On the forensic value of tattoos for human identification ­ a literature review / Da importância forense das tatuagens para identificação humana ­ uma revisão da literatura

Disaster victim identification is structured according to international recommendations on the attempt to optimize forensic logistics. The International Criminal Police Organization (INTERPOL) establishes primary and secondary methods for human identification. This study aimed to revisit the existing literature to address the forensic importance of tattoos. The scientific literature has shown advances in the forensic analyses of tattoos specially when it comes to the application of especial imaging techniques, namely photography with infrared light to visualize latent tattoo inks and cover-up tattoos, as well as the use of biochemical processing to distinguish components of the tattoo inks. Other relevant aspect is the fields dedicated to tattoo descriptions in software used worldwide for disaster victim identification, namely PlassData. Coding systems have been proposed as well to facilitate communication in the human identification process. The future of forensic analyses of tattoos is promising considering the increase of research in recent years. Forensic practice might benefit from it with more scientific evidence to support the utilization of tattoo analyses in casework

A identificação de vítimas de desastres em massa é estruturada de acordo com recomendações internacionais na tentativa de otimizar a logística forense. A INTERPOL (International Criminal Police Organization) estabelece métodos primários e secundários para identificação humana. Este estudo teve como objetivo revisitar a literatura existente para abordar a importância forense das tatuagens. A literatura científica tem mostrado avanços nas análises forenses de tatuagens, especialmente no que diz respeito à aplicação de técnicas especiais de imaginologia, como a fotografia com luz infravermelha para visualizar tintas latentes de tatuagens e tatuagens de cobertura, bem como a utilização de processamento bioquímico para distinguir componentes das tintas de tatuagem. Outro aspecto relevante são os campos dedicados à descrição de tatuagens em softwares utilizados mundialmente para identificação de vítimas de desastres em massa, como o PlassData. Sistemas de codificação também foram propostos para facilitar a comunicação no processo de identificação humana. O futuro das análises forenses de tatuagens é promissor considerando o aumento das pesquisas nos últimos anos. A prática forense pode beneficiar-se com mais evidências científicas para apoiar a utilização de análises de tatuagens na condução de casos periciais

Forensic analysis of suicide deaths: Comparing forensic information with public information and investigating factors contributing to psychiatric consultations.

Aim: This study aimed to examine the usefulness of forensic information on suicide deaths in Japan for epidemiological studies on suicide and determine the factors that lead people with suicidal ideation to seek psychiatric care prior to attempting suicide. Methods: We focused on forensic information of 514 suicide deaths that occurred in Osaka City in 2019. First, to examine whether the data used in this study can be generalized to these cases, we compared the information on suicide deaths officially published by Osaka City with that used in this study, utilizing Pearson's χ 2 test. Next, the forensic data were analyzed using multivariate logistic regression analysis to confirm the relationship between demographic factors and the likelihood of having a history of psychiatric consultation before suicide. Results: Both the official information and the data used in this study showed a higher number of males than females who died by suicide, with no significant differences in values between the data sets. Multivariate logistic regression analysis showed significant correlations. More females were associated with seeking a psychiatric consultation. However, those with regular jobs or students were more likely to avoid a psychiatric consultation. Conclusion: The findings of this study provide insights into the phenomenon of suicide deaths by using a forensic perspective. The results of this study suggest that psychiatric consultation may be effective in reducing deaths by suicide. Forensic data should be incorporated into the formulation of suicide-prevention policies in Japan to conduct a more multifaceted analysis and improve suicide-prevention measures.

Korean radiographers' awareness, experiences, and education needs in forensic medicine and forensic radiology.

This study assesses the need for education in forensic medicine and forensic radiology among radiographers by investigating the perceptions and experiences of Korean radiographers working in medical institutions. A structured questionnaire was administered to participants, collected, and analyzed. The results showed that despite receiving frequent forensic cases, Korean radiographers face difficulties in taking appropriate measures about forensic radiology due to a lack of awareness and knowledge of its forensic aspects. The participants indicated that university education in forensic medicine and forensic radiology is necessary. Therefore, it is imperative to develop and implement policies for forensic education programs to enhance radiographers' forensic knowledge and capabilities. Universities should conduct courses on forensic radiology and provide continuing education for radiographers working in this field.

