Laryngeal anomalies: Pitfalls in adult forensic autopsies.

OBJECTIVE: This is the first paper to group together most of adult laryngeal anomalies or malformations which may be misinterpreted by the forensic pathologist and taken for a proof of violence. MATERIAL AND METHODS: A review of the literature, to list the main pitfalls, to explain their nature and their origins. RESULTS: We found two main categories, the congenital defects and the acquired anomalies. CONCLUSIONS: The laryngeal region is complex. The pathologist must keep in mind anatomical variations or malformations, but also sequelae of old injuries and iatrogenic lesions. The survey, the patient's clinical history, the findings of the whole autopsy and, if necessary, histology may help to interpret a laryngeal anomaly.

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.

Suicidal and criminal immolations: an 18-year study and review of the literature.

We aimed to examine our autopsy data in order to analyze epidemiological and injury characteristics in criminal and suicidal immolation cases. During the 18-year period, we recorded 29 suicides and three homicides due to fire burns. In suicide group there was a majority of men (gender ratio: 3.1:1) and the mean age was 42.8 years (range 20-72). In the homicide group, the victims were two men and one woman. Their mean age was 44 years (range 39-54). The location of self-immolation was mostly the deceased's car or home and most suicides happened during the evening and the night. The main frequent motives for self-immolation were affective problems, financial problems, or both. One or several flammable fluids, usually petrol or alcohol, were used in 18 suicide cases and in one homicide. The median total body surface area burnt was 79.3% (range 10-100%) in self inflicted group and 83.3% (range 50-100%) in assault group. The sole of the feet was spared in all suicide cases. Blood CO-Hb level was measured in 27 self-immolation cases. It ranged between 1% and 10% in 11 cases and was superior to 10% in the remaining. Twenty-three self-immolation victims and one homicide victim had soot in their respiratory tracts. Soot in the respiratory tracts was associated to soot in the digestive tracts in six cases. Alcohol and drugs intoxication played a minor role. In six cases, the victim associated self incineration with one or more other methods of suicide (complex suicides). The presence of associated trauma raises the problem of vitality and interpretation of the lesions in determining the manner of death.

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.

The 'relics of Joan of Arc': a forensic multidisciplinary analysis.

Archaeological remains can provide concrete cases, making it possible to develop, refine or validate medico-legal techniques. In the case of the so-called 'Joan of Arc's relics' (a group of bone and archaeological remains known as the 'Bottle of Chinon'), 14 specialists analysed the samples such as a cadaver X of carbonised aspect: forensic anthropologist, medical examiners, pathologists, geneticists, radiologist, biochemists, palynologists, zoologist and archaeologist. Materials, methods and results of this study are presented here. This study aims to offer an exploitable methodology for the modern medico-legal cases of small quantities of human bones of carbonised aspect.

Sudden adult death: a medico-legal series of 77 cases between 1995 and 2000.

Among all the autopsies performed between 1995 and 2000 in our Department, 77 adult cases of sudden death were selected. Sex, age, place of death, circumstances of death, causes of death and heart weight were reported from these 77 post-mortem records. A complete forensic autopsy was performed in every case. Sudden death occurred more frequently in males at rest. Strenuous activity was rarely involved in sudden death and 72.7% of the cases died from cardiovascular disease, mainly coronary atherosclerosis. Non-cardiac causes were dominated by pulmonary and neurological diseases. Cardiomegaly was a frequent finding in cases who died from cardiac pathology. This study underlines the importance of complete medico-legal investigations in case of sudden death. Multiple heart samples are required in order to detect focal microscopic lesions, such as myocarditis and some forms of cardiomyopathy with minimal gross abnormalities. The post-mortem diagnosis of such cardiomyopathies is very important because the family of the deceased may undergo a possible screening. Toxicology is useful in the diagnosis of epileptic seizure and in identifying drugs like metamphetamine as a risk factor for some lethal cardiovascular pathologies such as aortic dissection. Molecular biology can also be helpful when limits of morphological diagnosis have been reached.

Postmortem revelation of sickle cell disease following fatal episode of acute bronchial asthma.

A 19-year-old black male with previous history of mild bronchial asthma presented sudden dyspnea and died in a state of respiratory distress in spite of resuscitation attempts. Autopsy showed typical lesions of acute bronchial asthma in a context of long-standing asthma associated with a massive and disseminated intravascular sickling. Hemoglobin electrophoresis diagnosed heterozygous sickle cell disease. This rare case raises the problem of the accuracy of death certificate, especially the difficulties to distinguish postmortem lesions as the underlying cause of death or the contributory cause of death.