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Background In 2019, there are 6.5 million migrants living in France. Numerous quantitative studies show inequalities in access and quality of care, in particular in women’s health. This study aimed to explore migrant women’s experience of gynaecological care. Methods We conducted 17 semi-structured in-depth interviews with migrant women in Toulouse (France). We used a Grounded Theory approach to perform the analysis. Results Although migrant women were generally satisfied with the gynaecological care received, they also reported dysfunctions. Positive elements were the French health insurance system, the human qualities of the healthcare providers and the performance of the health system. Although reassuring, the structured framework was perceived to have little flexibility. This was sometimes felt as oppressive, paternalistic or discriminatory. These obstacles, amplified by the women’s lifestyle instability and precariousness, the language barrier and the difficulty to understand a totally new healthcare system, made women’s health care and, especially, preventive care, a difficult-to-achieve and low-priority objective for the women. Conclusions Migrant women’s overall satisfaction with the healthcare system contrasted with the known health inequalities in these populations. This is a good example of the concept of acculturation. Healthcare professionals need to make an introspective effort to prevent the emergence of stereotypes and of discriminatory and paternalistic behaviours. A better understanding and respect of the other person’s culture is an indispensable condition for intercultural medicine, and thus for reducing the health inequalities that migrant women experience.

International audience; Age at death estimation is a major part of forensic anthropology, but is often poor in the latter decades of life and should benefit from specific population standards. The aim of this study was to test a virtual reference sample with a uniform age distribution in order to improve the accuracy of age estimation for individuals over 40~years of age. We retrospectively built a random virtual reference sample of pubic symphyses from 1100 clinical cases using computed tomography at two French hospitals; this was compared with a test sample (pubic symphyses from 75 corpses undergoing post-mortem computed tomography at a French forensic department) and with the sample originally used in the Suchey-Brooks (SB) system. Inaccuracy and bias were calculated and the proportions of cases in which the real age fell within~the estimated age \textpm~1 standard deviation were calculated. Compared to using the SB sample, using our French sample resulted in a lower inaccuracy for males over 55~years and bias showed that that for males aged 56 to 70~years were less underestimated. Compared to using the SB sample, using our French sample resulted in a lower inaccuracy for females over 70~years and bias showed that that for females aged 56 and older were less underestimated. This study presents a large data set of pubic symphyseal phases from a French virtual sample that allows for improving age estimation accuracy at death, particularly for individuals over 40~years. This kind of material can be useful to improve the age estimation accuracy in a specific region. However, the reliability remains poor and the variability of pubic symphysis morphology related to bone degeneration seems to be an unavoidable limit of the method.

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.

Decision trees provide an alternative to multivariate discriminant analysis, which is still the most commonly used in anthropometric studies. Our study analyzed the metric characterization of a recent virtual sample of 113 coxal bones using decision trees for sex determination. From 17 osteometric type I landmarks, a dataset was built with five classic distances traditionally reported in the literature and six new distances selected using the two-step ratio method. A ten-fold cross-validation was performed, and a decision tree was established on two subsamples (training and test sets). The decision tree established on the training set included three nodes and its application to the test set correctly classified 92% of individuals. This percentage was similar to the data of the literature. The usefulness of decision trees has been demonstrated in numerous fields. They have been already used in sex determination, body mass prediction, and ancestry estimation. This study shows another use of decision trees enabling simple and accurate sex determination.

Resume Les progres recents de la medecine et de l’anthropologie amenent a s’interroger aux relations et apports mutuels de ces deux disciplines. L’anthropologue s’interesse a la diversite humaine et l’etude de l’homme dans sa complexite, ses variations dans le temps, dans l’espace. L’analyse de l’evolution de la diversite humaine en rapport avec des accidents ecologiques ou des evenements historiques peut permettre une extrapolation vers le futur d’evenements actuels. De plus en plus souvent les maladies ou les predispositions se definissent par un ecart a la norme. Mais quelle norme, pour quelle population, voire pour quel individu ? L’approche anthropologique essaie de mesurer la normalite dans une population, en ce sens elle apparait complementaire de la medecine notamment preventive et peut permettre d’affiner des decisions de sante publique. L’anthropologie peut etre une aide a la determination et/ou l’actualisation des normes biomedicales, amenant a s’interroger de plus en plus souvent sur la methodologie de constructions scientifiques de ces normes. Les auteurs illustrent par quelques exemples (croissance, maturation osseuse, nutrition) l’apport de la reflexion anthropologique au champ des sciences medicales.

Few studies have been conducted to determine sex differences in the immature coxal bone and the results were often contradictory. The authors studied sexual dimorphic differences of the pubis using geometric morphometric analysis of five osteometric landmarks recorded by multislice computed tomography (MSCT), based on three-dimensional reconstructions of 188 children (95 boys, 93 girls) living in the region of Toulouse, southwestern France, ranging in age from 1 to 18 years old. They used geometric morphometric methodology first to test sexual dimorphism in size (centroid size) and shape (Procrustes residuals) and second to examine patterns of shape change with age (development) and size change with age (growth). Based on statistical significance test results, the pubic shape became sexually dimorphic at 13 years old, although visible shape differences were observed as early as 9 years old. This work showed that the trajectories of pubis shape (development) and size (growth) differed throughout ontogeny and between sexes.

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.

Aim of the study: Recent studies using post-mortem computed tomography (PMCT) have suggested this imaging modality is of value in the positive diagnosis of drowning. We summarize the data from the literature regarding the diagnostic value of CT in cases of drowning. Material and methods: We performed an all-language search of literature published from 1999 to 2013 with the key words “post-mortem CT scan”, “drowning and CT scan”, “near-drowning diagnosis”, and “drowning diagnosis”. Results : Only 11 articles, whose data enabled complementary statistical analysis, were included. The presence of fluid and sediment in paranasal sinuses appear to be the determinants of the diagnosis of drowning. The presence of fluid in the sinuses had a sensitivity of 100%, and of 90% in the trachea and main bronchi. The results were completed by the high specificity of the presence of sediment in the paranasal sinuses, upper airways and stomach, which was 100% for all three. Haemodilution was present in cases of drowning (p < 0.001). The values made it possible to formulate a decision algorithm for the diagnosis of drowning.

