Vehicle-assisted ligature decapitation: A case report and a review of the literature.

Decapitation resulting by vehicle-assisted ligature strangulation is a suicide method rarely described in the literature. The lesions observed at autopsy have a common morphology with to those found in post-hanging decapitation. They depend on the force applied by the acceleration of the vehicle, the slope of the road and the characteristics of the link used. They can also mimic a stabbing homicide. We report the case of a 43-year-old man who used a long steel rope, attached between his neck and a streetlight, and started his vehicle, causing a complete decapitation. The results of the autopsy provided information on the morphology of the cervical lesions, but also on the causes of death. In spite of decapitation, the histological examination of the organs confirmed the presence of asphyxiation process by a mechanical origin that occurred before decapitation.

An experimental investigation into the colonization of concealed cadavers by necrophagous blowflies.

We used seven baited boxes with different combinations of access holes and odor diffusion surfaces to study the arrival of necrophagous flies. During laboratory experiments, 30 gravid Lucilia sericata females were kept in a chamber with one of the boxes. The box with the largest odor diffusion surface (99 cm(2)) combined with the lowest accessibility (one 1 cm(2) entrance hole) was entered least (5 ± 3.7 flies per run). In contrast, the most frequently entered box (one 9 cm(2) entrance hole with no additional odor diffusion surface) caught a mean of 24.6 ± 3.4 flies per run. These results indicate that 1) L. sericata entered nearly inaccessible places and 2) both odor diffusion and accessibility impacted the number of flies caught. During field experiments, the seven boxes were placed together outdoors. The box with the most entrances (ten 9-cm(2) holes) caught the most flies (55.6-99.4% of the total). Only a few flies entered the other boxes. Access to the less accessible boxes (poor odor diffusion and small entrances) was also delayed. The major conclusions of the field experiments are that 1) boxes with low accessibility took longer to be accessed; 2) larger odor diffusion surfaces were more attractive to flies; and 3) flies accessed boxes more readily through larger holes than through an equivalent surface area made up of smaller holes. With these conclusions in mind, attempts to quantify the preappearance interval or to interpret the number of flies observed in indoor forensic entomology cases should be approached with caution.

[Clinical forensic valuation of school violence]. / Violences en milieu scolaire : 20 ans d'observations médico-légales en région Nord Pas-de-Calais.

AIM: In recent years, the National Education in France has developed tools to identify acts of violence in schools. This has allowed adjusting government policies for the care of victims. School violence can also be measured from the perspective of clinical forensic medicine, a special discipline for observing a society's violence. PATIENTS AND METHODS: This study summarized and compared three similar single-center, prospective, and descriptive studies conducted in 1992, 2002, and 2012 in the Department of Forensic Medicine, University Hospital of Lille, via an evaluation form completed during consultations requested by victims in cases of school violence. The purpose was to identify the characteristics of victims, those of their perpetrators, the circumstances and reasons for school assaults, as well as their medical and administrative consequences. RESULTS: Each study had identified about 160 such attacks annually. The victims were younger, especially boys (the average age decreased from 14.8 to 13.6). The gender distribution showed an increase in female victims (the sex ratio decreased from 2.9/1 to 2.3/1). The location of attacks changed, with a marked increase of attacks on the way to school (from 10% to 27%). Recurrence of attacks also rose: victims with a previous history of attacks increased from 18.5% to 32.2% with a high proportion of violence resulting in a strong psychological impact, increasingly requiring psychological support (from 9 to 16%). The duration of school cases rose sharply, from 20 to 53% in 2012. The grade level of the perpetrator showed a significant increase in cases of violence at junior high school (from 40 to 67%), with a relative stability of violence in elementary and high schools. The parameters measured to characterize the aggressors remained stable: they were known to their victims in approximately 80% of cases and these attacks were for the most part related to previous disagreements. DISCUSSION: Since the 1990s, government policies for the prevention, measurement, and punishment of violence in schools have not ceased to grow, but this violence has not attenuated. It is identified annually by the government and the data from the present study show comparable trends to national data. CONCLUSION: The progression of school violence over the past 20 years shows trends brought out through a forensic medicine framework. This discipline is indeed an observatory of violence and it has an important role to play in the detection of fragile psychological situations. This violence is increasing and compromises pupils' privacy. In the future, different forms of violence with a strong psychological impact should be emphasized, including the influence on academic achievement and child development.

Vaccinal status of healthcare students in Lille.

