Bela Kubat - Academia.edu (original) (raw)
Papers by Bela Kubat
Journal of Forensic Radiology and Imaging, 2017
This paper presents the outcome of the first international forensic radiology and imaging researc... more This paper presents the outcome of the first international forensic radiology and imaging research summit, organized by the International Society of Forensic Radiology and Imaging, the International Association of Forensic Radiographers, the National Institute of Justice of the United States of America, and the Netherlands Forensic Institute. During this meeting, an international and multidisciplinary panel of forensic scientists discussed the current state of science in forensic radiology, and drafted a research agenda to further advance the field. Four groups for further research focus were identified: big data and statistics, identification and biological profiling, multimodal imaging, and visualization and presentation. This paper describes each of these research topics and thereby hopes to contribute to the development of this exciting new field of forensic medical science. On November 27th, 2011 the International Society of Forensic Radiology and Imaging (ISFRI) was founded. One of the aims of this society is to encourage and develop research programs in forensic radiology and imaging. With this in mind, the ISFRI, in conjunction with the International Association of Forensic Radiographers (IAFR),
The Police Journal, May 1, 2015
ABSTRACT The European Convention on Human Rights requires states to protect the life of detainees... more ABSTRACT The European Convention on Human Rights requires states to protect the life of detainees and to investigate police custody deaths. Investigations into these deaths are not only necessary in the individual case but can also be important in preventing future deaths. Examination of multiple police custody deaths over a number of years provides the possibility to determine risk factors and to establish preventive measures for avoiding future deaths. A descriptive study was therefore performed on 78 case files relating to police custody deaths in the Netherlands in 2005–2010. The main findings of this study are that half of the calamities occurred during the relatively short period of apprehension and transport by the police. The consumption of drugs and/or alcohol seems to be an important factor in fatal medical emergencies occurring under the responsibility of the police.
Histopathology, Jul 20, 2022
AimsCutaneous metastases of internal malignancies occur in 1–10% of cancer patients. The diagnosi... more AimsCutaneous metastases of internal malignancies occur in 1–10% of cancer patients. The diagnosis can sometimes be challenging, especially in cases with an unknown primary cancer.Materials and methodsA retrospective case review was performed including all cases of skin metastases from primary internal malignancies diagnosed at the Department of Pathology at the Maastricht University Medical Centre+ from 2007 to 2021. The clinicopathological data were collected and immunohistochemical and molecular diagnostic tests were performed to confirm the primary origin of the metastases.ResultsWe identified 152 cases (71 female; 31 male patients) of cutaneous metastases of internal malignancies. 28 patients (20 women and 8 men) were diagnosed with multiple cutaneous metastases. Among the female patients, the most common primary tumour was breast cancer (50% of the cases), followed by lung (13.6%), gynaecological (7.3%), and gastrointestinal origin (7.3%). Among the male patients, the most common primary sites were gastrointestinal and lung origin (altogether, 50% of the cases). In 19 patients, the cutaneous metastasis was the first presentation of a clinically silent internal malignancy (18.6%), of which most (78.9%) represented metastatic lung carcinomas. Finally, metastasizing patterns were different across tumour types and gender.ConclusionBreast, lung, gastrointestinal, and gynaecologic cancers are the most common primary tumours demonstrating skin metastases. Infrequently, cutaneous metastases can be the first clinically visual manifestation of an underlying not yet diagnosed internal malignancy; therefore, occasional broad immunohistochemical profiling, molecular clonal analysis, and a continuous high level of awareness are necessary for a precise diagnosis of cutaneous metastases of internal malignancies.
Nederlands tijdschrift voor geneeskunde, Jan 22, 2003
A 27 year-old woman died unexpectedly due to a cyst of the pineal gland with a prominent cerebell... more A 27 year-old woman died unexpectedly due to a cyst of the pineal gland with a prominent cerebellar tonsillar herniation.
British journal of cancer, Jan 7, 2003
The clinical course of astrocytoma grade II (AII) is highly variable and not reflected by histolo... more The clinical course of astrocytoma grade II (AII) is highly variable and not reflected by histological characteristics. As one of the best prognostic factors, higher age identifies rapid progressive A II. For patients over 35 years of age, an aggressive treatment is normally propagated. For patients under 35 years, there is no clear guidance for treatment choices, and therefore also the necessity of histopathological diagnosis is often questioned. We studied the additional prognostic value of the proliferation index and the detection of genetic aberrations for patients with A II. The tumour samples were obtained by stereotactic biopsy or tumour resection and divided into two age groups, that is 18-34 years (n=19) and > or =35 years (n=28). Factors tested included the proliferation (Ki-67) index, and numerical aberrations for chromosomes 1, 7, and 10, as detected by in situ hybridisation (ISH). The results show that age is a prognostic indicator when studied in the total patient g...
