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Deaths due to external causes, mainly suicide, are a severe public health problem in Brazil. Evidence shows that the tendency to impulsive behavior is exacerbated after alcohol consumption. The relationship between alcohol and suicide is poorly described in the medical literature. The study aims to analyze the relationship between victims' blood alcohol levels and suicides in some municipalities in Greater São Paulo, Brazil. We reviewed the data from the medical records of 805 necropsies performed at the Medical Legal Institute of Sao Paulo in Franco da Rocha, Brazil, from 2001 to 2017. The manner of death was established based on the result of police inquiry. Deaths due to suicide (n=41) were selected for the study. Descriptive statistics and Student t-test was applied when appropriate. The variables studied were sex, age, suicide mechanism, and blood alcohol level (BAC). In all cases we could not determine how much time the deceased consumed alcohol before suicide. Of the individuals analyzed, 85.36% were male, and 14.64% were female. The most prevalent age range for males was between 18 and 23 (19.5%). For females, it was between 12 and 23 years (33.2%). Most suicides (48.78%) were due to hanging, followed by self-poisoning (22.08%) and firearms (17.1%). 38 victims (92.68%) presented a positive BAC, over 0.3 mg/dl. The higher levels were in the group of suicide by hanging (2.3 mg/ml). Thus, alcohol intoxication is common among suicide victims, and it can contribute to the fatal outcome as a risk factor. Further studies are necessary for a better comprehension of the effect of alcohol on suicide victims. [ABSTRACT FROM AUTHOR]

The authors present the case of a 58-year-old man found hanging from a radiator by his shoelaces. The time of death was approximately 6 h before the body was discovered. An autopsy was performed approximately 24 h after the body was found, which revealed hemorrhages in the thoracic aorta at the junctions of the posterior intercostal arteries. Before autopsy, a routine whole-body CT scan was performed. Histologic examination of the aorta and the posterior intercostal arteries revealed a fresh hemorrhage into the tunica adventitia of the aorta. To our knowledge, there is no case description of such findings in hanged persons in the literature. Conclusion: Hemorrhages into the tunica adventitia of the junction of the posterior costal arteries may occur in association with suicidal hanging. The significance of these hemorrhages as a sign of vitality may be debated. [ABSTRACT FROM AUTHOR]

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The "faciesympathique" is a vital sign first described by Etienne Martin in 1899 referring to unilateral miosis, with or without ptosis, at the opposite side from the knot in hanging. This mark is scarcely reported in legal medicine textbooks and scientific papers. Moreover, when cited, it is referred to differently from its original meaning, both as unilateral contraction (miosis) and dilatation (mydriasis) of the pupil depending on the antemortem firmness of the ligature's neck pressure in hanging with little attention to ptosis. Due to the sympathetic nervous pathway supplying the eye, the review of this ocular sign in hanging supports the importance of revitalizing the "facie sympathique" in research on lesion vitality in mechanical asphyxia. [ABSTRACT FROM AUTHOR]

Hanging is a common type of death, and the role of the medical investigation of such deaths by a forensic pathologist not only requires the determination of the cause of death but providing information to assist in the determination of the manner of death. The forensic pathologist should be well versed in the spectrum of injuries known to be associated with neck compression, to document injuries known to be associated with hanging, but also to identify those that are inconsistent with self-inflicted hanging or that may suggest the involvement of a third party in the death. Comprehensive identification and correct interpretation of external and internal injury are crucial for the appropriate degree of police and coroner/medical examiner investigation. We present two cases of deaths believed to be caused by self-inflicted hanging that were observed to have unexpected unilateral dislocation of the temporomandibular joint identified on routine post-mortem computed tomography, without any evidence of involvement of a third party. This injury was unexplained and had not been previously observed at our Forensic Institute nor was it identified after a review of the published biomedical research literature. Issues regarding the cause of this abnormality, possible mechanisms, and the medicolegal significance of this finding will be discussed. [ABSTRACT FROM AUTHOR]

Copyright of Rechtsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The thyrohyoid complex and cervical spine fracture distribution patterns may reflect the knot position as the force distribution by the noose to different neck regions may vary depending on it. Recently, machine learning models (MLm) were used to classify knot position through these fractures. The contribution of aging on the fracture susceptibility is better demonstrated, but data on body weight (BW) and height (BH) significance on this is more doubtful and MLm did not consider them. A retrospectively obtained autopsy data on sex, age, BW, BH and distribution of greater hyoid bone horn (GHH), superior thyroid cartilage horn (STH), and cervical spine fractures in 368 suicidal hangings were analyzed by standard statistics to determine association of the anthropometrics (age, BW, and BH) with the fracture occurrence, and by machine learning algorithms to determine if body weight and height improved MLm classification of hanging cases with typical and atypical knot positions. In the sample, unilateral GHH fracture was significantly more common in atypical hangings, while isolated STH fractures were more common in typical hangings. Age was a predictor of GHH fractures and BW of STH fractures, but BW poorly correlated with their number. BH was not a predictor of any thyrohyoid fracture. On the ROC curve analysis, the MLm that considered BW and BH did not perform statistically better than MLm that did not consider them. The study indicates that body weight and height are of no detrimental value in assessing the thyrohyoid and cervical spine fracture patterns in suicidal hangings. [ABSTRACT FROM AUTHOR]

In response to a recent case report published in the International Journal of Legal Medicine entitled “A case of hemorrhage at the junctions of the posterior intercostal arteries—a vital sign?”, we wish to corroborate the findings of periadventitial hemorrhages at the junctions of the posterior intercostal arteries in cases of suicidal hanging and to reveal two other novel aortic lesions associated with hanging. In our ongoing prospective study, we identified six cases of aortic intimal ruptures among 257 suicidal hanging deaths, along with the novel observation of subintimal hemorrhages—both of which have not been previously documented in the forensic literature. Our findings suggest that the complex anatomy of the aorta and surrounding structures may increase the vulnerability of vascular structures during hanging, particularly under conditions of complete suspension. We propose that reported aortic lesions may serve as significant morphological indicators of hanging, thereby enriching its medicolegal investigation. To establish the diagnostic relevance of these findings, further prospective autopsy studies with larger sample sizes are warranted. [ABSTRACT FROM AUTHOR]

