Histological examination of carotid artery tissue in cases of ligature strangulation and hanging

Violence against the neck can result in a range of macromorphological and micromorphological findings. However, the forensic relevance of the carotid sinus in cases of violence against the neck remains controversial. In this follow-up study of 22 cases of suicidal and accidental strangulations, carotid bifurcations were examined histologically for morphological changes implying direct trauma, including haemorrhage and immunohistochemical expression of heat-shock proteins 27, 60, and 70 and aquaporin-3. These cases were compared with a control group (82 cases) without neck compression or head trauma and with variable causes of death. No relevant histopathological findings implying direct trauma of the carotid bifurcation were found. No cases showed positive aquaporin-3 staining and only five cases showed positive heat-shock protein-27 staining, all of which were hangings. Without massive trauma of the carotid bifurcation, histological alterations cannot be expected. Without signs of rapid death, findings of acute circulatory failure, macromorphological and micromorphological findings of neck compression, and reliable markers indicating relevant impact on the carotid bifurcation the diagnosis of a lethal reflex cannot be verified.

Key points

• Among 22 cases of strangulation causing death, there were 16 cases of hanging and 6 cases of ligature strangulation
• Few cases showed small haemorrhages located predominantly in the surrounding fat and connective tissues; however, the haemorrhages did not have any effects on the tissues
• Neck compression had minimal effects on heat shock protein 27 expression in carotid artery tissue
• Aquaporin-3 staining suggested it is not a useful marker for relevant neck pressure, or that there had not been any relevant neck impact
• Our findings suggested no direct evidence for reflex cardiac death resulting from a brief force against the neck

     

Homicide by ligature strangulation in Finland: offence and offender characteristics

In Finland, homicide by ligature strangulation is a rare event. The purpose of this study was to investigate recent homicide cases by ligature strangulation and to analyse offence and offender characteristics. All forensic psychiatric evaluation statements of offenders accused of ligature strangulation homicides during the 7-year period 1996--2002 (n=19) were reviewed retrospectively. Thirty-five percent of the victims were females. In four cases, the victim was the offender's intimate partner; in one case, it was the stepson; in one case, a father and in the rest of the cases (n=13), an acquaintance. None of the cases involved planning, sadism or sexual elements. In 89% of the cases, the offender was either intoxicated or on drugs at the time of the offence and in 94% of the cases, the victim was found at the scene of the killing. Of the offenders, 63% had crime history, and approximately half of the offenders had experienced parental alcohol abuse, domestic violence or previous trauma. Most of the offenders were unemployed at the time of the offence. In all, 89% were diagnosed as having personality disorder and two were schizophrenic.     

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.     

A variant of incaprettamento (ritual ligature strangulation) in East Timor

Incaprettamento is a ritualized form of ligature strangulation often associated with the Italian Mafia. The hallmarks include ligature strangulation and binding of the body in a highly stereotyped fashion. The bindings include tying the wrists and ankles together, with the body in the prone position (similar to "hogtying"), and an additional ligature encircling the neck and attached to the bindings of the extremities. The binding of the body may be performed after death is inflicted by ligature strangulation, or it may be associated with self-strangulation, as shown by the arrangement of ligatures and the position of the body. A case with great similarities to incaprettamento, in which the body was exhumed from a grave in East Timor, is described in detail. However, in addition to prone-position binding and a hyoid fracture, chopping wounds of a knee and blunt trauma to the posterior torso were found. The implication of these wounds is discussed in relation to incaprettamento.     

Calculation of tension exerted on a ligature in incomplete hanging.

