Planned complex suicide: report of three cases

This article presents three planned complex suicide cases. The first case was a 46-year-old man, who had taken some antidepressant and antipsychotic drugs before cutting his right wrist and ingesting a large amount of concentrated hydrochloric acid. In the second case, a 34-year-old man was found dead in his home, hanging by his neck, with a suicidal stab wound on the left side of the chest. In the third case, a 22-year-old woman was found dead, hanging by her neck from a ceiling beam of her grandmother's a storage room, after taking of a solid rodenticide. The histories revealed psychiatric problems in all cases. The investigation of scene, the method employed, the autopsy findings and the interview with their relatives altogether pointed toward a suicidal etiology.     

Planned complex suicide: an unusual case

Abstract:  We report an unusual case of planned complex suicide. The victim was a woman aged 67 years, who was found dead in her bath in a state of advanced putrefaction. A plugged-in hairdryer was submerged in the water and the electrical fuses in the room had short-circuited. A kitchen knife lay below the body of the victim, whose left forearm bore incisions suggestive of wrist-cutting. At autopsy, no sign suggesting electrocution could be observed because of the advanced state of putrefaction of the body. Toxicological analysis revealed massive ingestion of tianeptine (blood concentration 15.5 mg/L). Although the exact cause of death could not be determined because of the state of the corpse, meticulous examination of the scene and information obtained from the victim's relatives led to the conclusion of suicide.     

Planned complex suicide. Report of two autopsy cases of suicidal shot injury and subsequent self-immolation

Two cases of planned complex suicide are presented. In both cases, the suicidal persons shot themselves after making sure that in the sequel their bodies would be burnt. In the first case, a 65-year-old man had shot himself in the mouth and consequently fell into a fire he had lighted before. In the second case, a 43-year-old man set fire to his flat and shot himself directly afterwards. On the basis of the reported cases, a short literature review on planned complex suicides is given.     

Childhood suicide: a report of four cases

A study of childhood suicide in individuals aged twelve years or less was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, FL, over the eight-year period from 1977 to the present. Four cases were collected; these are presented in some detail. A discussion then ensues along with a review of pertinent literature concerning this phenomenon.     

Paraquat myopathy: report on two suicide cases.

We describe two suicide cases in which old paraquat was ingested. In conjunction with lung involvement a pronounced degeneration was observed in skeletal muscle of one who died on the 14th day after the ingestion. The following sarcoplasmic or endoplasmic reticulum Ca2+ ATPase (SERCA) monoclonal antibodies were used for skeletal muscle fiber typing by an immunohistochemical method: NCL-SERCA1, reactive with type 2 fiber (fast-twitch), and NCL-SERCA2, reactive with type 1 fiber (slow-twitch). The examination revealed that the remarkably degenerated fibers belonged to type 1 muscle fibers. This case showed an abrupt increase of plasma CK levels (1796 mU/ml) on the fifth day after the ingestion. The authors presume that the damage to the skeletal muscle had occurred in this period. The degeneration of the muscle seemed to be attributable to the long retention of paraquat in the tissue because these findings were not observed in the other case who died on the fifth day. Paraquat-induced myopathy may develop in prolonged paraquat poisoning. The examination of CK levels in plasma will be useful for diagnosis of damage of skeletal muscle.     

Fatal tolperisone poisoning: autopsy and toxicology findings in three suicide cases

Tolperisone (Mydocalm) is a centrally acting muscle relaxant with few sedative side effects that is used for the treatment of chronic pain conditions. We describe three cases of suicidal tolperisone poisoning in three healthy young subjects in the years 2006, 2008 and 2009. In all cases, macroscopic and microscopic autopsy findings did not reveal the cause of death. Systematic toxicological analysis (STA) including immunological tests, screening for volatile substances and blood, urine and gastric content screening by GC-MS and HPLC-DAD demonstrated the presence of tolperisone in all cases. In addition to tolperisone, only the analgesics paracetamol (acetaminophen), ibuprofen and naproxen could be detected. The blood ethanol concentrations were all lower than 0.10 g/kg. Tolperisone was extracted by liquid-liquid extraction using n-chlorobutane as the extraction solvent. The quantification was performed by GC-NPD analysis of blood, urine and gastric content. Tolperisone concentrations of 7.0 mg/l, 14 mg/l and 19 mg/l were found in the blood of the deceased. In the absence of other autopsy findings, the deaths in these three cases were finally explained as a result of lethal tolperisone ingestion. To the best of our knowledge, these three cases are the first reported cases of suicidal tolperisone poisonings.     

Accidental deaths involving derringer handguns: a report of three cases

Accidental deaths due to discharge of dropped handguns have been previously reported. In this report, the authors review the history and design of the derringer handgun and describe three cases of accidental death due to discharge of derringer-type handguns. In two of these cases, the gun was dropped, resulting in a fatal discharge. The design of the derringer and the absence of a safety feature are cited as underlying factors. If the alleged weapon can be obtained, testing may demonstrate that discharge could occur if the gun were dropped.     

Human plague in New Mexico: report of three autopsied cases

Plague is a deadly disease of obvious concern to individuals, communities, and public health officials. The rapid recognition of plague victims is of paramount importance in saving the lives of the victims and in the protection of contacts. Three autopsied plague cases have been presented and the pathological features have been discussed.     