Potential role of the sella turcica X-ray imaging aspects for sex estimation in the field of forensic anthropology: a systematic review and meta-analysis.

Several studies have evaluated the parameters of normality of the sella turcica (ST), which is important to face different craniofacial syndromes that may affect this structure. Therefore, this research summarized the scientific evidence on the role of ST in the sex estimation of non-syndromic individuals. The research protocol was registered (Prospective International Registry of Systematic Reviews # CRD42021256469), followed by an electronic search in six databases (PubMed, LILACS, Web of Science, Scopus, EMBASE, and LIVIVO) and gray literature (Google Scholar and OpenGrey). Meta-analysis of linear (width, length, height, and diameter) and volumetric measurements, in addition to an assessment of risk of bias (RoB) and certainty of evidence, were performed. After the screening of 986 articles, 13 were evaluated by meta-analysis (1 307 males and 1 231 females). In subgroup analysis, females had lower values for width (lateral radiograph; -0.67 mm; P = 0.040), length (computed tomography; -0.23 mm; P = 0.020), and diameter (computed tomography; -0.27 mm; P < 0.001) compared to males. There was no statistically significant difference regarding height (P = 0.95), area (P = 0.72), and volume (P = 0.21). Most studies exhibited moderate RoB, and the certainty of evidence of the outcomes was very low. In this review, significant differences were observed between the sexes for the length and diameter of the ST; however, the heterogeneity of the studies must be considered. Key points: Studies from different geographic regions evaluated the morphology of ST according to sex and showed this anatomical structure as an important indicator of dimorphism.Meta-analysis showed shorter ST length and diameter in women.Subgroup analysis found lower ST width in women based on lateral skull radiographs.Subgroup analysis found smaller lengths and diameters in women based on CT scans.

[Morphology of sternum for formation of the biological profile of unidentified individual]. / Morfologiya grudiny dlya formirovaniya biologicheskogo profilya neopoznannogo individa.

Identification of a person by general group characteristics does not lose its relevance over a long period. An analysis of publications (2000-2023) devoted to the possibilities of using the sternum to determine gender and age showed a fairly large amount of work on this topic, with very promising results. The trend in the development of this area is the use of modern methods of medical imaging. This becomes the starting point for conducting such studies on the territory of the Russian Federation and developing a methodology that includes the Russian population, taking into account their population characteristics.

[Legal and forensic medical problems of postmortem donation]. / Pravovye i sudebno-meditsinskie problemy posmertnogo donorstva.

The article is devoted to legal and forensic medical problems of postmortem donation. The substantive provisions of postmortem donation, as well as normative legal documents regulating the processes of organs harvesting from deceased persons for subsequent transplantation and governing the work of transplantologists and forensic medical experts have been considered. The practical examples illustrating the essence and nature of the problem of postmortem forensic medical expertise of persons with absent organs has been given and the importance of the participation of a forensic medical expert involved in the decision-making process on possibility (or impossibility) of the corpse's organs and tissues explantation without prejudice to the further expert examination has been emphasized. The authors pay particular attention to the inadequacy of the legal framework, including the lack of a clear understanding of the legal status of the person holding the position of forensic medical expert, who provides an expert opinion on the organs' explantation.

Are gel blasters a safe toy? A study into their kinetic energy per unit area.

