Rectal explosion: a strange case of autoerotic death.

Autoerotic deaths refer to fatalities occurring during individual, solitary sexual activity, in which some device, situation, or act is used to gain or boost the sexual arousal of the subject. Anorectal autoeroticism is an autoerotic paraphilic activity that pertains to the self-insertion of various objects into the anal canal and rectal cavity to gain or heighten the subject's sexual drive. Although most foreign bodies inserted into the rectum do not cause significant injury, the introduction of some objects into the rectum might have unpredictable and even fatal effects. In this paper, we describe an intriguing autoerotic case of a 35-year-old male who sustained an explosive rectal trauma as a result of the unanticipated bursting of an expandable rubber pipe stopper that he inserted into his rectum and hyperinflated via an air blow gun connected through a pressure pipe to a centralized air-distribution system. The man sustained a circular abruption of the rectum with partial avulsion of the abdominal wall, associated with bleeding into the abdominal cavity and chest wall, and died before admission to the hospital. A police investigation revealed that the victim was a regular contributor to several web forums dedicated to unusual sexual activities. This case raises awareness of the broadening spectrum of methods and experiments associated with autoerotic behavior. We also reviewed the literature pertaining to this topic and outlined some of the characteristics of atypical autoerotic deaths. Although certain autoerotic methods are relatively common, other unusual autoerotic techniques may present novel challenges within the medicolegal field.

Hypothermia provokes hemorrhaging in various core muscle groups: how many of them could we have missed?

The postmortem diagnosis of hypothermia remains problematic even in the era of molecular and digital diagnostic advances. Gross hemorrhages in iliopsoas muscles have been regarded as a helpful diagnostic sign in hypothermia fatalities; nevertheless, they have received marginal attention since their original description. The present study attempts to fill that void by examining occurrence, localization, and diagnostic significance of the bleeding into the core muscles as evidence of death due to hypothermia in a series comprising 51 consecutive hypothermia autopsy cases. Hemorrhages into the core muscles were identified in 33 cases of fatal hypothermia (65%). Hemorrhages were present in iliopsoas muscles (19 cases; 37%), deep back muscles (18 cases; 35%), and in other core muscular groups such as the diaphragm, cervical, pectoral, and intercostal muscles (11 cases; 22%). The results of the study offer an attractive diagnostic opportunity and reaffirm the potential of the careful core muscle dissection for the clarification of hypothermic deaths. Centers lacking high-end imaging technologies and molecular postmortem programs may especially benefit, which may have implications in broader autopsy practice.

Hemolytic staining of the endocardium of the left heart chambers: a new sign for autopsy diagnosis of freshwater drowning.

Despite the availability of modern imaging and molecular tools, traditional autopsy, and laboratory findings remain the gold standard for the diagnosis of drowning. This article presents two cases of freshwater drowning in which hemolytic staining of the endocardium of the left heart chambers was observed at autopsy. One case was a suicidal drowning of an 84-year-old man, and the other case was an accidental drowning of an 86-year-old woman. In both cases, there was marked hemolytic staining of the endocardium of the left atrium and ventricle. The endocardium of the right heart chambers was clear and transparent in appearance. Hemolytic intimal staining of the aortic root was observed in one case. Gettler's test was positive in both cases. Hemolytic discoloration of the endocardium of the left heart chambers after freshwater drowning is analogous to hemolytic staining of the aortic root. Both staining patterns result from the hypo-osmolar hemolysis that occurs in the left heart chambers and systemic circulation after hypotonic fluid passes across the alveolocapillary membrane. Hemolytic discoloration of the endocardium of the left heart chambers at autopsy may support a diagnosis of freshwater drowning.

Significance of hemorrhages at the origin of the sternocleidomastoid muscles in hanging.

Hemorrhages at the periostal-clavicular origin of the sternocleidomastoid muscles are part of the indirectly induced autopsy findings in death by hanging. In a prospective study of 178 cases of hanging, clavicular hemorrhages were found in 110 cases (a relative frequency of 62%). A statistically significant association between occurrence of hemorrhages and completeness of the victim's body suspension was discovered (P = 0.046) as well as a significant association between the occurrence of hemorrhages and the location of the ligature knot on the neck (P = 0.008). The occurrence of hemorrhages at the clavicular origin of the sternocleidomastoid muscles was independent of age, sex, and weight. This article renews the knowledge of this important vital sign described mainly in the German medicolegal literature.

Complex suicide with black powder muzzle loading derringer.

Planned complex suicide is defined as the combination of more than one method of suicide, previously planned by the victim, to prevent failure of the first method. Herein, we present a case of planned complex suicide, committed by a black powder muzzle loading handgun and hanging. A 39-year-old man was found dead in the bathroom of his flat, hanging by the neck with a huge atypical gunshot entrance in the right temporal region of his head with extensive backspatter. The skin defects, as well as soft tissues in the subcutaneous pocket undermining, were heavily burnt. Along the wound canal were multiple bone fragments, and at the end of the path at the left temple was an embedded lead ogival projectile with a cross shaped artificial incision at its tip. The hanging was incomplete. There were no fractures of the hyoid bone and laryngeal cartilages. Cervical muscles and vessels were intact. Simon's sign was negative. Signs of asphyxia were not present. This is the first reported case of complex suicide with a black powder derringer and manipulated projectile.

Reversed configuration of the muzzle imprint mark in a pistol contact entrance wound mimicking a non-suicidal act.

