[Complications after laser hair removal: the standpoint of a dermatological legal expert regarding liability]. / Accidents secondaires aux actes de photoépilation : la pratique d'un expert de justice dermatologue en matière de responsabilité

BACKGROUND: Laser hair removal is widely used, including outside medical settings. Potential complications, notably burns, may engage the operator's liability. In this case, investigations by medical experts are frequently requested. PATIENTS AND METHODS: We describe 6 expert examinations carried out by the same legal dermatology expert between 2012 and 2014. They concerned burns of varying severity caused by laser hair removal procedures carried out by a doctor, a physiotherapist and 4 beauticians. DISCUSSION: Laser hair removal is carried out in many beauty centres, although in France it is restricted by law to medical use. This practice is thus currently the subject of legal and economic controversy. The analysis of 6 medical expert investigations of accidents involving laser hair removal illustrates the various types of fault in which the operator's liability may be engaged and it also serves to redefine the legal framework of this act within the realm of aesthetic medicine.

Diagnostic value of high-resolution peripheral quantitative computed tomography (HR-pQCT) in the qualitative assessment of cribra orbitalia: a preliminary study.

Cribra orbitalia are a porotic or sieve-like lesions in the bony orbital roof. This characteristic has frequently been detected in palaeopathological skulls from many parts of the world and has been the object of extensive research. Our objective was to determine if high-resolution peripheral quantitative computed tomography (HR-pQCT) could produce reliable information in the study of cribra orbitalia. Seven skulls displaying cribra orbitalia were investigated by HR-pQCT. The two-dimensional slices were compared with histological sections. The HR-pQCT images and histological sections showed similar results, i.e. two groups of lesions with different characteristics. HR-pQCT can be of great value in palaeopathological research. It is a nondestructive, fast and precise technique that allows an easy evaluation of the bone architecture without destruction of the sample.

The usefulness of post-mortem CT angiography in injuries caused by falling from considerable heights: three fatal cases.

OBJECTIVE: Post-mortem computed tomography is a diagnostic tool forming part of the arsenal available to forensic pathologists today. In addition to its usefulness in detecting bone lesions, which has long been recognized, this technique has nowadays been enhanced by the development of CT angiography. The role of multiphase post-mortem computed tomography angiography (multiphase PMCTA) is primordial, improving detection of solid organ lesions and permitting vascular lesions to be visualized directly. MATERIAL AND METHODS: Our paper presents a series of three deaths by falling from a considerable height recorded since the beginning of 2012. We report the usefulness of PMCTA and the various mechanisms involved in the trauma. RESULTS: Most of the lesions were diagnosed by both PMCTA and autopsy, including the rare lesions, but the peripheral bone lesions and the hemopneumatocele were diagnosed only by PMCTA, while dislocation of vertebrae and the testicular fractures were detected solely by autopsy. CONCLUSION: PMCTA is a new, minimally-invasive technique which, combined with autopsy, provides better visualization and detection of certain lesions, particularly in the case of death by falling from a great height.

Virtual anthropology and forensic identification using multidetector CT.

Virtual anthropology is made possible by modern cross-sectional imaging. Multislice CT (MSCT) can be used for comparative bone and dental identification, reconstructive identification and lesion identification. Comparative identification, the comparison of ante- and post-mortem imaging data, can be performed on both teeth and bones. Reconstructive identification, a considerable challenge for the radiologist, identifies the deceased by determining sex, geographical origin, stature and age at death. Lesion identification combines virtual autopsy and virtual anthropology. MSCT can be useful in palaeopathology, seeking arthropathy, infection, oral pathology, trauma, tumours, haematological disorders, stress indicators or occupational stress in bones and teeth. We examine some of the possibilities offered by this new radiological subspeciality that adds a new dimension to the work of the forensic radiologist. A multidisciplinary approach is crucial and involves communication and data exchange between radiologists, forensic pathologists, anthropologists and radiographers.

Diagnosis of drowning using post-mortem computed tomography - state of the art.

AIM OF THE STUDY: Recent studies using post-mortem computed tomography (PMCT) have suggested this imaging modality is of value in the positive diagnosis of drowning. We summarize the data from the literature regarding the diagnostic value of CT in cases of drowning. MATERIAL AND METHODS: We performed an all-language search of literature published from 1999 to 2013 with the key words "post-mortem CT scan", "drowning and CT scan", "near-drowning diagnosis", and "drowning diagnosis". RESULTS: Only 11 articles, whose data enabled complementary statistical analysis, were included. The presence of fluid and sediment in paranasal sinuses appear to be the determinants of the diagnosis of drowning. The presence of fluid in the sinuses had a sensitivity of 100%, and of 90% in the trachea and main bronchi. The results were completed by the high specificity of the presence of sediment in the paranasal sinuses, upper airways and stomach, which was 100% for all three. Haemodilution was present in cases of drowning (p < 0.001). The values made it possible to formulate a decision algorithm for the diagnosis of drowning.

