Asphyxia Homicides in Finland, 1983–2012

Finland has one of the highest homicide rates in Western Europe, and almost every tenth homicide is caused by asphyxiation. Reliable statistics, a strict legislation, and an exceptionally high medico-legal autopsy rate formed a base for a nationwide analysis of asphyxia homicides (n = 383) during 30 years. The cases were identified through multiple records, and all the forensic pathology case files were studied in detail. In more than one out of five cases, there were indications of staging, and the homicide was revealed first at autopsy in close to one in ten cases. The vast majority of the homicides took place in private locations and involved persons known to each other. Every third victim was an intimate partner, and every tenth a child. Almost half of the victims died from manual strangulation, one in three from ligature strangulation. Smothering, choking, neck compression with a firm object, and thoracic compression were more rare methods. Drownings were excluded from this study material. Of all the victims, 7% had no observable external injuries. Petechiae were recorded in approximately in 61%, laryngohyoid fractures in 47%, and vocal cord hemorrhages in 16% of the cases. Every tenth female victim had genital injuries. Toxicological analyses were performed in close to all of the cases, and almost three out of four victims tested positive for blood alcohol. The various aspects of the demographics and autopsy findings covered in this study contribute reliable and accurate data to further strengthen the spectrum of observable medico-legal characteristics of asphyxia homicides.     

美国马里兰州涉及电击枪死亡案例分析

目的 研究美国马里兰州涉及电子武器(电击枪)死亡案件的特点,探讨其法医学鉴定要点.方法 收集2004-2009年美国马里兰州法医局鉴定的涉及电击枪死亡案件13例,案件均经详细的现场调查,尸体进行系统解剖,并进行全面的毒(药)物检测及组织病理学检验.从一般情况、电击枪类型及接触方式、毒物检测结果、死亡方式、死亡原因等方面...     

Forensic assessment of survived strangulation

By a retrospective analysis of all survived strangulation cases examined at the Institute of Forensic Medicine of Berne, Switzerland between 1987 and 2002, the authors tried to find out, if findings and symptoms of victims could be related to the fierceness of the assault and the mode of strangulation and if general evaluation criteria could be established on the basis of objective findings. One hundred and thirty-four survived strangulation cases were analysed on the basis of written reports, photographies and schematical sketches. Findings and symptoms reflected the fierceness of the assault in 71% of all cases by displaying a continuum of findings from minor injuries to severe traumatisation. This applied especially for cases of manual strangulation while other modes of strangulation resulted in different constellations of findings. As a result of this study, the authors deem the following classification of three degrees of severity as practical on condition that a complete forensic medical examination was performed upon the surviving victim shortly after the incident of strangulation: Light strangulation, confined to skin abrasions and/or reddening of the skin of the neck. Moderate strangulation, defined as bruising to, and/or bleeding from the neck, and/or damage to deeper soft tissues or the larynx, as exhibited by the symptoms of sore throat, difficulty in swallowing, and hoarseness. Severe, life-threatening strangulation if the victim presents petechial bleedings as a result of venous congestion with or without accompanying loss of consciousness.     

Myocardial hypertrophy induces carotid body hyperplasia

The carotid bodies tend to enlarge after long-standing cardiopulmonary disease. Our objective was to investigate whether cardiac hypertrophy is associated with carotid body hyperplasia. Fifteen autopsy cases with combined left and right ventricular hypertrophy were examined and compared with two control groups (16 cases). The study involved a meticulous dissection of carotid bifurcations, thin serial sections, and morphometric analysis of carotid body volume and cell types (progenitor, dark, light, and sustentacular). There was a significant increase in sustentacular cells in all individuals with cardiac hypertrophy, which was not drug-induced, and accompanied by a similar increase in carotid body volume. Dark or light cell accumulation was detected focally and only in three instances. It appears that the generalized sustentacular cell hyperplasia is the result of long-standing hypoxia, while a superimposed focal prominence of dark or light cells may be proliferative or metaplastic in nature and attributed to short-term hypoxia.     

