Christophe Bartoli

Age-at-death estimation based on the study of frontosphenoidal sutures

Determination of age at the time of death based on the observation of cranial sutures has led to numerous studies with sometimes contradictory results. The initial hypothesis being that suture closure is part of an age-related physiological process, the conflicting results have been interpreted by various authors as secondary to the choice of sutures, under the co-existing influence of pathological factors or genetic factors, or even independent of age. Despite these differences, macroscopic methods remain much used in anthropology and in forensic medicine. In our work, we evaluated the value of the degree of closure of the frontosphenoidal suture in estimating age at death of mature subjects, with the secondary objective of establishing a linear regression which could be used in routine practice. The study concerned bone specimens from individuals whose age, sex and medical history were known. Macroscopic observation was carried out on the ectocranial and endocranial sides according to four stages of closure previously defined. 290 sutures were taken from a population of whom two-thirds were men. The method can be repeated and reproduced and the regression established shows the confidence range for average error to be +/-1.5 years. While this result is of interest in terms of precision in prediction for a group of people, the prediction range is too great (+/-23 years) to be applicable to a single individual as part of a forensic procedure.

Angioscanner post-mortem: faisabilité de l'abord artériel sous guidage échographique

Nous rapportons un cas d’angioscanner post-mortem corps entier realise par ponctionarterielle femorale sous controle echographique, chez un patient de 24ans, victime d’unaccident de moto, decede a l’arrivee du Samu. Le scanner a ete demande dans un cadremedicolegal suite a l’examen externe par les medecins legistes qui retrouvaient essen-tiellement des contusions de la face et du thorax. Des prelevements sanguins et d’urines,notamment toxicologiques, ont ete realises avant la procedure.L’acquisition a ete realisee 20h apres le constat du deces sur un scanner 64coupesdouble source (Siemens Medical System, Erlangen, Allemagne) avec un protocolecomportant une premiere acquisition sans injection corps entier. Initialement, l’arterefemorale droite a ete ponctionnee sous controle echographique a l’aide d’un catheter18gauge—30mm, puis catheterisee a l’aide d’un guide hydrophile 0,035’’ (Terumo). Uneinjectiontestaeterealiseegrâceaunintroducteuravalve6Fmettantenevidenceunedis-section de l’artere iliaque externe et une extravasation de produit de contraste. L’arterefemorale gauche a donc secondairement ete ponctionnee, toujours sous guidage echogra-phique, et catheterisee par un kit de microponction (Skater Introducer, Angiotech), dontle guide, qui presente une extremite plus souple, a sans doute permis un catheterisme

Buprenorphine-related deaths: unusual forensic situations

The success of high-dose buprenorphine (HDB) as substitution therapy for major opioid dependence is related to its partial agonist effect on opioid receptors, which in theory makes it very safe to use. However, numerous deaths directly attributable to buprenorphine have been described in the literature. These deaths are generally related to misuse of HDB with intravenous administration and/or concomitant use of benzodiazepines, and they usually occur in patients on HDB substitution therapy for opioid dependence. We present three deaths attributed to HDB which arose from uncommon mechanisms and led to unusual forensic situations. The first death was that of a patient admitted to hospital after simultaneous prescription of HDB, clonazepam, oxazepam, and cyamemazine. The second death followed forcible administration of a very low dose of HDB to a patient with post-hepatitis C cirrhosis and heart failure. The third death was subsequent to an HDB overdose, probably with suicidal intent, in a young woman who had not been prescribed the drug as opiate substitute. Such deaths raise the question of the mechanisms involved and draw attention to the resulting unusual forensic situations.

Fatal Accidental Hydrogen Sulfide Poisoning: A Domestic Case

Hydrogen sulfide (H2S) poisonings are classically reported in occupational settings. We describe an unusual domestic case of fatal acute poisoning by H2S inhalation. A mother and her infant daughter were found dead in the kitchen of their home. The emergency medical team described a strong smell of rotten eggs, suggesting acute H2S poisoning. Autopsies revealed only multiorgan congestion. H2S was measured in blood and lung tissue samples by gas chromatography/mass spectrometry. Body fluids were negative, but H2S was found in the lungs of both the mother and the child at concentrations of 1.46 and 1.92 mg/kg, respectively, concentrations described in the literature as potentially lethal. Expert surveys of the premises suggested a complex mechanism involving both defective maintenance of the pipes and drains of the building and faulty assembly of the sink siphon, which led to stagnation of waste water and formation of a pocket of H2S.

Child pedestrian anthropometry: evaluation of potential impact points during a crash

This paper highlights the potential impact points of a child pedestrian during a crash with the front end of a vehicle. Child anthropometry was defined for ages between 3 and 15 years. It was based on the measurement of seven different segment body heights (knee, femur, pelvis, shoulder, neck, chin, vertex) performed on about 2,000 French children. For each dimension, the 5(th), 50(th) and 95(th) percentile values were reported, and the corresponding linear regression lines were given. Then these heights were confronted with three different vehicle shapes, corresponding to a passenger car, a sport utility vehicle and a light truck, to identify impact points. In particular, we show that the thigh is directly hit by the bumper for children above 12 years of age, whereas the head principally impacts the hood. The influence of child anthropometry on the pedestrian trajectory and the comparison with test procedures in regulation are discussed.

