Biomedical subjects

Georges Leonetti

Publications and source records attributed to Georges Leonetti.

11 recordsLinked to original sources

PubMed2006

Malnutrition, a rare form of child abuse: diagnostic criteria.

Infantile malnutrition is often difficult to diagnose as it is rarely observed in industrialized countries. It may be associated with physical violence or occur in isolation. The essential clinical sign is height and weight retardation, but malnutrition also causes a variety of internal and bone lesions, which lead to neuropsychological sequelae and death. We report a rare case of death by malnutrition in a female child aged 6 1/2 months. The infant presented height and weight growth retardation and internal lesions related to prolonged protein-energy malnutrition (fat and muscle wasting, thymic atrophy, liver steatosis) resulting in a picture of marasmus or kwashiorkor. We detail the positive and negative criteria that established the diagnosis of abuse, whereas the parents had claimed a simple dietary error.

Acetone↗

PubMed2005

An unusual case of post-mortem redistribution of ethanol.

We report an unusual case of post-mortem redistribution of ethanol in a woman diver who died by drowning in seawater. The ethanol concentrations were right heart blood 0.60 g/l, left heart blood 2.08 g/l, femoral venous blood 0.63 g/l, gastric contents 5.87 g/l, bile 0.83 g/l. The mechanisms of post-mortem redistribution of ethanol described in the literature, that is, early redistribution from the stomach or the lung parenchyma in the case of inhalation of gastric contents, are inadequate to account for the degree of variation observed between the measurements. We believe that this difference in concentration is explained by the presence of seawater in the pulmonary alveoli at the time of death.

Alcoholic Beverages↗

PubMed2005

Comparison of ethanol concentrations in right cardiac blood, left cardiac blood and peripheral blood in a series of 30 cases.

The aim of this study was to compare ethanol concentrations in right cardiac blood, left cardiac blood and peripheral blood. Samples were taken from a series of 30 medicolegal autopsies. Ethanol was measured by headspace GC-FID. In each case, the degree of putrefaction, chest or abdominal injury, and/or regurgitation of gastric contents into the airways were noted. Our results show that there exists in certain cases a marked increase in ethanol concentration in left cardiac blood compared with right cardiac blood and peripheral blood. In these cases, we observed (i) a high concentration of ethanol in the gastric contents and (ii) regurgitation of gastric contents into the airways. The authors discuss the post-mortem redistribution mechanisms which could explain these results and stress the value of sampling right cardiac blood at autopsy.

Central Nervous System Depressants↗

PubMed2005

Unusually high concentrations in a fatal GHB case.

The first case in France involving a fatal overdose resulting from the ingestion of gamma-hydroxybutyrate (GHB) is presented. GHB was tested by gas chromatography-mass spectrometry (GC-MS) after precipitation. Briefly, 20 microL of body fluids (blood, bile, urine, gastric contents, or vitreous humor) was pipetted in a glass tube, followed by 20 microL GHB-d6 and 45 microL acetonitrile. After vortex mixing and centrifuging, the supernatant was collected and evaporated to dryness. The residue was derivatized with BSTFA with 1% TMCS for 20 min at 70 degrees C. After injection on a 30-m HP5 MS capillary column, GHB (m/z 233, 204, and 147) and GHB-d6 (m/z 239) were identified by MS. GHB was also tested in pubic hair after incubation in 0.01 N NaOH, neutralization, acidification, extraction in ethyl acetate and derivatization with MTBSTFA, using GC-MS-MS. GHB was positive in all the tested specimens, with the following concentrations 2937, 33,727, 1800, and 2856 mg/L in femoral blood, urine, bile, and vitreous humor, respectively. This seems to be the highest blood concentration ever observed. Postmortem redistribution appears weak, as the concentration in cardiac blood was 3385 mg/L (cardiac blood/femoral blood ratio of 1.15). Oral route was suggested with GHB at 7.08 g in 100 mL of gastric contents. Pubic hair analysis clearly indicated chronic GHB abuse, with concentrations along the shaft in the range 19.4 to 25.0 ng/mg (in comparison with physiological concentrations < 2 ng/mg). Methylenedioxymethamphetamine was present in femoral blood at 144 ng/mL. These results are consistent with an acute fatal overdose of GHB.

Adult↗

PubMed2005

Hyperostosis frontalis interna: forensic issues.

The use of pathological conditions in age and sex determination, important factors in personal identification, is not widespread in anthropology and legal medicine. Hyperostosis frontalis interna (HFI) is a bone condition that mainly affects the inner table of the frontal bone. Although there are numerous publications on the subject, at the present time its etiology remains obscure. Several associations of symptoms, whose incidence varies according to the population studied, have been described. Age and gender appear to be linked with the preponderance of this condition, as does the presence of behavioral disturbances. The aim of our study, based on a series of 1532 autopsies, was to define the incidence and the associations observed with other pathological conditions. Thirteen cases of HFI were identified (0.8% of autopsies), 12 women and one man whose mean age was 59.15 years (range: 42-79 years). All had behavioral disturbances and most were under psychiatric care. This study emphasizes the value of this condition in medico-legal identification.