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.

Resume But de l’etude Cet article presente une evaluation des repercussions de la reforme de la medecine legale sur l’activite de l’institut medico-legal (IML) de Toulouse. Materiel et methodes Cette etude descriptive et comparative a concerne les autopsies et examens externes realises entre juillet 2008 et juin 2013, soit 2 ans et demi avant et 2 ans et demi apres la mise en œuvre de la reforme. Resultats Nous avons mis en evidence une majoration des actes medico-legaux et principalement du nombre d’autopsies, apres la mise en œuvre de la reforme. Sur cette periode, la part deces par mort violente a egalement ete plus importante et le nombre de medecins pratiquant plus de 50 autopsies par an est passe de 1 a 4. Parallelement, les prelevements biologiques etaient plus frequents et plus souvent analyses. Conclusion L’application de la reforme a eu des repercussions quantitatives et qualitatives sur l’activite thanatologique locale a l’origine d’adaptations fonctionnelles au sein du service. Il serait pertinent de mesurer l’impact de la reforme au plan national.

Summary More than 10 years after the establishment of the law of 4 March 2002 on patients’ rights and quality of health system, the application of one of its measures, suspension of sentence for medical reasons, remains poor. This arrangement should enable inmates with serious diseases to benefit from a release to be cared for and die free. The low effectiveness of the measure questioned its necessity and sufficiency to meet the goal of a dignified end of life. There are two opposing views regarding its necessity. For proponents of Kantian inherent dignity, detainee's release is not a prerequisite to a dignified end of life. Conversely, it becomes necessary when one adheres to a modern vision of autonomy and ‘good death’, defined by the expression of their own will. Anyway, caregivers are not responsible for the decision to grant the release, but participate daily to a third way. The terminally ill prisoner is particularly vulnerable. Serious illness affects drastically the identity and lifestyle, individualization factors already weathered by years of detention. Attention and kindness of the caregiver involved in restoring the deteriorated autonomy of the patient in the twilight of his/her life. Only acceptance of our responsibility towards this person, even transgressive, can promote more than the application of the law, the defence of the dignity of the terminally ill prisoner.

A 53-year-old woman suffering from radicular pain due to cervical herniation underwent a spinal surgery consisting of anterior cervical discectomy and fusion with an implantable titanium cage. Five hours after the procedure, the patient developed cervical swelling and dyspnea. An emergency surgery permitted evacuation of a deep cervical hematoma and intubation of the patient, who died some minutes later. The family of the deceased lodged a complaint with the public prosecutor because of unclear circumstances of death. After analysis of the medical records by two forensic pathologists, a medicolegal autopsy was ordered. Massive retropharyngeal and mediastinal hematomas were diagnosed. Pathological study confirmed acute cervical hemorrhage, but failed to detect the source of bleeding. The forensic pathologists concluded that death was due to mechanical asphyxia secondary to pharyngeal compression by the cervical hematoma. To the best of our knowledge, death secondary to retropharyngeal hematoma in this neurosurgical context is rarely encountered.

A 58-year-old man died suddenly in Madagascar and poisoning was suspected. The body was embalmed after death and the general state of preservation was good. We found a major aortic dissection with a large false lumen from the aortic root to the common iliac arteries and a hemopericardium with formalinized blood clot. The intimal tear was on the ascending aorta, and an intramural hemorrhage was noted at the right coronary artery, attesting to a retrograde dissection. Microscopic studies confirmed aortic dissection with extensive intramural hemorrhage and also confirmed the retrograde dissection to the right coronary artery with a reduction of 90% of the true lumen. Classically, aortic dissection occurs in individuals with hypertension and individuals with genetic disorders of collagen formation. The diagnosis is often first established at the postmortem examination. Aortic dissection is therefore dealt with largely in necropsy studies. The usual cause of death is rupture into the pericardial sac. One case of bloodless dissection has been reported but the sudden death was explained by acute myocardial ischemia secondary to dissection of the left coronary artery. In our case, we found major hemopericardium and also intramural hemorrhage at the right coronary artery. We were able to make the diagnosis of aortic dissection and exclude the suspicion of homicide 15 days after death and after embalming.

The contribution of magnetic resonance imaging to forensic age estimation of living individuals is a subject of ongoing research. Several studies have focused on the wrist, clavicle, knee, and foot, and shown interesting results regarding the 18-year threshold. Authors have developed various staging systems for epiphyseal growth plate maturation. However, the procedure is observer-dependent and requires experience and a certain time-learning process. To reduce these pitfalls, we have developed an automatic method based on the analysis of variations of gray levels within the epiphyseal-metaphyseal junction. This method was tested on 160 MRI scans of the distal tibial epiphysis in a sample of individuals aged from 8 to 25 years old, after intensity non-uniformity correction of all images. Results showed that in our sample, 97.4 % of males and 93.9 % of females aged 18 years or more would be correctly classified using this method. To our knowledge, automatic methods for MRI analysis have not been used in the field of age estimation yet. Further studies should be performed to assess the validity of this procedure.

Resume Objectif Les objectifs de cette etude etaient de mesurer la prevalence des violences a l’encontre des soignants, d’identifier les principales caracteristiques de la victime et de l’agresseur, d’evaluer les consequences medico-legales des agressions. Methode Une enquete epidemiologique, descriptive et retrospective a ete menee au sein de la consultation de coups et blessures du service de medecine legale du CHU Rangueil a Toulouse entre janvier 2004 et juillet 2012 Resultats Nous avons etudie 2439 certificats de coups et blessures et en avons recense 66 concernant des personnels de sante, alleguant etre victimes d’agression lors de leur activite professionnelle (soit 2,7 %). Les professions les plus exposees au risque d’agression sont les infirmiers, suivis des aides-soignants et des medecins. Soixante-quinze pour cent de ces professionnels de sante exercent en milieu hospitalier ou sont salaries d’une structure de soins. La victime a ete examinee principalement sur requisition de l’autorite judiciaire. Une incapacite totale de travail au sens penal du terme a ete determinee et evaluee en moyenne a un jour. Discussion Les resultats de notre etude ont confirme plusieurs donnees de la litterature concernant les caracteristiques socioprofessionnelles des victimes et le profil des agresseurs. Nous avons explore pour la premiere fois la prise en charge juridique avec les suites engagees sur le plan penal et les incapacites totales de travail. Ainsi, la seule redaction d’un certificat de coups et blessures volontaires nous parait totalement insuffisant. Une prise en charge globale, associant medecins du travail et specialistes en victimologie, apparait necessaire.

