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For shooting scene reconstruction purposes, knowledge about the ricochet behavior of bullets provides valuable information. In this study, the critical ricochet angles of four cartridge types were established on plain float glass. The estimates of the critical ricochet angles varied between cartridge types and were 21.0° for .32 Auto FMJ bullets, 15.8° for 9 mm Luger FMJ bullets, 17.6° for .45 Auto FMJ bullets, and 21.3° for 9 mm Luger, Action NP bullets. The corresponding ricochet and deflection angles per incidence angle varied depending on the state of the ricocheted bullets. The mean ricochet angles are always lower than the corresponding angles of incidence, and the mean ricochet angles for the FMJ bullets with undamaged jackets are lower than those of bullets where the jacket is either damaged or the bullet partially ricocheted and partially perforated. Mean ricochet angles are lower for undamaged FMJ bullets than for undamaged Action NP bullets., (© 2016 American Academy of Forensic Sciences.)

When a bullet ricochets from wood, various parameters will influence its behavior. In this study, the influence of the wood grain on the ricochet angle (β) and deflection angle (γ) is assessed. Series of five .32 Auto bullets were fired at different angles of incidence (α) on boards of six wood types. The results confirm the previously shown effect that the mean β-angles usually exceed α and increase when α increases. Overall, the maximum mean γ occurs when the angle of wood grain (ζ), in relation to the plane of impact, lies between 30° and 75° but differs per combination of wood and α. The results show the inclination of γ toward the left or right, depending on the bullets left or right rotation while also showing that the direction of ζ can enhance or counteract this effect considerably, especially when α is close to the critical ricochet angle., (© 2016 American Academy of Forensic Sciences.)

Based on the spatial relation between a primary and secondary bullet defect or on the shape and dimensions of the primary bullet defect, a bullet's trajectory prior to impact can be estimated for a shooting scene reconstruction. The accuracy and precision of the estimated trajectories will vary depending on variables such as, the applied method of reconstruction, the (true) angle of incidence, the properties of the target material and the properties of the bullet upon impact. This study focused on the accuracy and precision of estimated bullet trajectories when different variants of the probing method, ellipse method, and lead-in method are applied on bullet defects resulting from shots at various angles of incidence on drywall, MDF and sheet metal. The results show that in most situations the best performance (accuracy and precision) is seen when the probing method is applied. Only for the lowest angles of incidence the performance was better when either the ellipse or lead-in method was applied. The data provided in this paper can be used to select the appropriate method(s) for reconstruction and to correct for systematic errors (accuracy) and to provide a value of the precision, by means of a confidence interval of the specific measurement., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Managing context information in forensic casework aims to minimize task-irrelevant information while maximizing the task-relevant information that reaches the examiner. A design and implementation of context information management (CIM) is described for forensic firearms examination. Guided by a taxonomy of different sources of context information, a flow-chart was constructed that specifies the process of casework examination and context information management. Due to the risk of bias, another examiner may need to be involved when context information management is unsuccessful. Application of context information management does not make a subjective examination objective, but can limit the risks of bias with a minimal investment of time and resources., (Copyright © 2015 The Chartered Society of Forensic Sciences. Published by Elsevier Ireland Ltd. All rights reserved.)

The use of ballistic gelatine, generally accepted as a human muscle tissue simulant in wound ballistic studies, might be improved by adding a preservative (Methyl 4-hydroxybenzoate) which inhibits microbial growth. This study shows that replacing a part of the gelatine powder by the preservative does not significantly alter the penetration depth of projectiles. Storing prepared blocks of ballistic gelatine over time decreased the penetration depth of projectiles. Storage of prepared gelatine for 4 week already showed a significant effect on the penetration depth of projectiles., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

In shooting scene reconstructions, risk assessment of the situation can be important for the legal system. Shooting accuracy and precision, and thus risk assessment, might be correlated with the shooter's physical movement and experience. The hit patterns of inexperienced and experienced shooters, while shooting stationary (10 shots) and in running motion (10 shots) with a semi-automatic pistol, were compared visually (with confidence ellipses) and statistically. The results show a significant difference in precision (circumference of the hit patterns) between stationary shots and shots fired in motion for both inexperienced and experienced shooters. The decrease in precision for all shooters was significantly larger in the y-direction than in the x-direction. The precision of the experienced shooters is overall better than that of the inexperienced shooters. No significant change in accuracy (shift in the hit pattern center) between stationary shots and shots fired in motion can be seen for all shooters., (© 2015 American Academy of Forensic Sciences.)

