Accuracy of magnetic resonance imaging in determining cause of sudden death in adults: comparison with conventional autopsy.
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Adult↗
Biomedical subjects
B Swift
Publications and source records attributed to B Swift.
The exploding bullet.
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Accidents, Occupational↗
Forensic web watch--medicolegal aspects of paediatric pathology.
The trials over the deaths of Matthew Eappen and Victoria Climbie have highlighted the importance of forensic evidence in cases of suspected child abuse. The debate as to whether bruises, fractures or head injuries have been sustained as a result of previous trauma or non-accidental injury is central to these, and other, cases. A variety of subjects are encountered in forensic paediatric pathology, including Shaken Baby Syndrome, non-accidental injury, retinal haemorrhage, skeletal injury, Sudden Infant Death, sexual abuse and Munchausen Syndrome by Proxy. The coverage of these areas on the internet was assessed using two search engines (Google and the meta-search engine Mamma) and revealed patchy coverage. The majority of sites uncovered were, unsurprisingly, aimed at the layperson concerned by such issues; however, several sites containing useful information for the professional are available.
Journal Article↗
Experimental study of large-volume microwave ablation in the liver.
BACKGROUND: Microwave coagulation therapy is useful in the destruction of small, irresectable liver tumours of primary and secondary origin. Unfortunately, the small lesion size produced by currently available equipment makes it difficult and time consuming completely to ablate lesions larger than 3 cm in diameter. A microwave system capable of producing large-volume ablations in very short periods of time has been developed. Using a large-animal model the ability of the equipment to produce large-volume lesions in a safe, predictable and dose-dependent manner was tested. METHODS: Fourteen large white pigs were anaesthetized and underwent multiple microwave treatments. The animals were killed at different timepoints to investigate lesion size and evolution. RESULTS: The microwave system was able to generate large-volume ablations of up to 6.5 cm in diameter in a controlled and dose-dependent manner. CONCLUSION: This novel microwave system allows the ablation of large volumes of liver tissue in a short period of time. The ability to produce lesions reproducibly and safely highlights the potential of this system in the future treatment of irresectable liver tumours.
Analysis of Variance↗
Examination of insulin injection sites: an unexpected finding of localized amyloidosis.
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Adipose Tissue↗
Death certification: an audit of practice entering the 21st century.
AIMS: Death certification, a legal duty of doctors, continues to be poorly performed despite Royal College recommendations and increased education at an undergraduate level. Therefore, the current performance of certifying doctors was audited within a large teaching hospital entering the new century. METHODS: A total of 1000 completed certificate counterfoils were examined retrospectively for appropriateness of completion and the ability to construct a logical cause of death cascade. RESULTS: Only 55% of certificates were completed to a minimally accepted standard, and many of these failed to provide relevant information to allow adequate ICD-10 coding. Nearly 10% were completed to a poor standard, being illogical or inappropriately completed. CONCLUSIONS: The results show no improvement in the state of certification. Possible interventions to improve outcomes are discussed; however, in light of a recent high profile legal case a current Home Office review of death certification may suggest the passing of statutory law to ensure accurate completion.
Cause of Death↗
An estimation of the post-mortem interval in human skeletal remains: a radionuclide and trace element approach.
Estimation of the post-mortem interval remains a contentious issue, with forensic pathologists often relying upon the recognition of morphological changes.A radionuclide approach has often been suggested in the literature, although limitations have prevented its application, most notably those of diagenesis. Within this pilot study, we show for the first time that there is a correlation between certain radionuclide content and time since death.A larger study is proposed to confirm these findings and possibly provide a calibration against which bones uncovered can be dated.
Adolescent↗
Forensic web watch.
A search for forensic odontology sites on the Internet revealed thousands of 'hits', of which many constituted dentists offering a private service on their homepages. Several organisations and associations were identified following extensive sifting through these addresses and, despite its growing acceptance in the forensic community, the resources available were superficial and of only moderate educational content. Although many of the sites provided non-specialist information and points of contact for local experts only one was commended for its design and depth. The need for improvement in this field is therefore recommended.
Journal Article↗
Meniscal ossification in spontaneous osteoarthritis in the guinea-pig.
OBJECTIVE: The purpose of this study was to evaluate the ossification state of the meniscus in the guinea-pig stifle joint using micro-computerized tomography. DESIGN: Hind limbs from six (N=12) and 24 (N=11) month-old male Hartley guinea-pigs were removed and the joints were imaged using high resolution micro-computerized tomography. The ossified volume of the medial and lateral menisci from both groups of animals was quantified. RESULTS: Ossification of both the medial and lateral menisci of the both the 6- and 24-month-old animals was observed. In both age groups, the ossified region of the medial meniscus was significantly larger than the lateral meniscus. In addition, there is a significant increase in ossified volume of the medial meniscus between 6 and 24 months of age. CONCLUSIONS: There is a significant amount of ossification of the menisci in the male Hartley guinea-pig, with the medial compartment showing more bone than the lateral. In addition, as the animals age, there is an increase in ossification within the medial compartment. Bone remodeling and cartilage degeneration is evident in the medial compartment within these animals as they age. It is possible that the increased ossification of the medial meniscus could alter the joint biomechanics and, in part, stimulate this medial compartment joint destruction.