Although the overall suicide rate worldwide has changed minimally over the past 100 years, different trends have been observed over time in the USA, Australia, and New Zealand (NZ). However, few studies have focused on suicides in children (< 18 years), making evaluation of possible trends difficult. The last 20 years has also seen an increase in childhood obesity, eating disorders, and body image issues for children in many developed nations; however, few studies have shown whether a significant proportion of child suicides have an abnormal BMI. The current study evaluates child suicides (from 2008 to 2017) in South Australia (Australia), compared with the jurisdictions of Auckland (NZ) and Hennepin County (USA). Demographic data (age, sex, ethnicity), body mass index (BMI), the number of cases of youth suicide, and the method of suicide from these three regions were collected and analyzed. Across the 10-year period, the jurisdiction of Auckland had a downward trend, while Hennepin County and South Australia had increasing numbers of cases. The most common method of child suicide in all centers was hanging, occurring in > 80% of cases in South Australia and Auckland and 56% in Hennepin County. Hennepin County had a greater proportion of suicides using firearms (28%), compared to 1.9% in Auckland and 5.1% in South Australia. Unusual means of suicide were used less frequently by youth than previously. [ABSTRACT FROM AUTHOR]

Cases of suicidal hanging are a common death referred for medico-legal autopsy throughout the world. Although some advocate using postmortem computed tomography (PMCT) without traditional invasive autopsy (TIA) to investigate such deaths, others reject this approach. There is currently limited evidence to guide practice. In this context, the TIA reports and PMCT images of 50 cases of suspected suicidal hanging during an 11-month period were reviewed. The reviewers were blinded to the findings of the other modality. A Cohen's Kappa coefficient (K) was calculated to assess agreement between TIA and PMCT across a range of pertinent findings. This analysis demonstrated perfect agreement for identification of a ligature (K = 1.00) and a strong level of agreement for identification of a ligature suspension point (K = 0.832) but only a minimal level of agreement for overall ligature mark (K = 0.223). PMCT demonstrated a weak level of agreement for fractures of hyoid bone (K = 0.555) and thyroid cartilage (K = 0.538). Three probable fractures not identified at TIA were identified on PMCT. TIA was shown to be superior in the identification of intramuscular and laryngeal fracture–related haemorrhage/bruising whereas PMCT was superior to TIA in identifying body gas deposition. There was overall good correlation between the natural disease and trauma identified elsewhere in the body during the TIA and PMCT. The study demonstrates that PMCT can assist the investigation of suspected suicidal hangings. However, the accuracy of many findings is limited, and if it is used as an alternative to the TIA, potentially pertinent findings, such as fractures of the laryngeal cartilages, could be missed. [ABSTRACT FROM AUTHOR]

Background: Although suicide rates and methods used may vary according to society, gender, and age there are epidemiological studies reporting that suicide rates increase with advanced age in all societies, particularly accelerating after the age of 65 years. This study aimed to investigate the demographic data and suicide characteristics—such as the location and method, among others—of the elderly suicide deaths among forensic deaths between 2011 and 2020 in Denizli, Turkey. Results: It was determined that elderly suicides constituted 13.8% of all suicides and increased gradually over the years during the 10-year period. The vast majority of cases were male (82%). It has been observed that hanging is the most frequently used method. It is also noteworthy that although firearm suicide among men was the second most common method, women do not choose this method at all. The majority of elderly suicides (88.5%) in Denizli occurred in the home and its annexes. Conclusions: Suicide prevention programmes should promote the elderly to benefit widely from social and health services. Therefore, there is a need to include widespread home care services and firearms regulations in prevention programmes. [ABSTRACT FROM AUTHOR]

Purpose: To report the electrophysiological and neuroimaging findings in a patient who developed visual loss after attempted suicide by hanging. Methods: A 45-year-old male presented with bilateral visual loss and difficulty in walking following a suicide attempt by hanging six months ago. He underwent a complete ophthalmologic examination, posterior segment optical coherence tomography (OCT), various electrophysiological tests and neuroimaging. Results: His bilateral best-corrected visual acuity was logMAR 1.08. Intraocular pressures and ocular examination were normal except for bilateral temporal disk pallor. Macular OCT showed bilateral ganglion cell layer-inner plexiform layer complex thinning. Electroretinogram showed reduced b/a wave amplitude ratio in all the dark- and light-adapted International Society for Clinical Electrophysiology of Vision protocols in both the eyes. Pattern-reversal visually evoked potential (VEP) showed delayed latency of the P100 component in both the eyes. Electrooculography showed a normal light peak-to-dark trough ratio in both the eyes. Magnetic resonance imaging (MRI) brain showed chronic infarct and gliosis in both the occipital lobes. MR angiography showed pruning of P4 segments of both the posterior cerebral artery. Perfusion imaging showed reduction of perfusion in both the parieto-occipital lobes. Conclusion: Hanging survivors can develop visual loss after their recovery. The visual loss may be a result of simultaneous ischemic insult to the occipital lobe cortex, optic nerve and retina. [ABSTRACT FROM AUTHOR]

