Asphyxial suicide by inhalation of helium inside a plastic bag

Asphyxial suicide by placing a plastic bag over the head, especially in combination with inhalation of gases, is a rarely described method of committing suicide. This article reports a case of suicidal asphyxiation by inhaling the inert gas helium inside a plastic bag. A 64-year-old man probably followed the instructions described in an article about committing suicide written by a medical practitioner from Zürich. This form of suicide is recommended by right-to-die groups and in the internet as a certain, fast, and painless suicide method. Additionally, it leaves only seldom externally visible marks or pathomorphological findings on the body. If the plastic bag and other auxiliary means are removed by another person, the forensic death investigation of cause and manner of death may be very difficult. Therefore, the death scene investigation and the inquiry ordered in the environment of the deceased are very important.     

Toxicological analysis after asphyxial suicide with helium and a plastic bag

A 23-year-old man was found on a raised hide in lying position, the head wrapped in a plastic bag connected with a helium gas cylinder by a polypropylene tube. The autopsy did not show any specific findings nor did the routine toxicological analysis reveal significant information regarding the cause of death (BAC 0.9 mg/g, diphenhydramine 0.81 μg/ml in heart serum). For the detection of helium in the lungs, gas samples from both lungs were collected by a method ensuring minimal dilution. Gas analyses were performed using a GC–MS with a split–splitless injector and a headspace syringe. As carrier gas the commonly used helium was replaced by nitrogen. Helium was found in clearly elevated concentrations in gas samples from both lungs. Therefore, suffocation by breathing helium enriched, and thus oxygen deficient atmosphere, can strongly be assumed as the cause of death.     

Complex autoerotic death with full body wrapping in a plastic body bag

Autoerotic deaths are normally classified as accidental deaths occurring during individual, and usually solitary, sexual activity in which a device, apparatus, or prop used to enhance sexual stimulation of the deceased somehow causes unintended death. The most common methods of autoerotic practices are asphyxia by hanging, ligature, plastic bag, chemical substances, or a mixture of these. However, atypical methods such as overdressing/body wrapping have also been reported. In fact, overdressing/body wrapping is so rare that it is implicated in only 1.5% of published cases. Although plastic bags are often implicated in autoerotic deaths, there has been only one previous case that involved a plastic covering the victim's body from head to toe. We here report the case of a 34-year-old man who died due to asphyxia, secondary to body wrapping in the largest and most complex plastic bag ever involved in a published case of autoerotic death.     

Plastic bag as the method in suicide and homicide

The report describes a suicide and a homicide by suffocation in a plastic bag. Both cases were copy-cat acts. The suicide copied the method--taking medicines and pulling a plastic bag over his head from a personal model. In the homicide the perpetrator followed the example of a film sequence from the US feature film "Charade".     

Asphyxial deaths and petechiae: a review

Conjunctival and facial petechiae, although nonspecific findings, are considered hallmarks of asphyxial deaths. Consensus in the literature suggests that their pathogenesis is related to the combined effects of increased cephalic venous pressure and hypoxic damage to endothelial cells. Despite the common knowledge that they are neither predictable findings in all asphyxial deaths nor rare in natural, nonasphyxial deaths, the belief persists that petechiae are corroborative evidence of asphyxia. We suggest that a clear, physiologically based understanding of the pathogenesis of petechiae of the head is critical for their appropriate interpretation. We present a review of the literature and the basis of our conclusion that conjunctival and facial petechiae are the product of purely mechanical vascular phenomena, unrelated to asphyxia or hypoxia.     

Asphyxial games in children and adolescents

Asphyxial games, as played by young adolescents, and going by various names, are not new phenomena. What seems to be different at present is an increase in lethality introduced by the increasing use of ligatures and "playing" the game alone. The authors present a properly certified but insufficiently appreciated case followed 2 years later by 2 closely spaced but unrelated deaths in young adolescent males that made known this practice in New Hampshire youth. Other cases presented to the author from other jurisdictions are reviewed in aggregate. Presented are characteristics of victims of this practice that may help distinguish these deaths from suicidal asphyxia. A relative paucity of literature regarding asphyxial games outside the realm of autoerotic asphyxia gives rise to certification difficulties given the high prevalence of youth suicide.     

