Sharp bone trauma diagnosis: a validation study using epifluorescence microscopy.

Identifying tool mark and involved weapon in sharp force trauma is essential to understanding the circumstances of death. But accuracy and reliability of such expert testimony remains unknown, and validation studies are rare in forensic literature. That is why, we conducted an experiment in order to determine error rates and predictive values on identifying the right implement through different types of knife-inflicted trauma. Human bone cut marks were analysed through epifluorescence microscopy. The samples were examined through a randomised, blinded, controlled study by three researchers with varying degrees of experience with direct and indirect observation of cut marks (photography). Our results showed that identifying the weapon involved is possible thanks to numerous criteria analysis. Correct classification rates were high and misclassifications rare. Asymmetric blades obtained better results than symmetric blades. Predictive values were also calculated, and the negative one reached very high levels, near 100% with regard to all the implements. Positive predictive values were more variable. But even if individual diagnoses remain in doubt, triage can be done and tools not implicated in injury can be eliminated with certainty. Moreover, our work clearly highlighted the importance of experience in such activities. A high level of experience is fundamental to obtain the best values, especially in such a context where evidence reliability is extremely important for forensic admissibility testimony in the court.

Towards multi-phase postmortem CT angiography in children: a study on a porcine model.

PURPOSE: Multi-phase postmortem computed tomography angiography (MPMCTA) is a growing technique, which is standardized for adults. Application of this protocol for a children population is not so well defined. Our study aims to adapt the adult's protocol to children, using a porcine model. MATERIAL AND METHODS: Three groups of 18 pigs were studied, with a weight distribution between 4 and 48 kg. Different pump devices were used. Pigs of group I were studied using the Virtangio® machine, whereas pigs of groups II and III were studied using used the Medrad® machine. Study of vascular opacification was possible using a semi-quantitative method based on 26 arterial and 26 venous segments that were distributed over the entire body from the cephalic extremity to the posterior pawns. RESULTS: While thoracic, abdominal, and pelvic vascular opacification were complete for each individual pig in a group, group III showed better vascular opacification for the cephalic extremity. This was also true for anterior and posterior pawns vascular opacification. Spearman correlation tests showed a significant relationship between anthropometric characteristics of pigs, injection parameters, and percentage of opacified segments. A higher percentage of opacification was obtained for individuals of lower weights, with comparatively lower quantities of contrast agent injected. CONCLUSION: Postmortem computed tomography angiography (PMCTA) was possible for all the individuals, particularly for small weights (4 kg) using the Medrad® machine. However, further studies are needed to better understand the procedure.

[Complications after laser hair removal: the standpoint of a dermatological legal expert regarding liability]. / Accidents secondaires aux actes de photoépilation : la pratique d'un expert de justice dermatologue en matière de responsabilité

BACKGROUND: Laser hair removal is widely used, including outside medical settings. Potential complications, notably burns, may engage the operator's liability. In this case, investigations by medical experts are frequently requested. PATIENTS AND METHODS: We describe 6 expert examinations carried out by the same legal dermatology expert between 2012 and 2014. They concerned burns of varying severity caused by laser hair removal procedures carried out by a doctor, a physiotherapist and 4 beauticians. DISCUSSION: Laser hair removal is carried out in many beauty centres, although in France it is restricted by law to medical use. This practice is thus currently the subject of legal and economic controversy. The analysis of 6 medical expert investigations of accidents involving laser hair removal illustrates the various types of fault in which the operator's liability may be engaged and it also serves to redefine the legal framework of this act within the realm of aesthetic medicine.

Diagnosis of drowning using post-mortem computed tomography - state of the art.

AIM OF THE STUDY: Recent studies using post-mortem computed tomography (PMCT) have suggested this imaging modality is of value in the positive diagnosis of drowning. We summarize the data from the literature regarding the diagnostic value of CT in cases of drowning. MATERIAL AND METHODS: We performed an all-language search of literature published from 1999 to 2013 with the key words "post-mortem CT scan", "drowning and CT scan", "near-drowning diagnosis", and "drowning diagnosis". RESULTS: Only 11 articles, whose data enabled complementary statistical analysis, were included. The presence of fluid and sediment in paranasal sinuses appear to be the determinants of the diagnosis of drowning. The presence of fluid in the sinuses had a sensitivity of 100%, and of 90% in the trachea and main bronchi. The results were completed by the high specificity of the presence of sediment in the paranasal sinuses, upper airways and stomach, which was 100% for all three. Haemodilution was present in cases of drowning (p < 0.001). The values made it possible to formulate a decision algorithm for the diagnosis of drowning.

