Three-dimensional reconstruction of King Henri IV's paranasal sinuses and mastoid cells.

PURPOSE: The preserved head of King Henri IV of France (life 1553-1610, reign 1589-1610) has survived to the present day thanks to high-quality embalming and favorable conservation conditions. The aim of this study was to examine Henry IV's upper resonant cavities and mastoids using an original and innovative forensic three-dimensional segmentation method. METHODS: The paranasal sinuses and mastoid cells of King Henri IV of France were studied by cross-referencing available biographical information with clinical and flexible endoscopic examination and computed tomography (CT-scan) imaging. The paranasal sinuses and mastoid cells were delineated and their volumes were assessed using ITK-SNAP 4.0 software (open-source). Graphical representations were created using Fusion 360® (Autodesk Inc., San Rafael, CA, USA) and MeshMixer® (Autodesk Inc., San Rafael, CA, USA). RESULTS: Paranasal sinus tomodensitometry revealed abnormalities in shape and number. Henri IV of France suffered from sinus aplasia. Neither the left sphenoid nor left frontal sinus contrasted sharply, and a remarkable pneumatization of the right clinoid processes extended throughout the height of the right pterygoid process. The total volumes of Henri IV's mastoid air-cells were estimated at 27 and 26 mL, respectively, for the right and left sides, exceeding the normal mean and the maximum of modern subjects by a wide margin. No sign of chronic ear or sinus condition was found. CONCLUSIONS: An innovative method has been developed in forensic medicine to establish hypotheses about the growth and respiratory conditions of the face.

Henri IV of France's larynx 3D reconstitution.

OBJECTIVES: King Henri IV of France (reign from 1589 to 1610) was one of the most important kings of France. Embalmed and buried in Saint-Denis, his remains were beheaded in 1793. His head (including his larynx) survived in successive private collections until its definitive identification in 2010. The purpose of the study was to provide a morphologic study of the larynx with a 3D reconstitution. METHODS: A flexible endoscopy was performed via the mouth and via the trachea. Measures of the larynx (vocal folds lengths, thickness, width, larynx height) were collected from the CT-scan by a panel of experts blind each other. The segmentation of the laryngeal anatomical components (vocal folds, cartilages) was performed using 3DSlicer®. Mesh smoothing and 3D reconstitution were performed using Fusion 360®. Reconstitution was discussed between the experts. Decision was made by consensus after discussion. RESULTS: Cricoid, thyroid, arytenoid cartilages, vocal folds and hyoid bone were identified and a computed 3D reconstitution of the larynx was made. The laryngeal 3D model appeared morphologically similar to a living subject. Measures were similar but smaller than those of a modern subject. CONCLUSIONS: The 3D reconstitution of the larynx of Henri IV of France was conducted from the CT-scan of his mummified head. This work constitutes a first valuable morphologic analysis of a larynx from an embalmed individual. This anatomical work is the first step towards the reconstruction of the voice of this historical character, which we hope to concretize with computer modeling tools in a second step. LEVEL OF EVIDENCE: V based on experiential and non-research evidence.

[Not Available]. / Les produits d'embaumement égyptiens : nouvelles données pharmacologiques.

Today, the development of analytic methods brings new scientific insights into the research on the mummification process used by embalmers in ancient Egypt. The application of these techniques of molecular analysis, elementary analysis, botanical analysis and bibliographic analysis of ancient texts allows us to know the composition of mummification balms and material involved in the conservation of the body. Such substances, which are mineral, animal or plant material, played a practical and a symbolic part in the composition of balms used for the preservation of mummified bodies and therefore in the passage to the eternal life after the death. The comparison of analysis results can inform us about changes in embalming techniques depending of the time, the place of mummification, the deceased's social status. However the number of mummies studied is very small compared to the number of bodies that were mummified. Finally the techniques of mummification and making balms were very variable according to practitioners and their modus operandi. Today, using these technic of chemical analysis and medical imaging techniques, we can authenticate and reconstruct the history of museum pieces, as we have done in the unpublished studies conducted in support of literature data previously collected.

Contrast-enhanced ultrasound of focal nodular hyperplasia: a matter of size.

OBJECTIVES: To assess the contrast-enhanced ultrasound (CEUS) frequencies of centrifugal enhancement, spoke-wheel sign and central scar in focal nodular hyperplasia (FNH) as a function of lesion size. METHODS: Ninety-four FNHs were retrospectively reviewed to assess their largest diameter and enhancement pattern, including centrifugal enhancement from one central artery, spoke-wheel sign, diffuse or centripetal enhancement, central scar and late-phase washout. RESULTS: Mean FNH-lesion size was 3.7 ± 2.1 cm. Only 43.6 % of FNHs had centrifugal enhancement, with a spoke-wheel pattern (23.4 %) or without (20.2 %), while 56.4 % showed diffuse or centripetal enhancement. Centrifugal enhancement was observed in 73.9 % of FNHs ≤3.1 cm and 14.6 % of FNHs >3.1 cm (P < 10(-4)). Size and frequency of centrifugal enhancement were negatively correlated (r = -0.57, P < 10(-4)). The spoke-wheel pattern was also seen more frequently in smaller (37 %) than in larger FNHs (10.4 %) (P < 10(-3)). Late-phase washout was described in 5.3 % of FNHs and was not size-dependent. Lesions with a central scar were larger than those without, respectively, 5.7 ± 1.7 and 3.6 ± 2.0 cm (P = 0.012). CONCLUSIONS: Typical centrifugal enhancement yielding a confident FNH diagnosis is seen significantly more frequently when the lesion is ≤3.1 cm. KEY POINTS: • CEUS yields confident diagnoses of FNHs ≤3.1 cm • The larger the FNH, the lower the diagnostic sensitivity of CEUS • Final diagnosis of FNHs >3.1 cm should be obtained with MRI not CEUS.

