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A scavenging postmortem crawfish (Austropotamobius pallipes) is presented. A 60-year-old woman was found dead immersed in 2m of water in an artificial lack near a dam. The divers, on discovering the body, observed numerous crawfish near... more
A scavenging postmortem crawfish (Austropotamobius pallipes) is presented. A 60-year-old woman was found dead immersed in 2m of water in an artificial lack near a dam. The divers, on discovering the body, observed numerous crawfish near the face, the abdomen and the hands of the cadaver that disappeared at their approach. Her face showed extensive hemorrhagic lesions of the eyelids, lips and neck, initially attributed by the police investigators to a possible criminal assault. On autopsy, the face injuries were identified as a postmortem defect by animal scavenging. We present the macro- and microscopic aspects of these postmortem changes in relation to animal predation.
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Si tous les manuels de medecine legale et toutes les recommandations en matiere d'harmonisation des pratiques s'accordent a dire que les examens anatomo-pathologiques, et, plus precisement histologiques, sont indispensables en... more
Si tous les manuels de medecine legale et toutes les recommandations en matiere d'harmonisation des pratiques s'accordent a dire que les examens anatomo-pathologiques, et, plus precisement histologiques, sont indispensables en complement de l'examen macroscopique autopsique, aucun de ces documents n'indique veritablement un pro- tocole de prelevement et de conditionnement des echantillons. Pourtant, la qualite de cet examen, et donc, du rapport final d'autopsie, en dependent largement. Ainsi, le medecin legiste se doit de connaitre les bases rudimentaires de l'examen anatomopathologique et le devenir des pieces qu'il adresse afin d'ameliorer la qualite de l'indispensable collaboration entre ces deux disciplines complementaires. Objectif: Proposer un protocole de prelevement des differents organes a realiser au cours d'une autopsie medico-legale, et d'echantillonnage destine a l'examen anatomopathologique conformement aux recommandation...
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Resume La restauration tegumentaire est une etape importante de l’autopsie medicolegale qui se fait sous la responsabilite du medecin. L’acceptation du geste autopsique par les proches du defunt peut etre grandement facilitee par une... more
Resume La restauration tegumentaire est une etape importante de l’autopsie medicolegale qui se fait sous la responsabilite du medecin. L’acceptation du geste autopsique par les proches du defunt peut etre grandement facilitee par une restauration de qualite. Pourtant, dans certains cas, l’examen externe du corps necessite d’etre accompagne d’incisions cutaneomusculaires pour la mise en evidence d’hematomes profonds ou pour evaluer la profondeur des ecchymoses. Ces incisions et leurs sutures sont particulierement inesthetiques lorsqu’elles siegent sur les zones decouvertes (visage, mains) et peuvent choquer les familles au moment de la presentation du defunt avant la mise en biere. Nous proposons une methode simple et efficace de restauration des teguments au niveau de ces incisions.
Research Interests: Humanities and Art
ABSTRACT Introduction Le contrôle-qualité des greffons cornéens nécessite une détermination précise de la Densité Cellulaire Endothéliale (DCE). Le dénombrement des CE se fait actuellement par « dilatation osmotique » au NaCl 0,9 %... more
ABSTRACT Introduction Le contrôle-qualité des greffons cornéens nécessite une détermination précise de la Densité Cellulaire Endothéliale (DCE). Le dénombrement des CE se fait actuellement par « dilatation osmotique » au NaCl 0,9 % donnant des résultats très imparfaits. Notre objectif est de remplacer cette technique par une coloration vitale non toxique permettant de visualiser les CE aussi parfaitement qu’avec le Rouge Alizarine (RA), non utilisable car toxique mais servant de référence. Matériels et Méthodes Après recherche bibliographique, nous avons sélectionné 30 colorants susceptibles de teinter les CE. Une paire de cornées animales de 3 espèces différentes (porc, veau, lapin) a été exposée pendant 1 minute avec une solution de l’un de ces trente colorants (solution commerciale ou dilution à 1 %, puis dilutions successives à 0,5, 0,1, 0,05, 0,01 %), puis observée au microscope à fond clair et en fluorescence. Les résultats ont été comparés aux résultats obtenus avec le RA et le type de coloration notée (bordures cellulaires, cytoplasmes, noyaux). Les colorants permettant un dénombrement aussi précis que le RA ont fait l’objet d’un test de toxicité au Bromure de 3- (4–5 diméthylthiazol-2-yl)-diphényl tétrazolium sur CE en culture. Résultats Six des 30 colorants se sont révélés intéressants (Hémalun, Rose Bengale, Rouge Nucléaire, Rouge Congo, Bleu Evans et Chicago Sky Blue). Les colorants de la famille des diazoïques à très faible concentration (Rouge Congo, Bleu Evans et Chicago Sky Blue) colorent le contour des CE aussi parfaitement que le RA et mettent en évidence les noyaux des cellules altérées. La toxicité de ces composés semble par ailleurs faible. Discussion Nos travaux suggèrent que les colorants diazoïques pourraient avoir un intérêt majeur dans l’appréciation de la qualité des greffons cornéens en donnant des indications morphologiques et fonctionnelles sur l’endothélium Conclusion L’évaluation des propriétés tinctoriales et de la toxicité de ces candidates colorants sur des cornées humaines scientifiques ex vivo est en cours ainsi que l’évaluation de la toxicité post greffe sur un modèle animal avant d’envisager une évaluation en banque de cornée.