An automated landmark method to describe geometric changes in the human mandible during growth.

OBJECTIVE: The principal aim of this study was to assess an automatic landmarking approach to human mandibles based on the atlas method. The secondary aim was to identify the areas of greatest variation in the mandibles of middle-aged to older adults. DESIGN: Our sample consisted of 160 mandibles from computed tomography scans of 80 men and 80 women aged between 40 and 79 years. Eleven anatomical landmarks were placed manually on mandibles. The automated landmarking through point cloud alignment and correspondence (ALPACA) method implemented in 3D Slicer was used to automatically place landmarks to all meshes. Euclidean distances, normalized centroid size, and Procrustes ANOVA were calculated for both methods. A pseudo-landmarks approach was followed using ALPACA to identify areas of changes among our sample. RESULTS: The ALPACA method showed significant differences in Euclidean distances for all landmarks compared to the manual method. A mean Euclidean distance of 1.7 mm was found for the ALPACA method and 0.99 mm for the manual method. Both methods found that sex, age, and size had a significant effect on mandibular shape. The greatest variations were observed in the condyle, ramus, and symphysis regions. CONCLUSION: The results obtained using the ALPACA method are acceptable and promising. This approach can automatically place landmarks with an average accuracy of less than 2 mm, which may be sufficient in most anthropometric analyses. In the light of our results, however, odontological application such as occlusal analysis is not recommended.

Root and canal morphology of the permanent teeth in medieval and current French population.

OBJECTIVE: This work describes and compares the root and root canal morphology of a medieval population dating from the 8th to 10th century from the southwest of France, and a current French population. DESIGN: The root morphology of 579 teeth from 70 medieval individuals was analyzed using cone beam computed tomography, and compared with 690 teeth from a current French population of 329 individuals. The Vertucci classification was used to describe the root canal configuration. RESULTS: In the medieval population, the maxillary first premolar usually had one root. In contrast, in the current population this tooth predominantly had two roots, and the three-root form had appeared. Mandibular canine with two roots was observed in 5.7% of cases, and in the current population this form was found in 1.6% but the difference was not significative. The greatest variability between the two populations in terms of root canal configuration was in one-rooted maxillary first and second premolars, the mandibular canines, and the distal roots of the mandibular first molars. Differences in root numbers and canal configurations of the maxillary molars investigated among the two populations were not significant. CONCLUSIONS: This study indicated that the upper first premolar of the current population tended to have more than one root, while this tooth type of the medieval group mostly appeared with only one. For the root canal configuration, studies in the upper premolars, lower canines and first molars of the current population apparently revealed a significant simplification compared with the ancient group.

[Damage repair in breast cancer has to evolve]. / Évaluation du dommage corporel en sénologie : une nécessaire évolution.

Breast damage is likely to result in compensation according to the principle of full compensation. However, breast damage, little covered in the scales usually used, requires a specific methodology. The quantification of functional prejudice must be done with regard to the age of the victim and must take into account the possible repercussions on mobility (shoulder and/or spine) as well as the psychological repercussions. Whether or not the nipple and areola are preserved should be described. Temporary aesthetic damage (before breast reconstruction) must be assessed on the basis of objective elements, its duration and quantification on a scale of 0 to 7. Permanent aesthetic damage takes into account scars, deformities, amputations and quality of the prosthesis. A new scale for evaluating permanent aesthetic damage is proposed. Sexual prejudice must take into account an impairment of the pleasure related to sexuality and its erotic function, in line with the concept of sexual health. However, even after reconstruction, the areas of quality of sexual life and sexual satisfaction often remain affected. An exploration using standardized questions from validated questionnaires such as BREAST-Q can be useful. The sequelae linked to the damage on a breast can also lead the woman to limit certain pleasure activities, in particular because of psychological discomfort or even be the cause of a loss of opportunity to carry out a family's life plan.

Three-dimensional analysis of bitemarks: A validation study using an intraoral scanner.

Conservation of the three-dimensional aspect of bitemarks optimizes their analysis. Although bitemarks could be recorded with a surface scanner, in clinical dentistry, intraoral scanners are used as an alternative to conventional dental impressions. Here we assess the reproducibility and the reliability of a three-dimensional bitemark analysis protocol using an intraoral scanner. Twenty-seven volunteers bit on different materials: dental wax, hard cheese, chocolate and apple. Then, bitemarks and dentitions were scanned with the PlanMeca® Emerald intraoral scanner and the scans obtained were exported into the mesh comparison software, CloudCompare®, which can generate overlays automatically. For this purpose, dentitions were aligned and compared with the indentations. The meshing and non-meshing areas were visualized using a colorimetric scale. First, the same blinded observer compared the bitten materials by analyzing 256 meshing areas for each. Secondly, comparisons of bitemarks from wax were analyzed in a randomized blinded study involving four observers (dentist, dental student, forensic scientist and police officer) and predictive values were calculated. The wax support obtained the best result and apple the worst. The rate of correct classifications was high and misclassification was rare. For the all observers, negative predictive values were near 100%. Positive predictive values were more variable. Moreover, the work clearly highlighted the importance of experience in odontology.