Background: Acute screening of pediatric strangulation and hanging injuries has evolved at many institutions to include cervical arterial vascular imaging. As current standards in pediatric imaging support less radiation exposure and increased imaging appropriateness, it is questionable whether vascular arterial injury is a true risk in this population. Objective: To determine the role of cervical vascular arterial imaging in the evaluation of pediatric hanging and strangulation injuries. Materials and methods: This is a retrospective study of patients who present at a Level 1 pediatric trauma center with a history of hanging and strangulation injuries. All relevant studies, including computed tomography (CT) angiography of the neck, contrast-enhanced neck CT, cervical magnetic resonance (MR) angiography, magnetic resonance imaging (MRI) and/or CT of the brain and cervical spine and associated clinical records, were reviewed. Results: Sixty-six patients were identified, 60 with vascular arterial imaging studies. No vascular injury was identified. Soft-tissue injury was noted in 20/66 (30%) patients and craniocervical injury was suspected in 2/66 (3%), but no cervical spine fracture was identified. Only 49 patients had brain imaging, with 7/49 (14%) demonstrating changes consistent with cerebral edema, which correlated negatively with survival (P<0.01). Conclusion: Vascular arterial imaging, particularly with CT angiography, performed in the pediatric population after hanging and strangulation injury resulted in no positive studies for cervical arterial injury. This study supports the need to reevaluate routine screening CT angiography in this study population. [ABSTRACT FROM AUTHOR]

Hanging by the neck is the leading method of suicide globally. The epidemiological risk factors for suicidal hanging can contribute to construct a socioeconomic and demographic profile of hanging victims. These profiles can then be used to identify individuals at the highest risk for committing suicide by hanging for referral to a suicide prevention program. The aim of this study was to describe the socioeconomic and demographic profiles of hanging victims in Bloemfontein, South Africa. A retrospective descriptive study was performed using data from the Bloemfontein Forensic Mortuary, for the period 1 January 2008 to 31 December 2015. In total, 9085 autopsies were performed during the study period; 355 (3.9%) were hanging victims. The median age of the victims was 31.4 (range 11–78) years, with 138 (38.9%) cases being 21–30 years of age. Three hundred and twenty-three (91.0%) of the victims were male, 227 (63.9%) were single, 201 (56.6%) were unemployed, and 129 (36.3%) completed their high school education. The most common location where the hanging occurred was at home. Single, unemployed males 21–40 years of age were found to have the highest risk for committing suicide by hanging. The group at the lowest risk were married and employed individuals older than 60 years, who had a tertiary education. We report the first socioeconomic and demographic profiles of individuals who commit suicide by hanging in central South Africa, emphasizing the need for a National Suicide Prevention Program via a multidisciplinary team approach. [ABSTRACT FROM AUTHOR]

A 41-year-old man was found by his wife in an atypical hanging situation in their apartment. As there was a known previous psychiatric illness and a history of suicide attempts, the investigative authorities assumed this case was a suicide. However, the autopsy revealed numerous findings that are unusual for a suicidal atypical hanging, including numerous cuts on the face, the arms and the penis. According to his wife, the deceased suffered from Asperger's syndrome with auto-aggressive behavior. He had allegedly injured himself with household scissors in the days before his death and had hit himself numerous times in the face the night before his death. His wife also revealed that she would injure him with scissors at his request. Even though the observed injury pattern in this case contradicted a self-infliction, the information given by the wife about the chronology of the occurrence of injuries could be reconciled with the findings of the immunohistochemical estimation of wound age. The circumstances that led to the hanging remained unresolved. [ABSTRACT FROM AUTHOR]

Autoerotic accidents are well-known occurrences in forensic casework. Reports about unintentional deaths in a sexual context involving other persons are much rarer. Three cases of fatal incidents related to asphyxiophilia during consensual BDSM activity are reported. Two men died while visiting a dominatrix, the third one in the presence of a male casual sexual partner. Paraphernalia associated with BDSM/fetishism were found at the scene in all cases. Autopsy findings were compatible with death by strangulation. The cases are compared with published autoerotic accidents and similar unintentional deaths involving other individuals. The difficulties concerning the forensic assessment and reconstruction of the cases are discussed. [ABSTRACT FROM AUTHOR]

The concept of autoerotic asphyxiation refers to the use of devices or substances intended to enhance one's arousal by inducing cerebral hypoxia, which can involuntarily lead to death. Although in most cases death occurs accidentally, it is nonetheless true that the same devices might be used by the practitioners in order to attempt suicide. The case of a 34-year-old practitioner of autoerotic asphyxiation found dead in his apartment with bondage-like ligatures and masking is reported here. The case raised some issues concerning the accidental or suicidal nature of the act. The aspects taken into account in the management of the case are discussed, along with a compared approach to the data provided by literature. [ABSTRACT FROM AUTHOR]

Complete decapitation as a result of a suicidal hanging is rarely observed in forensic practice. The authors report a case of a 38-year-old man hanging from a bridge with a 4.2 m nylon rope. The man, weighing 70 kg, was wearing a 6.5 kg rucksack. The headless body was found lying in the river below the bridge and his head was found the next day in the river 6 m away from the bridge. Autopsy findings recorded a regular and concentric skin abrasion pattern and cervical spine transection between C2 and C3. Radiologic study depicted C2-C3 neck transection and the fracture of the left lamina and the spinous process of the axis. The force applied to the neck and the kinetic energy were calculated. [ABSTRACT FROM AUTHOR]