Post-mortem computed tomography in a case of suicide by air embolism

a Laboratoire d’imagerie interventionnelle expérimentale, faculté de médecine, Aix-Marseille université, boulevard Jean-Moulin, 13385 Marseille cedex 5, France b Pôle imagerie médicale, service de radiologie, hôpital de la Timone, Assistance publique des Hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France c Pôle RUSH, service de médecine hyperbare, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13274 Marseille cedex 9, France d UMR MD2, dysoxie tissulaire, Aix-Marseille université, boulevard Pierre-Dramard, 13916 Marseille cedex 20, France e Service de médecine légale et droit à la santé, hôpital de la Timone, Assistance publique des Hôpitaux de Marseille, 264, rue Saint-Pierre, Marseille cedex 05, France

Can subclavian blood be equated with a peripheral blood sample? A series of 50 cases

If femoral blood is not available at autopsy, toxicological analyses, in particular blood ethanol measurements, are carried out on cardiac blood. This is known to be subject to major redistribution. We aimed to determine whether subclavian blood can be equated with a peripheral blood sample and could be used if femoral blood is not available. The study was based on 50 medicolegal autopsies in which we compared ethanol concentrations between subclavian blood, the different heart blood compartments (right and left cardiac blood), and femoral blood. Mechanisms that could lead to variations in concentration, i.e., postmortem redistribution and/or endogenous production, were also taken into account in interpreting the results. Ethanol concentrations were determined by headspace gas chromatography with a flame ionization detector. In each case, we recorded the circumstances of death, resuscitation attempts if any, degree of putrefaction, chest or abdominal trauma, and/or inhalation of gastric fluid in the airways. Ethanol concentrations in subclavian blood were found to be close to those in peripheral blood (p = 0.948) and were not influenced by the degree of putrefaction (r = 0.017, p = 0.904), gastric ethanol concentration (r = −0.011, p = 0.940), inhalation of gastric contents in the airways (p = 0.461), or cardiac resuscitation attempts (p = 0.368). We discuss the possible explanations for these findings and stress the value of sampling subclavian blood when femoral blood is not obtainable at autopsy.

Manual strangulation: experimental approach to the genesis of hyoid bone fractures.

Discovery of a fracture of the hyoid bone during forensic autopsy is a feature that raises suspicions of constriction of the neck. Studies have shown the influence of gender and build of the individual on the morphology of this bone. Our aims were to confirm these findings and to develop an experimental protocol for simulating manual strangulation in order to determine the force required to fracture the hyoid bone and the influence of anthropometric parameters on this force. A total of 77 intact hyoid bones were obtained, scanned, modeled, measured and embedded in resin. Using a hydraulic press, we applied force to the distal extremity of the greater horn. The relationships between the parameters of sex, weight and height of the subject, anteroposterior length of the hyoid, width between the greater horns, angle, fusion of the greater horns and force applied were analyzed. Our study confirmed sexual dimorphism, shown by greater length in males (>37.8 mm) than in females, and a larger angle in females (a shorter bone with a width>43.7 mm and an angle>31°01). The study confirmed the positive correlation between the length of the hyoid and the weight and height of the subject (p<0.05). Sixty-seven of the 77 hyoid bones fractured during the experiment (87% fracture rate). Of the fractures, 48% occurred at the junction between the body and the greater horns, 49% in the greater horns (mean distance from the distal extremity of the horn 17.33±4.37 mm), and 3% in the median part of the body. No significant association was found between gender and type of fracture, or between fusion or non-fusion of the horn (p>0.05). Fused bones were not more susceptible to fracture than non-fused bones. Fracture occurred at a mean force of 30.55 N (±18.189). Multiple linear regression showed a significant negative correlation between force required for fracture and age, weight and height of the subject, anteroposterior length and angle. The younger the individual, the slighter their build, the longer the bone and the smaller the angle, the greater the force required to fracture the hyoid bone.

Planned complex suicide: an unusual case.

Abstract:  We report an unusual case of planned complex suicide. The victim was a woman aged 67 years, who was found dead in her bath in a state of advanced putrefaction. A plugged‐in hairdryer was submerged in the water and the electrical fuses in the room had short‐circuited. A kitchen knife lay below the body of the victim, whose left forearm bore incisions suggestive of wrist‐cutting. At autopsy, no sign suggesting electrocution could be observed because of the advanced state of putrefaction of the body. Toxicological analysis revealed massive ingestion of tianeptine (blood concentration 15.5 mg/L). Although the exact cause of death could not be determined because of the state of the corpse, meticulous examination of the scene and information obtained from the victim’s relatives led to the conclusion of suicide.

Retrograde cerebral venous air embolism: a rare cause of intracranial gas.

The emergency department requested a head computed tomography (CT) without contrast media for a brain trauma (fall from height) in a 92-year-old female patient followed for Alzheimer’s disease. The patient presented an acute confusional status but neurological examination was considered to be normal. Head CT detected several intracranial bubbles of air density. They were mainly right-sided, at the contact of orbital fissure and jugular foramen (Fig. 1). A careful bone window examination was not able to identify any fracture of the vault or base of the skull. Analysis of the topography of the gas bubbles found them all within venous structures: right cavernous sinus and right inferior ophthalmic vein, left cavernous sinus and right sigmoid sinus. Moreover, the CT technologist reported that the patient ripped out her peripheral venous catheter, inserted at the crook of her right elbow, immediately before the examination. The final diagnosis was therefore retrograde venous air embolism. i s v i