Gel blasters are currently imported and marketed as children's toys in Australia. Gel blasters closely imitate the appearance of many genuine firearms of all types and are designed to propel small hydrated gel balls of approximately 7-8 mm in diameter, by means of compressed air or gas. They are considered illegal in all states of Australia except Queensland but these items aren't specifically written into most state firearms legislation. However, to be considered as children's toys, they must not exceed the recommended kinetic energy (KE) of 2500 J/m2 as outlined in the Australian/New Zealand Standard Safety of Toys - Part 1: Safety aspects related to mechanical and physical properties (Safety of Toys ASNZS ISO 8124.1:2019) [1]. The aim of this study was to determine if a range of gel blasters would conform to the Australian & New Zealand Standard and have projectiles with kinetic energy of less than 2500 J/m2. Utilising the testing procedure outlined in ASNZS ISO 8124.1:2019 (Australian/New Zealand Standard Safety of Toys - Part 1: Safety Aspects related to Mechanical and Physical Properties (Safety of Toys ASNZS ISO 8124.1:2019) [1]), a range of gel blasters were tested. In addition, a number of NERF™ toys and airsoft firearms were tested to provide reference between an accepted child's toy and items considered to be a firearm, such as airsoft firearms. A NERF™ toy (commonly referred to as a blaster) fires a foam projectile at very low velocities through direct spring/striker impact to the rear of the dart, battery-powered motorised flywheel, or by compressed air generated by a small piston inside a cylinder. Airsoft firearms are designed to fire hard plastic balls (typically 6 mm in diameter) and can achieve velocities upwards of 90 m/s with the potential to cause injuries to soft tissue. Results showed the KE per unit area of pellets fired from airsoft firearms significantly exceeded the recommended 2500 J/m2 ranging from approximately 10,620 J/m2 to 69,650 J/m2. Twenty of the twenty-four gel blasters tested (83 %) exceeded 2500 J/m2, with values ranging between 2112 J/m2 and 42,645 J/m2. NERF™ toys were found to be notably under 2500 J/m2, ranging from approximately 1230 J/m2 to 2129 J/m2. The results suggest that the majority of gel blasters (items of seizures) tested, currently being imported and marketed as children's toys in Australia, easily exceed 2500 J/m2 as outlined in the ASNZS ISO 8124.1:2019 and are not safe to be marketed and sold as children's toys. Reinforcing the position of most jurisdictions, the Australian Federal Police (AFP) in Canberra made the following statement in 2019: 'ACT (Australian Capital Territory) Policing is reminding the public that replica firearms known as gel blasters are illegal in the ACT'. Taking the results determined throughout this research and the statement by AFP into consideration, gel blasters should not be exempt from control under Firearms Legislation because they are claimed to be toy.

Examining the use of alternative light sources in medico-legal assessments of blunt-force trauma: a systematic review.

The ability to analyze blunt-force trauma is crucial for deciphering valuable clues concerning mechanisms of injury and as evidence for medico-legal investigations. The use of alternate light sources (ALS) has been studied over the past decade, and is proposed to outperform conventional white light (CWL) during bruise assessments. In response to the growing interest of the technology worldwide, a systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to address the ability of ALS to detect and visualize bruising. From an initial 4055 records identified, ten studies met the eligibly criteria and were selected for this review. Evaluation also included a novel framework, referred to as SPICOT, to further systematically assess both scientific evidence and risk of bias in forensic literature. Analysis reveals that narrowband wavelengths within in the infrared or ultraviolet spectral ranges do not significantly outperform CWL in visualizing or detecting bruising. However, wavelengths within the visible spectrum, particularly 415 nm combined with longpass or bandpass yellow filters, are more effective. However, the majority of selected studies only address the sensitivity of ALS, and therefore, results may only be considered valid when the location of a bruise is known. Further investigation is required to understand the specificity of ALS, in particular how the use of topical cosmetic products, previous wounds/scar-tissue, tattoos, moles and freckles may affect detection. The ethical concern regarding the interpretation of enhanced visualized trauma should also be considered in prospect discussions prior to implementing ALS into routine practice. Nevertheless, this review finds that narrowband ALS within the visible spectrum demonstrates potential for improved injury documentation, outperforming CWL in the detection and visualization of bruising.

Bilateral mandible fractures in the paediatric patient in a case of peer-to-peer violence: a case report and literature review.

Mandible fractures are relatively uncommon despite the mandible being the most commonly fractured facial bone in the paediatric population. The aetiology of mandible fractures can be categorized as intentional (e.g. as a result of assault, peer-to-peer violence, family violence) or non-intentional (e.g. as a result of falls, motor vehicle crashes, sporting incidents). Peer-to-peer violence affects up to a third of male school aged children in Australia. This case report details the case of a paediatric patient with bilateral mandibular fractures who presented to a general dental practice after an episode of peer-to-peer violence. Clinical examination, radiographic findings and treatment are reported. This paper explores the experience and impact of peer-to-peer physical violence on the individual and his family. A review of the relevant literature is presented. © 2024 Australian Dental Association.

Gender differences in homicides. A comparative analysis of 106 fatalities in forensic autopsy data.