Purpose: Previous experiments in rats have indicated that there are histological changes in skeletal muscle in drowning deaths; these changes include muscle fibers that contain ragged red fibers (RRF). The purpose of this study was to examine whether these changes also occur in humans. Methods: Histologic and histochemical examinations of three muscles (diaphragm, pectoralis, and psoas) were performed on 24 cadavers with three different causes of death: 8 drowning, 8 hanging, and 8 sudden cardiac disease. Muscle samples were stained with hematoxylin-eosin, MGT, nicotinamide adenine dinucleotide-tetrazolium reductase, succinate dehydrogenase, ATPase, and acid phosphatase via standard staining procedures. Results: There were statistically significant differences in the detection of RRFs in these cohorts. Additionally, several other cytoarchitectural changes (whorled and core-like fibers) were observed in the diaphragm in the drowning cohort and to a lesser extent in the hangings. These structural abnormalities were not observed in the sudden cardiac disease deaths, thus suggesting a common mechanism for the production of these muscular changes that is not shared in the cardiac death group. The mechanism is most likely intense hypoxia and mechanical trauma of the respiratory muscles in the setting of active blood circulation with intense muscle contraction. Conclusions: Our results confirmed that there are histological changes in the diaphragm in drownings and, to a lesser extent, in hangings. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the added value of postmortem magnetic resonance imaging (MRI) compared to postmortem computed tomography (CT) and autopsy in cases of fatal hanging. In addition, the study analyzed the strengths of each examination method regarding typical injuries in these cases. We investigated a cohort of 25 decedents who underwent CT, MRI and autopsy. Two radiologists assessed all MR images of the head and neck as well as the corresponding CT images. The results were compared to autopsy findings by retrospectively analyzing the autopsy reports. Postmortem MRI revealed intramuscular hemorrhages in a large number of cases, however, autopsy did not confirm all of the detected hemorrhages. CT and autopsy detected fractures in several cases, whereas MRI showed a fracture in just one single case. Other previously described vital signs and relevant findings, such as fracture-related gas bubbles, soft tissue emphysema or pneumomediastinum, were observed in only a few individual cases. MRI provided added diagnostic value in the detection of soft tissue injuries and lymph node swelling in fatal hangings. As an adjunct to autopsy, postmortem MRI may reveal additional hemorrhages, which might be missed at autopsy. Since standard MRI demonstrated low sensitivity for the detection of fractures, an additional imaging modality or autopsy is required to overcome this limitation. [ABSTRACT FROM AUTHOR]

This paper presents an unusual complex suicide case that died of nicotine addiction. The deceased was a 40-year-old male who was found lying dead on the floor in his room. In external findings, many incision wounds on his forearms and skin discoloration with epidermolysis on his cervical region could be seen. In the room, a blood-stained scissors and electric cord hanged on the exercise bike were found. Moreover, nine cigarette residues which were only the filter part and empty bottle of coffee were found on his side. At autopsy, we found that those injuries were not serious enough to lead him to the death. Toxicologically, caffeine, nicotine, cotinine, mirtazapine, and olanzapine could be detected, and the concentrations of nicotine were 3.740, 2.140, 3.100, and 451.100 μg/ml in cardiac blood, peripheral blood, urine, and stomach contents, respectively. These concentrations were evaluated as the fatal levels, and the cause of his death was diagnosed as acute nicotine intoxication. [ABSTRACT FROM AUTHOR]

Suicide by ligature strangulation/hanging inside vehicles is uncommon, and only few cases have been reported in the literature. This study aimed to conduct a comprehensive review of reported cases of suicide by ligature strangulation/hanging inside vehicles, analyzing the features of the death scene, of the ligature and furrow, autopsy findings, and causes of death. The comprehensive review was performed following the PRISMA guidelines by using the most common scientific databases. According to inclusion criteria, a total of 20 cases of vehicle-assisted strangulation/hanging were reviewed: 13 cases were assessed as ligature strangulation resulting in 7 complete decapitations and 7 other cases as hanging. All victims were young or adult males, except for one 48-year-old female. Death was assessed as suicide in all cases, except for a possible accidental autoerotic death. In 8 cases, a history of depression or other psychiatric disorders was reported. Toxicological analysis were positive in 7 cases. Hard ligature materials (nylon, steel, plastic, hemp ropes) were used in most cases, but only 13 cases had a well-demarcated furrow. In 2 cases, no internal findings of asphyxia were found. An additional case of ligature strangulation inside a motor vehicle off is also presented, where no autopsy findings of asphyxia were observed, except for a broad pale furrow and monolateral conjunctival petechiae. This study highlights the challenges in classifying suicidal hanging and ligature strangulation in motor vehicles. [ABSTRACT FROM AUTHOR]

Geocaching is a high-tech treasure-hunt game that uses GPS-enabled devices or smartphone apps to find cleverly hidden treasures marked by GPS coordinates that are shared online. Like any other outdoor activity, geocaching is associated with risks of falls, environmental injuries, asphyxia and natural events. Despite the apparent risk of serious injury and potential death, no relevant reports aiming to identify the characteristics of geocaching-related deaths have appeared in the medical literature to date. We report a case of an experienced geocacher who was found suspended from a bridge pillar with his climbing ropes and helmet straps twisted across his face and neck; he had apparently attempted to rappel from a 30-m-high railway bridge to find a geocache. A recording of the rappelling sequence from the camera found on the chest strap assisted in reconstructing what had actually happened. An autopsy confirmed that the cause of death was asphyxiation due to hanging, with the occlusion of the external airways and positional asphyxia serving as contributory factors. The salient features of this unusual case are discussed, and several forensic issues of geocaching are highlighted. [ABSTRACT FROM AUTHOR]

Hanging is one of the most common methods of suicide, and, although it is known that decomposition and patterns of insect fauna colonization of hanging cadavers differ from those of cadavers decomposing on the ground, these differences have only been sparsely studied in Europe so far. We studied the decomposition and insect colonization patterns of ten pig (Sus scrofa domestica) carcasses in a spruce forest near Neuchâtel, Switzerland, over a 32-day period in summer 2013 (July 1st - August 2nd). Five pig carcasses were suspended horizontally in metal cages one meter above the ground and five carcasses were placed directly on the ground. The species occurrence and abundance of Coleoptera and Diptera recovered from passive pitfall traps and collected manually on the carcasses were recorded. Indicator species of decomposition stages and suspended vs. ground cadavers were identified by Indicator Value (IndVal) analysis. The ground carcasses decomposed significantly faster than the suspended carcasses. Coleoptera and Diptera communities differed significantly over time, between treatment, and the treatment effect varied over time. Diptera were evenly distributed among the two treatments. Coleoptera were more abundant and less differentiated on the ground carcasses and represent better indicators of cadavers decomposing on the soil as well as decomposition stages. Our results suggest possible applications such as evaluating if a hanged cadaver has been dropped to the ground, or inversely if a cadaver first lying on the soil has later been hung to fake a suicide. However differences among studies suggest possible effects of meso-climate determined by habitat which should be explored further. [ABSTRACT FROM AUTHOR]

