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Summary We report the case of a patient who died after falling on the antenna of a radio receiver that was stood on the floor. External examination showed an orificial contuse wound, less than a centimetre in diameter, on the right upper eyelid. There was no ocular lesion. Full-body CT (computed tomography) scan imagery revealed a fracture of the roof of the right orbit and diffuse intra and pericerebral haemorrhages. Those haemorrhages had caused the death of the patient. Penetrating transorbital traumas represent a very small part of cranial traumas and orbital pathologies. They are usually linked to the high-velocity traumas associated with traffic accidents or penetration by firearm projectiles. Low-energy penetrating transorbital traumas are even less frequent; associated prognoses are rarely lethal and generally functional. These traumas cause minimal palpebral or periocular wounds that can seem insignificant upon external forensic examination, especially when the foreign body involved is fully intracranial or absent. Performing a cerebral scan, or even post-mortem angiography, thus appears to be a key-procedure, very useful to the medical examiner.

Resume Les fractures de l’os hyoide s’observent le plus souvent lors d’une pression directe appliquee au niveau de la region cervicale au cours de manœuvres de strangulation (manuelle ou au lien) ou par pendaison. La decouverte de ce type de fracture chez un individu victime d’un traumatisme a haute energie cinetique lors d’une collision ou d’un franchissement par un vehicule automobile souleve, dans certains cas, l’interrogation suivante : la fracture de l’os hyoide peut-elle etre secondaire au polytraumatisme ou a-t-elle ete provoquee par une strangulation ayant precede le polytraumatisme dans un contexte d’homicide maquille en accident ? Les auteurs illustrent cette situation a travers l’expose d’un cas clinique original d’un individu ayant ete franchi par un vehicule automobile et presentant un polytraumatisme gravissime comportant notamment un fracas comminutif de la boite crânienne et du massif facial ainsi qu’un traumatisme thoraco-abdominal. La dissection soigneuse de la region cervicale retrouvait une fracture ecchymotique de la grande corne gauche et une dislocation de la grande corne droite de l’os hyoide associee a une fracture de la mandibule et a une infiltration ecchymotique du muscle sterno-cleido-mastoidien gauche. Apres confrontation des donnees de l’autopsie, des examens complementaires et des donnees de l’enquete avec les donnees bibliographiques, les auteurs discuteront des mecanismes de la fracture de l’os hyoide dont decoulent les causes de la mort.

In this daily practice, the forensic pathologist is rarely confronted with postmortem hyperthermia associated with the rapid onset of rigor mortis. We report 2 similar cases where the rectal temperature value taken during the on-scene investigations by the forensic pathologist was greater than 40°C (104°F) in both cases, and rigor mortis was complete within less than 6 hours postmortem. The first case was due to a deadly intoxication by ecstasy and the second one to the deadly association of methadone and a possible neuroleptic malignant syndrome. Infection-related deaths were eliminated. Thus, the association of postmortem hyperthermia and rapid-onset rigor mortis would suggest in the first hypothesis a toxic death, particularly 3,4-methylenedioxymethamphetamine. However, an autopsy and toxicological analysis are necessary to confirm the cause of death.

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

Resume Une serie de 9 deces intervenus dans un contexte d’usage ou de mesusage de dispositifs transdermiques (TD) a base de fentanyl (Durogesic ® ou generiques) est rapportee. Les observations concernent 5 hommes et 4 femmes âges de 26 a 73 ans, avec un nombre de patches impliques compris entre 1 et 16 (doses de 48 a 1500 μg/h). Huit cas correspondaient a des applications multiples de patches au niveau cutane (avec dans un cas une possible injection intraveineuse associee du fentanyl recueilli par deconditionnement d’un ou plusieurs patches), et un cas a l’ingestion d’un patch. Les concentrations sanguines en fentanyl variaient de 2,2 a 234 ng/mL. Au vu des donnees de la litterature, les auteurs insistent sur les difficultes d’interpretation posees par ces situations medico-legales, s’agissant notamment d’apprecier la responsabilite du ou des dispositif(s) TD dans la survenue du deces ; plusieurs facteurs (proximite voire recouvrement entre taux sanguins therapeutiques et toxiques, frequence des polyintoxications, redistribution post-mortem) rendent compte de ces interpretations delicates, et imposent de considerer chaque situation au cas par cas, non seulement au vu des taux sanguins mais aussi de l’ensemble des donnees disponibles (anamnese, autopsie, histologie).

