An Unusual Suicide Inside a Grave with Two Gunshot Wounds to the Head—The Psychological Approach

Abstract: In this report, the authors present a case of suicide committed by a 66-year-old man, inside a grave at the local cemetery, with two gunshot wounds to the head. A multiple-paged, handwritten suicide note was found in an army type bag inside the victim’s car, while a second one was found in his house. Medicolegal examination of the body revealed two typical contact gunshot entrance wounds and one exit wound to the head. Toxicological analysis of the femoral blood was negative for alcohol and drugs. The history, scene and autopsy findings, along with further police investigation, indicated an obvious case of suicide. The literature is reviewed and discussed. We report this case as the place of suicide is extremely uncommon and as there is no mention of a gunshot suicide inside a grave in the current literature.     

Planned Complex Occupation‐related Suicide by Captive‐bolt Gunshot and Hanging*

Abstract: Planned complex suicides are committed by using two or more previously planned methods simultaneously to make sure that death will occur even if one method fails. Herein, we presented a case of occupation‐related planned complex suicide, committed by captive‐bolt gunshot and hanging. A 29‐year‐old man, who worked as a butcher, was found dead in the stable, hanging by the neck with a captive‐bolt gun embedded in the forehead region of his head. The hanging was complete. Along the bolt canal were bone fragments, and at the end of the path was the punched‐out fragment of the skin and soft tissue. There were no fractures of the hyoid bone and laryngeal cartilages, and a superficial hemorrhage was present in the right sternocleidomastoid muscle. Our case underlines the utility of forensic autopsy and death scene investigation in reconstructing the mechanism of death, as well as the dynamics of the event.     

An Unplanned Complex Suicide by Multiple Blank Cartridge Gunshots and Cutting

Blank firing guns are readily accessible in most countries due to an absence of legal regulations. These weapons are capable of causing lethal injuries. We report a rare case of secondary (unplanned) complex suicide committed with a knife and blank cartridge pistol. A 59‐year‐old man was found dead with three superficial incisions in his neck and a gunshot wound to the chest. The external examination revealed an entrance wound in the left chest region consistent with contact shooting. The appearance of a muzzle imprint suggested two discharges. The autopsy showed a slightly hemorrhaged but otherwise intact pericardium, blood in the pericardial sac, and a channel‐like defect in the anterior wall of the left cardiac ventricle. The cause of death was attributed to cardiac tamponade. To the best of our knowledge, this is the first reported case of unplanned complex suicide involving an unmodified blank firing gun.     

Double Hanging with Single Ligature: An Unusual Method in Suicide Pact

A married casual labor couple was found hanging in their makeshift bedroom with each end of a single chunni (a cloth worn around the neck by Indian women) spread across an iron bar below the roof. They left their two children, daughter, and son of 4 and 3 yrs age, respectively, with their grandmother living separately nearby, and went to attend cremation of one of their relatives. They returned late in the evening and found hanging in their bedroom next morning by neighbors.     

Self‐Strangulation Through A Sphygmomanometer: An Uncommon Suicide

Suicide by asphyxia is quite a common event in forensic practice and may be implemented in different ways. The authors report a unique case of a 16‐year‐old youth who committed suicide by means of a standard mercury sphygmomanometer. This manner of suicide has never been described in the literature reviewed. A complete forensic investigation led to the conclusion that the cause of death was mechanical asphyxia, ascribed to self‐strangulation by means of an atypical item. The victim suffered from attention‐deficit/hyperactivity disorder (ADHD) syndrome and was assisted by support teachers. He had a solitary and depressive personality. The exceptional nature of this case suggests that sphygmomanometers may be regarded as possible means of self‐strangulation. The case also highlights the importance of managing patients with psychiatric or cognitive disorders; indeed, particular caution is required to keep them away from objects that, although apparently harmless, can become lethal.     