The Open Neurology Journal, 2008
Aims: To explore whether Chlamydia pneumoniae, Cytomegalovirus and Herpes Simplex Virus type 1 co... more Aims: To explore whether Chlamydia pneumoniae, Cytomegalovirus and Herpes Simplex Virus type 1 could be detected in large and small cerebral arteries, as well as in an area of brain parenchyma where white matter lesions (leukoaraiosis) can be found, in patients with clinically unmanifested cerebrovascular atherosclerosis. Methods and results: Arterial specimens from the basilar artery and middle cerebral artery, and brain samples from the basal ganglia and periventricular white matter were obtained. Neuropathological changes were assessed in Haematoxylin-Eosin stained sections. Polymerase chain reaction (PCR) was performed on paraffin embedded sections. Subsequently, we performed immunohistochemical staining on samples, which were found positive in PCR. We failed to detect C. pneumoniae, CMV, or HSV-1, in any of the cerebral large vessels. In the brain tissue, we found only one case positive for CMV, and one for C. pneumoniae. Conclusions: our findings suggest a limited role for C. pneumoniae, CMV and HSV-1 in cerebral large and small vessel atherosclerosis.
Journal of Clinical Pathology
AimsThe aim of this study is to evaluate whether agreement with autopsy-determined cause of death... more AimsThe aim of this study is to evaluate whether agreement with autopsy-determined cause of death (COD) increases by use of postmortem CT (PMCT) or PMCT in combination with postmortem sampling (PMS), when compared with clinical assessment only.MethodsThis prospective observational study included deceased patients from the intensive care unit and internal medicine wards between October 2013 and August 2017. The primary outcome was percentage agreement on COD between the reference standard (autopsy) and the alternative postmortem examinations (clinical assessment vs PMCT or PMCT+PMS). In addition, the COD of patient groups with and without conventional autopsy were compared with respect to involved organ systems and pathologies.ResultsOf 730 eligible cases, 144 could be included for analysis: 63 underwent PCMT without autopsy and 81 underwent both PMCT and autopsy. Agreement with autopsy-determined COD was significantly higher for both PMCT with PMS (42/57, 74%), and PMCT alone (53/81...
Poster: "ECR 2017 / C-3053 / The value of post-mortem CT for establishing the cause of death... more Poster: "ECR 2017 / C-3053 / The value of post-mortem CT for establishing the cause of death: initial results" by: "F. C. Bakers, A. peer van, B. Latten, C. Mihl, B. kubat, R. rennenberg, R. koopmans, P. A. M. Hofman; Maastricht/NL"
Virchows Archiv
Autopsy rates are declining, while major discrepancies between autopsies and clinical diagnoses r... more Autopsy rates are declining, while major discrepancies between autopsies and clinical diagnoses remain. Still, little is known about the impact of suspected underlying diseases, for example, a diagnosis of cancer, on the autopsy rate. The aim of this study was to investigate the relation between the clinical cause of death, a history of cancer, and the medical autopsy rate using data from the Netherlands Cohort Study on Diet and Cancer (NLCS), a large prospective cohort study with a long follow-up. The NLCS is a prospective study initiated in 1986 and includes 120,852 persons (58,279 males and 62,573 females), 55–69 years of age at the time of enrollment. The NLCS was linked with the Dutch Nationwide Pathology Databank (PALGA), the Dutch Population Register (GBA), the Netherlands Cancer Registry, and the causes of death registry (Statistics Netherlands). If applicable, the 95% confidence intervals were calculated. During the follow-up of the NLCS, 59,760 deaths were recorded by link...
