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    MAYNARD, Lorena Oliveira Dantas

    2015-11-01

    Full Text Available Com o refinamento das técnicas de cirurgias e imunogenética pela medicina nas últimas décadas e com os avanços na farmacoterapia, o transplante de órgãos e tecidos tornou-se uma possibilidade real e uma alternativa essencial ao prolongamento e à qualidade da vida humana. Este estudo objetivou analisar o consentimento para remoção de órgãos e tecidos post mortem na legislação brasileira, na perspectiva da autorização da família. Adotou-se, para tanto, estratégia metodológica qualitativa através de revisão de literatura e revisão legislativa, que permitem um aprofundamento no universo dos significados, dos motivos, das aspirações, das crenças, dos valores e das atitudes em relação ao tema. Os resultados apontam que, na atual Lei de Transplantes, os direitos da personalidade e o princípio da autonomia da vontade são institutos pouco homenageados em função da predominância do monopólio da decisão familiar na hipótese de um confronto entre a vontade do doador e a vontade da família. Frente ao problema da escassez de órgãos no país, a solução mais consentânea com a justiça seria uma adequação entre os dispositivos de lei do Código Civil e a Lei de Transplantes. Oportuno partir do texto já existente do artigo 4º da Lei n. 9.434/1997, para incluir a manifestação da vontade do doador em vida, devidamente documentada. É igualmente importante a informação e a conscientização popular sobre a natureza humanitária da doação de órgãos como medidas direcionadas à discussão do princípio da solidariedade para uma política de doação de órgãos.

  19. Post-mortem analysis of suicide victims shows ABCB1 haplotype 1236T-2677T-3435T as a candidate predisposing factor behind adverse drug reactions in females.

    Science.gov (United States)

    Rahikainen, Anna-Liina; Palo, Jukka U; Haukka, Jari; Sajantila, Antti

    2018-04-01

    Genetic variation in efflux transporter, permeability glycoprotein (P-gp), has recently been associated with completed violent suicides and also violent suicide attempts. As depression is known to be a risk factor for suicide and many antidepressants are P-gp substrates, it has been speculated that inadequate antidepressant treatment response or adverse side effects could be involved. The aim of this study was to investigate whether there is an association between the P-gp coding ABCB1 gene and completed suicides in citalopram users. Also, the effect of sex and suicide method used (violent vs. non-violent) was evaluated. All cases included in the study population, 349 completed suicide victims and 284 controls, were shown to be positive for antidepressant citalopram in a post-mortem toxicological drug screen. ABCB1 1236C>T, 2677G>T/A and 3435C>T polymorphisms were determined by TaqMan genotyping assays. Haplotypes were constructed from genotype data using the PHASE software. The association between the manner of death and the ABCB1 haplotype was tested with logistic regression analysis. No statistically significant differences were observed in the ABCB1 allele or genotype frequencies between the suicide and control groups. However, the ABCB1 1236T-2677T-3435T haplotype was associated with completed suicides of female citalopram users (odds ratio: 2.23; 95% confidence interval: 1.22-4.07; P=0.009). After stratification by the method used for suicide, the association emerged in fatal intoxications (odds ratio: 2.51; 95% confidence interval: 1.29-4.87; P=0.007). In other groups, no statistically significant associations were observed. Our results suggest that female citalopram users with ABCB1 1236T-2677T-3435T are more vulnerable to adverse effects of the drugs as this haplotype was enriched in non-violent suicides of female citalopram users. Even though the biological mechanism behind this observation is unknown, the results provide another example of the importance

  20. Impact of fluoroquinolone treatment on delay of tuberculosis diagnosis: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Catherine A Hogan

    2017-01-01

    Full Text Available Background: Fluoroquinolones are among the most commonly used antibiotics for the treatment of respiratory infections. Because fluoroquinolones show bactericidal activity against Mycobacterium tuberculosis, there is concern that their use can delay the diagnosis of tuberculosis. We conducted a systematic review and meta-analysis to assess whether empiric treatment with fluoroquinolones delays the diagnosis and treatment of tuberculosis in patients with respiratory tract infections. Objectives: The primary objective was to assess the delay in days in the diagnosis and treatment of tuberculosis, among patients who received quinolones, compared to those who received non-fluoroquinolone antibiotics. Methods: We included studies of adult patients treated with fluoroquinolones prior to a confirmed diagnosis of tuberculosis. We performed a literature search of 7 databases (including PubMed, Embase and Cochrane Library with no language restrictions. We calculated an unweighted mean of estimate of difference in delay across all studies. For the studies for which the estimate was available as a mean with standard deviation, a weighted average using a random effects meta-analysis model was estimated. Results: A total of 3983 citations were identified from the literature search; of these, 17 articles were selected for full-text review. A total of 10 studies were retained for the synthesis. These included 7 retrospective cohort studies and 3 case-control studies. Only one of these studies was from a high TB burden country, South Africa. The most commonly used fluoroquinolones were levofloxacin, gemifloxacin and moxifloxacin. The unweighted average of difference in delay between the fluoroquinolone group and non-fluoroquinolone group was 12.9 days (95% CI 6.1–19.7. When these differences were pooled using a random effects model, the weighted estimate was 10.9 days (95% CI 4.2–17.6. When stratified by acid-fast smear status, the delay was

  1. Diagnosis and treatment delays among elderly breast cancer patients with pre-existing mental illness.

    Science.gov (United States)

    Iglay, Kristy; Santorelli, Melissa L; Hirshfield, Kim M; Williams, Jill M; Rhoads, George G; Lin, Yong; Demissie, Kitaw

    2017-11-01

    This study aimed to compare diagnosis and treatment delays in elderly breast cancer patients with and without pre-existing mental illness. A retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results-Medicare data including 16,636 women 68+ years, who were diagnosed with stage I-IIIa breast cancer in the United States from 2005 to 2007. Mental illness was identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes recorded on inpatient and outpatient claims during the 3 years prior to breast cancer diagnosis. Patients were classified as having no mental illness, anxiety, depression, anxiety and depression, or severe mental illness (bipolar disorder, schizophrenia, and other psychotic disorder). Multivariable binomial regression was used to assess the association between mental illness and delays of ≥60 and ≥90 days after adjustment for confounders. Patients with comorbid anxiety and depression had an increased risk for diagnosis delay of ≥90 days from symptom recognition (RR 1.11; 95% CI 1.00, 1.23), and those with severe mental illness had an increased risk for initial treatment delay of ≥60 days from diagnosis (RR 1.36; 95% CI 1.06, 1.74). Patients with any mental illness experienced an increased risk for adjuvant chemotherapy delay of ≥90 days from last operation (RR 1.13; 95% CI 1.01, 1.26) and each category of mental illness, except depression, showed a non-significant trend for this association. Breast cancer patients with mental illness should be closely managed by a cross-functional care team, including a psychiatrist, a primary care physician, and an oncologist, to ensure adequate care is received within an appropriate timeframe.

  2. In vivo quantitative imaging of point-like bioluminescent and fluorescent sources: Validation studies in phantoms and small animals post mortem

    Science.gov (United States)

    Comsa, Daria Craita

    2008-10-01

    source strength within 20 %. For sources 14mm deep, the inaccuracy in determining the relative source strength increased to 30 %. Measurements on small animals post mortem showed that the use of measured in situ optical properties to characterize heterogeneous tissue resulted in a superior estimation of the source strength and depth compared to when literature optical properties for organs or tissues were used. Moreover, it was found that regardless of the heterogeneity of the implant location or depth, our algorithm consistently showed an advantage over the simple assessment of the source strength based on the signal strength in the emission image. Our bioluminescence algorithm was generally able to predict the source strength within a factor of 2 of the true strength, but the performance varied with the implant location and depth. In fluorescence imaging a more complex technique is required, including knowledge of tissue optical properties at both the excitation and emission wavelengths. A theoretical study using simulated fluorescence data showed that, for example, for a source 5 mm deep in tissue, errors of up to 15 % in the optical properties would give rise to errors of +/-0.7 mm in the retrieved depth and the source strength would be over- or under-estimated by a factor ranging from 1.25 to 2. Fluorescent sources implanted in rats post mortem at the same depth were localized with an error just slightly higher than predicted theoretically: a root-mean-square value of 0.8 mm was obtained for all implants 5 mm deep. However, for this source depth, the source strength was assessed within a factor ranging from 1.3 to 4.2 from the value estimated in a controlled medium. Nonetheless, similarly to the bioluminescence study, the fluorescence quantification algorithm consistently showed an advantage over the simple assessment of the source strength based on the signal strength in the fluorescence image. Few studies have been reported in the literature that reconstruct known

  3. Delay in Diagnosis of Celiac Disease in Patients Without Gastrointestinal Complaints.

    Science.gov (United States)

    Paez, Marco A; Gramelspacher, Anna Maria; Sinacore, James; Winterfield, Laura; Venu, Mukund

    2017-11-01

    The purpose of our study is to investigate the delay in diagnosis of patients with biopsy-proven celiac disease in those who present with gastrointestinal complaints vs nongastrointestinal complaints at our tertiary care center. Celiac disease is an autoimmune disorder that affects approximately 1% of the population worldwide. Celiac disease can have variable clinical presentations; it can be characterized by predominately gastrointestinal symptoms, or it may present without any gastrointestinal symptoms. We retrospectively reviewed the charts of 687 adult patients who carried the diagnosis of celiac disease. Patients included had biopsy-proven celiac disease and were categorized based on presence or absence of gastrointestinal symptoms prior to their diagnosis. There were 101 patients with biopsy-proven celiac disease that met inclusion criteria. Fifty-two patients presented with gastrointestinal symptoms and 49 had nongastrointestinal complaints. Results from Mann-Whitney statistical analysis showed a median delay in diagnosis of 2.3 months for the gastrointestinal symptoms group and 42 months for the nongastrointestinal group (P symptoms had abnormal thyroid-stimulating hormone, as opposed to 15.5% in the gastrointestinal symptom group (P = .004). Of patients with nongastrointestinal symptoms, 69.4% had anemia, compared with 11.5% of the gastrointestinal symptom group (P symptom group, 68%, were noted to have abnormal bone density scans, compared with 41% in the gastrointestinal symptom group. No sex differences were noted on chi-squared analysis between the 2 groups (P = .997). Although there is growing awareness of celiac disease, the delay in diagnosis for patients without gastrointestinal symptoms remains prolonged, with an average delay of 3.5 years. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Vital Signs: Human Immunodeficiency Virus Testing and Diagnosis Delays - United States.

    Science.gov (United States)

    Dailey, Andre F; Hoots, Brooke E; Hall, H Irene; Song, Ruiguang; Hayes, Demorah; Fulton, Paul; Prejean, Joseph; Hernandez, Angela L; Koenig, Linda J; Valleroy, Linda A

    2017-12-01

    Persons unaware of their human immunodeficiency virus (HIV) infection account for approximately 40% of ongoing transmissions in the United States. Persons are unaware of their infection because of delayed HIV diagnoses that represent substantial missed opportunities to improve health outcomes and prevent HIV transmission. Data from CDC's National HIV Surveillance System were used to estimate, among persons with HIV infection diagnosed in 2015, the median interval (and range) from infection to diagnosis (diagnosis delay), based on the first CD4 test after HIV diagnosis and a CD4 depletion model indicating disease progression and, among persons living with HIV in 2015, the percentage with undiagnosed infection. Data from CDC's National HIV Behavioral Surveillance were analyzed to determine the percentage of persons at increased risk for HIV infection who had tested in the past 12 months and who had missed opportunities for testing. An estimated 15% of persons living with HIV in 2015 were unaware of their infection. Among the 39,720 persons with HIV infection diagnosed in 2015, the estimated median diagnosis delay was 3.0 years (interquartile range = 0.7-7.8 years); diagnosis delay varied by race/ethnicity (from 2.2 years among whites to 4.2 years among Asians) and transmission category (from 2.0 years among females who inject drugs to 4.9 years among heterosexual males). Among persons interviewed through National HIV Behavioral Surveillance, 71% of men who have sex with men, 58% of persons who inject drugs, and 41% of heterosexual persons at increased risk for HIV infection reported testing in the past 12 months. In each risk group, at least two thirds of persons who did not have an HIV test had seen a health care provider in the past year. Delayed HIV diagnoses continue to be substantial for some population groups and prevent early entry to care to improve health outcomes and reduce HIV transmission to others. Health care providers and others providing HIV testing

  5. Findings chest radiograph and CT in mediastinitis: effcacy of CT in patients with delayed diagnosis

    International Nuclear Information System (INIS)

    Son, Eun Ju; Hong, Yong Kook; Choe, Kyu Ok

    1999-01-01

    To analyse the causes the radiologic findings in patients with mediastinitis and to evaluate the efficacy of chest CT scanning in patients with delayed diagnosis. Seventeen patients with histopathologically(n=15) or clinically diagnosed(n=2) mediastinitis were involved in this study. Eleven of the former group underwent surgery, and in four, tube drainage was performed. All underwent chest radiography and CT scanning, and in seven patients, the causes of delayed diagnosis were analysed. The most common cause of mediastinitis was esophageal rupture(n=11). Others were extension from neck abscess to the mediastinum(n=3), complications after a Benthall procedure(n=1), tuberculous lymphadenitis(n=1) and mycotic aneurysm(n=1). Patients with esophageal rupture suffered from underlying diseases such as esophageal cancer(n=2), iatrogenic esophageal rupture(n=2), Boerhaave's syndrome(n=2), and esophagitis(n=1). In patients with neck abscess (n=3), each was secondary to infected cystic hygroma, Ludwig angina, or deep neck infection, respectively. On chest CT, patients with esophageal rupture(n=11) had an abscess in the posterior mediastinum ; nine abscesses extended to the cervical area along the retropharyngeal space, and the patient with Ludwig angina had an abscess involving all compartments of the mediastinum. Among the total of 17 patients, diagnostic delays were found in seven, while five had spontaneous esophageal ruptures and two suffered complications after a Benthall procedure and Tbc lymphadenitis, respectively. The causes of diagnostic delay varied. Among seven patients, pnevmonia was initially diagnosed in two, who were treated ; one had multiorgan failure, and one was suffering from pericardial effusion and lung abscess. In three other patients, chest radiographs initially showed non-specific findings, leading to delayed CT examination. The most common cause of mediastinitis was esophageal rupture, and in these patients, chest radiographs and clinical symptoms

  6. Delay in an Eating Disorder Diagnosis: The Reason Was a "Shox".

    Science.gov (United States)

    Reed, Sara; Curran, Kelly A; Middleman, Amy B

    2018-04-01

    Patients' underlying medical conditions might affect the presentation and progression of an eating disorder. We describe a patient with an undiagnosed, rare, genetic skeletal dysplasia with effects on body mass index that likely led to body image distortion and delayed the diagnosis of an eating disorder. It is critical to fully assess disordered eating in the context of each patient's clinical status. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  7. Social support and delays seeking care after HIV diagnosis, North Carolina, 2000–2006

    OpenAIRE

    McCoy, Sandra I.; Strauss, Ronald P.; MacDonald, Pia D. M.; Leone, Peter A.; Eron, Joseph J.; Miller, William C.

    2009-01-01

    Many adults in the United States enter primary care late in the course of HIV infection, countering the clinical benefits of timely HIV services and missing opportunities for risk reduction. Our objective was to determine if perceived social support was associated with delay entering care after an HIV diagnosis. Two hundred sixteen patients receiving primary care at a large, university-based HIV outpatient clinic in North Carolina were included in the study. Dimensions of functional social su...

  8. Monitoring delays in diagnosis of pulmonary tuberculosis in eight cities in Colombia

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    David A. Rodríguez

    Full Text Available ABSTRACT Objective To measure time between onset of tuberculosis (TB symptoms and start of treatment, and to identify factors associated with delay in eight Colombian cities. Methods Operational research with a retrospective analytical cohort design was conducted in 2014 using routinely collected data about new smear-positive pulmonary TB patients from eight cities in Colombia (Barranquilla, Bogotá, Bucaramanga, Cali, Cúcuta, Medellín, Pereira, and Villavicencio. Date of symptom onset was sourced from TB surveillance databases. Data on all other variables came from National TB Program (NTP registers. Results There were 2 545 new cases of smear-positive pulmonary TB, but a plausible date of symptom onset was available for only 1 456 (57%. Median number of days between symptom onset and treatment start was 51 days (interquartile range: 27–101. A total of 72% of patients had a delay (> 30 days between symptom onset and treatment start, and 28% had a 3+ bacillary load at diagnosis. Based on multiple logistic regression, three factors were significantly associated with delay: being uninsured (odds ratio (OR: 1.30; 95% confidence interval (CI: 1.01–1.68 and having an unknown HIV status (OR: 1.81; CI: 1.04–3.17, which increased risk, and coming from a neighborhood with NTP-employed community health workers, which decreased risk (OR: 0.56; CI: 0.34–0.90. Conclusions Delays still prevent timely TB diagnosis and treatment in Colombia. As the country aims for TB elimination, delays must be reduced, especially in cities and vulnerable neighborhoods, to stop community transmission. The NTP should focus not only on the number of cases detected but also on how long it takes to detect them. To monitor interventions designed to reduce delays, additional dates in the process should be recorded routinely. In addition, reliability and completeness of data are crucial for monitoring.

  9. Copro-diagnosis of Echinococcus granulosus infection in dogs by amplification of a newly identified repeated DNA sequence

    NARCIS (Netherlands)

    Abbasi, Ibrahim; Branzburg, Anna; Campos-Ponce, Maiza; Abdel Hafez, Sami K; Raoul, Francis; Craig, Philip S; Hamburger, Joseph

    Diagnosis of Echinococcus granulosus infection in dogs by detecting adult worms recovered post mortem or purged from the intestines after treatment with arecoline is not suitable for mass screening. Large-scale diagnosis by detection of copro-antigens is useful but only with relatively high

  10. Comparison between two tests of delayed recall for the diagnosis of dementia

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    Takada Leonel Tadao

    2006-01-01

    Full Text Available Diagnosis of dementia is a challenge in populations with heterogeneous educational background. OBJECTIVE: To compare the accuracies of two delayed recall tests for the diagnosis of dementia in a community with high proportion of illiterates. METHOD: The delayed recall of a word list from the CERAD battery (DR-CERAD was compared with the delayed recall of objects presented as line drawings from the Brief Cognitive Screening Battery (DR-BCSB using ROC curves. Illiterate (23 controls and 17 patients with dementia and literate individuals (28 controls and 17 patients with dementia were evaluated in a community-dwelling Brazilian population. RESULTS: The DR-BCSB showed higher accuracy than the DR-CERAD in the illiterate (p=0.029, similar accuracy in the literate individuals (p=0.527, and a trend for higher accuracy in the entire population (p=0.084. CONCLUSION: the DR-BCSB could be an alternative for the diagnosis of dementia in populations with high proportion of illiterates.

  11. Delay in Diagnosis and Treatment of Breast Cancer among Women Attending a Reference Service in Brazil

    Science.gov (United States)

    Romeiro Lopes, Tiara Cristina; Gravena, Angela Andréia França; Demitto, Marcela de Oliveira; Borghesan, Deise Helena Pelloso; Dell`Agnolo, Cátia Millene; Brischiliari, Sheila Cristina Rocha; Carvalho, Maria Dalva de Barros; Pelloso, Sandra Marisa

    2017-11-26

    Background: Cancer is a major public health problem. Early diagnosis and treatment are essential for reducing mortality. This study aimed to analyze factors associated with delay in breast cancer diagnosis and treatment among women attending a reference cancer service. Methods: This retrospective, cross-sectional study was performed with data collected from medical records and interviews conducted with women diagnosed with breast cancer and treated from October 2013 to October 2014 at a cancer reference hospital in Paraná, Southern Brazil. Results: A total of 82 participants were enrolled during the study period; their average age was 58.2 ± 11.5 years. The average time taken for final diagnosis of breast cancer was 102.5 ± 165.5 days. Treatment onset was delayed in the majority of cases, and the average time elapsing from diagnostic biopsy to onset of primary treatment was 72.3 ± 54.0 days. The odds of treatment delay were higher among the women with a low educational level. Conclusions: The results underline the need for proposals aimed at early detection, identification of risk factors and timely provision of treatment by health managers that focus on this group. Creative Commons Attribution License

  12. Estudio post-mortem de un hormigón refractario colocado en la línea de escorias de una cuchara de acería

    Directory of Open Access Journals (Sweden)

    de Aza, A. H.

    2003-12-01

    Full Text Available A high alumina concrete with synthetic spinel (MgAl2O4 addition, conformed as a brick, has been tested in the slag line of a secondary steel ladle. A post-mortem study allowed to establish the elements diffusion profile inside the refractory as well as its microstructural evolution. This study was carried out by means of X-ray diffraction, reflected optical light microscopy and scanning electron microscopy coupled with energy dispersive X-ray analysis. From the analysis of the obtained results, making use of the Al2O3-MgO-CaO-SiO2 quaternary system, it has been possible to establish the mechanism of corrosion, justifying, at the same time, the role that spinel and calcium hexaluminate (CaAl12O19 play. The spinel, that is the only stable solid phase in the slag - refractory interface, admits in its structure large amount of bivalent and trivalent elements (e.g. Mn2+, Fe2+, Fe3+, Cr3+.... Therefore, the slag becomes silica-rich and highly viscous, as CaAl12O19 is precipitated, decreasing the corrosion. The calcium hexaluminate grows from coarse and medium-sized grains of alumina to form a network of interlocked crystals that act as unions among the alumina grains. This microstructure together with that the CaAl12O19 also admits in solid solution large quantities of Fe2+ and Fe3+, provide a smaller, slower and more uniform wear of the refractory material.

