[Determination of the total work incapacity]. / Détermination de l'ITT.

At the request of the patient or required by a requisition, the physician may be asked to deliver medical certificates with determination of total work incapacity (TWI). This is an attestation of what he has observed and incurs his penal, civil and ethical responsability. The drafting of such certificates implies not only the doctor and the patient, but also the judicial authorities and the alleged offender or offenders. The impact of the determination of the TWI is important to know in order to write "good" certificates before justifying TWI.

Fatal poisoning due to snorting buprenorphine and alcohol consumption.

High dosage buprenorphine (Subutex(®)) has been prescribed as a replacement therapy for major opioid dependencies in France since 1996. However, several studies have underlined its lethal risk, especially when administered intravenously, or when combined with benzodiazepines, alcohol or other central nervous system depressants. We report three fatal buprenorphine-related poisonings after snorting, among outside protocol individuals, observed at the Forensic Medicine Unit of Caen University Hospital. Medico-legal autopsies and complementary examinations were performed. The results are presented and discussed. Lethal poisoning after snorting buprenorphine was considered the most probable cause of death. These observations illustrate the risk of fatal poisoning by buprenorphine per-nasal route, which has rarely been reported in the literature although snorting is particularly prized by individuals outside the substitution therapy. We also observed the combination of buprenorphine and alcohol. By evaluating the pharmacological characteristics of this substance, as well as the data previously published in the literature, we have attempted to explain the pathophysiological mechanisms of this particular mode of poisoning that can easily be fatal.

The French medico-legal concept of aptitude and fitness appraisal by occupational physicians: an ethical issue?

For many years, medical aptitude in occupational health, a French exception, did not raise any particular issue. However, from the 1980's onwards, this concept has been approached from a more critical point of view, authors questioning its compatibility with personal liberty. The increase in precarious working conditions have but reinforced such criticism, raising the question of the confrontation of such a concept with due respect of the right to work and the right for health protection. Special decrees, in particular the CMR decree (relating to carcinogenic, mutagenic and toxic substances for reproduction), issued in 2001, have added further force to the debate, particularly with regard to the problematic compatibility between the notice of aptitude and the respect of medical ethics and deontology. After having exposed the reasons behind the debate on aptitude in occupational health, and having identified the associated ethical issues, we will discuss the eventuality of the concept's abolition, together with possible replacement solutions.

Age at death estimation of adult males using coxal bone and CT scan: a preliminary study.

INTRODUCTION: Age at death estimation is of major importance for the forensic scientist. Currently, various methods have used macroscopic osseous criteria for articular surfaces. Particularly in the pelvis, articular surfaces are used to classify bone evolution and age. The objective was to assess coxal bone computed tomography (CT) scan procedure to initially estimate adult male age at death and model this age using quantitative measurements. MATERIALS AND METHODS: The material used included 33 coxal bones obtained from adult males of known age. Samples were obtained from 27 males during forensic autopsies and the 6 remaining samples were collected by the Normandy Whole Body Donation Center. Criteria of all bone samples were measured by CT scan. The criteria were inspired by previous osseous anthropological methods for age estimation using coxal symphyseal, auricular and acetabular surfaces. Inter- and intra-reproducibility of each criterion was calculated. Then, correlation to age at death of the reproducible variables was calculated. RESULTS: Correlation factors were used. These link CT scan criteria data to age at death. Reproducible criteria included in the analysis as reproducible and correlated to age were: auricular surface apex activity, symphyseal ventral rampart and acetabular fossa porosity. CONCLUSION: The results suggest that research using CT scan criteria data could be a useful forensic tool to determine age at death.

Children employed in the performing arts, advertising and fashion industry: what legal protection do they have?

Ill-treatment can sometimes take on an unfamiliar face. Particularly, this is the case for certain types of child employment. In France, as in most European countries, there are laws for protecting children and guaranteeing their right to schooling. Over and above the frequently observed apprenticeship contracts, obtained by eligible under 16 years, there is also the dispensatory case of children employed in the performing arts, advertising and the fashion industry. In France, legislators take the child's vulnerability into account when developing legislative and regulatory mechanisms, concerning the modalities of his/her professional activity, particularly in artistic fields and in fashion modelling. Since both may employ very young children, or even infants, one essential question ought to be raised: from a legal point of view, are these children sufficiently protected, with regard to the potential physical and psychological consequences of their particular professional activities?

Comparative analysis of medicolegal compensation for occupational cancers in France and other western European countries: development proposals.

In France, contemporary medicolegal reparation system of occupational diseases--in particular occupational cancer--has been questioned, constantly, due to changes in the state's legal system. For a long time, associated legislation was considered as a genuine social breakthrough. However, it shall remain acknowledged that over the past 15 years, it has been the French legal system itself that generated a certain level of inequality among victims of occupational diseases.. This inequality came to exist following certain jurisdictional understandings of legal matters, as well as the creation of exceptional schemes for granting compensation for physical injuries. It is agreed by both, courts and compensatory funds, that full compensation must be granted for particular group of victims. Yet, this is not the case as for granting compensation over occupational diseases, where reparation is on a set lump sum basis. In light of this proved inequality in the France legal system, with regard to the medicolegal reparation for loss or damage, associated with a claimant's occupational activity, we aim at investigating the procedures as practiced in various European countries occupational cancer in order to identify optimal compensation for these disorders.

Injuries inflicted by a pet ferret on a child: morphological aspects and comparison with other mammalian pet bite marks.

Ferrets are becoming more and more popular pets in American homes. Nevertheless, they can cause potentially dangerous injuries, particularly in small children. Based on the case of an infant injured by a ferret, the characteristics of the wounds are described and compared with those of other animals. The potential legal implications are also discussed.