Hormone-refractory prostate cancer and the skeleton

Prostate cancer is the second most common cancer in men in the UK. Androgen ablation with luteinising hormone-releasing hormone agonists (LHRH agonists) alone, or in combination with anti-androgens is the standard treatment for men with metastatic prostate cancer. Unfortunately, despite maximal androgen blockade, most patients will go on to develop progressive disease after a variable period of time of 2-3 years. The management of hormone-refractory prostate cancer is challenging, as there is yet no uniform accepted strategy. In this thesis the comparitive efficacy of the two widely used palliative agents, 89Strontium and bisphosphonates in the management of hormone refractory prostate cancer is evaluated. Neither 89Strontium nor bisphosphonates have been so far shown to prolong survival, but our data do demonstrate that both agents have the potential to decrease the incidence of spinal cord compression and hence to significantly reduce the morbidity associated with this most severe skeletal complication of the late stage of prostate cancer. This potential may prove of importance in deciding which palliative treatment to use in hormone refractory prostate cancer, especially if patients have an increased risk for spinal cord compression or in patients with chemotherapy-refractory prostate cancer.LEI Universiteit LeidenBot en mineraalonderzoe

Embryology, normal anatomy, and imaging techniques of the hyoid and larynx with respect to forensic purposes: a review article

Experiences with pre- and postmortem imaging in a forensic setting create more and more interest. If autopsy is permitted, forensic pathologists perform careful examination of the neck structures, which plays an important role as this is decisive in the diagnostics of compressive neck injury. Primary tools are important: forensic pathologists and radiologists are supposed to be aware of the complex anatomy of the neck, especially the laryngeal region, to interprete their findings at autopsy and after imaging. It is of great interest whether CT and MR imaging techniques would be useful in comparing findings of autopsy and document findings if autopsy is refused. In the light of this, the embryology, anatomy and a review of imaging techniques of the neck will be highlighted in this article, with special attention to the value of updated imaging techniques of the larynx for forensic purposes in living people and postmorte

A case of fatal coin battery ingestion in a 2-year-old child

Foreign body aspiration is frequently encountered in young children, in the majority of cases it will not lead to an adverse outcome. However, in case of coin battery ingestion more serious adverse outcomes, including death, have been reported. We present a case with fatal outcome due to exsanguination, of a 2-year-old child with an aberrant right subclavian artery (or arteria lusoria) and coin battery ingestion. Radiological and autopsy findings and relevant literature are discusse

The value of post-mortem CT in neonaticide in case of severe decomposition: description of 12 cases

In cases of neonaticide with delayed finding of the body, interpretation of autopsy results can be difficult because of decomposition. Postmortem computed tomography (PMCT) has become an increasingly popular tool in the (pediatric) forensic field. We performed a retrospective study to compare the outcome of PMCT with autopsy results in suspected neonaticide, in neonates found more than one week after their demise. We compared the performance of both methods on (1) determining gestational age, (2) differentiating between live birth and still birth and (3) determining cause of death. We selected all consecutive neonaticide cases with an estimated postmortem interval longer than one week, who underwent a forensic autopsy including a total body PMCT in the Netherlands Forensic Institute in the period 2008-2012. Both a pathologist and radiologist scored gestational age, signs of live birth and cause of death for each case. 22 cases of neonaticide were identified in the study period, of which 15 cases were estimated to be found more than 1 week after death. In 12 of these a total body PMCT was performed. In all cases, late postmortem changes were present. Gestational age could be assessed with PMCT in 100% of the cases and with autopsy in 58% of the cases. In all cases neither PMCT nor autopsy was able to assess live birth and cause of death. PMCT is a better tool for estimating gestational age in case of suspected neonaticide with late postmortem changes compared to autopsy and should therefore be a standard part of the work-up. Signs of live birth and cause of death could not be determined with neither of the methods, an adjusted post mortem examination including limited autopsy for these cases might be develope

The use of 3D-CT in weapon caused impression fractures of the skull, from a forensic radiological point of view

Objective: The aim of this study was to analyze the usefulness of the three-dimensional (3D) volume renderings (VRTs), based on computed tomography (CT) images of the head, to gain more insight in the etiology of impression skull fractures. Materials and methods: 3D-CT scans of 12 forensic cases with impression skull fractures after head injury were selected. Ten radiologists were asked to determine the shape of the used object, the amount of blows and the location of the fracture, based on 2D CT images and 3D volume renderings. Afterwards, the results of the assessments were compared with the real shapes of the true object in case. Results: In 7 out of 12 cases, the used weapon was a hammer. In 62% of the cases the shape of the used object was determined correctly by the radiologists and in 72% of the cases the amount of blows on the skull was correct. There was no significant difference in results between the forensically experienced and forensically inexperienced radiologists. Conclusion: 3D-CT is useful in a forensic setting, to determine the shape of a suspected weapon and the amount of blows. However, assessment of the CT data should always be combined with information about the scene and a profound morphological inspection of the wound

