Case report of accidental stab wound to the heart

A 33 year-old Polish field-worker was found by his colleagues kneeling in front of his trailer, with a bloody stab wound in the heart region. In spite of prompt surgical intervention, the man died from his injury a few hours later. Upon examination of the dead man's trailer a blood-smeared vegetable-knife was found in the sink, and on the floor, a pullover with a slit-like cut. On the wall hung a jacket on a hook with a cut in the inner surface of the left breast pocket but not in the outside layer. The examination of the clothes, the autopsy and a reconstruction of the sequence of events led to the following conclusion: The knife had been placed into the breast pocket of the jacket with the tip facing downwards. As the man put down a sack of potatoes, the knife hooked into a pre-existing gap in the sack and was driven into the chest cavity by the pressure weight of the heavy sack.     

Unusual suicide caused by a stab wound in the neck

A case is reported of a man with a deep nape stabwound completely severing the medulla of the spine. A strangely formed bottle neck fragment is the assumed weapon. Further investigations allow a scene reconstruktion, police inquiries throw light on a previous acute psychotic disorder of the suicide.     

Delayed pericardial tamponade following a stab wound to a branch of the right coronary artery

A 45-year-old man was attacked with a knife and suffered multiple stab wounds to the chest and abdomen. After surgical treatment and hospitalization for 9 days he was discharged in a stable condition. The following day he was found dead in his apartment. The autopsy revealed a pericardial tamponade caused by acute bleeding from an injured branch of the right coronary artery. This case shows that life-threatening late complications in patients with penetrating cardiac wounds may occur despite an initially uneventful course.     

根据双刃刺器刺创口推断刺器宽度

解决根据皮肤创口推断刺器宽度的问题。实验在自愿捐献的12具男性尸体的胸部,用不同宽度和厚度的双刃匕首致创221个。应用法医学、解剖学及数理统计的理论和技术对创口形成机理、影响因素及其与刺器宽度的相关关系进行分析,得出了以下结论：刺器厚度与创口长度无明显相关,刺器宽度与创口长相关,创口回缩程度与创口方向及刺器宽度相关。并建立了两个最优回归方程,提出了一个根据皮肤双刃利器创口推断刺器宽度的方法。     

Differentiation between self-inflicted and homicidal stab wounds to the neck

39 autopsy cases with throat incision examined in the Bonn Institute of Legal Medicine in the years 1990 through 1998 were evaluated with respect to the query whether the morphological criteria generally established for the differentiation between homicide and suicide are also suitable for the assessment in this special localization. Integrative consideration of localization, direction of incision, hesitative resp. tentative injuries, defence injuries, concomitant injuries and capability to act allowed for a discrimination on grounds of legal medical findings in 84 per cent of the cases.     

Mandibular fracture following stab injury with a knife

Stab injuries of the face accompanied by fractures of the jaws are rare. The report deals with the case of a young man, who suffered a penetrating stab injury to the cheek and fracture of the mandible in an assault. The forensic questions to be answered were if the findings were compatible with a stab and subsequent fracture, if one of the confiscated instruments could have been the causative weapon and if the injury had to be assessed as life-threatening. Both the soft and the hard tissue injury confirmed the assumption that they were caused by a stab. It was not possible, however, to assign the injury to a specific knife from the submitted exhibits on the basis of the clinical findings. In the discussion the serious nature of stab injuries in the facial region is emphasized.     

Decision making in a schizophrenic population

Over the past decade, competence to make decisions has become a prominent topic in forensic psychology. We employed a gambling paradigm to measure ability to weigh risks, benefits, and probabilities in an internally consistent manner. Decision-making behavior of chronic, involuntarily committed schizophrenic inpatients was compared to outpatient schizophrenics and first-degree relatives of the patients. We found significant differences between inpatients and non-mentally-ill relatives, and between inpatient and outpatient schizophrenics. When WAIS-R Vocabulary subtest score was statistically controlled,no significant differences between any of the groups remained. Vocabulary x group interactions revealed that Vocabulary subtest predicted decision-making behavior for outpatients and controls, but not inpatients. Severity of psychiatric symptoms and number of prior hospitalizations predicted decision-making behavior for inpatient schizophrenics. Results suggest that competence assessments that rely primarily on verbal abilities may be inadequate to assess competence in acutely ill psychiatric patients.     