While most homicides worldwide are committed against men, women and girls are disproportionately affected by domestic violence and its fatal consequences. The Istanbul Convention mandates the prevention of gender-based violence, particularly against women. This study analyzes the characteristics of male and female victims of homicides to provide a comprehensive understanding of the different situations and ways in which men and women are killed. Files of 106 forensic autopsies of homicide victims aged 14 years and older (51.9% males, 48.1% females) from 2012 to 2019 were reviewed. Demographic data, previous history with a focus on the perpetrator-victim relationship, substance influence, type of violence and law enforcement data were recorded. A gender-separated statistical analysis was carried out. Male victims were killed most often outside their own home (63.6%) by acquaintances or friends (54.5%). They were frequently under the influence of substances (56.4%). The perpetrators suffered from addictive diseases in 49.1%, and 52.7% had prior convictions. In both groups, stab/cut injuries were the most common causes of death, but stab/cut and gunshot injuries occurred more frequently in male victims. Female victims were killed most often in their own homes (76.5%) by intimate partners (62.7%). Compared to male victims, violent asphyxiation and blunt force trauma were more common causes of death. Furthermore, there was a higher frequency of multiple injuries (33.3%). The prevalence of a guilty verdict of the perpetrators was nearly equal in both groups. Gender-specific aspects should be considered when investigating homicides and establishing prevention and intervention strategies for interpersonal violence. Protective concepts are easier to establish in the public sphere than in private homes, which is why homicides against women require special attention in society, law enforcement, and legislation. Significant gender differences were found in the circumstances and the perpetrator-victim relationships of homicides. Gender-specific aspects should be taken into account when investigating homicides and developing prevention and intervention strategies. Homicides against women require special attention in society, law enforcement and legislation.

Assessing the Need for Clinical Forensic Medicine Training in the Medical Undergraduate Curriculum.

OBJECTIVE: This study was conducted to assess the need for clinical forensic medicine (CFM) training (hands-on and bedside) in medical undergraduate students and to determine the utility of skill-based teaching methodology in CFM. METHOD: A cross-sectional study was carried out in the Government Medical College, where we used the mixed model approach (qualitative and quantitative component) to access the approach of three groups containing 50 participants each from (1) resident doctors/interns, (2) faculty, (3) casualty medical officers, toward skill-based teaching of CFM. A structured pretested questionnaire was administered to all study participants. The questionnaire was based on their perception regarding the legal problems faced during clinical practice and their attitude toward the need for CFM. It was followed by a focus group discussion (FGD) arranged separately for each group of 10 participants. Each FGD session lasts for 40 minutes with a moderator and recorder. RESULT: Present MBBS (Bachelor of Medicine & Bachelor of Surgery) curriculum teaches CFM very early is strongly agreed by 20 (40%) of the faculty, four (8%) of interns, and three (6%) of medical officers. 40 (80%) of interns, 43 (86%) of medical officers, and 40 (80%) of faculty necessitate hands-on training in CFM in the MBBS curriculum. Forensic medicine specialists should handle clinical medico-legal cases (MLCs), as agreed by 50 (100%) faculty, 46 (98%) interns, and 47 (94%) medical officers. CONCLUSION: Hands-on training in CFM is needed for a better practical approach for doctors toward handling MLCs. Hands-on training should be introduced in the second-year MBBS curriculum, and their clinical aspects should be taught simultaneously with clinical subjects till the internship.

Evaluation of foreign national cases applied to Tokat Gaziosmanpasa University Hospital Forensic Medicine Department, 2014-2022.

INTRODUCTION/AIM: Turkey has experienced a heavy migration burden in recent years due to its location and benevolent policies. This study aimed to retrospectively examine and discuss the reports prepared for foreign nationals who requested assistance at the Forensic Medicine Department of Tokat Gaziosmanpasa University Hospital in Tokat, which is located in the Middle Black Sea Region of Turkey, between 2014 and 2022. MATERIALS AND METHODS: This study retrospectively evaluated reports prepared between 2014 and 2022 in the outpatient clinics of Forensic Medicine at Tokat Gaziosmanpasa University Hospital. RESULTS: Based on the files reviewed, 219 cases were included in the study, of which 70.8% (n = 155) were male and 29.2% (n = 64) were female. Among the 75 cases referred by judicial authorities, 34.6% (n = 26) involved assault, 28% (n = 21) involved determination of the ability to understand the legal significance and consequences of the act, 16% (n = 12) involved traffic accidents, 8% (n = 6) involved poisoning, 9.3% (n = 7) involved abuse, and 4% (n = 3) involved age determinations. DISCUSSION: Problems with immigrants, which have always been a reality due to Turkey's location on migration routes, have increased significantly in recent years. For this reason, we believe that studies with multicenter and larger series should be conducted to determine the current situation that foreigners create for themselves and Turkey to facilitate necessary arrangements, determine proposed solutions, increase the quality of services offered, and develop plans for the future.