Effects of Decomposition on Gunshot Wound Characteristics: Under Moderate Temperatures with Insect Activity

Abstract:  Previous studies document characteristics of gunshot wounds shortly after they were inflicted. This study was conducted to determine if the early stages of decomposition obscure or alter the physical surface characteristics of gunshot wounds, thereby affecting the quantity and quality of information retrievable from such evidence. The study was conducted in August and September, 2005 in Nova Scotia, Canada in forested and exposed environments. Recently killed pigs were used as research models and were shot six times each at three different ranges (contact, 2.5 cm, and 1.5 m). Under these test conditions, the gunshot wounds maintained the characteristics unique to each gunshot range and changes that occurred during decomposition were not critical to the interpretation of the evidence. It was concluded that changes due to decomposition under the conditions tested would not affect the collection and interpretation of gunshot wound evidence until the skin was degraded in the late active or advanced decay stage of decomposition.     

Characteristics and Frequency of Chipping Effects in Near‐Contact Gunshot Wounds

The presence of “chipping” or “flaking” around the edges of gunshot entry wounds has been described among the characteristics of gunshot wounds in bone. In this study, the real frequency of such a peculiar feature was investigated. The presence of “chipping” was assessed on 22 gunshot wounds fired at a near‐contact range on bovine ribs with 9‐mm bullets. As controls, five samples were shot with a 3 cm range, and five from 40 cm. In 77% of cases shot at near‐contact range, a detachment of small fragments of the upper layers of bone was detected, mainly with a circumferential disposition, whereas this feature was lacking in control samples. The study demonstrated the frequency of “chipping” and that it may probably be due to a combined ballistic effect of impact of the bullet itself and expansion of gases. It may be thus considered indicative of close‐range shots.     

Detection of Gunshot Primer Residue on Bone in an Experimental Setting—An Unexpected Finding*

Abstract: Pork ribs with intact muscle tissue were used in an experimental attempt to identify bullet wipe on bone at distances from 1 to 6 feet with 0.45 caliber, full metal jacket ammunition. This resulted in the unexpected finding of primer‐derived gunshot residue (GSR) deep within the wound tract. Of significance is the fact that the GSR was deposited on the bone, under the periosteum, after the bullet passed through a Ziploc^® bag and c. 1 inch of muscle tissue. It is also important to note that the GSR persisted on the bone after the periosteum was forcibly removed. The presence of primer‐derived GSR on bone provides the potential to differentiate gunshot trauma from blunt trauma when the bone presents an atypical gunshot wound. In this study, the presence of gunshot primer residue at a distance of 6 feet demonstrates the potential for establishing maximum gun‐to‐target distance for remote shootings.     

Complex Suicide by Self‐stabbing and Drowning: A Case Report and a Review of Literature

Sharp force injuries and drowning are methods exceptionally combined in complex suicides. We report a challenging case of complex suicide by self‐stabbing and drowning that illustrates the difficulty in discriminating between homicide and suicide in such circumstances of death. The corpse of a young man was found submerged in a river, stabbed nine times with two wounds that had penetrated the thorax and had caused lung injuries and a hemopneumothorax. The postmortem and histological examinations were consistent with a death caused by drowning, but the manner of death still remained undetermined. Police investigation finally concluded to a suicide, although no suicide note had been left and the victim had no underlying diagnosed mental disorder. The parameters that may help distinguish suicide from homicide at the autopsy should be interpreted in light of a thorough forensic investigation to determine the exact manner of death in such a case.     

Determined to Die! Ability to Act Following Multiple Self‐inflicted Gunshot Wounds to the Head. The Cook County Office of Medical Examiner Experience (2005–2012) and Review of Literature

Cases of multiple (considered 2+) self‐inflicted gunshot wounds are a rarity and require careful examination of the scene of occurrence; thorough consideration of the decedent's psychiatric, medical, and social histories; and accurate postmortem documentation of the gunshot wounds. We present a series of four cases of multiple self‐inflicted gunshot wounds to the head from the Cook County Medical Examiner's Office between 2005 and 2012 including the first case report of suicide involving eight gunshot wounds to the head. In addition, a review of the literature concerning multiple self‐inflicted gunshot wounds to the head is performed. The majority of reported cases document two gunshot entrance wound defects. Temporal regions are the most common affected regions (especially the right and left temples). Determining the capability to act following a gunshot wound to the head is necessary in crime scene reconstruction and in differentiation between homicide and suicide.     