    Se ha diseñado y preparado un hormigón de alta alúmina con espinela, el cual ha sido ensayado, en forma de piezas preconformadas, en la línea de escorias de una cuchara de acería secundaria. El estudio post-morten del material ha permitido establecer las reacciones químicas que tienen lugar durante el proceso de corrosión y determinar el mecanismo imperante durante este proceso haciendo uso del diagrama de equilibrio Al2O3-MgO-CaO-SiO2. Dicho estudio se ha llevado a cabo mediante difracción de rayos X, microscopía óptica de luz reflejada y microscopía electrónica de barrido con

  13. Factors contributing to delayed diagnosis of cancer among Aboriginal people in Australia: a qualitative study

    Science.gov (United States)

    Shahid, Shaouli; Teng, Tiew-Hwa Katherine; Bessarab, Dawn; Aoun, Samar; Baxi, Siddhartha; Thompson, Sandra C

    2016-01-01

    Background/objectives Delayed presentation of symptomatic cancer is associated with poorer survival. Aboriginal patients with cancer have higher rates of distant metastases at diagnosis compared with non-Aboriginal Australians. This paper examined factors contributing to delayed diagnosis of cancer among Aboriginal Australians from patient and service providers' perspectives. Methods In-depth, open-ended interviews were conducted in two stages (2006–2007 and 2011). Inductive thematic analysis was assisted by use of NVivo looking around delays in presentation, diagnosis and referral for cancer. Participants Aboriginal patients with cancer/family members (n=30) and health service providers (n=62) were recruited from metropolitan Perth and six rural/remote regions of Western Australia. Results Three broad themes of factors were identified: (1) Contextual factors such as intergenerational impact of colonisation and racism and socioeconomic deprivation have negatively impacted on Aboriginal Australians' trust of the healthcare professionals; (2) health service-related factors included low accessibility to health services, long waiting periods, inadequate numbers of Aboriginal professionals and high staff turnover; (3) patient appraisal of symptoms and decision-making, fear of cancer and denial of symptoms were key reasons patients procrastinated in seeking help. Elements of shame, embarrassment, shyness of seeing the doctor, psychological ‘fear of the whole health system’, attachment to the land and ‘fear of leaving home’ for cancer treatment in metropolitan cities were other deterrents for Aboriginal people. Manifestation of masculinity and the belief that ‘health is women's domain’ emerged as a reason why Aboriginal men were reluctant to receive health checks. Conclusions Solutions to improved Aboriginal cancer outcomes include focusing on the primary care sector encouraging general practitioners to be proactive to suspicion of symptoms with appropriate

  14. Barriers and Delays in Tuberculosis Diagnosis and Treatment Services: Does Gender Matter?

    Directory of Open Access Journals (Sweden)

    Wei-Teng Yang

    2014-01-01

    Full Text Available Background. Tuberculosis (TB remains a global public health problem with known gender-related disparities. We reviewed the quantitative evidence for gender-related differences in accessing TB services from symptom onset to treatment initiation. Methods. Following a systematic review process, we: searched 12 electronic databases; included quantitative studies assessing gender differences in accessing TB diagnostic and treatment services; abstracted data; and assessed study validity. We defined barriers and delays at the individual and provider/system levels using a conceptual framework of the TB care continuum and examined gender-related differences. Results. Among 13,448 articles, 137 were included: many assessed individual-level barriers (52% and delays (42%, 76% surveyed persons presenting for care with diagnosed or suspected TB, 24% surveyed community members, and two-thirds were from African and Asian regions. Many studies reported no gender differences. Among studies reporting disparities, women faced greater barriers (financial: 64% versus 36%; physical: 100% versus 0%; stigma: 85% versus 15%; health literacy: 67% versus 33%; and provider-/system-level: 100% versus 0% and longer delays (presentation to diagnosis: 45% versus 0% than men. Conclusions. Many studies found no quantitative gender-related differences in barriers and delays limiting access to TB services. When differences were identified, women experienced greater barriers and longer delays than men.

  15. Barriers and delays in tuberculosis diagnosis and treatment services: does gender matter?

    Science.gov (United States)

    Yang, Wei-Teng; Gounder, Celine R; Akande, Tokunbo; De Neve, Jan-Walter; McIntire, Katherine N; Chandrasekhar, Aditya; de Lima Pereira, Alan; Gummadi, Naveen; Samanta, Santanu; Gupta, Amita

    2014-01-01

    Background. Tuberculosis (TB) remains a global public health problem with known gender-related disparities. We reviewed the quantitative evidence for gender-related differences in accessing TB services from symptom onset to treatment initiation. Methods. Following a systematic review process, we: searched 12 electronic databases; included quantitative studies assessing gender differences in accessing TB diagnostic and treatment services; abstracted data; and assessed study validity. We defined barriers and delays at the individual and provider/system levels using a conceptual framework of the TB care continuum and examined gender-related differences. Results. Among 13,448 articles, 137 were included: many assessed individual-level barriers (52%) and delays (42%), 76% surveyed persons presenting for care with diagnosed or suspected TB, 24% surveyed community members, and two-thirds were from African and Asian regions. Many studies reported no gender differences. Among studies reporting disparities, women faced greater barriers (financial: 64% versus 36%; physical: 100% versus 0%; stigma: 85% versus 15%; health literacy: 67% versus 33%; and provider-/system-level: 100% versus 0%) and longer delays (presentation to diagnosis: 45% versus 0%) than men. Conclusions. Many studies found no quantitative gender-related differences in barriers and delays limiting access to TB services. When differences were identified, women experienced greater barriers and longer delays than men.

  16. Factors influencing delay in the diagnosis of colorectal cancer: a study protocol

    International Nuclear Information System (INIS)

    Esteva, Magdalena; Ramos, Maria; Cabeza, Elena; Llobera, Joan; Ruiz, Amador; Pita, Salvador; Segura, Josep M; Cortés, Jose M; González-Lujan, Luis

    2007-01-01

    Colorectal cancer (CRC) is the second most frequent tumor in developed countries. Since survival from CRC depends mostly on disease stage at the time of diagnosis, individuals with symptoms or signs suspicious of CRC should be examined without delay. Many factors, however, intervene between symptom onset and diagnosis. This study was designed to: 1) Describe the diagnostic process of CRC from the onset of first symptoms to diagnosis and treatment. 2) Establish the time interval from initial symptoms to diagnosis and treatment, globally and considering patient's and doctors' delay, with the latter due to family physician and/or hospital services. 3) Identify the factors related to defined types of delay. 4) Assess the concordance between information included in primary health care and hospital clinical records regarding onset of first symptoms. Descriptive study, coordinated, with 5 participant groups of 5 different Spanish regions (Balearic Islands, Galicia, Catalunya, Aragón and Valencia Health Districts), with a total of 8 acute public hospitals and 140 primary care centers. Incident cases of CRC during the study period, as identified from pathology services at the involved hospitals. A sample size of 896 subjects has been estimated, 150 subjects for each participant group. Information will be collected through patient interviews and primary health care and hospital clinical records. Patient variables will include sociodemographic variables, family history of cancer, symptom perception, and confidence in the family physician; tumor variables will include tumor site, histological type, grade and stage; symptom variables will include date of onset, type and number of symptoms; health system variables will include number of patient contacts with family physician, type and content of the referral, hospital services attending the patient, diagnostic modalities and results; and delay intervals, including global delays and delays attributed to the patient

  17. Delayed diagnosis of congenital hypothyroidism in an adolescent results in avoidable complications: a case report

    Directory of Open Access Journals (Sweden)

    Indra Ihsan

    2017-04-01

    Full Text Available Delayed diagnosis of congenital hyporhyroidism (CH remains a serious problem. A retrospective analysis of 1,000 CH cases in Turkey found a mean age of 49 months at the time of clinical diagnosis. Only 3.1% of cases were diagnosed during the neonatal period and 55.4% were diagnosed after 2 years of age.1 In Cipto Mangunkusumo Hospital, Jakarta, 53% cases were diagnosed at 1-5 years, 3.3% at 6-12 years, and 6.7% after 12 years of age, while the remainder were diagnosed at < 1 year of age.2 The majority of affected children exhibit signs and symptoms that are highly non-specific, as most infants with CH are asymptomatic at birth, and only 5% of cases can be diagnosed based on clinical examination during the first day of life.3 The other factors that contribute to delayed diagnosis are uneducated parents, who do not notice or dismiss the importance of mild/moderate deviations in physical and mental growth, as well as constipation, feeding difficulties, or other vague, non-specific symptoms in infancy. Parents are often unaware of the importance of early diagnosis and commencement of therapy for CH.4

  18. Delayed Diagnosis of Vesicouterine Fistula After Treatment for Mixed Urinary Incontinence: Menstrual Cup Management and Diagnosis.

    Science.gov (United States)

    Goldberg, Leah; Elsamra, Sammy; Hutchinson-Colas, Juana; Segal, Saya

    2016-01-01

    A vesicouterine fistula is a rare form of urogenital fistula, yet there is increasing prevalence in the United States because of the rising rate of cesarean deliveries. Vesicouterine fistulas have various presentations including menouria, hematuria, or urinary incontinence. A 39-year-old multiparous woman presented with urine leakage after her third cesarean delivery. She had been treated for mixed urinary incontinence with overactive bladder medications and a midurethral sling with continued complaints of urine leakage. The patient noticed her symptoms of urine leakage improved during menses when she used a menstrual cup. After confirmation of vesicouterine fistula, the patient underwent robotic-assisted surgery and her symptoms of insensible urine leakage resolved. When evaluating women with urinary incontinence and a history of cesarean deliveries, use of menstrual cup may aid in the diagnosis of vesicouterine fistula. Robotic-assisted laparoscopic repair with tissue interposition flap is an efficacious minimally invasive method for treatment of vesicouterine fistula.

  19. Delay in diagnosis of malaria because of improper effects of antibiotic therapy

    International Nuclear Information System (INIS)

    Jalali Tabatabai, M.; Vosough, P.; Samadpour, H.; Yousefi, Sh.

    2000-01-01

    Although most parts of Iran is free of malaria owing to appreciable struggle against this disease by the Ministry of Public Health, in every case of fever of unknown origin possibility of malaria should not be neglected. Unjustified administration of antibiotics can delay the diagnosis because of diminishing effect in number of malaria parasites in peripheral blood. For this reason frequent peripheral blood smears may be necessary to establish the diagnosis. In this article, 10 cases of malaria (age ranged from 2 mo. to 12 r) were diagnosed at Hazart Ali Asghar Hospital, Mostly referred to as fever of unknown origin with possible diagnosis of malignancy, within the last 10 years (1986-1996)

  20. Diagnostic performance and system delay using telemedicine for prehospital diagnosis in triaging and teatment of STEMI

    DEFF Research Database (Denmark)

    Rasmussen, Martin Bøhme; Frost, Lars; Stengaard, Carsten

    2014-01-01

    diagnoses established by telemedicine confirmed on hospital arrival, and we determined system delay in patients diagnosed before hospital arrival and triaged directly to the catheterisation laboratory. Methods: Design: Population-based follow-up study. Setting: Central Denmark Region. Participants: 15 992...... patients diagnosed using telemedicine. Results: During the study period, a tentative diagnosis of STEMI was established in 1061 patients, of whom 919 were triaged directly to the PCI centre. In 771 (84%) patients, a diagnosis of STEMI was confirmed. Patients transported ... living telemedicine for prehospital diagnosis and triage of patients directly to the catheter laboratory is feasible and allows 89% of patients living up to 95 km from the invasive centre to be treated...

  1. Effect of pre-rigor stretch and various constant temperatures on the rate of post-mortem pH fall, rigor mortis and some quality traits of excised porcine biceps femoris muscle strips.

    Science.gov (United States)

    Vada-Kovács, M

    1996-01-01

    Porcine biceps femoris strips of 10 cm original length were stretched by 50% and fixed within 1 hr post mortem then subjected to temperatures of 4 °, 15 ° or 36 °C until they attained their ultimate pH. Unrestrained control muscle strips, which were left to shorten freely, were similarly treated. Post-mortem metabolism (pH, R-value) and shortening were recorded; thereafter ultimate meat quality traits (pH, lightness, extraction and swelling of myofibrils) were determined. The rate of pH fall at 36 °C, as well as ATP breakdown at 36 and 4 °C, were significantly reduced by pre-rigor stretch. The relationship between R-value and pH indicated cold shortening at 4 °C. Myofibrils isolated from pre-rigor stretched muscle strips kept at 36 °C showed the most severe reduction of hydration capacity, while paleness remained below extreme values. However, pre-rigor stretched myofibrils - when stored at 4 °C - proved to be superior to shortened ones in their extractability and swelling.

  2. Psychosocial Characteristics of Women with a Delayed Diagnosis of Turner Syndrome.

    Science.gov (United States)

    Reimann, Gabrielle E; Bernad Perman, Martha M; Ho, Pei-Shu; Parks, Rebecca A; Comis, Leora E

    2018-05-09

    To characterize the psychosocial profiles of adult women diagnosed with Turner syndrome before (early diagnosis) and at or after (late diagnosis) 13 years of age. Women with Turner syndrome ages 22 and older at evaluation (n = 110) participated in a cross-sectional study at the National Institutes of Health. Researchers performed nonparametric and logistic regression analyses to assess early and late diagnosis cohorts on measures of depression, substance use, and perceptions of competence and identity. Of study participants, 47% received a Turner syndrome diagnosis at or after age 13 years. Median age at diagnosis was 12.0 years (range, 0-43). Covariate-adjusted models revealed that women with late diagnoses had an increased likelihood of developing mild to severe depressive symptoms (OR,  7.36) and a decreased likelihood of being perceived as competent (OR, 0.26). Women with a late diagnosis also exhibited more frequent substance use compared with women with early diagnoses. These data suggest that Turner syndrome diagnoses received at or after age 13 years may contribute to adverse outcomes related to depression, substance use, and perceptions of competence. Delayed Turner syndrome diagnoses may place women and girls at risk for negative psychosocial development extending into adulthood. These findings indicate it is important for pediatricians to evaluate psychosocial domains in girls with Turner syndrome regularly, particularly among those diagnosed at age 13 years or older. ClinicalTrials.gov: NCT00006334. Published by Elsevier Inc.

  3. Delayed Diagnosis and Complications of Predominantly Antibody Deficiencies in a Cohort of Australian Adults

    Directory of Open Access Journals (Sweden)

    Charlotte A. Slade

    2018-05-01

    Full Text Available BackgroundPredominantly antibody deficiencies (PADs are the most common type of primary immunodeficiency in adults. PADs frequently pass undetected leading to delayed diagnosis, delayed treatment, and the potential for end-organ damage including bronchiectasis. In addition, PADs are frequently accompanied by comorbid autoimmune disease, and an increased risk of malignancy.ObjectivesTo characterize the diagnostic and clinical features of adult PAD patients in Victoria, Australia.MethodsWe identified adult patients receiving, or having previously received immunoglobulin replacement therapy for a PAD at four hospitals in metropolitan Melbourne, and retrospectively characterized their clinical and diagnostic features.Results179 patients from The Royal Melbourne, Alfred and Austin Hospitals, and Monash Medical Centre were included in the study with a median age of 49.7 years (range: 16–87 years, of whom 98 (54.7% were female. The majority of patients (116; 64.8% met diagnostic criteria for common variable immunodeficiency (CVID, and 21 (11.7% were diagnosed with X-linked agammaglobulinemia (XLA. Unclassified hypogammaglobulinemia (HGG was described in 22 patients (12.3%, IgG subclass deficiency (IGSCD in 12 (6.7%, and specific antibody deficiency (SpAD in 4 individuals (2.2%. The remaining four patients had a diagnosis of Good syndrome (thymoma with immunodeficiency. There was no significant difference between the age at diagnosis of the disorders, with the exception of XLA, with a median age at diagnosis of less than 1 year. The median age of reported symptom onset was 20 years for those with a diagnosis of CVID, with a median age at diagnosis of 35 years. CVID patients experienced significantly more non-infectious complications, such as autoimmune cytopenias and lymphoproliferative disease, than the other antibody deficiency disorders. The presence of non-infectious complications was associated with significantly reduced survival in the

  4. Diagnosis of ORF in West African dwarf goats in Uyo, Akwa Ibom ...

    African Journals Online (AJOL)

    Background: Sixty (60) male West African Dwarf goats were reported with clinical signs of enlarged lymph nodes, scabs on the mouth, nose and ears. Two of the goats died and post mortem examination reveals enlarged submandibular lymph nodes and vesicular lesions on the tongue. Clinical diagnosis of Orf has been ...

  5. Adopted Korean woman with symptoms of cystitis – Delayed diagnosis of tuberculosis leading to disseminated disease

    Directory of Open Access Journals (Sweden)

    Mose M

    2017-01-01

    Full Text Available We report a rare case of miliary tuberculosis (TB in an adopted woman that developed following delayed diagnosis of presumed urogenital TB. The patient had a two year history of urological symptoms, diagnosed as interstitial cystitis and treated with cyclosporine. At admission, she presented with symptoms of pyelonephritis. Neck stiffness led to lumbar puncture that showed pleocytosis with lymphocytic predominance, high protein and low glucose levels, suggestive of TB meningitis. Computed tomography and magnetic resonance imaging scans showed nodular lung changes, lumbar spine destructive lesions, a unilateral kidney abscess and a parietal lobe tuberculoma. Urine and cerebrospinal fluids were positive for TB by polymerase chain reaction (PCR and culture. The patient developed complications in the form of hydrocephalus. She was treated with a ventriculoperitoneal shunt and four drug anti-tuberculosis therapy. She was discharged to neurorehabilitation on continued anti-tuberculosis treatment, developing longer term sequelae in the form of severe cognitive disabilities. This case emphasizes the importance of continuing to include TB in the differential diagnosis of a variety of diseases, particularly in patients at possible increased risk of infection, and highlights the potentially serious consequences of delayed or missed TB diagnosis.

  6. Delayed Diagnosis in an Elderly Schizophrenic Patient with Catatonic State and Pulmonary Embolism

    Directory of Open Access Journals (Sweden)

    Hsueh-Chin Hu

    2013-09-01

    Full Text Available Catatonia is a syndrome with any two of five core features: stupor/motoric immobility/catalepsy/waxy flexibility, excitement, negativism/mutism, posturing, and echolalia/echopraxia. We describe a case of delayed diagnosis of pulmonary embolism with an atypical presentation in an elderly schizophrenia male patient, which led to a life-threatening brain infarction. A 75-year-old male was hospitalized in a psychiatric ward because of stupor, poor intake and mutism under a diagnosis of recurrent catatonia. His inability to express his suffering, dehydration, exacerbation of chronic obstructive pulmonary disease, and upper gastrointestinal bleeding, however, made an accurate diagnosis difficult. Finally, the high D-dimer level and further chest computed tomography confirmed pulmonary embolism in the trunk of the bilateral main pulmonary arteries. The brain computed tomography also confirmed brain infarcts. He was transferred to the cardiac intensive care unit and was eventually rescued from near death due to pulmonary embolism and brain infarction. A careful differential diagnosis for pulmonary embolism-induced delirium and catatonic state is important in the treatment of patients with a previous diagnosis of catatonic schizophrenia.

  7. Factors contributing to delay in diagnosis and start of treatment of leprosy

    DEFF Research Database (Denmark)

    Nicholls, P.G.; Chhina, N; Aaen, Karen Bro

    2005-01-01

    The objective of our research was to identify factors contributing to delay in diagnosis and start of treatment in leprosy, focussing on patients' narratives of help-seeking behaviour. Our research took place in Purulia, West Bengal, India and in Nilphamari, northern Bangladesh. Between January...... and August 2000, we conducted semi-structured interviews with 104 patients that explored each individual's narrative of help-seeking behaviour and the context of beliefs and attitudes towards leprosy. Subsequently we surveyed 356 patients currently receiving treatment for leprosy and recorded specific...... aspects of each help-seeking action and their reports of local beliefs and attitudes towards leprosy. Delay was estimated from time of first symptoms through to start of effective treatment (mean 18 months, median 9 months in Purulia and mean 20 months, median 12 months in Nilphamari). The number of help...

  8. Delays before Diagnosis and Initiation of Treatment in Patients Presenting to Mental Health Services with Bipolar Disorder.

