Penile strangulation: report of a fatal case

Penile strangulation or entrapment is an unusual entity that requires urgent treatment due to its potential complications. Several cases have been reported in the medical literature, some of them describing serious injuries such as necrosis, gangrene, and amputation of the penis. However, as far as we know, no fatal cases have been described before. We present the death of an adult male secondary to the complications due to penile strangulation with a plastic bottle neck. The time of incarceration was unknown, but according to a witness it could be about 10 to 14 days. The findings of autopsy were penile strangulation, necrosis of the penis, acute pyelonephritis, and bronchopneumonia. The subject's refusal to ask for medical help was the cause of this atypical evolution.     

Suicidal ligature strangulation: case report and review of the literature

An unusual case of suicidal ligature strangulation is described. The victim is a 42-year-old white male who devised a very elaborate ligature mechanism comprised of thin wire, a plastic tub filled with water, and a combination of other common objects to commit suicide while in custody. A brief review of the literature follows.     

Fatal and non-fatal bilateral delayed carotid artery dissection after manual strangulation

Carotid artery (CA) dissection and/or thrombosis may occur in a number of medical and forensic relevant situations. However, post traumatic carotid artery dissection is considered rare, and often underestimated due to possible delayed presentation. We describe two cases of carotid artery dissection following strangulation with delayed symptoms as well as discuss medical diagnostic problems and their forensic implications.     

Rapidly growing internal carotid artery aneurysm after amphetamine abuse: case report

Amphetamine is one of the most common illicitly abused drugs in certain countries. It is a potent sympathomimetic that may lead to vascular events, including stroke and myocardial infarction. Most reports of stroke after amphetamine abuse are of intracerebral hemorrhage. In this report, the authors describe a ruptured aneurysm of the right internal carotid artery in a young man with amphetamine abuse. It grew rapidly within 2 weeks. Surgery revealed fibrosis and fibrinoid necrosis around the aneurysm. The aneurysm was successfully embolized with Guglielmi detachable coil. A rapidly growing aneurysm in the major intracranial vessels resulting from amphetamine abuse is very rare.     

Sudden death due to congenital malformation of the left coronary artery: A case report

A case of sudden death during heavy exercise in a young athletic man due to a rare but well-known congenital coronary malformation is reported, and the main aspects concerning the condition are discussed.     

Sudden death after a cold drink: case report

We report a case of sudden cardiac death in a 12-year-old boy after rapid ingestion of a frozen slurry drink. The cause of death was determined to be a cardiac arrhythmia secondary to a previously undiagnosed cardiac rhabdomyoma with associated myocardial scarring. Ingestion of cold liquids has been associated with syncope, but not sudden cardiac death. In this case, bradycardia induced by cold-induced vasovagal reflex may have precipitated the terminal arrhythmia. Ingestion of cold liquids should be considered a potential trigger for fatal cardiac arrhythmias in patients with underlying heart disease.     

左臀部刀刺伤致左股深动脉假性动脉瘤1例

王某,男,38岁.1995年4月8日下午3时许,因工作矛盾纠纷,被人用自制匕首刺伤臀部,经两次住院并行手术探查,诊断为左股深动脉假性动脉瘤.被告人认为其假性动脉瘤与其伤害行为没有直接因果关系,申请法医学鉴定.     

A triad of laryngeal hemorrhages in strangulation: a report of eight cases

The results of histological studies on larynges from eight cases of manual strangulation, all that had intracartilaginous laryngeal hemorrhages, a recently described and under-recognized lesion associated with strangulation, are reported. Formalin-fixed larynges were examined in serial section using a standardized protocol. In all cases, intracartilaginous laryngeal hemorrhages were associated with subepithelial laryngeal hemorrhages, and intralaryngeal muscular hemorrhages forming a "triad of hemorrhages." In five cases, the triad was found in the presence of laryngeal cartilage microfractures. Since cartilage microfractures can be causally related to mechanical injury to the neck, it is likely that the triad of hemorrhages has diagnostic value as an independent morphological criterion for the postmortem diagnosis of strangulation. Since a proportion of cases of strangulation lack characteristics that are self-evidently due to violent application of pressure on the neck, recognition of the triad may have important implications for the postmortem diagnosis of strangulation.     

广泛性软组织挫伤后肺脂肪栓塞1例

广泛性软组织挫伤后一般是由于继发休克、弥漫性血管内凝血 (ＤＩＣ)或者挤压综合征而导致死亡[1～ 3 ] ,引起肺脂肪栓塞则少见。广泛性软组织挫伤后因血液中脂肪释放引起肺脂肪栓塞致死则更为罕见 ,笔者曾遇一例 ,现予以报道如下 :案　例孙某 ,男 ,2 4岁 ,农民。某日夜 11:30伙同杨某 (男 ,18岁 )到某菜场里偷窃蔬菜时 ,被守护菜农抓获后被数人分别用木棒、铁棒、铁锨、拳脚殴打约 1小时。次日凌晨 2 :2 0送医院。急诊病历记载 :全身多处疼痛 ,左小腿畸形、疼痛、出血。体检 :Ｔ37.0℃ ,ＢＰ13/ 9ｋＰａ ,Ｐ80次 /分 ,Ｒ2 0次 /分 ,神清 ,…     