Whiplash is a lay term combining all the complications of a cervical sprain or distortion associated with an extension. It may lead to cervical or back pain, but patients may also complain about functional visual impairment. These visual complaints: fixation disparity, heterophoria or convergence insufficiency, are frequently neglected and difficult to quantitate and treat. Establishing the relationship between the indirect cervical trauma and the visual signs may be challenging for the medical-legal expert and must include consideration of the previous oculomotor status of the patient.

This paper describes a new approach to determine characteristics of the implement used to inflict trauma which involves the histological analysis of exogenous particles. Based on Locard’s principle “every contact leaves a trace,” we decided to assess whether histological examination of bone and soft tissue around a penetrating injury (sharp force trauma) could provide evidence of the offending implement. Case reports and experimental studies have demonstrated the potential of cut mark features in bone to identify the causative implement and potentially assist in identifying the perpetrator. Scanning electron microscopy in combination with energy-dispersive X-ray spectrometry (SEM/EDS) have previously been reported to identify exogenous particles from various implements. In medical research, histological techniques are used to study the impact of foreign particles in tissues originating from implants. However, the routine use of histology in forensic medicine focuses on understanding type and timing of injuries. Based on three forensic cases, the results presented in this paper demonstrate that histology offers a cost-efficient and reliable means to detect foreign particles related to offending implement and/or to the environment where the victim was located. The interpretation of histological results was performed in conjunction with the macroscopic autopsy findings and anthropological analysis of bone samples.

The chapter illustrates the historical, judicial and juridical framework of personal injury assessment and compensation in France, describing the expert’s qualification and competences and detailing the ascertainment methodology and criteria of evaluation utilized for identifying, describing and estimating any personal injury, its temporary and permanent consequences and the causal value/link between the event and the injury and between the injury and the impairment/disability.

This chapter presents the International Guidelines developed by the Working Group on Personal Injury and Damage under the patronage of the International Academy of Legal Medicine (IALM) regarding the Methods of Ascertainment of any suspected Whiplash-Associated Disorders (WAD).

Genetic testing for cardiac channelopathies in sudden unexplained death (SUD) has developed substantially over the last years. The Next Generation Sequencing (NGS) technology provides an unprecedented opportunity to screen for genetic variations underlying arrhythmogenic genes in a short period of time at a low cost. The present study aimed to perform genetic testing with NGS technologies on the Ion Torrent Personal Genome Machine™ (Ion PGM™) sequencer, in targeting a total of 23 genes reported to be associated with inherited cardiac channelopathies in order to identify the possible cause of death in a cohort of post-mortem cases. The molecular analyses focused on 16 cases of SUD, aged less than 35 years old. In all cases, the cause of death could not be determined after a rigorous autopsy associated with histopathological and toxicological analyses according to the guidelines of the Association for European Cardiovascular Pathology. DNA was extracted from fresh frozen tissue. An average of 200 variants was identified per case. However, after the prioritization process using a new scoring program (VaRank) and after the conjunction of clinical data and molecular findings, four “likely pathogenic” variants (including two undescribed variants), were identified in three cases (18.75%) of our cohort in the genes KCNH2 , ANK2 , SCN5A and RYR2 . One case, who died during psychiatric hospitalization after administration of a QT prolonging drug, showed a double “likely pathogenic” variant in Long QT genes ( ANK2 and SCN5A ) which may have predisposed to drug-induced cardiac arrhythmias. Our study illustrates that the NGS approach based on AmpliSeq™ libraries and Ion Torrent PGM™ sequencing may be an efficient approach, integrated to post-mortem examination. Given the massive amount of information generated by NGS, a rigorous filtration strategy of variants coupled with multidisciplinary collaboration is crucial to determine the potential pathogenic role of identified variants in the cause of death.

A fatal case of sildenafil citrate (Viagra1) overdosage is presented. The deceased was a 56-year old male found dead at home, with a past history of diabetes mellitus, hypertension, chronic alcoholism, anxio-depressive disorders, and erectile dysfunction. The main autopsy findings were cardiomegaly (650 g) with dilated cardiomyopathy, diffuse coronary atherosclerosis with no sign of acute ischaemic disease, and extensive fibrosis of the myocardium, especially affecting the cardiac conducting tissue. As measured by HPLC/MS, sildenafil concentration in postmortem blood (6.27 mg/mL) exceeded at least four times the highest therapeutic levels previously reported. The results are discussed in the light of the literature about the cardiovascular side effects of sildenafil, with special emphasis on the recently evidenced arrhythmogenic potential of the drug. This is the first report of a fatality caused by sildenafil overdosage.