    Science.gov (United States)

    Patel, Rashmi; Shetty, Hitesh; Jackson, Richard; Broadbent, Matthew; Stewart, Robert; Boydell, Jane; McGuire, Philip; Taylor, Matthew

    2015-01-01

    Bipolar disorder is a significant cause of morbidity and mortality. Although existing treatments are effective, there is often a substantial delay before diagnosis and treatment initiation. We sought to investigate factors associated with the delay before diagnosis of bipolar disorder and the onset of treatment in secondary mental healthcare. Retrospective cohort study using anonymised electronic mental health record data from the South London and Maudsley NHS Foundation Trust (SLaM) Biomedical Research Centre (BRC) Case Register on 1364 adults diagnosed with bipolar disorder between 2007 and 2012. The following predictor variables were analysed in a multivariable Cox regression analysis: age, gender, ethnicity, compulsory admission to hospital under the UK Mental Health Act, marital status and other diagnoses prior to bipolar disorder. The outcomes were time to recorded diagnosis from first presentation to specialist mental health services (the diagnostic delay), and time to the start of appropriate therapy (treatment delay). The median diagnostic delay was 62 days (interquartile range: 17-243) and median treatment delay was 31 days (4-122). Compulsory hospital admission was associated with a significant reduction in both diagnostic delay (hazard ratio 2.58, 95% CI 2.18-3.06) and treatment delay (4.40, 3.63-5.62). Prior diagnoses of other psychiatric disorders were associated with increased diagnostic delay, particularly alcohol (0.48, 0.33-0.41) and substance misuse disorders (0.44, 0.31-0.61). Prior diagnosis of schizophrenia and psychotic depression were associated with reduced treatment delay. Some individuals experience a significant delay in diagnosis and treatment of bipolar disorder after initiation of specialist mental healthcare, particularly those who have prior diagnoses of alcohol and substance misuse disorders. These findings highlight a need for further study on strategies to better identify underlying symptoms and offer appropriate treatment sooner

  9. Delays before Diagnosis and Initiation of Treatment in Patients Presenting to Mental Health Services with Bipolar Disorder.

    Directory of Open Access Journals (Sweden)

    Rashmi Patel

    Full Text Available Bipolar disorder is a significant cause of morbidity and mortality. Although existing treatments are effective, there is often a substantial delay before diagnosis and treatment initiation. We sought to investigate factors associated with the delay before diagnosis of bipolar disorder and the onset of treatment in secondary mental healthcare.Retrospective cohort study using anonymised electronic mental health record data from the South London and Maudsley NHS Foundation Trust (SLaM Biomedical Research Centre (BRC Case Register on 1364 adults diagnosed with bipolar disorder between 2007 and 2012. The following predictor variables were analysed in a multivariable Cox regression analysis: age, gender, ethnicity, compulsory admission to hospital under the UK Mental Health Act, marital status and other diagnoses prior to bipolar disorder. The outcomes were time to recorded diagnosis from first presentation to specialist mental health services (the diagnostic delay, and time to the start of appropriate therapy (treatment delay.The median diagnostic delay was 62 days (interquartile range: 17-243 and median treatment delay was 31 days (4-122. Compulsory hospital admission was associated with a significant reduction in both diagnostic delay (hazard ratio 2.58, 95% CI 2.18-3.06 and treatment delay (4.40, 3.63-5.62. Prior diagnoses of other psychiatric disorders were associated with increased diagnostic delay, particularly alcohol (0.48, 0.33-0.41 and substance misuse disorders (0.44, 0.31-0.61. Prior diagnosis of schizophrenia and psychotic depression were associated with reduced treatment delay.Some individuals experience a significant delay in diagnosis and treatment of bipolar disorder after initiation of specialist mental healthcare, particularly those who have prior diagnoses of alcohol and substance misuse disorders. These findings highlight a need for further study on strategies to better identify underlying symptoms and offer appropriate treatment

  10. Stage at diagnosis and delay in seeking medical care among women with breast cancer, delhi, India.

    Science.gov (United States)

    Pakseresht, Sedigheh; Ingle, Gopal Krishna; Garg, Suneela; Sarafraz, Nahid

    2014-12-01

    Patients with cancer often delay seeking medical advice in developing countries. It can adversely influence the outcome of disease. The present study was performed to determine the stage at diagnosis and delay in seeking medical care among women with breast cancer in Delhi, India. This was a cross-sectional study based on a census (case series) approach to reach all women (172) diagnosed with primary breast cancer "detected in surgery Out Patient Department (OPD) from January 2007 to December 2009" at Lok Nayak Hospital, Delhi, India. Patients were interviewed using a self-structure questionnaire. Seeking behavior variables were awareness of problem, first consultation, followed physician's advice, detection of problem, system of medicine and gap between knowing the problem and consultation (patient delay). Statistical Analysis was performed using the Microsoft SPSS-pc version 14.0 statistical program. The analytic methods were used (mean, standard deviation, X(2), Fisher's Exact Test, K-S, Kruskal-Wallis) for variables. All statistical tests were performed at a significance level of 5% (P cancer at the time of diagnosis. The mean duration of gap between knowing the problem and consulting a physician (patients delay) was 10.90 months. There was no significant association between stage of cancer and consultation gap. A significant association was found between the stage of breast cancer and income; women with lower income had a higher stage of breast cancer (P breast cancer. It seems necessary to design educating programs for women in both clinical and community settings, about breast cancer and early detection practices.

  11. Findings chest radiograph and CT in mediastinitis: effcacy of CT in patients with delayed diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Son, Eun Ju; Hong, Yong Kook; Choe, Kyu Ok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-01-01

    To analyse the causes the radiologic findings in patients with mediastinitis and to evaluate the efficacy of chest CT scanning in patients with delayed diagnosis. Seventeen patients with histopathologically(n=15) or clinically diagnosed(n=2) mediastinitis were involved in this study. Eleven of the former group underwent surgery, and in four, tube drainage was performed. All underwent chest radiography and CT scanning, and in seven patients, the causes of delayed diagnosis were analysed. The most common cause of mediastinitis was esophageal rupture(n=11). Others were extension from neck abscess to the mediastinum(n=3), complications after a Benthall procedure(n=1), tuberculous lymphadenitis(n=1) and mycotic aneurysm(n=1). Patients with esophageal rupture suffered from underlying diseases such as esophageal cancer(n=2), iatrogenic esophageal rupture(n=2), Boerhaave's syndrome(n=2), and esophagitis(n=1). In patients with neck abscess (n=3), each was secondary to infected cystic hygroma, Ludwig angina, or deep neck infection, respectively. On chest CT, patients with esophageal rupture(n=11) had an abscess in the posterior mediastinum ; nine abscesses extended to the cervical area along the retropharyngeal space, and the patient with Ludwig angina had an abscess involving all compartments of the mediastinum. Among the total of 17 patients, diagnostic delays were found in seven, while five had spontaneous esophageal ruptures and two suffered complications after a Benthall procedure and Tbc lymphadenitis, respectively. The causes of diagnostic delay varied. Among seven patients, pnevmonia was initially diagnosed in two, who were treated ; one had multiorgan failure, and one was suffering from pericardial effusion and lung abscess. In three other patients, chest radiographs initially showed non-specific findings, leading to delayed CT examination. The most common cause of mediastinitis was esophageal rupture, and in these patients, chest radiographs and clinical

  12. A delayed diagnosis of unsuspected retinoblastoma in an in vitro fertilisation infant with retinopathy of prematurity

    Institute of Scientific and Technical Information of China (English)

    Tian Tian; Xun-Da Ji; Qi Zhang; Jie Peng; Pei-Quan Zhao

    2016-01-01

    Dear Editor,Iam Dr.Tian Tian,from the Department of Ophthalmology,Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,China.I write to present a rare case report of a delayed diagnosis of unsuspected retinoblastoma(RB)in an in vitro fertilisation(IVF)infant with retinopathy of prematurity.The simultaneous presentation of RB and prematurity of retinopathy(ROP)in an IVF infant is very rare.The relationship between RB and IVF is still indeterminate and mechanisms that lead to ocular or systemic abnormalities

  13. Multiple growing fractures and cerebral venous anomaly after penetrating injuries: delayed diagnosis in a battered child

    International Nuclear Information System (INIS)

    Makkat, S.; Vandevenne, J.E.; Parizel, P.M.; Schepper, A.M. de

    2001-01-01

    A growing fracture usually results from a skull fracture with dural tear after blunt head trauma during infancy. We present a case of child abuse with multiple growing fractures resulting from penetrating head trauma by scissors. MR imaging confirmed the presence of growing fractures and revealed a presumably post-traumatic venous anomaly (occluded left cavernous sinus and aberrant posterior venous drainage via the internal cerebral veins). Diagnosis of the growing fractures and venous anomaly was delayed until the age of 15 years. Medical expertise should be more readily available to battered children, and MR imaging is advocated in growing skull fracture to exclude associated post-traumatic brain lesions. (orig.)

  14. Multiple growing fractures and cerebral venous anomaly after penetrating injuries: delayed diagnosis in a battered child

    Energy Technology Data Exchange (ETDEWEB)

    Makkat, S.; Vandevenne, J.E.; Parizel, P.M.; Schepper, A.M. de [Dept. of Radiology, Universitair Ziekenhuis Antwerpen, Edegem (Belgium)

    2001-05-01

    A growing fracture usually results from a skull fracture with dural tear after blunt head trauma during infancy. We present a case of child abuse with multiple growing fractures resulting from penetrating head trauma by scissors. MR imaging confirmed the presence of growing fractures and revealed a presumably post-traumatic venous anomaly (occluded left cavernous sinus and aberrant posterior venous drainage via the internal cerebral veins). Diagnosis of the growing fractures and venous anomaly was delayed until the age of 15 years. Medical expertise should be more readily available to battered children, and MR imaging is advocated in growing skull fracture to exclude associated post-traumatic brain lesions. (orig.)

  15. A High-Grade Chondrosarcoma of Calcaneum Mimicking as a Benign Pathology: Delayed Diagnosis and Management.

    Science.gov (United States)

    Baba, Muzamil Ahmad; Nazir, Naila; Shabeer, Maajid; Mir, Bashir Ahmed; Kawoosa, Altaf Ahmad

    2016-10-01

    This case is presented to highlight a rare case of chondrosarcoma of calcaneum in a young adult mimicking as a benign pathology and to highlight the diagnosis and early management of such cases to prevent complications and even death. Chondrosarcoma constitutes less than 10% of all primary malignancies of bone and occurs mostly in proximal locations such as pelvis, proximal femur, and proximal humerus. We present a case of high-grade chondrosarcoma at a very rare site, calcaneum of a 40-year-old male that was mimicking as a benign pathology. This case report highlights the importance of proper clinical examination, evaluation, and suspicion for benign occurring lesions to prevent complications related to a delay in diagnosis. Therapeutic, Level IV: Case study. © 2016 The Author(s).

  16. Delayed diagnosis of post-surgical pyoderma gangrenosum: A multicenter case series and review of literature

    Directory of Open Access Journals (Sweden)

    Rawaa Almukhtar

    Full Text Available Introduction: Pyoderma gangrenosum is a chronic neutrophilic dermatosis which can occur following trauma or surgery and can mimic infection. Surgical intervention can lead to progression of disease. Presentation of cases: This case series describes 3 cases of post-surgical pyoderma gangrenosum with delayed diagnosis from two large medical centers. Discussion: Epidemiology, pathogenesis, clinical and histopathologic presentation, and management of post-surgical pyoderma gangrenosum are discussed with a review of the literature. Conclusion: Post-surgical pyoderma gangrenosum (PSPG can mimic ulcerative disorders including bacterial infection. The diagnosis should be suspected in post-operative wounds with negative bacterial cultures which progress despite broad-spectrum antibiotics and surgical debridement. Recognizing the clinical features of PSPG is fundamental to prevent severe destruction and deformity. Keywords: Post-surgical, Pyoderma gangrenosum, Necrotizing fasciitis, Case report

  17. Fast track diagnosis as a means of reducing diagnostic delay in cancer

    DEFF Research Database (Denmark)

    Larsen, Mette Bach; Vedsted, Peter; Olesen, Frede

    of cancer and expanded services to the general practitioners. Objective: To investigate the diagnostic delay of cancer, patient and provider satisfaction and health economic aspects in two Danish regions with special emphasis on the possible benefits of fast track diagnosis. Methods: The study......Background: Denmark has the highest morbidity and mortality from cancer in Western Europe, and studies suggest that Danish cancer patients are diagnosed at a later stage than patients in the other Nordic countries. To address this issue a Danish hospital has introduced fast track diagnosis...... will be designed as a cross-sectional study with the construction of a clinical database of all incident cancers in two Danish regions within a year (12,000 patients). Data will be collected from general practitioners, patients and national registers. In the first part of the analysis the general variation...

  18. Delayed diagnosis of xanthogranulomatous pyelonephritis in a quadriplegic patient with uncontrolled cutaneous fistula

    Science.gov (United States)

    Yang, Jae-Hyuk; Shin, Jin Yong; Roh, Si-Gyun; Chang, Suk-Choo; Lee, Nae-Ho

    2018-01-01

    Abstract Rationale: Xanthogranulomatous pyelonephritis (XGP) is a chronic destructive granulomatous inflammation that is characterized by urinary tract obstruction and invasion of the renal parenchyma. Although rare, XGP can lead to fatal complications, including perinephric inflammation, psoas abscess, and cutaneous fistula. Patient concerns: A quadriplegic patient initially presented to the hospital with a chronic open wound and cutaneous fistula. Diagnoses: Abdominal computed tomography revealed a renal obstructing stone and enlarged right kidney with a perinephric fluid collection that communicated with the cutaneous fistula. Interventions: The patient underwent a right nephrectomy at the department of urology. Outcomes: Two months after surgery, the patient was clinically well with no discharging fistula. Lessons: The XGP accompanied by complications requires an immediate evaluation and early diagnosis. In this case, the diagnosis was delayed because the state of quadriplegia rendered no symptoms of XGP. PMID:29480882

  19. Paternal versus maternal coping styles with child diagnosis of developmental delay.

    Science.gov (United States)

    Barak-Levy, Yael; Atzaba-Poria, Na'ama

    2013-06-01

    Parents of children with disabilities vary in their reaction to their children's diagnosis. The current study focused on fathers in addition to mothers and examined their resolution and coping styles when having children diagnosed with developmental delay (DD). Sixty-five fathers and 71 mothers were interviewed using the reaction to the diagnosis interview (RDI; Pianta & Marvin, 1992a). Results indicated that the majority of parents were unresolved with their child's diagnosis, with no differences found between fathers' and mothers' rates of resolution. Furthermore, both parents of children that were diagnosed at a later age and parents that were less educated tended to be unresolved, as did fathers of a lower socioeconomic status. Older age of both children and mothers was related to maternal lack of resolution. Finally, an in-depth examination revealed significant differences in the manner in which fathers and mothers cope with their children's diagnosis: whereas mothers were more prone to using an emotional coping style, fathers tended to use a cognitive coping style. The clinical implications of paternal versus maternal coping styles are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. [Hyperthyroidism in the elderly: aspecific signs may cause a delay in diagnosis].

    Science.gov (United States)

    Rozendaal, F P

    2005-05-01

    The clinical manifestations of thyroid diseases in the elderly are often atypical and can easily be attributed to other medical conditions or 'normal aging'. Two nursing home patients with hyperthyroidism are described. Due to the atypical presentation of the thyroid disease their complaints were attributed to other conditions. In both patients there was a significant delay in diagnosis and treatment of hyperthyroidism. In elder patients signs and symptoms of thyreotoxicosis are frequently related to cardiovascular, gastrointestinal and neuropsychiatric disorders. Most often occur atrial fibrillation, worsening of cardiac failure and angina pectoris, weight loss, anorexia, constipation, cognitive impairment and delirium. Delay of diagnosis and treatment of hyperthyroidism may be potentially harmful to the patient. Untreated thyreotoxicosis may lead to serious cardiovasculair complications (particularly cardiac failure and cerebrovascular accidents), mental deterioration and osteoporosis. In elder people with unexplained and vague signs and symptoms thyroid function should always be checked. The TSH assay is a very accurate diagnostic test for screening thyroid function. A normal TSH indicates euthyroidism with an accuracy of almost 100%. The medical treatment for hyperthyreoidism in the elderly are antithyroid drugs. When an euthyroid state is rendered, suppletion with L-thyroxine may be nessecary. Radioactive iodine treatment is preferred in some cases though there may be practical difficulties with the application of this treatment in nursing home patients because temporary isolation is necessary.

  1. [Macroscopical estimation of the post mortem interval (PMI) and exclusion of the forensically relevant resting period--a comparison of data presented in the literature with recent osteological findings].

    Science.gov (United States)

    Holley, Stephanie; Fiedler, Sabine; Graw, Matthias

    2008-01-01

    The aim of the present study was to determine to what extent macroscopical parameters mentioned in the literature are suitable for the estimation of the post mortem interval (PMI) and particularly for the exclusion of the forensically relevant resting period for recent bone material. The macroscopical examination of recent bone material with a known PMI showed that only one published parameter (relics of adipocere in the cross section of the compacta) was consistent with our findings for this particular resting period (27-28 years). Other macroscopical parameters presented in the literature were contradictory to the results observed in this study. Among those are the rigidity of bones, the adhesion of soft tissue, the filling of the marrow cavity, and the permeation of the epiphyses with adipocere. Concerning the exclusion of the forensically relevant resting period, a similar result was observed. This study identified some diagnostic findings in bones with a resting period of less than 50 years which according to the literature should only be present after a resting period of more than 50 years. These features included the lack of macroscopical traces of adipocere, degradation of the compacta surface, detachment of the cortical substance, the ability of bone to be broken with bare hands, and superficial usures. Moreover, in one-third of our cases we identified some intra-individual differences not previously described in the literature. In addition to the other results, those intra-individual differences make an estimation of the PMI more difficult. However it should be noted that those published parameters were collected from bone material which was stored in a "relatively arid sand-grit-clay soil of the broken stone layer of Munich". The bones in the present study were stored in acidic and clayey-loamy soil, partly with lateral water flow. In conclusion, the present study demonstrates that one should use caution estimating the post mortem interval and excluding

  2. Topographic distribution of brain iron deposition and small cerebrovascular lesions in amyotrophic lateral sclerosis and in frontotemporal lobar degeneration: a post-mortem 7.0-tesla magnetic resonance imaging study with neuropathological correlates.

    Science.gov (United States)

    De Reuck, Jacques; Devos, David; Moreau, Caroline; Auger, Florent; Durieux, Nicolas; Deramecourt, Vincent; Pasquier, Florence; Maurage, Claude-Alain; Cordonnier, Charlotte; Leys, Didier; Bordet, Regis

    2017-12-01

    Amyotrophic lateral sclerosis (ALS) is associated with frontotemporal lobar degeneration (FTLD) in 15% of the cases. A neuropathological continuity between ALS and FTLD-TDP is suspected. The present post-mortem 7.0-tesla magnetic resonance imaging (MRI) study compares the topographic distribution of iron (Fe) deposition and the incidence of small cerebrovascular lesions in ALS and in FTLD brains. Seventy-eight post-mortem brains underwent 7.0-tesla MRI. The patients consisted of 12 with ALS, 38 with FTLD, and 28 controls. Three ALS brains had minor FTLD features. Three coronal sections of a cerebral hemisphere were submitted to T2 and T2* MRI sequences. The amount of Fe deposition in the deep brain structures and the number of small cerebrovascular lesions was determined in ALS and the subtypes of FTLD compared to control brains, with neuropathological correlates. A significant increase of Fe deposition was observed in the claustrum, caudate nucleus, globus pallidus, thalamus, and subthalamic nucleus of the FTLD-FUS and FTLD-TDP groups, while in the ALS one, the Fe increase was only observed in the caudate and the subthalamic nuclei. White matter changes were only significantly more severe in the FTLD compared to those in ALS and in controls brains. Cortical micro-bleeds were increased in the frontal and temporal lobes of FTLD as well as of ALS brains compared to controls. Cortical micro-infarcts were, on the other hand, more frequent in the control compared to the ALS and FTLD groups. The present study supports the assumption of a neuropathological continuity between ALS and FTLD and illustrates the favourable vascular risk profile in these diseases.

  3. A retrospective analysis of delays in the diagnosis of lung cancer and associated costs

    Directory of Open Access Journals (Sweden)

    Gildea TR

    2017-05-01

    IV disease and lowest among patients diagnosed at Stage I disease ($7,239 Stage I, $9,484 Stage II, $11,193 Stage IIIa, $17,415 Stage IIIb, and $21,441 Stage IV. Conclusion: This study showed that most patients experienced long periods of delay between their first diagnostic test for lung cancer and a definitive diagnosis, and the majority were diagnosed at advanced stages of disease. Costs associated with the management of lung cancer increased substantially with higher stages at diagnosis. Procedures that diagnose lung cancer at earlier stages may allow for less resource use and costs among patients with lung cancer. Keywords: biopsy (lung, cost, health care utilization, pulmonary nodule, staging

  4. Not Always Asthma: Clinical and Legal Consequences of Delayed Diagnosis of Laryngotracheal Stenosis

    Directory of Open Access Journals (Sweden)

    Adam C. Nunn

    2014-01-01

    Full Text Available Laryngotracheal stenosis (LTS is a rare condition that occurs most commonly as a result of instrumentation of the airway but may also occur as a result of inflammatory conditions or idiopathically. Here, we present the case of a patient who developed LTS as a complication of granulomatosis with polyangiitis (GPA, which was misdiagnosed as asthma for 6 years. After an admission with respiratory symptoms that worsened to the extent that she required intubation, a previously well 14-year-old girl was diagnosed with GPA. Following immunosuppressive therapy, she made a good recovery and was discharged after 22 days. Over subsequent years, she developed dyspnoea and “wheeze” and a diagnosis of asthma was made. When she became pregnant, she was admitted to hospital with worsening respiratory symptoms, whereupon her “wheeze” was correctly identified as “stridor,” and subsequent investigations revealed a significant subglottic stenosis. The delay in diagnosis precluded the use of minimally invasive therapies, with the result that intermittent laser resection and open laryngotracheal reconstructive surgery were the only available treatment options. There were numerous points at which the correct diagnosis might have been made, either by proper interpretation of flow-volume loops or by calculation of the Empey or Expiratory Disproportion Indices from spirometry data.

