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In summary, a patient with multiple coronary aneurysms and operative therapy is described and 17 previously reported similar cases are reviewed. The proper type of operation for this condition is as yet unclear, but, nevertheless, the reported cases and our case with operative therapy have done well postoperatively despite a variety of procedures performed. [ABSTRACT FROM AUTHOR]

Since the late 1980s, northern Iberia has yielded some of the earliest radiocarbon dated Aurignacian assemblages in Western Europe, probably produced by anatomically modern humans (AMHs). This is at odds with its location furthest from the likely eastern entry point of AMHs, and has also suggested to some that the Châtelperronian resulted from cultural transfer from AMHs to Neanderthals. However, the accuracy of the early chronology has been extensively disputed, primarily because of the poor association between the dated samples and human activity. Here, we test the chronology of three sites in northern Iberia, L'Arbreda, Labeko Koba and La Viña, by radiocarbon dating ultrafiltered collagen from anthropogenically modified bones. The published dates from Labeko Koba are shown to be significant underestimates due to the insufficient removal of young contaminants. The early (c.44 ka cal BP [thousands of calibrated years before present]) Aurignacian chronology at L'Arbreda cannot be reproduced, but the reason for this is difficult to ascertain. The existing chronology of La Viña is found to be approximately correct. Together, the evidence suggests that major changes in technocomplexes occurred contemporaneously between the Mediterranean and Atlantic regions of northern Iberia, with the Aurignacian appearing around 42 ka cal BP, a date broadly consistent with the appearance of this industry elsewhere in Western Europe., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Recent judicial decisions have specified that one foundation of reliability of comparative forensic disciplines is description of both scientific approach used and calculation of error rates in determining the reliability of an expert opinion. Thirty volunteers were recruited for the analysis of dermal bite marks made using a previously established in vivo porcine-skin model. Ten participants were recruited from three separate groups: dentists with no experience in forensics, dentists with an interest in forensic odontology, and board-certified diplomates of the American Board of Forensic Odontology (ABFO). Examiner demographics and measures of experience in bite mark analysis were collected for each volunteer. Each participant received 18 completely documented, simulated in vivo porcine bite mark cases and three paired sets of human dental models. The paired maxillary and mandibular models were identified as suspect A, suspect B, and suspect C. Examiners were tasked to determine, using an analytic method of their own choosing, whether each bite mark of the 18 bite mark cases provided was attributable to any of the suspect dentitions provided. Their findings were recorded on a standardized recording form. The results of the study demonstrated that the group of inexperienced examiners often performed as well as the board-certified group, and both inexperienced and board-certified groups performed better than those with an interest in forensic odontology that had not yet received board certification. Incorrect suspect attributions (possible false inculpation) were most common among this intermediate group. Error rates were calculated for each of the three observer groups for each of the three suspect dentitions. This study demonstrates that error rates can be calculated using an animal model for human dermal bite marks, and although clinical experience is useful, other factors may be responsible for accuracy in bite mark analysis. Further, this study demonstrates that even under carefully controlled conditions, albeit in a forced-decision model, errors in interpretation occur even amongst the most experienced analysts., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)

Multiple fatality incidents frequently have a significant forensic dental identification component. The use of radiographs, that provide objective evidence of the dentition prior to and after death is a vital part of the reconciliation procedure. Although these events share some common elements, every multiple fatality incident response has its own idiosyncrasies that require both flexibility and advance planning. The focus, from a post mortem perspective, is the making of excellent, permanent, and archival-quality images. The post mortem plan should have a capability for conventional film-based and digital imaging. Additionally, images should be produced in a radiobiologically responsible manner using optimum body-substance precautions. Finally, images (both ante mortem and post mortem) must be held in a secure fashion at a distance, protected from further hazard., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)