INTRODUCTION: Vaccine recommendations are the same for healthcare students than for other health care workers. The aim of this study was to describe mandatory and recommended vaccinal coverage and evaluate the benefit of systematic monitoring by a medical team in the Lille Medical School. POPULATION AND METHODS: A survey was performed from June 2011 to August 2011 on all students in the first year of Health Care Studies. The personal immunization record was considered as evidence of vaccination. The reference vaccinal schedule was the one recommended by the French High Council for Public Health in 2011. RESULTS: We analyzed the personal immunization records of 553 students. The vaccination coverage was 96.7% (535) for DTP, 74.7% (413) for hepatitis B, and 92.2% (510) of the students had a tuberculin test result. Concerning the recommended vaccinations, 78% (431) were covered for measles, and 78.9% (436) had a history of either chickenpox or its immunization. About 72.7% (402) of students were vaccinated for Haemophilus influenzae and Bordetella pertussis. Respectively, 24.2% (134) and 81% (448) had previously been vaccinated for Neisseria meningitis and tuberculosis. The monitoring of students allowed improving hepatitis B vaccination coverage by 22.28% (123). The student's vaccinal coverage was still inadequate for hepatitis B and measles. The systematic monitoring allowed significantly improving vaccinal coverage for hepatitis B.

Philemon and Baucis syndrome: three additional cases of double deaths of married couples.

The simultaneous death of two people is immediately considered as a suspect. However, this feeling is reinforced when the individuals are spouses. In these situations, criminal and forensic investigations are required to establish whether or not the deaths were homicidal in nature. Despite many descriptions of simultaneous deaths being present in the literature, the simultaneous death of two spouses from natural causes is poorly described with Ciesiolka et al., Department of Legal Medicine in Gießen (Germany), being the only ones to have reviewed two case reports involving these circumstances. The scarcity of this type of information in the literature renders the task of claiming natural simultaneous death as the final outcome of an investigation difficult. We would like to report three additional cases with the aim of better describing this type of event. In all three cases, the bodies were those of a married couple in their 80s. The bodies were discovered in the same room. In each case, the death of one of the spouses could be attributed to natural cause; however the death of the other spouse could not be determined with certainty, and shared several similarities in all cases: simultaneity in death; a pre existing cardiovascular disease/disorder; a certain degree of fragility and dependence on the other spouse whose death could lead to acute psychological stress. Intense psychological disorder could trigger acute coronary or rhythmic disorders. The mechanisms by which brain activity influences cardiac electrophysiology are now known to take place via the autonomic nervous system mediation. This brain activity could provide an explanation for the death of the individuals with pre-existing heart conditions, who underwent significant stress upon occurrence of the death of their partners. The death of these individuals, which took place at the same place and time as their deceased spouses, can be attributed to natural causes: the Philemon and Baucis syndrome.

Typical external skull beveling wound unlinked with a gunshot.

Lesions of the cranial vault resulting from firearms are traditionally described in forensic medical literature with many reports illustrating atypical bone lesions carried out to the skull by gunshot wounds. The authors present this report which illustrates an external beveled skull wound, associated with internal beveling damage, caused by a stabbing injury. A partially buried human skeleton was found in a forest. The examining of the skull revealed a hole resembling the exit wound caused by a bullet and two other smaller stab wounds. No typical entering bullet wound and no other bone lesions were found. During the course of the investigation, one of the perpetrators admitted to hitting the victim, using a sickle, and to hiding the body. For this purpose, he dragged the corpse with the sickle still implanted in the skull, using it as a hook. Upon retrieving the sickle, a piece of cranial vault was removed, thus creating an external beveled wound. In order to identify the mechanism which brought about this kind of lesion, experimental work was carried out on a human skull. In this particular case, the tip of the sickle penetrated into the bone, creating a lesion that would typically be produced with a stabbing instrument when applied with vertical force. When the body was dragged, using the sickle as a hook, this was a hand-produced vertical force, which was applied in the opposite direction. It caused the tearing of a piece of bone and the creation of an outer bevel. This atypical lesion should be made known to medical examiners and pathologists in order to help investigating and understanding of the circumstances of injuries.

[Organ procurement in forensic deaths]. / Prélèvements d'organes et décès médico-légaux.