Circulation, Nov 25, 2014
Forensic Science International, 2019
The last decennia autopsies have been declining worldwide, whereas non-invasive methods have been... more The last decennia autopsies have been declining worldwide, whereas non-invasive methods have been proposed as an alternative for the conventional autopsy. Some of these methods add needle biopsies to imaging techniques to provide an alternative to histological examination of autopsy-derived tissue. The aim of this study was to investigate the representativeness of the histology of computed tomography (CT)-guided post-mortem needle biopsies in comparison to autopsy derived tissue from the same organ. Method: Consent of next of kin was obtained from relatives of deceased within the department of Internal Medicine to perform an autopsy, postmortem CT and CT-guided needle biopsies. The lungs and the liver were routinely sampled with CT-guided postmortem biopsies and during the autopsy. In some cases extra CT-guided biopsies of lesions reported on the CT were sampled. The biopsy and the autopsy reports were independently reported and retrospectively coded according to the Nationwide Network and Registry of Histo-and Cytopathology in the Netherlands (PALGA). Three pathologists with an interest in autopsy pathology and three physicians of the department of internal medicine separately and independently interpreted all histological results in relation to the cause of death as formulated in the autopsy report. Fleiss's Kappa was calculated and a consensus grade was defined. Results: Fleiss's Kappa showed substantial agreement in both lungs and moderate agreement in the liver. Of the 60 included cases 44% of the CT-guided postmortem biopsies in the left lung and 30% in the right lung showed false negative findings, primarily concerning a bronchopneumonia. In contrast, 91% of the liver biopsies showed concordant results, however only 22% of all liver biopsies concerned a major diagnosis related to the cause of death. The positive predictive value of the biopsies of the left lung, right lung and the liver were respectively 86.6%, 88.8% and 100%. The negative predictive values of these biopsies were 32.4%, 50% and 92.7%. Conclusion: CT-guided postmortem biopsies of the lungs have a mediocre predictive value. Due to a low prevalence of relevant findings the overall usefulness of biopsies of the liver are limited. Conventional autopsy should still be preferred to biopsy-based postmortem examination. Postmortem biopsies are only an alternative if consent for an autopsy cannot be obtained. In the forensic setting, where no consent of the relatives is necessary, complete autopsy should always be the method of choice.
Journal of Forensic and Legal Medicine, 2013
Thorough investigation of deaths related to police actions or of persons placed under the 'care' ... more Thorough investigation of deaths related to police actions or of persons placed under the 'care' of governmental authorities is anchored in the legal systems of every democratic system. The quality of this investigation should be guarded by an adequate set of control measures. Recently the Dutch Ombudsman published a report about this issue In the Netherlands no central registry of these deaths exists. The estimates based on the available data number some 400e500 deaths in custody in the past 10 years in the Netherlands of which only in 193 cases a legal postmortem was performed. We present an overview of these cases and discuss the present Dutch practice in the perspective of national and international legislation.
BJS Open, 2018
Background: Iatrogenic ureteric injury remains a risk in laparoscopic pelvic procedures. Near-inf... more Background: Iatrogenic ureteric injury remains a risk in laparoscopic pelvic procedures. Near-infrared fluorescence (NIRF) imaging is a promising new technique for enhanced intraoperative visualization of anatomical structures that could improve the safety of laparoscopic surgery. A new dye, IRDye ® 800-BK, has been developed for intraoperative visualization of the ureters using NIRF. The present study was a first evaluation of the performance of IRDye ® 800-BK for ureteric imaging during NIRF laparoscopy. Methods: This study consisted of three parts: real-time in vivo NIRF imaging using IRDye ® 800-BK in pigs during laparoscopic surgery, ex vivo NIRF imaging of freshly explanted pig ureters and ex vivo NIRF imaging of explanted human ureters. Results: In all animals, both left and right ureters were visualized throughout the laparoscopic procedure for 120 min, with the best results at a dose of 0⋅15 mg dye per kg bodyweight. NIRF imaging was successful in all human and porcine ureters studied, with a range of dye concentrations. Conclusion: NIRF imaging of the ureters using IRDye ® 800-BK was used successfully both in vivo in a porcine model, and ex vivo in porcine and human ureters. Funding information Karl Storz (Tuttlingen, Germany) provided the fluorescence equipment LI-COR Biosciences (Lincoln, Nebraska, USA) provided the fluorescent dye
1Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands 2Department of... more 1Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands 2Department of Physiology, VU University Medical Center. 3Department of Cardiology, VU University Medical Center. 4Cardiothoracic Surgery, VU University Medical Center. 5ICaR-VU, VU University Medical Center. 6Netherlands Forensic Institute, The Hague, The Netherlands. 7Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands. 8Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands 9Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands *These authors contributed equally to this study
VU University Medical Center, Departments of Pathology1, Physiology6, Cardiothoracic Surgery8 Ams... more VU University Medical Center, Departments of Pathology1, Physiology6, Cardiothoracic Surgery8 Amsterdam, the Netherlands. 2Netherlands Forensic Institute, The Hague, the Netherlands. 3Institute for cardiovascular research (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands. Academic Medical Center Amsterdam, Laboratory Genetic Metabolic Diseases and Department of Pediatrics/Emma’s Children Hospital4, Core Facility Cellular Imaging / LCAM-AMC7, Amsterdam. 5Maastricht University Medical Center, Department of Pathology, Maastricht, the Netherlands.
