Comparison between postmortem computed tomography and autopsy in the detection of traumatic head injuries.

INTRODUCTION: The aim of this study was to assess the agreement between postmortem computed tomography (PMCT) and autopsy in detecting traumatic head injuries. MATERIALS AND METHODS: Consecutive cases of death that underwent both unenhanced PMCT and conventional autopsy were collected from our institution database during a period of 3 years and reviewed retrospectively. PMCT images were reviewed for the presence of fractures (cranial vault, skull base, facial bones and atlas/axis) and intracranial hemorrhage. Kappa values were calculated to determine the agreement between PMCT and autopsy reports. RESULTS: 73 cases were included, of which 44 (60%) had head trauma. Agreement between PMCT and autopsy was almost perfect (κ = 0.95) for fractures and substantial (κ = 0.75) for intracranial hemorrhage. PMCT was superior to autopsy in detecting facial bone and upper cervical spine fractures, and intraventricular hemorrhage. However, in some cases thin extra-axial blood collections were missed on PMCT. CONCLUSIONS: The agreement between PMCT and autopsy in detecting traumatic head injuries was good. Using a combination of both techniques increases the quality of postmortem evaluation because more lesions are detected.

Toward the adoption of cementochronology in forensic context.

Because acellular dental cementum is considered to be formed continually throughout life and to not undergo remodeling processes, cementochronology is considered to be a method with the potential for directly assessing chronological age. Considering that most previous studies on humans have assumed the superior performance of this method, it is surprising that this technique is not more widely adopted in anthropology. To understand this controversy, we highlight that there is no standardized procedure for sample preparation. The numerous technical approaches that exist impact the reliability of the method, and the recent creation of an international work group (Cementochronology Research Program) demonstrates the need for researchers to share their experience to overcome these obstacles. This paper aims to address this paradox by debating the aspects that contribute to the limited use of this method and by illustrating its potential through an application on forensic cases. A protocol, which was recently certified according to the ISO-9001, was applied to nine anthropological cases from the Forensic Medicine Institute of Lille (northern France) and compared with routine osteological and dental methods. The results show that traditional methods matched the known age due to the wide extent of their range, while the accuracy and precision of cementochronological estimates was also notable. This paper establishes that cementochronology may serve as a particularly important tool for age estimation for forensic anthropologists and should, at least, be used in addition to other methods.

Forensic features of a fatal Datura poisoning case during a robbery.

Datura poisonings have been previously described but remain rare in forensic practice. Here, we present a homicide case involving Datura poisoning, which occurred during a robbery. Toxicological results were obtained by second autopsy performed after one previous autopsy and full body embalmment. A 35-year-old man presented with severe stomach and digestive pain, became unconscious and ultimately died during a trip in Asia. A first autopsy conducted in Asia revealed no trauma, intoxication or pathology. The corpse was embalmed with methanol/formalin. A second autopsy was performed in France, and toxicology samples were collected. Scopolamine, atropine, and hyoscyamine were found in the vitreous humor, in addition to methanol. Police investigators questioned the local travel guide, who admitted to having added Datura to a drink to stun and rob his victim. The victim's death was attributed to disordered heart rhythm due to severe anticholinergic syndrome following fatal Datura intoxication. This is a recent case of a rare homicide involving Datura that highlights general information on Datura and discusses forensic interpretation after a previous autopsy and body embalmment.

[Clinical forensic valuation of school violence]. / Violences en milieu scolaire : 20 ans d'observations médico-légales en région Nord Pas-de-Calais.

AIM: In recent years, the National Education in France has developed tools to identify acts of violence in schools. This has allowed adjusting government policies for the care of victims. School violence can also be measured from the perspective of clinical forensic medicine, a special discipline for observing a society's violence. PATIENTS AND METHODS: This study summarized and compared three similar single-center, prospective, and descriptive studies conducted in 1992, 2002, and 2012 in the Department of Forensic Medicine, University Hospital of Lille, via an evaluation form completed during consultations requested by victims in cases of school violence. The purpose was to identify the characteristics of victims, those of their perpetrators, the circumstances and reasons for school assaults, as well as their medical and administrative consequences. RESULTS: Each study had identified about 160 such attacks annually. The victims were younger, especially boys (the average age decreased from 14.8 to 13.6). The gender distribution showed an increase in female victims (the sex ratio decreased from 2.9/1 to 2.3/1). The location of attacks changed, with a marked increase of attacks on the way to school (from 10% to 27%). Recurrence of attacks also rose: victims with a previous history of attacks increased from 18.5% to 32.2% with a high proportion of violence resulting in a strong psychological impact, increasingly requiring psychological support (from 9 to 16%). The duration of school cases rose sharply, from 20 to 53% in 2012. The grade level of the perpetrator showed a significant increase in cases of violence at junior high school (from 40 to 67%), with a relative stability of violence in elementary and high schools. The parameters measured to characterize the aggressors remained stable: they were known to their victims in approximately 80% of cases and these attacks were for the most part related to previous disagreements. DISCUSSION: Since the 1990s, government policies for the prevention, measurement, and punishment of violence in schools have not ceased to grow, but this violence has not attenuated. It is identified annually by the government and the data from the present study show comparable trends to national data. CONCLUSION: The progression of school violence over the past 20 years shows trends brought out through a forensic medicine framework. This discipline is indeed an observatory of violence and it has an important role to play in the detection of fragile psychological situations. This violence is increasing and compromises pupils' privacy. In the future, different forms of violence with a strong psychological impact should be emphasized, including the influence on academic achievement and child development.