[Broncho-pulmonary aspiration of brain and cartilage tissue in a context of gasping]. / Inhalation broncho-pulmonaire de matières cérébrales et cartilagineuses au cours d'une respiration agonique.

Evidence of post-mortem breath movements are rarely reported. We present two cases of broncho-pulmonary aspiration of brain and cartilage tissue following two fatal suicidal gunshots to the head. We also discuss the physiopathological implications for the agony.

Maori heads (mokomokai): the usefulness of a complete forensic analysis procedure.

Based on an analysis of 19 mummified Maori heads (mokomokai) referred to our forensic laboratory for anthropological analysis prior to their official repatriation from France to New Zealand, and data from the anthropological and medical literature, we propose a complete forensic procedure for the analysis of such pieces. A list of 12 original morphological criteria was developed. Items included the sex, age at death, destruction of the skull base, the presence of argil deposits in the inner part of the skull, nostrils closed with exogenous material, sewing of eyelids and lips, pierced earlobes, ante-mortem and/or post-mortem tattoos, the presence of vegetal fibers within nasal cavities, and other pathological or anthropological anomalies. These criteria were tested for all 19 mokomokai repatriated to New Zealand by the French authorities. Further complementary analyses were limited to fiberscopic examination of the intracranial cavities because of the taboo on any sampling requested by the Maori authorities. In the context of global repatriation of human artifacts to native communities, this type of anthropological expertise is increasingly frequently requested of forensic anthropologists and other practitioners. We discuss the reasons for and against repatriating non-authentic artifacts to such communities and the role played by forensic anthropologists during the authentication process.

Is post-mortem ultrasonography a useful tool for forensic purposes?

PURPOSE: To investigate the interest of post-mortem ultrasonography in the diagnosis of pathological background, and manner and cause of death. METHODS: Post-mortem ultrasonography exams were carried out on 38 fresh human adult cadavers referred to the Department of Forensic Medicine and Pathology (Garches, France). Data obtained from ultrasonography were independently compared with further forensic autopsy findings. RESULTS: Two important limitations relative to ultrasound utilization appeared: hyper-echoic abdominal and thoracic walls, with gas distension of the whole digestive tube and subcutaneous tissues (due to precocious putrefactive gas releasing); and difficulty in accessing lateral and posterior structures (i.e. liver, spleen, kidneys, lung bases, aorta) due to rigor mortis and evident non-compliance of the subject. Post-mortem diagnoses (moderate ascites, gallbladder stones, bladder globe, chronic kidney disease, cirrhosis, thyroid gland cysts and hypertrophy, intrauterine device), were strongly limited. False negative diagnoses comprised fatty liver, pleural effusion, thoracic aortic dissection, and focal organ and/or soft tissues lesions (for example, wounds or infarcts). CONCLUSION: According to the results, post-mortem ultrasonography seems to have a very limited role for forensic purposes. Other post-mortem utilizations are cited, proposed, and discussed.

Forensic description of impalement and associated torture lesions by Napoleon troops (Egypt, 1800).

Impalement bone traumas are very rarely described in the medical literature. We here present the first case of such a diagnosis carried out on a skeleton. The patient is Soleyman el-Halaby, executed in June 1800, who was the 24-year-old murderer of the Napoleonic general Kléber. The skeleton is now held in the National Museum of Natural History (Paris). This report describes the traumatic lesions diagnosed after a careful forensic anthropological examination. Such a case is important from a medical point of view, whether the origin of the pelvic or abdominal impalement is accidental or criminal. Forensic examination of skeletons conserved in anthropological collections may help reconstruct the modalities of death, and give data for an eventual repatriation process to the original community.

[Sirenomelia as a part of VACTERL association: a study of three cases]. / Sirénomélie entrant dans le cadre d'une association VACTERL : à propos de trois cas.

Sirenomelia, characterized by a fusion of lower limb buds, is rare. Moreover, the coexistence of this malformation with a VACTERL sequence is exceptional. We report, here, three new observations associating these two diseases on fetuses from 14 to 26 weeks gestation. With these three new cases associating sirenomelia and VACTERL, observed in our unit and examined in light of data from the medical literature, we discuss the embryologic origin of such malformations and the nosologic frontiers between these two diseases.

Mudslide and/or animal attack are more plausible causes and circumstances of death for AL 288 ('Lucy'): A forensic anthropology analysis.

Following a global morphological and micro-CT scan examination of the original and cast of the skeleton of Australopithecus afarensis AL 288 ('Lucy'), Kappelman et al. have recently proposed a diagnosis of a fall from a significant height (a tree) as a cause of her death. According to topographical data from the discovery site, complete re-examination of a high-quality resin cast of the whole skeleton and forensic experience, we propose that the physical process of a vertical deceleration cannot be the only cause for her observed injuries. Two different factors were involved: rolling and multiple impacts in the context of a mudslide and an animal attack with bite marks, multi-focal fractures and violent movement of the body. It is important to consider a differential diagnosis of the observed fossil lesions because environmental factors should not be excluded in this ancient archaeological context as with any modern forensic anthropological case.