Aesthetic Surgery Journal, 2021
Background Autologous facial fat grafting has gained popularity in recent years and is considered... more Background Autologous facial fat grafting has gained popularity in recent years and is considered to be safe. This paper presents the case of a patient who died due to massive cerebral microfat embolism after facial fat grafting. Objectives The aim of this study was to raise awareness and provide more evidence on the prevention and treatment of this potentially lethal complication of facial fat grafting. Methods A detailed report was made of the case. Two online databases were searched for similar cases of facial fat embolism resulting in neurologic and/or visual symptoms. Thereafter a literature search was conducted to verify the etiology, current treatment options, and preventive measures. Results Forty-nine cases with similar events were found in the literature. The most common injected area was the glabella (36.1%), and an average of 16.7 mL fat was injected. The main complications were visual impairment, with 88.5% of cases resulting in permanent monocular blindness, and neurol...
Forensic Science International, 2021
INTRODUCTION Most findings of forensic pathology examinations are presented as written reports. T... more INTRODUCTION Most findings of forensic pathology examinations are presented as written reports. There are currently no internationally accepted recommendations for writing forensic pathology reports. Existing recommendations are also varied and reflect the differences in the scope and role of forensic medical services and local settings in which they are to be implemented. The legal fact-finder thus faces wide variation in the quality of forensic pathology reports, which poses a threat to the reliability of legal decision-making. To address this issue, the development of the "PERFORM-P (Principles of Evidence-based Reporting in FORensic Medicine-Pathology version)" was undertaken. The goal of the PERFORM-P is to provide common practice recommendations adaptable to local requirements to promote evidence-based practice (EBP) in forensic pathology. METHODS An international consensus study was conducted in three phases by (1) developing a long-list of items to be considered in the reporting recommendations, (2) conducting a Delphi process (an iterative survey method to transform individual opinions into group consensus) with international forensic pathologists, and (3) designing the PERFORM-P prototype and its accompanying manual. RESULTS With assistance from 106 forensic pathologists/forensic medical practitioners from 41 countries, the PERFORM-P was developed. The PERFORM-P consists of a list of 61 items to be included in a forensic pathology report, which is accompanied by its Explanation and Elaboration (E&E) document. DISCUSSION To prepare forensic pathology (postmortem) reports that incorporate principles of evidence-based practice, internationally accepted recommendations might be helpful. The PERFORM-P identifies recommendations for necessary elements to include in a forensic pathology report. PERFORM-P can be applied to a wide range of matters requiring forensic pathological analysis, acceptable to forensic pathologists from a representative selection of jurisdictions and medico-legal systems.
International Journal of Legal Medicine, 2019
The aim of this study is to assess the added value of post-mortem computed tomography (PMCT) in f... more The aim of this study is to assess the added value of post-mortem computed tomography (PMCT) in fatal shooting incidents compared with autopsy findings. For this study, the analysis was restricted to the following four features: location of the entrance and exit wounds, internal injuries, location of projectiles or metal fragments and course of the trajectories. These features were selected because they provide essential information on the cause and manner of death. All data were retrospectively collected from medical forensic examinations of fatal shooting incidents in the Netherlands that occurred in 2010-2014. Twenty-one fatal shooting victims were included in this study, with a total of 100 trajectories. For all 100 trajectories, the forensic radiologist and pathologist came to a consensus on which examination had the highest diagnostic value for each of the four features. PMCT provides superior information on the presence of metal fragments, internal injuries and the course of trajectories. PMCT provides limited information on the discrimination of entrance and exit wounds. In conclusion, PMCT provides additional relevant information in over 60% of forensic medical examinations of deceased victims of shooting incidents. We therefore recommend adding PMCT as a standard examination in these cases.