Resume Introduction Aucune etude n’a fait etat d’une distinction entre les victimes consultant avec ou sans requisition. L’objectif de cette etude est de determiner s’il existe des caracteristiques specifiques des victimes et des violences alleguees par ces dernieres lorsqu’elles consultent avec une requisition. Patients et methodes Les dossiers de 33 269 victimes se presentant a la consultation de medecine legale entre le 1er janvier 2004 et le 31 decembre 2012 ont ete etudies. Le sexe, l’âge, le motif de consultation et le type de procedure mise en place ont ete recueillies de maniere retrospective. Resultats Les victimes consultant avec requisition etaient significativement (p Discussion et conclusion Cette etude a permis de mettre en evidence que deux evenements ont sensiblement modifie le nombre de requisitions ; les instructions sur les violences conjugales de 2006 et dans une moindre mesure, les effets de la reforme de la medecine legale en 2011.

Resume L’electrocution est une cause rare de deces. Peu d’articles decrivent les lesions anatomopathologiques dans les cas de deces par electrocution. Nous rapportons deux cas d’electrocution bien distincts tant sur le plan clinique que des conclusions finales. Pour chaque cas, les resultats de l’autopsie et de l’examen anatomopathologique sont decrits et la contribution des resultats de l’examen microscopique a la reflexion medico-legale est discutee. Le premier cas concerne une femme retrouvee morte a proximite d’un câble electrique de 380 volts non isole situe au sol. L’autopsie mettait en evidence des lesions suggerant une asphyxie et de multiples brulures cutanees evocatrices de brulures electriques. L’examen microscopique confirmait l’asphyxie mecanique au niveau pulmonaire et retrouvait des signes de brulure cutanee avec une metallisation epidermique. Cette derniere attestait le contact direct avec le câble. Le syndrome d’asphyxie mecanique etait evocateur de spasmes respiratoires dans le contexte d’ « electrocute bleu ». Le second cas concernait un jeune homme dont l’echelle a bascule sur une ligne haute tension de 20 000 volts. Il a fait l’objet de manœuvres de reanimation invasives avant de mourir a l’hopital. L’autopsie retrouvait des lesions cutanees a type de brulures electriques des membres superieurs et inferieurs. L’examen microscopique du cœur mettait en evidence des aspects ischemiques et hemorragiques ainsi que des lesions evocatrices de fibrillation ventriculaire (FV). Dans les deux cas presentes, l’examen anatomopathologique apportait des arguments qui, associes aux donnees de l’enquete et aux resultats de l’autopsie, permettaient d’emettre des hypotheses quant au mecanisme lesionnel.

Resume L’autopsie medicale, malgre un declin progressif ces dernieres annees, reste un outil diagnostique fondamental. A Toulouse s’est mise en place une collaboration entre medecins legistes et anatomopathologistes des le temps autopsique. But de l’etude Nous proposons une etude retrospective de l’ensemble des autopsies effectuees depuis la mise en place de ce systeme. Patients et methode Nous avons examine les comptes-rendus autopsiques et anatomopathologiques de janvier 2006 a juin 2010 et collige les donnees epidemiologiques et medicales, les lesions macro- et microscopiques ainsi que les differentes causes de deces. Resultats Trente-huit autopsies ont ete realisees durant cette periode. Les patients etaient majoritairement de sexe masculin (sex-ratio 1,5), âges en moyenne de 45,7 ans avec deux populations, les sujets hospitalises porteurs d’importantes comorbidites et les sujets exterieurs decedes dans un contexte de mort subite. La cause du deces a ete determinee dans 73,7 % des cas avec une preponderance d’etiologies infectieuses. Le degre de discordance diagnostique ante- et post-mortem etait de 50 %. Dans 47,3 % des cas, le diagnostic n’a ete obtenu qu’au temps microscopique. Les prelevements de cerveau, de cœur et de poumons etaient les plus informatifs et permettaient d’expliquer plus de la moitie des deces. Conclusion L’autopsie presente un interet majeur dans le diagnostic des causes de la mort par une confrontation des donnees macro- et microscopiques. Celle-ci est realisee a Toulouse par une collaboration entre un medecin legiste et un anatomopathologiste ou chacun apporte son expertise, ce qui permet d’ameliorer la qualite de la pratique autopsique et d’augmenter le rendement diagnostique.

Age estimation of living individuals is of critical importance in forensic practice, especially because of the increased migration in developed countries. Recently, the contribution of magnetic resonance imaging (MRI) to age evaluation has been studied, as it seems to be an efficient technique to analyze growth plate maturation and epiphyseal fusion. We developed an MRI staging system for the distal tibial epiphysis and the calcaneal epiphysis and evaluated its reliability on 180 MRI scans of the ankle and foot in a sample of individuals aged from 8 to 25 years old. For both bones, the degree of union between the metaphysis and epiphysis was classified in three stages. Intra- and inter-observer variabilities were good, showing the validity and reproducibility of the method. Our results were consistent with data in the literature indicating that both epiphyses mature earlier in females than in males. Bayesian predictive probabilities were used to assess the validity of our method in estimating the age of an individual in relation to the 18-year threshold. MRI of the ankle and foot can be used in association with other methods to estimate age in living individuals.