Biting Through an Arteriovenous Hemodialysis Graft: An Unusual Method of Suicide

Abstract:  Patients on long-term hemodialysis often have multiple medical and social problems with associated psychological stress and depression. The suicide rate in this population is higher than the general population, and suicides have been reported following severing or disconnection of hemodialysis vascular access sites. We report a patient on chronic hemodialysis with a history of depression and suicidal ideation who bit into his forearm arteriovenous graft and exsanguinated.     

Suicide by Self‐Administration of a Drug Mixture (Propofol,Midazolam, and Zolpidem) in an Anesthesiologist: The First Case Report in Italy

The authors report an unusual case of suicide of an anesthesiologist, in which the suicide manner and means depend upon the victim's occupation. This is the first case report published in Italy of a death involving propofol and other drugs. The anesthesiologist was found dead with an empty drip still inserted in the hand and another one near his body. Forensic and toxicological findings suggested that the cause of death was a respiratory depression due to a self‐administration of a rapidly infused lethal drug mixture. Analytical drug quantification was performed by gas chromatography‐mass spectrometry. Blood analysis revealed: zolpidem (0.86 μg/mL), propofol (0.30 μg/mL), midazolam (0.08 μg/mL), thiopental (0.03 μg/mL), and amitriptyline (0.07 μg/mL). Adipose tissue and hair analysis suggested a previous and repeated use of these drugs verifying the fact that in Italy recreational abuse of anesthetic and sedative agents in health care practitioners is becoming an increasing problem.     

Multiple Self‐Inflicted Stab Wounds to Neck,Chest and Abdomen as a Unique Manner of Suicide

Abstract: This is a case report of a 30‐year‐old man found dead in his flat lying on the floor with multiple stab wounds over the body, surrounded by an extensive volume of blood. Examination of the scene of death showed a secure flat, locked from inside. A blood‐stained knife was present close to the body and two unstained notes left on the sofa at the locus. A small plastic bag containing white powder (which following toxicological examinations appeared to be cocaine) and an almost full bottle of beer were present on a table. Autopsy revealed more than 40 stab wounds to neck, chest, and abdomen arranged in isolated groups within which the wounds showed similar directions and had a transverse orientation. Together with hesitation marks located on the neck and wrists these characteristics allowed to interpret this case as a suicide.     

Unusual Suicide in Italy: Criminological and Medico‐Legal Observations—A Proposed Definition of “Atypical Suicide” Suitable for International Application

This work is the result of a kind of categorization of suicidal conduct based on an empirical–phenomenological approach, with integrated assessment of certain criteria, such as the dynamics, correlation of types of injury and how they were produced, evidence gathered during official inspections in loco, and case history findings about “suicide.” This categorization is an attempt to provide a nosographic definition of atypical suicide, that is, cases in which the parameters of “typical” suicide are missing. Case studies are described, taken from a systematic exploration mainly of the Italian specialized literature of the 20th century, supplemented by earlier references when deemed significant. In‐depth analysis of atypical suicide can supply additional interpretations of the problem of differential diagnosis of suicide, homicide, and accidental death, that is, the real punctum dolens in overall medico‐legal determination of the cause of death in scenarios in which death cannot be definitely traced to a deliberate act.     

Simultaneous Homicide–Suicide: A Case Report of Double Drowning

Homicide–suicide is a tragic phenomenon which typically does not result in a criminal charge or trial. However, correct diagnosis and classification of homicide–suicide cases are important to determine the perpetrators and dynamics of each category properly. The deaths in the homicide–suicide acts can be divided into two categories with respect to the number of involved individuals: dyadic deaths and triple or multiple deaths. These two categories can also be divided into two subgroups according to the chronology of the incidents: simultaneous deaths and consecutive deaths. Herein, a simultaneous homicide–suicide case of a father and daughter where both deaths occurred through drowning which was not found in the selected literature review and where the victim was a child is presented. The article aims to clarify the term discrepancies about multiple death cases in the literature and to discuss the pathological and psychosocial characteristics of the simultaneous dyadic death cases.     