In 2010, the Netherlands Forensic Institute (NFI) and the University of Amsterdam (UvA) started a series of tests for the NFI's Firearms Section. Ten cartridge case and bullet comparison tests were submitted by various external parties as regular cases and mixed in the flow of real cases. The results of the tests were evaluated with the VU University Amsterdam (VUA). A total of twenty-nine conclusions were drawn in the ten tests. For nineteen conclusions the submitted cartridge cases or bullets were either fired from the questioned firearm or from one and the same firearm, in tests where no firearm was submitted. For ten conclusions the submitted cartridge cases or bullets were either fired from another firearm than the submitted one or from several firearms, in tests where no firearm was submitted. In none of the conclusions misleading evidence was reported, in the sense that all conclusions supported the true hypothesis. This article discusses the design considerations of the program, contains details of the tests, and describes the various ways the test results were and could be analyzed., (Copyright © 2015 The Chartered Society of Forensic Sciences. Published by Elsevier Ireland Ltd. All rights reserved.)

Purpose: To describe the health-related quality of life (HRQoL) of an unselected population of patients with chronic lymphocytic leukaemia (CLL) including untreated patients., Methods: HRQoL was measured by the EORTC QLQ-C30 including the CLL16 module, EQ-5D, and VAS in an observational study over multiple years. All HRQoL measurements per patient were connected and analysed using area under the curve analysis over the entire study duration. The total patient group was compared with the general population, and three groups of CLL patients were described separately, i.e. patients without any active treatment ("watch and wait"), chlorambucil treatment only, and patients with other treatment(s)., Results: HRQoL in the total group of CLL patients was compromised when compared with age- and gender-matched norm scores of the general population. CLL patients scored statistically worse on the VAS and utility score of the EQ-5D, all functioning scales of the EORTC QLQ-C30, and the symptoms of fatigue, dyspnoea, sleeping disturbance, appetite loss, and financial difficulties. In untreated patients, the HRQoL was slightly reduced. In all treatment stages, HRQoL was compromised considerably. Patients treated with chlorambucil only scored worse on the EORTC QLQ-C30 than patients who were treated with other treatments with regard to emotional functioning, cognitive functioning, bruises, uncomfortable stomach, and apathy., Conclusions: CLL patients differ most from the general population on role functioning, fatigue, concerns about future health, and having not enough energy. Once treatment is indicated, HRQoL becomes considerably compromised. This applies to all treatments, including chlorambucil, which is considered to be a mild treatment.

The properties of a bullet, an object, and the incidence angle determine whether the bullet will penetrate, perforate, or ricochet. In this study, the critical angle for ricochet was established for .32 Auto and 9 mm Luger bullets on Abachi, Southern Yellow Pine, Beech, and Ipe wooden boards. Results show that the critical angle differs depending on caliber and wood type. The critical angle is higher for .32 Auto bullets than for 9 mm Luger bullets and increases with increasing wood density and Janka hardness. The established critical angles for ricochet on the lightest and softest wood (Abachi) are 10.4° and 10.3° for .32 Auto and 9 mm Luger, respectively. For the heaviest and hardest wood (Ipe), the angles were 45.0° and 33.4°, respectively. The combined results on the four tested woods show a strong linear relationship between both the density and the hardness and the critical angle for both calibers., (© 2015 American Academy of Forensic Sciences.)

A 19-year-old woman was admitted to our hospital because of unexplained pain in the right upper abdomen and fever. Her medical history noted a recent uncomplicated pregnancy and birth of a healthy child. Our differential diagnosis included pyelonephritis, pulmonary embolism, pneumonia causing pleural pain, a gastrointestinal cause, or a subphrenic abscess. A vaginal culture was taken as part of a second opinion by a gynaecologist. However, after a few days PCR on the vaginal sample was positive for Chlamydia trachomatis, indicating a case of Fitz-Hugh-Curtis syndrome. This syndrome is a complication of pelvic inflammatory disease caused by a bacterial infection, most frequently Gonococcal or Chlamydia species. The patient was treated with doxycycline and recovered quickly. As a result of ignoring a possible gynaecological cause in this patient, the time to diagnosis and treatment was delayed. Left untreated, this disease might result in infertility and in complications in the newborn. A broad differential diagnosis is therefore important.