Unusual suicide with a chainsaw

Described here is a case of suicide with the use of a chainsaw. A female suffering from schizophrenia committed suicide by an ingenious use of a chainsaw that resulted in the transection of her cervical spine and spinal cord. The findings of the resulting investigation are described and the mechanism of suicides with the use of a chainsaw is reviewed. A dry bone study was realized to determine the bone sections, the correlation between anatomic lesions and characteristics of chainsaw. The damage of organs and soft tissues is compared according to the kinds of chainsaw used.     

Asphyxial deaths: a retrospective study and review of the literature

An increasing death rate as a result of violence constitutes a large group in medicolegal autopsies. Specially, deaths due to asphyxia are one of the most important causes in violence deaths.During the 21-year period from January 1984 to October 2004, there were 134 asphyxial deaths autopsied by the Department of Forensic Medicine, Trakya University, Edirne, Turkey. Asphyxial deaths comprise 15.7% of all forensic autopsies; 20.8% of the cases are aged between 30 and 39 years, and the average age was 41.9 years. Males constitute 79.8% of all the cases.The most frequent method of asphyxiation death is hanging (56 cases, 41.8%), followed by drowning (30.5%) and carbon monoxide poisoning (8.2%). More violent methods, such as ligature or manual strangulations, constitute 2.9% and 2.3% of all asphyxial deaths, respectively. Although it was varying according to the methods of asphyxiation, suicide was found to be the manner of death in the majority of the cases.     

Asphyxial death during prone restraint revisited: a report of 21 cases

Determining the cause of death when a restrained person suddenly dies is a problem for death investigators. Twenty-one cases of death during prone restraint are reported as examples of the common elements and range of variation in these apparently asphyxial events. A reasonable diagnosis of restraint asphyxia can usually be made after ruling out other causes and collecting supportive participant and witness statements in a timely fashion. Common elements in this syndrome include prone restraint with pressure on the upper torso; handcuffing, leg restraint, or hogtying; acute psychosis and agitation, often stimulant drug induced; physical exertion and struggle; and obesity. Establishing a temporal association between the restraint and the sudden loss of consciousness/death is critical to making a correct determination of cause of death.     

Asphyxial deaths as a result of aspiration of dental appliances: a report of three cases

Three cases of asphyxial deaths as a result of aspiration of dental appliances are presented. The possible association of this condition with resuscitative effort and patient debilitation is discussed. A recommendation to improve diagnosis and facilitate resuscitation is offered.     

Unusual basal skull fracture in a vehicle equipped with an air bag

A woman who was the lap/shoulder belt-restrained driver of a car equipped with a full-size air bag was involved in an oblique frontal collision with a tractor-trailer combination. She was extremely out of position, i.e., witnessed to be slumped over the steering wheel before impact. This preimpact positioning led to fatal injuries resulting from the inflating air bag. Postmortem examination showed an unusual partial ring fracture of the base of the skull, which to the authors' knowledge has not previously been reported.     

Bloodstain pattern analysis in a case of suicide with a compound bow and arrow

The incidence of human fatalities due to arrow injuries in the medical literature is rare. We report an incident involving a 46-year-old man who was found in his secured apartment with a fatal arrow wound of his chest and abdomen. The initial scene investigation suggested that the victim impaled himself with an arrow attached to a razor-sharp, 4-bladed broad-head hunting tip before collapsing on the floor. However, analysis of the bloodstain patterns suggested that the victim used the compound bow to propel the arrow.When investigating deaths due to bows and arrows, thorough scene investigation along with bloodstain pattern analysis is essential in determining the mechanism of injury and manner of death.     