Planned complex suicide by self-poisoning and a manipulated blank revolver: remarkable findings due to multiple gunshot wounds and self-made wooden projectiles

A remarkable case of complex suicide with poisoning and multiple self-inflicted gunshot wounds to the head is reported. After ingestion of a liquid insecticide, the victim shot himself twice in the head, once in each temple. Self-manufactured wooden dowels were used as projectiles in combination with conventional blank cartridges. The dowels had been glued on top of the blank cartridges and expelled by propellant gases. Moreover, the blank revolver used had been extensively manipulated in a rarely observed manner. Several occlusive devices had been removed from the barrel and the cylinder chamber to enable the expulsion of the wooden projectiles. The investigation of the methods used and the circumstances found at the scene pointed towards a planned complex suicide. A remarkable case with unusual projectiles, i.e., wooden dowels, fired by an extensively manipulated blank gun is reported, emphasizing the importance of close collaboration between the police firearm laboratory and forensic pathology in practical casework.     

Wounding characteristics of glaser safety ammunition: a report of three cases

Handgun ammunition that contains multiple pellets (birdshot) comes in two forms. We describe here the autopsy and radiographic findings in three individuals who were fatally wounded with Glaser safety ammunition and contrast the findings to those reported in shot shell injuries.     

Postmortem wound dehiscence. A report of three cases

Three cases of healing incised wounds that dehisced following death are reported. All three deaths were apparent drownings during summer months. The incised wounds had occurred from 1 week to 6 months prior to death. The length of post-mortem immersion ranged from 2 days to 3 weeks, and all three decedents exhibited significant decompositional changes. Proper recognition of this postmortem artifact eliminates undue suspicions and contributes to proper identification.     

Planned and unplanned complex suicides: a 5-year retrospective study

The notion of planned and unplanned complex suicides first appeared in 1974 by Marcinkowski and, since then, no systematic study of complex suicides has been published in the English forensic literature. Here, the authors present a 5-year retrospective study of complex suicides. Nineteen complex suicides were reviewed: five unplanned and 14 planned, including the first case of an unplanned complex suicide in a woman. All cases were analyzed in terms of gender, age, methods of suicide, the presence of a suicide note, and past suicide attempts, and statistically compared with a 50-case sample of simple suicides. A further comparison was established with compiled data from the literature. Similarities were revealed regarding incidence of complex suicides, male gender predominance, and types of methods used. In contrast, results showed a higher average age for planned complex suicide victims. Finally, the authors discuss the application of the complex suicide definition.     

Suicide by intravenous injection of cocaine. A report of three cases

Death as a consequence of cocaine abuse is continuing to increase in all parts of the United States. Cocaine use may cause the development of psychosis, with subsequent expression of suicidal ideations, and potentially even successful suicide. Cocaine dependence may also cause depression in the individual who is unable to control his or her craving for the drug, and suicide may be perceived as the only solution to a desperate problem. Despite the dramatic escalation of cocaine abuse and the potential toxicity of this drug, there have been no reports within the United States of cocaine being used as the agent to accomplish a suicide. Herewith are reported three cases in which depression and desperation over cocaine dependence were the motivations for successful suicide, which was accomplished through the intravenous injection of cocaine to the point of death. True cocaine suicide is probably only identified through the presence of objective scene information that unequivocally proves suicidal intent, such as notes or letters which contain information to this effect. A careful search of the scene of death in cocaine fatalities is mandatory, and diligent application of routine scene investigation principles may reveal that suicide through the use of cocaine is more widespread than first appearances would suggest.     

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.     

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.     

Unusual circumstances in a fourfold complex suicide

Complex suicides are defined as suicides using more than one method, which may sometimes suggest homicide. We present the case of a 27-year-old man who killed himself by using four different methods. The man was known as a loner and sufferd from bipolar psychosis. An eyewitness saw him afire and falling out of a window on the 4th floor of a hotel. He was wearing a judo dress with the belt wound twice around his neck. He died in a hospital about two hours later. The autopsy showed signs of neck compression typical of (self)-strangulation, several stab and cut wounds in the thoracic and abdominal region from sharp force, extensive first- to third-degree burns caused by the effect of heat, contusions of internal organs, serial rib fractures and several bone fractures of the extremities as signs of blunt force. The CO-Hb value in the blood amounted to 7%; the other toxicological tests were negative. Death was found to be due to exsanguination from a deep stab wound in the abdomen and multiple trauma caused by the fall from a great height in the course of a suicide. Homicide could be excluded due to the circumstances of the case, which demonstrated again that both the medical findings and the investigation results of the police are indispensable for the differentiation between suicide and homicide.     

Thiamylal: review of the literature and report of a suicide

A 28-year-old white male medical student was found hanging by the neck from the bathroom closet of a hotel room. An intravenous infusion line leading from a bottle of thiamylal sodium (an ultrashort-acting barbiturate) was inserted into the antecubital vein of the left arm. Blood was analyzed for alcohol and other volatiles and for acidic, basic, and neutral drugs. Only thiamylal was detected. Thiamylal was quantified by high-performance liquid chromatography with ultraviolet detection, and its presence was confirmed by gas chromatography/mass spectrometry. The tissue distribution of thiamylal was 29 mg/L in blood, 1.4 mg/L in urine, 16 mg/L in bile, 135 mg/kg in liver, 25 mg/kg in kidney, and 0.4 mg in the stomach contents. The uptake and distribution of thiamylal is similar to thiopental. The distribution of the drug in this case was compared to that of other fatalities involving ultrashort-acting barbiturates.