Under rigorously controlled laboratory conditions, mechanically induced simulated human bite marks were made on pig skin to enable the clinical and histopatholgical study of experimental bite marks in-vivo. A series of bite marks were created on the abdomen and thorax of live anaesthetized juvenile pigs at specific times just prior to and after death. Following the release of the biting force clinical observations of antemortem wounds revealed slow diminishment of the bite indentations presumably due to dermal elastic recovery. Minutes after euthanasia of the animals, the indentations of the teeth from the postmortem bite marks faded rapidly. After the biting process the animals were placed on either the right or left side and this side was maintained until necropsy to examine for dependant and non-dependent side differences. All bite mark injuries located on the non-dependent side revealed specific pattern characteristics. However, on the dependent side whether the bite mark was antemortem or postmortem in areas of livor mortis, no clear pattern was visible. Histologically, the observations for each bite mark specimen were categorised by the presence or absence of extravasated red blood cells in the fatty or muscle layers. The histopathological findings correlate with the clinical observations of antemortem and postmortem bite marks located on the non-dependent side in regard to muscular erythema and extravasated red blood cells. It is clinically difficult to comment on temporal relationship of a bite mark in relation to time of death in areas affected by blood-pooling seen on the dependent side. In these situations, histopathological studies could be a reliable alternative to provide information regarding antemortem or postmortem injuries.

Chronic pulmonary aspiration (CPA) in children is an important cause of recurrent pneumonia, progressive lung injury, respiratory disability and death. It is sporadic, intermittent and variable, and often occurs in children with complicated underlying medical conditions and syndromes that produce symptoms indistinguishable from CPA. For most types of aspiration there is no gold-standard diagnostic test. The diagnosis of CPA is currently made clinically with some supporting diagnostic evaluations, but often not until significant lung injury has been sustained. Despite multiple diagnostic techniques, the diagnosis or exclusion of CPA in children is challenging. This is of particular concern given the outcome of unrecognised progressive lung injury and the invasiveness of definitive therapies. Although new techniques have been introduced since the 1990s and significant advances in the understanding of dysphagia and gastro-oesophageal reflux have been made, characterisation of the aspirating child remains elusive.

Radiology has been used extensively in conventional dental identification, anatomically based identification and identification using maxillofacial skeletal landmarks such as the frontal sinus. Examples of these are well documented in the literature. The purpose of this paper was to revisit the methods where radiographic methods may be used to determine identity using the teeth, the root structures and the frontal sinuses. Additionally suggestions are offered for management of radiography in mass disasters and cases where age determination is required. Computer assisted tomography can be used in the assessment of the degree of fit of a weapon to a wound in cases of blunt force skull injury and plane films can assist in depicting the pattern of post mortem skull fractures. Micro-computed tomography has been used in matching weapons to wounds in sharp-force injury cases. The radiologist's role in cases of civil litigation and fraud is discussed and case examples are given. There are gaps in the science where radiological methods are used. The author offers several suggestions for possible research projects to close some of these gaps.

Porcine skin has been shown to have similar histological, physiological and immunological properties to human skin and has been suggested as a good analogue for medical and forensic research. This study was undertaken to examine the appearance of bite mark wounds inflicted at known time intervals before and after death. Under general anaesthesia, a series of bite marks were created on a pig's abdomen with a device designed to mechanically produce simulated human bite mark wounds. The pig skin model showed that bite mark characteristics are similar to those found on human skin. This study has provided information on the window of time showing clearly detailed bite marks occurring around the time of death. It also demonstrated that it is possible under certain conditions to determine that a bite mark was made before or after death in a porcine model. Under these experimental conditions, the results suggest that an in-vivo porcine skin model should be considered as a representative model for the study of human bite marks.

Controversy exists as to whether there is less secondary caries at the margins of glass ionomer restorations compared with other materials that do not release fluoride. This study examined the incidence of secondary caries for three types of restorative materials in Class V restorations in xerostomic patients. The study group consisted of 45 high caries-risk adult patients who had undergone head and neck irradiation for the treatment of cancer. All were substantially xerostomic and in need of at least three restorations in the same arch. Every patient received a restoration with each of the test materials, a conventional glass ionomer (GI), a resin modified glass ionomer (RMGI) and a resin composite (C). Patients were instructed in the daily use of a neutral pH sodium fluoride gel in custom trays. Recall appointments were made at 6, 12, 18 and 24 months, and the restorations were examined for material loss, marginal integrity and recurrent caries at the restoration margin. Fluoride compliance was determined at each recall period and recorded as the percentage of recommended use during that interval. Patients were categorized at the end of the study as fluoride non-users if their average compliance was 50% or less. Those with greater than 50% compliance were categorized as fluoride users. In the latter group, no recurrent caries was found for any of the restorations, whereas a material-dependent incidence of recurrent caries was found in the fluoride non-user group. None of the GI, one RMGI and eight C restorations failed due to recurrent caries. For the fluoride non-user patients, Fishers exact test (p=0.05) showed no statistical difference between GI and RMGI but statistical differences were found among those materials and resin composite at each recall period. Recurrent caries reductions for GI and RMGI relative to C were greater than 80% in xerostomic patients not using topical fluoride supplementation.