OBJECTIVE: There is a chronic shortage of transplants. There are many obstacles on organ procurement and some are related to forensics aspects of deaths. In these situations in France, the judge decides whether or not to perform the organ recovery. These refusals are about 40 donors per year, representing a loss of more than 120 potential transplants. STUDY DESIGN: Retrospective study of 9 years (2003-2011) aimed to study the expectations of judges in comparing them with forensics issues. PATIENTS AND METHODS: Sixty-two cases of organ recovery with judicial proceedings have been treated in collaboration between the Agency of Biomedicine (Northeast) and the Medico-Legal Institute of Lille (northern France). RESULTS: When there is a judicial opposition to an organ procurement, it is mostly upon criminal circumstances (57%). The main reason is the need to perform an autopsy (38%), raising fears of a loss of evidence because of resuscitation and surgery for the judges. However, autopsies rule out these problems if strict protocols are followed. CONCLUSIONS: In case of forensic death, French law provides that a forensic examination to take place prior to surgical procedures. The law also provides for collaboration between caregivers and medical examiners. Nevertheless, judicial oppositions persist and appear to belong to a lack of communication between actors (judges/medical examiners/organ procurement organization). Better collaboration through protocols must be thought to satisfy the demands of justice and public health.

Mechanisms of hyoid bone fracture after modelling: evaluation of anthropological criteria defining two relevant models.

Several studies have attempted to describe the morphology of the hyoid bone, while other authors have focused on discovering the role of this bone in the occurrence of fractures. Hyoid fractures are known to be dependent on the force applied against the bone, or on the location at which the force is applied. We wished to assess the value of defining one or more models of the hyoid bone by analyzing variations in the size and angle of the various component parts of the bone relative to the sex and morphology of an individual (height and weight) in a sample of 72 bones obtained during forensic autopsy at our institution. Statistical analyses were developed using SAS software (Statistical Analysis System, version 9.2). We observed that the length of the hyoid bone and the angle between the greater horns differed significantly between men and women. Length was significantly greater in men (38.20 ± 4.67 mm) than in women (30.49 ± 7.90 mm) and the angle between the greater horns of the hyoid bone was larger in women (36.46 ± 13.77°) than in men (27.56 ± 13.02°). There was also a statistically significant correlation between the body mass index of an individual and the length of the hyoid bone. As weight increased, the hyoid bone was found to be longer. The weight of an individual was also significantly correlated with the angle of the hyoid bone, with lower weight resulting in larger angles of the bone. Furthermore, hierarchical classification enabled the hyoid bone to be differentiated into two groups or clusters according to anthropometric measurements. ROC curves were used to determine threshold values of length, width and angle to classify the hyoid bones in these two clusters: the first was composed of individuals with longer hyoid bones, and the second of individuals with greater hyoid bone widths and wider angles. Logistic regression showed male gender was more frequently associated with the first group. The morphology of the hyoid bone can be differentiated according to the gender and corpulence of an individual because these parameters are correlated. These findings are crucial in establishing a protocol for modelling the mechanism of fracture of the hyoid bone in strangulation. Two models of the hyoid bone appear to be needed to meet the practical requirements that are the purpose of these biomechanical studies.

Low bone accrual is associated with osteocyte apoptosis in alcohol-induced osteopenia.

INTRODUCTION: Alcohol is known to decrease bone mineral density (BMD) and to induce trabecular microarchitecture deterioration. However, little is known about the effects of chronic alcohol consumption on osteocytes in situ. The aim of this study was to assess the effects of a high alcohol dose on osteocytes in an alcohol-induced osteopenia model. MATERIALS AND METHODS: 24 male Wistar rats, 2-months old were separated in 2 groups: Control (C) or Alcohol (A35). The rats in the A35 group drank a beverage composed of 35% ethanol v/v mixed to water for 17 weeks. BMD was assessed by DXA, while the microarchitecture was analyzed using µCT. Bone remodeling was studied measuring serum concentration of osteocalcin, NTx and TRAP. Bone marrow adiposity, osteoblastic lineage differentiation, osteocyte morphology and apoptosis were assessed using bright field, epifluorescence, transmission electron and confocal microscopy. RESULTS: BMD, trabecular thickness, TRAP and NTx concentration were significantly decreased in A35, while cortical thickness was thinner. There were 10 fold more cells stained with cleaved caspase-3, and 35% more empty lacunae in A35, these data indicating a large increase in osteocyte apoptosis in the A35 group. The number of lipid droplets in the marrow was increased in A35 (7 fold). Both the osteocyte apoptosis and the fat bone marrow content strongly correlated with femur BMD (p=0.0017, r = -0.72 and p=0.002, r = -0.70) and whole body BMD. CONCLUSION: These data suggest that low BMD is associated with osteocyte apoptosis and bone marrow fat content in alcohol-induced osteopenia.