Circulation, Nov 25, 2014
Journal of Forensic Radiology and Imaging, 2014
Journal of Forensic Radiology and Imaging, 2017
This paper presents the outcome of the first international forensic radiology and imaging researc... more This paper presents the outcome of the first international forensic radiology and imaging research summit, organized by the International Society of Forensic Radiology and Imaging, the International Association of Forensic Radiographers, the National Institute of Justice of the United States of America, and the Netherlands Forensic Institute. During this meeting, an international and multidisciplinary panel of forensic scientists discussed the current state of science in forensic radiology, and drafted a research agenda to further advance the field. Four groups for further research focus were identified: big data and statistics, identification and biological profiling, multimodal imaging, and visualization and presentation. This paper describes each of these research topics and thereby hopes to contribute to the development of this exciting new field of forensic medical science. On November 27th, 2011 the International Society of Forensic Radiology and Imaging (ISFRI) was founded. One of the aims of this society is to encourage and develop research programs in forensic radiology and imaging. With this in mind, the ISFRI, in conjunction with the International Association of Forensic Radiographers (IAFR),
The Police Journal, May 1, 2015
ABSTRACT The European Convention on Human Rights requires states to protect the life of detainees... more ABSTRACT The European Convention on Human Rights requires states to protect the life of detainees and to investigate police custody deaths. Investigations into these deaths are not only necessary in the individual case but can also be important in preventing future deaths. Examination of multiple police custody deaths over a number of years provides the possibility to determine risk factors and to establish preventive measures for avoiding future deaths. A descriptive study was therefore performed on 78 case files relating to police custody deaths in the Netherlands in 2005–2010. The main findings of this study are that half of the calamities occurred during the relatively short period of apprehension and transport by the police. The consumption of drugs and/or alcohol seems to be an important factor in fatal medical emergencies occurring under the responsibility of the police.
Histopathology, Jul 20, 2022
AimsCutaneous metastases of internal malignancies occur in 1–10% of cancer patients. The diagnosi... more AimsCutaneous metastases of internal malignancies occur in 1–10% of cancer patients. The diagnosis can sometimes be challenging, especially in cases with an unknown primary cancer.Materials and methodsA retrospective case review was performed including all cases of skin metastases from primary internal malignancies diagnosed at the Department of Pathology at the Maastricht University Medical Centre+ from 2007 to 2021. The clinicopathological data were collected and immunohistochemical and molecular diagnostic tests were performed to confirm the primary origin of the metastases.ResultsWe identified 152 cases (71 female; 31 male patients) of cutaneous metastases of internal malignancies. 28 patients (20 women and 8 men) were diagnosed with multiple cutaneous metastases. Among the female patients, the most common primary tumour was breast cancer (50% of the cases), followed by lung (13.6%), gynaecological (7.3%), and gastrointestinal origin (7.3%). Among the male patients, the most common primary sites were gastrointestinal and lung origin (altogether, 50% of the cases). In 19 patients, the cutaneous metastasis was the first presentation of a clinically silent internal malignancy (18.6%), of which most (78.9%) represented metastatic lung carcinomas. Finally, metastasizing patterns were different across tumour types and gender.ConclusionBreast, lung, gastrointestinal, and gynaecologic cancers are the most common primary tumours demonstrating skin metastases. Infrequently, cutaneous metastases can be the first clinically visual manifestation of an underlying not yet diagnosed internal malignancy; therefore, occasional broad immunohistochemical profiling, molecular clonal analysis, and a continuous high level of awareness are necessary for a precise diagnosis of cutaneous metastases of internal malignancies.
Nederlands tijdschrift voor geneeskunde, Jan 22, 2003
A 27 year-old woman died unexpectedly due to a cyst of the pineal gland with a prominent cerebell... more A 27 year-old woman died unexpectedly due to a cyst of the pineal gland with a prominent cerebellar tonsillar herniation.
British journal of cancer, Jan 7, 2003
The clinical course of astrocytoma grade II (AII) is highly variable and not reflected by histolo... more The clinical course of astrocytoma grade II (AII) is highly variable and not reflected by histological characteristics. As one of the best prognostic factors, higher age identifies rapid progressive A II. For patients over 35 years of age, an aggressive treatment is normally propagated. For patients under 35 years, there is no clear guidance for treatment choices, and therefore also the necessity of histopathological diagnosis is often questioned. We studied the additional prognostic value of the proliferation index and the detection of genetic aberrations for patients with A II. The tumour samples were obtained by stereotactic biopsy or tumour resection and divided into two age groups, that is 18-34 years (n=19) and > or =35 years (n=28). Factors tested included the proliferation (Ki-67) index, and numerical aberrations for chromosomes 1, 7, and 10, as detected by in situ hybridisation (ISH). The results show that age is a prognostic indicator when studied in the total patient g...