The study is devoted to one of the numerous factors (namely, body posture), which determine the strength of the neck compression in hanging. Mathematical modeling method and achievements of biomechanics were used. Human body was supposed to consist of 16 freely joined hard parts. The possibility of ligature tension calculation in any position in incomplete hanging is shown. Weight ranges for hanging of male persons in different body positions are presented: in standing posture the ligature is stretched by more than 65% of the body weight, in kneeling position by 64-74%, in sitting by 17-32%, in recumbent posture by less than 18% of the body weight. The importance of the accurate recording of a corpse posture at the place of accident is emphasized, as well as the necessity of the corpse mass evaluation. Significance of the work for medico-legal practice is illustrated by the study of the neck organocomplex trauma in 108 cases of suicidal hanging. Injuries were revealed stereomicroscopically after the complete preparation of the hyoid bone and laryngeal cartilages, preliminary fixed in the formalin solution. Trauma to the neck complex (fractures, infractions, fissures) was found in more than 64% of cases, differences in many of the groups compared are significant, P<0.05. Vulnerability index hyoid bone/thyroid cartilage was 1.75 in complete hanging of the body, 0.88 in standing position, 0.63 in kneeling, 0.33 in sitting, 0.25 in recumbent posture. Results of the study may be used for investigation of dying processes and morphology of hanging.     

An unusual, deep lingual hemorrhage as a consequence of ligature strangulation

During the course of the daily practice of forensic pathology, little or no attention is generally devoted to the tongue (if it is even removed at all during the autopsy examination) except in a handful of relatively well-defined situations. In some other instances, such as injuries involving the neck and laryngopharyngeal organs, the tongue may be removed, but examined in only a cursory manner, since the serious pathology which caused or contributed to death is most often located in adjacent structures. While the postmortem examination was being carried out on a victim of ligature strangulation who exhibited relatively sparse external and laryngeal findings of significance, a unique and apparently heretofore undescribed patterned hemorrhage was discovered within the deep musculature of the tongue, having an appearance and contour identical to that of the curved edge of the subjacent hyoid bone. In difficult cases where strangulation is suspected as well as other potentially medicolegal problems with trauma involving the neck organs, a detailed inspection of the tongue through an easily accomplished dissection technique may provide invaluable information as to the mechanism of injury.     

Aspiration of gastric contents in hanging with typical position of the strangulation cord and free suspension]

Among 193 cases of hanging from the years 1978 to 1991 examined in the institute of Forensic Medicine of the Freie Universit?t Berlin 8 cases with an aspiration of stomach contents had been reported. Herefrom 3 cases were hanging in a "typical" position (suspension point at the back of the head, free suspension of the hanging body) and did not undergo resuscitation. By free suspension of the hanging body the observed massive aspiration of gastric contents only can be explained by an at least partly open connecting passage between the laryngeal entry and the entrance of the oesophagus. The post mortem flowing in of stomach contents as well as a post mortem gastro-oesophageal peristalsis seem not to be able for explicating the findings. Differences in important parameters (e.g. gastric contents, alcoholization) to the cases of hanging without aspiration were not found. Even by free suspension of the body, running noose and point of suspension in the back of the neck sometimes the connection between larynx and oesophagus may stay open, especially when by emesis a high pressure is produced by the stomach.     

Two unusual cases of suicide by hanging

Two unusual cases of suicide by hanging are described, in the first case the deceased's left hand tied to the left thigh with the head and face covered by a heavy winter coat. In the second case the deceased's hands were tied behind his back.     

Visualization of biological traces on evidence by ninhydrin

Because of possible contamination of samples with PCR inhibitors and to avoid the typing of mixed profiles the source material for forensic DNA investigations should be collected as directly and securely as possible from the evidence. This approach requires a detectability of the source material which is often not given. The procedure introduced here using selected cases enables visualization of DNA-containing materials on evidence and hence controlled analysis. For this purpose the specimen is treated with ninhydrin. A following dye reaction verifies the presence of biological material, which possibly contains DNA. An impact on subsequent STR-analysis was not observed.     

Immunocytochemical examination of biological traces on knife blades

In cases of penetrating stab wounds by different knives it is highly relevant to prove which knife caused which injury, especially if one of the injuries was lethal. This is possible by immunocytochemical examination of cellular material remaining on the injuring blade because some organs have organ-specific antigen determinants such as alpha-l-fetoprotein in the liver cells or cardiac troponin I in the heart muscle cells, to which antibodies can bind. Even when penetrations occur through several layers of clothing, enough cells from the injured organ remain on the blade of a knife to allow immunohistochemical examination. These cells can be collected by means of adhesive film or wiping the blade and can be stained immunocytochemically. The organ specificity of the examined proteins allows proof of their origin. The present study shows that immunocytochemical alpha-l-fetoprotein and cardiac troponin I staining of the cells remaining on a knife blade enables proof of whether the knife blade injured the heart or the liver, or both.     