Resume En France, les morts violentes font l’objet de peu d’etudes et restent sous-estimees par les statistiques. Notre objectif est de souligner l’importance d’un outil epidemiologique emanant des differents services de medecine legale. Tous les actes medicolegaux realises dans le service de medecine legale de Toulouse de janvier 2008 a juin 2011 ont ete codes selon la dixieme revision de la Classification internationale des maladies (CIM10). Durant cette periode, 900 actes ont ete retenus pour notre etude, parmi lesquels etait note 36 % de morts naturelles et 35 % de suicides. Le mecanisme lesionnel le plus represente etait la pendaison. Seulement 34 % des noyes etaient autopsies. Un outil de codification des causes medicolegales de deces pourrait avoir un double interet : de sante publique et egalement medicojudiciaire. Il apparait necessaire que cet outil soit evolutif et permette une homogeneisation nationale. En effet, une comparabilite des donnees, une evaluation de la pertinence des examens complementaires et un retour des demandes d’examens aupres des parquets constitueraient pour les differents professionnels medicojudiciaires un precieux outil d’auto-evaluation.

The simultaneous death of two people is immediately considered as a suspect. However, this feeling is reinforced when the individuals are spouses. In these situations, criminal and forensic investigations are required to establish whether or not the deaths were homicidal in nature. Despite many descriptions of simultaneous deaths being present in the literature, the simultaneous death of two spouses from natural causes is poorly described with Ciesiolka et al., Department of Legal Medicine in Giesen (Germany), being the only ones to have reviewed two case reports involving these circumstances. The scarcity of this type of information in the literature renders the task of claiming natural simultaneous death as the final outcome of an investigation difficult. We would like to report three additional cases with the aim of better describing this type of event. In all three cases, the bodies were those of a married couple in their 80s. The bodies were discovered in the same room. In each case, the death of one of the spouses could be attributed to natural cause; however the death of the other spouse could not be determined with certainty, and shared several similarities in all cases: simultaneity in death; a pre existing cardiovascular disease/disorder; a certain degree of fragility and dependence on the other spouse whose death could lead to acute psychological stress. Intense psychological disorder could trigger acute coronary or rhythmic disorders. The mechanisms by which brain activity influences cardiac electrophysiology are now known to take place via the autonomic nervous system mediation. This brain activity could provide an explanation for the death of the individuals with pre-existing heart conditions, who underwent significant stress upon occurrence of the death of their partners. The death of these individuals, which took place at the same place and time as their deceased spouses, can be attributed to natural causes: the Philemon and Baucis syndrome.

Resume L’execution d’une peine privative de liberte peut etre modulee par de nombreux amenagements permettant au condamne de ne pas purger l’integralite de sa peine en detention. Le legislateur par la loi du 4 mars 2002 a rendu possible une suspension de la peine. Elle peut s’appliquer quel que soient la nature et la duree de la peine encourue, aux conditions que le detenu soit atteint d’une pathologie engageant le pronostic vital ou que son etat de sante soit incompatible avec la detention. La jurisprudence par un arret du 28 septembre 2005 a precise que le pronostic vital devait etre engage a court terme. Suite a cette modification jurisprudentielle amenee au droit positif, il est demande a l’expert medical d’effectuer un pronostic temporel. Pour autant le medecin expert a t-il la possibilite scientifique de repondre a la question posee ? Si sa reponse n’est pas purement scientifique, quelle est alors sa legitimite et l’ethique est-elle respectee ? L’analyse des termes des missions adressees aux experts ainsi que de leur reponse a permis de soulever de nombreuses problematiques : lexicales, epistemologiques et ontologiques. Le probleme de la transposition du pronostic illustre la complexite, en sciences medicales, de la validite des savoirs et de leur interaction avec la variabilite du vivant. Une reflexion commune entre corps medical et judiciaire pourrait probablement repondre de facon simple et efficiente a ces difficultes.

ObjectifsNous proposons dans ce travail d’etudier sept mesures de la pars basilaris a partir de reconstructions scanographiques bidimensionnelles et de determiner les plus discriminantes pour l’estimation de l’âge fœtal.Population d’etude et methodeNotre population d’etude etait composee de trente-sept fœtus âges de 22 a 40 semaines d’amenorrhees (SA). Pour chaque individu, nous avons realise des reconstructions scanographiques en filtre mou et dur puis nous avons mesure sept longueurs. L’etude statistique a ete realisee avec le logiciel R. Le coefficient de correlation interclasse et le coefficient de correlation R2 et p ont ete calcules.ResultatsLes sept distances mesurees en filtres mou et dur sont correlees entre elles (coefficient de correlation interclasse ≥ 0,78). Il existe une relation significative entre les mesures et l’âge, quel que soit le filtre (p < 0,001). Les distances les plus discriminantes pour l’estimation de l’âge fœtal sont hauteur maximale droite (ML) et largeur maximale (MW) en filtre dur (coefficient de correlation R2 de MLd = 0,87, de MWd = 0,89).ConclusionTous les resultats obtenus dans ce premier travail a partir de reconstructions scanographiques sont concordants avec les donnees de la litterature concernant l’etude d’os sec. Les largeurs les plus discriminantes pour l’estimation de l’âge fœtal sont distance entre le milieu de la corne droite et le milieu de la corne gauche (MW et L) la hauteur la plus discriminante est ML.

Amniotic fluid embolism (AFE) continues to be one of the most feared complications of pregnancy. A healthy 32-year-old woman died during delivery after a normal 39-week third pregnancy. The family filed a complaint with a criminal court as the causes of death appeared unclear. No risk factor associated with AFE was identified. Clinical presentation was typical, including sudden onset of cardiovascular and respiratory symptoms. Autopsy confirmed the histological diagnosis of amniotic embolism and excluded an iatrogenic cause of death or anesthetic malpractice. This article highlights the value of both antemortem records and histological features in establishing the diagnosis of AFE and demonstrates the fundamental importance of autopsy in an unexpected death related directly or indirectly to a medical procedure. Maternal death during delivery is rare, but traumatic for the medical teams. When a patient dies during anesthesia or immedi- ately following a surgical procedure, the liability of the anesthetic and gynecological teams may be sought. This attitude is generally explained by the fact that it is impossible for the medical team to establish the immediate cause of death with any certainty. The death of the mother is experienced as a tragedy, especially as the women giving birth are young and healthy (1). In the volatile situa- tion that follows unexpected death, the risk of legal proceedings is high, and autopsy may be indicated to investigate the causes of death and the possibility of medical liability. When death occurs during anesthesia and surgery, it has been observed that the rela- tives and ⁄ or their counsel frequently tend to consider the medical chart data as inadequate or untrustworthy (2,3).

