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PubMed1996

Minimally invasive neurosurgery.

BACKGROUND: The philosophy and practice of minimally invasive surgery have fundamentally altered the practice of general and gynaecological surgery, and are currently transforming the practice of neurosurgery. The goal of minimally invasive surgery is to reduce tissue disruption and thus morbidity. This is a review of the development, applications, and benefits of minimally invasive neurosurgery, and its wider surgical implications. METHODS: A synthesis of the literature is presented. RESULTS: Interactive computer imaging with frame-based and frameless stereotaxy, ultrasonographic and endoscopic techniques are increasingly being used independently and in combination in order to execute minimally invasive approaches and to navigate a safe path within the cranium or spine. Interaction using an interlinking stereotactic instrument or robot between the surgeon, a graphic interface (such as a computer workstation) and the patient, enables precise planning and execution of surgery with exact correspondence of imaging data and the living pathology. The direct influence of virtual reality, cybernetics, robotics, and telepresence will further revolutionize the practice of neurosurgery and will impact increasingly on other surgical disciplines. Safety and precision are further enhanced by intra-operative physiological monitoring techniques. Interventional neuroradiology and stereotactic radiosurgery add further dimensions to the minimally invasive approach and may not only diminish the need for open surgery, but in selected cases obviate the need altogether. CONCLUSIONS: Minimally invasive neurosurgery is a major force in contemporary neurosurgery and many of the current neurosurgical applications will have far-reaching effects on the practice of surgery in general.

Brain↗

PubMed2004

Magnetization transfer ratio and myelin in postmortem multiple sclerosis brain.

Several quantitative magnetic resonance (MR) measures are used to investigate multiple sclerosis (MS) in vivo. Precise quantitative investigation of the histopathological correlates of such measures has, to date, been limited. This study investigates the relationship of quantitative measures of myelin content, axonal density, and gliosis with quantitative MR measures in postmortem (PM) MS tissue. MR imaging (MRI) was performed on a 1.5T scanner and T1-relaxation time (T1-RT) and magnetization transfer ratio (MTR) maps were acquired in fresh PM brain of 20 MS subjects. Myelin content, axonal counts, and the extent of gliosis all were quantified using morphometric and digital imaging techniques. MRI and pathological data were in most cases coregistered using stereotactic navigation. Using multiple regression analysis, we detected significant correlations between myelin content (Tr(myelin)) and MTR (r = -0.84, p < 0.001) and myelin content and axonal count (-0.80, p < 0.001); MTR correlated with T1-RT (r = -0.79, p < 0.001). No association was detected between the extent of gliosis and either MR measure. MTR was significantly higher in remyelinated than demyelinated lesions (means: 30.0 [standard deviation, 2.9] vs 23.8 [standard deviation, 4.3], p = 0.008). In conclusion, MTR is affected by myelin content in MS white matter.

Adult↗

PubMed1997

A non-invasive patient registration and reference system for interactive intraoperative localization in intranasal sinus surgery.

A basic problem common to all systems for computer assisted surgery (CAS) is patient referencing, or the transfer of preoperative image data to the intraoperative pathology. The authors describe a highly precise CAS system with non-invasive referencing that can be used in ear, nose and throat (ENT) surgery of the paranasal sinuses. It is based on optical digitizing with several custom-made self-localizing surgical instruments. The accuracy of the system was tested in an experimental model using a plastic head. Measurements of repositioning the reference bow had a mean error of 0.81 mm +/- 0.31 mm. The system was evaluated clinically with 11 patients who received surgery for different pathologies of the paranasal sinuses. These trials met with a high rate of success and specific results are reported.

Biopsy↗

PubMed2004

Can magnetic resonance imaging predict circumferential margins and TNM stage in rectal cancer?