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.

Management of pregnancy in women with type 1 diabetes mellitus: guidelines of the French-Speaking Diabetes Society (Société francophone du diabète [SFD]).

AIM: The clinical guidelines reported by the French-Speaking Diabetes Society (Société francophone du diabète) include updated recommendations for preconceptual planning and care in the management of pregnancy in women with type 1 diabetes mellitus (T1DM). METHODS: The working group included diabetologists, as well as an obstetrician, a nurse and a dietician. A review of the literature was performed using PubMed and Cochrane databases. Guidelines published by foreign diabetes societies were also consulted. RESULTS: In women with T1DM, pregnancy increased the risks of hypoglycaemia, diabetic ketoacidosis, pregnancy-induced hypertension, infections and worsening of diabetic microvascular disease. Moreover, T1DM during pregnancy had an impact on the embryo and the fetus, and may have increased the risk of spontaneous miscarriages, malformations, premature births, and fetal and neonatal complications. However, intensive glycaemic control and preconceptual care have been shown to decrease the rate of fetal demise and malformations. Also, the use of insulin analogues during pregnancy is now regarded as safe. Tight glucose control and frequent follow-up are recommended throughout pregnancy in women with T1DM. Their obstetric management should take place in a maternity hospital with an appropriate perinatal environment and in close collaboration with diabetologists. CONCLUSION: Pregnancy planning and adequate management during pregnancy are mandatory for improving the outcomes of women with T1DM.

Prisoners and skin diseases in Toulouse, France: epidemiological analysis and evaluation of life impact.

BACKGROUND: Dermatology in a penitentiary environment is an under-researched field. OBJECTIVES: To study the prison population seeking medical advice for skin diseases and to assess among detainees the life impact of these diseases, an approach that to the best of our knowledge has not previously been reported. METHODS: This prospective study was carried out in the male population of two penal institutions in the region of Toulouse, south-western France. RESULTS: One hundred seventy-eight men were seen, for a total of 234 diagnoses and 281 consultations. The five most frequent diagnoses, in order of decreasing frequency, were disorders of the pilosebaceous follicle, fungal diseases, benign skin tumours, warts and eczemas, which are common skin diseases. However, 72% of inmates believed their skin disease was directly related to detention. This belief was related to the conditions of life in prison (seclusion and its effects) and to frequent psychological problems. CONCLUSIONS: The disorders observed were generally benign skin conditions that could be expected in a population of young men living in a closed community. They led to a high demand for care and treatment: skin diseases represented the largest specialist consultation in our institutions. Skin problems can easily be managed in an outpatient unit, which confirms the usefulness of a dedicated dermatology clinic within the outpatient consultation units of penal institutions in order to provide care of equivalent quality to that available in a free environment. The dermatologist can have an important role in the medical management and the health education of prisoners.

[Value of radiographic evaluation of the second metacarpal in the determination of bone age]. / Apport de la radiographie du second métacarpien pour la détermination de l'âge osseux.

PURPOSE: Age determination based on bone maturate evaluation is routinely used in forensic science and anthropology. The aim of this study was to purpose a quantitative method of age determination on the second metacarpal in a population of children and adolescents by measurements of the epiphyso-metaphysal ratio (REM) (epiphysal diameter divided by metaphysal diameter) and the cortical index (IC). MATERIAL: and methods. We evaluated the REM and the IC on 417 hand radiographs of 2 from aged 20-year-old children. RESULTS: The correlation between REM and age for males (R2=0.62; p<0.001) and females (R2=0.68; p<0.001) was a good and significant. The correlation between IC and age for males (R2=0.34; p<0.001) and females (R2=0.30; p<0.001) was also significant but poor. CONCLUSION: Measurement of IC should not be used for age assessment. Measurement of REM is simple, reproducible and poor X-ray exposing technique. It should be very useful for age determination.

[Medicolegal considerations in the musculoskeletal interventional radiology: patient information and informed consent]. / Aspects médico-légaux des gestes interventionnels en radiologie ostéo-articulaire. Information du patient et consentement éclairé.