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Two cases of scavenging postmortem freshwater shrimps (Gammarus pulex) are presented. We report the two first illustrated observations of cutaneous postmortem injuries inflicted by a G. pulex population, a small freshwater crustacean, on... more
Two cases of scavenging postmortem freshwater shrimps (Gammarus pulex) are presented. We report the two first illustrated observations of cutaneous postmortem injuries inflicted by a G. pulex population, a small freshwater crustacean, on two non putrefied drowning victims, and we describe their particular histological features and their potential in forensic investigations.
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Purpose: A reliable viability test for corneal endothelium is necessary for the assessment of new processes likely to affect it (storage media, lamellar cutting methods...). Aim: to improve the classical calcein-AM (C)/Ethidium homodimer... more
Purpose: A reliable viability test for corneal endothelium is necessary for the assessment of new processes likely to affect it (storage media, lamellar cutting methods...). Aim: to improve the classical calcein-AM (C)/Ethidium homodimer (E) double staining (live/dead assay) by adding Hoechst and by using a 3D microscope and image analysis that allow a quantitative assessment on the whole endothelium. As an example of application, the assessment of the actual endothelial viability immediately before graft is given. Methods: The endothelial side was incubated 45 min at 31°C with 200 μL of C (2μM), E (5μM), H (10μM). After flat mount, images of the whole endothelial area (81mm²) were taken using a microscope equipped with a motorized stage (IX81, Olympus) and a x4 objective. Z stacks were taken and an extended focal imaging algorithm allowed taking account of corneal folds. Endothelial cell density (ECD) and mortality were determined by automatic counting of H+ and E+ nuclei. Area of C+ cells was measured. Results: This upgraded staining on the whole endothelium allowed the exhaustive assessment of ECD, cell mortality and metabolic activity. On corneas immediately before graft, it highlighted a dramatic lower number of viable cells than expected with the routine assessment of ECD only, done 48H before graft in the eye bank. Conclusions: The triple HEC staining takes account of the heterogeneous pattern of lesions within the whole endothelial layer and is therefore far less biased than assessment done on small cell samples. Its use improves the assessment of all new processes likely to affect the endothelium ex vivo.
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Introduction : Alors que l INSERM recense environ 1 000 intoxications mortelles (tous produits confondus) par an en France, les décès d origine médicamenteuse ne font l objet d aucune déclaration systématique en France, ce qui rend... more
Introduction : Alors que l INSERM recense environ 1 000 intoxications mortelles (tous produits confondus) par an en France, les décès d origine médicamenteuse ne font l objet d aucune déclaration systématique en France, ce qui rend difficile l évaluation de la dangerosité des produits, l élaboration de statistiques fiables et la mise en place de mesures préventives adaptées. Objectifs : Les buts de notre étude sont d identifier les molécules mises en cause dans les décès médicamenteux et leurs différents mécanismes d action mortels. Matériel et méthode : II s agit d une étude rétrospective portant sur 955 dossiers de patients autopsiés dans le service de médecine légale du CHU de Saint Etienne entre le 1er janvier 2005 et le 31 décembre 2010. Résultats : 83 décès attribués à des intoxications médicamenteuses ont été répertoriés et analysés. 59.7% des décès résultent d un mécanisme toxique pur sans pathologie ayant pu contribuer à l exitus, avec un âge moyen des victimes de 40.3 ans ...
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Edmond Locard, un des peres de la criminalistique, est a l'origine du principe des echanges qui stipule que deux objets ou individus ne peuvent entrer en contact sans laisser une trace de leur rencontre l'un sur l'autre. Cet... more
Edmond Locard, un des peres de la criminalistique, est a l'origine du principe des echanges qui stipule que deux objets ou individus ne peuvent entrer en contact sans laisser une trace de leur rencontre l'un sur l'autre. Cet axiome, applicable en dehors de tout contexte criminel, nous a permis a deux reprises d'identifier l'origine de plaies post mortem grâce a l'analyse de poils retrouves a leur niveau. A chaque fois, au cours de l'autopsie, un poil different de ceux du defunt a ete identifie ; sa description macroscopique et microscopique nous a permis de conclure qu'il provenait d'un rongeur. C'est un ensemble de caracteristiques morphologiques (couleur, distribution et taille des pigments, forme de la medullaire, mensurations, analyse des deux extremites...) qui conduit en fin de compte a une identification d'espece. La synthese des informations recueillies aupres de l'anatomopathologiste, du medecin legiste et des enqueteurs a ens...