Adult↗

PubMed2004

Pellagra: a rare disease observed in a victim of mental and physical abuse.

Lesions of the brain stem and cerebellum due to nutritional deficiencies are mostly seen in chronic alcohol abuse and more rarely in severe malnutrition. We report the case of a 27-year-old woman, found dead in the family flat. She presented cachexia (167 cm, 25 kg) and multiple hematomas of the limbs. Postmortem examination revealed lesions due to peritonitis. Neuropathological examination showed severe atrophy of the corpus callosum and central neuronal chromatolysis, which are observed in pellagra. Inflammatory colitis or celiac disease was not found. Toxicological analysis was negative, in particular no alcohol absorption. Pellagra, which is due to nicotinamide deficiency, is a disease rarely seen in this country. In this case, nutritional deficiency was the consequence of failure to eat in a context of abuse. The woman was born of an incestuous relationship and presented intellectual retardation due to poor affective relations with her mother.

Adult↗

PubMed2004

Fetal visceral maturation: a useful contribution to gestational age estimation in human fetuses.

With regard to the law, estimating fetal age is essential to assess viability (after 20 weeks according to the WHO) and the proposed methods generally use long bone measurements. Here, we evaluated the accuracy of soft tissue maturational stage and compared it with long bone measurements. First, eight kinds of tissues or organs from 448 fetuses with known medical history were studied (macroscopically or histologically). We clearly demonstrated that adrenal glands and skin were very good age indicators, because some characteristics appeared only after 20 weeks. We established a linear regression with a 95% confidence interval of +/- 2.9 weeks. Second, we applied our original formula using femur measurement and we combined soft tissues and bones in a multiparametric regression. The confidence interval was reduced to +/- 2.5 weeks. We conclude that the pathologist must use both histological and anthropometric data to determine fetal age as accurately as possible.

Femur↗

PubMed2003

New forensic approach to age determination in children based on tooth eruption.

The present study proposes equations for age determination both in living and dead children, obtained with the help of stepwise ascending multiple linear regression. The equations should be applied, based on the number of erupted teeth and tooth germs, which were detected on radiographs, during clinical examination and in infant skeletal remains. The proposed equations proved to be efficient just like Demirjian's method used as a reference today, and permit age estimation till 20 years of age.

Adolescent↗

PubMed2003

[Probabilistic approach to age estimation of children by dental maturation].

Two probabilist methods of age prediction in children are proposed: they are both based on the radiological presence of erupted teeth or germs. Using an apprenticeship sample of known age and sex, we established several discriminant models (+/- 13, +/- 16, +/- 18 years old). We also evaluated a Bayesian model with the following age groups: < 13, [13-16[, [16-18[, > or = 18 years old, or [X and Y] years old. When applied on a known test sample, Fisher's linear functions presented a success rate greater than 90%, above 13 years threshold, and below 16 and 18 years thresholds, and Bayesian approach, greater than 85%. Therefore, these methods provide an interesting alternative for children age determination that can be applied in biological and forensic anthropology, too.

Adolescent↗

PubMed2002

[New formula for the determination od fetal age].

The methods utilised in anthropology for foetal age assessment are generally rather old, based on small samples and have never been tested on other samples than the one they were established on. In this study, we establish a formula on 344 foetuses of known age, and compare it with other age determination methods found in the scientific literature. Except our formula, the tested other methods do not give the limits of the prediction's confidence interval, and therefore do not take into account the total variability. Therefore, we demonstrate the necessity to establish formulas based on large samples and on a validated methodology.

Embryonic and Fetal Development↗

PubMed2002

Validation of a radiographic method to establish new fetal growth standards: radio-anatomical correlation.

In forensic medicine, specialists might face difficulties when estimating age at death from fetal remains. Depending on the state of preservation, this age assessment is essentially based on the diaphyseal size of long bones. In a previous work, for the measurement of fetal femoral ossified shafts, we already established a simple and reliable method using a radiographic protocol. Since we previously stated that radiographic measurement values were closer to real anatomical size than ultrasonographic ones, in the present study we decided to check the importance of the difference between radiographic and anatomical measurements. Therefore, we dissected 30 pairs of fetal femurs and compared the difference between the two kinds of measurements (in percentages). This difference seemed to be slight (4.027%), but it was large enough to entail significant differences (p < 0.001). In order to provide a correction factor for radiographic measurements, we established a linear regression formula, which was tested on another sample of 30 pairs of dissected femurs. As a consequence of the good results, we improved the linear regression using a powerful statistical tool: the bootstrap. Finally, we obtained a simple equation that allowed us to figure out the real anatomical size with an R2 of 99% and a mean relative difference of 0.153% (with a standard error of 0.252 mm, and therefore a 95% confidence interval with limits of -0.35 and 0.657 mm). This difference did not entail any significant differences (p = 0.498), and therefore, we concluded that with the proposed correction, radiographic measurements can easily be used by forensic specialists in their daily tasks or to establish new growth standards in order to best fit their population of interest.

Age Determination by Skeleton↗