The daily practice of radiologists has evolved and radiologists are increasingly being directly involved with patient care and treatment. Consequently, radiologists have become a part of the therapeutic team available to patients. This active role, in hospital based or out-patient practices, does not only have an impact on the radiologist's professional activities. New liabilities related to interventional procedures or treatments are now added to already existing professional liability from diagnostic activities. Therefore, musculoskeletal radiologists performing interventional procedures must be aware and familiar with their obligations towards patients, including the requirement to provide adequate information to patients and documenting that informed consent was obtained.

[The anaesthetist's liability and bullfights]. / Responsabilité de l'anesthésiste et corrida.

Whether you are an aficionado or completely uninitiated, everyone has an opinion on bull-fighting. The bull-fighter is in constant risk of injury. A medical team made up of surgeons, anesthetists, emergency physicians and nurses remains present throughout the show. For the anaesthetist and surgeon, a wounded bullfighter is an emergency because the vital and functional prognosis are engaged. The team must act in conformity with normal practice and the Code of Medical Ethics because any lack of coordination between the practitioners is punishable by law in the same way as technical fault. Several specific aspects of this type of medical procedure should be highlighted: firstly, the legal restrictions within the corrida, and secondly, the nature of the medical team, which may be comprised of doctors normally based within a public health institution and others who practice in a private health establishment. The particularity of the situation reveals differences in the system of liability, and civil liability must be distinguished from administrative liability: both of these allow the victim to obtain compensation for harm caused, but the consequences of each are different according to doctor status. The fact that the anaesthetists frequently work on a voluntary and benevolent basis does not exonerate them from liability. Lastly, a question frequently addressed is whether or not the doctor is covered by his professional insurance when he is on ringside duty.

End-of-life patients, intensive care and consent: difficulties facing French intensivists.

BACKGROUND: The French legislature passed a law in 2005 that assigns a new role to the physician and redefines his liability in end-of-life decisions. METHOD: This law is presented and discussed in context with current French legal practice. RESULTS: This law emphasizes patient autonomy, advocating that the patient be fully informed before treatment, and creates specific procedures to be followed according to whether the patient is conscious or unconscious. In the latter situation, the law reinforces the role of both the patient's surrogate and the patient's advance directives in establishing consent. In these extreme situations, doctors have the option to request a second medical opinion. This joint decision-making procedure is laid down by law and becomes obligatory in the interests of transparency. CONCLUSION: Respect for patients' consent implies the possibility that they may refuse medical care, creating an ethical and legal dilemma of providing medical care or respecting the patients' wishes. The key issue concerning end-of-life patients rests in the decisions taken concerning the continuation or withdrawal of life support and the administration of palliative care.

Comment on the provisions of the French laws of 6 August 2004 and 8 December 2004 relative to the protection of genetic inventions.

The question of gene patentability has raised some opposition in France. Too broad a definition of the rights conferred by patent would hamper the development of research. The French legislature strictly defined genetic inventions in the Laws of 6 August 2004 and 8 December 2004. Exclusivity of use applies only to the function or functions precisely described in the patent application. Potential abusive use of rights by the holder of the patent has also been addressed through reinforcement of the provisions of the Code of Intellectual Property to combat such abuse. The Laws we discuss smooth the way to the granting of dependency licenses and broaden the field of application of ex officio licenses. The French legislature has achieved satisfactory balance between the legal protection of genetic inventions necessary to finance research, and the free circulation of scientific knowledge indispensable for medical progress.

[Role of modern cross-sectional imaging in thanatology: a pictorial essay]. / Application à la thanatologie de l'imagerie en coupe: revue iconographique.

The development of new imaging modalities such as computed tomography and magnetic resonance imaging is a new phenomenon in thanatology. The growing accessibility to these technologies allows, under some conditions, the acquisition of cross-sectional images on cadavers. The authors present a practical pictorial review of post-mortem changes and deadly injuries, illustrating the contributions of modern cross-sectional imaging techniques in thanatology.

Homicide-suicide by stabbing study over 10 years in the toulouse region.

The authors conducted a retrospective study of 70 cases of homicide and suicide in the Toulouse region to identify the variables that enable us to determine whether a death is a homicide or a suicide. This work showed that the following characteristics-a female victim, numerous wounds, and the presence of 1 or more vertical chest wounds-suggest homicide. It also highlights the importance of inspecting clothing, in particular the position of clothing and the presence or absence of slashes.

Coracoclavicular joints. Reflections upon incidence, pathophysiology and etiology of the different forms.