  5. Delayed diagnosis of intermittent mesenteroaxial volvulus of the stomach by computed tomography: a case report

    Directory of Open Access Journals (Sweden)

    Woon Colin

    2008-11-01

    Full Text Available Abstract Introduction Gastric volvulus is a rare condition. Presenting acutely, mesenteroaxial gastric volvulus has characteristic symptoms and may be easily detected with upper gastrointestinal contrast studies. In contrast, subacute, intermittent cases present with intermittent vague symptoms from episodic twisting and untwisting. Imaging in these cases is only useful if performed in the symptomatic interval. Case presentation We describe a patient with a long history of intermittent chest and epigastric pain. An earlier barium meal was not diagnostic. Diagnosis was finally secured during the current admission by a combination of (1 serum investigations, (2 endoscopy, and finally (3 computed tomography. Conclusion Non-specific and misleading symptoms and signs may delay the diagnosis of intermittent, subacute volvulus. Imaging studies performed in the well interval may be non-diagnostic. Elevated creatine kinase and aldolase of a non-cardiac cause and endoscopic findings of ischaemic ulceration and difficulty in negotiating the pylorus may raise the suspicion of gastric volvulus. In this case, abdominal computed tomography with spatial reconstruction was crucial in securing the final diagnosis.

  6. Effect of delayed diagnosis on disease course and management of Churg-Strauss syndrome: a retrospective study.

    Science.gov (United States)

    Sokołowska, Barbara; Szczeklik, Wojciech; Mastalerz, Lucyna; Kuczia, Paweł; Wodkowski, Michał; Stodółkiewicz, Edyta; Macioł, Karolina; Musiał, Jacek

    2013-03-01

    Delayed diagnosis in patients with Churg-Strauss syndrome (CSS) is largely attributed to the variable and nonspecific presentation of the disease's initial symptoms. The aim of the study was to evaluate the effect of delayed diagnosis on the course of CSS. We conducted a retrospective study of 30 CSS patients followed up in our department. In each patient, we assessed the delay in CSS diagnosis (the time when patients already fulfilled four out of six of the American College of Rheumatology criteria and the diagnosis was not yet established), the disease activity at the time of diagnosis, and organ involvement during CSS course. A median value of 2 weeks was chosen as the cutoff point after which the diagnosis was considered as delayed. Sixteen patients were diagnosed before (group 1) and 14 patients after this cutoff point (group 2). In group 2, we found a higher Birmingham Vasculitis Activity Score at the moment of diagnosis (20.4 vs 25.1, p < 0.05) and a more severe disease course, resulting in more frequent hospitalization rates (0.64 vs 2.26/year, p < 0.00001), higher corticosteroids dose requirements (5.87 vs 11.57 mg/day converted to methylprednisolone, p < 0.0001), and additional immunosuppressive therapy administration (56.2 vs 92.8 %, p < 0.05) to maintain disease remission. All six perinuclear pattern of antineutrophil cytoplasmic antibobodies (pANCA)-positive patients (20 %) were found in group 1. Concluding, the delay in diagnosis of CSS of more than 2 weeks was found to be associated with a disease course that was more severe. The presence of the pANCA antibodies may occasionally facilitate establishment of the diagnosis.

  7. Our experience with the aetiological diagnosis of global developmental delay and intellectual disability: 2006-2010.

    Science.gov (United States)

    López-Pisón, J; García-Jiménez, M C; Monge-Galindo, L; Lafuente-Hidalgo, M; Pérez-Delgado, R; García-Oguiza, A; Peña-Segura, J L

    2014-09-01

    Global developmental delay (GDD) and intellectual disability (ID) are common reasons for consultation in paediatric neurology. Results from aetiological evaluations of children with GDD/ID vary greatly, and consequently, there is no universal consensus regarding which studies should be performed. We review our experience with determining aetiological diagnoses for children with GDD/ID who were monitored by the paediatric neurology unit over the 5-year period between 2006 and 2010. During the study period, 995 children with GDD/ID were monitored. An aetiological diagnosis was established for 309 patients (31%), but not in 686 (69%), despite completing numerous tests. A genetic cause was identified in 142 cases (46% of the total aetiologies established), broken down as 118 cases of genetic encephalopathy and 24 of metabolic hereditary diseases. Our data seem to indicate that diagnosis is easier when GDD/ID is associated with cerebral palsy, epilepsy, infantile spasms/West syndrome, or visual deficit, but more difficult in cases of autism spectrum disorders. Genetic studies provide an increasing number of aetiological diagnoses, and they are also becoming the first step in diagnostic studies. Array CGH (microarray-based comparative genomic hybridisation) is the genetic test with the highest diagnostic yield in children with unexplained GDD/ID. The cost-effectiveness of complementary studies seems to be low if there are no clinically suspected entities. However, even in the absence of treatment, aetiological diagnosis is always important in order to provide genetic counselling and possible prenatal diagnosis, resolve family (and doctors') queries, and halt further diagnostic studies. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  8. Delayed diagnosis of ocular syphilis that manifested as retinal vasculitis and acute posterior multifocal placoid epitheliopathy

    Directory of Open Access Journals (Sweden)

    Jong Hoon Park

    2013-01-01

    Full Text Available A 55-year-old female presented with bilateral progressive retinal vasculitis. She was on systemic and intravitreal steroids on the basis of uveitis work-up result (negative result including rapid plasma reagin, but her visual acuity continued to deteriorate to light perception only. Ocular examination showed retinal vasculitis, multiple yellow placoid lesions and severe macula edema in both eyes. Repeated work-up revealed positivity of fluorescent treponemal antibody-absorption in serum and subsequently in cerebrospinal fluid. Ocular syphilis was diagnosed. And intravenous penicillin G resulted in rapid resolution of vasculitis and macular edema. To avoid delay in the diagnosis of ocular syphilis, high index of suspicion and repeating serological tests (including both treponemal and non-treponemal tests are warranted.

  9. Gastric cancer in young people under 30 years of age: worse prognosis, or delay in diagnosis?

    International Nuclear Information System (INIS)

    López-Basave, Horacio Noé; Morales-Vásquez, Flavia; Ruiz-Molina, Juan Manuel; Ñamendys-Silva, Silvio A; Vela-Sarmiento, Itzel; Ruan, Javier Melchor; Rosciano, Alejandro E Padilla; Calderillo-Ruiz, German; Díaz-Romero, Consuelo; Herrera-Gómez, Angel; Meneses-García, Abelardo A

    2013-01-01

    Gastric cancer is an aggressive disease with nonspecific early symptoms. Its incidence and prognosis in young patients has shown considerable variability. Our objective was to retrospectively study patients from our institution aged <30 years with gastric carcinoma. The study was undertaken to describe the experience of gastric cancer in this population, and to demonstrate its specific clinical and pathological characteristics. We reviewed the cases of histologically confirmed gastric cancer between 1985 and 2006 at the Instituto Nacional de Cancerología of Mexico (INCan); emphasis in our review was placed on clinical presentation, diagnostic and therapeutic intervention, pathology, and the results. Thirty cases of gastric carcinoma were reviewed. The patients’ median age was 27 years (range, 18–30 years) and the male:female ratio was 1:1. Gastric cancer exhibits different behavior in patients aged, 30 years, but delay in diagnosis and the tumor’s behavior appear to be the most important factors in prognosis of the disease

  10. Delayed diagnosis of an isolated posterolateral corner injury: a case report.

    Science.gov (United States)

    Welsh, Patrick; DeGraauw, Christopher; Whitty, David

    2016-12-01

    Isolated injuries to the posterolateral corner of the knee are a rare and commonly missed injury associated with athletic trauma, motor vehicle accidents, and falls. Delayed or missed diagnoses can negatively impact patient prognosis, contributing to residual instability, chronic pain, and failure of surgical repair to other ligaments. A 44-year-old male CrossFit athlete presented with a history of two non-contact hyperextension injuries to his left knee while walking on ice. The only positive finding was the Dial Test at 30 degrees of knee flexion, indicative of an isolated posterolateral corner injury. After a delay in diagnosis, the patient underwent a reconstruction of the posterolateral corner and subsequent rehabilitation. Early recognition of this injury is important as this can affect the prognosis and activities of daily living of the patient. This case will discuss the clinical presentation, diagnostic procedures, and management of an isolated posterolateral corner injury and highlight the importance of early recognition and referrals from primary contact healthcare practitioners.

  11. Differential diagnosis between adrenal adenomas and non-adenomas with gadolinium MR in delayed scans: another diagnostic possibility

    International Nuclear Information System (INIS)

    Mondello, Eduardo J.; Eyheremendy, Eduardo P.; Stoisa, Daniela

    2001-01-01

    Purpose: To determine the value of measuring delayed post gadolinium signal intensity by displaying a curve, to make the differential diagnosis between adrenal adenomas and non-adenomas, and compare it to chemical shift MR imaging and unenhanced/delayed contrast enhanced CT. Material and methods: Nine adrenal masses have been evaluated by unenhanced/delayed contrast enhanced CT, chemical shift MR imaging and Dynamic Scan at 5, 15, 30 minutes or more, with measurement curves. The 'in phase' imaging have been compared to the 'out phase' ones. Results: Adenomas have shown drop of the curve at 30 minutes of the contrast injection. Non-adenomas have conserved an ascending curve with the same delay. Conclusion: Gadolinium-enhanced MR imaging at delayed scans can characterize adrenal masses as adenomas or non-adenomas. This technique could be considered as a new complementary diagnostic method. (author)

  12. Glioblastoma as differential diagnosis of autoimmune encephalitis.

    Science.gov (United States)

    Vogrig, Alberto; Joubert, Bastien; Ducray, Francois; Thomas, Laure; Izquierdo, Cristina; Decaestecker, Kévin; Martinaud, Olivier; Gerardin, Emmanuel; Grand, Sylvie; Honnorat, Jérome

    2018-03-01

    To identify the clinical and radiological features that should raise suspicion for the autoimmune encephalitis (AE)-like presentation of glioblastoma. This is an observational, retrospective case series of patients referred to the French National Reference Center on Paraneoplastic Neurological Diseases for suspected AE (possible, probable or definite, using the 2016 criteria) who later received a final diagnosis of glioblastoma according to 2016 WHO criteria. An extensive literature search was also conducted for similar existing cases. Between 2014 and 2016, 306 patients were referred to our center for suspected AE. Six of these patients (2%) later developed pathologically confirmed glioblastoma. Thirteen patients (9 male) were included for analysis (6 from the present series and 7 from the literature); median age was 63. Initially, a diagnosis of AE was clinically suspected based on: working memory deficits (77%), seizures (62%) (including status epilepticus in 23%), and psychiatric symptoms (46%). Initial brain MRI was not in favor of a typical glioblastoma pattern and showed bilateral (54%) or unilateral selective limbic involvement. Five patients exhibited initial slight contrast enhancement. A clear inflammatory CSF was present in five patients and three from the literature showed autoantibody positivity (NMDAR, VGKC, GluRepsilon2). Median delay between suspicions of AE to GBM diagnosis was 3 months (range 1.5-24) and one patient from the literature was diagnosed post-mortem. An alternative diagnosis of glioblastoma should be considered in patients presenting initially as AE, especially in patients who do not fulfill the criteria for definite AE and in those with a poor clinical evolution despite initial improvement.

  13. A STUDY OF IMPACT OF DETERMINANTS OF PATIENTS AND HEALTH SYSTEM DELAY ON TUBERCULOSIS DIAGNOSIS AND TREATMENT IN BANGALORE

    Directory of Open Access Journals (Sweden)

    Jagadish Siddalinga Devaru

    2013-01-01

    Full Text Available Setting: TU/DMCs of Bangalore city. India. All new sputum positive patients registered to the selected TU/DMCs were interviewed. A total of 468 patients aged above 20 years were enrolled. The study period was from January to June 2009. Objectives: To track the delay in diagnosis and treatment of patients reporting to tuberculosis units and microscopy centers. Design: A cross sectional study. TU/DMCs were randomly selected. A pretested questionnaire was administered to collect data. Results: The study population had 326 (69.7% males. The mean age of study population was 38.5 years. 74.4% were married, 20.7% were illiterates, 27.8% were daily wagers, 10.5% were unemployed. The median and mean total delays from development of cough to diagnosis were 41 days and 36.04 days; the median and mean patient delay was 24 days and 20.7 days, and health system delay was 18 and 15.31 days respectively. There was a significant difference among the different age group of patients with older people having longer patient delay (p<0.0001. Lower income, illiteracy, unemployment, showed significant association with patients delay (p<0.0001. Alcohol intake and smoking habit among the male patients had significant association for longer patient delay (p=0.00004. Health seeking behavior like self medication, also had longer patient delay. Other socio demographic factors had no significant influence on the patient delay. Longer health system delay was found among patients who visited general practitioners and Ayurvedic medicine. Conclusion: More specific and effective health education of the general public on tuberculosis and seeking of appropriate medical consultation are likely to improve case detection.

  14. A STUDY OF IMPACT OF DETERMINANTS OF PATIENTS AND HEALTH SYSTEM DELAY ON TUBERCULOSIS DIAGNOSIS AND TREATMENT IN BANGALORE

    Directory of Open Access Journals (Sweden)

    Jagadish Siddalinga Devaru

    2012-12-01

    Full Text Available Setting: TU/DMCs of Bangalore city. India. All new sputum positive patients registered to the selected TU/DMCs were interviewed. A total of 468 patients aged above 20 years were enrolled. The study period was from January to June 2009. Objectives: To track the delay in diagnosis and treatment of patients reporting to tuberculosis units and microscopy centers. Design: A cross sectional study. TU/DMCs were randomly selected. A pretested questionnaire was administered to collect data. Results: The study population had 326 (69.7% males. The mean age of study population was 38.5 years. 74.4% were married, 20.7% were illiterates, 27.8% were daily wagers, 10.5% were unemployed. The median and mean total delays from development of cough to diagnosis were 41 days and 36.04 days; the median and mean patient delay was 24 days and 20.7 days, and health system delay was 18 and 15.31 days respectively. There was a significant difference among the different age group of patients with older people having longer patient delay (p<0.0001. Lower income, illiteracy, unemployment, showed significant association with patients delay (p<0.0001. Alcohol intake and smoking habit among the male patients had significant association for longer patient delay (p=0.00004. Health seeking behavior like self medication, also had longer patient delay. Other socio demographic factors had no significant influence on the patient delay. Longer health system delay was found among patients who visited general practitioners and Ayurvedic medicine. Conclusion: More specific and effective health education of the general public on tuberculosis and seeking of appropriate medical consultation are likely to improve case detection.

  15. Dissecting the pathobiology of altered MRI signal in amyotrophic lateral sclerosis: A post mortem whole brain sampling strategy for the integration of ultra-high-field MRI and quantitative neuropathology.

    Science.gov (United States)

    Pallebage-Gamarallage, Menuka; Foxley, Sean; Menke, Ricarda A L; Huszar, Istvan N; Jenkinson, Mark; Tendler, Benjamin C; Wang, Chaoyue; Jbabdi, Saad; Turner, Martin R; Miller, Karla L; Ansorge, Olaf

    2018-03-13

    Amyotrophic lateral sclerosis (ALS) is a clinically and histopathologically heterogeneous neurodegenerative disorder, in which therapy is hindered by the rapid progression of disease and lack of biomarkers. Magnetic resonance imaging (MRI) has demonstrated its potential for detecting the pathological signature and tracking disease progression in ALS. However, the microstructural and molecular pathological substrate is poorly understood and generally defined histologically. One route to understanding and validating the pathophysiological correlates of MRI signal changes in ALS is to directly compare MRI to histology in post mortem human brains. The article delineates a universal whole brain sampling strategy of pathologically relevant grey matter (cortical and subcortical) and white matter tracts of interest suitable for histological evaluation and direct correlation with MRI. A standardised systematic sampling strategy that was compatible with co-registration of images across modalities was established for regions representing phosphorylated 43-kDa TAR DNA-binding protein (pTDP-43) patterns that were topographically recognisable with defined neuroanatomical landmarks. Moreover, tractography-guided sampling facilitated accurate delineation of white matter tracts of interest. A digital photography pipeline at various stages of sampling and histological processing was established to account for structural deformations that might impact alignment and registration of histological images to MRI volumes. Combined with quantitative digital histology image analysis, the proposed sampling strategy is suitable for routine implementation in a high-throughput manner for acquisition of large-scale histology datasets. Proof of concept was determined in the spinal cord of an ALS patient where multiple MRI modalities (T1, T2, FA and MD) demonstrated sensitivity to axonal degeneration and associated heightened inflammatory changes in the lateral corticospinal tract. Furthermore

  16. How do patients access the private sector in Chennai, India? An evaluation of delays in tuberculosis diagnosis.

    Science.gov (United States)

    Bronner Murrison, L; Ananthakrishnan, R; Swaminathan, A; Auguesteen, S; Krishnan, N; Pai, M; Dowdy, D W

    2016-04-01

    The diagnosis and treatment of tuberculosis (TB) in India are characterized by heavy private-sector involvement. Delays in treatment remain poorly characterized among patients seeking care in the Indian private sector. To assess delays in TB diagnosis and treatment initiation among patients diagnosed in the private sector, and pathways to care in an urban setting. Cross-sectional survey of 289 consecutive patients diagnosed with TB in the private sector and referred for anti-tuberculosis treatment through a public-private mix program in Chennai from January 2014 to February 2015. Among 212 patients with pulmonary TB, 90% first contacted a formal private provider, and 78% were diagnosed by the first or second provider seen after a median of three visits per provider. Median total delay was 51 days (mean 68). Consulting an informal (rather than formally trained) provider first was associated with significant increases in total delay (absolute increase 22.8 days, 95%CI 6.2-39.5) and in the risk of prolonged delay >90 days (aRR 2.4, 95%CI 1.3-4.4). Even among patients seeking care in the formal (vs. informal) private sector in Chennai, diagnostic delays are substantial. Novel strategies are required to engage private providers, who often serve as the first point of contact.

  17. Diagnosis of Nocardia paucivorans central nervous system infection by DNA sequencing from paraffin-embedded tissue.

    Science.gov (United States)

    Schiaroli, Elisabetta; Pasticci, Maria Bruna; De Carolis, Elena; Mello, Enrica; Pallotto, Carlo; Leli, Christian; De Socio, Giuseppe Vittorio; Baldelli, Franco; Sanguinetti, Maurizio; Mencacci, Antonella

    2016-06-01

    Infections by Nocardia spp. are generally regarded as opportunistic diseases in immunocompromised patients, but can also affect immunocompetent subjects. Such infections represent an important diagnostic challenge for clinicians and microbiologists, and diagnosis is frequently delayed or even conducted post mortem. A 54-year-old man was admitted to our hospital because of ventriculitis and relapsing brain abscess. Five months prior, this patient had undergone external ventricular drain and surgery for a cerebellar abscess. Histopathology demonstrated pyogenic inflammatory reaction, microbiologic investigations proved negative and empiric antimicrobial therapy was administered for a total of eight weeks. Six weeks later, the patient developed relapsing neurologic manifestations. On reviewing the patient's clinical history it emerged that the patient had suffered pneumonia two months prior to neurosurgery, treated with amoxicillin/clavulanate 3g a day and levofloxacin 500mg a day for three weeks. On the CNS relapsing manifestations, nocardiosis was suspected and DNA sequencing from the formalin-fixed paraffin-embedded cerebellar tissue collected during neurosurgery allowed diagnosis of Nocardia paucivorans infection. The patient received medical therapy for 11 months. At follow-up, eight months after treatment was discontinued, the patient was aymptomatic. Nocardia spp. infections need to be suspected not only in immunocompromised, but also in immunocompetent patients. Proper samples need to be collected for proper microbiologic investigations. Paraffin-embedded tissue genomic sequencing can be a useful tool for diagnosis of nocardiosis.

  18. Barriers and Explanatory Mechanisms of Delays in the Patient and Diagnosis Intervals of Care for Breast Cancer in Mexico.

