Isabelle Huynh-Charlier

Postmortem abdominal CT: Assessing normal cadaveric modifications and pathological processes

PURPOSE To investigate the interest of postmortem non-enhanced computer tomography (CT) for abdominal lesions in a forensic context of suspicions death and to list the different radiological cadaveric modifications occurring normally at abdominal stage, which must be known by non forensic radiologists in case of any postmortem exam. MATERIALS AND METHODS 30 cadavers have been submitted to a body CT-scan without injection of contrast material. CT exams were reviewed by two independent radiologists and radiological findings were compared with forensic autopsy data. RESULTS False positive CT findings included physiological postmortem transudates misdiagnosed with intra-abdominal bleedings, and putrefaction gas misdiagnosed with gas embolism, aeroporty, aerobily, digestive parietal pneumatosis. Incidentalomas without any role in death process were also reported. False negative CT findings included small contusions, vascular thromboses, acute infarcts foci, non radio-opaque foreign bodies. Normal cadaveric modifications were due to livor mortis and putrefaction, and are seen quickly (some hours) after death. CONCLUSION The non forensic radiologist should be familiar with the normal abdominal postmortem features in order to avoid misdiagnoses, and detect informative lesions which can help and guide the forensic practitioner or the clinical physician.

The microscopic (optical and SEM) examination of dental calculus deposits (DCD). Potential interest in forensic anthropology of a bio-archaeological method

This article describes the potential interest in forensic anthropology of the microscopic analysis of dental calculus deposits (DCD), a calcified residue frequently found on the surface of teeth. Its sampling and analysis seem straightforward and relatively reproducible. Samples came from archaeological material (KHB-1 Ras al-Khabbah and RH-5 Ras al-Hamra, two Prehistoric graveyards located in the Sultanate of Oman, dated between the 5th and 4th millennium B.C.; Montenzio Vecchia, an Etruscan-Celtic necropolis from the north of Italy, dated between the 5th and 3rd century B.C.; body rests of Agnès Sorel, French royal mistress died in 1450 A.D.; skeleton of Pierre Hazard, French royal notary from the 15th century A.D.). Samples were studies by direct optical microscope (OM) or scanning electron microscopy (SEM). Many cytological, histological and elemental analyses were possible, producing precious data for the identification of these remains, the reconstitution of their alimentation and occupational habits, and propositions for manner of death.

Multidisciplinary medical identification of a French king’s head (Henri IV)

Philippe Charlier and a multidisciplinary team explain how they confirmed an embalmed head to be that of the French king Henry IV using a combination of anthropological, paleopathological, radiological, forensic, and genetic techniques

The microscopic (optical and SEM) examination of putrefaction fluid deposits (PFD). Potential interest in forensic anthropology

This article describes the potential interest in physical and forensic anthropology of the microscopic analysis of residues of putrefaction fluid, a calcified deposit frequently found associated with bone rests. Its sampling and analysis seem straightforward and relatively reproducible. Samples came from archeological material (Monterenzio Vecchia, an Etruscan necropolis from the north of Italy dated between the fifth and third century B.C.; body rests of Agnès Sorel, royal mistress died in 1450 A.D.; skull and grave of French King Louis the XI and Charlotte of Savoy dated from 1483 A.D.). All samples were studied by direct optical microscope and scanning electron microscopy. Many cytological, histological, and elemental analysis were possible, producing precious data for the identification of these remains and, in some cases, the cause of death.

Is post-mortem ultrasonography a useful tool for forensic purposes?

Purpose To investigate the interest of post-mortem ultrasonography in the diagnosis of pathological background, and manner and cause of death. Methods Post-mortem ultrasonography exams were carried out on 38 fresh human adult cadavers referred to the Department of Forensic Medicine and Pathology (Garches, France). Data obtained from ultrasonography were independently compared with further forensic autopsy findings. Results Two important limitations relative to ultrasound utilization appeared: hyper-echoic abdominal and thoracic walls, with gas distension of the whole digestive tube and subcutaneous tissues (due to precocious putrefactive gas releasing); and difficulty in accessing lateral and posterior structures (i.e. liver, spleen, kidneys, lung bases, aorta) due to rigor mortis and evident non-compliance of the subject. Post-mortem diagnoses (moderate ascites, gallbladder stones, bladder globe, chronic kidney disease, cirrhosis, thyroid gland cysts and hypertrophy, intrauterine device), were strongly limited. False negative diagnoses comprised fatty liver, pleural effusion, thoracic aortic dissection, and focal organ and/or soft tissues lesions (for example, wounds or infarcts). Conclusion According to the results, post-mortem ultrasonography seems to have a very limited role for forensic purposes. Other post-mortem utilizations are cited, proposed, and discussed.