INTRODUCTION: This study was designed to assess whether preoperative magnetic resonance imaging scans were able to predict 1) pathologic tumor and node stage, and 2) those patients with a pathologically clear circumferential resection margin. METHODS: Patients with histologically proven carcinoma of the rectum were staged preoperatively using magnetic resonance imaging. Histologic specimens from patients undergoing mesorectal excision were reported according to the Royal College of Pathologists minimum dataset. Agreement between radiologic staging of tumor, local lymph nodes and circumferential resection margin involvement, and pathologic reporting was assessed by means of the Kappa statistic. RESULTS: After exclusions (10 radiotherapy, 3 failed scans, 10 no surgery, 9 local surgery), 40 patients remained. Magnetic resonance imaging correctly staged the tumor in 20 patients, understaged in 12, and overstaged in 8. Statistically, there was poor correlation between pathologic and radiologic tumor staging (Kappa, 0.18; 95 percent confidence interval, -0.13 to 0.42). Magnetic resonance imaging correctly staged node status in 27 patients, overstaged in 9, and understaged in 4. Statistically, there was poor correlation between pathologic and radiologic node staging (Kappa, 0.38; 95 percent confidence interval, 0.08-0.64). Magnetic resonance imaging correctly reported the status of the circumferential resection margin in 39 patients and understaged 1. Statistically, there was good correlation between pathologic and radiologic reporting of circumferential resection margin involvement (Kappa, 0.66; 95 percent confidence interval, 0.03-1). CONCLUSIONS: Preoperative magnetic resonance imaging scans provide poor predictive data as to subsequent pathologic tumor and node stage. Preoperative magnetic resonance imaging does produce reliable prediction of clear circumferential resection margins and provides valuable information in assessing whether patients can proceed to surgery without the need for preoperative radiotherapy.

Adult↗

PubMed2006

Family history of gastric cancer: a correlation between epidemiologic findings and clinical data.

BACKGROUND: The pathogenetic mechanisms behind gastric cancer are still unclear. Its familial aggregation, on the other hand, has been very well documented by many epidemiologists. Nonetheless, only a limited number of studies have analyzed possible correlations between demographic and clinical data. METHODS: Between January 1988 and August 2004, 541 patients underwent gastric resection with a curative intent at our department; demographic information, laboratory data, imaging, operative notes, and pathology reports were available for all patients. During 2004 we conducted a series of structured interviews with the surviving patients or their closest relatives regarding oncological family history, limited to first-degree relatives. RESULTS: Family history could be obtained in 383 patients (70.8%). Gastric cancer was by far the most frequently associated tumor: 21.9% of the overall number of tumors reported in the family histories were gastric cancers. Patients were also subdivided into those having at least one other family member with stomach cancer (71 patients; 18.5%) and those with no relatives affected by gastric cancer (312 patients; 81.5%). No statistically significant differences between the groups were observed regarding the primary tumor location, size, pTNM classification, and ABO or Rh blood types. However, the intestinal histotype was significantly (P = 0.015) more frequently represented in individuals with at least one family member affected by gastric cancer compared with those with no relatives with stomach cancer (71.8% vs 55.1%, respectively). CONCLUSIONS: Stomach cancer has a relevant degree of familial aggregation and in our series of patients, this was even more pronounced for the intestinal histotype.

Adenocarcinoma↗

PubMed2006

GABA(A)-receptor mRNA expression in the prefrontal and temporal cortex of ALS patients.

There is evidence that excitotoxic cell death is involved in the pathogenesis of amyotrophic lateral sclerosis (ALS). Electrophysiological and histological studies support the pathophysiological concept of an impaired inhibitory, namely GABAergic, control of the motoneurons in the cerebral cortex of ALS patients. Recently, pathological, neuropsychological and functional imaging data have challenged the view that ALS is a disorder restricted to the motor system. The aim of our study was to investigate the expression of the most abundant GABA(A)-receptor subunit mRNAs and the GABA synthesizing enzyme glutamic acid decarboxylase (GAD) in the prefrontal, temporal, occipital and cerebellar cortex of ALS patients compared to tissue of control persons. We performed in situ hybridization histochemistry (ISH) on human post-mortem cortex sections of ALS patients (n=5) and age-matched controls with no history of neurological disease (n=5). In the prefrontal and temporal cortex of ALS patients, we detected significantly reduced mRNA expression of the alpha1-subunit, while the GABA synthesizing enzyme glutamic acid decarboxylase (GAD) was significantly upregulated in these regions. In the occipital and cerebellar cortex, we did not see disease-specific differences of the mRNA expression of the investigated subunits.

Aged↗

PubMedDate not supplied

High-resolution parathyroid sonography.