Several articles have described the use of postmortem computed tomography (CT) and postmortem magnetic resonance imaging (MRI) in forensic medicine. Although access to CT scanners and, particularly, access to MRI scanners, is still limited for several institutes, both modalities are being applied with increasing frequency in the forensic setting. Certainly, postmortem imaging can provide crucial information prior to autopsy, and this method has even been considered a replacement to autopsy in selected cases by some forensic institutes. However, the role of postmortem imaging has to be assessed individually according to various injury categories and causes of death. Therefore, this systematic review focuses on the role of postmortem CT and MRI in cases of hanging and ligature and manual strangulation. We assessed the most common and relevant findings on CT and MRI in cases of strangulation and compared the detectability of these findings among CT, MRI and autopsy. According to the available literature, mainly fractures of the hyoid bone or thyroid cartilage were investigated using postmortem CT. Compared to autopsy, CT demonstrated equivalent results concerning the detection of these fractures. A currently described "gas bubble sign" may even facilitate the detection of laryngeal fractures on CT. Regarding the detection of hemorrhages in the soft tissue of the neck, postmortem MRI is more suitable for the detection of this "vital sign" in strangulation. Compared to autopsy, postmortem MRI is almost equally accurate for the detection of hemorrhages in the neck. Another "vital sign", gas within the soft tissue in hanging, which is hardly detectable by conventional autopsy, can be clearly depicted by CT and MRI. The number of cases of manual and ligature strangulation that were investigated by means of postmortem CT and MRI is much smaller than the number of cases of hanging that were investigated by CT and MRI. Likewise, judicial hanging and the hangman's fracture on postmortem imaging were described in only a few cases. Based on the results of this systematic review, we discuss the additional value of CT and MRI in fatal strangulation compared to autopsy, and we reflect on where the literature is currently lacking. [ABSTRACT FROM AUTHOR]

A 28-year-old driver was found dead in his car after impact with a truck. At the scene he was seated in the driver's seat partially hanging out of the vehicle with the sash component of the seatbelt tightly pressed into his neck. At autopsy there was evidence of neck compression with bilateral conjunctival petechial hemorrhages and fracture of the right superior horn of the thyroid cartilage. Limb fractures and internal injuries were not associated with significant hemorrhage. There was no evidence of brain trauma. Death was, therefore due to neck compression from the seatbelt demonstrating an additional rare lethal mechanism that may be encountered in vehicle crashes. External bruises and abrasions may not be present around the neck due to padding from clothing, however conjunctival petechiae and neck injuries are supportive of the diagnosis. [ABSTRACT FROM AUTHOR]

In some rare cases of hanging, the so-called 'hangman's fracture' is observed. This occurs when a fall from height is associated with hanging, e.g. capital executions. We describe the case of an 81-year-old man who committed suicide by jumping off a bridge, with a rope wrapped around his neck. The combination of hanging and falling caused a series of bone fractures to the cervical spine and the hyoid bone, leading to dislocation of the vertebral column and multiple bone fragments, producing peculiar patterns. Computed tomography also identified a transverse full-thickness fracture of the dens, which is a rare event. This case highlights specific injuries associated with the combination of hanging and falling, and underlines the importance of a multidisciplinary approach in terms of radiological examination and complete autopsy. [ABSTRACT FROM AUTHOR]

On 30th March 1902 Police Constable George Doyle and Carnarvon Station manager Albert Dahlke were allegedly gunned down at Lethbridge’s Pocket in Central Queensland. Approximately 90 kg of ash and burnt human remains with articles belonging to the two men were later found in saddle bags left at the scene on a police horse. Subsequently two local cattle and horse thieves, Patrick and James Kenniff, were convicted in the Queensland Supreme Court of the wilful murder of Constable Doyle. Patrick was executed by hanging on 12th January 1903 and James had his sentence reduced to life imprisonment with hard labor. A number of irregularities were subsequently raised about the trial including the use of a “special” jury and the reliability of evidence from a witness who did not actually see the event. Forensic issues to be explored involve the accuracy of the descriptions of the carbonized material, whether the remains were actually those of Doyle and Dahlke, and whether the victims were dismembered before burning, as was alleged by the prosecution. [ABSTRACT FROM AUTHOR]

We performed external autopsies and examinations on two inmates who had committed suicide by hanging themselves with their underwear and using the window bars of their cells as ligature points after they had been placed in solitary confinement. In one case, the inmate had even been deprived of her clothing (with the exception to her underwear). Underwear has been rarely described as a means for self-harm and, to the best of our knowledge, no previous study has focused on cases of prison suicides committed using this garment, even though it is available to every inmate. The two cases were very similar; both inmates were young, physically aggressive and in their first week at a new facility; both had been affected by mental disorders, had been prescribed psychotropic medications and had histories of psychiatric hospitalisation. In each case, the psychiatric evaluations had highlighted significant suicidal risk. We discuss these two cases in an attempt to describe the complexity of and contradictions within the management of suicidal inmates at correctional facilities. We aim to propose new strategies and emphasise the need to introduce evidence-based standardised protocols over inhumane, ineffective and simplistic punitive measures in the management of these individuals. [ABSTRACT FROM AUTHOR]

