Post-mortem imaging in traffic fatalities: from autopsy to reconstruction of the scene using freely available software.

CT scan coupled with autopsy is the gold standard for the forensic investigation of fatal road traffic accidents. The objective of the present paper is to demonstrate that from this, it is possible to reconstruct elements of an accident with minimal human and material resources using basic knowledge of three-dimensional imaging software. This is illustrated by a case implicating a pedestrian and a motor vehicle in which the impact areas were matched using freely available computer-aided design software. Such an approach aims to improve the visualisation of forensic elements, which is crucial for the understanding of all parties involved in the legal implications of such accidents and which could become the standard practice in many institutes.

Evaluation of three rapid detection methods for the forensic identification of seminal fluid in rape cases.

We sought to discover whether spermatozoa concentration and the delay between ejaculation and test influence the results of seminal fluid fast detection tests. Two hundred and twenty-seven anonymous samples divided into four groups (normospermia, oligospermia, azoospermia, and controls) after a semen analysis were subjected to three fast detection semen tests: Diff-Quick fast coloration, Phosphatesmo Km Paper for acid phosphatases (AP) detection, and PSA-Check 1 for prostate specific antigen (PSA) detection. The study was performed at three time points (0, 48, and 72 h). Unlike cytology, results obtained with AP and PSA were not influenced by spermatozoa concentration. PSA detection results remained constant up to 72 h and were more reliable after 48 h than those obtained by AP detection.

Establishment of the medico-legal cause of death in two atypical cases of gas embolism in hospital: Importance of the scene.

Two cases of lethal gas embolism occurring in a hospital setting are presented. These did not differ with regards to the medical cause of death (MCOD), but did so with regard to the medico-legal cause of death (MLCOD). In the first case, the immediate recognition of a suspicious death and subsequent conservation of the scene led to a certain MLCOD (autolysis). In the second case, the death was initially treated as of natural cause. The subsequent disruption of the scene of death led to loss of evidence essential to establish the MLCOD, that was concluded to be undetermined. These cases illustrate the importance of medico-legal treatment of scenes of death to arrive at the MLCOD, and that the hospital setting is no exception especially as in view of potential medical liability.

Suicide with cisatracurium and thiopental: forensic and analytical aspects.

The suicide of a 43-year-old male by intravenous injection of cisatracurium, a non-depolarizing neuromuscular blocking agent, and thiopental, an ultra-short-acting barbiturate, is presented. Systematic toxicological screening by gas chromatography-mass spectrometry (GC-MS), liquid chromatography (LC)-diode-array detection, and LC-MS-MS confirmed the presence of thiopental. A large peak in the GC-MS chromatogram was matched by the Pfleger-Maurer library as corlumine, but neither atracurium neither its metabolite, laudanosine, were detected. To confirm the absence or the presence of laudanosine in the blood sample, an ultra-performance liquid chromatography-MS-MS method for cisatracurium and laudanosine quantification was developed. The calibration range was 2.5-500 ng/mL for laudanosine and 10-500 ng/mL for cisatracurium. The biases were lower than 12.3%. Intraday and interday precisions, expressed as coefficient of variation, were lower than 13.3%. This method allowed to confirm the presence of laudanosine and measurement of laudanosine in all samples. The femoral blood concentration was therapeutic (0.46 µg/mL). This case report documents a possible analytical pitfall and describes a simple and fast method for cisatracurium determination. Moreover, the purpose of this case report was to document the postmortem redistribution of cisatracurium and laudanosine, which could help make it possible to interpret tissue or cardiac blood concentrations in forensic cases where femoral blood is not available.

Chlamydia trachomatis infection in children: do not forget perinatal acquisition: a case report of a 7-year old girl, C. trachomatis infected, presumed sexually assaulted.

A 7-year old girl suspected of having been sexually abused owing to the presence of anal condyloma was found to be infected by Chlamydia trachomatis. Microbiological analysis and anamnesis were consistent with the infection having been acquired at birth. This case confirms that untreated infection acquired at birth can persist for months or years and highlights the value of examining those involved in the suspicion of sexual abuse of the child.

Myocardium distribution of sertindole and its metabolite dehydrosertindole in guinea-pigs.

Sertindole, like other atypical antipsychotics, has been shown to increase the action potential duration and QT interval in a concentration dependent manner, in in vitro electrophysiological studies. However, this does not always translate into increased duration of the QT interval, increased risk of torsade de pointes or sudden death in clinical practice. The reasons for these apparent discrepancies are unclear and many studies have underscored the importance of the interpretation of in vitro electrophysiological data in the context of other pharmacodynamic (e.g. cardiac ion channels target, receptor affinity) and pharmacokinetic parameters (total plasma drug concentration and drug distribution). To address the possible relevance of the concentrations used in experimental studies, the myocardium distribution of sertindole and its metabolite was determined after single and repeated intraperitoneal administration to guinea-pigs. The data suggest that the plasma concentration appears to predict the concentration in the myocardium and that the myocardium concentrations of sertindole are 3.1 times higher than plasma concentrations. Using these data, the relevance of in vitro electrophysiological studies to clinical plasma concentrations has been appraised.

Toxic epidermal necrolysis and clarithromycin.

Toxic epidermal necrolysis almost always occurs after taking a medication. Despite spectacular clinical signs, it is mainly diagnosed with pathologic techniques. The identification of a drug as the cause for the immune related cytotoxic reaction can be difficult if the molecule is not generally known to be a classical cause of this reaction. The present study describes a female patient who rapidly developed a severe bullous skin disease after taking clarithromycin for tonsillitis. The case illustrates the process involved in attributing causality to a molecule using an established imputability assessment framework.

Determination of myocardium to plasma concentration ratios of five antipsychotic drugs: comparison with their ability to induce arrhythmia and sudden death in clinical practice.

Reviewing available data shows that most of antipsychotic drugs are associated with arrhythmia and sudden death. Experimental studies have shown a HERG channel blockade, a dose-dependent increase in duration of action potential or of QT interval, with various degrees of indicators of serious arrhythmogenicity. However, it seems difficult to relate these in vitro and in vivo preclinical models to clinical findings, in part, because the relationship between concentrations used and in vivo tissue concentrations during treatment in man is not known. Consequently, we established the myocardium to plasma concentration ratios for a series of antipsychotic drugs by intraperitoneal administration of different level doses to the guinea pig. Then, we compared these values to their ability to induce arrhythmia or torsade de pointes in clinical practice. The myocardium to plasma concentration ratios were 2.2 for clozapine, 2.7 for olanzapine, 3.1 for sertindole, 4.5 for risperidone, and 6.4 for haloperidol. These data suggest that when the ratio is higher than 4, arrhythmia and sudden death may be expected. On the contrary, when the ratio is less than 3, little effect may be predicted. These results underscore the importance of interpreting HERG channel data and electrophysiological data in the context of other pharmacokinetic parameters such as myocardium to plasma distribution.