Eosinophilic Coronary Periarteritis with Arterial Dissection: The Mast Cell Hypothesis

A subset of coronary arterial dissections is associated with eosinophilic coronary periarteritis (ECPA); however, the pathogenesis of the process remains unclear. Mast cells normally reside in coronary arterial adventitia and are known mediators of eosinophilic inflammatory conditions such as type I hypersensitivity reactions. We report two cases in which coronary arterial dissection with ECPA was detected at autopsy. Tryptase, CD68, CD4, CD8, and CD1a immunohistochemical staining was performed to better characterize inflammation. While eosinophils represented a prominent periadventitial inflammatory cell, there were slightly more lymphocytes: CD4/CD8 ratios were within expected reference ranges. There were moderate numbers of macrophages, and few neutrophils or dendritic cells. Numbers of mast cells in dissected versus nondissected sections were compared: adventitial mast cell densities were threefold higher in dissected portions and showed a trend toward increased degranulation. These findings suggest that mast cells may play a role in orchestrating inflammation in cases of ECPA.     

Arterial Perfusion—A Useful Technique for Evaluating Incised Wounds

A 54‐year‐old woman was found deceased with incised wounds of both sides of her neck and both wrists. Postmortem CT scanning revealed air in the heart and in the dural veins in continuity with air in the right jugular vein. Death was due to incised wounds of the wrist and neck with blood loss and air embolism. The manner of death was suicide. At autopsy, perfusion of the thoracic ascending aorta produced a fine stream of water emanating from an incised wound of the right ulnar artery with no significant leakage of water from the wound of the left wrist. There was also leakage from the facial artery branch of the right external carotid artery. Perfusion testing can be used as a screening test prior to formal dissection and also to identify small vessels that may not be obvious on standard examination of an exsanguinated field.     

Hanging: suicide or homicide?

Death by Hanging: Suicide or Homicide. Six cases of homicidal hanging and murder presented as suicidal hanging are recorded. Suspension followed strangulation by ligature or throttling and head injuries in 4 cases. Distinction between homicide and suicide was easy in 5 cases: two of the perpetrators gave themselves up to the police, one committed suicide immediately after he had hanged his 15 year old daughter; in two cases tracks of blood, heavy injuries of the victims, and traces of robbery were obvious. Unless the victim is an infant or an adult person incapacitated by drink, disease, or drugs, or unless there are several assailants murder is difficult to accomplish. Distinction between murder and suicide may be impossible by an examination of the body alone. Detailed investigation of the scene, reconstruction of the position of the suspended body, examination of the rope, the knots, the direction of the fibres on the rope may serve to discover homicidal hanging. - Compared to suicidal hanging homicide has a frequency of about 1% in our autopsy material. However, we cannot estimate the number of obscure cases.     

Contribution of Antemortem Computed Tomography Findings to Cause of Death Determination: An Unusual Fatal Stroke

In the case reported here, the antemortem computed tomography scan (CT scan) was essential in the forensic investigation. A 32‐year‐old man was found fully awake with a facial abrasion, after what seemed to be a car accident. He lost consciousness suddenly one hour after initial management. Successive CT scan showed a facial fracture and a metallic foreign body in the carotid canal associated with an occlusion/dissection of the left internal carotid, a pseudoaneurysm, and a carotid‐cavernous fistula. The victim died from a stroke. Autopsy confirmed that the facial abrasion was a gunshot entrance wound, the metallic foreign body being a projectile. Intracranial vascular injuries linked with gunshot wounds are most of the time isolated and due to pelet embolism. The observed vascular injury association has never been described in the existing literature. The CT scan provided a better understanding of the chronology of events that led to death.     

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.     