A prospective radiological study of 96 patients with mandibular condylar neck fractures was undertaken to assess frequency and nature of mandibular condylar displacement. Data collected included age, gender, aetiology, and anatomical site of fracture and direction of displacement. Men aged 20-29 years sustained the majority of condylar fractures. Assault was the major cause of condylar fracture, followed by motor vehicle accidents and sport accidents. No anterior or posterior displacement of the condyle was noted. Medial displacement of the superior fragment was most frequently observed.

Following instruction in basic skills for electronic search, participants who practiced in a guided exploration mode developed stronger self-efficacy and greater satisfaction than those who practiced in a self-guided exploratory mode. Intrinsic motivation was not affected by exploration mode. On 2 post-training tasks, guided exploration participants produced more effective search strategies. expended less effort, made fewer errors, rejected fewer lines of search, and achieved higher performance. Relative lack of support for self-regulatory factors as mediators of exploration mode impacts was attributed to the uninformative feedback from electronic search, which causes most people to remain at a novice level and to require external guidance for development of self-efficacy and skills. Self-guided learning will be more effective on structured tasks with more informative feedback and for individuals with greater expertise on dynamic tasks.

Examination of the records of 88 consecutive patients with extranodal maxillofacial non-Hodgkin's lymphoma (ENHL) was undertaken. Each patient's complete record was reviewed. Males outnumbered females by 1.7:1. Age at diagnosis ranged from 22 to 94 years (median 60.0). Affected anatomic sites included: maxillary sinus (22), nasal cavity (8), maxilla (13), mandible (8), salivary glands (14), and other (23). The most common presenting symptom was a non-painful mass. Associated dental symptoms were present in 72 patients and included intraoral swelling, pain, and loose teeth. Treatment included chemotherapy and radiation with a follow-up of 1-25 years. Treatment trends indicate a shift towards multimodal therapy. Non-Hodgkin's lymphoma of the head and neck, if discovered early, has an excellent prognosis.

The possibility that personal lead shielding devices can increase absorption of radiation has not been entertained. The purpose of the present investigation specifically was to determine whether pituitary dose might be increased when a leaded apron and thyroid collar are used. Thermoluminescent dosimeters (TLDs) were used to measure absorbed dose. They were calibrated at the kVp used in the clinical situation and a calibration curve relating light output to dose was generated. Lithium fluoride TLD discs were placed in the pituitary gland region of a Rando-Alderson female human phantom. The equivalent of 100 transpharyngeal exposures were delivered. The resultant light output from recovered dosimeters was converted to a uGy value using the calibration curve. The experiment was repeated using a 0.25 mm lead equivalent collar and apron fitted to the phantom in the customary manner. The entire process was repeated in order to have 30 dosimeters for the unshielded and 30 dosimeters for the shielded conditions. A further 30 dosimeters were sham irradiated and served as controls. A statistical comparison between unshielded and shielded conditions was performed. When the leaded apron and thyroid collar were used the absorbed dose to the pituitary gland was increased significantly (P < 0.05). Following this a second group, using a different dosimetry system and a male phantom repeated the experiment. In both cases, the shielded phantom received significantly higher dose to the pituitary region than the unshielded.

Great advances had been made in rigid instrumentation, with the introduction of the glass rod telescope. With relatively few exceptions, however, bronchoscopy was still performed primarily for therapeutic indications, such as the removal of foreign bodies from the airway. It would remain for the introduction of the flexible bronchoscope to stimulate the widespread development of diagnostic bronchoscopy in pediatric practice.