    Science.gov (United States)

    Unger-Saldaña, Karla; Ventosa-Santaulària, Daniel; Miranda, Alfonso; Verduzco-Bustos, Guillermo

    2018-04-01

    Most breast cancer patients in low- and middle-income settings are diagnosed at advanced stages due to lengthy intervals of care. This study aimed to understand the mechanisms through which delays occur in the patient interval and diagnosis interval of care. We conducted a cross-sectional survey including 886 patients referred to four major public cancer hospitals in Mexico City. Based in a conceptual model of help-seeking behavior, a path analysis strategy was used to identify the relationships between explanatory factors of patient delay and diagnosis delay. The patient and the diagnosis intervals were greater than 3 months in 20% and 65% of participants, respectively. We present explanatory models for each interval and the interrelationship between the associated factors. The patient interval was longer among women who were single, interpreted their symptoms as not worrisome, concealed symptoms, and perceived a lack of financial resources and the difficulty of missing a day of work as barriers to seek care. These barriers were more commonly perceived among patients who were younger, had lower socioeconomic status, and lived outside of Mexico City. The diagnosis interval was longer among those who used several different health services prior to the cancer hospital and perceived medical errors in these services. More health services were used among those who perceived errors and long waiting times for appointments, and who first consulted private services. Our findings support the relevance of strengthening early cancer diagnosis strategies, especially the improvement of quality of primary care and expedited referral routes to cancer services. This study's findings suggest that policy in low- and middle-income countries (LMICs) should be directed toward reducing delays in diagnosis, before the implementation of mammography screening programs. The results suggest several factors susceptible to early diagnosis interventions. To reduce patient delays, the usually

  19. Delay in diagnosis of cancer as a patient safety issue - a root cause analysis based on a representative case report

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    Mansour Paul

    2011-07-01

    Full Text Available Abstract Background It is well known in the literature that imaging has almost no value for diagnosis of superficial bladder cancer. However, wide gap exists between knowledge on diagnosis of bladder cancer and actual clinical practice. Case presentation Delay in diagnosis of bladder cancer in a male person with tetraplegia occurred because of reliance on negative flexible cystoscopy and single biopsy, negative ultrasound examination of urinary bladder, and computerised tomography of pelvis. Difficulties in scheduling cystoscopy also contributed to a delay of nearly ten months between the onset of haematuria and establishing a histological diagnosis of vesical malignancy in this patient. The time interval between transurethral resection and cystectomy was 42 days. This delay was mainly due to scheduling of surgery. Conclusion We learn from this case that doctors should be aware of the limitations of negative flexible cystoscopy and single biopsy, cytology of urine, ultrasound examination of urinary bladder, and computed tomography of pelvis for diagnosis of bladder cancer in spinal cord injury patients. Random bladder biopsies must be considered under general anaesthesia when there is high suspicion of bladder cancer. Spinal cord injury patients with lesions above T-6 may develop autonomic dysreflexia; therefore, one should be extremely well prepared to prevent or manage autonomic dysreflexia when performing cystoscopy and bladder biopsy. Spinal cord injury patients, who pass blood in urine, should be accorded top priority in scheduling of investigations and surgical procedures.

  20. Molecular diagnosis of patients with epilepsy and developmental delay using a customized panel of epilepsy genes.

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    Laura Ortega-Moreno

    Full Text Available Pediatric epilepsies are a group of disorders with a broad phenotypic spectrum that are associated with great genetic heterogeneity, thus making sequential single-gene testing an impractical basis for diagnostic strategy. The advent of next-generation sequencing has increased the success rate of epilepsy diagnosis, and targeted resequencing using genetic panels is the a most cost-effective choice. We report the results found in a group of 87 patients with epilepsy and developmental delay using targeted next generation sequencing (custom-designed Haloplex panel. Using this gene panel, we were able to identify disease-causing variants in 17 out of 87 (19.5% analyzed patients, all found in known epilepsy-associated genes (KCNQ2, CDKL5, STXBP1, SCN1A, PCDH19, POLG, SLC2A1, ARX, ALG13, CHD2, SYNGAP1, and GRIN1. Twelve of 18 variants arose de novo and 6 were novel. The highest yield was found in patients with onset in the first years of life, especially in patients classified as having early-onset epileptic encephalopathy. Knowledge of the underlying genetic cause provides essential information on prognosis and could be used to avoid unnecessary studies, which may result in a greater diagnostic cost-effectiveness.

  1. Causes of delay in diagnosis of pulmonary tuberculosis in patients attending a referral hospital in Western Kenya.

    Science.gov (United States)

    Ayuo, P O; Diero, L O; Owino-Ong'or, W D; Mwangi, A W

    2008-06-01

    To determine the length of delays from onset of symptoms to initiation of treatment of pulmonary tuberculosis (PTB). Cross-sectional study. Chest/TB clinic, Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Newly diagnosed smear positive pulmonary tuberculosis (PTB) patients. Two hundred and thirty patients aged between 12 and 80 (median; 28.5) years were included in the study. They comprised 148 (64.3%, median 30 years) males and 82 (35.7%, median 28 years) females. One hundred and two (44%) came from urban and 128 (56%) came from rural setting covering a median distance of 10 (range 0-100) kilometres and paying Kshs 20 (range 0-200) to facility. Cough was the commonest symptom reported by 228 (99.1%) of the patients followed by chest pain in 214 (80%). The mean patient delay was 11 +/- 17 weeks (range: 1-78 weeks) with no significant difference between males and females, the mean system delay was 3 +/- 5 weeks (range: 0-39 weeks). The median patient, health systems and total delays were 42, 2, and 44 days respectively for all the patients. Marital status, being knowledgeable about TB, distance to clinic and where help is sought first had significant effect on patient delay. Patient delay is the major contributor to delay in diagnosis and initiation of treatment of PTB among our patients. Therefore TB control programmes in this region must emphasise patient education regarding symptoms of tuberculosis and timely health seeking behaviour.

  2. First trimester diagnosis of sirenomelia.

    Science.gov (United States)

    Van Keirsbilck, J; Cannie, M; Robrechts, C; de Ravel, T; Dymarkowski, S; Van den Bosch, T; Van Schoubroeck, D

    2006-08-01

    We present a case of sirenomelia diagnosed on a first trimester ultrasound at 10 weeks' gestation and confirmed on 3D-ultrasound and MRI. The pregnancy was terminated at 15 gestational weeks and the post-mortem examination, including RX and microscopy, is presented. The sirenomelia sequence is a rare and lethal anomaly characterized by fusion, rotation, hypotrophy or atrophy of the lower limbs and severe urogenital abnormalities leading to oligohydramnios in the second half of pregnancy. Our case illustrates that the diagnosis of sirenomelia can be reliably made in the first trimester.

  3. Evaluation of the efficiency of nested q-PCR in the detection of Mycobacterium tuberculosis complex directly from tuberculosis-suspected lesions in post-mortem macroscopic inspections of bovine carcasses slaughtered in the state of Mato Grosso, Brazil.

    Science.gov (United States)

    Carvalho, Ricardo César Tavares; Furlanetto, Leone Vinícius; Maruyama, Fernanda Harumy; Araújo, Cristina Pires de; Barros, Sílvia Letícia Bomfim; Ramos, Carlos Alberto do Nascimento; Dutra, Valéria; Araújo, Flábio Ribeiro de; Paschoalin, Vânia Margaret Flosi; Nakazato, Luciano; Figueiredo, Eduardo Eustáquio de Souza

    2015-08-01

    Bovine tuberculosis (BTB) is a zoonotic disease caused by Mycobacterium bovis, a member of the Mycobacterium tuberculosis complex (MTC). The quick and specific detection of this species is of extreme importance, since BTB may cause economic impacts, in addition to presenting imminent risks to human health. In the present study a nested real-time PCR test (nested q-PCR) was used in post-mortem evaluations to assess cattle carcasses with BTB-suspected lesions. A total of 41,193 cattle slaughtered in slaughterhouses located in the state of Mato Grosso, were examined. Of the examined animals, 198 (0.48%) showed BTB-suspected lesions. M. bovis was isolated in 1.5% (3/198) of the samples. Multiplex-PCR detected MTC in 7% (14/198) of the samples. The nested q-PCR test detected MTC in 28% (56/198) of the BTB-suspected lesions, demonstrating higher efficiency when compared to the multiplex-PCR and conventional microbiology. Nested q-PCR can therefore be used as a complementary test in the national program for control and eradication of bovine tuberculosis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Fatal Chromobacterium violaceum septicaemia in northern Laos, a modified oxidase test and post-mortem forensic family G6PD analysis

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    Mayxay Mayfong

    2009-07-01

    Full Text Available Abstract Background Chromobacterium violaceum is a Gram negative facultative anaerobic bacillus, found in soil and stagnant water, that usually has a violet pigmented appearance on agar culture. It is rarely described as a human pathogen, mostly from tropical and subtropical areas. Case presentation A 53 year-old farmer died with Chromobacterium violaceum septicemia in Laos. A modified oxidase method was used to demonstrate that this violacious organism was oxidase positive. Forensic analysis of the glucose-6-phosphate dehydrogenase genotypes of his family suggest that the deceased patient did not have this possible predisposing condition. Conclusion C. violaceum infection should be included in the differential diagnosis in patients presenting with community-acquired septicaemia in tropical and subtropical areas. The apparently neglected but simple modified oxidase test may be useful in the oxidase assessment of other violet-pigmented organisms or of those growing on violet coloured agar.

  5. Fatal Chromobacterium violaceum septicaemia in northern Laos, a modified oxidase test and post-mortem forensic family G6PD analysis.

    Science.gov (United States)

    Slesak, Günther; Douangdala, Phouvieng; Inthalad, Saythong; Silisouk, Joy; Vongsouvath, Manivanh; Sengduangphachanh, Amphonesavanh; Moore, Catrin E; Mayxay, Mayfong; Matsuoka, Hiroyuki; Newton, Paul N

    2009-07-29

    Chromobacterium violaceum is a Gram negative facultative anaerobic bacillus, found in soil and stagnant water, that usually has a violet pigmented appearance on agar culture. It is rarely described as a human pathogen, mostly from tropical and subtropical areas. A 53 year-old farmer died with Chromobacterium violaceum septicemia in Laos. A modified oxidase method was used to demonstrate that this violacious organism was oxidase positive. Forensic analysis of the glucose-6-phosphate dehydrogenase genotypes of his family suggest that the deceased patient did not have this possible predisposing condition. C. violaceum infection should be included in the differential diagnosis in patients presenting with community-acquired septicaemia in tropical and subtropical areas. The apparently neglected but simple modified oxidase test may be useful in the oxidase assessment of other violet-pigmented organisms or of those growing on violet coloured agar.

  6. Effect of longer health service provider delays on stage at diagnosis and mortality in symptomatic breast cancer.

    Science.gov (United States)

    Murchie, P; Raja, E A; Lee, A J; Brewster, D H; Campbell, N C; Gray, N M; Ritchie, L D; Robertson, R; Samuel, L

    2015-06-01

    This study explored whether longer provider delays (between first presentation and treatment) were associated with later stage and poorer survival in women with symptomatic breast cancer. Data from 850 women with symptomatic breast cancer were linked with the Scottish Cancer Registry; Death Registry; and hospital discharge dataset. Logistic regression and Cox survival analyses with restricted cubic splines explored relationships between provider delays, stage and survival, with sequential adjustment for patient and tumour factors. Although confidence intervals were wide in both adjusted analyses, those with the shortest provider delays had more advanced breast cancer at diagnosis. Beyond approximately 20 weeks, the trend suggests longer delays are associated with more advanced stage, but is not statistically significant. Those with symptomatic breast cancer and the shortest presentation to treatment time (within 4 weeks) had the poorest survival. Longer time to treatment was not significantly associated with worsening mortality. Poor prognosis patients with breast cancer are being triaged for rapid treatment with limited effect on outcome. Prolonged time to treatment does not appear to be strongly associated with poorer outcomes for patients with breast cancer, but the power of this study to assess the effect of very long delays (>25 weeks) was limited. Efforts to reduce waiting times are important from a quality of life perspective, but tumour biology may often be a more important determinant of stage at diagnosis and survival outcome. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. The outcome and the influencing factors of the age of onset in post-mortem of chronic bronchitis patients: a retrospective study

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    Zhu L

    2018-02-01

    Full Text Available Linyun Zhu,1 Zhenhua Ni,2 Xuming Luo,1 Zhuhua Zhang,1 Shiqiang Wang,1 Ziyu Meng,1 Xiandong Gu,1 Xiongbiao Wang1 1Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 2Central Laboratory, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China Purpose: Chronic bronchitis is thought to occur in elderly patients, and smoking seems to be an important risk factor. The outcomes related to the age of onset in patients with chronic bronchitis are still unclear. Patients and methods: A retrospective study was conducted on deceased patients whose diagnosis included bronchitis from 2010 to 2016. Patients were separated into two groups according to the age of onset (Group I, age ≤50 years old; Group II, age >50 years old. Information regarding disease course, smoking history, death age, number of admissions per year, Hugh Jones Index, and self-reported comorbidities of the patients was recorded. Results: The courses of chronic cough and sputum were 33.38±7.73 years and 14.44±8.60 years in Group I and Group II, respectively (p<0.05. The death ages of Group I and Group II were 77.65±7.87 years and 84.69±6.67 years, respectively (p<0.05. There was a significant negative correlation between the number of hospital admissions per year and the age of onset. The age of onset was negatively associated with daily smoking count (r=-0.210 and total smoking count (r=-0.146. In Group I, there were fewer cases of coronary heart disease (OR =0.41 [0.24–0.71], neurological diseases (OR =0.48 [0.24–0.97], and total comorbidities (OR =0.67 [0.54–0.85] than in Group II. Conclusion: Patients with early onset chronic bronchitis had a longer history, younger death age, poorer health status, and lower incidence of comorbidities. Keywords: chronic airway disease, comorbidity, Hugh Jones Index, smoking, hospital admission, disease course

  8. Diagnostic Dilemma in a Young Woman with Acute Headache: Delayed Diagnosis of Third Ventricular Colloid Cyst with Hydrocephalus

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    Jasem Y. Al-Hashel

    2015-01-01

    Full Text Available Objectives. To highlight the importance of early diagnosis of colloid cyst of the third ventricle and its early management. Clinical Presentation and Intervention. This is a young lady who presented with sudden onset headache. She attended a local clinic and also her area hospital. Her diagnosis was delayed several hours due to a diagnostic dilemma initially. No surgical intervention was tried since the patient developed early signs of brainstem coning by the time she was seen by neurosurgeon. Patient died after few days in spite of intensive ICU measures. Conclusion. Sudden onset headache in young adults should be looked at carefully. Early imaging is mandatory to prevent mortality.

  9. Durations and Delays in Care Seeking, Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai, India.

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    Nerges Mistry

    Full Text Available Timely diagnosis and treatment initiation are critical to reduce the chain of transmission of Tuberculosis (TB in places like Mumbai, where almost 60% of the inhabitants reside in overcrowded slums. This study documents the pathway from the onset of symptoms suggestive of TB to initiation of TB treatment and examines factors responsible for delay among uncomplicated pulmonary TB patients in Mumbai.A population-based retrospective survey was conducted in the slums of 15 high TB burden administrative wards to identify 153 self-reported TB patients. Subsequently in-depth interviews of 76 consenting patients that fit the inclusion criteria were undertaken using an open-ended interview schedule. Mean total, first care seeking, diagnosis and treatment initiation duration and delays were computed for new and retreatment patients. Patients showing defined delays were divided into outliers and non-outliers for all three delays using the median values.The mean duration for the total pathway was 65 days with 29% of patients being outliers. Importantly the mean duration of first care seeking was similar in new (24 days and retreatment patients (25 days. Diagnostic duration contributed to 55% of the total pathway largely in new patients. Treatment initiation was noted to be the least among the three durations with mean duration in retreatment patients twice that of new patients. Significantly more female patients experienced diagnostic delay. Major shift of patients from the private to public sector and non-allopaths to allopaths was observed, particularly for treatment initiation.Achieving positive behavioural changes in providers (especially non-allopaths and patients needs to be considered in TB control strategies. Specific attention is required in counselling of TB patients so that timely care seeking is effected at the time of relapse. Prioritizing improvement of environmental health in vulnerable locations and provision of point of care diagnostics

  10. Durations and Delays in Care Seeking, Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai, India.

    Science.gov (United States)

    Mistry, Nerges; Rangan, Sheela; Dholakia, Yatin; Lobo, Eunice; Shah, Shimoni; Patil, Akshaya

    2016-01-01

    Timely diagnosis and treatment initiation are critical to reduce the chain of transmission of Tuberculosis (TB) in places like Mumbai, where almost 60% of the inhabitants reside in overcrowded slums. This study documents the pathway from the onset of symptoms suggestive of TB to initiation of TB treatment and examines factors responsible for delay among uncomplicated pulmonary TB patients in Mumbai. A population-based retrospective survey was conducted in the slums of 15 high TB burden administrative wards to identify 153 self-reported TB patients. Subsequently in-depth interviews of 76 consenting patients that fit the inclusion criteria were undertaken using an open-ended interview schedule. Mean total, first care seeking, diagnosis and treatment initiation duration and delays were computed for new and retreatment patients. Patients showing defined delays were divided into outliers and non-outliers for all three delays using the median values. The mean duration for the total pathway was 65 days with 29% of patients being outliers. Importantly the mean duration of first care seeking was similar in new (24 days) and retreatment patients (25 days). Diagnostic duration contributed to 55% of the total pathway largely in new patients. Treatment initiation was noted to be the least among the three durations with mean duration in retreatment patients twice that of new patients. Significantly more female patients experienced diagnostic delay. Major shift of patients from the private to public sector and non-allopaths to allopaths was observed, particularly for treatment initiation. Achieving positive behavioural changes in providers (especially non-allopaths) and patients needs to be considered in TB control strategies. Specific attention is required in counselling of TB patients so that timely care seeking is effected at the time of relapse. Prioritizing improvement of environmental health in vulnerable locations and provision of point of care diagnostics would be

  11. Delay in Diagnosis of Testicular Cancer; A Need for Awareness Programs

    NARCIS (Netherlands)

    Ozturk, Cigdem; Fleer, Joke; Hoekstra, Harald J.; Hoekstra-Weebers, Josette E. H. M.

    2015-01-01

    Background Aim To gain insight into patient and doctor delay in testicular cancer (TC) and factors associated with delay. Materials and Methods Sixty of the 66 eligible men; median age 26 (range 17-45) years, diagnosed with TC at the University Medical Center Groningen completed a questionnaire on

  12. Isolation and determination of ivermectin in post-mortem and in vivo tissues of dung beetles using a continuous solid phase extraction method followed by LC-ESI+-MS/MS.

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    Antonio J Ortiz

    Full Text Available A new analytical method based on solvent extraction, followed by continuous solid-phase extraction (SPE clean-up using a polymeric sorbent, was demonstrated to be applicable for the detection of ivermectin in complex biological matrices of dung beetles (hemolymph, excreta or dry tissues using liquid chromatography combined with positive electrospray ionization tandem mass spectrometry (LC/ESI+-MS/MS. Using a signal-to-noise ratio of 3:1, the limit of detection (LOD in the insect matrices at trace levels was 0.01 ng g-1 and the limit of quantification (LOQ was 0.1 ng g-1. The proposed method was successfully used to quantitatively determine the levels of ivermectin in the analysis of small samples in in vivo and post mortem samples, demonstrating the usefulness for quantitative analyses that are focused on future pharmacokinetic and bioavailability studies in insects and the establishment of a new protocol to study the impact of ivermectin on non-target arthropods such as dung beetles and other insects that are related with the "dung community". Because satisfactory precision and accuracy values were obtained in both in vivo matrices, we suggest that the method can be consistently used for quantitative determinations that are focused on future pharmacokinetic and bioavailability studies in insects. Furthermore, this new analytical method was successfully applied to biological samples of dead dung beetles from the field suggesting that the method can be used to establish a new routine analysis of ivermectin residues in insect carcasses that is applied to complement typical mortality tests.

  13. Comparación de la técnica de Dennis con los hallazgos hepáticos post - mortem para el diagnóstico de la fasciolosis bovina

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    Alejandra Alvarez

    2009-10-01

    Full Text Available El presente estudio hace una comparación entre los resultados de la técnica de Dennis para diagnóstico de Fasciolosis bovina, frente a hallazgos post mortem, en hígados de bovinos faenados en la empresa Matadero de Tunja. Es un estudio experimental descriptivo, por cuanto expone los hallazgos en matadero frente a los arrojados por el método de Dennis. La población total de bovinos adultos fue de 2800, de los cuales se tomó una muestra de 139 animales. El muestreo se llevó a cabo durante el mes de febrero del año 2009. Los resultados indican que la técnica de Dennis no es lo suficientemente sensible para el diagnóstico de Fasciola hepática, por lo que se debe evaluar su uso rutinario.La técnica coprológica se fundamenta en el principio de sedimentación delos huevos, por lo tanto depende la salida de éstos en la materia fecal, lo que la hace poco efectiva para la detección del parásito. La razón de este estudiose sustenta en que la enfermedad se encuentra ampliamente distribuida en la región y en el país. Su diagnóstico se realiza rutinariamente mediante técnicas coprológicas aplicadas a los animales en los que se sospecha la enfermedad.

  14. SU-C-12A-04: Diagnostic Imaging Research Using Decedents as a Proxy for the Living: Are Radiation Dosimetry and Tissue Property Measurements Affected by Post-Mortem Changes?

