Philippe Charlier

Usefulness of Systematic Histological Examination in Routine Forensic Autopsy

Abstract:  The forensic community does not agree on the need to perform histological examination at forensic autopsy. The aim of our study was to determine the usefulness of systematic standard histology in forensic autopsies. A prospective study was carried out on 428 autopsy cases for which standard histological examination was systematic. Mechanism of death not shown by gross anatomic findings was discovered by histology in about 40% of the cases. Cause of death was established by only histology in 8.4% of the cases. Microscopic findings affected the manner of death in 13% of the cases. Histology provided complementary information about prior medical condition of the deceased in about 49% of the cases. Traumatic lesions were better documented by histology in about 22% of the cases. According to the results of our study, systematic standard histology for the main organs should be used in routine forensic autopsies.

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.

Measurement of atropine and scopolamine in hair by LC-MS/MS after Datura stramonium chronic exposure.

BACKGROUND Datura stramonium is an herbaceous annual plant. All parts of the plant contain tropane alkaloids such as atropine and scopolamine. We report the case of a 22-year-old man admitted to a general hospital for visual and aural hallucinations. One week after his admission, as the hallucinations remained, the patient was transferred to a psychiatric hospital. Neither blood nor urine was conserved during his hospitalization, so a hair analysis was requested in order to identify a possible consumption of a Datura seed infusion. METHODS After decontamination and washing, hair strands were segmented into four pieces and grinded into a fine and homogeneous powder. We then incubated 20 mg for 10 min in 1 mL of phosphate buffer at pH 5.0 in the presence of 100 ng of ketamine-d4, used as internal standard (IS). Liquid-liquid extraction was performed with 4 mL of a mixture of hexane/ethyl acetate (1/1, v/v). The residue was reconstituted in 80 μL of mobile phase. A further 10 μL were injected into an 1.9 μm Hypersil GOLD PFP column (100 mm×2.1 mm) eluted with a gradient of acetonitrile and 2 mmol/L 0.1% formate buffer at a flow rate of 300 μL/min. Compounds were detected by a LCQ TSQ Vantage XP triple-quadripole mass spectrometer equipped with an electrospray ionization (ESI) source set in positive mode. SRM transitions m/z 290.2→124.1, m/z 304.2→138.1, and m/z 242.1→129.1 were optimized for atropine, scopolamine and IS, respectively. RESULTS The assay was accurate and precise over the range of 1.0 (lower limit of quantification) to 1000.0 pg/mg (upper limit of quantification) in hair. Both atropine (from 8.4 to 15.0 pg/mg) and scopolamine (1.0-1.3 pg/mg) were identified in the four segment of the hair showing a regular consumption of Datura admitted by the patient himself. CONCLUSION We report here the first description of atropine with scopolamine in a Caucasian dark mans hair after D. stramonium chronic exposure, using a validated LC-MS/MS method.

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

Forensic and police identification of “X” bodies. A 6-years French experience

The identification of X bodies is an everyday preoccupation in forensic pathology. This retrospective analysis studied all methods of identification and characteristics of unidentified bodies arrived in the Department of Forensic Medicine and Pathology (University Hospital R. Poincaré, Garches, France) during a 6-years period (2003-2009). The aim was to determine the identification methods used during all the forensic investigations, but also to study causes and manner of death in this sample of the population. A total of 9.1% of all autopsies were on X cadavers (217 cases out of 2384). On this total, only 134 of them have been included in our series after exclusion of archaeological and animal samples, but also of unidentified individuals or incomplete data available. Almost 28% of them have been identified with molecular biology (DNA), 23% with odontological examination, 7.5% with fingerprinting and 6.7% with autopsy data. Manner of death was mainly suicide (40.3%) especially by asphyxia following drowning, then accidental death (17.9%) especially consecutive to multiple trauma after traffic accident, acute carbon monoxide intoxication or carbonization in a fire. A total of 11.9% natural deaths were found (50% of them being of cardio-vascular origin) and 11.2% of homicides (with the use of firearm in a third of them). For 18.7% of X cadavers, the mode of death was undetermined. 46.4% of all unidentified bodies in our series were only identified by the police investigations, using physical recognition (direct or with photographs) or personal effects or identity documents in close relationship with the body. Our study highlights the fact that quite half of all unidentified bodies are inhumed with an identity not scientifically proved. Bodies which remained unidentified after all investigations represent 10.2% of X cadavers (if we consider a group of 176 cases composed of our study sample of 134 cases plus 24 subjects identified just before the autopsy and the 18 cases which remained unidentified) and 0.8% of all autopsies performed in the department.

