Eric Baccino

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.

Toxicity and death following recreational use of 2-pyrrolidino valerophenone.

Abstract Background. Consumption of substituted cathinones, frequently called ‘legal highs’ or ‘designer drugs’, is increasing in the European Union. In July 2012, the French Medicine Agency listed the substituted cathinones chemical family as narcotic and psychotropic substances, to restrict their use and distribution. We present, here, the first documented cases of recreational use of 2-pyrrolidino valerophenone (PVP) associated with death for one patient, with post-mortem toxicological analysis. Case reports. Two men purchased the legal high Energy-3 (NRG-3). It can be sold as laboratory reagent and is available from Internet. The oldest died of sudden cardiac arrest. The other experienced visual hallucinations and psychotic symptoms for 24 h. He also presented bilateral mydriasis, sinus tachycardia and rhabdomyolysis. He reported an occasional intranasal use of NRG-3. Analysis of the powder and blood and urine from both men revealed the presence of PVP. Discussion and conclusion. PVP belongs to the substituted cathinones chemical family. These cases highlight the need for emergency physicians, toxicologists and networks of toxicovigilance to control the use of these substances and their dangers, quickly identify cases of severe poisoning associated with the use of new drugs and to develop detection methods.

Cooling rates of the ear and brain in pig heads submerged in water: implications for postmortem interval estimation of cadavers found in still water.

The state of the art for determining postmortem interval in submerged bodies reflects a serious lack of studies. The objectives of the present study were therefore to study cerebral and tympanic cooling in water and its relation to cooling in air, in a pig model. First of all, cerebral and tympanic cooling on a single head and on an entire body were compared and proven to be very similar in air and in water. Nine pairs of heads were then exposed to 9 temperature intervals from 0°C to 20°C. For every set temperature, one head was placed in water, the other in “ambient” air in a thermostatic chamber. Ear and brain temperature were simultaneously measured every 10 minutes during 8 hours. Results showed that both in air and in water, cooling curves were almost exponential, regardless of the site (ear or brain) or the environmental temperature. Cooling was always more rapid in water than in air. Cerebral and tympanic cooling always had a correlation coefficent of 0.98–0.99. Assuming that these cooling patterns are applicable to man, this research may provide a starting point for postmortem interval estimation in submerged cadavers.

A call for forensic anthropology in Europe

the forensic sciences has been gaining more and more relevance: forensic anthropology. Forensic anthropology has been defined according to the American Board of Forensic Anthropology as follows: “The application of the science of physical anthropology to the legal process. The identification of skeletal, badly decomposed, or otherwise unidentified human remains is important for both legal and humanitarian reasons. Forensic anthropologists apply standard scientific techniques developed in physical anthropology to identify human remains, and to assist in the detection of crime. Forensic anthropologists frequently work in conjunction with forensic pathologists, odontologists, and homicide investigators to identify a decedent, discover evidence of foul play, and/or the post-mortem interval. In addition to assisting in locating and recovering suspicious remains, forensic anthropologists work to suggest the age, sex, ancestry, stature, and unique features of a decedent from the skeleton” (http://www.csuchico.edu/ anth/ABFA). Such a definition could be expanded since nowadays forensic anthropology also entails issues concerning identification of living individuals. There has been an increase in forensic cases requiring expertise in identification of both dead and living individuals. In particular, the need for experts dealing with the retrieval, recovery and study of badly decomposed human remains has increased, also because of the growing rate of crime and clandestine immigration. At the Institute of Legal Medicine in Milano alone, which performs over 1,000 autopsies every year, there are on average 30–40 cases every year (many of them charred, skeletonised or dismembered) which require application of anthropological or odontological techniques, either for constructing an accurate biological profile (e.g. aging, sexing, facial reconstruction, etc.) or for performing positive identification. Furthermore in many cases (over 20 in the past 5 years) the application of forensic anthropology and forensic archaeology was required for the search Cristina Cattaneo · Eric Baccino

A multicentre and prospective study of suspected cases of child physical abuse

In this multicentre prospective study, the authors aim to describe the social and clinical characteristics of a population of children who arrived with a suspicion of physical abuse at five Emergency Services across France and who underwent clinical and thorough radiological screening according to a common predetermined protocol. A total of 185 cases of children seen at the Emergency units of five French hospitals over a 4-year period was assessed via a specific protocol and included in this study. The results of this study show socio-cultural factors consistent with previous reports on abused populations, and in particular give interesting data concerning the type and severity of lesions present, on the whole, in 80% of the population studied. In particular this study revealed a high prevalence (30%) of bone fractures. Apart from giving a perspective on the French population, this study adds some information to the too few preexisting studies of its kind—and stresses the importance of effective identification of possible cases of child abuse and of a thorough and sensitive screening protocol.