Homicide by stab to the neck with subsequent attempted suicide by cut to the neck

A 37-year-old Turkish woman was fatally injured by her 65-year-old Turkish husband with a stab to the cervical region. After her death he inflicted a deep cut to his own neck, which he survived thanks to immediate medical assistance. To the authors' knowledge this combination of a homicidal stab to the neck and a suicidal cut to the neck has not been described before. Kosher butchering, which is common in the couple's traditional cultural environment, is discussed as possible reason for the choice of the neck as site for applying sharp violence. It may have induced the perpetrator to choose this anatomical region.     

Sudden, unexpected death due to undiagnosed frontal glioblastoma in a schizophrenic patient

The incidence of sudden death due to undiagnosed primary intracranial tumor is low in forensic autopsy. We report a case of a 48-year-old white male, known to be a schizophrenic patient for several years, and in whom a medico-legal autopsy disclosed a large, previously undiagnosed, bilateral frontal glioblastoma infiltrating the genu of corpus callosum. We emphasize the importance of performing complete autopsy, including a thorough neuropathological examination, in all cases of sudden unexpected death, especially in those cases in which no extracerebral cause of death had been established and whose clinical history was primarily of a psychiatric nature.     

A transnasal intracranial stab wound by a plastic-covered umbrella tip

A 48-year-old man died from a transnasal intracranial stab wound caused by an umbrella. The track of the stab passed from the right nostril, through the sphenoid sinus, the left side of the sella turcica and anterior clinoid process, and finally reached the surface of the brain. The stab wound crossed the left internal carotid artery, causing an exsanguination and aspiration of blood into the airway, resulting in death. It is extremely rare that an umbrella tip used during a struggle would stab the nostril of the victim. Transnasal intracranial stab wounds can be overlooked and require sensitive handling.     

Suicide by self-inflicted stab wound of the chest

A case is presented in which a 44-year-old man stabbed himself in the heart with a kitchen knife, then changed his bloody clothes, and ate lunch with his aunt, who did not notice the event. After 2 h he died of cardiac tamponade.     

Morphologic patterns in suicidal stab injuries of the neck]

Stabs into the neck are seen very seldom in connection with suicide. If there are features typical of suicide, the medico-legal analysis of the pathomorphological findings essentially may contribute to the differentiation from homicidal injuries. On the basis of the observations already published and three own cases an attempt is made to derive criteria of self-infliction for differential diagnosis from the autopsy findings. Concomitant injuries and combination with another method of suicide have turned out to be important indications of self-infliction.     

Thoracic stab wound caused by a grilling scewer with defomration of the tool

Injuries by meat- or barbecue-skewers are rarely relevant as cause of death. Besides accidental injuries they are used as coincidental tools in capital crimes. Skewers are non-typical stabbing tools of pointed-squared structure, which need considerable force to penetrate the skin. The authors report on a 42-year-old man's fatal thorax stab injury, which he sustained during a barbecue and which stretched from the left mamilla into the back right shoulder tissue. Death was caused by exanguination following stabbing through the superior vena cava. At issue was the question what amount of force was necessary to inflict the wound. Based on the deformation of the stabbing tool, as a result of a material-technical expertise, compressive load application in longitudinal direction and a stabbing force of between 120 to 665 N were to be assumed. Furthermore, in addition to the features of a non-typical tool, the autopsy findings allowed to conclude a powerful stabbing.     

Suicide by skull stab wounds: a case of drug-induced psychosis

Suicide by stabbing to the head and/or driving sharp objects into the skull is of extreme rarity. This article reports the case of a 27-year-old man, who committed suicide by multiple knife stabs and cuts to the head, the torso, one shoulder and the forearms. Autopsy showed a perforating wound of the skull and the 10-cm long broken blade of the knife being still embedded in the right temporal lobe of the brain. The deceased had no history of psychiatric illness but was currently treated by mefloquine, a quinine derivative associated with a high rate of psychiatric adverse effects. Toxicological examination confirmed a recent intake of mefloquine together with chloroquine, another antimalarial drug. To our knowledge, this is the first report of a completed suicide with very strong evidence of mefloquine implication. Discussion focuses upon mefloquine-induced psychiatric disorders and highlights the importance of performing toxicological investigations in cases of unusual suicides.