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Research Interests: Medicine and Morphologie
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Research Interests: Toxoplasma, Medicine, Toxoplasmosis, Acute Myeloid Leukemia, Brain, and 13 moreHumans, Animals, Male, Polymerase Chain Reaction, Heart, Lung, Clinical Sciences, Middle Aged, Autopsy, Hemophagocytic Lymphohistiocytosis, Hematopoietic Stem Cell Transplantation, Immunosuppressive Agents, and Fatal outcome
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Research Interests: Cardiology, Immunohistochemistry, Protein synthesis, Humans, Female, and 15 moreMale, Acute Myocardial Infarction, Aged, Middle Aged, Acute Coronary Syndrome, Myocardial Infarction, Adult, Public health systems and services research, Elsevier, Dystrophin, Cardiac Disease, Case Control Studies, ribonucleic acid, Cardiovascular medicine and haematology, and endocardium
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Cardiac metastases are rare events encountered in pathological practice but with often dramatic fatal outcome. Among malignancies associated with cardiac involvement, we would like to draw the attention of clinicians about lingual... more
Cardiac metastases are rare events encountered in pathological practice but with often dramatic fatal outcome. Among malignancies associated with cardiac involvement, we would like to draw the attention of clinicians about lingual squamous cell carcinoma by reporting a sudden cardiac death in a 57-year-old woman without prior symptom and considered in remission 1 month before her death. The forensic autopsy led to the diagnosis emphasizing its role in epidemiology and public health.
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ABSTRACT
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Noonan syndrome is a well-known genetic condition associating congenital heart defects, short stature, and distinctive facial features. Pulmonary valve stenosis and hypertrophic cardiomyopathy are the most frequent cardiac abnormalities,... more
Noonan syndrome is a well-known genetic condition associating congenital heart defects, short stature, and distinctive facial features. Pulmonary valve stenosis and hypertrophic cardiomyopathy are the most frequent cardiac abnormalities, the latter being associated with a higher mortality. Here we report for the first time, a case of congenital left main coronary artery atresia in a Noonan syndrome associated with RIT1 variant, leading to unrescued sudden death. This case-report supports the already-suspected severity of the RIT1-related Noonan syndrome compared to average Noonan syndrome, and should encourage clinicians to be very cautious with these patients.
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The decline of the medical autopsy, in spite of the uncontested recognition of its utility, is not to be any more proved. By summarizing the legal frame of this exceptional act, we tried to identify the indications, the contraindications,... more
The decline of the medical autopsy, in spite of the uncontested recognition of its utility, is not to be any more proved. By summarizing the legal frame of this exceptional act, we tried to identify the indications, the contraindications, the precautions for use, the limits, the technical, legal and ethical constraints and the costs of this diagnostic and therapeutic tool. The discussion underlines that the main brake in the realization of the autopsies could be its too strict French legal frame.
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INTRODUCTION: Kidney disease is among the clinical manifestations of secondary syphilis, as this case report shows. OBSERVATION: During serologically confirmed secondary syphilis, a 63-year-old man developed a nephrotic syndrome diagnosed... more
INTRODUCTION: Kidney disease is among the clinical manifestations of secondary syphilis, as this case report shows. OBSERVATION: During serologically confirmed secondary syphilis, a 63-year-old man developed a nephrotic syndrome diagnosed after biopsy as ...
Kidney disease is among the clinical manifestations of secondary syphilis, as this case report shows. During serologically confirmed secondary syphilis, a 63-year-old man developed a nephrotic syndrome diagnosed after biopsy as membranous... more
Kidney disease is among the clinical manifestations of secondary syphilis, as this case report shows. During serologically confirmed secondary syphilis, a 63-year-old man developed a nephrotic syndrome diagnosed after biopsy as membranous nephropathy. Membranous nephropathy is an immunological complication of secondary syphilis. Recovery usually follows treatment. It is often associated with signs that may erroneously suggest connective tissue disease.