The purpose of this study was to assess the diagnostic utility of parathyroid ultrasonography to differentiate causes of hypercalcemia in dogs. We analyzed qualitative and quantitative ultrasound imaging findings and clinical pathology data from 33 dogs that underwent parathyroid ultrasound examination as part of the diagnostic evaluation for hypercalcemia. Diagnoses of the diseases causing hypercalcemia included parathyroid carcinoma (n = 5), parathyroid adenoma (n = 15), parathyroid adenomatous hyperplasia (n = 6), chronic renal insufficiency (n = 3), and hypercalcemia of malignancy (n = 4). All parathyroid lesions were round or oval and hypoechoic compared with surrounding thyroid parenchyma. Adenomatous and adenocarcinomatous glands were 4 mm or larger in longest linear measurement on US examination and were statistically significantly larger than hyperplastic glands. (p < 0.001) Linear measurements of parathyroid glands acquired at the time of ultrasound examination correlated well with direct size determination after surgical excision. (r2 = 0.9, p < 0.0001) Parathyroid lesions > or = 4 mm are highly suspicious for parathyroid adenoma or carcinoma, while US lesions < 4 mm most likely represent primary adenomatous hyperplasia or secondary parathyroid hyperplasia. Parathyroid size estimation from ultrasound examination is an accurate predictor of true size.

Animals↗

PubMed2004

Frontotemporal dementia linked to chromosome 3.

A large pedigree with autosomal dominant frontotemporal dementia has been identified. Positional cloning has linked the disease gene to the pericentromeric region of chromosome 3. Clinical, neuropsychological, imaging, pathological and molecular genetic data are presented. The genetic mutation responsible for the disease has not been identified.

Brain↗

PubMed2006

Cerebellar glioblastoma multiforme in an adult.

Cerebellar glioblastoma multiforme (GBM) is a rare tumor. This is the third case published in Brazilian literature and, the last one has been described more than 15 years ago. The aggressive behavior of GBM prompts for fast treatment, which can be hampered by the fact that the diagnosis of GBM requires a high degree of suspicion. We describe a case of GBM in a 46 years old man. In conjunction, we present a literature review including particular issues, clinical data, advances in imaging studies, pathological characteristics, treatment options and the behavior of such malignant tumor.

Biopsy↗

PubMed2002

Expression of MMP-2,TIMP-2 protein and the ratio of MMP-2/TIMP-2 in gallbladder carcinoma and their significance.

AIM: To study the correlation between expression of MMP-2, TIMP-2 protein and the ratio of MMP-2/TIMP-2 and clinical-pathological parameters of patients with gallbladder carcinoma. METHODS: Carcinomas (n=45) and polypoid lesions (n=15) of the gallbladder were studied for the expression of MMP-2 and TIMP-2 protein by immunohistochemical avidin-biotin-complex method and image analysis. Clinical-pathological data of patients with gallbladder carcinoma such as histological type, grade of differentiation, level of infiltration, liver invasion and lymph node involvement, etc, were recorded. RESULTS: There was significant difference between the average level (1.123+/-0.108 vs 1.030+/-0.054, P=0.002) of MMP-2, the ratio (1.050+/-0.013 vs 0.937+/-0.078, P=0.003) of MMP-2/TIMP-2 in gallbladder carcinomas and in polypoid lesions of the gallbladder. Significant difference was found between the expression of MMP-2 in early stage and advanced tumors, but there was no correlation between MMP-2 protein expression and histological type, differentiation degree, infiltration level, lymph node involvement or liver invasion. Although no difference was observed between TIMP-2 expression and histological type or differentiation degree, significant difference was found between TIMP-2 expression and different Nevin stage, infiltration level, local lymph node involvement or liver invasion (1.168+/-0.067 vs 1.048+/-0.075, 1.170+/-0.062 vs 1.039+/-0.069, 1.039+/-0.076 vs 1.147+/-0.083, 1.048+/-0.074 vs 1.103+/-0.095, P<0.05). MMP-2/TIMP-2 ratio did not correlate with histological type, grade of differentiation and liver invasion, but significant differences were found between MMP-2/TIMP-2 ratio and different Nevin stage, infiltration level and lymph node involvement in patients with carcinoma of gallbladder. CONCLUSION: TIMP-2 and MMP-2/TIMP-2 ratio could reflect more accurately biological characteristic of gallbladder carcinoma and MMP-2/TIMP-2 ratio might be a new significant marker in early diagnosis, in the judgment of invasion or metastasis and the estimate of prognosis in patients with gallbladder carcinomas.

Adenocarcinoma↗

PubMed1999

Pulmonary alveolar proteinosis in Israel: ethnic clustering.