A 39-year-old woman was found dead at home. She was single, foreign national, chronic alcoholic, and had given shelter to a compatriot for three days. This man found the deceased in her bed, after a night of heavy drinking. The emergency medical team observed numerous recent blue ecchymoses of the upper limbs. Because of the unclear circumstances, a medicolegal autopsy was ordered by the public prosecutor. Massive hemoperitoneum was diagnosed with no visible internal traumatic injury. Autopsy revealed hepatic and pancreatic abnormalities secondary to chronic alcoholism, which were confirmed by pathological study. The source of the hemoperitoneum was not identified despite careful visceral and vascular examination. The authors concluded that death was secondary to idiopathic spontaneous hemoperitoneum or abdominal apoplexy. The forensic literature on unexpected death due to massive nontraumatic intra-abdominal hemorrhage in association with liver cirrhosis is sparse, with only five cases reported, including the present case.

Our aim was to identify prescribed drugs associated with violent behaviours using the French PharmacoVigilance Database (FPVD).All reports of adverse drug reactions (ADR) recorded in the FPVD between 1 January 1985 and 31 July 2008 and including the terms aggressiveness or violence were selected. We compared proportion of exposure to different drugs between cases (reports with violence) and noncases (other reports in the database).Among 537 cases, 56 were included (48 men, mean age 46 years). Misuse was observed in ten cases (18%). In 25 cases (44.6%), a previous psychiatric history was documented. Main drugs involved were nervous system (63.6%) followed by respiratory (7.8%), alimentary tract and metabolism (7.8%), dermatological (5.2%) and anti-infective (5.2%) agents. Case/noncase analysis found an association with dopaminergic agonists (pergolide, pramipexole, bromocriptine, piribedil), benzodiazepines (alprazolam, bromazepam) and serotoninergic antidepressants (taken as a whole), but not antipsychotics or antiepileptics. Association was also found with varenicline, isotretinoin, interferon alpha-2b, rimonabant, benfluorex, topiramate and antiviral drugs (ribavirin, efavirenz).Dopaminergic agonists, benzodiazepines and serotoninergic antidepressants are the main pharmacological classes able to induce aggressive behaviour. This study also emphasises the putative role of other drugs less known to be involved in such ADR.

Multidisciplinary forensic, anthropological, and radiological studies of bone fragments encased in a concrete block were carried out to determine whether or not the bones were human. Multislice computed tomography (MSCT) investigation was performed before the bones were removed from the concrete. MSCT study pinpointed the location of the bone fragments within the concrete block, which was helpful for their extraction and recovery, and identified most of their types and nature. Osteological study on dry bones provided more accurate identification of the bones and of their side. According to both methods, the human skeletal remains were compatible with those of a child, aged 8-13 years old, with a minimum height of 128 cm. Neither investigation identified sex or racial phenotype. Both studies identified the skeletal remains as consisting of two animal and five human bones. Furthermore, both methods revealed that the concrete completely encased bones, suggesting a secondary burial.

Candida albicans spondylodiscitis is a fungal infection of the spine which is still unusual in spite of the increasing frequency of predisposing factors. A 22-year-old man received an abdominal stab wound during a physical assault. Initial medical care included surgery, prolonged use of indwelling vascular catheters with administration of broad-spectrum antibiotics, and hospitalization in intensive care. Two months after the event, the victim experienced back pain in the right lumbar region and septic spondylodiscitis secondary to C. albicans was diagnosed three weeks later. This case is noteworthy because of its clinical forensic context. In France, the public prosecutor orders a medico-legal assessment after an assault for all living victims in order to establish a causal relationship between the assault and its complications. In our case, the patient presented numerous risk factors for candidemia and the forensic specialist reasonably accepted that the causal relationship was certain but indirect. We have only found one published case of spondylodiscitis after an abdominal penetrating injury and the pathogenic agent was not mentioned. We have found no case reported in a forensic context. This unusual observation shows that it may be genuinely difficult to prove the causal relationship between an abdominal penetrating injury and an unusual infectious complication such as fungal spondylodiscitis.

Legal medicine is a cross-sectional specialty in which medico-legal situations very frequently combine with routine medical practice. A total of 132 students in the last year of the second cycle of medical studies (Year 6) replied anonymously and voluntarily to a questionnaire corresponding to the topics in the curriculum for the national ranking examination: law relating to death and the dying, examination of assault victims, medical malpractice liability rules, writing death certificates, respect of medical confidentiality and the principles of medical deontology. The most frequently cited activities of the forensic physician were autopsy (87.9%), writing certificates (75.8%) and consultations with victims of violence (60.6%). Students did not often come into contact with a medico-legal situation during Years 2–6 of medical studies. Assiduity in attending lectures was low. Students preferred the standard textbooks available in specialized bookshops. They were severe in their appraisal of their own competence at the end of the second cycle, and did not feel ready to examine a corpse (95.5%) or to examine victims of assault (92.4%). Knowledge of the law and of the risks of medical practice was felt to be inadequate by 60.5% of students, and of the writing of a medical certificate by 56.8%. Training medical students in this field is a major challenge in view of the limited number of teaching hours and the need to acquire increasingly specialized knowledge. Complementary initiatives appear to be necessary, such as partnership with other clinical specialties which are frequently confronted with medico-legal situations.