A gunfight between police and a gang of men led by the self-styled "Captain Moonlite", a.k.a. George Scott, occurred on 16th November 1879 at a farmhouse near Wantabadgery Station in the colony of New South Wales. The skirmish resulted in the deaths of two bushrangers and one police officer. As a result, Captain Moonlite and Thomas Rogan were hung in Sydney's Darlinghurst Gaol on 20 January 1880 for the murder of Constable Edward Webb-Bowen. Culpability for firing the fatal shot, however, has remained a source of controversy. Information obtained from an analysis of historical records was used to guide an archeological excavation at the scene of the shooting in which Terrestrial Laser Scanning (TLS) technology was employed to produce a digital (3D) terrain model of the siege location. Utilizing the terrain model, the relative positions of Moonlite, Webb-Bowen, and the other gang members were established with possible projectile trajectories plotted. This, in combination with inquest evidence from a gun maker and the medical practitioner who examined Constable Webb-Bowen's wound, indicates that the most likely shooter was Gus Warnicke, aged 15 years, the youngest member of the gang, who was also killed in the exchange of fire. [ABSTRACT FROM AUTHOR]

Purpose: Laparoscopic surgery has gained the acceptance of the hepatobiliary surgical community and expert teams are now advocating major laparoscopic liver resections (LLRs). In this setting, the liver hanging maneuver (LHM) has been described in numerous series. We conducted a systematic review to investigate the effectiveness of the LHM in LLR. Methods: We performed an electronic literature search using PubMed, EMBASE, and COCHRANE databases. The final search was carried out in December, 2015. Results: We found 11 articles describing a collective total of 104 surgical procedures that were eligible for this study. Laparoscopic LHM was used in LLR for both benign and malignant conditions, and also in living donor liver transplantation (LDLT). The LHM was used mainly in right hepatectomy and only two authors reproduced the original LHM. We investigated the intraoperative parameters, preservation of postoperative liver function, and oncological outcomes. The clear benefit of using the LHM in LLR is for better identification of the parenchymal transection plane with less blood loss. The other benefits of LHM could not be corroborated by solid data on its positive value. Conclusions: In view of the data published in the literature, our findings are not strong enough to support the systematic use of LHM in LLR. [ABSTRACT FROM AUTHOR]

Suicide is a catastrophic event to both families and communities yet it is potentially preventable. This study aims to determine incidence and patterns of suicide in children and young adolescents in our region, raise awareness of this entity as a potentially preventable cause of death in this age group, and identify its possible associated risk factors. We retrospectively reviewed suicide cases presenting as sudden unexpected death in children and adolescents that underwent coronial post-mortems at our institution. This is the largest pathological review of completed suicide in children and young adolescents within a single institution in the United Kingdom. We identified 23 suicide cases during a 12 year period from 2003 to 2015, in which 18 cases (78%) were male and 5 cases (22%) were female. The age range was from 8 to 16 years (mean age 12.82 +/− 2.52 SD). With the exception of one case, all of the victims were Caucasian. The majority, 19 cases (81%), were found dead inside their place of residence, 15 of whom were discovered in their own bedrooms. Twenty-one cases (91%) died from neck compression due to hanging; 6 cases (26%) had used the cord of a dressing gown and 5 (22%) opted to use a belt as the ligature. Two cases (9%) that died from multiple-drug toxicity were female. In 7 cases (30.5%) there was evidence of self-harm and in 3 cases (13%) there was a history of previous suicide attempts. Petechial hemorrhages were found at autopsy in more than half of hanging victims and only three cases (14%) displayed dual distribution of post-mortem hypostasis (back and legs). Seven victims (30.5%) left some form of suicide message to family members and friends, 2 of which wrote the message on their arm. Parental separation, conflict with parents, and depression, were common amongst decedents prior to committing suicide. Substance abuse was uncommon in suicide within our cases. Valuable information is available from thorough review of suicide data in children and young adolescents from a single institution. Pathologists and clinicians can play crucial roles in identifying potential risk factors that may contribute to prevent future deaths. [ABSTRACT FROM AUTHOR]

Acute pulmonary emphysema (APE) has been described in cases of mechanical asphyxia such as ligature or manual strangulation but not in cases of hanging. In this study, we wanted to verify by morphometric digital analysis of lung tissue whether APE occurs in death by hanging. We investigated 16 cases of hanging (eight complete, eight incomplete), 10 cases of freshwater drowning (positive control group), and 10 cases of acute external bleeding (negative control group). Tissue sections were obtained from each pulmonary lobe. For each slide, five fields were randomly selected. The area of every alveolar space was measured by image analysis software. The mean alveolar area (MAA) was calculated for each group. In incomplete hanging, MAA was significantly higher than that observed in complete hanging and similar to the one observed in freshwater drowning. APE in cases of incomplete hanging can be considered as a sign of vitality. The high number of conditions that can cause alveolar distension (that were excluded in this study) limits the applicability of this vital sign in the routine forensic practice. [ABSTRACT FROM AUTHOR]

Suicide is a multifaceted phenomenon often comprising the collaboration of a number of different risk factors, including psychiatric illnesses and adverse life events occurring during the course of the life. Suicide has a great public health effect. Suicide ranks among the top ten causes of death among individuals of all age groups in most developed countries. Objective To investigate suicidal deaths, over a period of two years in Eastern Province, Saudi Arabia. Methods A retrospective study was carried out on 145 suicide cases examined at the Forensic Medicine Center in Dammam, Kingdom of Saudi Arabia, since start of January 2012 till end of December 2013. Results Of the investigated 145 suicidal cases, 122 (84.1%) were males and 23 (15.9%) were females, and the ratio of the males to females was 5.3:1. Around 38.6% of the studied subjects were in their third decade. The largest percentage of suicides were among non-Saudis (116, 80%), and the highest is the Indian population (65, 45%), followed by Saudi nationals (29, 20%). Suicide by hanging was the most common method (110, 75.9%). The highest incidence of cases was encountered in Dammam ( N = 48, 33%) followed by Khobar, Jubail and Qatif with equal number of fatalities per each region ( N = 19, 13%). Conclusion In conclusion, extensive socio-demographic variability exists across different suicidal cases. Acknowledgement of this variability may help to tailor prevention efforts in different parts of the world. [ABSTRACT FROM AUTHOR]

