Fatima-Zohra Mokrane

Virtual anthropology: useful radiological tools for age assessment in clinical forensic medicine and thanatology.

Virtual anthropology consists of the introduction of modern slice imaging to biological and forensic anthropology. Thanks to this non-invasive scientific revolution, some classifications and staging systems, first based on dry bone analysis, can be applied to cadavers with no need for specific preparation, as well as to living persons. Estimation of bone and dental age is one of the possibilities offered by radiology. Biological age can be estimated in clinical forensic medicine as well as in living persons. Virtual anthropology may also help the forensic pathologist to estimate a deceased person’s age at death, which together with sex, geographical origin and stature, is one of the important features determining a biological profile used in reconstructive identification. For this forensic purpose, the radiological tools used are multislice computed tomography and, more recently, X-ray free imaging techniques such as magnetic resonance imaging and ultrasound investigations. We present and discuss the value of these investigations for age estimation in anthropology.

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.

Procedures and Frequencies of Embalming and Heart Extractions in Modern Period in Brittany. Contribution to the Evolution of Ritual Funerary in Europe.

The evolution of funeral practices from the Middle Ages through the Modern era in Europe is generally seen as a process of secularization. The study, through imaging and autopsy, of two mummies, five lead urns containing hearts, and more than six hundred skeletons of nobles and clergymen from a Renaissance convent in Brittany has led us to reject this view. In addition to exceptional embalming, we observed instances in which hearts alone had been extracted, a phenomenon that had never before been described, and brains alone as well, and instances in which each spouses heart had been placed on the others coffin. In some identified cases we were able to establish links between the religious attitudes of given individuals and either ancient Medieval practices or more modern ones generated by the Council of Trent. All of these practices, which were a function of social status, were rooted in religion. They offer no evidence of secularization whatsoever.

Technical note: A preliminary comparative study between classical and interventional radiological approaches for multi-phase post-mortem CT angiography

PURPOSE Multi-phase post-mortem computed tomography angiography (MPMCTA) is a new diagnostic tool, used in forensic pathology. On the one hand, this technique allows a better and direct visualization of vascular and solid organ lesions. On the other hand, the invasiveness of the procedure-which requires surgical denudation (inguinal and/or cervical) and the insertion of surgical cannulas-leads to many relatives refusing scientific autopsies. Our hypothesis states that a minimally-invasive procedure combining interventional radiological techniques with MPMCTA (replacement of surgical cannulas by radiological catheters) will improve the approval rate of scientific autopsies by families. The aim of this study was to evaluate the feasibility of the minimally-invasive MPMCTA approach and to compare its performance to the current reference-standard (the conventional approach). MATERIAL AND METHODS We included consecutively 16 corpses divided in two groups according to the contrast enhancement approach: radiological catheters (n=8), and surgical cannulas (n=8). Corpses were chosen and assigned randomly from our local data. The quality of the imaging procedure was compared according to four items: global vascular opacification, cerebral venous opacification, and lower limbs opacification (arterial and venous). RESULTS A minimally-invasive approach for scientific autopsies is feasible through a radiological catheter. Vascular opacification was optimal in 8 out of 8 cases and was no less effective than the control reference group using surgical cannula incision associated with their non-occlusive aspects.

An unusual homicidal stab wound of the cervical spinal cord: A single case examined by post-mortem computed tomography angiography (PMCTA)

We report an unusual case of homicidal stab wound of the cervical spinal cord, which illustrates the value of post-mortem computed tomography angiography (PMCTA) in cases of vascular injury. First, we noted a posterior and horizontal trajectory to the neck with complete section of the cervical spinal cord between the first and second cervical vertebrae. This lesion was accompanied by section of the right vertebral and right deep cervical arteries. We also noted an anterior cervical trajectory with an injury to the right internal jugular vein and an anterior right chest wound with a lung trajectory and section of the internal mammary vessels. Cases of spinal cord injuries secondary to stab wounds are rare in the literature. Only one large series has been published from Cape Town. Complete section of the cervical spinal cord accounts for only 4.5% of all cases. Furthermore, lethal cases are rare and classically victims survive and present neurological sequelae. We found only one similar case but despite the transection of the cervical spinal cord the patient survived. Some studies suggest that PMCTA may be very helpful in visualizing vascular system injuries. Our observations are consistent with this proposal. The use of different-time acquisitions was essential for detection of the injured vessels.

Semicircular canal angulation during fetal life: a computed tomography study of 54 human fetuses.