Prisoners and skin diseases in Toulouse, France: epidemiological analysis and evaluation of life impact.

BACKGROUND: Dermatology in a penitentiary environment is an under-researched field. OBJECTIVES: To study the prison population seeking medical advice for skin diseases and to assess among detainees the life impact of these diseases, an approach that to the best of our knowledge has not previously been reported. METHODS: This prospective study was carried out in the male population of two penal institutions in the region of Toulouse, south-western France. RESULTS: One hundred seventy-eight men were seen, for a total of 234 diagnoses and 281 consultations. The five most frequent diagnoses, in order of decreasing frequency, were disorders of the pilosebaceous follicle, fungal diseases, benign skin tumours, warts and eczemas, which are common skin diseases. However, 72% of inmates believed their skin disease was directly related to detention. This belief was related to the conditions of life in prison (seclusion and its effects) and to frequent psychological problems. CONCLUSIONS: The disorders observed were generally benign skin conditions that could be expected in a population of young men living in a closed community. They led to a high demand for care and treatment: skin diseases represented the largest specialist consultation in our institutions. Skin problems can easily be managed in an outpatient unit, which confirms the usefulness of a dedicated dermatology clinic within the outpatient consultation units of penal institutions in order to provide care of equivalent quality to that available in a free environment. The dermatologist can have an important role in the medical management and the health education of prisoners.

[Value of radiographic evaluation of the second metacarpal in the determination of bone age]. / Apport de la radiographie du second métacarpien pour la détermination de l'âge osseux.

PURPOSE: Age determination based on bone maturate evaluation is routinely used in forensic science and anthropology. The aim of this study was to purpose a quantitative method of age determination on the second metacarpal in a population of children and adolescents by measurements of the epiphyso-metaphysal ratio (REM) (epiphysal diameter divided by metaphysal diameter) and the cortical index (IC). MATERIAL: and methods. We evaluated the REM and the IC on 417 hand radiographs of 2 from aged 20-year-old children. RESULTS: The correlation between REM and age for males (R2=0.62; p<0.001) and females (R2=0.68; p<0.001) was a good and significant. The correlation between IC and age for males (R2=0.34; p<0.001) and females (R2=0.30; p<0.001) was also significant but poor. CONCLUSION: Measurement of IC should not be used for age assessment. Measurement of REM is simple, reproducible and poor X-ray exposing technique. It should be very useful for age determination.

[Medicolegal considerations in the musculoskeletal interventional radiology: patient information and informed consent]. / Aspects médico-légaux des gestes interventionnels en radiologie ostéo-articulaire. Information du patient et consentement éclairé.

The daily practice of radiologists has evolved and radiologists are increasingly being directly involved with patient care and treatment. Consequently, radiologists have become a part of the therapeutic team available to patients. This active role, in hospital based or out-patient practices, does not only have an impact on the radiologist's professional activities. New liabilities related to interventional procedures or treatments are now added to already existing professional liability from diagnostic activities. Therefore, musculoskeletal radiologists performing interventional procedures must be aware and familiar with their obligations towards patients, including the requirement to provide adequate information to patients and documenting that informed consent was obtained.

[Role of modern cross-sectional imaging in thanatology: a pictorial essay]. / Application à la thanatologie de l'imagerie en coupe: revue iconographique.

The development of new imaging modalities such as computed tomography and magnetic resonance imaging is a new phenomenon in thanatology. The growing accessibility to these technologies allows, under some conditions, the acquisition of cross-sectional images on cadavers. The authors present a practical pictorial review of post-mortem changes and deadly injuries, illustrating the contributions of modern cross-sectional imaging techniques in thanatology.

Comment on the provisions of the French laws of 6 August 2004 and 8 December 2004 relative to the protection of genetic inventions.

The question of gene patentability has raised some opposition in France. Too broad a definition of the rights conferred by patent would hamper the development of research. The French legislature strictly defined genetic inventions in the Laws of 6 August 2004 and 8 December 2004. Exclusivity of use applies only to the function or functions precisely described in the patent application. Potential abusive use of rights by the holder of the patent has also been addressed through reinforcement of the provisions of the Code of Intellectual Property to combat such abuse. The Laws we discuss smooth the way to the granting of dependency licenses and broaden the field of application of ex officio licenses. The French legislature has achieved satisfactory balance between the legal protection of genetic inventions necessary to finance research, and the free circulation of scientific knowledge indispensable for medical progress.