Abstract Correct histological classification of malignant lymphomas is important but has always been a difficult challenge. Since 2001 the World Health Organization (WHO) classification has been used, which should make it easier to define distinct disease entities. The purpose of this study was to evaluate the usefulness of a panel of expert hematopathologists in reviewing the diagnosis of malignant lymphomas and to examine whether the discordance between primary and panel diagnoses has declined throughout the years. All patients with a primary malignant lymphoma diagnosed between 2000-2001 and 2005-2006 were identified through the population based cancer registry. All diagnoses were reviewed by a panel of three expert pathologists. In 2000-2001, 344 patients were included, and in 2005-2006, 370 patients. The overall discordance rate decreased from 14% in 2000-2001 to 9% in 2005-2006 (p = 0.06). We were able to identify lymphoma subgroups with the highest discordance rates and lowest discordance rates (mantle cell lymphoma and classical Hodgkin lymphoma), which remained unchanged throughout the years. Based on these results we would propose to review all cases of malignant lymphoma with the exception of mantle cell lymphoma and classical Hodgkin lymphoma, when the initial pathologist has no doubt about the diagnosis.

We performed a comprehensive cost calculation identifying the main cost drivers of treatment of chronic lymphocytic leukaemia in daily practice. In our observational study 160 patient charts were reviewed repeatedly to assess the treatment strategies from diagnosis till the study end. Ninety-seven patients (61%) received ≥1 treatment lines during an average follow-up time of 6.4 years. The average total costs per patient were €41,417 (€539 per month). The costs varied considerably between treatment groups and between treatment lines. Although patients were treated with expensive chemo(immuno-)therapy, the main cost driver was inpatient days for other reasons than administration of chemo(immuno-)therapy., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

A 76-year-old woman presented with dyspnea. She had received breast conserving therapy for cancer in her left breast 26 years earlier. During physical examination a redness of the skin on the left side of the torso and neck, as well as disappearance of the left breast and shift of the left nipple was noted. This proved to be a metastatic recurrence of the breast cancer. Despite over 20 years of follow-up consisting of mammography, the complete shrinkage of the breast as an expression of locally recurrent disease was missed because no physical examination was performed. This underlines the importance of physical examination in addition to mammography in the follow-up of breast cancer patients.

A 50-year-old man presented with a persistently warm left foot, which did not perspire. What initially seemed to be an innocent disorder turned out to be a retroperitoneal germ cell tumour situated at Liii-Liv. In most people this location is the site of the lumbar paravertebral ganglia (an important part of the sympathetic nervous system). The fact that these ganglia were affected by the tumour explained the autonomic dysfunction in this case. The patient received curative chemotherapy. Exploration of the symptoms with respect to the pathophysiology and anatomy of the autonomous nervous system might have led to an earlier diagnosis.

A 42-year-old man with large B-cell non-Hodgkin lymphoma was admitted to hospital after eight chemotherapy cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP). He had high fever, non-productive cough, dyspnoea, and on chest X-ray, interstitial infiltrations. Extensive microbiological investigation excluded any infection, including opportunistic infection. Positron emission tomography (PET) scan was negative at previous lymphoma sites, but showed diffuse fluorodeoxyglucose uptake in both lungs. Pulmonary function testing demonstrated a restrictive pattern and a diffusion deficit. Review of the literature showed that this clinical picture closely corresponded with that of rituximab-induced interstitial pneumonitis. Treatment with prednisolone, 40 mg/day, resulted in a fast and complete recovery. Physicians administering rituximab should be aware of rituximab-induced interstitial pneumonitis, since according to recent literature this condition occurs in 9-14% of patients. It can run a mild course, but can also be fatal. Besides stopping rituximab, most patients need corticosteroid therapy.