A Study of Fatal and Nonfatal Hangings

Approximately 50% of all suicides performed worldwide are strangulations. This article presents options for the medicolegal examination of hanging. The pathogenetic mechanisms and clinical pictures of victims are discussed. Examples of the process of diagnosis and expert conclusions are given. This article is intended for physicians and forensic pathologists. The literature focusing on asphyxia by strangulation is reviewed. Data from Vilnius Hospitals and the State Forensic Medicine Service concerning strangulations performed between 2012 and 2014 are analyzed and include the findings of 5650 autopsies (36% asphyxia) and 4 survived victims. The predominant symptoms were neurological, cardiovascular, and respiratory symptoms. After asphyxia, patients should consult by a psychiatrist, ophthalmologist, gastroenterologist, and endocrinologist. A ligature mark was the most observable sign of asphyxia by neck strangulation. Only complications in the poststrangulation period were treated. Mechanical asphyxia must be identified as the main injury in the clinical diagnosis and encoded as ICD‐10.     

Investigation into "normal" background DNA on adult necks: implications for DNA profiling of manual strangulation victims

Others have investigated the role that DNA profiling could play as a method for identifying the perpetrator of manual strangulation. These studies have demonstrated that it is possible to collect offender DNA from the skin surface of a victim following physical contact. It is not known whether nonself biological material is normally present on the skin surface due to adventitious transfer occurring during innocent everyday interactions. To test the hypothesis that detectable amounts of nonself DNA are normally present on the skin surface of healthy adult individuals due to the adventitious transfer of DNA occurring during normal day-to-day social interactions, we designed an experiment in three phases. Phase 1 was used to deduce which DNA collection, extraction, and amplification methods were suited to investigating this question. During phase 2, the neck surface of 24 healthy adult volunteers was swabbed. DNA was extracted using the QIAamp DNA mini kit and amplified using the SGM Plus PCR amplification kit, using 28 PCR cycles. The work carried out during phase 3 involved a simulated assault to investigate primary and secondary transfer of DNA during physical contact. It was found that 23% of neck areas swabbed during phase 2 of this investigation showed nondonor alleles in the resulting DNA profile, with 5% of areas showing six or more nondonor alleles. The results of phase 3 showed that primary, secondary, and zero transfer of victim and/or offender DNA could be observed after physical contact and that alleles from an unknown source could still be detected in this more controlled experiment. The data presented in this paper demonstrate that DNA profiles generated after swabbing the skin surface of healthy adults can include components of an unknown source, present due to adventitious transfer. These components, if present in large quantities, have the potential to interfere with DNA profile interpretation of swabs taken for the investigation of physical assault by DNA profiling.     

Accidental Ligature Strangulation by an Ironing Machine: An Unusual Case*

Abstract: In this paper, we present a case of a 53‐year‐old woman who had her headscarf catch on the cylinder ironing machine in the laundry of the hospital where she worked. The hospital workers found the woman dead with her head stuck to the ironing machine. After the death scene investigation and autopsy were completed, it was determined that the death occurred as a result of accidental ligature strangulation. Accidental ligature strangulation in which an article of clothing is caught in such an electrical machine and strangles the wearer is very rare. This case highlights the fact that these kinds of machines can be hazardous to work around and that increased safety measures should be taken to insure worker safety; additionally, the people who use these machines should be educated on the potential hazards.     

Classification of Asphyxia: The Need for Standardization

Abstract: The classification of asphyxia and the definitions of subtypes are far from being uniform, varying widely from one textbook to another and from one paper to the next. Unfortunately, similar research designs can lead to totally different results depending on the definitions used. Closely comparable cases are called differently by equally competent forensic pathologists. This study highlights the discrepancies between authors and tries to draw mainstream definitions, to propose a unified system of classification. It is proposed to classify asphyxia in forensic context in four main categories: suffocation, strangulation, mechanical asphyxia, and drowning. Suffocation subdivides in smothering, choking, and confined spaces/entrapment/vitiated atmosphere. Strangulation includes three separate forms: ligature strangulation, hanging, and manual strangulation. As for mechanical asphyxia, it encompasses positional asphyxia as well as traumatic asphyxia. The rationales behind this proposed unified model are discussed.     

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.     

Self‐Strangulation Through A Sphygmomanometer: An Uncommon Suicide

Suicide by asphyxia is quite a common event in forensic practice and may be implemented in different ways. The authors report a unique case of a 16‐year‐old youth who committed suicide by means of a standard mercury sphygmomanometer. This manner of suicide has never been described in the literature reviewed. A complete forensic investigation led to the conclusion that the cause of death was mechanical asphyxia, ascribed to self‐strangulation by means of an atypical item. The victim suffered from attention‐deficit/hyperactivity disorder (ADHD) syndrome and was assisted by support teachers. He had a solitary and depressive personality. The exceptional nature of this case suggests that sphygmomanometers may be regarded as possible means of self‐strangulation. The case also highlights the importance of managing patients with psychiatric or cognitive disorders; indeed, particular caution is required to keep them away from objects that, although apparently harmless, can become lethal.     

Cervical Arterial Injury After Strangulation—Different Types of Arterial Lesions

After strangulation, cervical arterial injuries (CAI) are uncommon. We report three unusual cases where strangulation induced immediate stroke. CAI were examined using brain CT scan and Doppler ultrasonography in the three cases and then by autopsy in one of the victims. One of the two victims who survived the attempted strangulation had a unilateral carotid dissection, whereas in the other victim, no arterial dissection or thrombosis was observed. As regards the deceased victim, the autopsy confirmed the bilateral dissection showed on CT scan and Doppler ultrasonic examination and revealed that both carotid arteries were dilated up to two times the normal diameter. Microscopic examination showed a major bilateral hemorrhagic dissection of the media with obliterating fibrous endarteritis lesions associated with inflammatory damage. CT scan with arteriography does not demonstrate all the different types of arterial injury, particularly atheromatous embolism, direct compression, or prolonged spasm. Thus, traditional autopsy remains an essential forensic tool after strangulation to show the type of CAI.