The present study was carried out between 2010 and 2013, a total of 7968 Autopsies were conducted of which 3.31% ( n – 264) cases were deaths due to hanging. The most preferred ligature materials were Stole ( n – 79) and Bed spread/Sari ( n – 68). In 88% of the cases, hanging was complete. Females ( n – 136) and males ( n – 128) were equally affected. The major age group involved in both the sexes was of 31–40 years, contributing to 50.76% ( n – 136) of the self suspension. In 80.58% ( n – 213) of the incidents, ligature mark showed discontinuity (incomplete). A Slip type of knot was used in majority of the noose, contributing to 97.73% ( n – 258) of the suspensions. In 87.88% ( n – 232) of hanging an oblique shaped ligature mark was noticed. The horizontal and near oblique ligature marks were seen only in cases of partial suspension. In 95.45% ( n – 252) of the cases, the ligature mark showed blackening of the skin (friction burn). Only 4.54% ( n – 12) showed intact skin. The outer layer of the skin over the ligature mark showed displacement in majority of the cases. Married victims contributed to 70.45% of cases. Domestic issues were the commonest reason ( n – 82) for self suspension, of which female ( n – 68) formed the majority of victims. In 70.83% ( n – 187) of cases damage to neck muscle fibers and hemorrhage at the Sternal end of the Sternocleidomastoid muscle were present. In 85.61% ( n – 226) of cases the cervical vertebra was intact. In 52.27% ( n – 138) of the cases the internal carotid artery showed transverse tear. In 99.42% ( n – 248) cases the thyroid cartilage was found intact. The hyoid bone was damaged in 6.06% ( n – 16) of the victims. Majority of the victims, 59.09% ( n – 156) belonged to low socioeconomic class. [ABSTRACT FROM AUTHOR]

Copyright of Rechtsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rechtsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: This is a 5-year retrospective study including all autopsy reports of suicidal hanging deaths in Dammam city, Eastern province in Saudi Arabia. Hematoxyline and eosin stain has been used for the microscopic description of the three tissue biopsies that have been selected in this study. Other confirmatory tests have been performed for certain cases, when needed. The total number of cases was 62; 85.5% of the deceased were males, while 15% were females. The majority of cases (53%) were among the age group of 20–30 years. Hemorrhage of the sternocleidomastoid muscle and carotid intimal tear were both found in 90% of cases. Thyroid congestion was detected in 91%, and Hashimoto’s thyroiditis was diagnosed in 2% of studied cases. The study discusses the importance of biopsy examination in hanging deaths and compares its results with other similar previous studies. [ABSTRACT FROM AUTHOR]

The hanging mark is the most relevant feature of hanging and its characteristics are well known in the literature. Most of the time, the ligature material is not available during autopsy examination in hanging. Hence, the features of the ligature material are not submitted to systematic analysis. However, the type and position of the knot plays an important role in the mechanism of death and autopsy findings in hanging. Out of the total hanging deaths, complete hanging was seen in 67.7% of the cases, but a typical hanging was noted in only 10.2% of the cases. The commonest type of ligature material used for ligation around the neck was nylon rope followed by odhni and jute rope. The fixed knot was noted in 64.6% of the cases and a running (slip) in 21.3% of the cases. The commonest position of the knot was at nape of the neck, followed by the left side of the neck at mastoid process. The number of turns/loops of a ligature around the neck was one turn in 72.4% and two in 25.2% the hanging deaths. Most victims committed suicide by hanging in their homes, and the commonest ligature points were trees, flowed by beams and ceiling hook/fans. [ABSTRACT FROM AUTHOR]

This article examines how two of Japan's largest newspapers frame death penalty issues. Through a content analysis of 7,153 Asahi and Nikkei articles in the 66-month period from January 1, 2007 to June 30, 2012, 11 death penalty frames are identified: inevitability, atonement by dying, atonement by living, victims' rights and emotions, human rights, miscarriage of justice, calls for discussion, life without parole, deterrence, public support, and retribution. In addition to frames, we examined who the main voices are in each article on capital punishment. We found that avoidance and ambivalence are the two main approaches taken by Asahi and Nikkei to cover death penalty issues, and the most surprising finding is the high salience of atonement as a frame for thinking about capital punishment. In Japan, atonement is used to justify (atone by dying) and oppose (atone by living) the death penalty. Although atonement by living in prison and atonement by dying at the gallows imply radically different outcomes, the flexibility of the atonement frame may suggest new possibilities for Japan's anti-death penalty movement. [ABSTRACT FROM AUTHOR]

Autoerotic deaths are defined as accidental deaths that occur during individual, solitary sexual activity in which some type of apparatus that was used to enhance the sexual stimulation of the deceased caused unintentional death. In the Western countries, the incidence of these deaths is of approximately 0.5 deaths per million inhabitants per year. In this paper, five myths about autoerotic death are explored. Myth #1: the manner of death in autoerotic death is usually accidental but could also be suicidal or natural (reality: by definition, all autoerotic deaths are accidental). Myth #2: autoerotic death can happen with a sexual partner (reality: by definition, autoerotic deaths are solitary activities). Myth #3: an escape mechanism must be found at the scene (reality: there is no escape mechanism to be observed at the scene in the majority of autoerotic deaths). Myth #4: all autoerotic deaths are related to asphyxia (reality: not all autoerotic deaths are related to asphyxia). Myth #5: masturbation is an important component of all autoerotic activities and therefore all autoerotic deaths (reality: evidence of masturbation at the scene is a rare finding). [ABSTRACT FROM AUTHOR]