Macroscopic study of the first rib has been described by Kunos et al. as an efficient method of age estimation. We retrospectively reviewed a test sample of 160 first right ribs obtained from multislice computed tomography (MSCT) clinical investigations of living individuals aged 15–30 years old. Based on the descriptions of Kunos et al., we analyzed the morphological appearance of the sternal end of the first rib on two- and three-dimensional MSCT reconstructions and defined changes in appearance in stages (from 2 to 5). We also studied the calcification and ossification of the costal cartilage as an independent feature. By statistical analysis (ANOVA), we determined for each gender the correlation between the estimated stage of the costal face, the appearance of the costal cartilage, and the documented age of the subjects. We demonstrated that MSCT of the first rib appears to be an efficient noninvasive modality for bone age estimation.

Background Dermatology in a penitentiary environment is an under-researched field. Objectives To study the prison population seeking medical advice for skin diseases and to assess among detainees the life impact of these diseases, an approach that to the best of our knowledge has not previously been reported. Methods This prospective study was carried out in the male population of two penal institutions in the region of Toulouse, south-western France. Results One hundred seventy-eight men were seen, for a total of 234 diagnoses and 281 consultations. The five most frequent diagnoses, in order of decreasing frequency, were disorders of the pilosebaceous follicle, fungal diseases, benign skin tumours, warts and eczemas, which are common skin diseases. However, 72% of inmates believed their skin disease was directly related to detention. This belief was related to the conditions of life in prison (seclusion and its effects) and to frequent psychological problems. Conclusions The disorders observed were generally benign skin conditions that could be expected in a population of young men living in a closed community. They led to a high demand for care and treatment: skin diseases represented the largest specialist consultation in our institutions. Skin problems can easily be managed in an outpatient unit, which confirms the usefulness of a dedicated dermatology clinic within the outpatient consultation units of penal institutions in order to provide care of equivalent quality to that available in a free environment. The dermatologist can have an important role in the medical management and the health education of prisoners.

Value of radiographic evaluation of the second metacarpal in the determination of bone age. Purpose. Age determination based on bone maturate evaluation is routinely used in forensic science and anthropology. The aim of this study was to purpose a quantitative method of age determination on the second metacarpal in a population of children and adolescents by measurements of the epiphyso-metaphysal ratio (REM) (epiphysal diameter divided by metaphysal diameter) and the cortical index (IC). Material and methods. We evaluated the REM and the IC on 417 hand radiographs of 2 from aged 20-year-old children. Results. The correlation between REM and age for males (R 2 =0.62; p 2 =0.68; p 2 =0.34; p 2 =0.30; p Conclusion. Measurement of IC should not be used for age assessment. Measurement of REM is simple, reproducible and poor X-ray exposing technique. It should be very useful for age determination.

In France, in general emergency departments, psychiatric consultations are on the increase and suicidal behavior represents a frequent reason for consultation. Psychiatrists treat patients whose behavior may be impulsive and irrational, and whose critical judgment is impaired. In emergency units, the reception and initial assessment of the patient determines his or her future pathway through the healthcare system. By its very nature, emergency medicine deals with inherently unstable situations, which may lead to the risk of medical malpractice. The aim of this article is to provide a summary of the initial management of suicidal patients by general emergency units and to comment on the medical malpractice that may expose the practitioner to risk of liability. An analysis of case history has shown that in suicide cases, malpractice due to inadequate supervision is the most frequent ruling.

Whether you are an aficionado or completely uninitiated, everyone has an opinion on bull-fighting. The bull-fighter is in constant risk of injury. A medical team made up of surgeons, anesthetists, emergency physicians and nurses remains present throughout the show. For the anaesthetist and surgeon, a wounded bullfighter is an emergency because the vital and functional prognosis are engaged. The team must act in conformity with normal practice and the Code of Medical Ethics because any lack of coordination between the practitioners is punishable by law in the same way as technical fault. Several specific aspects of this type of medical procedure should be highlighted: firstly, the legal restrictions within the corrida, and secondly, the nature of the medical team, which may be comprised of doctors normally based within a public health institution and others who practice in a private health establishment. The particularity of the situation reveals differences in the system of liability, and civil liability must be distinguished from administrative liability: both of these allow the victim to obtain compensation for harm caused, but the consequences of each are different according to doctor status. The fact that the anaesthetists frequently work on a voluntary and benevolent basis does not exonerate them from liability. Lastly, a question frequently addressed is whether or not the doctor is covered by his professional insurance when he is on ringside duty.

Resume Objectifs Analyser les innovations techniques, leurs resultats et l’evolution de la legislation en France concernant la chirurgie du deferent a visee sterilisante ou contraceptive. Materiel et Methodes Une recherche bibliographique a ete realisee en utilisant les mots cles : malelcontraception/vas deferens. Parmi les 332 articles obtenus de la recherche PUBMED, nous avons selectionnes 54 articles pour leur qualite methodologique et l’importance de leurs resultats. Resultats La vasectomie reste la seule technique chirurgicale deferentielle validee. Bien que les techniques microchirurgicales reconstructrices aient permis d’ameliorer le taux de repermeabilisation, la vasectomie doit etre consideree comme une methode de sterilisation (definitive). Les autres techniques chirurgicales du deferent a visee contraceptives (reversibles) n’ont pas donne les garanties necessaires a leur utilisation en dehors de protocoles. Cependant, les resultats encourageants de certaines d’entre elles pourraient favoriser leur developpement a moyen terme. D’un point de vue legal, depuis la reforme relative aux chirurgies sterilisantes contenue dans l’article L2123- 1 du code de la Sante Publique, la realisation de la vasectomie est autorisee dans un cadre reglementaire. Conclusion L’assouplissement de la legislation et les avancees techniques dans le domaine des chirurgies deferentielles a visee contraceptives pourraient contribuer a moyen terme au developpement de la contraception masculine deferentielle en France. La diffusion de ces techniques passe par l’information du grand public et la sensibilisation de la communaute urologique.

