Revue de Medecine Legale最新文献

Le syndrome douloureux régional complexe (SDRC – ex algoneurodystrophie) est une pathologie fréquemment rencontrée en expertise. Elle soulève de nombreuses difficultés tant sur le diagnostic que sur le pronostic, l’imputabilité à un fait unique ou la prise en charge. Dans cette étude, nous avons analysé les réponses d’expertises demandées par une commission de conciliation et d’indemnisation (CCI) après avoir reprécisé les principales caractéristiques de cette pathologie, et avons pu constater des discordances dans la pratique. Nous pensons avoir ainsi dégagé de potentiels outils qui pourraient être utiles pour répondre aux principales interrogations posées dans ce contexte : éléments de diagnostic, critères d’imputabilité, durée moyenne d’évolution avant consolidation.

Complex regional pain syndrome (CRPS–ex algoneurodystrophy) frequently occur within medical expertise. This pathology gives numerous troubles in term of diagnostic, prognostic, accountability or therapeutic. In this study, we gave the main characteristics of CRPS, then we analysed the answers in the medical expertises asked by a conciliation and compensation commission (CCI) and found some difference in the way of the attainment. We think we have thus found potential tools to answer the main questions in this context: diagnostic elements, accountability elements, mean evolution time before consolidation.

Dans la pratique médicolégale autopsique, les embolies graisseuses sont fréquemment observées lors de l’examen microscopique des organes surtout en cas de décès traumatiques. Néanmoins, pour admettre le syndrome d’embolie graisseuse comme cause de décès, le médecin légiste doit appuyer ses constatations autopsiques macroscopiques et microscopiques sur un faisceau d’arguments cliniques et une discussion médicolégale succincte, prenant en compte les données scientifiques disponibles. Dans ce travail, nous rapportons un cas litigieux de syndrome d’embolie graisseuse survenu plus de deux mois après une fracture isolée des os de l’avant-bras, et nous exposerons la démarche du médecin légiste dans l’établissement du lien d’imputabilité entre le traumatisme initial et le décès par embolie graisseuse. Il s’agit du premier cas d’embolie graisseuse rapporté dans la littérature, succédant une fracture des os de l’avant-bras après un délai aussi long.

In Forensic practice, fat embolisms are frequently found during organs’ microscopic examination, especially in cases of traumatic death. However, to admit fat embolism syndrome as a cause of death, forensic pathologist must support his macroscopic and microscopic autopsy findings, through a bundle of clinical arguments and forensic discussion, taking into account available scientific data. In this paper, we report a litigious case of fat embolism syndrome occurring over two months after an isolated forearm's fracture and we aim to explain forensic approach in establishing the link of accountability between initial trauma and death. The originality of this case lies in the fact that this is the first case reported in the literature of fat embolism resulting from forearm's fracture after such a long delay.

Introduction

The hyoid bone is of great importance in forensic medicine and it has been studied for various forensic purposes. However, there have been few studies dealing with age and sex estimation using the hyoid bone, especially the radiographic methods.

Objective

To analyze the relationship between age, sex and metric parameters of hyoid bone in Tunisian population sample, using CT scan.

Materiel and methods

A prospective study was conducted in the department of Forensic Medicine of Fattouma Bourguiba Hospital of Monastir-Tunisia during 4 years. A total of 240 samples of hyoid bone were studied. The age of cases ranged from 18 days to 81 years. The specimens were collected only from the deceased of known age. Once dried, each hyoid bone was scanned using CT scan. For each specimen, 10 measurements were taken using a computer program. The measurements consisted of 6 lengths and 4 widths. A regression analysis was used to estimate the relationship between age, sex and different measurements. For age estimation, a multiple logistic regression was carried out for samples ≤ 35 years. For sex determination, ROC curve was performed. Discriminant value finally retained was based on the best specificity with the best sensitivity.

Results

The correlation between real age and estimated age was good (r² = 0.72) for samples aged 35 years or less. The unstandardized canonical function equation was estimated using three variables: maximum length of the right greater cornua, length from the middle of the left joint space to the middle of the right joint space and perpendicular length from the center point of a line between the distal ends of the right and left greater cornua to the center point of the anterior view of the body of the hyoid bone. For sex determination, the ROC curve analysis reveals that the area under curve was at 81.8%. Discriminant value was 0.451 with a specificity of 73% and sensibility of 79%. The equation function was estimated based on two variables: maximum length of the greater cornua and maximum length of the hyoid bone.

Conclusion

The findings of the current study suggest that metric analysis of the hyoid bone may predict the age ≤ 35 years. Sex estimation seems to be more reliable. Further studies dealing with the fusion of the hyoid bone and the current study could help to achieve more accurate age estimation rates.

Introduction

L’os hyoïde est d’une grande importance en médecine légale. Cependant, il y a eu peu d’études traitant de l’estimation de l’âge et la détermination du sexe à partir de l’os hyoïde, en se basant sur les méthodes radiographiques.

Objectif

Analyser la relation entre l’âge, le sexe et les paramètres scannométriques de l’os hyoïde à partir d’un échantillon de la population tunisie