Fatal accidental hanging by a high-chair waist strap in a 2-year-old girl

High chairs are commonly used to feed children after 6 months. Related injuries are oftentime minor and rarely leading to death. We describe a case of a 2-year-old female child who used to jump alone on her high chair and also had the habit to fasten the straps by herself. Her mother found her hanging by the waist straps. A thorough investigation showed that she climbed her high chair and fastened the waist straps but not the crotch one. The girl slid down into the seat, trapping her neck in the waist straps and thus resulting in hanging. In here, we concluded that the victim's death was caused by asphyxia, itself, caused by accidental hanging. The present case is of a special interest because of the rare similar cases reported. This case suggests that a correct restraint use and a close supervision would have prevented such a fatal issue.     

Fatal parvovirus B19 myocarditis in an 8-year-old boy

A report is given on an 8-year-old boy who suddenly and unexpected died. Autopsy findings point to acute heart failure. Microscopic examination of the heart showed increased interstitial and perivasal fibrosis and myocarditis with macrophage infiltration. Polymerase chain reaction (PCR) analysis for parvovirus B19 was positive in heart samples and in the spleen. Immunostaining for parvoviral surface antigens was negative. Although the virus does not appear to have infected the cardiomyocytes, we speculate that myocarditis arose from immunological cross-reaction to epitopes shared between the virus and the myocardium.     

Death caused by accidental hanging in the hand strap loop of a garage door

The authors report on a 10-year-old boy who accidentally hanged himself in the hand strap of a garage door. The door was an electric overhead door of an underground garage. The accident was reconstructed at the scene using a dummy. The strap of the door was long enough to be slipped over the head easily. In view of this background it seems advisable to consider whether the current safety regulations on the operation of electric doors should be changed accordingly.     

Fatal myeloencephalopathy due to accidental intrathecal vincristin administration: a report of two cases

We report on two fatal cases of accidental intrathecal vincristine instillation in a 5-year old girl with recurrent acute lymphoblastic leucemia and a 57-year old man with lymphoblastic lymphoma. The girl died seven days, the man four weeks after intrathecal injection of vincristine. Clinically, the onset was characterized by the signs of opistothonus, sensory and motor dysfunction and ascending paralysis. Histological and immunohistochemical investigations (HE-LFB, CD-68, Neurofilament) revealed degeneration of myelin and axons as well as pseudocystic transformation in areas exposed to vincristine, accompanied by secondary changes with numerous prominent macrophages. The clinical course and histopathological results of the two cases are presented. A review of all reported cases in the literature is given. A better controlled regimen for administering vincristine and intrathecal chemotherapy is recommended.     

Death of a 6-year-old boy with mental retardation: accident versus child abuse

This case study involved death of a 6-year-old child with a history of mental retardation secondary to meningitis at 11 months, spastic quadriplegia, seizure disorder, and hydrocephaly with a remote ventriculoperitoneal shunt placement and gastric tube feedings. Reportedly, the child was co-sleeping with his mother when she awoke and discovered him lying prone and not breathing on the carpeted floor next to the bed. He was transported to the hospital and died in the emergency room of unknown causes. The medical examiner assumed jurisdiction of the body. The external examination revealed petechial hemorrhages on the neck and face, with patterned linear pressure abrasions on the chest, arms, and face. X-rays revealed leg fractures of different ages. This case emphasizes the importance of coordination of death scene investigation, medical history review, and autopsy results through a forensic team approach to determine the accurate cause and manner of death.     

Homicidal hanging in a dyadic death

Homicide by hanging is rare. In this case report, a young man stabbed his wife, hanged his son, and then hanged himself. He was assumed to be mentally ill, consistent with some other studies of family murder-suicide.     

