Atypical suicide by single incising cut to the throat without hesitation marks: Case report and review of the literature.

Several studies have been performed to recognize the main features in homicide and suicide sharp wound-related death, revealing that a single cutting wound to the neck is an infrequent event in suicide cases, and several hesitation marks near the fatal injury are usually present. We report a case of an atypical self-inflicted cutthroat injury without tentative marks involving a 79-year-old female. The weapon used, a kitchen knife, was found at the crime scene. The wound had clean margins, and no other incisions were found. Scene circumstances, namely the absence of signs of a break-in, the victim found on the bed, the knife located near the body, the vital wound in an accessible site, and the absence of defense injuries, collectively support a likely suicide. A literature review was also performed to compare forensic data of the case presented with the other 6 cases reported regarding atypical suicide characterized by a single incising cut to the throat without hesitation marks. Given the few cases reported and the lack of gross descriptions and histopathological data available in the literature, additional knowledge of such a case may help forensic pathologists in the identification of suicidal events when a single neck injury is observed. In this frame, suicide by a unique single incising cut to the throat without hesitation marks near the lethal injury may be observed as an atypical presentation, and the crime scene investigation, together with additional background information of the deceased, aid in the identification of the manner of the death.

PHmetria esofagica abreviada: correlacion de valores del indice de reflujo (IR) en examenes de 8 a 24 hs / Eigth hours pHmetry: correlation of the GE reflux index

Los trazados de 23 pHmetrias esofagicas realizadas entre Enero y Agosto de 1995 fueron analizados retrospectivamente para determinar si un periodo mas corto de evaluacion (8hs) podria producir los indices determinador por la monotorizacion de 24 hs. Fueron analizados los siguientes indices en las primeras 8 hs. de trazado y en el trazado completo de 24 hs: IR; indice de reflujo (por ciento de tiempo con pH menor de 4), AUC; rea bajo la curva de pH<4 y 10 indice oscilatorio (por ciento tiempo con pH entre 3,75 y 4,25). Los valores normales indicados en la literatura para cada uno de estos par metros (IR<4 por ciento AUC<2000 y 10<10 por ciento) fueron utilizados para clasificar los trazados en "normales" y "alterados". El IR se mostro "alterado" en 11 trazados de 8 hs. y en 11 de 24 hs. Hubo un falso positivo y un falso negativo. La sensibilidad y especificidad fueron calculadas respectivamente en 90,9 por ciento y 91,6 por ciento y el valor predictivo positivo en 90,9 por ciento. Los valores de AUC y OI se encontraron "normales" en todos los trazados a las 8 y 24 hs y no fue posible analizarlos. Aunque muchos trabajos afirman que la pHmetria abrevida tiene indices de sensibilidad inferiores a los observados en ex menes de 24 hs, segun nuestros resultados podemos afirmar que el IR tomado en un periodo de 8hs durante el dia es representativo de 24 hs. y se puede utilizar para confirmarel diagnostico de reflujo de la infancia