Old hearts for modern investigations: CT and MR for archaeological human hearts remains.

INTRODUCTION: Among 800 burials dated between the 15th and 18th centuries and found in the center of Rennes (Brittany, France), a collection of five heart-shaped lead urns was discovered. This material was studied using classical methods (external study, autopsy and histology), and also modern imaging like computed tomography (CT), magnetic resonance (MR) before and after coronary opacification. The aim of this manuscript is to describe different steps of ancient soft tissues study, especially using imaging techniques. METHODS: The study gathered various specialists: anthropologists, archeologists, forensic pathologists, radiologists, pathologic physicians, and physicists. Imaging techniques were performed, before and after coronary opacification. Finally, hearts were autopsied and different histological samples were analyzed. RESULTS: Only heart n°2 was too damaged to be studied. Heart n°3 was considered as normal using all investigation techniques. The study of Hearts n°s 4 and 5 revealed dilated cardiomyopathy while Heart n°1 showed important signs of diffuse hypertrophic cardiomyopathy. Different fibro lipid plaques were identified using imaging techniques, and were confirmed by histology. CONCLUSIONS: The study of archeological soft tissues using modern imaging is possible if the material is well-preserved. This type of research can uncover principal findings, allowing scientists to establish diseases of ancient times.

Diagnostic value of high-resolution peripheral quantitative computed tomography (HR-pQCT) in the qualitative assessment of cribra orbitalia: a preliminary study.

Cribra orbitalia are a porotic or sieve-like lesions in the bony orbital roof. This characteristic has frequently been detected in palaeopathological skulls from many parts of the world and has been the object of extensive research. Our objective was to determine if high-resolution peripheral quantitative computed tomography (HR-pQCT) could produce reliable information in the study of cribra orbitalia. Seven skulls displaying cribra orbitalia were investigated by HR-pQCT. The two-dimensional slices were compared with histological sections. The HR-pQCT images and histological sections showed similar results, i.e. two groups of lesions with different characteristics. HR-pQCT can be of great value in palaeopathological research. It is a nondestructive, fast and precise technique that allows an easy evaluation of the bone architecture without destruction of the sample.

Radiographic identification of human remains through deformities and anomalies of post-cranial bones: a report of two cases.

Human remains can be identified radiographically by anomalies and deformities of the post-cranial bones when there are no old fractures and the cranium and extremities are not available. These anomalies and deformities of the sternum, vertebrae, sacrum and innominate bone are often protected from damage by scavengers. We report their use to exclude a proposed identity in one case and to confirm identity in another case. The value and number of these criteria and their pathogenesis is discussed with reference to their prevalence and their expression of inter- and intraindividual variability.

Cytological detection of spermatozoa: comparison of three staining methods.

Sperm detection can be an important factor in confirming sexual assault in cases of rape. This paper compares three of the most commonly used staining methods cited in the scientific literature: Christmas tree. hematoxylin-eosin, and alkaline fuchsin. The population studied was composed of 174 consenting women seen at the Male Infertility Center in Toulouse. France. The date of their last sexual intercourse was accurately known. Alkaline fuchsin did not seem effective in detecting spermatozoa in vaginal samples. Compared with hematoxylin-eosin, Christmas tree stain appeared to be the most useful test in the first 72 h. Two external factors were associated with decreased detection of spermatozoa: time since in tercourse and sperm volume.

Fatal cranial injuries caused by an electric angle grinder.

A case of fatal cranial injuries caused by an angle grinder is reported. The scalp lesions were typical of those produced by a cutting disk in a side-slipping movement. On the cranial vault were two bony losses of substance, one of which was deep enough for intracranial penetration of the disk. Signs of deflection of the disk, identical to those found on the scalp, were observed on the external bony table. Because of the circumstances in which the victim was discovered, in particular the damage to the machine which had a broken handle, and the lack of any indication of homicide or suicide, an accident is the most likely hypothesis.

Fatal injuries caused by guns using shotshell: case reports and ballistic studies.

The authors present six cases of homicide and suicide in which the weapon involved was a handgun using shotshell. The injuries caused are described and the ballistic characteristics of the weapons are studied. Such weapons, which are relatively easy to obtain, are not as innocuous as they may appear, since they may be modified either by changing the barrel or by removal of the device inside the barrel which is intended to prevent the firing of solid slugs.