Objective In humans, the inner ear reaches its final configuration and adult size during fetal life. According to the literature, this occurs between 18 and 25 weeks of amenorrhea (WA). The ossification of the otic capsule is believed to arrest any further configuration change. There have, however, been some observations of slight changes in the orientation of the semicircular canals (SCCs) occurring later in fetal life. The present study aim was to examine changes of angulations between bony SCCs during fetal life. Patients Fifty-four human fetuses aged 22 to 40 WA. Intervention Computed tomography scanner. Main Outcome Measure SCC angulation (in degrees) studied with Amira software. Results We found mean angles between the lateral SCC and anterior SCC, the lateral SCC and posterior SCC, and the anterior SCC and posterior SCC of 88.67, 92.60, and 90.19 degrees, respectively. Inter-SCC angles did not change significantly between the different age groups (22 WA, 24 WA, 26 WA, 29–31 WA, 34–36 WA, 38–40 WA). There was no difference of angulation between males and females and no intraobserver or interobserver variability. Conclusion The absence of correlation of SCC angles with age in our sample of fetuses indicates that the three-dimensional configuration of the SCC has already reached its adult form at 22 WA. As often described in the literature, these angles are close to orthogonality, probably reflecting an optimal vestibular function configuration.

Anaphylactic reaction and cardiac arrest due to gadobenate dimeglumine

Magnetic resonance imaging (MRI) with gadolinium-based contrast media injection has increased over the last decade. This media is considered as safe, but exceptional side effects have been described, in particular the development of nephrogenic systemic fibrosis, as well as anaphylactic reactions. The first cases of immediate hypersensitivity reactions were published in the 1990s, with symptoms often occurring within the 15 minutes following injection [1]. Several epidemiological studies showed that severe cases of anaphylaxis were rare and cardiac arrest exceptional [2–4]. We relate the case of cardiac arrest after gadobenate dimeglumine (Gd-BOPTA) injection, with a positive neurological evolution that was nevertheless permeated by severe complications. MRI with Gd-BOPTA injection was performed in an ambulatory 76-year-old patient for a lumbar spinal stenosis. She presented no allergic history and did not report any complications after a previous MRI done a few years ago. Her medical history included a hypertrophic cardiomyopathy, high blood pressure, dyslipidaemia, hypothyroidism and lower limb arteriopathy. She took an antiplatelet agent, levothyroxin, perindopril and spironolactonealtizide. A dose of 0.1 mL/kg (0.05 mmol/kg of gadobenate dimeglumine Gd-BOPTA/Dimeg, Multihance, Bracco, Milano, Italy) contrast agent was manually administered intravenously at a rate of 2 mL/s, followed by a 20 mL saline solution flush. Just after the GdBOPTA injection, the patient experienced an agitated state associated with acute respiratory distress evolving in a few seconds towards cardiac arrest. The resuscitation team confirmed an asystoly at their arrival. The no-flow period was less than 5 minutes. Spontaneous circulatory activity was recovered after 16 minutes of cardiopulmonary resuscitation, 12 mg of intravenous titrated epinephrine and alkalinisation. A few minutes after resuscitation, the patient suffered a second cardiac arrest and recovered in 4 minutes. After this second episode, she was transferred to the Intensive Care Unit. At admission, ultrasonic cardiography was in favour of a distributive shock with a left ventricular hyperkinesia. The right

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.

CT Scan Imaging of the Human Fetal Labyrinth: Case Series Data Throughout Gestation.

Objectives: The inner ear in humans reaches its final configuration and its adult size during fetal life. According to the literature, this occurs between 18 and 25 weeks of amenorrhea (WA). Our goal is to clarify the course of inner ear size development. Methods: Using computed tomography (CT) scanner, we studied 13 measurements in the inner ear of a collection of 153 fetuses from 21 to 40 WA. Results: We found no side-related differences or sexual dimorphism in the measurements. Cochlear and vestibular bone measurements did not show growth from 21 to 40 WA, with the exception of the lateral semicircular canal (LSCC) bony island, which grows until 25 WA. Internal auditory canal (IAC) and cochlear aqueduct (CA) growth are correlated with gestational age. As our cochlear measurements are similar to those of infants and adults, in accordance with the literature we conclude that the cochlea has reached its adult size before 21 WA. The continuous growth of the IAC and CA is linked to petrous ossification that continues during fetal gestation and after birth. Conclusion: We confirm that the cochlea reaches its adult size during the second trimester of fetal life.