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Biomedical subjects

D Malicier

Publications and source records attributed to D Malicier.

At least 19 recordsLinked to original sources
PubMed2002

Fatal overdosage with sildenafil citrate (Viagra): first report and review of the literature.

A fatal case of sildenafil citrate (Viagra) overdosage is presented. The deceased was a 56-year old male found dead at home, with a past history of diabetes mellitus, hypertension, chronic alcoholism, anxio-depressive disorders, and erectile dysfunction. The main autopsy findings were cardiomegaly (650 g) with dilated cardiomyopathy, diffuse coronary atherosclerosis with no sign of acute ischaemic disease, and extensive fibrosis of the myocardium, especially affecting the cardiac conducting tissue. As measured by HPLC/MS, sildenafil concentration in postrmortem blood (6.27 microg/mL) exceeded at least four times the highest therapeutic levels previously reported. The results are discussed in the light of the literature about the cardiovascular side effects of sildenafil, with special emphasis on the recently evidenced arrhythmogenic potential of the drug. This is the first report of a fatality caused by sildenafil overdosage.

Alcoholism↗
PubMed2001

Method for determining if a corpse has been frozen: measuring the activity of short-chain 3-hydroxyacyl-CoA dehydrogenase (SCHAD).

Accidental deaths by exposure to the cold have figured in many publications, whereas the freezing of the corpse is not well known. The study which we have reported was motivated by an observation of homicide in which ignorance of the fact that the body had been frozen was responsible for an underestimation of the time since death. It proved that measuring the activity of short-chain 3-hydroxyacyl-CoA dehydrogenase (SCHAD) could reveal that the body had been frozen.

3-Hydroxyacyl CoA Dehydrogenases↗
PubMed2001

[Indications of medical-legal autopsy in France].

The crime can be disimulate under differents masks: a natural death, an accident, a suicide. The doubt exists anytime; for everybody: forensic pathologist, magistrate and policemen. It is most of the fine impossible to be sure of the cause of the death without an autopsy. In case of maltreated children, only the autopsy can confirm that the death is in relation ship with au shaking child syndrom. When a practitioner signs a certificate of death, he must be very careful all time.

Accidents↗
PubMed2000

[Importance of medicolegal data for national cause of death statistics].

OBJECTIVE: The validity of French cause of death statistics largely depends on the transmission of the medical information reported on the dedicated part of the death certificate. Data referring to death causes are collected and analyzed at the Information Department on the cause of death (INSERM SC8). In major urban areas with one or more forensic institutions, it has been observed that the proportion of death certificates indicating ìno particular cause of deathî is higher than the national average. We therefore examined deaths occurring in 1996 in the Lyons region. METHODS: This retrospective study involved 5,208 deaths recorded in Lyons France in 1996. Complementary information on these deaths was obtained from INSERM SC8 and Lyons Medicolegal Institute. RESULTS: It was observed that a large portion of violent deaths occurring in this city in 1996 (more than 30%) were not recorded appropriately in the national statistics due to a lack of communication after autopsy. CONCLUSION: Considering the importance of epidemiology and suicide prevention in the national public health strategy, improved information transmission must be developed in the near future.

Accidents↗
PubMed2000

Unsuspected cardiac lesions associated with sudden unexpected perioperative death.

The retrospective analysis of 1700 forensic autopsies over 17 years (1981-97) following unexpected sudden cardiac death revealed a group of 50 cases that could have been related to surgery and/or anaesthesia. Patients were young with no history of cardiac disease. Surgery was performed for uncomplicated disorders, all classified as ASA 1. Cardiac arrest took place at induction of anaesthesia in 16% of cases, during surgery in 64% and at the end of surgery in 20%. Investigation and expertise reports ordered by the public prosecutor revealed none of the typical causes of death usually associated with surgery or anaesthesia. Pathological examination showed cardiac lesions in 47 cases: arrhythmogenic right ventricular cardiomyopathy in 18 cases, coronary artery disease in 10 cases, cardiomyopathy in eight cases, structural abnormalities of the His bundle in nine cases, mitral valve prolapse in one case, and acute myocarditis in one case. Identification of the cause of death of patients at low risk may provide major relief to the family of the patient and the medical staff.

Adolescent↗
PubMed1999

False rape: a case report.

A 16-year-old girl was admitted to the emergency department for sexual assault. The forensic examination revealed genital lesions of an age that were incompatible with her statements. She also presented extragenital lesions that resembled self-inflicted lesions. The reports of false rape allegations in the literature have all dealt with the motivations of the false victims. This case report is a reminder that an allegation of rape can be considered only on the basis of proof and not on speculation.

Abdominal Injuries↗
PubMed1999

Arsenic speciation in human organs following fatal arsenic trioxide poisoning--a case report.