Isoenzyme determinations as aids in the identification of biological traces

The findings are described that were determined after a fatal traffic accident. By means of blood and isoenzyme typing, a piece of tissue adhering to the bottom of a car was ascribed to the victim.     

A study of fatal strangulation cases in Varanasi (India)

Strangulation is one of the oldest and widely used methods of committing murder in the Indian subcontinent. It is usually carried out by constricting the neck either with the hands, elbow, or other parts of body or by ligature, stick, and the like. In this paper we report a study of 26 cases of fatal strangulation occurring in the district of Varanasi (India) during 1982-1983 and analyze their epidemiological, medicolegal, and forensic pathological aspects. The paper also projects the mentality of perpetrators who, after strangling their victims, tried to hide the crime by disposing of the dead bodies by burning, burying, hanging, throwing them into water, or concealing them in distant places in most of the cases.     

Suicide by hanging. A review of 56 cases

Fifty-six consecutive cases of suicide by hanging are reviewed. The data provide some evidence for associations between suicide by hanging and youth, incarceration, black males, and clustering. Evidence was noted of low incidence in females, rarity of white female hangings at home, a preference to hang oneself away from home if there have been previous suicide attempts, and possible seasonal trends which may differ from suicide overall. Thus, aside from the method chosen, hanging victims as a group displayed some differences from suicides in general.     

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.     

Visualisation by confocal microscopy of traces on bullets and cartridge cases

The capabilities of confocal scanning laser microscopy for the visualisation of marks on bullets and cartridge cases were investigated. Confocal microscopy provides solutions to important limitations of conventional comparison microscopy with grazing light incidence, as generally used for the examination of these marks. It is expected that confocal microscopy, thanks to its broad applicability within the field of firearms investigation and its capability of non-destructively gathering quantitative three-dimensional information, will lead to a more complete and objective forensic examination of bullets and cartridge cases.     

Immunocytochemical examinations of biological traces on expanding bullets (QD-PEP)

When a crime victim has been injured with several different objects, it is of central importance for the forensic investigation to be able to show which object caused which injury, especially if one of the injuries was lethal. In cases of bullet penetration wounds it is often not possible to find such evidence. However, immunocytochemical investigations can accurately match a victim's injury to a particular bullet path through the body. In cases where expanding bullets have been used and the heart or liver has been struck by a projectile, it can be shown that the cells remaining on the bullet stem from those particular organs. In this case the specific cytological evidence was established by means of marking heart- and liver-specific tissue proteins with appropriate antibodies (cardiac troponin I and HepPar 1) followed by disclosure with an appropriate chromogen. Thus, in principle, cells can be used as evidence after being extracted from the projectiles by either damp cotton-wool swabs or adhesive trace evidence tape. Because of the specificity of the used immunocytochemical antibodies, finding evidence of an antigen on a particular projectile proves that it was the object that injured the organs.     

The importance of Simon's symptom in cases of hanging (author's transl)

Radiological and patho-anatomical investigations of the spines of 32 corpses of persons who had committed suicide by hanging revealed spine damage in 81% of the cases. The cervical spine was damaged in 69%, the lumbar spine in 56% of the cases. The typical damage of the cervical spine is a loosening of the discs at the dorsal side, usually at the level of C 4/5 to C 6/7. In the region of the lumbar spine, bleeding between the (anterior) ventral ligament and the discs is the most frequently observed damage (Simon's sy;mtpom). Simon bleeding is brought about by traction force and is not dependent on the age at death or on any existing degenerative changes of the spine.     

Development and validation of molecular methodologies for identification of biological traces from crime scenes

This study aimed to develop a methodology to identify biological fluids in sexual assault cases through mRNA markers. Biological fluid samples such as blood, saliva, and semen were collected from volunteers and submitted to RT-qPCR reactions with specific primers for the biomarkers HTN3 (saliva), ALAS (blood) andTGM4 (semen). The Melting (Tm) of each biological fluid was analyzed and the result inferred a high specificity capable of differentiating such traces. Biplex systems were generated to improve trace analysis in a single qPCR reaction.