Postmortem CT compared to autopsy in children; concordance in a forensic setting

The aim of this study is to assess the accuracy of postmortem CT (PMCT) in determining the cause of death in children who underwent a forensic autopsy because of a suspected nonnatural death. We selected forensic pediatric autopsies at the Netherlands Forensic Institute, whereby the subject underwent PMCT between 1-1-2008 and 31-12-2012. Cause of death was independently scored by a radiologist and a pathologist. Cause of death was classified (1) in categories being natural, unnatural, and unknown; (2) according to the ICD-10; and (3) according to institutional classification. In the study period, 189 pediatric forensic autopsies were performed. Fifteen were excluded because of putrefaction. Of the remaining 174 autopsies, 98 (56 %) underwent PMCT. PMCT and autopsy identified the same category in 69/98 cases (70 %, kappa 0.49). They identified the same cause of death in 66/98 cases (67 %, kappa 0.5) using ICD-10; in 71/98 (72 %, kappa 0.62) using a forensic classification. PMCT performed better in unnatural deaths (59-67 % agreement) than in natural deaths (0 % agreement). If no cause of death was detected with autopsy, PMCT failed to identify a cause of death in 98 % (39/40). Pediatric PMCT does identify the majority of unnatural causes of death, but does not identify new diagnoses (true positives) if no cause of death is found during autopsy. Diagnostic accuracy in natural deaths is low. aEuro cent The case mix is an important predictor for the concordance between PMCT and autopsy. aEuro cent In case of an unnatural death, 72--81 % of PMCT results matches autopsy results. aEuro cent In case of a natural death, 0 % of PMCT results matches autopsy results. aEuro cent If no cause of death is identified with autopsy, 98 % of PMCT results concur

Forensic imaging in legal medicine in the Netherlands: Retrospective analysis of over 1700 cases in 15 years' experience

Introduction: Forensic radiology in the living and postmortem is a new horizon in legal medicine for the detection and documentation of forensic evidence and reconstruction of the manner of death. A collaboration was undertaken 15 years ago between the Netherlands Forensic Institute, where all forensic autopsies in the Netherlands are performed, and the department of radiology in the Groene Hart Hospital (GHH). Methods: Without exception, all forensic radiological cases performed/interpreted in the GHH between 2000 and 2015 were included in the database. Radiologic imaging was always performed in addition to autopsy or medico-legal investigation. Retrospectively, the corresponding autopsy/forensic reports were studied to obtain case information. Imaging modalities, sex, age, cause and manner of death/trauma were analyzed in both living and postmortem cases. Results: A total of 1734 radiology cases was included, of which 82% was post-mortem. Male/female ratio was 2:1, mean age was 36 years (0-98). Performed imaging modalities were: total body CT: 656, cranial CT: 571, skeletal x-ray: 349, larynx-hyoid x-ray: 327, MRI: 118. Reported preliminary diagnoses were: blunt trauma (battering: 458, blunt objects: 121, transportation accidents: 156, airplane accidents: 34, explosions: 8, falls: 137), penetrating trauma: 199, ballistic trauma: 150, asphyxial deaths (strangulation, suffocation): 305, submersion: 98, fire: 80, diseases: 156, no anatomical cause of death (discovered corpses: 159, exhumed bodies: 27, sudden unexplained death in infancy: 76). Conclusion: This annually growing forensic radiological database enables data analysis in pre- and post-mortem cases and has proved to be a useful source for retrospective research and scientific collaboration

The development of the human hyoid-larynx complex revisited

The hyoid-larynx complex is highly prone to anatomical variation. The etiology of anatomical variants such as Eagle's syndrome and the aberrant hyoid apparatus can be explained from embryonic development. Modern textbooks state that the hyoid bone body develops from the second and third pharyngeal arch cartilages, and that thyroid cartilage derives from the fourth and sixth arch cartilages. This description, however, is incompatible with various anatomical variants, and it is unclear whether it was based on observations in human embryos or on comparative embryology. 14 human embryos from the Carnegie collection between Carnegie stage 17 and 23 (42-60 days) were selected based on their histological quality. Histological sections of the selected embryos were examined. Three-dimensional models were prepared in an interactive format. These anatomical models provide crucial spatial information and facilitate interpretation. We observed a less-complicated development of the hyoid-larynx complex than is currently described in textbooks. The body of the hyoid bone originates from a single growth center, without overt contributions from second and third pharyngeal arch cartilages. The fourth and sixth arch cartilages were not detected in human embryos; the thyroid and cricoid cartilages develop as mesenchymal condensations in the neck region. Despite new research techniques, theories about hyoid-larynx complex development from the beginning of the 20th century have not been refuted properly and can still be found in modern literature. Based on observations in human embryos, we propose a new and relatively simple description of the development of the hyoid-larynx complex to facilitate better understanding of the etiology of anatomical variants. NA Laryngoscope, 201