Cerebellar agenesis in a suicide

A case of a suicidal death associated with autopsy findings of right cerebellar and vermian agenesis is described. A review of the literature points out the various recurrence of agenesis, symptoms, and the likelihood of motor deficits. The singular coexistence of only behavioral and intellectual deficiency with suicidal inclination in an adult man with partial cerebellar agenesis is discussed.     

Suicide by a locomotive with unusual transport of suicide victims

Two suicides are described in which the victims were transported for 400 m and 16 km (!) hanging from the locomotive's hook coupling. According to the Deutsche Bahn AG, it would be possible for a body caught on a coupling to be dragged for almost 600 km without being discovered. Upon discovery of such a body, the police must search long stretches of the railroad tracks.     

A suicide with neuromuscular blocker

We experienced an autopsy case in which a 29-year-old woman committed suicide by parenteral application of a neuromuscular blocker combined with thiobarbital. These medicines were easily accessible to the victim who was an anesthesiologist in a hospital. Paralyzing the respiratory muscles the usual dose of neuromuscular blockers can cause death unless a breathing apparatus is used. Unusual medicines given in small doses are difficult to detect in the autopsy materials. In our case in the course of forensic investigation we successfully identified the traces of a neuromuscular blocker by mass spectrometry.     

The cutaneous ink sign: a tipoff to suicide or suicide notes

The presence of smeared or unsmeared ink on the skin resulting from the writing process has been observed in a number of suicide victims who have left suicide notes. The authors report a case of a palmar "cutaneous ink sign" and discuss its forensic science import.     

Suicide with two guns represents a special type of combined suicide

Suicide by simultaneous gunshots with two firearms is rare. The case of a 90-year-old man who killed himself with two 6.35 mm pistols fired at the temples at the same time is presented. The victim was found dead on the terrace of his home; two guns and two cartridges were present near the corpse. Cases of suicides with two guns published in the literature are compared, and the Italian cases are illustrated briefly. The authors describe the circumstances and autopsy findings that permitted the assertion that it was a case of suicide and to exclude an homicide and show, by figures, the three-dimensional reconstruction of cranial shooting injuries. The use of two guns is considered a representation of a special type of "combined suicide" or "planned complex suicide."     

饮酒与自杀

饮酒和许多非正常死亡有关,如自杀、他杀、意外伤害死亡等,对各国社会公共健康卫生有着不容忽视的影响。自杀同时也是一个独立的社会公共健康问题,在世界各国均成为日渐严重的社会问题,尤其在青少年群体中,这两种社会现象尤其严重。对饮酒和自杀的关系的研究已有数十年的历史,早在1966年Durkheim就提出酒精消耗在自杀中是一个精神病理的个人因素,1991年Skog等提出酒精消耗作为一种社会现象对自杀有着深远的影响。[1]近年随着饮酒与自杀研究的逐年深入,目前人们已经普遍认识到无论是急性饮酒还是慢性酒精依赖均与自杀有关,[2]Bris-mar等甚…     

Ecstasy and suicide

Deaths due to the ring-derivative amphetamines are not common and are usually accidental involving dehydration and hyperthermia. Suicides from 3,4-methylenedioxymethamphetamine (MDMA) and related ring-derivative amphetamines overdose are rare. A 15-year-old female who had a history of depression and previous suicide attempts was found dead with a suicide note. Toxicology demonstrated lethal serum concentrations of MDMA (9.3 mg/L), with 34 mg/kg of MDMA in the liver, 2.4 mg/L in the urine, and 530 mg/kg in the stomach. The cause of death was MDMA toxicity, the manner suicide. While MDMA may be detected in victims in other drug-related or traumatic deaths, it is only rarely used in isolation in suicide, with a predominance in the 21- to 25-year-old range. Despite the rarity of such events, the possibility of a nonaccidental manner of death should be considered when high levels of MDMA and associated amphetamines are found at autopsy.