The Open Neurology Journal, 2008
Aims: To explore whether Chlamydia pneumoniae, Cytomegalovirus and Herpes Simplex Virus type 1 co... more Aims: To explore whether Chlamydia pneumoniae, Cytomegalovirus and Herpes Simplex Virus type 1 could be detected in large and small cerebral arteries, as well as in an area of brain parenchyma where white matter lesions (leukoaraiosis) can be found, in patients with clinically unmanifested cerebrovascular atherosclerosis. Methods and results: Arterial specimens from the basilar artery and middle cerebral artery, and brain samples from the basal ganglia and periventricular white matter were obtained. Neuropathological changes were assessed in Haematoxylin-Eosin stained sections. Polymerase chain reaction (PCR) was performed on paraffin embedded sections. Subsequently, we performed immunohistochemical staining on samples, which were found positive in PCR. We failed to detect C. pneumoniae, CMV, or HSV-1, in any of the cerebral large vessels. In the brain tissue, we found only one case positive for CMV, and one for C. pneumoniae. Conclusions: our findings suggest a limited role for C. pneumoniae, CMV and HSV-1 in cerebral large and small vessel atherosclerosis.
Journal of Clinical Pathology
AimsThe aim of this study is to evaluate whether agreement with autopsy-determined cause of death... more AimsThe aim of this study is to evaluate whether agreement with autopsy-determined cause of death (COD) increases by use of postmortem CT (PMCT) or PMCT in combination with postmortem sampling (PMS), when compared with clinical assessment only.MethodsThis prospective observational study included deceased patients from the intensive care unit and internal medicine wards between October 2013 and August 2017. The primary outcome was percentage agreement on COD between the reference standard (autopsy) and the alternative postmortem examinations (clinical assessment vs PMCT or PMCT+PMS). In addition, the COD of patient groups with and without conventional autopsy were compared with respect to involved organ systems and pathologies.ResultsOf 730 eligible cases, 144 could be included for analysis: 63 underwent PCMT without autopsy and 81 underwent both PMCT and autopsy. Agreement with autopsy-determined COD was significantly higher for both PMCT with PMS (42/57, 74%), and PMCT alone (53/81...
Poster: "ECR 2017 / C-3053 / The value of post-mortem CT for establishing the cause of death... more Poster: "ECR 2017 / C-3053 / The value of post-mortem CT for establishing the cause of death: initial results" by: "F. C. Bakers, A. peer van, B. Latten, C. Mihl, B. kubat, R. rennenberg, R. koopmans, P. A. M. Hofman; Maastricht/NL"
Virchows Archiv
Autopsy rates are declining, while major discrepancies between autopsies and clinical diagnoses r... more Autopsy rates are declining, while major discrepancies between autopsies and clinical diagnoses remain. Still, little is known about the impact of suspected underlying diseases, for example, a diagnosis of cancer, on the autopsy rate. The aim of this study was to investigate the relation between the clinical cause of death, a history of cancer, and the medical autopsy rate using data from the Netherlands Cohort Study on Diet and Cancer (NLCS), a large prospective cohort study with a long follow-up. The NLCS is a prospective study initiated in 1986 and includes 120,852 persons (58,279 males and 62,573 females), 55–69 years of age at the time of enrollment. The NLCS was linked with the Dutch Nationwide Pathology Databank (PALGA), the Dutch Population Register (GBA), the Netherlands Cancer Registry, and the causes of death registry (Statistics Netherlands). If applicable, the 95% confidence intervals were calculated. During the follow-up of the NLCS, 59,760 deaths were recorded by link...