Artificial intelligence and future perspectives in Forensic Medicine: a systematic review.

Objective: Artificial intelligence (AI) is the ability of a computer machine to display human capabilities such as reasoning, learning, planning, and creativity. Such processing technology receives the data (already prepared or collected), processes them, using models and algorithms, and answers questions about forecasting and decision-making. AI systems are also able to adapt their behavior by analyzing the effects of previous actions and working then autonomously. Artificial intelligence is already present in our lives, even if it often goes unnoticed (shopping networked, home automation, vehicles). Even in the medical field, artificial intelligence can be used to analyze large amounts of medical data and discover matches and patterns to improve diagnosis and prevention. In forensic medicine, the applications of AI are numerous and are becoming more and more valuable. Method: A systematic review was conducted, selecting the articles in one of the most widely used electronic databases (PubMed). The research was conducted using the keywords "AI forensic" and "machine learning forensic". The research process included about 2000 Articles published from 1990 to the present. Results: We have focused on the most common fields of use and have been then 6 macro-topics were identified and analyzed. Specifically, articles were analyzed concerning the application of AI in forensic pathology (main area), toxicology, radiology, Personal identification, forensic anthropology, and forensic psychiatry. Conclusion: The aim of the study is to evaluate the current applications of AI in forensic medicine for each field of use, trying to grasp future and more usable applications and underline their limitations.

Bite marks: To opine or not to opine?

Much has been written about bite mark comparisons and bite mark analysis. It has largely been written for, and remained within the domain of, the forensic odontologist despite the limited number of such specialists and the even smaller subset who have expertise in this area. For those health professionals who work in the field of clinical forensic medicine, most will not have access to a forensic odontologist. Courts can be reticent about the costs involved in obtaining another expert opinion. For health professionals, who will likely encounter more bite marks in their career than forensic odontologists, the difficulty is knowing what can legitimately be opined about such injuries.

Forensic medicine in (West-Bank) Palestine visions and obstacles.

Forensic medicine in Palestine is a new branch of medicine compared with other medical specialties and is still at a nascent stage. Only 6 medical doctors specializing in forensic medicine are currently practicing in Palestine, including only one female specialist (the author). Palestine has adopted a system that combines clinical forensic medicine and forensic pathology. Forensic doctors can deal with both the living and the dead and deal with cases of physical and sexual assault, gender-based violence, and domestic violence. In different courts, such as civil, military, and shariah, Palestinian judicial decisions depend primarily on forensic medical reports and the testimonies that forensic doctors provide for the court to explain their reports. Forensic medicine has a significant role and crucial impact on achieving justice for victims of all types of abuse, either dead or alive. However, the role of forensic medicine in achieving justice for victims, and hence fighting and eradicating violence, is underestimated and not fully understood by the general population. This paper introduces to the reader the status of forensic medicine in Palestine, focusing on the challenges and obstacles faced by both the victims and forensic doctors. Meeting these challenges and overcoming obstacles is essential for fighting all types of violence, including violence against women in Palestinian society. The current provision of forensic medical services in Palestine is less than satisfactory, being considerably hampered by the lack of legislation and regulations. Palestine is in great need of continued international support for forensic medicine and forensic services. Two projects supported by the United Nations put the country on the road, but there are still many miles to go toward the aim.

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections among sexual assault victims referred to three French clinical forensic units.