The embalmed heart of Richard the Lionheart (1199 A.D.): a biological and anthropological analysis

During the Middle Ages, the partition of the cadaver of the elite members was a current practice, with highly technical treatment given to symbolic organs such as the heart. Considered mostly from a theoretical point of view, this notion of dilaceratio corporis has never been biologically explored. To assess the exact kind of embalming reserved to the heart, we performed a full biomedical analysis of the mummified heart of the English King Richard I (1199 A.D.). Here we show among other aspects, that the organ has been embalmed using substances inspired by Biblical texts and practical necessities of desiccation. We found that the heart was deposed in linen, associated with myrtle, daisy, mint, frankincense, creosote, mercury and, possibly, lime. Furthermore, the goal of using such preservation materials was to allow long-term conservation of the tissues, and good-smelling similar to the one of the Christ (comparable to the odor of sanctity).

A glimpse into the early origins of medieval anatomy through the oldest conserved human dissection (Western Europe, 13(th) c. A.D.).

Introduction Medieval autopsy practice is very poorly known in Western Europe, due to a lack of both descriptive medico-surgical texts and conserved dissected human remains. This period is currently considered the dark ages according to a common belief of systematic opposition of Christian religious authorities to the opening of human cadavers. Material and methods The identification in a private collection of an autopsied human individual dated from the 13th century A.D. is an opportunity for better knowledge of such practice in this chrono-cultural context, i.e. the early origins of occidental dissections. A complete forensic anthropological procedure was carried out, completed by radiological and elemental analyses. Results The complete procedure of this body opening and internal organs exploration is explained, and compared with historical data about forensic and anatomical autopsies from this period. During the analysis, a red substance filling all arterial cavities, made of mercury sulfide (cinnabar) mixed with vegetal oil (oleic and palmitic acids) was identified; it was presumably used to highlight vascularization by coloring in red such vessels, and help in the preservation of the body. Conclusions Of particular interest for the description of early medical and anatomical knowledge, this “human preparation” is the oldest known yet, and is particularly important for the fields of history of medicine, surgery and anatomical practice.

Shrunken head (tsantsa): A complete forensic analysis procedure

Based on the analysis of shrunken heads referred to our forensic laboratory for anthropological expertise, and data from both anthropological and medical literature, we propose a complete forensic procedure for the analysis of such pieces. A list of 14 original morphological criteria has been developed, based on the global aspect, color, physical deformation, anatomical details, and eventual associated material (wood, vegetal fibers, sand, charcoals, etc.). Such criteria have been tested on a control sample of 20 tsantsa (i.e. shrunken heads from the Jivaro or Shuar tribes of South America). Further complementary analyses are described such as CT-scan and microscopic examination. Such expertise is more and more asked to forensic anthropologists and practitioners in a context of global repatriation of human artifacts to native communities.

Sirénomélie entrant dans le cadre d’une association VACTERL : à propos de trois cas

Sirenomelia, characterized by a fusion of lower limb buds, is rare. Moreover, the coexistence of this malformation with a VACTERL sequence is exceptional. We report, here, three new observations associating these two diseases on fetuses from 14 to 26 weeks gestation. With these three new cases associating sirenomelia and VACTERL, observed in our unit and examined in light of data from the medical literature, we discuss the embryologic origin of such malformations and the nosologic frontiers between these two diseases.

3-Dimensional Brain Surface Reconstruction From Dried Skull Interest for Retrospective Diagnosis in Forensic Anthropology

FIGURE 1. Three-dimensional brain surface reconstruction of Henri IV (from right to left and top down: left, right, frontal, occipital, vertex, and base view). To the Editor: Themummified head of the French King Henri IV (died 1610 at the age of 56 years) has been identified according to both scientific (forensic anthropology) and historical arguments. Conventional computed tomography (CT) scan put to light a poor health state with huge antemortem tooth loss, massive dental abscesses, osteoarthritis, atherosclerosis, and cataract. As any other cadaver in the context of Virtopsy, only direct observations were carried out.Wewanted to test the feasibility of a 3-dimensional reconstruction of the whole brain according to the endocranial morphology. All Dicom data from Henri IV’s original mummified head axial CT scan were imported into Osirix Dicom viewer (Pixmeo; Geneva, Switzerland) and exported in OBJ format to Zbrush 3-dimensional package (Pixologic, USA). The remaining soft tissues were peeled off until reaching the skull bones. At this stage, the external poligons of the skull were hidden to reveal the arachnoid “stamp,” and some partial remains of the arteries were cut off to access the endocranium volume. In some cases, the matrix filling precludes one from observing the endocranial cavity and the internal features of the skull. Computed tomography enabled us to reconstruct electronically its endocast, representing the 3-dimensional surface of the imprints left by the brain on the internal surface of the skull, with its superficialassociated vascularization (sinuses including a bipartite torcular herophili, the presence of a sigmoid sinus, meningeal vessels, and pacchionian granulations) (Fig. 1). Classical morphometric data were quantified on this endocast. Moreover, we observe the classical anatomical features of anatomical modern humans and the frequent pattern or right frontal–left occipital pattern of asymmetry. Besides taking anthropometric measurements (craniometrical in this case), the detection of lesions initially hidden by ground filling or partial preservation of