Daniel Malicier

Heart lesions associated with anabolic steroid abuse: Comparison of post-mortem findings in athletes and norethandrolone-induced lesions in rabbits

Among 15,000 forensic post-mortem examinations performed on the coroners order over a 24-year period (January 1981-December 2004) in the area of Lyon, France (population: 2,000,000), 2250 cases of unexpected cardiac sudden death were identified retrospectively according to WHO criteria. Of these, 108 occurred during recreational sport and 12 occurred in athletes. In the latter category, a history of anabolic steroid abuse was found in 6 cases, whereas pre-existing ordinary cardiac lesions were observed in the 6 remaining cases. To shed light on the possible role of anabolic steroids in the induction of cardiac lesions, an experimental study was conducted in rabbits that were treated orally with norethandrolone 8mg/kg/day for 60 days, and sacrificed at day 90. The histopathological examination of the heart from treated animals showed coronary thrombosis associated with left ventricle hypertrophy in 3 cases, and lesions analogous to toxic or adrenergic myocarditis in all other treated animals. These findings were very similar to those observed after cardiac sudden death in the 6 athletes with a history of anabolic steroid abuse. In addition, elevated caspase-3 activity in the heart of treated rabbits as compared to controls suggests that apoptosis is involved in the induction of norethandrolone-induced cardiac lesions. These results confirm the cardiotoxic potential of anabolic steroid abuse.

Gas chromatography–tandem mass spectrometry assay for the quantification of four benzodiazepines and citalopram in eleven postmortem rabbit fluids and tissues, with application to animal and human samples

Pharmacokinetic studies and postmortem toxicological investigations require a validated analytical technique to quantify drugs on a large number of matrices. Three-step liquid/liquid extraction with online derivatization (silylation) ahead of analysis by gas chromatography-tandem mass spectrometry was developed and validated on rabbit specimens in order to quantify citalopram and 4 benzodiazepines (diazepam, nordazepam, oxazepam and temazepam) in 11 biological matrices (blood, urine, bile, vitreous humor, liver, kidney, skeletal muscle, brain, adipose tissue, bone marrow (BM) and lung). Since the 11 biological matrices came from the same animal species, full validation was performed on 1 matrix, bone marrow (considered the most complex), while the other 10 underwent partial validation. Due to non-negligible matrix effects, calibration curves were performed on each matrix. Within-day and between-day precision (less than 12.0% and 12.6%, respectively) and accuracy (from 88.9% to 106.4%) were acceptable on BM at both low and high concentrations. Assessment on the other matrices confirmed accuracy and within-day precision (less than 12%, and generally between 85.1% and 114.5%, respectively). The lower limit of quantification of the method was 1ng/g for nordazepam, 5ng/g for citalopram and 10ng/g for oxazepam, diazepam and temazepam. The combination of 3-step extraction and MS/MS detection provided good selectivity in all matrices, including the most lipid-rich. Application to real-case samples showed that the method was sensitive enough to describe distribution patterns in an animal experiment, and specific enough to detect molecules in highly putrefied samples from human postmortem cases.

Suicide with “non-lethal” firearm

patient was immediately transferred to the operating room. During induction of anaesthesia, she had a cardiac arrest. Sternotomy was done and blood evacuated from the pericardium. The left ventricular wall had a 6 3 cm bruised and bleeding surface, and there was a 3 mm wound that squirted blood near the apex. There were no bullets in the pericardium, and it had not been perforated. The left pleural cavity was opened and 3 L of blood drained. There was a large laceration of the lingula that poured out blood and air. 11 brown rubber bullets were removed from the left pleural cavity. Bleeding from the heart was nearly controlled, but the bruised area of the left ventricle burst, and attempts at repair were unsuccessful. The patient died on the table. Necropsy showed a contact entrance wound of 35 28 mm, with an abrased ring 3 mm wide; a subcutaneous blast chamber 7 cm diameter and a haematoma of the left breast and pectoral muscle. There were fractures of anterior arch of the third and fourth ribs and perforation of the second and the third left intercostal space. The 12th rubber bullet was found in the pleural cavity. The weapon used for this suicide was a “non-lethal” single-barrelled hand gun, type GC27, manufactured by SAPL (France) and loaded with a “non-lethal” 12 gauge, 50 mm mini Gomm-Cogne cartridge that contains 12 rubber bullets of 7 mm diameter (figure). “Non-lethal” weapons were first supplied to security forces. Deaths have been reported with rubber missiles (15 3·8 cm, 150 g) and with M-16 plastic and rubber ammunition. With rubber ammunition produced to be used in shotguns, severe but not lethal wounds have been reported. This is, to our knowledge, the first case of death due to such a weapon at contact range. The ventricular lesions are explained by the transmission of the kinetic energy of the missiles through the intact pericardium. Since these weapons are sold to be used by inexperienced citizens for self-defence, reported further lethal accidents will probably occur.

False rape: a case report.

A 16-year-old girl was admitted to the emergency department for sexual assault. The forensic examination revealed genital lesions of an age that were incompatible with her statements. She also presented extragenital lesions that resembled self-inflicted lesions. The reports of false rape allegations in the literature have all dealt with the motivations of the false victims. This case report is a reminder that an allegation of rape can be considered only on the basis of proof and not on speculation.