BACKGROUND: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are the most common bacterial sexually transmitted infections (STIs) worldwide. These STIs are frequently asymptomatic, which often delays diagnosis and treatment with the risk of serious long-term complications. Current French recommendations call for targeted screening of populations considered to be at risk, including victims of sexual assault. However, no recent data on the prevalence of these STIs in this population are available in France. The aim of this study was therefore to determine the prevalence of CT/NG infections among victims of sexual assault attending three Clinical Forensic Units (CFUs). METHODS: We retrospectively reviewed the forensic records of patients aged over 12 years reporting a sexual assault and referred between January 1, 2020 and December 31, 2021 to the CFU of Montpellier, Angers or Saint-Denis de La Réunion. Patients who had been screened for CT and NG infections were included. RESULTS: 341 alleged victims of sexual assault (324 women, 17 men, median age = 23 years) were screened for CT/NG STIs during the inclusion period (Montpellier, n=196; Angers, n=63; Saint-Denis, n=82). The median time between the sexual assault and the examination was 1 day. CT and NG were detected in 28 patients (8.2 %) and 8 patients (2.3 %) respectively, with no men tested positive. Positive results concerned genital samples, except for two CT-positive anorectal samples and one NG-positive oropharyngeal sample. Two patients (0.6 %) were co-infected with CT/NG. The overall prevalence of CT/NG STIs was 10.0 % and was higher in the 18-24 age group, reaching 13.2 % for CT. CONCLUSIONS: This multicenter study confirms the high prevalence of CT/NG STIs in victims of sexual assault, and the vulnerability of the youngest age groups to these infections. Systematic screening for CT/NG STIs at the time of the forensic examination is the key to early diagnosis and effective treatment to prevent transmission and subsequent complications in these patients.

Lightning deaths in three outdoor dogs: A case study.

This case report presents findings in three German Shepherd placed outdoor, dead after a night of thunderstorm.

Investigation of triticeal cartilage anatomy in forensic autopsy cases.

PURPOSE: This study aims to determine the presence and morphology of triticeal cartilage (TrC) through autopsy cases and to examine its relationship with age, gender, and height, thus contributing to clinical practices and forensic perspective. MATERIALS AND METHODS:  Our study was conducted on a total of 84 autopsy cases between the ages of 20-90 years who came to Tokat Forensic Medicine Institute. The laryngeal region was palpated to determine whether TrC was present. The dimensions of the TrC and the length of the upper horn of thyroid cartilage (UHThC) were measured with precise digital calipers, and its weight was measured with an accurate digital scale. RESULTS: The presence of TrC was identified in 56% of the autopsy cases examined. The prevalence of TrC was higher in males (61.9%) than in females (23.1%). It was determined to be bilateral in 45% of the cases and unilateral in 11%. TrCs had a cylindrical shape in 68.2%, an oval shape in 25.8%, and a pyramidal shape in 5.8%. The average weight of TrC was 67.93 ± 33.91 mg on the right side and 72.67 ± 32.23 mg on the left. As the individual's height increased, the weight of TrC increased (p < 0.001). Additionally, there was a strong positive correlation between the lengths of TrC and UHThC and the individual's height (p < 0.001). CONCLUSION: TrC may be confused with UHThC fractures. Therefore, we believe that knowledge of the presence and morphology of TrC will contribute to clinical approaches and forensic cases, especially in relation to the neck region.

[Sudden death in adults : Data from 305 consecutive autopsy cases in Algeria]. / Mort subite de l'adulte : données de 305 cas d'autopsies consécutives en Algérie.

BACKGROUND-AIMS: Sudden death in a young adult who showed no prodrome or complaint during his lifetime is a tragedy. The death often remains unexplained by doctors and is often the subject of a judicial investigation following which an autopsy is ordered. Our study joins several studies around the world, where the results have linked sudden death in adults to a cardiac origin. METHODS: Through a series of 305 autopsies carried out in the forensic medicine department of the Frantz Fanon hospital in the city of Bejaia in Algeria over a period of two years, 57 cases corresponded to unexplained sudden deaths, i.e. an incidence of 3 cases per 100,000 inhabitants per year. RESULTS: Sudden death was of cardiac origin in 50.8% of cases (N=28). Two epidemiologic profiles emerge in our study: the first is that of a man aged between 50 and 60 years of age, with several deleterious lifestyle habits (in particular smoking) with a cardiovascular history, previously followed by a cardiologist, who died suddenly out-of-hospital, from ischemic heart disease. The second is that of a young adult under 40 years of age, of average build, with no particular medical history, having not previously consulted a cardiologist, who died suddenly of hypertrophic cardiomyopathy. CONCLUSIONS: In many instances, we observed major anatomical lesion, which had not motivated any prior medical consultation either with a general practitioner or with a cardiologist.