The Analysis of Gun‐Cleaning Oil as Long‐Distance Gunshot Residue and Its Implications for Chemical Tags on Bullets

Using a BB gun, it was shown that a gun‐cleaning oil (GCO) can be wiped from the barrel by a projectile and carried much longer distances than those usually associated with solid gunshot residue (GSR). Analysis of GCO subsequently deposited on a target was performed using pentane extraction and gas chromatography. (Hoppe's GCO was used here as a model.) When a 0.45 caliber handgun was used, analysis reveals that most of the GCO wiped from the barrel does not survive, owing to the elevated temperatures encountered. However, two components of the GCO, a long‐chain fatty acid and its ethyl ester, do survive and can be detected in the bullet wipe. This suggests that GCO may be considered as GSR, uniquely detectable at long distances, and that other chemical compounds could either be added to a GCO or directly to bullets, to serve as identifying chemical tags.     

Frequency and Clinical Features of Patients who Attempted Suicide by Hara‐Kiri in Japan

Hara‐kiri is a unique Japanese custom, primarily stemming from the manners and customs that a samurai held. The aim of the present study was to investigate the clinical features of individuals who attempted suicide by hara‐kiri. We enrolled 647 patients who had attempted suicide. Clinical features were compared between those who had employed hara‐kiri and those who had used other methods. 25 of the 647 subjects had attempted suicide by hara‐kiri. The ratio of men to women and the proportion of patients with mood disorders were significantly higher in the hara‐kiri group than in the other methods group. The average length of stay in either the hospital or in the intensive care unit was also longer in the hara‐kiri group than in the other methods group. Hara‐kiri is an original Japanese method of attempting suicide, and suicide attempts by hara‐kiri may be aimed at maintaining a reputation or taking responsibility.     

Study of the Behaviors of Gunshot Residues from Spent Cartridges by Headspace Solid‐Phase Microextraction–Gas Chromatographic Techniques

Gunshot residues, produced after shooting activity, have acquired their importance in analysis due to the notoriety of firearms‐related crimes. In this study, solid‐phase microextraction was performed to extract the headspace composition of spent cartridges using 85‐μm polyacrylate fiber at 66°C for 21 min. Organic compounds, that is, naphthalene, 2,6‐dinitrotoluene, 2,4‐dinitrotoluene, diphenylamine, and dibutyl phthalate were detected and analyzed by gas chromatography‐flame ionization detection technique. Evaluation of chromatograms for diphenylamine, dibutyl phthalate, and naphthalene indicates the period after a gunshot was discharged, whether it was 1 days, 2–4 days, <5 days, 10 days, 20 days, or more than 30 days ago. This study revealed the potential effects of environmental factors such as occasional wind blow and direct sunlight on the estimation of time after spent cartridges were discharged. In conclusion, we proposed reliable alternative in analyzing the headspace composition of spent cartridges in a simulated crime scene.     

Death Due to an Unusual Angio‐Seal‐Related Complication: Case Report and Literature Review

Angio‐SealTM is a vascular closure device (VCD) that can be applied to the femoral artery following cardiac catheterization to achieve hemostasis. Although it has been demonstrated to be superior to conventional manual pressure and to reduce time to hemostasis and patient ambulation, the use of this VCD is not without its complications. In this report, we describe the case of a 55‐year‐old man who died due to an extremely rare event that occurred several hours after the deployment of an Angio‐SealTM VCD: acute complete transverse laceration of the femoral artery that occurred because of the particular fragility of the vessel due to an unrecognized and asymptomatic arteriosclerotic disease. Few data are available in the literature about the incidence of such events, and much more remains to be done to determine how to prevent and manage its occurrence.