Medical liabilities of the French physician passenger during a commercial air flight.

Nearly two billion passengers travel each year on commercial air flights. More elderly people and/or people with a pre-existing condition are taking to the air and with the anticipated growth of air travel, in-flight illnesses and injuries are expected to increase as well. Even if in-flight medical events and deaths are still uncommon, physician passengers are occasionally called upon to render assistance. Although no case law exists as yet in France, physicians who often travel on commercial flights should be aware of the risks they run if they do not respond to the well-known call, 'Is there a doctor on board?', or if they assist a sick passenger. This paper describes in-flight resources available to a physician who is called upon to treat an ill or injured passenger. Two questions concerning the French physician passenger are discussed: What are the liabilities of the physician who does not respond to the call of a medical event aboard an aircraft? What are the liabilities of the physician providing assistance to a sick passenger? The different liabilities and also the legal status of the French physician passenger are examined.

Child barbarity and torture: a case report.

Penile strangulation with a strand of hair, acting as a tourniquet, and perforation of the eyes with a knife are uncommon accidental injuries in children. In such a situation, a mistreatment must be evoked. We present a case of barbarity and torture involving a young boy 3 years old. He was a victim of penis strangulation and perforation of the eyes, performed on previous surgical and infectious lesions. The mistreatment was performed by his mother's boyfriend. The perpetrator used the previous lesions to hide his misdeed. This amazing case of mistreatment points out the violence of the wounds and their being performed on previous lesions.

Neutron diffraction study of the size-induced tetragonal to monoclinic phase transition in zirconia nanocrystals.

Accurate neutron powder diffraction experiments at several temperatures allow one to monitor the reconstructive tetragonal to monoclinic phase transition as a function of the size of zirconia nanoparticles. The structure of the tetragonal phase observed in the nanocrystals is identical to that observed in micrometric zirconia above 1400 K. A uniaxial strain depending on grain size is observed. The phase transition occurs above a threshold crystal size. These results are analyzed within the Landau theory and can be understood as a mechanism of size-dependent phase transition where the primary order parameter is altered by the nanoparticle size.

[Subdural hematomas in children: role of cerebral and spinal MRI in the diagnosis of child abuse]. / Collections sous durales de l'enfant: place de l'IRM cerebrale et medullaire dans le diagnostic de maltraitance.

PURPOSE: To determine if the presence of multiple subdural hematomas (SH) of varying signal intensities at MRI was suggestive of repeated injuries allowing a diagnosis of non accidental head injury (NAHI). MATERIAL AND METHODS: We included 13 patients (9 boys/4 girls; mean age 15.3 weeks) with suspected NAHI and bilateral SH. Six patients had MRI during acute admission (first week) and seven patients between 10 and 30 days after head trauma (mean 12.6 days). A total of 8/13 patients had spinal MRI. We assessed the distribution and signal intensity of SH, brain, epidural and spinal cord abnormalities. Our findings were compared to medico-legal investigations in 7/13 patients to evaluate the correlation between the age of SH on MRI and the date of injuries. RESULT: Lesions detected included cerebral edema, ischemia, contusions and cranio-cervical axonal injury and 2/8 patient had spinal epidural hematomas. Multiple SH with varying signal intensities were seen. The commonest location was the frontoparietal areas (100%) and suboccipital region (77%). In 5/6 cases, MRI during the acute admission revealed multiple and small SH having the same signal intensity. When MRI was performed later multiple SH of varying signal intensity were found in 54% of cases. We found a good correlation between the age of the SH and the date of suspected injuries in all cases. Nevertheless, in 5 patients, other SH of various ages were present suggesting rebleeding. CONCLUSION: Our findings confirm the value of MRI in the detection of brain and spinal cord lesions and SH of varying signal intensities in non accidental head injury. MRI is not able to predict whether different signal intensities correspond to spontaneous repeated bleedings or repeated injuries. The presence of these lesions without clinical evidence of accidental trauma justifies a medico-legal evaluation to confirm the diagnosis of child abuse and to protect these patients.

Aggressive and neutral interventions in conflicts in captive groups of brown lemurs (Eulemur fulvus fulvus).