BACKGROUND: Pulmonary alveolar proteinosis is a rare disease in which a surfactant-like phospholipid-rich protein accumulates in the lungs. The disease is amenable to effective therapy by total lung lavage. OBJECTIVES: To investigate the prevalence, ethnic distribution and course of PAP in Israel. METHODS: A countrywide survey was conducted during which pulmonologists were questioned about patients with PAP. The patients were examined and their charts, radiological images, pathological slides and physiological data were reviewed. RESULTS: The survey yielded 15 patients (8 females) during the period 1976-98 (14 in the last decade), giving a prevalence of 3.7 x 10(6) and an incidence of 0.36 x 10(6)/year. Mean age of the patients was 33 +/- 13 years (range 0.5-46 years). Seven patients were North African (two were siblings), four were from Iraq and two were Arabs; there was only one Ashkenazi Jew (a child). Symptoms at the onset were dyspnea and chest pain. Spontaneous remission occurred in at least 3 patients, and 10 patients required 1-4 bronchoalveolar lavage treatments. The subjective and physiological response was favorable, but there was less consistent radiological improvement. CONCLUSION: The prevalence of PAP in Israel is approximately 3.7 x 10(6). Most cases occurred in Jews who had immigrated from North Africa or Iraq, and two were siblings. The prevalence among the Arab population appears to be similar. This clustering suggests the existence of a genetic predisposition. The course of the disease appears to be similar to that reported elsewhere.

Adolescent↗

PubMed2004

[Diagnosis and therapy of intracavernosal cavernous hemangioma].

OBJECTIVE: To study the diagnosis and therapy of intracavernosal cavernous hemangioma. METHODS: The clinical data, including pathology, epidemiology, medical imaging, operation procedure, and post-operational complication, of 43 intracavernosal cavernous hemangioma patients undergoing operations in Tiantan Hospital 1996 to 2003 were analyzed. Frontotemporal craniotomy, frontal craniotomy, and combined fronto-temporal preauricular subtemporal approach were used for the 43 patients. RESULTS: The male/female ratio of these cases was 1:2.58. The average age of onset was 44.28 (11 approximately 67). The initial symptoms included headache, diminution of vision, paralysis of occulomotor nerve, ambiopia, facial pain or numbness epilepsy, etc. Although showing no specific typical feature, MRI still helped in diagnosis. The tumor was totally removed in 22 cases, subtotally removed in 11 cases, and partially removed in 10 cases. The main post-operational complications included oculomotor nerve paralysis (16 cases), abducent nerve paralysis (10 cases), and facial nerve paralysis (3 cases). No postoperative death occurred. CONCLUSION: Operation is still the best choice for intracavernosal cavernous hemangioma patients.

Adolescent↗

PubMed1997

Malignant paraganglioma of the prostate: case report, depiction by meta-iodobenzylguanidine scintigraphy and review of the literature.

OBJECTIVE: To describe the 123-I-MIBG scintigraphic, CT, MRI, operative and pathological findings in a case of malignant prostatic paraganglioma and to review the literature on this very rare tumor. EXPERIMENTAL DESIGN: Clinical imaging and pathological correlation of data in a referred patient. SETTING: Regional referral center and tertiary referral academic medical center. PATIENT: 17 year old man presenting with painless hematuria and a large prostatic mass. Interventions and measures. Renal ultrasound, transrectal ultrasound, ultrasound guided prostatic biopsy, pelvic CT and MRI, planar and SPECT 123-I-MIBG scintigraphy, and surgical exploration. RESULTS: The patient had a significant hydronephrosis of the left kidney and marked enlargement (120 ml) of the prostate gland by ultrasound. Ultrasound guided biopsies of the prostate and a left pelvic lymph node revealed a neuroendocrine tumor staining positive for chromogranin. CT and MRI revealed a large tumor of the prostate invading the seminal vesicles, bladder and rectum with extensive pelvic lymph node spread. The primary tumor and one of the nodes were shown to be 123-I-MIBG avid confirming the neuroendocrine nature of the tumor. The lesion was unresponsive to chemotherapy and unresectable at surgical exploration. CONCLUSIONS: To date there have only been 5 reports of prostatic paragangliomas. To our knowledge this is the first to have been studied by MIBG scintigraphy and like most paragangliomas it was MIBG-avid.

