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.

[Peripheral localizations in diffuse idiopathic skeletal hyperostosis]. / Localizzazioni periferiche in corso di iperostosi scheletrica idiopatica diffusa.

The extra-spinal manifestations of diffuse idiopathic skeletal hyperostosis (DISH) are described in 73 consecutive cases, detected during radiographic screening of the thorax for other problems. The characteristic spinal changes (calcification and ossification of the ligaments in the antero-lateral aspects of the vertebral bodies) are present in all individuals. Extra-spinal changes include "whiskering" at the site of the attachment of muscle in the pelvis and long bones, ligament and tendon ossification, periarticular osteophytes, and spurring of the calcaneous and the olecranon. The radiographic patterns in the peripheral skeleton are frequently distinctive and allow the radiologist to suggest the diagnosis, even in the absence of axial radiographs. The diagnosis of DISH is based on preselected radiographic criteria, but the etiology remains elusive.

[Radiographic aspects of the hand in diffuse idiopathic skeletal hyperostosis]. / Aspetti radiografici della mano in corso di iperostosi scheletrica idiopatica diffusa.

Radiographs of the hand of 53 patients with diffuse idiopathic skeletal hyperostosis (DISH) were compared with 20 acromegalic subjects and 100 matched controls. Bone qualitative changes, characteristic of DISH, include: (1) arrow-heading of the distal phalangeal tufts; (2) enthesopathy of the proximal phalanges; (3) enlarged sesamoid bones; (4) hook-like exostoses at the metacarpophalangeal heads; (5) cortical thickness of diaphyseal tubular bones. Therefore, the hand in this disease appears as a "robust" form, particularly in males, resembling acromegalic pattern, but in this disease, the hand is much more coarse (so called squared hand), especially because of the soft tissue involvement and articular cartilaginous hypertrophy. Only enthesopathy seems to be the most characteristic and peculiar finding of the disease. Quantitative bone change measurements have demonstrated in DISH that metacarpal and Exton Smith indices differ statistically toward the controls. The hand is wider, but in males bone mass may result the same and in female is shortly reduced. Soft tissue alterations, compared with the controls, are not significant. On the contrary, in acromegaly there is a significant statistical difference in all the quantitative measurements of both the skeletal and soft tissue lesions, compared with the controls and patients affected by DISH.

[The ribs in beta-thalassemia. Course of the changes in relation to transfusion therapy]. / Le coste nelle beta-talassemie. Evoluzione delle alterazioni in rapporto alla terapia trasfusionale.

At the present time, the only treatment available to correct the anemia in Cooley's disease is the use of blood transfusions. The patients maintained at a higher baseline level of Hb (Hypertransfusion Regimen = HTR, with Hb levels of 8 divided by 10 g/100 cm3) are in general, in better health and have smaller organs: particularly, the changes in the skull and in other bones become less pronounced and may recede. The authors have reviewed in 77 patients with beta-thalassemia syndromes a spectrum of rib changes, including widening, osteoporosis with or without localized lucencies, "rib-within-a-rib" appearance, subcortical lucency and extramedullary hematopoietic masses. These radiological changes are explained on the basis of the relationship of the proliferating marrow to the medulla, cortex and periosteum. The type of abnormalities depends on the type of transfusion regimen. HTR begun early in life will prevent the development of any abnormal rib changes; on the other hand, in the majority of cases, abnormal findings did not regress with LTR (= Low Transfusion Regimen, with Hb level of 4 divided by 6 g/100 cm3).