Since the first description of the coracoclavicular joint in 1861, many papers have been published reporting its occurrence, anatomical description, and geographical distribution. However, there are as yet no published articles with a convincing explanation for the rather variable forms of this variant. In this study, we investigated the occurrence of the coracoclavicular joint in the current and medieval population of Toulouse city and propose, through biometric measures, an explanation for the different forms of this anatomical variant. A total of 2192 chest X-rays taken for various conditions at a receiving hospital and 392 specimens (784 scapulae and an equal number of clavicles) of the L'Isle-Jourdain Series were examined with this aim. When present in the osteologic collection, the sizes of the articular conoid process as well as the height of the corresponding coracoid and acromial processes were noted. A coracoclavicular joint was noted in 0.82% and in 1.78% of the individuals examined in the radiological and osteologic series, respectively. The conoid process varied in size and correlated with the disposition of each correspondent coracoacromial arch. Osteoarthritis was noted in some of these joints when there was discordance between the conoid process size and the architecture of the correspondent coracoacromial arch, suggesting impingement. Our findings support a genetic origin for this variant, and suggest that its occurrence is also probably influenced by environmental factors. Osteoarthritis of this joint may be responsible for shoulder pain.

[Heterogeneity of expert psychiatric conclusions. Study of 101 authors of voluntary homicides]. / Hétérogénéité des conclusions des expertises psychiatriques. Etude chez 101 auteurs d'homicides volontaires.

OBJECTIVES: Specify the prevalence of various mental pathologies observed in authors of voluntary homicides and assess the interest of the psychiatric expertise of these persons. METHODS: The conclusions of the psychiatric expertises of 101 authors of voluntary homicide; condemned (94.20%) or declared irresponsible because of mental or personality disorders (5.80%), in the Court of Appeal of Bordeaux, over a period of 10 years (1989-1999) were analyzed. RESULTS: Several elements were underlined, among which the multiplicity of the diagnoses made by the expert psychiatrists and the large proportion of these criminals suffering from mental pathologies (81.60%), which contrasted with the low percentage of such criminals declared irresponsible (5.80%) or suggesting they might be dangerous (7.80%). DISCUSSION: The use of a standardized classification of mental diseases would provide the members of the jury and the magistrates with a clearer picture of the mental status of criminals. This is essential to avoid that more than 80% of the latter are quoted as exhibiting a mental pathology when the experts present their conclusions.

The effect of incarceration on prisoners' perception of their health.

The aim of the study is to assess the quality of life among male prisoners using the French version of the Nottingham Health Profile, then to investigate the influence of incarceration on emotional reaction. Before the obligatory medical examination at reception into prison, self-administration by prisoners of the French version of the Nottingham Health Profile. Two prisons in Toulouse (south-western France) are concerned: 199 men are included. The score of each dimension on the French version of the Nottingham Health Profile questionnaire and the responses to questions on socio-demographic and penal characteristics and results of medical survey have been studied. The response rate and rate of completion for each dimension are excellent (100%). Considerable evidence is found for the reliability of the Nottingham Health Profile (Cronbach a > 0.72 for all dimensions except energy 0.64 and physical mobility 0.64) and for construct validity in terms of distinguishing between groups with expected health differences. Three variables concerning aspects of life in prison are correlated with variation of the emotional reaction dimension. The Nottingham Health Profile can be used in prison populations. It is easy to use, acceptable to inmates, and fulfils stringent criteria of reliability and validity. It allows recognition of the factors correlated with variation of emotional reaction classically connected with suicidal behaviour in prison.

Cytological detection of spermatozoa: comparison of three staining methods.

Sperm detection can be an important factor in confirming sexual assault in cases of rape. This paper compares three of the most commonly used staining methods cited in the scientific literature: Christmas tree. hematoxylin-eosin, and alkaline fuchsin. The population studied was composed of 174 consenting women seen at the Male Infertility Center in Toulouse. France. The date of their last sexual intercourse was accurately known. Alkaline fuchsin did not seem effective in detecting spermatozoa in vaginal samples. Compared with hematoxylin-eosin, Christmas tree stain appeared to be the most useful test in the first 72 h. Two external factors were associated with decreased detection of spermatozoa: time since in tercourse and sperm volume.

Fatal cranial injuries caused by an electric angle grinder.

A case of fatal cranial injuries caused by an angle grinder is reported. The scalp lesions were typical of those produced by a cutting disk in a side-slipping movement. On the cranial vault were two bony losses of substance, one of which was deep enough for intracranial penetration of the disk. Signs of deflection of the disk, identical to those found on the scalp, were observed on the external bony table. Because of the circumstances in which the victim was discovered, in particular the damage to the machine which had a broken handle, and the lack of any indication of homicide or suicide, an accident is the most likely hypothesis.