Padova Charter on personal injury and damage under civil-tort law Medico-legal guidelines on methods of ascertainment and criteria of evaluation

Compensation for personal damage, defined as any pecuniary or non-pecuniary loss causally related to a personal injury under civil-tort law, is strictly based on the local jurisdiction and therefore varies significantly across the world. This manuscript presents the first “International Guidelines on Medico-Legal Methods of Ascertainment and Criteria of Evaluation of Personal Injury and Damage under Civil-Tort Law”. This consensus document, which includes a step-by-step illustrated explanation of flow charts articulated in eight sequential steps and a comprehensive description of the ascertainment methodology and the criteria of evaluation, has been developed by an International Working Group composed of juridical and medico-legal experts and adopted as Guidelines by the International Academy of Legal Medicine (IALM).

A case of drug-facilitated sexual assault involving 3,4-methylenedioxy-methylamphetamine.

Abstract Typical scenarios of drug-facilitated sexual assaults usually involve victims having ingested a drink after which they had little, partial or no recollection of events for a period of time. We were surprised by the case of a woman who was sexually assaulted and described a state of amazement, leading to an incapacity to resist physically or verbally to her aggressor, and who remembered everything. Alcohol was first suspected but toxicological analysis revealed the presence of 3,4-methylene-dioxy-methylamphetamine (MDMA, Ecstasy). In the literature review, a few cases of sexual assault involving involuntarily MDMA intake are described.

Methadone-related deaths in Montpellier and Region, from 2000 to 2010.

PURPOSE The objectives of this analysis were to assess the role of methadone and related substances in death occurring, discussing methadone blood concentrations and the contribution of the autopsy to the accountability of methadone in the death process. METHOD We retrospectively analyzed all forensic cases positive for methadone from January 2000 to December 2010, in Montpellier and the region served by our laboratory. RESULTS During the study period, 64 cases of deaths (11 women, 53 men) with methadone detection were recorded. A progressive increase between 2001 (2 cases) and 2010 (8 cases) was observed. The median age was 33 years old. An autopsy was available in 56.3% of cases. The most frequent finding at the autopsy was non-specific asphyxia death signs (67.6%). Tolerance to opioids was documented in 21 cases. The methadone blood concentrations ranged from 1 to 2 800 ng/mL (59 cases, median value 330 ng/mL). Most of the cases (88%) were polydrug intoxications. The most commonly associated drugs were benzodiazepines (61%), cannabinoids (28%), opioids (19%) and cocaine (12.5%). CONCLUSION During a 11-year period, toxicological analyses related to 1991 death cases were performed at the Toxicology Laboratory of Montpellier University Hospital. Of these patients, 64 deaths were possibly related to methadone. Several relevant elements (biological analysis and autopsy) were used to attribute the deaths to the sole methadone (12 cases) or to methadone and associated substances (8 cases).

Value of histological study in the fronto-sphenoidal suture for the age estimation at the time of death

The macroscopic study of cranial sutures is one of the methods that may be used in forensic anthropology to estimate age at the time of death. The present study aims at assessing the value of a microscopic analysis of the fronto-sphenoidal suture (FSS) sampled at autopsy, to determine both the physiological mechanisms responsible for the FFS closing during ageing and its value in the estimation of age at the time of death. We assessed the vascular capital as well as the apoptosis of conjunctive cells intervening as parameters in the physiological mechanism involved in cell ageing, in a population of individuals, whose gender and age was known. The FSS analysis was performed after decalcification and standard histological study, respectively with immunohistochemistry (Factor Von Willebrand antibody) VWF and (TdT-mediated dUTP nick end labelling) TUNEL method and caspase-3 immunohistochemical expression. In this study we found a significant reversed correlation between the degree of vascular expression of VWF and age at the time of death. There was also a significant positive correlation between the degree of apoptosis in the conjunctive cells of the FSS and age at the time of death. According to these results, suture closing during ageing can be explained by these two combined mechanisms of conjunctival apoptosis and vascular involution. Thus, the findings justify the study of closing sutures to estimate age at the time of death. Besides, it also enabled us to establish linear regressions. The vascular expression of the VWF enables to estimate an individuals age at the time of his death more or less at about 1.55 years, offering an interesting perspective both in forensic pathology and anthropology.

Whiplash-Associated Disorders: Clinical and medico-legal guidelines on the methods of ascertainment

The manuscript presents the International Guidelines developed by the Working Group on Personal Injury and Damage under the patronage of the International Academy of Legal Medicine (IALM) regarding the Methods of Ascertainment of any suspected Whiplash-Associated Disorders (WAD).The document includes a detailed description of the logical and methodological steps of the ascertainment process as well as a synoptic diagram in the form of Flow Chart.