Lésions intracrâniennes après un traumatisme crânien accidentel chez l'enfant de moins de trois ans

Objectif : Etude descriptive clinique et radiologique des traumatismes crâniens graves de l enfant de moins de trois ans afin de déterminer s il existe des concordances entre les circonstances de survenue, les signes cliniques et les signes tomodensitométriques. Méthodologie : Etude rétrospective portant sur les données cliniques, cutanées, et radiologiques des enfants de moins de trois ans, hospitalisés pour un traumatisme crânien accidentel et ayant bénéficié d un TDM cérébral entre janvier 2002 à février 2010. Les conditions de survenue ont été classées en fonction du mécanisme (haute ou basse énergie). Les signes d alerte et les signes de gravité ainsi que les signes cutanés ont été recherchés. Les scanners cérébraux ont été revus. Les atteintes des parties molles, des structures osseuses et cérébrales ont été notées. La lésion cérébrale la plus sévère a été retenue. Conclusion : Il existe un lien fort entre mécanisme du traumatisme, lésions osseuses et lésions intracrâniennes. Les hématomes sous-duraux surviennent lors d accident à haute énergie . Les hématomes extraduraux sont possibles pour des chutes de petite hauteur. La recherche d un maximum de témoignages fiables de l accident ainsi que de lésions cutanées associées est nécessaire. En cas de doute sur la concordance des lésions intracrâniennes et du mécanisme de l accident, une équipe pluridisciplinaire doit être systématiquement réunie afin de statuer sur le cas présenté.ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

The contribution of Micro-CT to the evaluation of trabecular bone at the posterior part of the auricular surface in men

International audienceAimUsing multi-slice computed tomography (MSCT), Barrier et al. described the disappearance at the posterior auricular surface of a “central line” (CL) and “juxtalinear cells” (JLCs) belonging to a trabecular bundle, and a trabecular density gradient around the CL that decreased with age. The aim of our study was to use micro-CT to test these findings, referring to the concept of Ascadi and Nemeskeri.MethodologyThe coxal bones of fifteen males were used; age was known. CLs were identified on MSCT-sections using Barrier’s method (64 detectors, 0.6 mm slice thickness, 0.1 mm overlap) with two different software programs (Synapse®, Amira®). Then, CLs were researched on microCT slices (pixel size: 36 μm). Three volumes of interest were defined (around, above, and below CL), and 3D morphometric parameters of the trabecular microarchitecture (particularly BV/TV and DA) were calculated. Two-tailed statistical analyses were performed attempting to correlate these parameters with age at death.ResultsCLs and JLCs were observed on micro-CT slices, but with moderate agreement between both imaging techniques. Their presence was not correlated with the age of the subjects. Around the CL, BV/TV decreased significantly with age; DA was negatively correlated with BV/TV and had a tendency to increase with age. Between areas above and below the CL, there was a BV/TV gradient and both BV/TVs decreased in parallel with age.ConclusionOur findings regarding the contribution of micro-CT to the evaluation of trabecular bone could be a promising research approach for application in a larger study population.</p

Male Victims of Rape: An Observational Study over Four Years in Paris, France

Sexual violence is a common and under-reported form of violence that affects all categories of individuals. We sought to provide epidemiological data on men aged 15 years and over, victims of rape or suspecting a rape, and who reported it to the police. We conducted a retrospective study at the Department of Forensic Medicine of H&ocirc;tel-Dieu, Paris, France, between 2018 and 2021. Two-hundred men were included in the study, with an average age of 28.8 years. A vulnerability was mentioned for 17.5% of them. Most of the patients reported anal penetration, committed by a single male assailant, whom they met on the day of the assault. More than 60% of the patients reported the voluntary consumption of alcohol and/or illicit substances prior to the assault. Most patients were examined shortly after the assault (median 1 day). Anal lesions were found on examination in 37.0% of patients reporting anal penetration regardless of the time frame. The presence of anal lesions was statistically higher when patients were examined within 48 h. Our results reinforce the data in the literature on the risk factors associated with sexual violence among men, notably the consumption of alcohol and illicit substances, and psychological, economic, and social vulnerability

An overview of forensic operations performed following the terrorist attacks on November 13, 2015, in Paris