Cable ties used as tool in homicide: relevance of the DNA analysis

An investigation of strangulation tools often reveals DNA of the victim. In some cases, DNA of the suspect can also be demonstrated, even in strangulation tools with a smooth surface like cables. The authors report a case of strangulation of two victims with cable ties. In addition, several used and unused cable ties were found at the crime scene. The DNA analysis detected DNA of the victims, but also genomic and mitochondrial DNA of various other persons not knowingly involved in the crime. Experiments with unused cable ties revealed that even a single handling of a cable tie may leave DNA traces. An enquiry of the companies selling cable ties showed that the cable ties are manually handled, so that foreign DNA must always be expected.     

Blood aspiration as a vital sign detected by postmortem computed tomography imaging

Blood aspiration is a significant forensic finding. In this study, we examined the value of postmortem computed tomography (CT) imaging in evaluating findings of blood aspiration. We selected 37 cases with autopsy evidence of blood in the lungs and/or in the airways previously submitted to total-body CT scanning. The CT-images were retrospectively analyzed. In one case with pulmonary blood aspiration, biopsy specimens were obtained under CT guide for histological examination. In six cases, CT detected pulmonary abnormalities suggestive of blood aspiration, not mentioned in the autopsy reports. CT reconstructions provided additional data about the distribution and extent of aspiration. In one needle-biopsied case, the pulmonary specimens showed blood in the alveoli. We suggest the use of CT imaging as a tool complementary to traditional techniques in cases of blood aspiration to avoid misdiagnosis, to guide the investigation of lung tissue, and to allow for more evidence-based inferences on the cause of death.     

The Role of Postmortem Computed Tomography in the Evaluation of Strangulation Deaths

We explored the value of postmortem computed tomography (PMCT) to augment autopsy in evaluating strangulation fatalities. A literature search identified 16 studies describing autopsy findings in 576 deaths and two studies describing autopsy and PMCT findings in six deaths. Similar cases were identified from our institution, yielding 130 deaths with autopsy findings and 14 deaths with both autopsy and PMCT findings. The presence of laryngohyoid fracture and soft tissue hemorrhage was compared from autopsy and autopsy+PMCT cases. The detection rates of fractures in autopsy and autopsy+PMCT cases were not significantly different. PMCT identified all fractures observed at autopsy and five fractures not identified. While PMCT may not detect soft tissue injuries in decomposed remains or subtle internal hemorrhages in neck injury, it is equally able to detect bony injuries as autopsy and might surpass autopsy in detecting subtle fractures. We conclude PMCT is useful to supplement autopsy in strangulation cases.     

Homicidal and suicidal ligature strangulation--a comparison of the post-mortem findings

Suicides by ligature strangulation are rare events. In Berlin (3.5 million inhabitants; ca. 500 suicides per year) approximately one case per year occurs. Here, we present the main findings of 19 cases investigated between 1978 and 1998, compared to 47 cases of homicidal ligature strangulation. Two of the 19 suicidal victims had single fractures of the upper thyroid horns and one victim a fracture of a lower thyroid horn; other types of laryngohyoid injuries were not observed. In the homicidal series, the laryngohyoid structures were unaffected in 26 cases (12 of these victims were children or adolescents), single thyroid horn fractures were present in three cases and more significant injuries in 18 cases. Macroscopic bleedings of the laryngeal muscles were found in 12 victims of the homicidal group and in none of the suicidal. Bleedings in the neck muscles seldom occurred in suicides. According to these findings, the laryngohyoid injuries can be helpful in the differentiation of suicide from homicide, if more than a single thyroid horn fracture or a laryngeal soft tissue trauma is present.     

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.     

Amussat’s Sign in Hanging—A Prospective Autopsy Study

Abstract: Amussat’s sign is typically a transverse laceration of the intimal layer of carotid arteries described in cases of hanging. Subtotal laceration of the carotid artery is not strictly specific for hanging and can be also caused by blunt neck trauma, extreme overstretching, or whiplash‐injuries. In a prospective autopsy study of 178 cases of hanging, Amussat’s sign was found in 29 cases (a relative frequency of 16.1%). A statistically significant association between the occurrence of tears in the intimal layer of carotid arteries and the victims’ age was discovered in the cases studied (the frequency increased with age; p < 0.05). The occurrence of Amussat’s sign was independent of gender, weight, completeness of the victim’s body suspension, and position of the ligature knot on the neck. The study demonstrates the fact that the most probable cause of Amussat’s sign is a combination of direct compression of the artery by the rope and indirect stretching because of the gravitational drag produced by the weight of the body.     

