Self-inflicted burns: the value of collaboration between medicine and law

Self-inflicted burns are rare in France, but they lead to major, often life-threatening complications. The authors reviewed medical data for patients hospitalized in a burn center from January 2004 to December 2008. Thirty-eight cases of self-inflicted burns were compared with 220 accidental burns. Women were predominantly affected (57.9%, n = 22). A psychiatric history (71%, n = 27) was more frequent in this population. The mean age of the victims was 38 years. The leading method of suicide was flame (94%, n = 36) associated with gasoline used as an accelerant (77.7%, n = 28). Mean total burn surface area (41.5%) and mortality (36.9%) were higher in the self-inflicted burn population. By recognizing epidemiological characteristics and patients at risk, we can better classify lesions related to self-immolation. It is important for the forensic physician to consult survival details to correlate these data with the results of autopsy.     

Retropharyngeal Hematoma Secondary to Cervical Spine Surgery: Report of One Fatal Case

A 53‐year‐old woman suffering from radicular pain due to cervical herniation underwent a spinal surgery consisting of anterior cervical discectomy and fusion with an implantable titanium cage. Five hours after the procedure, the patient developed cervical swelling and dyspnea. An emergency surgery permitted evacuation of a deep cervical hematoma and intubation of the patient, who died some minutes later. The family of the deceased lodged a complaint with the public prosecutor because of unclear circumstances of death. After analysis of the medical records by two forensic pathologists, a medicolegal autopsy was ordered. Massive retropharyngeal and mediastinal hematomas were diagnosed. Pathological study confirmed acute cervical hemorrhage, but failed to detect the source of bleeding. The forensic pathologists concluded that death was due to mechanical asphyxia secondary to pharyngeal compression by the cervical hematoma. To the best of our knowledge, death secondary to retropharyngeal hematoma in this neurosurgical context is rarely encountered.     

Human coxal bone sexual dimorphism and multislice computed tomography: geometric morphometric analysis of 65 adults

The authors studied sexually dimorphic differences in coxal shape using geometric morphometric analysis of 15 osteometric landmarks recorded by multislice computed tomography (MSCT), based on three-dimensional reconstructions of 65 Caucasian adults. Geometric morphometric analysis, principal component analysis, canonical variates analysis, and other discriminant analysis (Goodall's F-test and Mahalanobis distance) were performed for the three separate bones of the left innominate (pubis, ilium, and ischium), the modified pubis (pubis and ischiopubic ramus), the modified ilium (ilium and ischial spine), three bone complexes (ischiopubic, iliopubic, and ilio-ischial), and the complete innominate. A cross-validation test was also performed. All areas studied were dimorphic, but results for sexual dimorphism in decreasing order were as follows: the modified pubis, followed by the ischiopubic complex, the iliopubic complex and the complete innominate, the pubis, the modified ilium, the ilio-ischial complex, the ilium, and finally the ischium. These results show the potential of this approach for future anthropological research.     

On National Courts, European Law and Constitutions: Dialogue and Conflict

Books reviewed in this article:
A.-M. Slaughter, A. Stone Sweet, J.H.H. Weiler (eds), Legal Change in Its Social Context     

What I think I see: reflections on the foundations of social policy*

‘I wouldn't like to be sure my vision is true, but I am quite sure that there is something for us to see, aren't you?’ Plato's Republic: Socrates to Glaucon     

The Effect of Coercion on Aggression and Mental Health Among Reciprocally Violent Couples

Researchers have not investigated mental health outcomes among couples who are reciprocally violent towards each other. The present study investigated differences in partner violence (psychological, physical, and sexual) and mental health symptoms (depression, anxiety, hostility, and somatic) between two types of reciprocally violent couples: situational couple violence (SCV) and mutual control violence (MVC). SCV couples use violence to address stressful family conflicts, while MVC couples use violence as a tool to control each other. Participants (N = 609) completed surveys that contained several instruments that measured past violence, coercive behaviors, physical injuries, and mental health symptoms. Results revealed that MVC reported significantly higher levels of violent perpetration and worse physical and mental health than SCV. These findings have implications for understanding the role of coercion in partner violence and mental health, which can be used for the development of appropriate mental health services for couples who are mutually violent towards each other.     

From population- to subject-based limits of T/E ratio to detect testosterone abuse in elite sports

In elite sports, indirect testing of testosterone abuse is mainly based on the testosterone over epitestosterone (T/E) ratio. Since this marker is characterized by a small ratio of intra- to inter-individual variation, it is surprising that current anti-doping strategy uses a screening test based on a population-based limit. From a database of more than 15,000 steroid profiles obtained from routine controls, the collection of steroids profiles of 11 elite athletes followed during 2 years, and a longitudinal study involving 17 amateur athletes, 8 of which were orally administrated testosterone undecanoate pills, we selected 12 case studies to represent the possible scenarios to which the anti-doping laboratories are confronted. Various detection strategies at the disposal of the laboratories are employed and discussed, including isotope ratio mass spectrometry (IRMS) analysis and a Bayesian interpretation of the T/E-time profile. The weak sensitivity versus specificity relation of a population-based limit for the T/E ratio is outlined. As a result, we propose a Bayesian screening test whose T/E threshold progressively evolves from a population basis to a subject basis as the number of individual test results increases. We found that this screening test heightens drastically the capacity to detect testosterone abuse, at no additional financial and administrative expenses for anti-doping authorities.     

Intraventricular hemorrhage originating from choroid plexus angioma in a road accident victim

A 76-year-old woman sustained severe multiple injuries when hit by a car. During the treatment a massive intraventricular hemorrhage was found by computer tomography. The postmortem examination revealed no craniocerebral injuries except for a small contused wound of the scalp. Microscopic examinations revealed a choroid plexus angioma in the lateral ventricle as the cause of the hemorrhage into cerebral ventricles.