    Energy Technology Data Exchange (ETDEWEB)

    Sandoval, D; Heintz, P [Department of Radiology University of New Mexico School of Medicine, Albuquerque, NM (United States); Weber, W; Melo, D [Lovelace Respiratory Research Institute, Albuquerque, New Mexico (United States); Adolphi, N; Hatch, P [Radiology-Pathology Center for Forensic Imaging, University of New Mexico School of Medicine, Albuquerque, New Mexico (United States)

    2014-06-01

    Purpose: Radiation dose (RD) from diagnostic imaging is a growing public health concern. Implanting dosimeters is a more accurate way to assess organ dose, relative to commonly used mathematical estimations. However, performing accurate dosimetry using live subjects is hindered by patient motion and safety considerations, which limit the RD and placement of implanted dosimeters. Performing multiple scans on the same subject would be the ideal way to assess the impact of dose reduction on image quality; however, performing multiple non-standard-of-care scans on live subjects for dosimetry and image quality measurements is generally prohibited by IRB committees. Our objective is to assess whether RD and tissue property (TP) measurements in post-mortem (PM) subjects are sufficiently similar to those in live subjects to justify the use of deceased subjects in future dosimetry and image quality studies. Methods: 4 MOSFET radiation dosimeters were placed enterically in each subject (2 sedated Rhesus Macaques) to measure the RD at 4 levels (carina, lung, heart, and liver) during CT scanning. The CT protocol was performed ante-mortem (AM) and 2 and 3 hours PM. For TP analysis, additional scans were taken at 24 hours PM. To compare AM and PM TP, regions-of-interest were drawn on selected organs and the average CT density with standard deviation (in units of HU) were taken; additionally, visual comparisons of images were made at each PM interval. Results: No significant difference was observed in 8 of 9 measurements comparing AM and PM RD. Only one measurement (liver of the first subject) showed a significant difference (7% lower on PM measurement), possibly due to subject re-positioning. Initial TP visual and quantitative analyses show little to no change PM. Conclusion: Our results suggest that realistic radiation dosimetry and image quality measurements based on tissue properties can be performed reliably on recently deceased subjects.

  15. Brain-derived neurotrophic factor (BDNF) and neurotrophin 3 (NT3) levels in post-mortem brain tissue from patients with depression compared to healthy individuals - a proof of concept study.

    Science.gov (United States)

    Sheldrick, A; Camara, S; Ilieva, M; Riederer, P; Michel, T M

    2017-10-01

    The neurotrophic factors (NTF) hypothesis of depression was postulated nearly a decade ago and is nowadays widely acknowledged. Previous reports suggest that cerebral concentrations of NTF may be reduced in suicide victims who received minimal or no antidepressant pharmacotherapy. Recent evidence suggests that antidepressant treatment may improve or normalise cerebral concentrations of neurotrophic factors. Therefore, we examined the concentration of brain-derived neurotrophic factor (BDNF) and neurotrophin 3 (NT3) in different brain regions (cortex, cingulate gyrus, thalamus, hippocampus, putamen and nucleus caudatus) of 21 individuals - 7 patients of which 4 patients with major depressive disorder (MDD) and overall age 86.8±5 years who received antidepressant pharmacotherapy (selective serotonin re-uptake inhibitors [SSRI]; tricyclic antidepressants [TCA]), 3 patients with MDD without antidepressant treatment and overall age 84.3±5 years versus 14 unaffected subjects at age 70.3±13.8. We detected significant elevation of BDNF (parietal cortex) and NT3 (parietal, temporal and occipital cortex, cingulate gyrus, thalamus, putamen and nucleus caudatus regions) in MDD patients who received antidepressant medication compared to MDD untreated patients and controls. Moreover, we detected a significant decrease of NT3 levels in the parietal cortex of patients suffering from MDD non-treated patients without treatment compared to healthy individuals. Although the limited statistical power due to the small sample size in this proof of concept study corroborates data from previous studies, which show that treatment with antidepressants mediates alterations in neuroplasticity via the action of NTF. However, more research using post-mortem brain tissue with larger samples needs to be carried out as well as longitudinal studies to further verify these results. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  16. Collagen degradation as a possibility to determine the post-mortem interval (PMI) of animal bones: a validation study referring to an original study of Boaks et al. (2014).

    Science.gov (United States)

    Jellinghaus, Katharina; Hachmann, Carolin; Hoeland, Katharina; Bohnert, Michael; Wittwer-Backofen, Ursula

    2018-05-01

    Estimation of the post-mortem interval (PMI) of unknown skeletal remains is a common forensic task. Boaks and colleagues demonstrated a new method for PMI estimation in showing a reduction of the collagen to non-collagen content (Co/NCo ratio) in porcine bones after a PMI of 12 months using the Sirius Red/Fast Green Collagen Staining Kit from Chondrex in 2014 (Boaks et al. Forensic Sci Int 240: 104-110, 2014). The aim of our study was to reproduce this method and to investigate if the method could be used for forensic issues. Sixteen fresh porcine bones were placed in prepared boxes where they were treated regularly with distilled water or with water from hay infusions. For determining the Co/NCo ratio, we used the Sirius Red/Fast Green Collagen Staining Kit from Chondrex, which stains collagenous (Co) proteins red and non-collagenous (NCo) proteins green Chondrex Inc. (2008). After a PMI of 1-3 months, an analysis of porcine bone thin sections was performed on the one hand with spectrophotometry, on the other hand with stereomicroscopy. Using spectrophotometry, we go low and partially negative Co/NCo ratios which were up to 100-fold lower than the results we expected to get. The data we got by stereomicroscopy and calculating the Co/NCo ratio from extracting the red and green content with the software MATLAB and so calculating the Co/NCo ratio showed a correlation between PMI and the Co/NCo ratio in the porcine bone samples. Regular addition of distilled water or water from a hay infusion did not produce any significant differences so that an increased presence of microorganisms had obviously no influence on collagen degradation.

  17. Gorlin syndrome: Importance of clinical signs and danger of delayed diagnosis - A case report with eight years follow-up

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    Erica Dorigatti de-Avila

    2015-02-01

    Full Text Available Nevoid basal cell carcinoma (NBCCS or Gorlin-Goltz syndrome (GS is a multidisciplinary problem, the early diagnosis of which allows secondary prophylaxis that follows an appropriate regimen to delay progression of the syndrome. The aim of this study was to present a case of delayed diagnosis of GS in a young patient who received multidisciplinary treatment 5 years after onset. The patient presented for evaluation with painless swelling of the left maxilla. Histological examination confirmed the diagnosis of a keratocyst odontogenic tumor (KOT that was enucleated. On presentation, the patient's symptoms and clinical signs were not related to complications of GS, and the possibility of GS was initially rejected, as he did not have a family history of the syndrome. Four years after the first surgery to remove the lesion, the patient came to our clinic with a brown, pigmented lesion. Computed tomography revealed ectopic lamellar calcification of the falx cerebri, which was the conclusive factor for the diagnosis of GS. It is important that clinicians recognize the clinical signs of GS, which mainly manifests itself as multiple basal cell carcinomas in the skin. [Arch Clin Exp Surg 2015; 4(1.000: 49-53

  18. Initial Misdiagnosis of Proximal Pancreatic Adenocarcinoma Is Associated with Delay in Diagnosis and Advanced Stage at Presentation.

    Science.gov (United States)

    Swords, Douglas S; Mone, Mary C; Zhang, Chong; Presson, Angela P; Mulvihill, Sean J; Scaife, Courtney L

    2015-10-01

    Delay in diagnosis of pancreatic ductal adenocarcinoma (PDAC) is associated with decreased survival. The effect of an initial misdiagnosis on delay in diagnosis and stage of PDAC is unknown. This study is a retrospective review (2000-2010) from a University-based cancer center of new diagnoses of proximal PDAC. Of 313 patients, 98 (31.3 %) had an initial misdiagnosis. Misdiagnosed patients were younger, 62.8 ± 12.6 vs. 68.0 ± 10.1 (p < 0.001). The most common initial misdiagnoses were: gallbladder disease, gastroesophageal reflux disease, and peptic ulcer disease. After excluding patients with prior cholecystectomy, 14.2 % were misdiagnosed with gallbladder disease and underwent cholecystectomy before PDAC diagnosis. Misdiagnosed patients had higher rates of abdominal pain (p < 0.001), weight loss (p = 0.04), and acute pancreatitis (p < 0.001) and lower rate of jaundice (p < 0.001). Median time between symptoms to PDAC diagnosis was longer in misdiagnosed: 4.2 months vs. 1.4 (p < 0.001). Median time from contact with medical provider to axial imaging was longer in misdiagnosed (p < 0.001). Rate of stages III-IV disease at diagnosis was higher in misdiagnosed: 61.2 vs. 43.7 % (p = 0.004), with a 1.4 (95 % confidence interval (CI), 1.12-1.74) higher risk of stages III-IV disease at diagnosis; however, there was no difference in median overall survival in misdiagnosed patients (9.6 months in misdiagnosed vs. 10.3 months in correctly diagnosed, p = 0.69). Initial misdiagnosis of patients with proximal PDAC is associated with delay in diagnosis and higher risk of locally advanced or advanced disease at time of PDAC diagnosis.

  19. Fatal air embolism during endoscopic retrograde cholangiopancreatography (ERCP): An 'impossible' diagnosis for the forensic pathologist.

    Science.gov (United States)

    Marchesi, Matteo; Battistini, Alessio; Pellegrinelli, Moira; Gentile, Guendalina; Zoja, Riccardo

    2016-01-01

    Fatal air embolism related to endoscopic retrograde cholangiopancreatography is a very rare phenomenon. The authors describe the case of a 51-year-old female patient who developed this mortal complication; a computed tomography (CT) examination was performed in articulo mortis by the physicians. Autopsy was unreliable because of bizarre post-mortem changes (reabsorption of intra-cardiac gas vs. conservation of intra-cranial gas) and a lack of strong diagnostic value of histological findings. The right diagnosis was possible thanks only to the CT examination that permitted the assumption of this possible cause of death before the autopsy and to prepare the necessary procedures to recognise and probe air embolism. This case exemplifies how early post-mortem imaging can be crucial to avoid a wrong diagnosis. © The Author(s) 2015.

  20. Juridical aspects of post mortem adoption

    Directory of Open Access Journals (Sweden)

    Sergio Rodrigo Martinez

    2015-12-01

    Full Text Available The legislature, with the enactment of the Statute of Children and Adolescents, now provides the named posthumous adoption, allowing the death of the adopter, in the course of the procedure does not generate the extinction pleaded adoption. Has the purpose to show that, notwithstanding the absence of such law, the construction of new adopters and adopted by families are recognized, since permeated the socially demonstrated affection, even in passing the death of the person occurs before you have to start legal formalization of the adoption petition, thus characterizing the figure of posthumous adoption without prior judicial manifestation.

  1. Association of Previous Clinical Breast Examination With Reduced Delays and Earlier-Stage Breast Cancer Diagnosis Among Women in Peru.

    Science.gov (United States)

    Romanoff, Anya; Constant, Tara Hayes; Johnson, Kay M; Guadiamos, Manuel Cedano; Vega, Ana María Burga; Zunt, Joseph; Anderson, Benjamin O

    2017-11-01

    Mammographic screening is impractical in most of the world where breast cancers are first identified based on clinical signs and symptoms. Clinical breast examination may improve early diagnosis directly by finding breast cancers at earlier stages or indirectly by heightening women's awareness of breast health concerns. To investigate factors that influence time to presentation and stage at diagnosis among patients with breast cancer to determine whether history of previous clinical breast examination is associated with earlier presentation and/or earlier cancer stage at diagnosis. In this cross-sectional analysis of individual patient interviews using a validated Breast Cancer Delay Questionnaire, 113 (71.1%) of 159 women with breast cancer treated at a federally funded tertiary care referral cancer center in Trujillo, Peru, from February 1 through May 31, 2015, were studied. Method of breast cancer detection and factors that influence time to and stage at diagnosis. Of 113 women with diagnosed cancer (mean [SD] age, 54 [10.8] years; age range, 32-82 years), 105 (92.9%) had self-detected disease. Of the 93 women for whom stage was documented, 45 (48.4%) were diagnosed with early-stage disease (American Joint Committee on Cancer [AJCC] stage 0, I, or II), and 48 (51.6%) were diagnosed with late-stage disease (AJCC stage III or IV). Mean (SD) total delay from symptom onset to initiation of treatment was 407 (665) days because of patient (mean [SD], 198 [449] days) and health care system (mean [SD], 241 [556] days) delay. Fifty-two women (46.0%) had a history of clinical breast examination, and 23 (20.4%) had undergone previous mammography. Women who underwent a previous clinical breast examination were more likely to have shorter delays from symptom development to presentation compared with women who had never undergone a previous clinical breast examination (odds ratio, 2.92; 95% CI, 1.30-6.60; P = .01). Women diagnosed with shorter patient delay were more

  2. Rolling bearing fault diagnosis based on time-delayed feedback monostable stochastic resonance and adaptive minimum entropy deconvolution

    Science.gov (United States)

    Li, Jimeng; Li, Ming; Zhang, Jinfeng

    2017-08-01

    Rolling bearings are the key components in the modern machinery, and tough operation environments often make them prone to failure. However, due to the influence of the transmission path and background noise, the useful feature information relevant to the bearing fault contained in the vibration signals is weak, which makes it difficult to identify the fault symptom of rolling bearings in time. Therefore, the paper proposes a novel weak signal detection method based on time-delayed feedback monostable stochastic resonance (TFMSR) system and adaptive minimum entropy deconvolution (MED) to realize the fault diagnosis of rolling bearings. The MED method is employed to preprocess the vibration signals, which can deconvolve the effect of transmission path and clarify the defect-induced impulses. And a modified power spectrum kurtosis (MPSK) index is constructed to realize the adaptive selection of filter length in the MED algorithm. By introducing the time-delayed feedback item in to an over-damped monostable system, the TFMSR method can effectively utilize the historical information of input signal to enhance the periodicity of SR output, which is beneficial to the detection of periodic signal. Furthermore, the influence of time delay and feedback intensity on the SR phenomenon is analyzed, and by selecting appropriate time delay, feedback intensity and re-scaling ratio with genetic algorithm, the SR can be produced to realize the resonance detection of weak signal. The combination of the adaptive MED (AMED) method and TFMSR method is conducive to extracting the feature information from strong background noise and realizing the fault diagnosis of rolling bearings. Finally, some experiments and engineering application are performed to evaluate the effectiveness of the proposed AMED-TFMSR method in comparison with a traditional bistable SR method.

  3. Limited value of delayed radiothallium image in the diagnosis of nodular goiter

    International Nuclear Information System (INIS)

    Misaki, Takashi; Yagi, Kanji; Dokoh, Shigeharu; Koh, Toshikiyo; Shimbo, Shin-ichiro

    1991-01-01

    To test whether delayed thallium image can improve the diagnostic accuracy of thyroid tumor, we have reviewed 35 patients with cold nodules of proven histopathology. Early and delayed images were taken 10-20 min and 3-4 hr postinjection, respectively. In this study, a thyroid nodule was interpreted as malignant if it had normal or increased uptake on early scan and more residual radioactivity than paranodular tissue on delayed scan. In the eighteen patients who had carcinoma, a disappointing 44% false negative rate was observed. No significant difference was seen between retention-positive and negative cases in tumor size or histological type of cancer. Nor could any demographic bias explain the low sensitivity. Of the six false negatives, macroscopic cystic degeneration was seen in two cases, but tumors in the other four were grossly solid. Considering the histological heterogeneity often seen within a thyroid tumor, the portion with increased retention of radiothallium may be too small to be detected in the false negative cases. Furthermore, 3 false positive readings were obtained in 17 patients with benign conditions. We conclude that the contribution of the delayed thallium image was quite limited in predicting or ruling out malignancy in nodular goiters. (author)

  4. Mycobacterium marinum infections of the distal upper extremities: clinical course and imaging findings in two cases with delayed diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Amrami, K.K.; Sundaram, M. [Dept. of Radiology, Mayo Clinic, SW, Rochester, MN (United States); Shin, A.Y.; Bishop, A.T. [Dept. of Orthopedics, Mayo Clinic, Rochester, MN (United States)

    2003-09-01

    Mycobacterium marinum infections cause tenosynovitis of the distal upper extremities and develop as a consequence of skin abrasions acquired in contaminated water. We report on two patients whose MR imaging studies showed tenosynovitis of the distal upper extremity secondary to M. marinum. In one patient sequential MR imaging showed development of bony erosions. Appropriate treatment was delayed in both patients because the diagnosis was not considered. We report on and discuss the clinical course and MR imaging findings in two patients with M. marinum infection. (orig.)

  5. Mycobacterium marinum infections of the distal upper extremities: clinical course and imaging findings in two cases with delayed diagnosis

    International Nuclear Information System (INIS)

    Amrami, K.K.; Sundaram, M.; Shin, A.Y.; Bishop, A.T.

    2003-01-01

    Mycobacterium marinum infections cause tenosynovitis of the distal upper extremities and develop as a consequence of skin abrasions acquired in contaminated water. We report on two patients whose MR imaging studies showed tenosynovitis of the distal upper extremity secondary to M. marinum. In one patient sequential MR imaging showed development of bony erosions. Appropriate treatment was delayed in both patients because the diagnosis was not considered. We report on and discuss the clinical course and MR imaging findings in two patients with M. marinum infection. (orig.)

  6. Placas de refratários aluminosos do sistema de válvula gaveta de panelas de aciaria: análise post mortem da degradação química

    Directory of Open Access Journals (Sweden)

    B. B. de Sousa

    Full Text Available Resumo Em uma aciaria, os recipientes que comportam o aço líquido, tais como o forno e a panela de aciaria, são revestidos com materiais refratários especiais para alta temperatura e elevada resistência ao desgaste. O custo desses materiais é alto e, portanto, almeja-se aumentar sua vida útil sem afetar seu desempenho. Este trabalho teve o objetivo de investigar as transformações que ocorrem no material refratário aluminoso de placas de válvula gaveta de panela de aciaria. Para tanto, a região das placas post mortem que entraram em contato com o material líquido a alta temperatura foi caracterizada por meio de análise visual e análises de composição e estrutura através das técnicas de fluorescência de raios X, difração de raios X e análise de microestrutura por microscopia eletrônica de varredura com espectroscopia por dispersão em energia. Como resultado, têm-se contribuições sobre o processo de corrosão química proporcionada pelo contato de escórias residuais com o canal das placas da válvula gaveta. Constatou-se a presença de materiais com alto teor de Ca e compostos por fases como mervinita e guelenita, características de escória, aderidos às placas. Ao mesmo tempo, foi possível estabelecer que a espessura de interação entre o material aderido e a superfície da placa variou entre 0,4 e 1,2 mm. Assim, quando associada à erosão pelo fluxo de aço, a corrosão química decorrente do contato com a escória tem o potencial de intensificar o desgaste da placa refratária.

  7. Interspecies somatic cell nuclear transfer in Asiatic cheetah using nuclei derived from post-mortem frozen tissue in absence of cryo-protectant and in vitro matured domestic cat oocytes.

    Science.gov (United States)

    Moulavi, F; Hosseini, S M; Tanhaie-Vash, N; Ostadhosseini, S; Hosseini, S H; Hajinasrollah, M; Asghari, M H; Gourabi, H; Shahverdi, A; Vosough, A D; Nasr-Esfahani, M H

    2017-03-01

    Recent accomplishments in the field of somatic cell nuclear transfer (SCNT) hold tremendous promise to prevent rapid loss of animal genetic resources using ex situ conservation technology. Most of SCNT studies use viable cells for nuclear transfer into recipient oocytes. However, preparation of live cells in extreme circumstances, in which post-mortem material of endangered/rare animals is improperly retained frozen, is difficult, if not impossible. This study investigated the possibility of interspecies-SCNT (iSCNT) in Asiatic cheetah (Acinonyx jubatus venaticus), a critically endangered subspecies, using nuclei derived from frozen tissue in absence of cryo-protectant at -20 °C and in vitro matured domestic cat oocytes. No cells growth was detected in primary culture of skin and tendon pieces or following culture of singled cells prepared by enzymatic digestion. Furthermore, no live cells were detected following differential viable staining and almost all cells had ruptured membrane. Therefore, direct injection of donor nuclei into enucleated cat oocytes matured in vitro was carried out for SCNT experiments. Early signs of nuclear remodeling were observed as early as 2 h post-iSCNT and significantly increased at 4 h post-iSCNT. The percentages of iSCNT reconstructs that cleaved and developed to 4-16 cell and morula stages were 32.3 ± 7.3, 18.2 ± 9.8 and 5.9 ± 4.3%, respectively. However, none of the iSCNT reconstructs developed to the blastocyst stage. When domestic cat somatic and oocytes were used for control SCNT and parthenogenetic activation, the respective percentages of oocytes that cleaved (51.3 ± 13.9 and 77.3 ± 4.0%) and further developed to the blastocyst stage (11.3 ± 3.3 and 16.8 ± 3.8%) were comparable. In summary, this study demonstrated that enucleated cat oocytes can partially remodel and reactivate non-viable nuclei of Asiatic cheetah and support its reprogramming back to the embryonic stage. To our knowledge, this is

  8. [The role of endotracheal aspiration in the diagnosis of ventilator associated pneumonia].