3-Iodobenzylguanidine↗

PubMed2004

In vivo 4.0-T magnetic resonance investigation of spinal cord inflammation, demyelination, and axonal damage in chronic-progressive experimental allergic encephalomyelitis.

PURPOSE: To image and dissect the lumbar spinal cord of guinea pigs with chronic-progressive experimental allergic encephalomyelitis (CP-EAE) and directly correlate the pathology to the magnetic resonance (MR) image data obtained at 4 T and determine if these MR contrasts can accurately differentiate a specific type of pathology from control tissue. MATERIALS AND METHODS: The amount of inflammation, demyelination, and axonal pathology were quantified in the whole cord cross sections. The signal intensities (SIs) for 228 individual regions of interest (ROIs) (normal-appearing white matter (NAWM) and tissue containing inflammation with or without demyelination) were measured directly from the corresponding area on the MR images. RESULTS: Conventional MR contrast SIs and magnetization transfer ratio (MTR) were related to the degree of demyelination and presence of inflammation. MTR and proton density-weighted (PDw) SIs were both moderately related to axonal density. The SIs for NAWM and in lesions containing both cellular infiltrates and demyelination in all conventional MR contrast images were also increased, whereas the MTR was decreased when compared to control tissue. CONCLUSION: The SIs from the conventional MR contrasts and MTR at 4 T were sensitive to the presence of disease within CP-EAE spinal cord, but were not specific to the underlying pathology.

Analysis of Variance↗

PubMed2003

Practice patterns of lymph-node mapping and sentinel-node biopsy for breast cancer in British Columbia.

INTRODUCTION: Because there is no standardized technique for mapping of lymph nodes and no optimal technique for evaluating the sentinel node, we decided to evaluate practice patterns for sentinel-node biopsy (SNB) for breast cancer in British Columbia 5 years after its introduction in 1996. METHODS: We carried out mail and telephone surveys of general surgeons performing at least 1 SNB (n = 28) or not performing SNB (n = 50), and carried out telephone surveys or on-site visits with pathologists (n = 7) and nuclear medicine physicians (n = 5) from institutions supporting SNB in the province. We collected data on training, perceived indications and techniques for the surgical, imaging and pathologic assessments of SNB to obtain data on practice patterns in 2001 and the degree of consistency among surgeons and institutions involved in performing SNB and reasons for not adopting the SNB technique. RESULTS: By 2001, SNB was incorporated into the practice of 19% of surgeons (28 of 150) performing breast cancer surgery in British Columbia. The survey response rate among SNB surgeons was 89% (25 of 28). Twelve (48%) of the 25 surgeons implemented SNB in the context of a validation study. Ten (40%) of the 25 had no data management support to monitor their results. Surgical training included intraoperative mentoring alone (48%), formal training courses alone (20%), both (24%) and self-teaching (8%). One-third of the surgeons had performed fewer than 10 procedures. Five surgeons had abandoned routine axillary dissection. There was considerable variation regarding the indications for SNB, definition of a sentinel node and surgical techniques. All nuclear medicine departments had a written lymphatic mapping protocol, but each used a different volume and activity of radiotracer. Immunohistochemical evaluation of the sentinel nodes was performed at just 3 pathology laboratories. The survey response rate from surgeons not practising SNB was 54% (27 of 50). Among 24 responders in active practice, 7 (29%) planned to perform SNB; 79% had not decided on the SNB indications. Lack of operating room time was a major limiting factor. CONCLUSIONS: There was considerable variation in the surgical, nuclear medicine and pathology techniques for SNB in the absence of a planned approach for its implementation in British Columbia. Developing consensus around written guidelines for the indications and techniques of SNB may reduce this variation.

Breast Neoplasms↗

PubMed1996

Three-dimensional H-1 MR spectroscopic imaging of the in situ human prostate with high (0.24-0.7-cm3) spatial resolution.