Aging↗
Dating human skeletal remains: investigating the viability of measuring the equilibrium between 210Po and 210Pb as a means of estimating the post-mortem interval.
Estimating the post-mortem interval in skeletal remains is a notoriously difficult task; forensic pathologists often rely heavily upon experience in recognising morphological appearances. Previous techniques have involved measuring physical or chemical changes within the hydroxyapatite matrix, radiocarbon dating and 90Sr dating, though no individual test has been advocated. Within this paper it is proposed that measuring the equilibrium between two naturally occurring radio-isotopes, 210Po and 210Pb, and comparison with post-mortem examination samples would produce a new method of dating human skeletal remains. Possible limitations exist, notably the effect of diagenesis, time limitations and relative cost, though this technique could provide a relatively accurate means of determining the post-mortem interval. It is therefore proposed that a large study be undertaken to provide a calibration scale against which bones uncovered can be dated.
Bone and Bones↗
Porcelain veneers: the effects of contaminants and cleaning regimens on the bond strength of porcelain to composite.
An in-vitro study was carried out to investigate the effects of contamination of the porcelain surface on the shear-bond strength of a dual-cure composite luting cement to etched, silanated porcelain. Furthermore, the effects of different cleaning regimens were studied. A total of 390 etched, silanated porcelain specimens were randomly divided into 13 groups of 30. Shear-bond strengths were measured for a control group and for specimens contaminated with saliva, die stone, and latex gloves. Freshly contaminated samples were subject to three cleaning regiments; water wash and dry, cleansing with acetone, and cleansing with 37% phosphoric acid gel. Bond strengths to the cleansed surfaces were measured. Weibull analysis and analysis of variance were applied to the results. Saliva and latex glove contamination did not significantly affect shear-bond strength. Die stone contamination markedly reduced the bond strength and cleaning did not restore the bond strength for these specimens. Contact between porcelain veneers and stone models should therefore be avoided. The wash/dry and phosphoric acid cleaning regimens did not significantly improve or reduce bond strengths for contaminated specimens. Acetone cleaning produced a marked reduction in bond strength under all experimental conditions and should not be used.
Acetone↗
Severe withdrawal syndrome after substitution of a short-acting benzodiazepine for a long-acting benzodiazepine.
A severe withdrawal syndrome occurred in a patient after oxazepam 10 mg bid was substituted for diazepam 5 mg bid. The onset of symptoms was consistent with the rate of decline of diazepam and its active metabolite, desmethyldiazepam. Reintroduction of diazepam produced prompt symptom remission. This report and others suggest the need for caution when substituting a short-acting drug for a long-acting one, even when usual doses of each are used. The chronic use of benzodiazepines for eight months or longer prior to substitution or withdrawal appears to place the patient at a higher risk of incurring withdrawal phenomena. Slow and careful tapering of drug is required in such patients to reduce the risk of withdrawal symptoms.
Diazepam↗
The role of big endothelin-1 in colorectal cancer.
INTRODUCTION: Changes in liver blood flow caused by an unknown splanchnic vasoconstrictor have been noted in colorectal cancer patients with liver metastases. This prospective study was performed to assess whether plasma levels of big endothelin-1 (big ET-1) were raised in patients with colorectal cancer. METHODS: Plasma samples from peripheral vein of patients who underwent surgery for primary colorectal cancer (n=60) and those with known colorectal liver metastases (n=45) for a period of 15 months were taken prior to treatment and compared to age- and sex-matched controls (n=20). Plasma samples were analysed by using a single-step sandwich enzyme immunoassay. Immunohistochemistry and in situ hybridisation were also performed on tumour sections to investigate the expression of ET-1 by cancer cells. RESULTS: The median (range) plasma concentration of big ET-1 in controls was 2.1 pg/mL (1.2-13.4 pg/mL). The median (range) plasma concentration of big ET-1 in colorectal cancer patients with no overt hepatic metastases was 3.8 pg/mL (1.2-15.8 pg/mL), p=0.002, and the median (range) plasma concentration of big ET-1 in colorectal cancer patients with hepatic metastases was 5.2 pg/mL (1.7-30 pg/mL), p=0.0001; both were significantly elevated compared to the control group. A significant difference in immunostaining for big ET-1 was noted between paired normal colonic mucosa (median score-1) and tumour sections (median score-3), p=0.01. CONCLUSION: This study has demonstrated elevated concentrations of big ET-1 in colorectal cancer patients, especially in those with hepatic metastases. Upregulation of ET activity in colorectal cancer could be inferred by the increased immunostaining of big ET-1 in cancer cells. Therefore, plasma big ET-1 levels should be evaluated as a potential tumour marker for the identification of hepatic metastases at an earlier stage.
Biomarkers, Tumor↗