On the evening of November 13, 2015, the city of Paris and its surroundings was hit by a series of attacks committed by terrorist groups, using firearms and explosives. The final toll was 140 people deceased (130 victims and 10 terrorists or their relatives) and more than 413 injured, making these attacks the worst mass killings ever recorded in Paris in peacetime. This article presents the forensic operations carried out at the Medicolegal Institute of Paris (MLIP) following these attacks. A total of 68 autopsies of bodies or body fragments and 83 external examinations were performed within 7 days, and the overall forensic operations (including formal identification of the latest victims) were completed 10 days after the attacks. Over this period, 156 body presentations (some bodies were presented several times) were provided to families or relatives. Regarding the 130 civilian casualties, 129 died from firearm wounds and one died from blast injuries after an explosion. Of the 10 terrorists or their relatives who were killed, eight died from suicide bombing, one was shot by police and one died from crush injuries due to partial collapse of a building following the police raid against a terrorist’s hideout after the attacks. All mass shootings were perpetrated with AK-47 or Zastava M70 assault rifles using 7.62 mm × 39 mm cartridges. In the case of ballistic injuries, death was most often obviously caused by craniocerebral injuries, extensive organ lacerations and/or massive haemorrhage. Among the terrorists killed by bombing, the lesion patterns were body transection, multiple amputations, extreme organ lacerations and the presence of foreign bodies owing to the shrapnel load (steel nuts, glass fragments) or the explosive charge fastening system of the devices. This discussion highlights the particular difficulties of interpretation encountered within the framework of ballistic injuries, a conclusion that should lead to a modest and realistic approach in these exceptional situations where forensic operations involve a very large number of victims in a constrained time

FGM/C Complications

Chapter sections: 6.1. Acute 6.2. Long Term 6.3. Acute and Long Term 6.4. Surgical Treatments of Complications of FGM/C 6.5. Defibulation Reference </p

Pictures Without FGM/C

This chapter will help the physician: - To make a vulvar examination (Figs. 3.1 and 3.2) - To provide a referential for surgeons undertaking procedures (Figs. 3.3, 3.4, and 3.5) - To recognize anatomical variations (Figs. 3.6, 3.7, 3.8, 3.9, 3.10, and 3.11). - To identify “ambiguous” genitals or mucocolpos (Figs. 3.12 and 3.13) - To identify dermatological conditions (Figs. 3.14, 3.15, 3.16, 3.17, 3.18, 3.19, and 3.20) - To identify urethral lesions (Figs. 3.21 and 3.22) - To identify genital trauma (Fig. 3.1 of chapter “Pictures with Potential Differential Diagnosis of FGM/C”) - To make differential diagnosis of FGM/C (Figs. 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 3.10, 3.11 of chapter “Pictures with Potential Differential Diagnosis of FGM/C”, and Fig. 3.1 of chapter “Pictures with FGM/C”)</p

Pictures with FGM/C

Chapter Sections: 5.1. FGM/C Type I 5.2. FGM/C Type II 5.3. FGM/C Type III 5.4. FGM/C Type IV References </p

Consent and Photography

Informed consent is essential to ensuring a trauma-informed, survivor-centered, ethical process that respects the (developing) autonomy of a patient. Chapter sections: 2.1. Informed Consent 2.2. Trauma-Informed Care 2.3. Photography: Technical Tips Appendix: Standardized Form Used at University College London Hospitals as an Example [10] References </p

Assessing the Infant/Child/Young Person with Suspected FGM/C

Femawle Genital Mutilation/Cutting (FGM/C) comprises all procedures that involve partial or total removal of the external female genitalia or injury to the female genital organs that are medically unnecessary (i.e. performed primarily for cultural or religious reasons), especially when done without the consent of the affected person. Such procedures are usually carried out in infancy or childhood and, most often before the age of 15. Although some pictorial and training tools are available, existing literature focuses primarily on adults. The signs of FGM/C particularly in prepubertal girls, can be subtle and depend on the type as well as on the experience of the examiner. The health care provider (HCP) should be trained to be familiar with, and able to identify a wide range of both modified and unmodified genitalia, as well as findings that may superficially look like FGM/C but actually reflect the normal range of genital anatomy. Knowledge of FGM/C types and subtypes, as well as complications and differential diagnoses of physical findings, are critical. We present a reference guide and atlas containing iconographic material of both the pre- and post-pubertal external female genital area with and without genital cutting/alteration. Our purpose is to facilitate training of health care professionals in making accurate diagnoses, providing appropriate clinical management, ensuring culturally informed/sensitive patient–provider communication, and accurate recording and reporting to child welfare/law enforcement agencies, where required. Chapter sections: 1.1. How Does the Child First Present? 1.2. Clinical Setting 1.3. Taking the History 1.4. The Examination 1.5. When FGM/C Is Confirmed 1.6. When FGM/C Is Not Identified 1.7. Conclusion References </p