广泛性软组织挫伤后肺脂肪栓塞1例

广泛性软组织挫伤后一般是由于继发休克、弥漫性血管内凝血（DIC）或者挤压综合征而导致死亡［1～3］,引起肺脂肪栓塞则少见。广泛性软组织挫伤后因血液中脂肪释放引起肺脂肪栓塞致死则更为罕见,笔者曾遇一例,现予以报道如下:     

An unusual mechanical asphyxia in a homicide-suicide case by smothering and strangulation

A very unusual homicide of 2 children by smothering and strangulation by means of a rubber adhesive band carried out by the mother who committed suicide by the same manner is presented. Smothering is supposed to be one major cause of death in child homicide. Suicide by smothering is relatively uncommon. Suicidal smothering by winding strips of adhesive tape around the head to cover the nose and mouth is an even rarer method recently described in literature. The circumstances of the crime and the macroscopic and microscopic evidence are discussed to reduce the potential for underdiagnoses or mistakes in such cases in which it may be difficult to establish whether suicide or homicide occurred.     

Embolism of heart tissue to the middle cerebral artery as a complication of heart surgery.

After suture closure of an intraarterial septal defect an atrioventricular block occurred in a 6 years old child. Therefore, the suture was removed and the defect closed by a Dacron patch. The sinus rhythm returned. After the operation convulsions occurred, the patient died after 16h which was considered to be due to cerebral air embolism. Autopsy confirmed a correct operation, but the right middle cerebral artery has been found to be completely occluded by heart muscle and pericardial fat tissue.     

Pheochromocytoma and sudden death as a result of cerebral infarction in Turner's syndrome: report of a case

Various etiologies for hypertension in Turner's syndrome, a common feature of the disorder, are well recognized. Pheochromocytoma is not among them. A young woman with Turner's syndrome, recently diagnosed with hypertension, died suddenly and unexpectedly. A hemorrhagic cerebral infarct and an adrenal gland pheochromocytoma were found at necropsy. This is the first reported case of pheochromocytoma associated with Turner's syndrome.     

Traumatic subarachnoid hemorrhage and extracranial vertebral artery injury: a case report and review of the literature

The case is presented of a 19-year-old man who was assaulted and died shortly afterward from a large traumatic basal subarachnoid hemorrhage (TBSAH) that arose from rupture of the left vertebral artery, proximal to the point at which the artery penetrated the dura. The literature regarding TBSAH and vertebral artery rupture is reviewed, and a number of points are highlighted: patients with TBSAH may remain conscious for a period of hours after injury, subcutaneous or muscular bruising may be contralateral to the ruptured vessel, fractures of the transverse processes of the cervical vertebrae and significant pathology of the vertebral artery are not typically associated with TBSAH, and rupture of the vertebral artery may be intracranial, junctional, or extracranial.     

Sudden death due to dissecting pulmonary artery aneurysm: a case report and review of the literature

Pulmonary artery aneurysm and pulmonary artery dissection are rare antemortem diagnoses, most often associated with sudden death. These pathologic entities are strongly associated with chronic pulmonary hypertension due to structural cardiac defects, either congenital or acquired. We report the case of a 49-year-old woman who died suddenly due to dissection and rupture of a large pulmonary trunk aneurysm, with subsequent cardiac tamponade. Key historical and physical findings are described. Additionally, we present a discussion of the incidence, clinical presentation, pathogenesis, and pathologic diagnostic features of pulmonary artery dissection.     

Caffeine fatality: a case report

A case of fatal caffeine toxicity due to suicidal ingestion of a "look-alike" illicit drug is reported. Caffeine concentrations were determined by high pressure liquid chromatography (HPLC) with the brain having the highest level reported in the literature to date. Also, the blood concentration of caffeine was one of the highest among the cases reported. A literature review of caffeine fatalities is presented.     

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.     

Refusing medical treatment after attempted suicide: rethinking capacity and coercive treatment in light of the Kerrie Wooltorton case

The inquest into the death of Kerrie Wooltorton in Norfolk, England, ignited extensive public debate on the scope of the common law right to refuse medical treatment where a patient is distressed, depressed or actively suicidal. In Australia, a patient's wishes need not be honoured if the patient is not legally competent, if he or she falls within the ambit of the compulsory treatment provisions in the mental health legislation, and possibly also if there is a recognised public interest in preventing suicide which is sufficient to override the patient's choice. This article argues that decisions about whether to give medical treatment despite an apparent refusal should be based solely on a determination of the patient's competence to make their own choice. However, the test for legal competence must take into account the person's agency in making the decision, and decisions which will effectively end the person's life must be shown to be thought through.     

Human cannibalism: a case report

Human cannibal cases are relatively rare in modern civilized societies. We report a single case of familial cannibalism that occurred in Oklahoma in 1977. The investigation posed unique problems in pathology, psychiatry, criminalistics, and serology.