Intérêt de l’analyse anatomopathologique dans une série de 400 autopsies médicolégales

A Comprehensive Review of Pathological Examination in Forensic Medicine: Past, Present, and Future

Pathological examination (PE) encompasses a gross or macroscopy and histopathological or microscopic examination. It is prudent in finding the cause of death (COD) in clinical and medicolegal autopsies. There are various auxiliary techniques in the form of clinical history, communication, specialized training, and protocols for consolidation of the PE results. After a thorough search of the literature in PubMed with relevant keywords along with further analysis of the results, it emerged that even with the modernization of forensic medicine, a PE is unbeatable in detecting the COD. It has various useful aspects, apart from regular finding the COD, such as in student teaching, epidemiology of disease, audit tool, and quality assurance. There are also limitations of PE, which should be dealt with great caution. Hence, limitations must be understood by a forensic expert as well as a pathologist. In this review, all factors that are related to PE in any manner are discussed in detail, and the scope for improving the quality of PE to be relevant in the present scenario is reviewed. It is a comprehensive reassessment of the literature review that also casts light on the future along with a critical analysis of the facts that deal with PE.

[Forensic autopsies and pathological examination: Current practice in Montpellier's jurisdiction. A retrospective study of 630 autopsies]

INTRODUCTION

In France, pathological examination is not systematically required in forensic autopsies. The factors affecting the decision to carry out a pathological expertise have not yet been defined. The aim of this study was to describe in which conditions a pathological expertise was required after forensic autopsy by the high court of Montpellier.

METHODS

This study included and analyzed retrospectively all of the autopsy elements, of all forensic autopsies carried out over a year. These elements were classified: pre-autopsy, per-autopsy, and post-autopsy.

RESULTS

A pathological expertise was required in 19.2% of 630 cases, among which 31% in a context of undetermined cause of death and in 14% of cases of determined causes of death. The forensic practitioner recommended a pathological expertise in 10 to 31% of autopsies. Overall, 64 pathological examinations were realized out of 121 recommended examinations (52.9%), this rate varied from 25 to 73% depending on the court. The magistrate tended to favor anatomopathological expertise in cases of determined causes of death, and in certain manner of death (80% homicide versus 35% natural). The pathologist's expertise enabled to change the cause of death in 22% of cases and the manner of death in 19%. The pathological approach was a major asset in the 65% of unknown manner of deaths and in the 20% of natural, whereas the expertise did not help in cases of homicides, suicides and accidents. The cause of death was modified in 5.6% of initially determined causes of death, against 42.9% in case of initially unknown cause.

CONCLUSION

The use of pathologic examination in forensic autopsies is scarce and uneven. The factors resulting to its request are not directly linked to its scientific assets. A conjoint work between forensic and pathologist practitioners would be beneficial.

Intentional Carbofuran poisoning in 7 dogs

Background

Carbofuran is a widely used broad-spectrum pesticide that, despite strict regulation and being banned for more than a decade, is still encountered in cases of intentional poisoning in dogs and wildlife. The objective of the study was to provide a complete and detailed description of the pathological, histological and toxicological findings of 7 cases of intentional carbofuran poisoning in dogs.

Results

In this retrospective study, 7 cases of carbofuran intoxication recorded from July 2015 to June 2017 were analyzed. Following complete history recording, all cases were examined by complete necropsy and histopathology. Carbofuran intoxication was confirmed in all cases by gas chromatography. The postmortem examination revealed extensive hemorrhaging and congestion located mainly within the respiratory, nervous and cardiovascular systems, accompanied by degeneration and necrosis within the lungs, heart, and kidneys.

Conclusions

Although carbamates have been banned in the European Union, carbamate poisoning is still frequently encountered, especially in wild animals. This paper will contribute to a better understanding of the occurrence and pathogenesis of acute carbofuran exposure in dogs and contribute some peculiar pathological features of this type of poisoning to the current literature.

Pediatric medicolegal autopsy in France: A forensic histopathological approach

The aim of postmortem medicolegal examination in pediatric death is primarily to establish the circumstances and causes of death and to exclude child abuse. In France, pediatric death is systematically documented by medicolegal or medical autopsy. In case of medicolegal autopsy, the complementary examinations, requested and financed by justice, are rarely limited to a histopathological examination. However in medical autopsies other tools are available to the pathologist as toxicology, biochemistry and molecular biology. The purpose of this article is to evaluate the efficacy of forensic histopathology in pediatric forensic autopsies. We analyze the main causes of pediatric death in a forensic context. Between 2004 and 2015, 157 infant deaths were identified in Marseille university hospital. The forensic histopathology and autopsy reports of all 157 cases were available for systematic review. Medical or surgical causes represented 41,3% of deaths in our center, accidental causes 8.1% and child abuse 28,8%. The definitive diagnosis was made at autopsy in 30% of cases and at histopathological examination in 70% highlighting that forensic histopathology is an indispensable tool in pediatric medicolegal autopsies. Significant histological abnormalities may be detected in selected organs such as the brain, lungs, heart, liver, adrenal glands and kidneys in spite of macroscopically normal appearances. This justifies systematic sampling of all organs. Despite the implementation of the French sudden infant death protocol which recommends medical autopsies, too many pediatric autopsies are carried out in a medicolegal context. 30% of the cases remain without diagnosis at the end of the autopsy and histological examination. This number could be reduced by the contribution of others laboratory investigation.