Third-party interventions in conflicts have revealed complexity in primate social relationships. This type of intervention has seldom been analyzed in prosimians, although many of these species exhibit complex (multimale/multifemale) social organizations. The present study on captive brown lemurs (Eulemur fulvus fulvus) shows that dominant individuals were more likely to intervene in conflicts. Both males and females intervened aggressively in conflicts. Female aggressive interventions occurred mainly on behalf of close kin, whereas males mainly intervened on behalf of juveniles. This study also provides the first record of neutral or peaceful interventions in lemurs. Although females intervened neutrally, almost all neutral interventions were by dominant males. Dominant males intervened in conflicts neutrally more often than aggressively, principally in conflicts between adults and juveniles or between juveniles. Neutral interventions by males always ended the conflicts and were often followed by affiliative contacts between participants (intervenors and opponents). In lemurs, female interventions can be explained by kin selection, while the nature of dominant males' interventions suggests a control role. Interventions by males on behalf of juveniles may increase the formers' fitness.

[Use of gamma-hydroxybutyric acid (GHB) at rave parties and in date rape in France: myth of reality?]. / Utilisation de l'acide gamma-hydroxybutyrique (GHB) dans les rave-parties et pour la soumission chimique en France: mythe ou réalité?

Since many years gamma-hydroxybutyric acid (GHB) is presented as very popular in rave-parties and for bodybuilders. It seems to be a controversy between media coverage and the results of toxicological analysis done in high-level laboratories. In order to clarify this problem, we compiled the data of 6 laboratories. They used the same analytical method by GC/MS. Depending the laboratory, the limit of detection was 1-2 micrograms/mL and the limit of quantification was 2.5-5 micrograms/mL. Two labs where looking for GHB in each forensic case (100 and 150 cases a year). Others labs performed GHB analysis only on specific request (each 10 cases a year). Mean time between ingestion of GHB and blood/urine sampling was 12-48 h. Mean time between sampling and analysis was much higher (a few hours to a few month. All samples were stored at +4 degrees C. Only 3 cases were considered as positive (blood GHB: 165, 132 and 114 micrograms/mL, urine GHB: 7450 and 436 micrograms/mL) They were admitted in an hospital EU. Interpreting results remains very difficult because GHB is endogenous, present in blood and urine, and its half-life is very short. One has to report only "positive" GHB results when amounts are higher than 5 micrograms/mL in blood and 10 micrograms/mL in urine. Obviously, forensic toxicologists have to play a very important part in diagnosis of GHB intoxications and estimating its frequency. Actually, because the lack of data in France, it is not possible to answer the question asked in the title of this paper.

Utilisation de l'acide gamma-hydroxybutyrique (ghb) dans les rave-parties et pour la soumission chimique en france : mythe ou réalité?

Since many years gamma-hydroxybutyric acid (GHB) is presented as very popular in rave-parties and for bodybuilders. It seems to be a controversy between media coverage and the results of toxicological analysis done in high-level laboratories. In order to clarify this problem, we compiled the data of 6 laboratories. They used the same analytical method by GC/MS. Depending the laboratory, the limit of detection was 1-2 µg/mL and the limit of quantification was 2.5-5 µg/ mL. Two labs where looking for GHB in each forensic case (100 and 150 cases a year). Others labs performed GHB analysis only on specific request (each 10 cases a year). Mean time between ingestion of GHB and blood/urine sampling was 12-48 h. Mean time between sampling and analysis was much higher (a few hours to a few month. All samples were stored at +4°C. Only 3 cases were considered as positive (blood GHB : 165, 132 and 114 µg/mL, urine GHB : 7450 and 436 µg/ mL) They were admitted in an hospital EU. Interpreting results remains very difficult because GHB is endogenous, present in blood and urine, and its half-life is very short. One has to report only « positive ¼ GHB results when amounts are higher than 5 µg/mL in blood and 10 µg/mL in urine. Obviously, forensic toxicologists have to play a very important part in diagnosis of GHB intoxications and estimating its frequency. Actually, because the lack of data in France, it is not possible to answer the question asked in the title of this paper.

[The obligation of means and the obligation of results]. / L'obligation de moyen et l'obligation de résultat.