3D-MSCT imaging of bullet trajectory in 3D crime scene reconstruction: two case reports.

Postmortem investigations are increasingly assisted by three-dimensional multi-slice computed tomography (3D-MSCT) and have become more available to forensic pathologists over the past 20years. In cases of ballistic wounds, 3D-MSCT can provide an accurate description of the bullet location, bone fractures and, more interestingly, a clear visual of the intracorporeal trajectory (bullet track). These forensic medical examinations can be combined with tridimensional bullet trajectory reconstructions created by forensic ballistic experts. These case reports present the implementation of tridimensional methods and the results of 3D crime scene reconstruction in two cases. The authors highlight the value of collaborations between police forensic experts and forensic medicine institutes through the incorporation of 3D-MSCT data in a crime scene reconstruction, which is of great interest in forensic science as a clear visual communication tool between experts and the court.

Philemon and Baucis syndrome: three additional cases of double deaths of married couples.

The simultaneous death of two people is immediately considered as a suspect. However, this feeling is reinforced when the individuals are spouses. In these situations, criminal and forensic investigations are required to establish whether or not the deaths were homicidal in nature. Despite many descriptions of simultaneous deaths being present in the literature, the simultaneous death of two spouses from natural causes is poorly described with Ciesiolka et al., Department of Legal Medicine in Gießen (Germany), being the only ones to have reviewed two case reports involving these circumstances. The scarcity of this type of information in the literature renders the task of claiming natural simultaneous death as the final outcome of an investigation difficult. We would like to report three additional cases with the aim of better describing this type of event. In all three cases, the bodies were those of a married couple in their 80s. The bodies were discovered in the same room. In each case, the death of one of the spouses could be attributed to natural cause; however the death of the other spouse could not be determined with certainty, and shared several similarities in all cases: simultaneity in death; a pre existing cardiovascular disease/disorder; a certain degree of fragility and dependence on the other spouse whose death could lead to acute psychological stress. Intense psychological disorder could trigger acute coronary or rhythmic disorders. The mechanisms by which brain activity influences cardiac electrophysiology are now known to take place via the autonomic nervous system mediation. This brain activity could provide an explanation for the death of the individuals with pre-existing heart conditions, who underwent significant stress upon occurrence of the death of their partners. The death of these individuals, which took place at the same place and time as their deceased spouses, can be attributed to natural causes: the Philemon and Baucis syndrome.

Typical external skull beveling wound unlinked with a gunshot.

Lesions of the cranial vault resulting from firearms are traditionally described in forensic medical literature with many reports illustrating atypical bone lesions carried out to the skull by gunshot wounds. The authors present this report which illustrates an external beveled skull wound, associated with internal beveling damage, caused by a stabbing injury. A partially buried human skeleton was found in a forest. The examining of the skull revealed a hole resembling the exit wound caused by a bullet and two other smaller stab wounds. No typical entering bullet wound and no other bone lesions were found. During the course of the investigation, one of the perpetrators admitted to hitting the victim, using a sickle, and to hiding the body. For this purpose, he dragged the corpse with the sickle still implanted in the skull, using it as a hook. Upon retrieving the sickle, a piece of cranial vault was removed, thus creating an external beveled wound. In order to identify the mechanism which brought about this kind of lesion, experimental work was carried out on a human skull. In this particular case, the tip of the sickle penetrated into the bone, creating a lesion that would typically be produced with a stabbing instrument when applied with vertical force. When the body was dragged, using the sickle as a hook, this was a hand-produced vertical force, which was applied in the opposite direction. It caused the tearing of a piece of bone and the creation of an outer bevel. This atypical lesion should be made known to medical examiners and pathologists in order to help investigating and understanding of the circumstances of injuries.

[Organ procurement in forensic deaths]. / Prélèvements d'organes et décès médico-légaux.

OBJECTIVE: There is a chronic shortage of transplants. There are many obstacles on organ procurement and some are related to forensics aspects of deaths. In these situations in France, the judge decides whether or not to perform the organ recovery. These refusals are about 40 donors per year, representing a loss of more than 120 potential transplants. STUDY DESIGN: Retrospective study of 9 years (2003-2011) aimed to study the expectations of judges in comparing them with forensics issues. PATIENTS AND METHODS: Sixty-two cases of organ recovery with judicial proceedings have been treated in collaboration between the Agency of Biomedicine (Northeast) and the Medico-Legal Institute of Lille (northern France). RESULTS: When there is a judicial opposition to an organ procurement, it is mostly upon criminal circumstances (57%). The main reason is the need to perform an autopsy (38%), raising fears of a loss of evidence because of resuscitation and surgery for the judges. However, autopsies rule out these problems if strict protocols are followed. CONCLUSIONS: In case of forensic death, French law provides that a forensic examination to take place prior to surgical procedures. The law also provides for collaboration between caregivers and medical examiners. Nevertheless, judicial oppositions persist and appear to belong to a lack of communication between actors (judges/medical examiners/organ procurement organization). Better collaboration through protocols must be thought to satisfy the demands of justice and public health.