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Marseille, France

Shojai R.,Marseille University Hospital Center | Bretelle F.,Marseille University Hospital Center | D'Ercole C.,Marseille University Hospital Center | Boubli L.,Marseille University Hospital Center | Piercecchi M.-D.,Service de Medecine Legale
Journal de Gynecologie Obstetrique et Biologie de la Reproduction

Objectives: To analyse the nature of medico-legal claims in a high-risk speciality. Materials and methods: Retrospective review of the causes of medico-legal disputes at the department of Obstetrics and Gynaecology of the North University Hospital of Marseilles between November 1997 and December 2010. Disputes were defined by complaints, judicial or conciliatory claims and intentional declaration of potential medico-legal case by physicians. Results: Fifty-nine controversial medico-legal cases were identified within this 13-year period. Ninety percent (n = 53) of cases concerned obstetrics and 10% (n = 6) gynaecology. The rate of litigations tripled in a decade. Half of the litigations led to judicial or conciliatory expertise. The average rate of malpractice litigations was 2.4 per physician. Uterine rupture was the most common cause of complaints. Conclusion: Increased awareness of the nature of litigations may help elaborate risk reduction management programs in order to reduce professional liability on the long run. © 2012 Elsevier Masson SAS. All rights reserved. Source

Mazoyer C.,Laboratoire LAT LUMTOX | Carlier J.,Laboratoire LAT LUMTOX | Boucher A.,Center Devaluation Et Dinformation Sur La Pharmacodependance Of Lyon | Peoc'h M.,Service de Medecine Legale | And 2 more authors.
Journal of Forensic Sciences

We report the case of a man who died twelve hours after ingesting powdered iboga root, commonly taken for its stimulant and hallucinogenic properties. Ibogaine and ibogamine were quantified in the powder ingested and the victim's body fluids by GC-MS/MS after liquid-liquid extraction (Toxi-tubes A®). The concentrations of ibogaine measured in the blood samples taken at the scene and in the peripheral blood, urine, and gastric fluid samples taken during the autopsy were 0.65, 1.27, 1.7, and 53.5 μg/mL, while the iboga content in the powder was 7.2%. Moreover, systematic toxicological analyses of biological samples showed the presence of diazepam and methadone in therapeutic concentrations. Death was attributed to the ingestion of a substantial quantity of iboga in the context of simultaneous methadone and diazepam consumption. © 2013 American Academy of Forensic Sciences. Source

Purpose of the study: To determine forensic imputability of a sleep apnea syndrome (SAS) to a polytrauma taking into account former state, predisposing condition, and consequences of each individual trauma. Patient and methods: The examination of the victim, the study of medical data, the realization of additional examinations, and the review of literature will allow validation of the criteria of imputability. Results: A polytraumatism is responsible for a cranial trauma and for a prolonged confinement to bed. The patholophysiogical study shows, that on one hand there is a discrepancy between the initial hurts and the onset of SAS, and on the other hand, that the deadlines of diagnosis do not match. The presence of a predisposing state is finally retained at the origin of this SAS, as well as the absence of previous state or external cause. Finally, the absence of certain, direct, and total, link of causality is retained. Conclusion: After verification of criterions of imputability, this apnea syndrome cannot be imputed, both directly and indirectly, and even partially to the polytrauma. © 2013 Elsevier Masson SAS. Source

Carlier J.,Laboratoire LAT LUMTOX | Escard E.,Hopitaux Universitaires Of Geneva | Peoc'h M.,Service de Medecine Legale | Boyer B.,Institut Universitaire de France | And 4 more authors.
Journal of Forensic Sciences

In March 2009, the body of a 51-year-old man was found in the boot of his car. The body had been frozen before being dismembered at the abdomen. The autopsy failed to determine the cause of death. Systematic toxicological analyses of the victim's peripheral blood and urine showed the presence of atropine, a powerful anticholinergic. Atropine was therefore specifically detected and quantified throughout the victim's biologic samples by HPLC-MS2 in the biologic fluids and UHPLC-MS2 in the hair. The atropine concentrations were 887 ng/mL in the cardiac blood, 489 ng/mL in the peripheral blood, 6693 ng/mL in the gastric contents (1.1 μg), 6753 ng/mL in the urine, and 2290 pg/mg in the hair. The blood concentrations measured in the decedent were consistent with an overdose of atropine, which was determined as the cause of death. The manner of death was a homicide with criminal intent. © 2014 American Academy of Forensic Sciences. Source

Schlatter J.,Laboratoire Of Toxicologie Medicolegale | Chiadmi F.,Laboratoire Of Toxicologie Medicolegale | Chariot P.,Service de Medecine Legale | Chariot P.,University of Paris 13
Annales de Biologie Clinique

Smokable herbal mixtures under the brand name Spice were first sold on the Internet and in various specialised shops in 2006 or earlier. When smoked, the Spice products have effects similar to those of cannabis. Forensic investigations were undertaken by German and Austrian authorities in order to identify the psychoactive ingredients of Spice. A new psychoactive substance JWH-018 has been identified in Spice products. JWH-018 was first synthesized in 1995 and produces effects similar to those THC. Subsequently, the synthetic cannabinoid CP 47,497was also identified. Outside of Europe, the United States Drug Enforcement Administration reported that another potent synthetic cannabinoid, HU-210, had been found. Since 2009, other synthetic cannabinoids were identified in Europe. None of the above-mentioned synthetic cannabinoids is internationally controlled as a drug and there is no information on any of them having been authorised as a medicinal product in the European Union. There are no officially published safety data and little is known about their effects in humans. Some of the characteristics of these compounds, e.g. volatility and activity in small doses, are likely to present further analytical and toxicological challenges. Responding to potential health concerns, Europe has taken legal actions to ban or otherwise control Spice products and related compounds. Source

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