Circulation, Nov 25, 2014
Forensic Science International, 2019
The last decennia autopsies have been declining worldwide, whereas non-invasive methods have been... more The last decennia autopsies have been declining worldwide, whereas non-invasive methods have been proposed as an alternative for the conventional autopsy. Some of these methods add needle biopsies to imaging techniques to provide an alternative to histological examination of autopsy-derived tissue. The aim of this study was to investigate the representativeness of the histology of computed tomography (CT)-guided post-mortem needle biopsies in comparison to autopsy derived tissue from the same organ. Method: Consent of next of kin was obtained from relatives of deceased within the department of Internal Medicine to perform an autopsy, postmortem CT and CT-guided needle biopsies. The lungs and the liver were routinely sampled with CT-guided postmortem biopsies and during the autopsy. In some cases extra CT-guided biopsies of lesions reported on the CT were sampled. The biopsy and the autopsy reports were independently reported and retrospectively coded according to the Nationwide Network and Registry of Histo-and Cytopathology in the Netherlands (PALGA). Three pathologists with an interest in autopsy pathology and three physicians of the department of internal medicine separately and independently interpreted all histological results in relation to the cause of death as formulated in the autopsy report. Fleiss's Kappa was calculated and a consensus grade was defined. Results: Fleiss's Kappa showed substantial agreement in both lungs and moderate agreement in the liver. Of the 60 included cases 44% of the CT-guided postmortem biopsies in the left lung and 30% in the right lung showed false negative findings, primarily concerning a bronchopneumonia. In contrast, 91% of the liver biopsies showed concordant results, however only 22% of all liver biopsies concerned a major diagnosis related to the cause of death. The positive predictive value of the biopsies of the left lung, right lung and the liver were respectively 86.6%, 88.8% and 100%. The negative predictive values of these biopsies were 32.4%, 50% and 92.7%. Conclusion: CT-guided postmortem biopsies of the lungs have a mediocre predictive value. Due to a low prevalence of relevant findings the overall usefulness of biopsies of the liver are limited. Conventional autopsy should still be preferred to biopsy-based postmortem examination. Postmortem biopsies are only an alternative if consent for an autopsy cannot be obtained. In the forensic setting, where no consent of the relatives is necessary, complete autopsy should always be the method of choice.
Journal of Forensic and Legal Medicine, 2013
Thorough investigation of deaths related to police actions or of persons placed under the 'care' ... more Thorough investigation of deaths related to police actions or of persons placed under the 'care' of governmental authorities is anchored in the legal systems of every democratic system. The quality of this investigation should be guarded by an adequate set of control measures. Recently the Dutch Ombudsman published a report about this issue In the Netherlands no central registry of these deaths exists. The estimates based on the available data number some 400e500 deaths in custody in the past 10 years in the Netherlands of which only in 193 cases a legal postmortem was performed. We present an overview of these cases and discuss the present Dutch practice in the perspective of national and international legislation.
BJS Open, 2018
Background: Iatrogenic ureteric injury remains a risk in laparoscopic pelvic procedures. Near-inf... more Background: Iatrogenic ureteric injury remains a risk in laparoscopic pelvic procedures. Near-infrared fluorescence (NIRF) imaging is a promising new technique for enhanced intraoperative visualization of anatomical structures that could improve the safety of laparoscopic surgery. A new dye, IRDye ® 800-BK, has been developed for intraoperative visualization of the ureters using NIRF. The present study was a first evaluation of the performance of IRDye ® 800-BK for ureteric imaging during NIRF laparoscopy. Methods: This study consisted of three parts: real-time in vivo NIRF imaging using IRDye ® 800-BK in pigs during laparoscopic surgery, ex vivo NIRF imaging of freshly explanted pig ureters and ex vivo NIRF imaging of explanted human ureters. Results: In all animals, both left and right ureters were visualized throughout the laparoscopic procedure for 120 min, with the best results at a dose of 0⋅15 mg dye per kg bodyweight. NIRF imaging was successful in all human and porcine ureters studied, with a range of dye concentrations. Conclusion: NIRF imaging of the ureters using IRDye ® 800-BK was used successfully both in vivo in a porcine model, and ex vivo in porcine and human ureters. Funding information Karl Storz (Tuttlingen, Germany) provided the fluorescence equipment LI-COR Biosciences (Lincoln, Nebraska, USA) provided the fluorescent dye
1Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands 2Department of... more 1Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands 2Department of Physiology, VU University Medical Center. 3Department of Cardiology, VU University Medical Center. 4Cardiothoracic Surgery, VU University Medical Center. 5ICaR-VU, VU University Medical Center. 6Netherlands Forensic Institute, The Hague, The Netherlands. 7Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands. 8Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands 9Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands *These authors contributed equally to this study
VU University Medical Center, Departments of Pathology1, Physiology6, Cardiothoracic Surgery8 Ams... more VU University Medical Center, Departments of Pathology1, Physiology6, Cardiothoracic Surgery8 Amsterdam, the Netherlands. 2Netherlands Forensic Institute, The Hague, the Netherlands. 3Institute for cardiovascular research (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands. Academic Medical Center Amsterdam, Laboratory Genetic Metabolic Diseases and Department of Pediatrics/Emma’s Children Hospital4, Core Facility Cellular Imaging / LCAM-AMC7, Amsterdam. 5Maastricht University Medical Center, Department of Pathology, Maastricht, the Netherlands.
