F i

Figure 3.34A A prebiopsy axial image through the chest of Marie O'Day. The tip of the biopsy needle (A) was located just above the target (B), a calcification in the chest.

TP 83.0 POST BIOPSY

IMA 24

SEQ 10

Figure 3.34B Following the biopsy attempt, the target (arrow) was still in place.

Figure 3.35 Percutaneous transthoracic needle biopsy with ct guidance on George/Fred.
Needle Tip After Repeated Use
Figure 3.36 coaxial needle tip bent after biopsy attempt.
Figure 3.37 Bone marrow aspiration needle in place with coaxial needle passing through the inner lumen under CT guidance.

was then inserted through the inner lumen of the bone marrow biopsy aspiration needle (Figure 3.37). Scrapings were made with the tip of the coaxial needle within the hepatic tissue. The coaxial biopsy needle was then removed from the inner lumen of the bone marrow biopsy aspiration needle. A series of syringes were then alternately leur-locked onto the proximal end of the bone marrow biopsy aspiration needle, and attempts were made to create a vacuum to draw tissue scrapings up through the cannula and into the syringe barrel. Syringe sizes included a 1 cc tuberculin syringe, a 20 cc syringe, and a 60 cc syringe, with each producing varying results (Figure 3.38). In addition to CT guidance and due to adequate access routes, the coaxial needle biopsy attempts and the bone marrow biopsy aspiration needle were placed under endoscopic visualization. The sample was sent to a trace elements laboratory for analysis.

Once the bone marrow biopsy aspiration needle was in place, the different syringes yielded varying results. The 1 cc tuberculin syringe was unable to aspirate a sample. The 20 cc syringe was able to gather a scant sample, which appeared as brown flakes from the needle scraping. The 60 cc syringe was superior in aspirating a reasonable sample, which consisted of a larger volume of brown-colored flakes (Figure 3.39). Both the 20 cc and the 60 cc aspirate samples were then analyzed. The sample was analyzed at the Cedar Crest College trace evidence laboratory; the results of infrared analysis are displayed in Figures 3.40 and 3.41. The trace laboratory results indicated that sample #1 from the 20 cc syringe was of protein composition, possibly albumin, casein, gelatine, and trypsin. The major infrared peaks were seen at 1641, 1526, and 1237 cm-1. Analysis of sample #2 from the 60 cc syringe aspirate shows a chemical composition indicating adipose tissue and bis (1-methylheptyl) adipate, a fire ant repellent, with major IR peaks at 1724, 1454, 1233, and 1162 cm-1.

Given the necessity of biopsy in many cases involving mummified human remains, it is critical to be able to accurately biopsy the target organ or tissue. CTPNB is clearly an excellent means of precise tissue biopsy. The study by Conlogue et al. (2005) using transthoracic percutaneous needle biopsy did not use gravity dependence or an aspirational technique, and, as a result, did not acquire a usable sample. The report by Ruhli et al. (2002) used CT guidance and gravity dependence and did collect a usable sample. If the remains have already been transported to an advanced imaging facility, the results of this study suggest that a non-gravity-dependent needle scrape/aspiration method may negate the need to manipulate the mummified remains in order to use a gravity-dependent biopsy approach. This, in turn, may reduce the potential for disruptions in the spatial relationships of the

Figure 3.38 Various syringes used to apply vacuum following scraping. Top to bottom: 1 cc tuberculin (TB) syringe, 20 cc syringe, and 60 cc syringe.

internal context. Non-gravity-dependent percutaneous needle aspiration biopsy has been used extensively in clinical medicine, in particular, in lung needle aspiration biopsy procedures (Larscheid et al. 1998; Cox et al. 1999). In clinical medicine, the advantage of this procedure is that the target tissue is hydrated, and a more direct vacuum can be created during the aspiration process. In dried mummified tissue, however, the absence of hydrated

Figure 3.39 Liver aspirate seen in a 60 cc syringe.

tissue necessitates the addition of a scraping maneuver and greater airflow generation to evacuate these tissue scrapings.

The study results suggest that using a larger syringe (60 cc in this study) may produce a greater airflow and, therefore, a greater potential for sample acquisition in a non-gravity-dependent technique. This may be due, in part, to the degree of increased airflow created when the plunger of the syringe is drawn back at various rates. Based on the results of this study, it is not known if even a greater flow would result in a better sample. Further research including a standardized vacuum draw with a catch trap in-line would help address this question. In addition, the standardized vacuum system

Liver Apirate Sample 1 Major Peaks: 1641, 1526, 1237 cm-1

Chemical Composition: Protein (possibly albumin, casein, gelatine, trypsin) 100

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File #3: LIVER ASPIRATE SAMPLE 1 12/5/2007 12:36 PM Res = 4 cm-1

Figure 3.40 Infrared results for liver aspirate #1.

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File #3: LIVER ASPIRATE SAMPLE 1 12/5/2007 12:36 PM Res = 4 cm-1

Liver Aspirate Sample 2

Major Peaks: 1724, 1454, 1233, 1162 cm-1

Chemical Composition: Adipose tissue (bis(1-methylheptyl) adipate)

Liver Aspirate Sample 2

Major Peaks: 1724, 1454, 1233, 1162 cm-1

Chemical Composition: Adipose tissue (bis(1-methylheptyl) adipate)

3000

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4000

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Transmission/Wavenumber (cm 1)

File #4: LIVER ASPIRATE SAMPLE 2

Figure 3.41 Infrared results for liver aspirate #2.

may allow for greater negative flow than could be developed from a syringe system. The authors would recommend using a clinical adjustable suction device to evacuate bodily secretions with a collection trap in-line in an attempt to quantify the vacuum required for sample acquisition.

Researchers must also consider the quality of the preserved target organ, which would influence the ability to scrape tissue for aspiration. If the organ is very durable, less material may be released during the scraping procedure. In addition, the manner in which the material is scraped has additional implications for the obtainable sample. Terms related to scraping such as gentle, moderate, or vigorous need to be defined and standardized in future reports using this technique. With this said, the size of the sample obtained from the needle scrape/aspiration technique may also be a concern depending on the analyses desired. Since the sample is often scant, it would be difficult to say with any degree of certainty that a disease was or was not present in the sample.

The fire ant repellent found in the sample was likely the result of fumigation efforts associated with the original warehouse location of this subject. The mummy was held for many years in Florida, which is well known for its fire ant population. This finding could have forensic implications under different circumstances.

The results of this study suggest that the non-gravity-dependent percutaneous needle scrape/aspiration biopsy technique holds promise in preserving the internal context, given that the mummified remains do not need to be manipulated into a gravity-dependent position.

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