PURPOSE: To evaluate if three-dimensional hydrogen-1 magnetic resonance spectroscopic imaging (3D MRSI) when combined with a clinical MR imaging examination could discriminate prostatic adenocarcinoma from normal prostatic zonal anatomy and benign prostatic hyperplasia (BPH) on the basis of observable metabolite levels. MATERIALS AND METHODS: Combined phased-array, endorectal MR imaging and 3D MRSI was performed in nine young healthy volunteers, five patients with BPH, and 85 patients with prostate cancer and BPH. Volume MR imaging and 3D MRSI data were analytically corrected for the reception profile of the endorectal and pelvic phased-array coils, aligned with the MR imaging data, and compared with postoperative pathologic histology findings. RESULTS: Statistically significant variations in metabolite levels with prostatic zonal anatomy, age, and pathologic condition were detected with a 3D MRSI examination added to a clinical MR imaging examination. Significantly higher choline levels and significantly lower citrate levels were observed in regions of cancer compared with BPH and normal peripheral zone tissues. The ratio (choline + creatine/citrate) in regions of cancer (2.1 +/- 1.3 [standard deviation]) had no overlap with normal peripheral zone values and minimal overlap with BPH values (0.61 +/- 0.21). An estimate of the spatial extent of prostate cancer was determined by generating metabolite images in which this metabolite ratio significantly exceeded normal peripheral zone values in multiple contiguous sections. CONCLUSION: These results suggest that a 3D MRSI examination added to a clinical MR imaging examination may help define the presence and spatial extent of prostate cancer.

Adenocarcinoma↗

PubMed2001

Association of recall rates with sensitivity and positive predictive values of screening mammography.

OBJECTIVE: The performance of screening mammography is measured mainly by its sensitivity, positive predictive value, and cancer detection rate. Recall rates are also suggested as a surrogate measure. The main objective of this study was to measure the effect on sensitivity and positive predictive value as recall rates increase in the community practice of mammography. MATERIALS AND METHODS: Mammography and pathology data are linked in the Carolina Mammography Registry, a population-based registry of screening mammography. Our mammography database is created from prospectively collected data from mammography facilities; the data include information on the woman and the imaging studies. Our pathology database is created from prospectively collected breast pathology data received from pathology sites and the Central Cancer Registry. Women in the registry who were 40 years old and older and who underwent screening mammography between January 1994 and June 1998 were included. "Recall rate" was defined as the percentage of screening studies for which further workup was recommended by the radiologist. RESULTS: The study included 215,665 screening mammograms. The mean age of the women was 56 years. The recall rates of the average practice ranged from 1.9% to 13.4%. Sensitivity rose from a mean of 65% in the lowest recall rates to 80.2% at the highest level of recall rates. The positive predictive value of screening decreased from 7.2% in the lowest level of recall to 3.3% in the highest. As recall rates increased, sensitivity increased very little beyond a recall rate of 4.8%, and positive predictive value began decreasing significantly at a recall rate of 5.9%. CONCLUSION: Practices with recall rates between 4.9% and 5.5% achieve the best trade-off of sensitivity and positive predictive value.

Adult↗

PubMed2003

Forensic pathological aspects of postmortem imaging of gunshot injury to the head: documentation and biometric data.

To determine the value of imaging procedures such as computer tomography (CT) and magnetic resonance imaging (MRI) of the head in providing additional information of forensic relevance, we examined 17 cadavers of human victims of gunshot wounds to the head. Three of the victims briefly survived the gunshot wound. The weapons involved were all guns with low muzzle energy (<550 J), i.e., handguns and low-velocity rifles. In the majority of cases ( n=15) a penetrating wound to the head was found, only two cases showed the bullet lodged in the brain. In some cases, imaging of the skull and brain was performed prior to autopsy; in others imaging took place after autopsy on the isolated, formalin-fixed brain. The imaging findings were correlated with the criminological data and the results of macroscopic and microscopic examination of the brain. The findings on the bony structures of the head provided imaging criteria for differentiation between entrance and exit of the gunshot wounds, which corresponded to the forensic pathological findings at autopsy. CT scans and MRI of the cerebral parenchyma revealed lanes of opaque bone and missile fragments along the course of the missile, which allowed recognition of the missile track in 3D reconstruction. Biometric reconstruction allowed easy determination of the angle of the missile track in all three planes. Examination of the parenchymal structures and imaging of the isolated, formalin-fixed brain enabled tracking of the missile path directly along the zone of destruction as well as demonstration of secondary changes such as air bubbles along the bullet course, hemorrhage and edema. The significance of a translucent zone surrounding the missile track in several cases remains unclear; it probably represents tissue destruction secondary to temporary cavitation. The imaging procedures described here allowed excellent documentation of in situ conditions, while the storing of data enabled biometric reconstruction for determination of the angle of trajectory, of entrance and exit wounds, and the extent of tissue damage along the missile track and, possibly, in the zone of temporary cavitation.

Adult↗