Caroline Capuani

Deciphering the elusive nature of sharp bone trauma using epifluorescence macroscopy: a comparison study multiplexing classical imaging approaches

Characterization of sharp-force trauma on human bones can be extremely useful in providing information regarding the nature and context of death. Nevertheless, in the identification of weapons used to cause sharp-force trauma and analysis of bone wounds, challenging tasks still remain. Current analysis attempting to dissect bone wound characteristics varied quite a lot and mixed different criteria, thus leading sometimes to conflicting results. In this context, the aim of our study is to clarify qualitative aspects of cut marks induced by sharp weapons on human bones. For that purpose, we analyzed bone samples via an original approach based on bone autofluorescence with an epifluorescence macroscope and compared it to previous existing methods. In this study, we used bone sections from human clavicles on which three different kinds of lesions were manually implemented, using different weapons. The bone wounds were analyzed by three different methodologies, light microscopy, scanning electron microscopy (SEM), and micro-computed tomography, and were compared with epifluorescence macroscopy. We paid attention more significantly to the aspect of walls and floor of the kerf, so as to conclude on the nature and distinguish between weapons used. Among all technologies used in this study, the most precise and efficient methods were epifluorescence macroscopy and SEM. Nonetheless, epifluorescence macroscopy is faster, cheaper, and more accessible than SEM. More significantly, this technique, which has the potential to accurately document the nature of the damage, is nondestructive, and could thus be highly useful in forensic science as anthropology.

Primary sellar melanocytic tumor: report of new case and literature review

Context primary sellar melanocytic tumors are extremely rare, and they can mimic hormonally inactive pituitary macroadenoma both clinically and radiologically. Objectives the aim of this study was to describe a new case of primary sellar melanocytic tumor, and place it in the context of published literature. Design this is a case report. Patient the case of a 61-year-old woman presenting with a 2-month history of fatigue and progressive bitemporal hemianopia is described. Endocrine investigation revealed anterior pituitary insufficiency and hyperprolactinemia without diabetes insipidus. Magnetic resonance imaging demonstrated a sellar tumor mass with suprasellar extension compressing the optic chiasm, and intense gadolinium enhancement. Transsphenoidal surgical excision of the pituitary tumor was undertaken. Histological examination showed a melanocytic tumor. An extensive search failed to find evidence of any other primary or secondary site. Due to the presence of significant tumor residue at 3-month follow-up, another surgical resection was done followed by post-operative stereotactic radiotherapy of the sellar region. Conclusion Primary sellar melanocytic tumors are exceptional lesions presenting most often as a tumor syndrome and/or anterior pituitary insufficiency mimicking a non-secreting pituitary macroadenoma. The management of these tumors consists of surgical removal of the tumor. However, surgery is often incomplete and stereotactic fractionated radiotherapy is frequently indicated.

Epifluorescence analysis of hacksaw marks on bone: Highlighting unique individual characteristics

Analysis of dismemberment trauma aims at identifying characteristics of false starts and complete sections in order to identify the class of saw. Nevertheless, determination of the individual weapon remains a challenging task. We attempted to determine the unique characteristics of different blades within the same class of saws using epifluorescence macroscopy, a non-invasive technique, in order to establish an individual injury profile. Two hacksaw blades of identical characteristics (size, set and shape of the teeth) were used to create false starts and complete sections on partially defleshed pig bones. These wounds were then analyzed using epifluorescence macroscopy. Bone lesion analysis determined characteristics that were common to both blades, corresponding to size, raker set and ripcut shape. The data collected made it possible to reconstruct the trauma. Furthermore, we highlighted specific characteristics of each blade in both false starts and complete sections. These characteristics mainly related to the shape and profile of the kerf, the consistency of cut and type of fluorescent wall striations. The sum of the information collected in examination of dismemberment wounds can identify, through comparative analysis, the individual weapon responsible for the imprints observed on the bones.

Tissue microscopic changes and artifacts in multi-phase post-mortem computed tomography angiography in a hospital setting: A fatal case of systemic vasculitis

A 27-year-old man suddenly died in hospital of acute respiratory distress syndrome secondary to severe systemic vasculitis. Multi-phase post-mortem computed tomography angiography followed by scientific autopsy of the thoracic and abdominal cavity and histology was performed, illustrating the advantages and drawbacks of such techniques. Imaging enabled us to examine the cranium, as the family refused cerebral dissection. MPMCTA revealed absence of opacification of the left middle cerebral artery. But parenchymal findings of thoracic and abdominal organs were still difficult to interpret after both imaging and macroscopic examination during the autopsy. Microscopic examination provided the definitive diagnosis of cause of death. Analysis revealed systemic vasculitis of the lung complicated by diffuse alveolar, mediastinal, splenic and retroperitoneal lesions. We were unable to determine the type of vasculitis, whether polyarteritis nodosa or microscopic polyangiitis, because of artifactual glomerular collapse. We observed some structural changes in tissue secondary to contrast agent injection, affecting the vascular system and renal parenchyma in particular. Such artifacts must be known in order to avoid misinterpreting them as pathological findings. MPMCTA and conventional autopsy are two complementary techniques showing both their specific advantages and limits which have to be known in order to choose the appropriate technique. One limit of both techniques is the detection of microscopic findings which can only be obtained by additional histological examination. This case report underlines this fact and demonstrates that caution is required in some cases if microscopic analyses are carried out after contrast agent injection.