Several important decisions were made in 2000 concerning the proof of malpractice and the fundamental principles of medical responsibility. In order to guarantee indemnities for victims of medical accidents, the French courts have facilitated the implication of medical responsibility for medical accidents. The notion of a "virtual fault" was developed allowing the courts to retain the responsibility of the surgeon for instance for injury to the sublingual nerve during extraction of a wisdom tooth or for injury to the popliteal artery (March 23, 2000). These decisions not only facilitate the demonstration of malpractice but also modify the definition of responsibility, all physicians being required to use all available means. Likewise, although jurisprudence asserts that a safe result is mandatory in certain areas, the essential obligation is the absence of "fault" and not the result despite the disquieting arguments put forward by the Paris appeals court in its January 15, 1999 decree. The patient's right to a result was sustained only in well defined areas.

[Medical civil responsibility in the year 2000]. / Responsabilité médicale: les apports de l'an 2000.

In France, during the last year, important jurisprudence was established by the French Supreme Court of Appeal concerning the physician's civil responsibility. On october 7, 1998, the Court decided that "the physician is not exempted for the obligation to provide information by the simple fact that these risks only materialize exceptionally". This means that from now, the physician must inform the patient of all risks that might influence the patient's decision, particularly information concerning life-threatening or severe consequences, but also, as in the past, concerning frequent even benign consequences. The limits of this jurisprudence and the completeness of the information, as established in 1998, are emergency, patient refusal and impossibility to inform the patient. In the decree of May 23, 2000, the Court gave its definition of impossibility to inform the patient, thus establishing the "therapeutic limits". But the judges recognized that the requirement for information delivery is independent of the necessary or unnecessary nature of the therapeutic act. However, in the decree of June 20, 2000, the Court established the conditions for awarding indemnities for defective information delivery. Defective information delivery is not sufficient in itself to constitute a civil offense. Real damage is also necessary. To be awarded with an indemnity, the patient must prove that the lack of information affected his/her decision to consent. If it appears that even if he/she had been well informed, the patient had consented to the care given, the physician would not be obliged to provide the patient with an indemnity. The judges want to find a compensation and make the proof easier for the patient. They accept the potential fault when an organ was injured in the course of an operation. But, these decisions concern the proof and they don't modify the medical responsibility. The physicians have got a duty to use reasonable skill and care and they don't have any obligation to achieve a certain result. Sometimes, the physician has got an obligation to achieve a certain result but it isn't a general rule (November 08, 2000).

High-performance liquid chromatographic method to screen and quantitate seven selective serotonin reuptake inhibitors in human serum.

A high-performance liquid chromatographic screening method (HPLC) is described for the determination of seven selective serotonin reuptake inhibitors (SSRIs) (fluvoxamine, milnacipran, paroxetine, sertraline, fluoxetine, citalopram, venlafaxine) and for three pharmacologically active N-demethylated metabolites (desmethylcitalopram, didesmethylcitalopram and norfluoxetine). A tricyclic antidepressant, clomipramine, was used as an internal standard. The method consists of liquid extraction of serum after alcalinisation at pH 9.50, followed by chromatography on a Beckman C18 reversed-phase column. Compounds were detected at 200.4 nm. The standard curves were linear over a working range of 50-1,000 ng/ml for fluvoxamine, 15-1,000 ng/ml for fluoxetine, 25-500 ng/ml for norfluoxetine, 50-500 ng/ml for sertraline, 20-500 ng/ml for paroxetine, 25-550 ng/ml for citalopram, 25-750 ng/ml for desmethylcitalopram, 25-800 ng/ml for didesmethylcitalopram, 25-650 ng/ml for milnacipran, and 25-500 ng/ml for venlafaxine. The quantitation limits of the method were 15 ng/ml for fluoxetine, 20 ng/ml for paroxetine, 25 ng/ml for venlafaxine, norfluoxetine and citalopram, and its metabolites, 40 ng/ml for sertraline and 50 ng/ml for fluvoxamine. No interferences were noted with this sensitive and specific method which can be used for therapeutic drug monitoring.

Case report: recovery of Calliphora vicina first-instar larvae from a human traumatic wound associated with a progressive necrotizing bacterial infection.

Human myiasis caused by Calliphora vicina is rare in Europe. Here we report a case of C. vicina infection occurring in the traumatic leg wound of a healthy 21-year-old man. Firstly, a progressive necrotizing infection developed in the wound despite administration of antibiotics. Aeromonas hydrophila was isolated from the wound samples. Secondly, during debridement, C. vicina first-instar larvae were isolated from the wound. To our knowledge, this is the first European case of C. vicina wound myiasis associated with severe A. hydrophila infection.