The interest of postmortem bacteriology in putrefied bodies.

A 27‐year‐old man was found dead in an advanced decomposition stage at home. On external examination, his body showed petechial hemorrhages of the skin. At autopsy, petechial hemorrhages of the epicardium were found, but no sign of meningitis was detected. Toxicological investigations remained negative. Bacteriological conventional analyses showed no significant result. Neisseria meningitidis serogroup B was finally isolated on cerebrospinal fluid by a specific real‐time polymerase chain reaction. To our knowledge, there are no available data about the postmortem diagnosis of an infectious cause of death in a decomposed corpse. In such situations, the polymicrobial overgrowth usually hampers the interpretation of bacteriological conventional methods and questions their diagnostic value. Such molecular bacteriological approaches appear to constitute an important diagnostic tool for forensic scientists and should be widely processed in case of suspected infectious death or sudden death whatever the postmortem interval.

Postmortem measurement of caffeine in bone marrow: Influence of sample location and correlation with blood concentration

Bone marrow (BM) analysis is of forensic interest in postmortem toxicological investigation in case of limited, unavailable or unusable blood samples. However, it remains difficult to determine whether a drug BM concentration is therapeutic or represents overdose, due to the lack of studies on this alternative matrix. Given the variations in BM composition in the body, sample location was suggested to be a relevant factor in assessing BM concentration. The aim of the present study was to compare postmortem caffeine concentrations in various BM sample locations and secondly to consider the correlation between BM and blood concentrations. Six BM samples (right and left side: proximal and medial femur and 5th rib) and a blood sample were collected from 21 forensic autopsies. Gas chromatography coupled to tandem mass spectrometry was performed. Blood caffeine concentrations ranged from 60 to 7591ng/mL. Femoral and rib BM concentrations ranged from 51 to 6171ng/g and 66 to 7280ng/g, respectively. Blood concentrations were always higher than BM concentrations. As a good correlation was demonstrated between blood and rib BM and between blood and the average of the four femoral BM concentrations, blood caffeine concentrations could be correctly extrapolated from BM concentrations. BM caffeine concentration was found to depend on sample location. Rib BM caffeine concentrations appeared to be systematically greater than averaged femur values and concentrations were much more variable between the 4 femur BM samples than between the 2 ribs. From a practical point of view, for caffeine analysis, rib BM appeared more relevant than femoral BM, which requires multisampling to overcome the concentration variability problem.

Fatal Mephenesin Intoxication

ABSTRACT: This report describes a death related to the abuse of and intoxication by mephenesin. To the best of our knowledge, this is the first report case of lethal intoxication involving solely mephenesin and reporting mephenesin blood concentrations. The victim was a 48‐year‐old woman found unconscious at home. Resuscitation was unsuccessful. Toxicological analysis was performed on a blood sample collected during resuscitation. The results being negative, the body was exhumed for an autopsy, which revealed bronchial inhalation syndrome. Analysis in a second laboratory has revealed the presence of mephenesin in samples collected during autopsy. No other drug/toxin was found, and alcohol was negative. Reanalysis of the peripheral blood collected during resuscitation found a mephenesin concentration of 15.81 μg/mL (15‐fold greater that the maximum concentration that would result from a single intake of a 500 mg formulation). The pathologist has concluded on a bronchial inhalation syndrome consecutive to a mephenesin overdose as the cause of death. The manner of this death is discussed in the light of the toxicological hair analysis and the medical past of the victim.

Method for determining if a corpse has been frozen: measuring the activity of short-chain 3-hydroxyacyl-CoA dehydrogenase (SCHAD)

Accidental deaths by exposure to the cold have figured in many publications, whereas the freezing of the corpse is not well known. The study which we have reported was motivated by an observation of homicide in which ignorance of the fact that the body had been frozen was responsible for an underestimation of the time since death. It proved that measuring the activity of short-chain 3-hydroxyacyl-CoA dehydrogenase (SCHAD) could reveal that the body had been frozen.

The perfect crime: myth or reality?

The primum movens of a forensic autopsy is to track down the crime. The perfect crime can be defined as one which will never be suspected and/or one for which the criminal will never be arrested. We have reported several cases that have been adjudicated or are being adjudicated, and we show how actual homicides could have been taken for accidental deaths, suicides, or even natural deaths.

FORENSIC Autopsy of People Having Committed Suicide in 2002 and in 2012: Comparison of Epidemiological and Sociological Data

This work compares epidemiological and sociological data on persons having committed suicide in 2002 and in 2012 through a retrospective study of every suicide case having led to an autopsy at the Institute for Forensic Medicine of Lyon in 2002 and in 2012. The study included sociodemographic data, medical data, and toxicological data. A total of 486 cases were included (242 cases in 2002 and 244 cases in 2012). People committing suicide were on average older in 2012 than in 2002 with a larger proportion of over 55. There was also an increase in the proportion of psychiatric antecedents (p < 0.001). Whatever the date of death by suicide, the most affected age range is the 45–54. The results highlight the necessity of bolstering the prevention plans, in particular for people over 45.