Beneficial Effect of Conversion to Belatacept in Kidney-Transplant Patients with a Low Glomerular-Filtration Rate

Belatacept has been found to be efficient at preserving good kidney function in maintenance kidney-transplant patients. Herein, we report on the use of belatacept as a rescue therapy for two kidney-transplant patients presenting with severe adverse events after treatment with calcineurin inhibitors (CNIs) and mammalian target-of-rapamycin (mTOR) inhibitors. Two kidney-transplant patients developed severely impaired kidney function after receiving CNIs. The use of everolimus was associated with severe angioedema. Belatacept was then successfully used to improve kidney function in both cases, even though estimated glomerular-filtration rate before conversion was <20 mL/min. These case reports show that belatacept can be used as a rescue therapy, even if kidney function is very low in kidney-transplant patients who cannot tolerate CNIs and/or mTOR inhibitors.

Modeling and determination of directionality of the kerf in epifluorescence sharp bone trauma analysis

Characteristics of sharp bone trauma can be extremely useful to determine the origin of cut marks and to provide information regarding the context of death. Using human ribs and clavicle bones, this study analyzes the characteristics of bone kerfs made by different bladed implements, thanks to epifluorescence macroscopy. This technique, which is a nondestructive tool that uses autofluorescence of bones, documents bone damage precisely with high resolution. Both qualitative and quantitative criteria are analyzed. Our results identify unique class characteristics on bone lesions, allowing modeling kerf depending on the weapon, regardless of the type of bone that is wounded. Moreover, we demonstrate for the first time microscopic criteria of directionality, using fluorescence excitation. Orientation of cracks, flakes, and lateral pushing back especially helps in determining the tip and the end of the lesion, leading to the position of the aggressor. Kerf wall characteristics and striation location are also very useful. Epifluorescence macroscopy could be a new tool of choice in anthropology through cut mark analysis in establishing how the blade was used and providing details about the blow.

Spine injury following a low-energy trauma in ankylosing spondylitis: a study of two cases.

We report two cases of spine injury following a low-energy trauma in persons with ankylosing spondylitis (AS) and discuss the forensic considerations. A 60-year-old man presented with a wide anterior fracture of the superior endplate of T8 after an accidental fall down three wooden steps. A 93-year-old man presented with disjunction between C6 and C7 and 90-degree spinal angulation after a fall from a standing height or a fall from a bed. Post-mortem multislice computed tomography (MSCT) was performed before autopsy in both the cases. MSCT and autopsy findings were in agreement with a past medical history of AS. A spine injury occurring after a low-energy trauma is unusual and could be suspicious. In the forensic literature we found only a single case, which concerned multiple spinal fractures after a fall from a bicycle at low speed. Such specific mechanisms must be studied and known to the forensic expert. In this context, MSCT is a useful tool to investigate the spine and knowledge of the victims entire past medical history is essential.

Multifocal Skeletal Tuberculosis in 2 Immunocompetent Children

To the Editor: Tuberculosis remains a worldwide major global health problem. Osteoarticular tuberculosis represents 1%–2% of cases. Multifocal skeletal forms are exceptional even in endemic countries and affect mainly immunocompromised patients. It is usually associated with a primary pulmonary tuberculosis1,2. Clinical presentation is often misleading and contributes to a delay in diagnosis. We describe 2 cases of multifocal skeletal tuberculosis in young immunocompetent patients, both coming from Africa and living in France for 3 years. A 12-year-old girl, a native of Ghana, presented with a 3-month history of lumbar pain and rapid-onset S1 left radicular distribution. She had a history of asthenia with weight loss of 3 kg without fever. On examination, she had tenderness over the thoracolumbar spine, with muscle spasm and stiffness. Lasegue’s sign was positive without any neurologic deficiency. Imaging [plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI)] revealed lytic lesions of the ninth and tenth ribs, wedging of the body of T12 with soft-tissue edema, and bone destruction of … Address correspondence to Dr. Gomez-Brouchet; E-mail: Brouchet.anne{at}chu-toulouse.fr

Une tumeur du rétropéritoine inhabituelle

Une patiente de 64 ans est hospitalisée en néphrologie devant la persistance malgré un traitement adapté, d’une insuffisance rénale obstructive par hydronéphrose bilatérale. Ses antécédents sont marqués par une myélofibrose idiopathique, difficilement contrôlée depuis quatre ans. L’examen clinique retrouvait des œdèmes des membres inférieurs et une hépatosplénomégalie. Il existait une protéinurie à 6,57 g/l et une augmentation de la créatininémie à 174 mol/l. L’IRM rénale montrait des uretères à paroi épaissie avec dilatation des cavités pyélocalicielles et atrophie corticale bilatérale. Il existait une importante fibrose périrénale et péri-urétérale, une hépatomégalie et une splénomégalie. Une biopsie rénale transpariétale était alors réalisée, ramenant deux carottes constituées essentiellement de tissu périrénal et d’un fragment de cortex rénal (Fig. 1). À l’examen histologique, le parenchyme rénal était remanié et comportait des lésions de glomérulosclérose nodulaire de type diabétique et une néphropathie interstitielle chronique inflammatoire obstructive. L’immunofluorescence permettait d’écarter une monotypie kappa/lambda. Le tissu périrénal était caractérisé par une prolifération tumorale sclérosante infiltrant le tissu adipeux (Fig. 2) et constituée d’épais trousseaux de collagène entre lesquelles on notait la présence de volumineuses cellules atypiques. Celles-ci étaient isolées ou groupées en petits amas et possédaient un ou plusieurs noyaux polylobés et hyperchromatiques sans mitose identifiable (Fig. 3). Il s’y associait un infiltrat inflammatoire polymorphe d’intensité modérée. L’étude immunohistochimique a montré