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The control of corneal transparency depends on the integrity of its endothelial monolayer, which is considered nonregenerative in adult humans. In pathological situations, endothelial cell (EC) loss, not offset by mitosis, can lead to... more
The control of corneal transparency depends on the integrity of its endothelial monolayer, which is considered nonregenerative in adult humans. In pathological situations, endothelial cell (EC) loss, not offset by mitosis, can lead to irreversible corneal edema and blindness. However, the hypothesis of a slow, clinically insufficient regeneration starting from the corneal periphery remains debatable. The authors have re-evaluated the microanatomy of the endothelium in order to identify structures likely to support this homeostasis model. Whole endothelia of 88 human corneas (not stored, and stored in organ culture) with mean donor age of 80 ± 12 years were analyzed using an original flat-mounting technique. In 61% of corneas, cells located at the extreme periphery (last 200 μm of the endothelium) were organized in small clusters with two to three cell layers around Hassall-Henle bodies. In 68% of corneas, peripheral ECs formed centripetal rows 830 ± 295 μm long, with Descemet membrane furrows visible by scanning electron microscopy. EC density was significantly higher in zones with cell rows. When immunostained, ECs in the extreme periphery exhibited lesser differentiation (ZO-1, Actin, Na/K ATPase, CoxIV) than ECs in the center of the cornea but preferentially expressed stem cell markers (Nestin, Telomerase, and occasionally breast cancer resistance protein) and, in rare cases, the proliferation marker Ki67. Stored corneas had fewer cell clusters but more Ki67-positive ECs. We identified a novel anatomic organization in the periphery of the human corneal endothelium, suggesting a continuous slow centripetal migration, throughout life, of ECs from specific niches.
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Primary central nervous system lymphoma (PCNSL) is a rare subtype of non-Hodgkin lymphoma (NHL) with extranodal location affecting only the CNS, meninges and eye, without visceral or lymph node involvement. Its incidence has increased... more
Primary central nervous system lymphoma (PCNSL) is a rare subtype of non-Hodgkin lymphoma (NHL) with extranodal location affecting only the CNS, meninges and eye, without visceral or lymph node involvement. Its incidence has increased sharply over the past three decades, especially in immunocompetent subjects. Most PCNSL cases are diffuse large B-cell lymphomas (DLBCLs). However, it differs from nodal DLBCL in that it has a worse prognosis. DLBCLs are a heterogeneous entity and according to new genomic discoveries, classifications into prognostic subgroups have been embarked upon. Two prognostic algorithms were then prepared using a panel of immunohistochemical markers (CD10, Bcl6, MUM1/IRF-4, and Bcl2), thus categorizing DLBCL into two subgroups, GCB (germinal centre B-cell-like) or non-GCB, and into Group 1 or Group 2. Our goal is to apply both of these two sub-classifications to 39 PCNSLs, in order to assess their usefulness and prognostic relevance. 74.3% of our PCNSLs were of a non-GCB phenotype, corresponding to an activated postgerminal origin. They were evenly distributed across G1 and G2. Two- and 5-year overall survival rates were 34.8% and 19.6%, respectively. Younger age (<65) and a therapeutic combination of chemotherapy and radiotherapy significantly improved our patients' survival rates. The other clinical or biological markers tested had no prognostic impact. The two classifications did not reveal any significant survival difference. The recent discovery of a specific "transcriptional signature" of PCNSL, marking them out of DLBCL could account for the irrelevance of such prognostic classifications to PCNSL.
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Ropinirole, a specific non-ergoline dopamine D2-receptor agonist, belongs to the drugs applied in treatment of Parkinson's disease (PD) and restless legs syndrome (RLS) and acts as a D2, D3, and D4... more
Ropinirole, a specific non-ergoline dopamine D2-receptor agonist, belongs to the drugs applied in treatment of Parkinson's disease (PD) and restless legs syndrome (RLS) and acts as a D2, D3, and D4 dopamine receptor agonist with highest affinity for D3. Therapeutic ropinirole plasma levels in adults are defined between 0.4 and 6 ng/mL. This case report documents a fatal intoxication involving ropinirole. Information about lethal ropinirole concentrations is hitherto lacking in the literature and the assessed ropinirole levels of this case may present a step towards defining potentially lethal concentrations. A 37-year-old man without medical history was found dead in a converted van used as place of residence and an autopsy was performed. The pathological findings did not reveal an apparent cause of death but the toxicological analysis revealed the presence of ropinirole, paracetamol, and alcohol in the peripheral blood sample. Quantitative analysis revealed that ropinirole was present at a peripheral blood concentration of 64 ng/mL. The ropinirole concentrations determined in vitreous humor, urine and bile were respectively, 11 ng/mL, 2670 ng/mL and 826 ng/mL. Paracetamol was detected at a blood level of <2 μg/mL. Based on the autopsy findings and toxicological results, the cause of death was primarily attributed to intoxication with ropinirole in combination with alcohol.