Abstract: Suicide has been around for as long as human society, ranking among the top 13 causes of death in all ages worldwide and continues to challenge our collective wisdom. The present study is a retrospective study evaluating suicide cases in Lucknow, capital of Uttar Pradesh and one of the largest cities in India, between Jan 2008 and Oct 2012. There were 5204 cases with 2946 male (56.61%) and 2258 female (43.38%) victims, between ages 20 and 60years; suicide rates ranged from 21.55 to 24.23 per 100,000 population. The method of suicide was different between male and female victims, as male victims tried to use more violent methods than females. The present study showed that suicide rates have increased since 1994, indicating a grave problem that needs to be solved. [Copyright &y& Elsevier]

Abstract: A retrospective study was carried out on 126 suicide cases autopsied at the Forensic Medicine Center in Dammam, Kingdom of Saudi Arabia, from 2000 to 2003. Of these 126 cases, 109 (86.5%) were males and 17 (13.49%) were females, and the ratio of the males to females was 6.4:1 with the highest ratio in 2000 (10:1). Around 88% of the studied subjects were in their third or fourth decades. The largest percentage of suicides were among non-Saudis, and the highest is the Indian population with 54 cases (42.85%), followed by Saudi nationals (15.07%) and then ten other nationalities. Suicide by hanging was the most common method (89.68%), followed by firearms in only eight individuals (5.55%) and other four methods of suicide. Family troubles were documented in 5.5% of cases. While a history of psychological illnesses was more than double this figure, 13.49%. Suicide notes were discovered at the scene of death in five cases. Postmortem blood alcohol was found in only 5.55% of cases, and toxicological analysis resulted in the detection of amphetamine and cannabinoids in 3.69% and 1.587% of them, respectively. There was an unstable curve in suicide rate in Dammam; in 2000 there were 33 cases, with fewer in 2001, more in 2002, and the fewest in 2003. [Copyright &y& Elsevier]

Planned complex suicide is defined as the combination of more than one method of suicide, previously planned by the victim, to prevent failure of the first method. Herein, we present a case of planned complex suicide, committed by a black powder muzzle loading handgun and hanging. A 39-year-old man was found dead in the bathroom of his flat, hanging by the neck with a huge atypical gunshot entrance in the right temporal region of his head with extensive backspatter. The skin defects, as well as soft tissues in the subcutaneous pocket undermining, were heavily burnt. Along the wound canal were multiple bone fragments, and at the end of the path at the left temple was an embedded lead ogival projectile with a cross shaped artificial incision at its tip. The hanging was incomplete. There were no fractures of the hyoid bone and laryngeal cartilages. Cervical muscles and vessels were intact. Simon's sign was negative. Signs of asphyxia were not present. This is the first reported case of complex suicide with a black powder derringer and manipulated projectile. [ABSTRACT FROM AUTHOR]

Introduction: Gender differences in suicide completion rates have been attributed to the differences in lethality of suicide methods chosen by men and women, but few empirical studies have investigated factors other than demographic characteristics that might explain this differential. Methods: Data from the 621 suicides in Summit County, Ohio during 1997-2006 were disaggregated by gender to compare known correlates of suicide risk on three methods of suicide-firearm, hanging and drug poisoning. Results: Compared to women, men who completed suicide with firearms were more likely to be married and committed the act at home. Unmarried men were likelier to hang themselves than married men, but unmarried women were less likely to hang themselves than married women. Men with a history of depression were more likely to suicide by hanging, but women with depression were half as likely to hang themselves compared to the women without a history of depression. Men with a history of substance abuse were more likely to suicide by poisoning than men without such history, but substance abuse history had no influence on women's use of poisoning to suicide. For both sexes, the odds of suicide by poisoning were significantly higher for those on psychiatric medications. [ABSTRACT FROM AUTHOR]

In 2006 the US National Vital Statistics Report recorded 33,300 suicides in the United States, of which hanging, strangulation and suffocation combined to account for 7,491 (22.5%) of the cases. Self strangulation by ligature is uncommon and in the majority of cases, scarves, belts, neckties and rope are used. We report three instances where cable ties were secured around the neck in order to commit suicide. All had a history of depression. One was a 37-year-old man who used a belt to complete the act after an unsuccessful attempt to use cable ties. The second was a 63-year old woman who used multiple cable ties to accomplish her goal. In the third case a tensioning tool was used by a 54-year old man to tighten a cable tie around his neck during self strangulation. Utilization of a tool to tighten the cable ties has not previously been reported. [ABSTRACT FROM AUTHOR]

We describe and discuss haemorrhages discovered in the back and auxiliary breathing muscles of a population of cases of suicidal death by hanging. Intramuscular haemorrhages were present in approximately 30% of the cases. Pre-existing illnesses with an increased tendency to bleed or an anticoagulant medication did not exist; corresponding skin and subcutaneous fatty tissue structures were intact in each case. In cases of death by hanging, the occurrence of muscle haemorrhages of this type may be explained pathophysiologically by the occurrence of increased respiratory exertions and/or seizures during the hanging process. Although the results of our study do not indicate an obligatory autopsy finding, evidence of internal haemorrhaging into the back and auxiliary breathing muscles may be called upon following consideration of differential diagnostic aspects as a further diagnostic indication of vital hanging. [ABSTRACT FROM AUTHOR]

We describe and discuss autopsy findings of bowel wall hemorrhage in a study population comprising cases of suicidal death by hanging. Intramural hemorrhages were seen in approximately 12% of the cases examined; no preexisting bowel diseases were found. In hanging deaths with a longer agonal phase, we opine that abdominal congestion during the hanging process provides a viable pathophysiological explanation for bowel wall hemorrhage. Though we are not dealing here with obligatory autopsy findings, the detection of bowel wall hemorrhage might be used as another sign of vital hanging after considering differential diagnostic aspects. [ABSTRACT FROM AUTHOR]