Resume La decouverte d’un infarctus du myocarde d’origine ischemique lors d’une autopsie scientifique ou medicolegale est parfois deroutante surtout lorsqu’il s’agit d’un sujet jeune. Elle pose le probleme de l’etiologie des lesions vasculaires pour la mise en route d’eventuelles mesures de prevention dans la famille. En post mortem des examens complementaires sont realisables afin de preciser le diagnostic d’infarctus du myocarde et d’approcher son etiopathogenie. Ces examens, souvent exploites en Medecine Legale, sont rarement utilises par les pathologistes lors des autopsies scientifiques. Pourtant certains milieux biologiques sont suffisamment stables pour permettre une analyse biologique, biochimique voire genetique. Nous proposons une mise au point sur ces examens post mortem en insistant sur leurs apports et leurs limites.

The development of new imaging modalities such as computed tomography and magnetic resonance imaging is a new phenomenon in thanatology. The growing accessibility to these technologies allows, under some conditions, the acquisition of cross-sectional images on cadavers. The authors present a practical pictorial review of post-mortem changes and deadly injuries, illustrating the contributions of modern cross-sectional imaging techniques in thanatology.

The concept of spondylarthropathy (SPAP) covers a series of pathologies sharing a common genetic basis and infectious triggers. Objectives. – To present and discuss the prevalence of SPAP in the Coimbra identified skeletal collection, a 19th–20th century Portuguese sample. Materials and methods. – Each of the 505 individuals was macroscopically examined; each joint being assessed for degenerative, inflammatory, ankylosing, entesopathic, traumatic, congenital, infectious, or associated lesions. For the diagnosis of SPAP, besides the criteria proposed by Rogers and Rothschild, it was also applied a new set of criteria established by Martin-Dupont. Associated and differential diagnoses were also discussed. Results. – Using these latter criteria, SPAP was definitely diagnosed in 34 individuals (6.7%), mostly women and elderly individuals. Furthermore, SPAP was diagnosed as probable in 32 (6.3%) and could not be excluded in 98 skeletons (19.4%). Except for the third category, the results were close to those obtained when using the arguments of others authors. Discussion. – The specificity of each criterion is discussed, and the results are precautiously compared with other studies both from past and contemporary samples. Graduating the diagnosis as certain, probable or unexcluded, seems to us of interest, leading to etiological discussion as in clinical practice. Conclusion. – The high prevalence of SPAP achieved for the Portuguese collection might be explained by high exposure to infectious triggers.

A 30-year-old man was admitted with chest trauma after a road traffic accident. The patient was paraplegic and suffered from transient monoparesia of the left arm. The chest X-ray revealed a severe right tension pneumothorax and thoracic spine fractures. Emergency right thoracic drainage was carried out followed by angiography. Unfortunately the patient died and an autopsy was not permitted. Consequently post-mortem multi-slice computed tomography (MSCT) was performed, revealing presence of air inside the right cerebral arteries, bilateral pneumothorax accompanied by a severe right tension pneumothorax, bilateral haematic pleural effusion, pneumomediastinum and bilateral lung contusions. Air was also observed within the right coronary artery, ascending aorta and right ventricle. Thoracic and cervical spinal epidural emphysema were diagnosed. Venous air embolism followed by arterial air embolism producing paradoxical embolism was diagnosed. To the best of our knowledge, this is the first case illustrating by post-mortem MSCT such simultaneous complications after chest trauma as spinal epidural emphysema and cerebral and coronary air embolism.

Resume Le groupe des spondylarthropathies (SPAP) englobe un ensemble de pathologies partageant les memes bases genetiques et les memes agents infectieux declenchants. Objectifs. – Presenter et discuter la prevalence des SPAP de la collection des squelettes identifies a Coimbra, un echantillon portugais des xix e et xx e siecles. Materiel et methodes. – Chacun des 505 individus a ete examine macroscopiquement, les lesions degeneratives, inflammatoires, ankylosantes, enthesopathiques, traumatiques, congenitales, infectieuses ou associees a d'autres maladies etaient recherchees au niveau de chaque articulation. Le diagnostic de SPAP etait fonde non seulement sur les criteres de Rogers et Rothschild mais egalement sur de nouveaux criteres etablis par Martin-Dupont. Les diagnostics differentiels et associes sont egalement discutes. Resultats. – En utilisant les criteres de Martin-Dupont, le diagnostic de spondylarthropathie etait certain chez 34 individus (6,7 %), la plupart etaient des femmes et des gens âges. De plus, les SPAP etaient probables sur 32 squelettes (6,3 %) et ne pouvaient pas etre exclues sur 98 squelettes (19,4 %). Excepte pour la troisieme categorie, les resultats sont proches de ceux des autres auteurs qui ont utilise d'autres criteres. Discussion. – La specificite de chaque critere est discutee, et les resultats sont compares precautionneusement avec d'autres etudes portant sur des echantillons anciens et contemporains. Classer les diagnostics en certains, probables et non-exclus nous semble utile pour discuter des etiologies comme en pratique clinique. Conclusion. – La grande prevalence des SPAP de l'echantillon portugais pourrait etre secondaire a une forte exposition aux agents infectieux declenchants.

The authors present a case of takotsubo cardiomyopathy (TTC) following physical assault. In France, public prosecutor orders a medicolegal assessment after an assault for all living victims. Medicolegal assessment aims to establish a causal relation between an aggression and the injury sustained. An 80-year-old jeweler was the victim of assault, restraint and confinement during the hold-up of his jewelry store. After the event, he experienced constrictive chest pain with a sensation of oppression. Transthoracic echography showed apical and middle wall akinesis with apical ballooning pattern. In this case, the experts reasonably accepted that there was a direct, certain, and exclusive causal relation between the aggression and the cardiomyopathy. Forensic specialists should be aware of TTC because it is a frequent complication of stress situations and its incidence in forensic cases is probably underestimated.