Many drugs, alone or in combination, have the potential to be used to facilitate sexual assault, including alcohol, benzodiazepines, antihistamines, antidepressants, marijuana, cocaine, and gamma-hydroxybutyrate (GHB). Whether taken voluntarily or involuntarily, such drugs are often metabolized and excreted before the victim suspects that a sexual assault may have occurred. This contributes to the underreporting of drug-facilitated sexual assault (DFSA). During the last 20 years both the police and medical personnel have become more aware of drug-facilitated sexual assault. The use of chloral hydrate knock-out drops dates back to the 1800s, where they were used to facilitate robbery. DFSA is not a new phenomenon.

Background and Purpose— Our objective was to evaluate the relationship between cannabis use and ischemic stroke in a young adult population. Methods— Forty-eight consecutive young patients admitted for acute ischemic stroke participated in the study. First-line screening was performed, including blood tests, cardiovascular investigations, and urine analysis for cannabinoids. If no etiology was found, 3D rotational angiography and cerebrospinal fluid analysis were performed. A control was planned through neurovascular imaging within 3 to 6 months. Results— In this series, there was multifocal intracranial stenosis associated with cannabis use in 21% (n=10). Conclusions— Multifocal angiopathy associated with cannabis consumption could be an important cause of ischemic stroke in young people.

International audience; We report a case with an atypical entrance wound as a result of a destabilized full metal jacket bullet penetration. The destabilized bullet by an impact with the dorsal hand experiences a yawing to tumbling motion in flight. The large angle of yaw induces a larger presenting profile upon impact that contributes, associated to a rapid deceleration, to a greater mechanical force on the projectile structure and a fragmentation into core and jacket. Forensic pathologists have to be aware that the metal jacket bullet could tend to break up outside or inside the body particularly after a shooting through a target. This phenomenon induces atypical entrance wounds and atypical X-ray presentation.

A nonfatal case of poisoning involving aldicarb, an extremely toxic carbamate pesticide, is presented. A 39-year-old female ingested an unknown amount of aldicarb, together with alprazolam and sertraline. On admission to ICU (T0), she displayed marked cholinergic symptoms and a deep coma. The patient was given pralidoxime and atropine. Her condition gradually improved on days 2 and 3 and she was discharged at T0+80 h. Aldicarb was assayed by high-performance liquid chromatography on 21 blood and 8 urine samples successively taken during hospitalization. At the same time, serum pseudocholinesterase activity was followed on 21 successive samples. Blood aldicarb level was 3.11 g/mL at T0 and peaked at T0+3.5 h (3.22 g/mL), then followed a two-slope decay with a terminal half-life of ca. 20 h. Aldicarb was detected in all urine samples (peak level: 6.95 g/mL at T0+31.5 h) and was still present at the time of discharge. Serum pseudo-cholinesterase activity remained low (10% of normal) until the 30th hour then rapidly increased and returned to normal after the 60th hour. The patient’s clinical picture closely followed blood aldicarb levels and serum pseudo-cholinesterase activities. To our knowledge, this is the first report of an aldicarb poisoning documented by repeated measurements of the drug in the intoxicated person. Human & Experimental Toxicology (2001) 20, 657–660.

Objectives: Children's stress research may benefit from the establishment of a standardized and validated methodology to measure cortisol and cortisone in hair, as this biomatrix is non-invasive, easily obtainable and more practicable compared to other commonly used matrices in stress research. Methods: A new analytical method using ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) is developed and validated to simultaneously detect cortisol and cortisone in children's hair. Applicability of the UPLC-MS/MS method is tested in 6 cm hair samples of 223 elementary school girls, and cortisol-to-cortisone ratios are calculated. Results: The LOD and LOQ were 2 pg mg−1 and 5 pg mg−1 respectively, for both cortisol and cortisone. Good linear responses in the ranges 5–1000 pg mg−1 (R2 > 0.99) and extraction recoveries of >84% and >87% were observed for cortisol and cortisone respectively. Relative standard deviation percentages were