Evaluation of Computed Tomography as a Screening Test for Death Inquest

Abstract: The Japanese method of inquest, which depends mostly on external examinations, may misdiagnose a considerable number of accidental deaths and suicides as death by disease. We conducted computed tomography (CT) scans of 80 cases for which police concluded death by disease or natural causes based on police investigations into the circumstances and results from external examinations. The cause of death was clearly determined by CT scan in 17 of 80 cases. Ten cases underwent autopsy after the police suspected criminality based on results of the CT examinations. The results suggest CT scan may be a tool for preventing a number of overlooked crimes and accidents in Japan. However, it cannot be a perfect tool for discerning between death by disease and other causes of death without cooperation from the investigative agencies and subsequent forensic examinations such as autopsy and toxicological tests.     

Extra- and intracranial injuries of the cerebral arteries as a sequela of assault

The case of an 47-year-old man is reported, who was injured in a fight while under the influence of alcohol. The culprit knocked him down and stamped several times on the left side of his head. The victim became unconscious. At the hospital, subarachnoid hemorrhage and massive ventricular bleeding was diagnosed via CT. Despite the implantation of a ventricular shunt, there was repeated massive cerebral pressure and arterial bleeding. Brain death occurred after 8 days. The main finding at autopsy was nearly complete disruption of the left inferior posterior cerebellar artery as the source of the lethal bleeding. The histological examination showed some additional, incomplete ruptures of this vessel and of the left intracranial vertebral artery. This is a typical result of "minor head injuries" sustained in fights: arterial rupture (ipsilateral) as a result of overstretching. Fracture of the left zygomatic arch and maxilla; no skull fracture; no primary traumatic brain damage. The extracranial carotid arteries were intact. When the vertebral arteries were examined (in the undamaged cervical spine), there was a surprising finding: distant dissection of the right vertebral artery between C1 and C2, which perhaps occurred as a result of compression (contralateral to the impact) of this region.     

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.     

Six‐Year Retrospective Study of Suicidal Hangings: Determination of the Pattern of Limb Lesions Induced by Body Responses to Asphyxia by Hanging*

Abstract: The objective of the present study was to estimate the proportion of hanging victims presenting with limb lesions, to compare this rate between hanging in restraint spaces and in more open settings, and to describe the usual pattern of limb lesions associated with hanging. Two hundred and seven cases of suicidal hanging were retrospectively reviewed and compared to 45 homicidal nonhanging strangulation victims. Bruises incidence was significantly lower in hanging victims (19.8%) compared to homicidal strangulation victims (55.6%). Bruises were more commonly encountered in restraint areas such as closets and staircases (56.3% and 66.7%, respectively) than in more open settings such as barn, bridge, fence, and park. Limb bruises on hanging victims were generally located on the posterior upper limb or the anterior lower limbs, whereas strangulation victims did not display this preferential bruises concentration. Possible suspicion criteria for limb bruises distribution are discussed, in relation to physiopathology of human asphyxia by hanging.     

An Unusual Method of Suicidal Ligature Strangulation

This article reports a case of suicidal strangulation by ligature of a 51‐year‐old woman with a psychiatric disorder. She had been suffering from depression with a history of previous suicidal attempt. The deceased accomplished self‐strangulation using two ligatures, with one placed above the other and consisting of a satin fabric and a shoelace. The underlying shoelace ligature was fastened by a secure fixed square knot at the back of the neck. The overlying fabric piece was tied with a half‐knot under the chin and was tightened around the neck manually. A detailed investigation and autopsy examination strongly suggests suicide. The case is of interest due to its rarity and uncommon method of execution.