Homicidal deaths in the Western suburbs of Paris: a 15-year-study.

AbstractThe aim of our study was to analyze the homicide pattern in the Western suburbs of Paris and its evolution between 1994 and 2008. All autopsy reports regarding homicides from the period January 1, 1994, to December 31, 2008, were retrospectively reviewed. Five hundred eleven homicide cases were selected of 4842 autopsy cases. The following data were recorded: assailants and victims characteristics, crime scene location, homicide motive, cause of death, and victim’s postmortem toxicological results. Homicide rate steadily declined over the period at the exception of the number of homicide-suicide per year, which remained constant. Homicide victims remained unidentified after medicolegal investigations in 2% of the cases. Child and elder homicide cases represented, respectively, 10.7% and 8.2% of the cases. Offenders were male in 88% of the cases. Male and female assailants showed distinct homicide patterns: females were involved more frequently in familial quarrel and child abuse. They never killed a stranger and committed homicide exclusively in a private place with a predominance of sharp weapons. Males, in contrast, assaulted almost equally a stranger or an acquaintance, often in a public place with a predominance of firearm. Victim knew the assailant(s) in 57% of the cases. Homicides mostly took place at the residence of the assailant or the victim. Homicide motive was clearly determined in 71% of the cases. Argument was the most common motive in 44% of the cases. Sexual assault was rarely found (10 cases). Gunshot wounds were the most common cause of death (37%), followed by stab wounds (27%), blunt trauma (19%), and asphyxia (13%). A decrease of gunshot wounds as a cause of death was found over the studied period. Alcohol was the most common toxic detected in blood of the victim, in 48.5% of the cases when toxicological results were available. Blood alcohol concentration ranged from 1 to 500 mg/dL with a mean value of 150 mg/dL.

Un tératome mature médiastinal vieux de 1 800 ans

La paleopathologie, c’est-a-dire l’etude medicale des restes humains provenant des fouilles archeologiques, permet d’identifier certaines maladies, parfois rarissimes, principalement sur des squelettes. Nous presentons ici le cas d’un teratome mature identifie sur le squelette d’une esclave de 25-45 ans provenant d’une necropole antique proche de Rome (2 e – 3 e siecle ap. J.-C.). De topographie mediastinale, il etait constitue d’une coque osseuse mesurant 4 cm de grand axe. A l’interieur de cette formation ont ete retrouves cinq bourgeons dentaires. Il s’agit du premier cas decrit d’une telle tumeur sur des restes humains anciens.

Are suicide rates higher in the cancer population? An investigation using forensic autopsy data

Previous population-based studies have identified increased suicide rates among cancer patients. Available post mortem data on the contribution of cancer to completed suicide are limited, however. This study examines forensic autopsy data in order to assess whether cancer is significantly more frequent in a suicide population compared with a control population. In total, 232 cases were included in both the suicide and the control groups. Based on a complete standard histological examination, cancer was significantly more often found in the suicide group than in the control one (8.6% vs. 3.9%, p=0.03). The multivariate analysis also showed that the presence of cancer increased the risk of suicide. Moreover, cancer was not known to the deceased in 70% of cases, while the most frequent mental disease found in cancer-related suicide cases was depression (75%). In the 20 cancer-related suicide cases analysed herein, it was difficult to ascertain whether malignancy was the only motive for committing suicide, as cancer could be considered to be either a major causative factor for suicide or an incidental finding. Therefore, further research is warranted with the help of the psychological autopsy method to investigate the link between suicide and cancer further.

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).

Ethics requirements and impact factor

Do all clinical research publications show strong application of ethics principles and respect for biomedical law? We examined, for the year 2009, the ethics requirements displayed on the website of 30 leading medical journals with an impact factor (IF) >10, and 30 others with an IF <10. We carried out a short study looking at the relationship between the IF of a journal and the ethics requirements in its instructions to authors. We show that the IF of a biomedical journal bears a direct relationship to its ethics requirements. Such results should improve the ethics requirements of all biomedical journals, especially those with low IF, so that they are internationally standardised to the higher standard required by journals with higher IF.