The purpose of this study was to assess a possible colour shift in the root surfaces of adult human teeth and if so, whether this colour change is related to chronological age. Teeth extracted from persons of known age and gender were obtained from Ontario dental practitioners and grouped into five-year age ranges. Three experiments were undertaken: (1) to identify a possible difference in yellow colouration between the four surfaces of tooth roots (mesial, distal, lingual, and buccal), (2) to investigate the difference in yellow colouration of tooth roots between non-molar teeth and molar teeth and (3) to assess the correlation between the age of teeth and root colour saturation for yellow, magenta, cyan and black. The teeth in all investigations were scanned by a flat-bed digital colour scanner with a Kodak colour scale control and viewed on a colour computer monitor. In the first two experiments the yellow colour saturation of the root surfaces was measured at six points on each root using Photoshop 5.0 software. A significant difference was observed in the percentage yellow colour saturation between the mesial and the other three anatomical surfaces (p < 0.01), and between the root surfaces of non-molar and molar teeth (p < 0.01) (ANOVA with Bonferroni post-test). The authors then randomly assigned tooth surfaces to select an equivalent number of posterior and anterior teeth in the study, assessing the relationship between age and root colouration. Four points of colour measurement on 40 teeth (sample size permitting, see Table 1) for each known age and gender were assessed for colour saturation (cyan, magenta, yellow and black). The correlation of chronological age to colour saturation was linear for all colours, with correlation coefficients ranging from r = 0.81 to r = 0.94. The high correlation values strongly support the conclusion that chronological age is related to increased root colouration.

The purpose of this paper is to investigate the utility of digital dental radiographic superimposition in the various stages of development of the human dentition. Digital, computer assisted dental identification is a means of identification which allows the spatial relationships of the root and support structures of the teeth to be compared one to the other. The technique has not been tested in patients with developing dentitions. Dental radiographs from patients in the pediatric, mixed and permanent dentition stages of development, simulating "antemortem" and "postmortem" radiographs, were digitized using a flat field radiograph scanner. Anatomic features were used as points of comparison utilizing image editing software whereby anatomic sections were digitally cut from the antemortem image and compared to the same anatomic locations on the postmortem image to assess for points of concordance. The technique was applied to 25 cases within the primary dentition, 25 cases within the mixed dentition and 25 cases within the permanent dentition. Results showed that this was a viable technique within both the pediatric and permanent dentition although it was of little value within the mixed dentition.

Objective: The purpose of this study was to analyze the effects of head and neck radiation therapy on jaw opening and mobility., Study Design: Maximum jaw opening and mandibular mobility were measured before and after radiation treatment in 58 patients presenting for angle down wedge, homolateral wedge pair, and parallel pair head and neck radiation treatment., Results: As dose to the temporomandibular joint and pterygoid muscles increased, maximal jaw opening decreased linearly. Mandibular dysfunction appeared to increase as radiation dose to the pterygoid muscles increased. Similar effects were not observed with temporomandibular joint irradiation. Irradiation of the pterygoid muscles appeared critical in the development of trismus. Angle down wedge treatment irradiated the temporomandibular joint and pterygoid muscles with clinical effects similar to those seen in homolateral wedge pair and parallel pair patients. Doses as low as 1493 cGy resulted in functional impairment., Conclusions: Future investigations into radiotherapy delivery and appropriate postradiation trismus treatment may reduce head and neck radiation morbidity.

Background: Digital radiographic images can be manipulated using personal computers. To test the potential for fraudulent use, the authors altered a series of dental radiographs, printed them to simulate duplicated films and submitted them for authorization of proposed treatment., Materials and Methods: The authors obtained periapical radiographs of teeth that contained small restorations or were unrestored from the files of three dental patients at a private dental practice. The authors used a flatbed scanner to digitize and import the radiographs into a computer. Then they added dental caries, large restorations, fractures and periapical pathosis to the radiographs. The authors proposed to the insurance companies that the teeth in question be restored using expensive treatment, such as root-canal therapy and full-coverage crowns., Results: In each case, the insurance companies authorized the proposed treatment based on the appearance of the teeth on the radiographs. The altered images illustrated an apparent need for dental treatment that was not required and that could have led to payment for treatment that was not actually performed., Conclusions: This study illustrates the potential for the fraudulent use of manipulated digital radiographic images., Clinical Implications: Dentistry should be aware of the implications of the potential for such abuse and should develop measures both to prevent it from occurring and to facilitate its detection.