A statistical model for determining whether a pair of documents, a known and a questioned, were written by the same individual is proposed. The model has the following four components: (i) discriminating elements, e.g., global features and characters, are extracted from each document, (ii) differences between corresponding elements from each document are computed, (iii) using conditional probability estimates of each difference, the log-likelihood ratio (LLR) is computed for the hypotheses that the documents were written by the same or different writers; the conditional probability estimates themselves are determined from labelled samples using either Gaussian or gamma estimates for the differences assuming their statistical independence, and (iv) distributions of the LLRs for same and different writer LLRs are analyzed to calibrate the strength of evidence into a standard nine-point scale used by questioned document examiners. The model is illustrated with experimental results for a specific set of discriminating elements.

Abstract. Signatures and handwriting have long played a role in dayto-day business transactions and in forensics, e.g., to authenticate documents, as evidence to establish crime or innocence, etc. The individuality of handwriting and signatures is the basis for their relevance to authentication and forensics. This very individuality makes them also potentially useful as a biometric modality. This chapter is concerned with automatic methods for verifying the writership of handwritten documents and signatures. The discussion consists of the individuality of handwriting, image pre-processing and interactive tools for forensic document examination, discriminating characteristics of handwriting, a statistical model of writer verification, and application of the model to signature verification.

Malignancy masquerading as liver abscess, and presenting with fever, is mainly described in patients with colorectal cancers with liver metastasis. Primary liver tumors such as hepatocellular carcinoma or intrahepatic cholangiocarcinoma presenting as non-resolving liver abscess is extremely uncommon and carries a dismal prognosis. We present a rare case of non-resolving liver abscess as a presenting manifestation of intrahepatic cholangiocarcinoma. ( J CLIN EXP HEPATOL 2015;5:89-92) F ebrile illness due to amoebic or pyogenic liver abscesses is frequently seen in tropical countries. Malignancy masquerading as liver abscess, and presenting with fever, is mainly described in patients with colorectal cancers with liver metastasis 1 and neuroendocrine tumors. 2 Fever maybe due to tumor necrosis getting liquefied and transforming into abscess, or due to release of cytokines, or due to paraneoplastic manifestation. Primary liver tumor such as hepatocellular carcinoma or intrahepatic cholangiocarcinoma presenting as liver abscess is extremely uncommon. 3,4 We report here a case of intrahepatic cholangiocarcinoma which masqueraded as a non resolving liver abscess. CASE REPORTA 57-year-old male, known case of type-2 diabetes mellitus, on oral hypoglycaemic agents for last 10 years, presented to us with 2-month history of low-grade intermittent fever, not associated with chills and rigor.The fever used to be in the range of 100 -101 F, not associated with any chills, rigors, or night sweats, and used to occur daily. There was no history of weight loss, pain abdomen, cough, jaundice, pruritus or any clinical feature of cholangitis. Prior to admission to our hospital, he had been investigated for the cause of fever at another medical center. Urine, blood cultures, Widal, typhoid serology and amoebic serology had been negative. His radiological investigations in the form of USG and CT abdomen (Figures 1 and 2) showed right lobe hypoechoic and hypodense, multi-septate lesion of size 7 cm  6 cm with irregular shaggy margins consistent with liver abscess. There was no evidence of any central or segmental intrahepatic biliary radical dilatation and the common bile duct was normal in size. Based on these findings, he was treated as a case of liver abscess, and received third generation cephalosporins plus antiprotozoal for 2 weeks. However, there was no abatement in his fever range, intensity or frequency. Hence, he was referred to our hospital.At presentation to our hospital his physical examination revealed pallor, a 2 cm tender hepatomegaly, but no splenomegaly. His investigations were as follows: Hb 10.9 g/dL, WBC 8.1  10 3 /mL, platelets 140  10 3 /mL, ESR 86 mm at 1 h, serum creatinine 0.53 mg/dL, serum bilirubin 0.3 mg/dL, AST 24 IU/L, ALT 32 IU/L, SAP 186 IU/L, and GGT 214 IU/L. Urine routine and microscopy examination was normal. Blood and urine cultures were sterile. Serum procalcitonin level was 0.28 ng/ml, Widal test was negative, amoebic and hydatid serologies were negative. His virology studies for HBV, HCV an...

Background and aims: Etiologic diagnosis of pyrexia of unknown origin is important in patients with cirrhosis for optimal management and to prevent flare up of infectious disease after liver transplantation. However, there is very limited literature available on this subject. The present study aimed to examine the safety and impact of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) in patients with cirrhosis. Methods: The study was conducted between January 2014 and January 2016 at a tertiary care center. A total of 50 (47 lymph nodes, 3 adrenal) EUS guided FNAs were performed in 46 patients. Data are presented as median (25 – 75 IQR). Results: The study included 46 patients (40 males) whose mean age was 47.9 ± 11.1 (SD) years; mean Child-Turcotte-Pugh (CTP) score and mean MELD (Model for End-Stage Liver Disease) score were 10 (8 – 11) and 18 (12 – 20), respectively. The Child Pugh class was A in 4, B in 14, and C in 28 (including three patients with adrenal FNAs). Indications for FNA were pyrexia of unknown origin and lymphadenopathy on CT imaging. The cytopathological diagnoses were metastatic disease in 1 (adrenal), granulomatous change in 10 (6 positive with acid fast bacilli stain), histoplasmosis in three (two adrenals, one lymph node), 32 lymph nodes were reactive and four lymph node FNAs showed inadequate cellularity. The pathologic nodes had significantly lower long-to-short axis ratio [1.25 (1.09 – 1.28) versus 1.46 (1.22 – 1.87), P = 0.020]; a higher proportion of hypoechoic echotexture (5 versus 3, P = 0.017), and sharply defined borders (4 versus 2, P = 0.029). Complications included mild hepatic encephalopathy related to sedation in two patients with Child’s C status. Conclusion: EUS guided FNA is safe in patients with cirrhosis and modified the management in 14/46 (30.4 %) patients.

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In patients with HCC and lymphadenopathy, EUS-guided FNA detected metastatic disease and precluded liver transplantation in approximately one third of patients.

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This small prospective single-center study showed local dural venous thrombolysis significantly improves clinical and radiological outcome in patients with CVT. A randomized control trial with large sample size is needed to substantiate our findings.