The aim of this investigation was to study the distribution of arsenic species in human organs following fatal acute intoxication by arsenic trioxide. The collected autopsy samples of most organs were ground and dried, and the total arsenic was measured by electrothermal atomic absorption spectrometry (ETAAS). The arsenic species--inorganic arsenic, in the form of arsenite [As(III)] and arsenate [As(V)], and its metabolites [monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA)]--were quantified by ETAAS after extraction with methanol/water (1:1, by volume) and separation by HPLC. The results indicate that after acute intoxication, the liver and kidneys show the highest concentrations of total arsenic and that the total concentration in blood is 7- to 350-fold less concentrated than in organs. In all organs, As(III) is the predominant species, and MMA is more concentrated than DMA. MMA and DMA are more prevalent in lipidic organs (49% of total arsenic) compared with other organs (25% of total arsenic). As(V) was found in small quantities in the liver, kidneys, and blood.

Adult↗
PubMed1998

The perfect crime: myth or reality?

The primum movens of a forensic autopsy is to track down the crime. The perfect crime can be defined as one which will never be suspected and/or one for which the criminal will never be arrested. We have reported several cases that have been adjudicated or are being adjudicated, and we show how actual homicides could have been taken for accidental deaths, suicides, or even natural deaths.

Accidents, Traffic↗
PubMed1998

Thrombolysis with intravenous rtPA in a series of 100 cases of acute carotid territory stroke: determination of etiological, topographic, and radiological outcome factors.

BACKGROUND AND PURPOSE: Although new, large, double-blind, randomized studies are needed to establish the efficiency of intravenous thrombolysis, open trials of sufficient size may also provide novel data concerning specific outcomes after thrombolysis. METHODS: An open study of intravenous rtPA in 100 patients with internal carotid artery (ICA) territory strokes between 20 and 81 years of age, with a baseline Scandinavian Stroke Scale (SSS) score of <48 at entry was conducted. Inclusion time was within 7 hours after stroke onset. rtPA (0.8 mg/kg) was infused for 90 minutes, with an initial 10% bolus. Heparin was given according to 3 consecutive protocols. The SSS evaluation was done on days 0, 1, 7, 30, and 90. CT scan was performed before treatment, on days 1 and 7. Etiological investigations included echocardiography and carotid Doppler sonography and/or angiography. Outcome at 1 year was documented by SSS score, the modified Rankin Scale (mRS) score, and a 10-point invalidity scale. Multivariate logistic regression was used to identify predictors of poor versus good outcome. RESULTS: At day 90, 45 patients (45%) had a good result, defined as complete regression or slight neurological sequelae (mRS score of 0-1), 18 patients had a moderate outcome (mRS 2-3), and 31 patients had serious neurological sequelae (mRS 4-5). Six patients died, 2 with intracerebral hematoma after immediate heparin. Five of 11 patients (45.5%) treated between 6 and 7 hours had a good result. The overall intracerebral hematoma rate was 7%. Higher values of fibrin degradation products at 2 hours were observed in the subgroup with intracerebral hematomas. Significant predictors of poor outcome on multivariate logistic regression analysis were baseline SSS score of <15 (odds ratio [OR], 3.38; 95% confidence interval [CI], 1.07 to 10. 74; P=0.04), indistinction between white and gray matter on CT scan (OR, 6.59; 95% CI, 2.19 to 19.79; P=0.0008), and proximal internal carotid thrombosis (OR, 3.29; 95% CI, 0.99 to 10.95; P=0.05). CONCLUSIONS: Our study confirms the safety of intravenous rtPA at a dose of 0.8 mg/kg and suggests efficacy for this drug even within 7 hours. Outcome and hematoma rates were at least as favorable as for trials of therapy with a 3-hour time window. Subgroups with a poor prognosis include low baseline neurological score, baseline CT changes, and proximal ICA thrombosis. However, approximately 30% of patients with each of these characteristics show a good outcome, so their inclusion in future routine rtPA protocols is still justified.

Adult↗
PubMed1998

[Medical responsibility in the public hospital environment].

Patients can take action against physicians in front of different courts: Penal or Administrative Courts. Most of the time, the counsel chooses the legal proceedings. In the past, it was always necessary to prove the existence of malpractice; today, since 1990, the Administrative Court admits that it is no more necessary to find a malpractice, a damage and a link between the both. The medical expert valuation takes an important place in this matter. Nevertheless, the magistrate is not bound by the expert's report. In the last ten years several decisions have changed the usual rules in the matter of medical liability. Actually, in some special cases the Administrative Court admit a medical responsibility without malpractice, and so judges speak of medical risk.

Ethics, Medical↗
PubMed1996

[Access to care, precariousness and misery conditions].

Fraternity among humans is a social trait as old as the world. Among primitive men and in antiquity the most favoured came to the aid of the least favoured. Through the ages, this assistance has taken on various forms: food, money, and free medical care. With the Christian era, such aid became a charitable duty. The throne also came to the assistance of the poor, but here such actions alternated with those of the police, for poverty, engendered delinquency. The French Revolution opened a new era. Thereafter, the poor had certain rights upon society. This immense change led to our present social legislation.

Delivery of Health Care↗