    Science.gov (United States)

    Gürgün, Alev; Korkmaz Ekren, Pervin; Bacakoğlu, Feza; Başoğlu, Ozen Kaçmaz; Dirican, Nigar; Aydemir, Şöhret; Nart, Deniz; Sayıner, Abdullah

    2013-01-01

    Ventilator associated pneumonia (VAP) is one of the most important causes of mortality in patients treated with invasive mechanical ventilation (IMV) in intensive care unit (ICU). Microbiological examinations are required as clinical and radiological findings are usually insufficient in the diagnosis. Twenty four patients who were receiving IMV because of respiratory failure, had a Clinical Pulmonary Infection Score (CPIS) of ≥ 6 in the follow-up and died with the suspicion of VAP were enrolled in our study. Six patients were excluded as post-mortem biopsy could not be performed. The patients who had pre-mortem CPIS ≥ 6, in whom a causative organism was identified from the culture of post-mortem lung biopsy and/or histopathological examination of lung biopsy was compatible with pneumonia were diagnosed as VAP. In the 18 patients in whom a post-mortem lung biopsy was performed, quantitative culture results of endotracheal aspirate performed 48 hours prior to death were compared with microbiological and histopathological results of post-mortem lung biopsy specimens, and the role of endotracheal aspirate in the diagnosis of VAP was evaluated retrospectively. Out of 18 patients (12 men, mean age 67.0 ± 13.0 years) included in the study, 11 (61.1%) were diagnosed as VAP. The quantitative culture of endotracheal aspirate was positive in 9 (81.8%) out of 11 patients diagnosed as VAP. The sensitivity, specificity, positive and negative predictive values of endotracheal aspirate culture for identifying VAP were found to be 81.8%, 14.3%, 60.0% and 33.3%, respectively. Our study shown that quantitative culture of endotracheal aspirate is a practical and reliable method that can be used for the diagnosis of VAP in patients receiving IMV in ICU and having CPIS ≥ 6.

  9. Delayed diagnosis of a heterotopic pregnancy as a cause of acute abdomen: A case report

    Directory of Open Access Journals (Sweden)

    Fatma Turkan Ayan

    2013-09-01

    Full Text Available Introduction: Heterotopic pregnancy is a life threating condition of intrauterine and extrauterine gestations which occur at the same time. We report a delayed diagnosed case of heterotopic pregnancy. Case: A 31 year-old primigravida was referred to our Emergency Gynaecology Service complicated by acute abdomen. She had been treated with clomiphene citrate and on admission intrauterine a missed abortus of about 8 weeks complicated by a large subchorionic hematoma was detected. Emergency laparotomy was performed because of diffuse intra-abdominal haemorrhage. A right-sided ectopic focus was recognized and excised, and dilatation - curettage was performed. Coclusion: Delay in diagnosing the condition can be fatal to both the mother and the intrauterine fetus. [J Contemp Med 2013; 3(3.000: 207-208

  10. Delay and poor diagnosis of Down syndrome in KwaZulu-Natal ...

    African Journals Online (AJOL)

    Down syndrome (DS) is the most common chromosomal disorder in newborns, with a birth ... has been undertaken on DS in black African children in SA, and. Christianson's[3] ..... in low- and middle-income countries.[15] If diagnosis, which is ...

  11. Unexplained weight loss in an elderly patient. Delayed diagnosis of thyrotoxicosis

    International Nuclear Information System (INIS)

    Weiss, R.J.

    1989-01-01

    Because the presenting symptoms of hyperthyroidism are often misleading in elderly patients, diagnosis depends on a high degree of clinical suspicion. The presence of unexplained weight loss, atrial fibrillation, or heart failure (especially in a patient without a history of heart problems) justifies testing for thyrotoxicosis

  12. Unexplained weight loss in an elderly patient. Delayed diagnosis of thyrotoxicosis

    Energy Technology Data Exchange (ETDEWEB)

    Weiss, R.J. (Medical College of Pennsylvania, Philadelphia (USA))

    1989-11-01

    Because the presenting symptoms of hyperthyroidism are often misleading in elderly patients, diagnosis depends on a high degree of clinical suspicion. The presence of unexplained weight loss, atrial fibrillation, or heart failure (especially in a patient without a history of heart problems) justifies testing for thyrotoxicosis.

  13. Delayed Diagnosis and Treatment among Children with Autism Who Experience Adversity

    Science.gov (United States)

    Berg, Kristin L.; Acharya, Kruti; Shiu, Cheng-Shi; Msall, Michael E.

    2018-01-01

    The effects of family adverse childhood experiences (ACEs) on timing of ASD diagnoses and receipt of therapies were measured using data from the 2011-2012 National Survey of Children's Health. Parametric accelerated failure time models estimated the relationship between family ACEs and both timing of ASD diagnosis and receipt of therapies among US…

  14. Transfer between hospitals as a predictor of delay in diagnosis and treatment of patients with Non-Small Cell Lung Cancer

    DEFF Research Database (Denmark)

    Iachina, Maria; Jakobsen, Erik; Fallesen, Anne Kudsk

    2017-01-01

    with treatment facilities during the care pathway. We wanted to investigate whether this organizational set-up influenced the time that patients wait for the diagnosis and treatment. Therefore, the objective of this study was to uncover the impact of transfer between hospitals on the delay in the diagnosis......BACKGROUND: Lung cancer is the second most frequent cancer diagnosis in Denmark. Although improved during the last decade, the prognosis of lung cancer is still poor with an overall 5-year survival rate of approximately 12%. Delay in diagnosis and treatment of lung cancer has been suggested...... and incomplete data on the dates of referral, diagnosis and treatment were excluded. RESULTS: A total of 11 273 patients were included for further analyses. Transfer patients waited longer for treatment after the diagnosis, (Hazard ratio (HR) 0.81 (0.68-0.96)) and in total time from referral to treatment (HR 0...

  15. Neurodevelopmental Delay Diagnosis Rates Are Increased in a Region with Aerial Pesticide Application

    Directory of Open Access Journals (Sweden)

    Steven D. Hicks

    2017-05-01

    Full Text Available A number of studies have implicated pesticides in childhood developmental delay (DD and autism spectrum disorder (ASD. The influence of the route of pesticide exposure on neurodevelopmental delay is not well defined. To study this factor, we examined ASD/DD diagnoses rates in an area near our regional medical center that employs yearly aerial pyrethroid pesticide applications to combat mosquito-borne encephalitis. The aim of this study was to determine if areas with aerial pesticide exposure had higher rates of ASD/DD diagnoses. This regional study identified higher rates of ASD/DD diagnoses in an area with aerial pesticides application. Zip codes with aerial pyrethroid exposure were 37% more likely to have higher rates of ASD/DD (adjusted RR = 1.37, 95% CI = 1.06–1.78, p = 0.02. A Poisson regression model controlling for regional characteristics (poverty, pesticide use, population density, and distance to medical center, subject characteristics (race and sex, and local birth characteristics (prematurity, low birthweight, and birth rates identified a significant relationship between aerial pesticide use and ASD/DD rates. The relationship between pesticide application and human neurodevelopment deserves additional study to develop safe and effective methods of mosquito prevention, particularly as communities develop plans for Zika virus control.

  16. Neurodevelopmental Delay Diagnosis Rates Are Increased in a Region with Aerial Pesticide Application.

    Science.gov (United States)

    Hicks, Steven D; Wang, Ming; Fry, Katherine; Doraiswamy, Vignesh; Wohlford, Eric M

    2017-01-01

    A number of studies have implicated pesticides in childhood developmental delay (DD) and autism spectrum disorder (ASD). The influence of the route of pesticide exposure on neurodevelopmental delay is not well defined. To study this factor, we examined ASD/DD diagnoses rates in an area near our regional medical center that employs yearly aerial pyrethroid pesticide applications to combat mosquito-borne encephalitis. The aim of this study was to determine if areas with aerial pesticide exposure had higher rates of ASD/DD diagnoses. This regional study identified higher rates of ASD/DD diagnoses in an area with aerial pesticides application. Zip codes with aerial pyrethroid exposure were 37% more likely to have higher rates of ASD/DD (adjusted RR = 1.37, 95% CI = 1.06-1.78, p  = 0.02). A Poisson regression model controlling for regional characteristics (poverty, pesticide use, population density, and distance to medical center), subject characteristics (race and sex), and local birth characteristics (prematurity, low birthweight, and birth rates) identified a significant relationship between aerial pesticide use and ASD/DD rates. The relationship between pesticide application and human neurodevelopment deserves additional study to develop safe and effective methods of mosquito prevention, particularly as communities develop plans for Zika virus control.

  17. Delayed Diagnosis of Gorlin-Goltz Syndrome: The Importance of the Multidisciplinary Approach.

    Science.gov (United States)

    Figueira, Jéssica Araújo; Batista, Fábio Roberto de Souza; Rosso, Karina; Veltrini, Vanessa Cristina; Pavan, Angelo José

    2018-03-08

    Gorlin-Goltz syndrome (GGS), also known as nevoid basal cell carcinoma syndrome, is an autosomal dominant inherited disorder with high penetrance and variable expressivity. The classic triad originally described by Gorlin and Goltz in 1960 is composed of multiple nevoid basal cell carcinomas (NBCCs), odontogenic keratocysts (OKCs) in the jaws and bifid ribs. in 1977, this triad was modified by Rayner et al, and to GGS diagnosis, the OKCs had to appear in combination with calcification of the cerebellar falx or palmar and plantar pits. It may occur that although GGS syndrome is a well-known condition, only the specific symptom could be observed by different specialists. Therefore, the patient cannot be placed in an always complex clinical panel. The authors introduce an example in this report. In the present case, the patient had NBCCs, OKCs, and probably other signs of GGS since 1998, and has been treated for this conditions separated, without a diagnosis of a syndromic condition. A 54-year-old white woman was referred to the oral medicine service due to cyst located in the right mandibular body. She had history of skin cancer and undergone surgeries and radiotherapies for the lesions treatment, scars on the skin face due to the lesions removed, and a new ulcerated lesion on the back of was diagnosed. In addition, the patient presented frontal and parietal bossing leading to increased cranial circumference, hypertelorism, strabismus, broad base, and mandibular prognathism. To the image examination, skull radiography revealed calcification of the falx cerebri; on chest X-ray bifid rib was observed and spine radiography showed vertebral osteophytes. Panoramic radiograph showed a well-defined bilocular radiolucent image located in posterior and anterior mandibular region. The whole elements induced us to investigate the patient's past medical history, which revealed that since 1998 had the diagnosis of NBCC and OKC. A multidisciplinary approach becomes necessary for

  18. Incontinence due to an infrasphincteric ectopic ureter: why the delay in diagnosis and what the radiologist can do about it

    Energy Technology Data Exchange (ETDEWEB)

    Carrico, C.; Lebowitz, R.L. [Children`s Hospital Medical Center, Boston, MA (United States). Dept. of Radiology

    1998-12-01

    Purpose. To determine (1) the reasons for the frequently long delay in the diagnosis of an infrasphincteric ectopic ureter in girls, and (2) what role the radiologist can play in decreasing the delay. Materials and methods. Twelve girls were referred to our hospital from June 1994 until April 1997 for evaluation of constant urinary dribbling and/or vaginal discharge. Available imaging studies, radiology reports, and clinic notes were reviewed. Results. Mean age at the time of diagnosis was 6 years 7 months (range 2 years 10 months to 11 years 11 months). Mean delay until diagnosis after presentation was 2 years 5 months. Excluding the one girl whose ectopic ureter was diagnosed while she was still in diapers, mean age at the time of the first parental ``complaint`` was 4 years 9 months. The significance of the classic history of constant urinary dribbling was not recognized by physicians in 7 girls for 4 months to 7 years 10 months after presentation. Physical exam was not meticulously performed, as the ectopic orifice was visible in 8 of 12 girls. Imaging studies were ineffectively utilized: no imaging was done (for 2 years in 2 girls), inappropriate studies were done (ultrasound and voiding cystourethrography) and were misleading, studies were called normal when they were not (ultrasound and excretory urography), or perinatal imaging led to the incorrect assumption of a congenitally absent kidney in one girl and a multicystic dysplastic kidney in another. Excretory urography (EU) was diagnostic in all 10 girls with a duplex kidney, and computed tomography (CT) was supportive in 2 with a dysplastic kidney. CT was an adjunct in 3 girls; a Tc-99m-dimercaptosuccinic acid (DMSA) scan was needed in 2. Conclusion. The classic history of constant urinary dribbling in a successfully toilet-trained girl should immediately lead to an imaging search for the portion of kidney (or entire kidney) drained by an infrasphincteric ectopic ureter. EU should usually be the first

  19. Incontinence due to an infrasphincteric ectopic ureter: why the delay in diagnosis and what the radiologist can do about it

    International Nuclear Information System (INIS)

    Carrico, C.; Lebowitz, R.L.

    1998-01-01

    Purpose. To determine (1) the reasons for the frequently long delay in the diagnosis of an infrasphincteric ectopic ureter in girls, and (2) what role the radiologist can play in decreasing the delay. Materials and methods. Twelve girls were referred to our hospital from June 1994 until April 1997 for evaluation of constant urinary dribbling and/or vaginal discharge. Available imaging studies, radiology reports, and clinic notes were reviewed. Results. Mean age at the time of diagnosis was 6 years 7 months (range 2 years 10 months to 11 years 11 months). Mean delay until diagnosis after presentation was 2 years 5 months. Excluding the one girl whose ectopic ureter was diagnosed while she was still in diapers, mean age at the time of the first parental ''complaint'' was 4 years 9 months. The significance of the classic history of constant urinary dribbling was not recognized by physicians in 7 girls for 4 months to 7 years 10 months after presentation. Physical exam was not meticulously performed, as the ectopic orifice was visible in 8 of 12 girls. Imaging studies were ineffectively utilized: no imaging was done (for 2 years in 2 girls), inappropriate studies were done (ultrasound and voiding cystourethrography) and were misleading, studies were called normal when they were not (ultrasound and excretory urography), or perinatal imaging led to the incorrect assumption of a congenitally absent kidney in one girl and a multicystic dysplastic kidney in another. Excretory urography (EU) was diagnostic in all 10 girls with a duplex kidney, and computed tomography (CT) was supportive in 2 with a dysplastic kidney. CT was an adjunct in 3 girls; a Tc-99m-dimercaptosuccinic acid (DMSA) scan was needed in 2. Conclusion. The classic history of constant urinary dribbling in a successfully toilet-trained girl should immediately lead to an imaging search for the portion of kidney (or entire kidney) drained by an infrasphincteric ectopic ureter. EU should usually be the first

  20. Clinical associations with a placental diagnosis of delayed villous maturation: a retrospective study.

    LENUS (Irish Health Repository)

    Higgins, Mary

    2015-05-20

    Delayed villous maturation (DVM) is a spectrum of placental disease characterized by decreased tertiary villus formation, reduced vasculosyncytial membrane formation, and, in its more severe forms, increased large bullous villi. In some series it has been associated with an increased risk of stillbirth in the late third trimester, but overall there are few data on its significance. The aim of this study was to assess perinatal factors associated with, and the clinical significance of, the finding of DVM on placental histology. This was a retrospective study investigating all pregnancies with DVM diagnosed on placental histology in a tertiary level unit between December 2001 and August 2006. Over a 6-year period, 2915 placentas were triaged for histopathological assessment, representing 6.1% of all 48 054 deliveries in this time period. One hundred ninety (6.3%) of these selected cases showed DVM. Fifteen placentas from infants with less than 34 completed weeks of gestation were excluded, leaving 175 for further analysis. When compared with controls matched for gestation and delivering within the same time period (n  =  175), DVM was significantly associated with pregestational diabetes (8% vs 2.8%, P < .05; relative risk 2.8 [95% confidence interval 1.03-7.6]), gestational diabetes (8.6% vs 3.4%, P < 0.05; relative risk 2.5 [95% confidence interval 0.99-6.3]), and prenatal or intrapartum intrauterine death (8.6% vs 0%, P < 0.05). Delayed villous maturation is associated with both gestational and pregestational diabetes mellitus and with perinatal death.

  1. A novel non-rapid-eye movement and rapid-eye-movement parasomnia with sleep breathing disorder associated with antibodies to IgLON5: a case series, characterisation of the antigen, and post-mortem study.

    Science.gov (United States)

    Sabater, Lidia; Gaig, Carles; Gelpi, Ellen; Bataller, Luis; Lewerenz, Jan; Torres-Vega, Estefanía; Contreras, Angeles; Giometto, Bruno; Compta, Yaroslau; Embid, Cristina; Vilaseca, Isabel; Iranzo, Alex; Santamaría, Joan; Dalmau, Josep; Graus, Francesc

    2014-06-01

    Autoimmunity might be associated with or implicated in sleep and neurodegenerative disorders. We aimed to describe the features of a novel neurological syndrome associated with prominent sleep dysfunction and antibodies to a neuronal antigen. In this observational study, we used clinical and video polysomnography to identify a novel sleep disorder in three patients referred to the Sleep Unit of Hospital Clinic, University of Barcelona, Spain, for abnormal sleep behaviours and obstructive sleep apnoea. These patients had antibodies against a neuronal surface antigen, which were also present in five additional patients referred to our laboratory for antibody studies. These five patients had been assessed with polysomnography, which was done in our sleep unit in one patient and the recording reviewed in a second patient. Two patients underwent post-mortem brain examination. Immunoprecipitation and mass spectrometry were used to characterise the antigen and develop an assay for antibody testing. Serum or CSF from 298 patients with neurodegenerative, sleep, or autoimmune disorders served as control samples. All eight patients (five women; median age at disease onset 59 years [range 52-76]) had abnormal sleep movements and behaviours and obstructive sleep apnoea, as confirmed by polysomnography. Six patients had chronic progression with a median duration from symptom onset to death or last visit of 5 years (range 2-12); in four the sleep disorder was the initial and most prominent feature, and in two it was preceded by gait instability followed by dysarthria, dysphagia, ataxia, or chorea. Two patients had a rapid progression with disequilibrium, dysarthria, dysphagia, and central hypoventilation, and died 2 months and 6 months, respectively, after symptom onset. In five of five patients, video polysomnography showed features of obstructive sleep apnoea, stridor, and abnormal sleep architecture (undifferentiated non-rapid-eye-movement [non-REM] sleep or poorly structured

  2. Presence of D4 dopamine receptors in human prefrontal cortex: a postmortem study Presença de receptores dopaminérgicos D4 em córtex cerebral humano: um estudo post-mortem

    Directory of Open Access Journals (Sweden)

    Donatella Marazziti

    2007-06-01

    Full Text Available OBJECTIVE: The aim of our study was to explore the presence and the distribution of D4 dopamine receptors in postmortem human prefrontal cortex, by means of the binding of [³H]YM-09151-2, an antagonist that has equal affinity for D2, D3 and D4 receptors. It was therefore necessary to devise a unique assay method in order to distinguish and detect the D4 component. METHOD: Frontal cortex samples were harvested postmortem, during autopsy sessions, from 5 subjects. In the first assay, tissue homogenates were incubated with increasing concentrations of [³H]YM-09151-2, whereas L-745870, which has a high affinity for D4 and a low affinity for D2/D3 receptors, was used as the displacer. In the second assay, raclopride, which has a high affinity for D2/D3 receptors and a low affinity for D4 receptors, was used to block D2/D3. The L-745870 (500 nM was added to both assays in order to determine the nonspecific binding. RESULTS: Our experiments revealed the presence of specific and saturable binding of [³H]YM-09151-2. The blockade of D2 and D3 receptors with raclopride ensured that the D4 receptors were labeled. The mean maximum binding capacity was 88 ± 25 fmol/mg protein, and the dissociation constant was 0.8 ± 0.4 nM. DISCUSSION AND CONCLUSIONS: Our findings, although not conclusive, suggest that the density of D4 receptors is low in the human prefrontal cortex.OBJETIVO: O objetivo deste estudo foi quantificar a presença e a distribuição de receptores dopaminérgicos do tipo 4 (D4 no córtex cerebral humano em amostras post-mortem através do bloqueio com ³H-YM-09151-2 - um antagonista com afinidade equivalente pelos receptores D2, D3 e D4 - e do desenvolvimento de um método para a detecção específica do componente D4. MÉTODO: Foram obtidas amostras de córtex cerebral de cinco cadáveres. Em um primeiro ensaio, os homogeneizados de tecido cerebral foram incubados em concentrações crescentes de ³H-YM-09151-2, enquanto que o L-745

  3. Patient perspectives on delays in diagnosis and treatment of cancer: a qualitative analysis of free-text data.

    Science.gov (United States)

    Parsonage, Rachel K; Hiscock, Julia; Law, Rebecca-Jane; Neal, Richard D

    2017-01-01

    Earlier cancer diagnosis is crucial in improving cancer survival. The International Cancer Benchmarking Partnership Module 4 (ICBP4) is a quantitative survey study that explores the reasons for delays in diagnosis and treatment of breast, colorectal, lung, and ovarian cancer. To further understand the associated diagnostic processes, it is also important to explore the patient perspectives expressed in the free-text comments. To use the free-text data provided by patients completing the ICBP4 survey to augment the understanding of patients' perspectives of their diagnostic journey. Qualitative analysis of the free-text data collected in Wales between October 2013 and December 2014 as part of the ICBP4 survey. Newly-diagnosed patients with either breast, ovarian, colorectal, or lung cancer were identified from registry data and then invited by their GPs to participate in the survey. A thematic framework was used to analyse the free-text comments provided at the end of the ICBP4 survey. Of the 905 patients who returned a questionnaire, 530 included comments. The free-text data provided information about patients' perspectives of the diagnostic journey. Analysis identified factors that acted as either barriers or facilitators at different stages of the diagnostic process. Some factors, such as screening, doctor-patient familiarity, and private treatment, acted as both barriers and facilitators depending on the context. Factors identified in this study help to explain how existing models of cancer diagnosis (for example, the Pathways to Treatment Model) work in practice. It is important that clinicians are aware of how these factors may interact with individual clinical cases and either facilitate, or act as a barrier to, subsequent cancer diagnosis. Understanding and implementing this knowledge into clinical practice may result in quicker cancer diagnoses. © British Journal of General Practice 2017.