The authors conducted a retrospective study of 70 cases of homicide and suicide in the Toulouse region to identify the variables that enable us to determine whether a death is a homicide or a suicide. This work showed that the following characteristics-a female victim, numerous wounds, and the presence of 1 or more vertical chest wounds-suggest homicide. It also highlights the importance of inspecting clothing, in particular the position of clothing and the presence or absence of slashes. Language: en

Resume En 2004, lors de sa creation, la mesure de suspension de peine pour raison medicale devait apporter une reponse aux situations complexes de fin de vie en detention. Depuis sa mise en application, son effectivite a ete amoindrie par la jurisprudence et des limites pratiques. Cet amenagement, qu’il soit obtenu ou non, reste donc contraint quant a sa possibilite de garantir une fin de vie digne aux detenus. Il ne permet, en effet, pas a lui seul d’assurer les criteres communement admis de « bonne mort » au sens de fin paisible et non d’euthanasie. L’existence de ces criteres est par ailleurs discutable, puisqu’elle nie en partie la singularite du patient et en particulier celle du patient detenu dont la trajectoire de vie et le referentiel socioculturel different souvent de la population generale. Assurer une fin de vie paisible aux detenus atteints de pathologie lourde n’est possible qu’en tenant compte de leur particularite et de leur souhait qu’il y ait eu ou non remise en liberte. Pour ce faire, seule une reflexion institutionnelle pourra reunir les conditions hospitalieres et penitentiaires necessaires, sans destabiliser la cohesion sociale deja tendue par des debats incessants autour de la dangerosite.

Resume Objectifs. Etude epidemiologique des signes osseux de l'arthrose et des enthesopathies degeneratives de la plus vieille population neolithique connue en Europe (d'il y a 7 700 ans). Comparaisons aux populations historiques et actuelles. Implications etiologiques. Methodes. Etude de 119 squelettes de sujets de plus de 20 ans provenant de deux necropoles d'Europe Centrale qui datent d'environ 5 700 ans Av. J.-C. soit 7 700 ans d'aujourd'hui. Resultats. Au neolithique, comme aujourd'hui, certains sujets semblent plus enclins que d'autres a developper des phenomenes degeneratifs. Les articulations de la main, de l'epaule et de la hanche ont toujours ete tres touchees par l'arthrose, tandis qu'au neolithique, comme dans de nombreuses populations historiques, le coude l'etait plus qu'actuellement. L'incidence de l'arthrose du genou, pourrait avoir peu varie lorsque que l'on tient compte des classes d'âge. Conclusions. Ces resultats signent l'importance des phenomenes microtraumatiques pour les arthroses du membre superieur. Pour les autres sites articulaires, lorsque des correctifs par classes d'âges sont effectues, au cours du temps la constance de l'incidence ainsi que des associations entre sites articulaires est assez surprenante. Elle signe l'importance d'une predisposition genetique aux phenomenes degeneratifs (« bone formers »), presente dans les populations europeennes des le debut du neolithique.

Chest pain is a common reason why cocaine-addicted patients call the emergency department, and acute coronary syndromes are difficult to diagnose in these situations. A 30-year-old cocaine-user patient contacts the Emergency Medical Assistance Service with constrictive chest pain. A doctor is sent out to the patient at home. The initial ECG is normal. No other aetiology of chest pain is revealed, except nicotine and cocaine addictions. First, a coronary artery spasm is suggested, caused by the injection of cocaine. During the journey, the patient indicates that the chest pain has returned. A 12-lead ECG shows repolarisation abnormality in the form of a subepicardial ischaemia. Fibrinolysis is not prescribed in view of the patient’s history and of the proximity of the interventional cardiology team. The coronary angiogram enables the diagnosis of myocardial bridging in the middle anterior interventricular artery, and no significant lesion of the coronary arteries is noted. A particular feature of prehospital management in France is that medical care can be given in the early stages by a physician who is called by the patient. This case report discusses the specific care requirements of which the emergency physician needs to be aware in the context of this unstable clinical situation due to the urgency associated with the difficulties of ECG diagnosis of ST-segment elevation in cocaine users.

Virtual anthropology is made possible by modern cross-sectional imaging. Multislice CT (MSCT) can be used for comparative bone and dental identification, reconstructive identification and lesion identification. Comparative identification, the comparison of ante- and post-mortem imaging data, can be performed on both teeth and bones. Reconstructive identification, a considerable challenge for the radiologist, identifies the deceased by determining sex, geographical origin, stature and age at death. Lesion identification combines virtual autopsy and virtual anthropology. MSCT can be useful in palaeopathology, seeking arthropathy, infection, oral pathology, trauma, tumours, haematological disorders, stress indicators or occupational stress in bones and teeth. We examine some of the possibilities offered by this new radiological subspeciality that adds a new dimension to the work of the forensic radiologist. A multidisciplinary approach is crucial and involves communication and data exchange between radiologists, forensic pathologists, anthropologists and radiographers.

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 victim's entire past medical history is essential.

Evaluation of fetal age is an essential element in many fields such as anthropology, odontology, paleopathology, and forensic sciences. This study examines the correlation between fetal age, femoral diaphyseal length (considered as the gold standard), and deciduous tooth germs of fetuses aged 22 to 40 weeks amenorrhea (WA) based on computed tomography (MSCT) reconstructions. Qualitative and quantitative studies of femoral and deciduous tooth germ lengths were performed on 81 fetuses (39 females and 42 males). R software was used for statistical analyses. Intra-observer and inter-observer variabilities and the interclass correlation coefficient (ICC) were calculated. Correlation coefficients (R (2)) and linear regression equations were calculated. Intra- and inter-observer variabilities were very satisfactory (intra-observer ICC ≥ 0.96, inter-observer ICC ≥ 0.95). Femoral length was significantly correlated with age (R (2) = 0.9). The correlation coefficient between age and height, width, and dental volume was R (2) ≥ 0.73. Tooth germs were good indicators of fetal age. Our method appears to be reliable and reproducible, and the results of this study agreed with those of the literature. The dental formula provided a precise estimation of fetal age between 25 and 32 WA. Tooth germs were reliable indicators of fetal age, and multislice computed tomography was shown to be an innovative and reliable technology for this purpose.