51/300. Asphyxial suicide with helium and a plastic bag. suicide by helium inhalation inside a plastic bag has recently been publicized by right-to-die proponents in "how to" print and videotape materials. This article reports a suicide performed according to this new and highly lethal technique, which is also a potentially undetectable cause of death. toxicology information could not determine helium inhalation, and drug screening did not reveal data of significance. The cause of death could be determined only by the physical evidence at the scene of death. helium inhalation can easily be concealed when interested parties remove or alter evidence. To ensure that their deaths are not documented as suicide, some individuals considering assisted suicide may choose helium methods and assistance from helpers. Recent challenges to oregon's physician-assisted suicide law may increase interest in helium instead of barbiturates for assisted suicide. ( info) |
52/300. Self-strangulation: an uncommon but not unprecedented suicide method. The authors report two cases of self-strangulation in which the investigators had initially suspected homicide but eventually deemed the cases to be suicide. Self-strangulation may be mistaken for homicide because it is widely believed to be impossible to carry out this act without assistance. An accurate medicolegal evaluation of the circumstances, a thorough postmortem examination, and methodical inspection of the site are extremely important in such cases. It is equally important to examine the knot or other means used to exert pressure on the neck and to document its position. Finally, to gain a full understanding of these unusual cases, close collaboration between the two different fields, investigative and medicolegal, is essential. ( info) |
53/300. Acute asphyxia caused by Gerhardt's syndrome associated with asthma. vocal cord dysfunction (VCD) has been frequently discussed as confounding the diagnosis of asthma, and it is recommended to examine vocal cord function in cases of difficult asthma. However, there is also strong evidence that asthma may be associated with VCD, sometimes masquerading as exercise-induced asthma. Gerhardt's syndrome frequently induces severe acute respiratory distress requiring ventilatory support, and this condition might be mistaken for a severe acute asthma attack. Here, a case of bilateral paralysis of the vocal cords, which was associated with asthma, is described. ( info) |
54/300. Fatal accidental hanging from a lanyard key chain in a 10-year-old boy. Lanyard chains are commonly worn around the neck to hold keys and identification badges. A ten-year-old Black male child was home alone jumping and swinging of the raised crossbars on his mother's four-poster bed. He commonly did this. He also wore a lanyard around his neck with his house key, which he used to let himself in after school. His mother found him hanging on the corner of the bedpost by the lanyard when she returned from work. The death scene showed that he was jumping on the bed and the lanyard hooked over the top of the corner bedpost, causing first and second cervical vertebrae dislocation of an abrupt "drop-type" hanging with neck abrasion marks. Lanyards, or any loose rope material around the neck, are inherently dangerous due to their strength and ability to catch fixed or moving objects. safety modifications to the lanyards are easily made with "breakaway" Velcro-type or plastic clip fasteners. This is the first reported case of an accidental hanging after review of the medical literature and files of the U.S. Consumer Products safety Commission. ( info) |
55/300. head injury with traumatic and postural asphyxia: a case report. An autopsy was performed on a 22-year-old tractor driver who was found on a cliff, 20 feet down from the highway, trapped between the wheel of a tractor trolley and some stones in an inverted position, after sustaining a head injury. Post mortem lividity was present above the knee joints except where the left arm was firmly adducted on the chest and where the cloth folds were compressing on the chest and abdomen all round. Sub-mucosal ecchymoses and petechial hemorrhages were present in the pharyngeal walls, and on both surfaces of the epiglottis and larynx above the vestibular folds. Such hemorrhages were first noticed along with other findings of traumatic and postural asphyxia. ( info) |
56/300. Delayed onset of status epilepticus after transient asphyxia in an asymptomatic full-term neonate. A full-term neonate presented with status epilepticus at 12 hours of age after a symptom-free interval following transient asphyxia at birth. Conventional neuroimaging failed to detect structural correlates to support recent injury. However, diffusion-weighted magnetic resonance imaging studies revealed recent ischemic brain injury. Placental examination documented multiple subacute and chronic findings indicative of decreased maternal/fetal perfusion. These antepartum placental abnormalities may have been associated with this child's inability to withstand the stress of a prolonged second stage of labor, resulting in intrapartum asphyxia leading to brain injury. This child's clinical presentation highlights the delayed reperfusion phase after ischemia-induced brain injury. ( info) |
57/300. "Suffocation roulette": a case of recurrent syncope in an adolescent boy. We present the case of a 12-year-old boy admitted with a complaint of recurrent syncopal episodes. A careful history taking revealed the cause of the syncopal episodes to be a dangerous game played by adolescents called "suffocation roulette." We believe that recognition of this game as a possible cause of syncopal events, together with prompt educative intervention, might prevent adolescent morbidity and mortality and also might eliminate the need for unnecessary medical investigations. ( info) |
58/300. The pathogenesis and management of massive pulmonary hemorrhage in the neonate. Case report of a normal survivor. A 1,760-G male infant SURVIVED MASSIVE PUlmonary hemorrhage. The literature is reviewed and the pathophysiologic changes and pathologic findings of this usually lethal complication of prematurity are discussed. Aggressive pulmonary toilet and ventilation seems warranted for these infants. ( info) |
59/300. Complex suicides by self-incineration. Among the few cases of suicidal self-incineration primary or secondary complex suicides are a rarity. Accordingly the number of reports on this subject in the forensic literature is small. In a retrospective analysis of the Freiburg and berlin autopsy material, four cases were found within an observation period of 11 years. These are described together with seven other cases reported in the literature. Altogether most of these suicides are primary combinations, especially with falls from a height. Other combinations include hanging or the infliction of stabs, cuts or gunshot injuries. The sex and age distribution is similar to that found for suicide by self-incineration alone. ( info) |
60/300. Fatal accident caused by isoflurane abuse. A fatal accident after isoflurane abuse is presented in this report. A hospital employee was found dead in the operating area with a plastic bag over his head. In his locker an almost empty bottle of isoflurane was found. autopsy revealed signs of asphyxiation and toxicological examination revealed nordazepam and isoflurane in non-toxic concentrations in the blood. Quantification of the anaesthetic was also carried out in urine, gastric contents, liver, kidney and brain samples, and in addition, oxazepam, prothipendyl and metabolites of midazolam and prothipendyl were found in the urine. Although the drug problems of the deceased were known before, no efforts had been made to restrict access to these drugs. ( info) |