  4. Severe rickets in a young girl caused by celiac disease: the tragedy of delayed diagnosis: a case report.

    Science.gov (United States)

    Al-Sharafi, Butheinah A; Al-Imad, Shafiq A; Shamshair, Amani M; Al-Faqeeh, Derhim H

    2014-10-08

    Celiac disease is a systemic immune mediated disease which usually presents with gastrointestinal symptoms, but it may present with extra gastrointestinal manifestations such as metabolic bone disease and failure to thrive. This may lead to a delay in the diagnosis. We present a 13 year old female from the middle east with an 8 year history of severe rickets causing multiple bone deformities leaving the child crippled with bowing of both of her arms and legs. The patient was also found to have growth failure, anemia and on further workup she was found to have celiac disease. We are presenting this case because it shows a severe case of rickets after malabsorption for many years. Celiac disease should be kept in mind as a cause of rickets in patients not responding to usual forms of treatment or when associated with other manifestations of malabsorption.

  5. Delayed Diagnosis of Osteonecrosis of the Jaw (ONJ Associated with Bevacizumab Therapy in Colorectal Cancer Patients: Report of Two Cases

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    Francesco Erovigni

    2016-10-01

    Full Text Available Medication-induced Osteonecrosis of the Jaw (MRONJ has been reported not only after use of antiresorptive agents (bisphosphonates and denosumab, but also in cancer patients receiving antiangiogenic agents, alone or combined with antiresorptive drugs. We report two cases of MRONJ observed in colorectal cancer patients after bevacizumab therapy only. MRONJ was diagnosed, respectively, two and seven months after a tooth extraction; both the patients had received two courses of bevacizumab infusions (for a total of 29 and 10 administrations, respectively. We discuss if tooth extraction during or after antiangiogenic therapy could be a potential trigger of MRONJ, but also if an underlying bone disease not evident before oral surgery might be a possible cause. A careful drug history has to be registered by dental specialists in cancer patients before oral surgery and adequate imaging might be obtained to avoid a delayed diagnosis.

  6. A Retinal Detachment Case with a Delay in Diagnosis Due to Unilateral Lens Coloboma and Bilateral Ectopic Pupil

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    Hüseyin Mayalı

    2015-12-01

    Full Text Available A 29-year-old female patient was admitted with the complaint of decreased vision in the left eye for the last 9 months. The visual acuity was 0.4 in the right eye and hand movements in the left eye. Biomicroscopic examination revealed ectopic pupils in both eyes and lens coloboma in the left eye; her right lens was normal. There was total retinal detachment in the left fundus. Optic disc, macula, and peripheral retina were normal in the right eye at her fundus examination. In our case, reduction of vision in the left eye was associated with ectopic pupil at various centers and this situation has led to delay in the diagnosis. Therefore, the importance of careful retinal examination should be kept in mind in cases in which the reduction of vision does not correlate with clinical picture. (Turk J Ophthalmol 2014; 44: 75-7

  7. Male lupus: a diagnosis often delayed--a case series and review of the literature.

    LENUS (Irish Health Repository)

    Ambrose, N L

    2012-02-01

    INTRODUCTION: Systemic lupus erythematosus (SLE) is an auto-immune disease that is characterised by autoantibody production. Male lupus is rare, apart from at either end of the age spectrum. AIM: In this series, we review the histories of six male lupus patients attending our service. RESULTS: Our patients presented in middle age and tended to develop haematological abnormalities, renal involvement and neurological manifestations which preceded the onset of their skin and joint complaints. Our patients accrued damage rapidly and overall did badly. They tended to respond sub-optimally to standard treatments. These cases highlight the need an increased awareness that male SLE patients present with a wide variety of symptoms, and that they accrue damage quickly. There is a need for timely diagnosis and appropriate initiation of treatment. This may help avoid preventable organ damage and increase the survival of men with SLE.

  8. Delayed diagnosis of pituitary stalk interruption syndrome with severe recurrent hyponatremia caused by adrenal insufficiency

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    Kyung Mi Jang

    2017-09-01

    Full Text Available Pituitary stalk interruption syndrome (PSIS involves the occurrence of a thin or absent pituitary stalk, hypoplasia of the adenohypophysis, and ectopic neurohypophysis. Diagnosis is confirmed using magnetic resonance imaging. Patients with PSIS have a variable degree of pituitary hormone deficiency and a wide spectrum of clinical manifestations. The clinical course of the disease in our patient is similar to that of a syndrome of inappropriate antidiuretic hormone secretion. This is thought to be caused by failure in the suppression of vasopressin secretion due to hypocortisolism. To the best of our knowledge, there is no case report of a patient with PSIS presenting with hyponatremia as the first symptom in Korean children. Herein, we report a patient with PSIS presenting severe recurrent hyponatremia as the first symptom, during adolescence and explain the pathophysiology of hyponatremia with secondary adrenal insufficiency.

  9. Delayed diagnosis of childhood deafness: the value of false negatives in the Programme for Early Detection of Neonatal Hearing Loss.

    Science.gov (United States)

    Martínez-Pacheco, María C; Ferrán de la Cierva, Luis; García-Purriños, Francisco J

    Despite its importance, the existence of false negatives (patients who are told they hear well, but they have some degree of hipacusia) is rarely evaluated in programs for early detection of hearing loss. The aim of this study is to determine the variables that can lead to a delayed diagnosis, especially the existence of false negatives and the lack of registration of risk factors. A retrospective study of prevalence has been carried out, in which the medical records of children diagnosed with sensorineural hearing loss born within 2005 and 2012 in the health centers of study have been analyzed. Of the 32 children with sensorineural hearing loss, 16 passed the OAE, 12 did not passed the OAE, and in four they were not carried out. Of the children who passed the OAE, 57% have severe hearing loss. 66% of children with hearing loss presented a risk factor for hearing loss at birth, being the most frecuent family history of hearing loss, but only 7% of those with family history of hearing loss were included in the risk group. The results of the study indicate that the late diagnosis of hearing loss is related to the presence of false negatives to the OAE and the non-registration of risk factors. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  10. Delayed diagnosis of tuberculous meningitis in a pregnant Nigerian: A case report

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    Isa Samson Ejiji

    2013-01-01

    Full Text Available Tuberculous meningitis (TBM is the most severe form of tuberculosis and is commoner in those with immunsuppression. Diagnosis continues to be difficult particularly in resource limited settings, and this may be truer in the setting of pregnancy. We report the case of a pregnant Nigerian who was diagnosed late with atypical features of TBM complicated by cerebral infarction. High index of suspicion and early administration of anti-tuberculous medications as daily therapy according to the national treatment guidelines: 600 mg Rifampicin, 300 mg Isoniazid, 1.2g Pyrazinamide and 800 mg Ethambutol plus 50 mg pyridoxine and 0.4 mg/kg body weight/day dexamethasone which was tapered weekly led to a slow but sustained clinical improvement. The relationship between pregnancy, susceptibility to TBM and presenting features of TBM requires further exploration. Clinicians should also be aware of atypical presentation of TBM in pregnancy, and the suspicion of TBM may be sufficient grounds to initiate empirical anti-tuberculous therapy.

  11. Delayed Diagnosis of Acute Rheumatic Fever in a Patient with Multiple Emergency Department Visits

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    Inna Kaminecki

    2018-01-01

    Full Text Available While the incidence of acute rheumatic fever (ARF in the United States has declined over the past years, the disease remains one of the causes of severe cardiovascular morbidity in children. The index of suspicion for ARF in health care providers may be low due to decreasing incidence of the disease and clinical presentation that can mimic other conditions. We present the case of a 5-year-old boy with a history of intermittent fevers, fatigue, migratory joint pain, and weight loss following group A Streptococcus pharyngitis. The patient presented to the emergency department twice with the complaints described above. On his 3rd presentation, the workup for his symptoms revealed the diagnosis of acute rheumatic fever with severe mitral and aortic valve regurgitation. The patient was treated with penicillin G benzathine and was started on glucocorticoids for severe carditis. The patient was discharged with recommendations to continue secondary prophylaxis with penicillin G benzathine every 4 weeks for the next 10 years. This case illustrates importance of primary prevention of acute rheumatic fever with adequate antibiotic treatment of group A Streptococcus pharyngitis. Parents should also receive information and education that a child with a previous attack of ARF has higher risk for a recurrent attack of rheumatic fever. This can lead to development of severe rheumatic heart disease. Prevention of recurrent ARF requires continuous antimicrobial prophylaxis. Follow-up with a cardiologist every 1-2 years is essential to assess the heart for valve damage.

  12. Factors associated with patient and provider delays for tuberculosis diagnosis and treatment in Asia: a systematic review and meta-analysis.

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    Jing Cai

    Full Text Available Delays in tuberculosis (TB diagnosis and treatment is a major barrier to effective management of the disease. Determining the factors associated with patient and provider delay of TB diagnosis and treatment in Asia may contribute to TB prevention and control.We searched the PubMed, EMBASE and Web of Science for studies that assessed factors associated with delays in care-seeking, diagnosis, or at the beginning of treatment, which were published from January 1992 to September 2014. Two reviewers independently identified studies that were related to our meta-analysis and extracted data from each study. Independent variables were categorized in separate tables for patient and provider delays.Among 45 eligible studies, 40 studies assessed patient delay whereas 30 assessed provider delay. Cross-sectional surveys were used in all but two articles, which included 17 countries and regions. Socio-demographic characteristics, TB-related symptoms and medical examination, and conditions of seeking medical care in TB patients were frequently reported. Male patients and long travel time/distance to the first healthcare provider led to both shorter patient delays [odds ratio (OR (95% confidence intervals, CI = 0.85 (0.78, 0.92; 1.39 (1.08, 1.78] and shorter provider delays [OR (95%CI = 0.96 (0.93, 1.00; 1.68 (1.12, 2.51]. Unemployment, low income, hemoptysis, and positive sputum smears were consistently associated with patient delay [ORs (95%CI = 1.18 (1.07, 1.30, 1.23 (1.02, 1.49, 0.64 (0.40, 1.00, 1.77 (1.07, 2.94, respectively]. Additionally, consultation at a public hospital was associated with provider delay [OR (95%CI = 0.43 (0.20, 0.91].We propose that the major opportunities to reduce delays involve enabling socio-demographic factors and medical conditions. Male, unemployed, rural residence, low income, hemoptysis, positive sputum smear, and long travel time/distance significantly correlated with patient delay. Male, long travel time/distance and

  13. Atraso diagnóstico do retinoblastoma Delayed diagnosis in retinoblastoma

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    Karla E. S. Rodrigues

    2004-12-01

    Full Text Available OBJETIVOS: Identificar os principais sinais e sintomas do retinoblastoma e determinar o tempo médio entre o início dos sintomas e o diagnóstico. MÉTODOS: Estudo retrospectivo, com revisão dos prontuários das crianças diagnosticadas com retinoblastoma entre janeiro de 1991 e junho de 2000 no Departamento de Pediatria do Hospital do Câncer de São Paulo. Análise estatística: teste t de Student, análise e variância, teste de Tukey-HSD (honest significant differences, teste de Levene, análise de regressão linear, curva ROC, regressão logística e análise de sobrevida pelo método de Kaplan-Meier. RESULTADOS: Foram revisados 327 prontuários, sendo 171 pacientes do sexo masculino. A idade média foi de 25 meses. Doença localizada foi verificada em 269 pacientes. Os sintomas mais freqüentes foram leucocoria (79%, estrabismo (10,7% e tumoração (3,4%. O tempo médio de queixa foi de 5,8 meses. Pacientes maiores de 2 anos de idade apresentaram maior tempo de queixa em relação aos lactentes (7,2 meses versus 4,7 meses; p = 0,001. Pacientes com estrabismo tiveram maior tempo de queixa (8,8 meses em comparação com pacientes com tumoração (2,3 meses ou leucocoria (5,6 meses (p = 0,014. Pacientes com doença metastática apresentaram maior tempo de queixa (10,6 meses; p OBJECTIVES: To identify the main symptoms of retinoblastoma and to determine the mean time between symptom onset and diagnosis (lag time. PATIENTS AND METHODS: We carried out a retrospective analysis of the patients diagnosed with retinoblastoma between January 1991 and June 2000, at the Pediatric Department of the Hospital do Câncer, São Paulo, Brazil. Statistical analyses performed were: Student's t test, ANOVA, Tukey-HSD test (honest significant differences, Levene's test, multiple regression, ROC curve, logistic regression, Kaplan-Meier, and log rank. RESULTS: 327 medical records (171 males were reviewed. The mean age was 25 months. Localized disease was

  14. Delayed diagnosis and worsening of pain following orthopedic surgery in patients with complex regional pain syndrome (CRPS).

    Science.gov (United States)

    Lunden, Lars K; Kleggetveit, Inge P; Jørum, Ellen

    2016-04-01

    patients found no alteration and one patient experienced an improvement of pain. None of the 22 patients reporting worsening, were diagnosed with CRPS prior to surgery, while retrospectively, a certain or probable diagnosis of CRPS had been present in 17/22 (77%) patients before their first post-injury surgical event. A mean time delay of 3.9 years before diagnosis of CRPS is unacceptable. A lack of attention to more subtle signs of autonomic dysfunction may be an important contributing factor for the missing CRPS diagnosis, in particular serious in patients reporting worsening of pain following subsequent orthopedic surgery. It is strongly recommended to consider the diagnosis of CRPS in all patients with a long-lasting pain condition. We emphasize that the present report is not meant as criticism to orthopedic surgical practice, but as a discussion for a hopefully increased awareness and understanding of this disabling pain condition. Copyright © 2015 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  15. "I Wasted 3 Years, Thinking It's Not a Problem": Patient and Health System Delays in Diagnosis of Leprosy in India: A Mixed-Methods Study.

    Science.gov (United States)

    Muthuvel, Thirumugam; Govindarajulu, Srinivas; Isaakidis, Petros; Shewade, Hemant Deepak; Rokade, Vasudev; Singh, Rajbir; Kamble, Sanjeev

    2017-01-01

    Worldwide, leprosy is one of the major causes of preventable disability. India contributes to 60% of global leprosy burden. With increasing numbers of leprosy with grade 2 disability (visible disability) at diagnosis, we aimed to determine risk factors associated with grade 2 disability among new cases and explore patients and providers' perspectives into reasons for late presentation. This was an explanatory mixed-methods study where the quantitative component, a matched case-control design, was followed by a qualitative component. A total of 70 cases (grade 2 disability) and 140 controls (grade 0) matched for age and sex were randomly sampled from new patients registered between January 2013-January 2015 in three districts of Maharashtra (Mumbai, Thane and Amaravati) and interviewed using a structured close ended questionnaire. Eight public health care providers involved in leprosy care and 7 leprosy patients were purposively selected (maximum variation sampling) and interviewed using a structured open-ended interview schedule. Among cases, overall median (IQR) diagnosis delay in months was 17.9(7-30); patient and health system delay was 7(4-16.5) and 5.5(0.9-12.5) respectively; this was significantly higher than the delay in controls. Reasons for delayed presentation identified by the quantitative and qualitative data were: poor awareness of leprosy symptoms, first health care provider visited being private practitioners who were not aware about provision of free leprosy treatment at public health care facilities, reduced engagement and capacity of the general health care system in leprosy control. Raising awareness in communities and health care providers regarding early leprosy symptoms, engagement of private health care provider in early leprosy diagnosis and increasing capacity of general health system staff, especially targeting high endemic areas that are hotspots for leprosy transmission may help in reducing diagnosis delays.

  16. Patient and Process Factors Associated With Type of First Neuroimaging and Delayed Diagnosis in Childhood Arterial Ischemic Stroke.

    Science.gov (United States)

    Daverio, Marco; Bressan, Silvia; Gregori, Dario; Babl, Franz E; Mackay, Mark T

    2016-09-01

    In-hospital factors contribute more to delayed diagnosis of childhood arterial ischemic stroke (AIS) than prehospital factors. We aimed to explore process and patient factors associated with type of and timing to neuroimaging in childhood AIS in the emergency department (ED). This was a retrospective hospital registry-based study of children with AIS, presenting to an Australian tertiary pediatric ED between January 2003 and December 2012. Neuroimaging data and timelines of care were also collected from referring hospitals for transferred patients. Seventy-one AIS episodes and 19 transient ischemic attacks were recorded. The majority (56%) were initially seen at a referring hospital. Patients underwent computed tomography (CT) as first scan more frequently than magnetic resonance imaging (MRI) as first scan (61% vs. 32%) at both the referring and the tertiary hospitals. Time to first scan as CT was significantly shorter compared with MRI (median = 1.5 hours vs. 10.9 hours, p first presenting to a referring hospital and those directly accessing the tertiary center. Patient characteristics including age, past medical history, conscious state, focal symptoms, and signs on arrival were not associated with the type of first neuroimaging or time to diagnostic MRI. Patients presenting during weekends were less likely to receive an MRI as first scan (odds ratio [OR] = 0.3, 95% confidence interval [CI] = 0.1-0.8), while time to MRI was significantly longer for children presenting after hours (5 pm-8 am; median = 17.6 hours vs. 8.4 hours, p = 0.026). MRI overall and as first scan was associated with a higher use of sedation than CT (OR = 6.5, 95% CI = 1.3-32.9; and OR = 3.9, 95% CI = 1.3-11.8), particularly for children younger than 5 years of age (OR = 12.5, 95% CI = 3-52.4). Strategies to improve rapid diagnosis of pediatric stroke should include shared regional hospital networks protocols to optimize local imaging strategies and where possible rapid transfer to the

  17. Delayed entry into HIV care after diagnosis in two specialized care and treatment centres in Cameroon: the influence of CD4 count and WHO staging

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    Noah F. Takah

    2016-07-01

    Full Text Available Abstract Background Delayed entry into HIV care has complicated the challenges faced in sub-Saharan Africa due to the high HIV burden. A clear knowledge of the factors affecting delayed entry will be essential in directing interventions towards reducing delayed entry into HIV care. There exist very limited data on delayed entry in Cameroon despite its relevance; hence this study was conducted to determine the rate of delayed entry and its associated factors in HIV programmes in Cameroon. Methods Data used for this study was routine data obtained from the files of HIV patients who were diagnosed between January 1, 2015 and June 30, 2015 at Limbe and Buea regional hospital HIV centers in the South West region of Cameroon. Data analysis was done using SPSS version 20. Results Of the 223 patients included in the study, nearly one-quarter of patients (22.4 % delayed to enter HIV care within 3 months. Those who delayed to enter care were less likely to present at first diagnosis (using HIV rapid test with symptoms such as fever > 1 month (5 % versus 30 %, p = 0.01 and weight loss > 10 % (13 % versus 48 %, p < 0.001. Alcohol consumption, WHO stage and CD4 count levels were also associated with delayed entry in bivariate analysis. In multivariate analysis only CD4 count greater than 500cells/μl and WHO stages I and II were independently associated with delayed entry into HIV care within 3 months. Conclusion In the South West region of Cameroon, approximately 1 out of 4 patients delay to enter HIV care. This high proportion of patients who delay to enter care correlates to the findings recorded by other studies in sub Saharan Africa. Interventions tackling delayed entry into HIV care might need to be favorably directed towards patients that have high CD4 counts and are at very early WHO clinical stages.

  18. Factors Contributing to the Delay in Diagnosis and Continued Transmission of Leprosy in Brazil – An Explorative, Quantitative, Questionnaire Based Study

    Science.gov (United States)

    Henry, Mary; GalAn, Noêmi; Teasdale, Katherine; Prado, Renata; Amar, Harpreet; Rays, Marina S.; Roberts, Lesley; Siqueira, Pedro; de Wildt, Gilles; Virmond, Marcos; Das, Pranab K.

    2016-01-01

    Background Leprosy is a leading cause of preventable disability worldwide. Delay in diagnosis of patients augments the transmission of infection, and allows progression of disease and more severe disability. Delays in diagnosis greater than ten years have