Stature estimation of 3-10-year-old children from long bone lengths

Estimation of stature in adult forensic cases with available long bones of the limbs is routine, but such estimation is less common in subadult cases. Long bones from subadult cases are often used to estimate age, but in some instances stature may be helpful or even critical for identification. Few published regression equations exist for consultation in such cases. Data from the longitudinal growth study conducted by the Child Research Council in Denver in the mid-1900s are utilized to produce dual-sex and single-sex regression equations for the six long bones of the limbs (humerus, radius, ulna, femur, tibia, and fibula) and for the combined femur+tibia length. All measurements are from radiographs and are of diaphyseal length. Examples show that similar results can be obtained using a two-step process of "ballpark" estimation from published tables of the Denver data, but these new regressions allow a one-step standard error estimate for the means. Regressions are further compared with those previously published by Finnish researchers, which are generally broadly comparable. More routine stature estimation in subadult cases is encouraged both as an aid to possible identification and as a test of the available regression equations.     

Asphyxiation by hanging in two young Hispanic children--homicide, suicide, or accidental deaths? A review of pediatric hangings

Case reports of asphyxiation by hanging in two young children are presented along with a review of the literature to determine the incidence and manner of death by hanging in the younger pediatric population.     

Fatal exsanguination from a small venous injury]

Report on a 34 year old man who bled to death sitting in an empty bath-tub by suicidal cutting in his groin. The source of the bleeding was a small lesion of the femoral vein with a diameter of 2 mm. No endogenous or exogenous coagulopathies could be established.     

Fatal Falls from Height in Taiwan

This study conducts an investigation of fatal falls from height, examines gender differences, and compares our findings with those of Western countries. We review deaths in Taiwan caused by falls from height that underwent forensic autopsy from 1994 to 2010. Among the examined cases, 182 were suicide, 156 were accidents, and 18 were homicides. Men who fell from greater heights had a lower probability of fatal head trauma (p = 0.045), and women exhibited a lower fatal head trauma rate when falling from heights of between 10 and 25 m in accident group (p = 0.003). There was no significant difference between cases of falling from greater and lower heights within the suicide group (p = 0.834). Psychiatric illness was only reported in 20.3% and 28.8% cases in suicide and accident groups. Only in male cases was the use of psychotropic substances higher in the suicide groups than in the accident groups (p = 0.047).     

Sudden, unexpected death in a 5-year-old boy with an unusual primary intracranial neoplasm. Ganglioglioma of the medulla

This report documents sudden, unexpected death in a 5-year-old boy from a ganglioglioma of the medulla. Gangliogliomas are rare, primary brain tumors that are encountered predominantly in childhood. We are unaware of any previous report of a similar case.     

Fatal retropleural hematoma from a ruptured abdominal aortic pseudo-aneurysm

This paper has reported a case of sudden unexpected death in a 19-year-old man, shot in the abdomen, who was surgically treated and discharged. He died of massive left retropleural hematoma from a spontaneous rupture of a traumatic pseudo-aneurysm of the abdominal aorta. Diagnosis of the retropleural hemorrhage and the aortic pseudo-aneurysm was possible, though not made antemortem, through chest X-rays and ultrasound studies of the abdomen correlated with the patient's symptoms. Early radiologic signs of the hematoma consisted of obliteration of the aortic silhouette on the anteroposterior view and the left primary sulcus on the lateral film by a convex expanding homogenous density whose medial border blended imperceptibly with the mediastinal shadow. On ultrasound study the pseudo-aneurysm appears as semilucent midline shadow anterior to the vertebral column and related to the aorta, giving the latter an appearance of increased diameter.     

Fatal falls from a height: two case studies

Two case studies are presented involving fatal falls of adult females from a height. One involved a launch at low speed from a balcony, and one involved a launch at high speed from the top of a cliff. Crime scene evidence obtained on the balcony itself provided a strong indication of homicide, but subsequent investigation showed that the fall was accidental. No crime scene evidence was obtained for the cliff fall since the fall initially appeared to be just another suicide from a popular suicide spot. Subsequent investigations indicated homicide based on measurements of cliff height, horizontal distance to the impact, and available runup distance, plus measurements of possible run, jump, and throw speeds. It was found that a female weighing 61 kg (134 lb) can be thrown at speeds up to 4.85 m/s by a strong male, more than enough to account for the estimated launch speed (4.5 m/s). Given the available 4.0 m runup distance, it was found that women of better than average rather than elite athletic ability can dive at speeds of about 3.5 m/s or jump feet first at speeds of about 4.0 m/s, both being less than the estimated launch speed. The decedent had no athletic ability and landed head first after falling through a height of 29 m.     