Aesthetic Surgery Journal, 2021
Background Autologous facial fat grafting has gained popularity in recent years and is considered... more Background Autologous facial fat grafting has gained popularity in recent years and is considered to be safe. This paper presents the case of a patient who died due to massive cerebral microfat embolism after facial fat grafting. Objectives The aim of this study was to raise awareness and provide more evidence on the prevention and treatment of this potentially lethal complication of facial fat grafting. Methods A detailed report was made of the case. Two online databases were searched for similar cases of facial fat embolism resulting in neurologic and/or visual symptoms. Thereafter a literature search was conducted to verify the etiology, current treatment options, and preventive measures. Results Forty-nine cases with similar events were found in the literature. The most common injected area was the glabella (36.1%), and an average of 16.7 mL fat was injected. The main complications were visual impairment, with 88.5% of cases resulting in permanent monocular blindness, and neurol...
Forensic Science International, 2021
INTRODUCTION Most findings of forensic pathology examinations are presented as written reports. T... more INTRODUCTION Most findings of forensic pathology examinations are presented as written reports. There are currently no internationally accepted recommendations for writing forensic pathology reports. Existing recommendations are also varied and reflect the differences in the scope and role of forensic medical services and local settings in which they are to be implemented. The legal fact-finder thus faces wide variation in the quality of forensic pathology reports, which poses a threat to the reliability of legal decision-making. To address this issue, the development of the "PERFORM-P (Principles of Evidence-based Reporting in FORensic Medicine-Pathology version)" was undertaken. The goal of the PERFORM-P is to provide common practice recommendations adaptable to local requirements to promote evidence-based practice (EBP) in forensic pathology. METHODS An international consensus study was conducted in three phases by (1) developing a long-list of items to be considered in the reporting recommendations, (2) conducting a Delphi process (an iterative survey method to transform individual opinions into group consensus) with international forensic pathologists, and (3) designing the PERFORM-P prototype and its accompanying manual. RESULTS With assistance from 106 forensic pathologists/forensic medical practitioners from 41 countries, the PERFORM-P was developed. The PERFORM-P consists of a list of 61 items to be included in a forensic pathology report, which is accompanied by its Explanation and Elaboration (E&E) document. DISCUSSION To prepare forensic pathology (postmortem) reports that incorporate principles of evidence-based practice, internationally accepted recommendations might be helpful. The PERFORM-P identifies recommendations for necessary elements to include in a forensic pathology report. PERFORM-P can be applied to a wide range of matters requiring forensic pathological analysis, acceptable to forensic pathologists from a representative selection of jurisdictions and medico-legal systems.
International Journal of Legal Medicine, 2019
The aim of this study is to assess the added value of post-mortem computed tomography (PMCT) in f... more The aim of this study is to assess the added value of post-mortem computed tomography (PMCT) in fatal shooting incidents compared with autopsy findings. For this study, the analysis was restricted to the following four features: location of the entrance and exit wounds, internal injuries, location of projectiles or metal fragments and course of the trajectories. These features were selected because they provide essential information on the cause and manner of death. All data were retrospectively collected from medical forensic examinations of fatal shooting incidents in the Netherlands that occurred in 2010-2014. Twenty-one fatal shooting victims were included in this study, with a total of 100 trajectories. For all 100 trajectories, the forensic radiologist and pathologist came to a consensus on which examination had the highest diagnostic value for each of the four features. PMCT provides superior information on the presence of metal fragments, internal injuries and the course of trajectories. PMCT provides limited information on the discrimination of entrance and exit wounds. In conclusion, PMCT provides additional relevant information in over 60% of forensic medical examinations of deceased victims of shooting incidents. We therefore recommend adding PMCT as a standard examination in these cases.
Circulation, Nov 25, 2014
Journal of Forensic Radiology and Imaging, 2014