Pericarotid bone splinter: a microscopic appearance in hanging

The investigation of the neck structures drawn from 145 cases of asphyxia involving pressure on the neck, for which microscopic examination was required at the Pathology Laboratory of the "Hotel Dieu" Hospital from Lyon, France, during January 1, 1999, to May 1, 2001, has pointed out in 3 cases, besides the classic signs already known, a particular lesion unmentioned yet in the literature, namely, a pericarotid bone splinter, placed in the proximity of the common carotid artery bifurcation. The bone splinters had dimensions between 0.25 and 0.7 mm and a certain antemortem character, surrounded by hemorrhagic areas and by fibrin. The 3 cases deal with adult males who had died through complete hanging, with the knot placed lateral, the hanging mark having the maximum depth in the laterocervical region, correspondent with our finding. Given the location of the bone splinter, we believe that this was produced by the tearing out from the transverse apophysis of the fourth cervical vertebra, as a consequence of the sudden traction during hanging. This sign appeared neither at other types of hanging nor at strangulation by hand or by ligature.     

Agonal sequences in a filmed suicidal hanging: analysis of respiratory and movement responses to asphyxia by hanging

The forensic literature on the pathophysiology of human hanging is still limited. Therefore, forensic pathologists often feel uncomfortable when confronted with related questions. Here presented is the filmed suicidal hanging of a 37-year-old man. This recording allows a unique analysis of agonal movement sequences: loss of consciousness (13 sec), convulsions (15 sec), decortication rigidity (21 sec), decerebration rigidity (46 sec), second decortication rigidity (1 min 11 sec), loss of muscle tone, (1 min 38 sec) and last isolated muscle movement (4 min 10 sec). As for respiratory responses, very deep respiratory attempts started at 20 sec. Respiratory movements progressively decreased and completely stopped at 2 min. Despite the fact that extending the presented data on all cases of hanging asphyxia would be a mistake, this case gives a very interesting insight into movement and respiratory response to asphyxia by hanging.     

Fatal hemorrhage from a periumbilical wound: Stabbing or hemorrhage from a caput medusae?

Varices are the main clinical manifestation of portal hypertension, and their bleeding is the predominant cause of mortality from this condition. Periumbilical varices are known as “caput medusae.” Reports of their bleeding are rare, with only three fatal cases described in the literature. The antemortem diagnosis is relatively simple, while the postmortem diagnosis is more complex. This paper is the first report of fatal hemorrhage from a caput medusae for which the diagnosis was made postmortem, thanks to a complete diagnostic process including scene and circumstances, medical history, and autopsy with detailed histology. The circumstantial analysis showed the presence of a large amount of blood at the scene, blood which originated from a small abdominal wound; an analysis of the subject's clinical data reported that he was affected by portal hypertension. The autopsy revealed some dilated and convoluted veins in the subcutaneous tissue of the umbilical region; a fistula between these veins and the abdominal wound was detected. The histological study confirmed the presence of periumbilical varices, one of them ruptured and connected with the overlying skin. The cause of death was attributed to a massive hemorrhage generated by a periumbilical varix in a patient affected by portal hypertension.     

Fatal descent from height in New York City

All deaths due to descent from height that underwent autopsy at the Manhattan Office of Chief Medical Examiner of New York City over a two year period (1997-1999) were reviewed. The scene and autopsy findings, psychiatric history, and toxicology results were examined. There were 120 deaths: 77 suicides, 36 accidents, 5 undetermined, and 2 homicides. Psychiatric illness was reported in 86% of suicides. The toxicological detection of psychiatric medications supports the high percentage of psychiatric disease in the suicide group. In the accidental group, the detection of ethanol and illicit drugs was higher (36%) than expected from the case investigation and similar to the suicide group (29%). Accidental falls by women made up fewer than 3% of all manners. Due to the variation in the extent of injuries, it is unwise to attempt to conclude how high a person descended based on the autopsy findings. Descents into water commonly have minimal findings on external examination with marked internal injuries. The methods of investigation and criteria for death certification using the study results are discussed.