The muzzle imprint mark characteristically associated with contact or near contact entrance gunshot wounds exemplifies one of the most informative external findings in forensic medical practice. The presence of the muzzle imprint mark on the body's surface proves ballistic trauma, point of entry, and range of fire. Moreover, its appearance and configuration may indicate the type of the involved weapon and the way the firearm had been positioned and held at the time of discharge. In this paper, we present the contact shot wound pattern of an 83-year-old man who committed suicide with a Frommer Stop 12 M autoloading pistol of caliber 7.65 mm Browning. Initially, the muzzle imprint mark configuration in relation to the entrance gunshot defect in the victim's right temple indicated an unusual application or orientation of the pistol's barrel during discharge, thus, strongly suggesting a non-suicidal act. However, a critical confrontation of postmortem findings along with the results of ballistic expertise provided a clear explanation, which comprised the remarkable construction and unique muzzle design of the used handgun.

Reconstruction of devastating head injuries: a useful method in forensic pathology.

Crushing head injuries usually do not allow direct visual identification of individuals, and above all, it constitutes an obstacle to comprehensive evaluation of discrete traumatic changes of the skin and soft tissues. We present our experience with the plastic adaptation of devastating head injuries in the two exemplary cases. The principal of the reconstruction is manual repositioning of bone fragments of the cranial and facial parts of the skull and careful approximation of the wound edges and their gradual suture using suture material. The reconstruction method can be recommended as an auxiliary technique in the identification of unknown victims with crushing head injuries and in the evaluation of devastating gunshot wound of the head.

An Unplanned Complex Suicide by Multiple Blank Cartridge Gunshots and Cutting.

Blank firing guns are readily accessible in most countries due to an absence of legal regulations. These weapons are capable of causing lethal injuries. We report a rare case of secondary (unplanned) complex suicide committed with a knife and blank cartridge pistol. A 59-year-old man was found dead with three superficial incisions in his neck and a gunshot wound to the chest. The external examination revealed an entrance wound in the left chest region consistent with contact shooting. The appearance of a muzzle imprint suggested two discharges. The autopsy showed a slightly hemorrhaged but otherwise intact pericardium, blood in the pericardial sac, and a channel-like defect in the anterior wall of the left cardiac ventricle. The cause of death was attributed to cardiac tamponade. To the best of our knowledge, this is the first reported case of unplanned complex suicide involving an unmodified blank firing gun.

Laryngohyoid fractures in suicidal hanging: A prospective autopsy study with an updated review and critical appraisal.

Laryngohyoid fractures in hanging victims are one of the most studied and paradoxically contradictory topics in forensic pathology. According to literary sources, the incidence of laryngohyoid fractures in hanging varies significantly, from 0% to 100%. To verify the diagnostic significance of these injuries in hanging, we prospectively and consecutively analyzed the occurrence of laryngohyoid fractures in a group of 178 suicidal hanging victims (M/F=150/28, aged 14-94years, mean age=50, complete suspension=111 cases, partial suspension=67 cases) in relation to selected variables (age, sex, weight, the completeness of body suspension, and ligature knot location). Altogether, we identified the following types of laryngohyoid fractures in 129 of 178 cases (72.5%): isolated fracture(s) to the thyroid cartilage in 60 cases (33.7%), combined thyrohyoid fractures in 41 cases (23.0%), isolated fracture(s) to the hyoid bone in 28 cases (15.7%), and no fractures to the cricoid cartilage or the cervical vertebrae. The highest frequency of laryngohyoid fractures was found in lateral hangings (right lateral: 26/34, 76.5%; left lateral: 31/37, 83.8%), whereas the lowest rate was found in anterior hangings (4/11, 36.4%). In lateral hangings, fractures more often occurred contralaterally to the suspension point. Statistical analysis revealed significant associations of the occurrence of laryngohyoid fractures with the age of the victim (p=0.028), with the position of the ligature knot on the neck (p=0.019) and with the age-corrected weight of the victim (p=0.026). In addition, we performed a systematic updated review and critical appraisal of relevant literary sources to report the incidence, fracture patterns, and contributing variables of laryngohyoid injuries in hanging. Both the results of our study and the provided literary synthesis show that if evaluated properly, laryngohyoid fractures in hanging may diagnostically offer far more than just evidence that injury to the neck occurred and may also present research opportunities regarding several issues that should be further analyzed and explained.

Circular saw-associated fatality mimicking gunshot injury.

A 61-year-old man was found dead in the yard of his house with penetrating injury of the trunk. Initial examination of the body revealed a single penetrating injury on his chest with a collar abrasion-the injury pattern that is similar to a gunshot entry wound or shored exit wound. According to witnesses, the man had cut wooden frames from old windows with a circular saw. X-rays of the torso revealed a contrast object resembling a projectile in the left scapular region. The internal examination disclosed an isolated trunk trauma involving the left lung. In the soft tissue, between the inner edge of the left scapula and thoracic spine, the fragment of a metal nail was found. The autopsy confirmed that the wound on the chest was a non-firearm-related injury. The death of deceased was attributed to massive internal hemorrhage. Further investigation revealed that the pseudo-gunshot wound injury of the trunk of the victim was caused by a fast-flying metal object thrown against the man's trunk from a circular saw while cutting the wooden beams of old windows.

What is the appropriate approach in sex determination of hyoid bones?

The hyoid bone is characterized by sexually dimorphic features, enabling it to occasionally be used in the sex determination aspect of establishing the biological profile in skeletal remains. Based on a sample of 298 fused and non-fused hyoid bones, the present paper compares several methodological approaches to sexing human hyoid bones in order to test the legitimacy of osteometrics-based linear discriminant equations and to explore the potentials of symbolic regression and methods of geometric morphometrics. In addition, two sets of published predictive models, one of which originated in an indigenous population, were validated on the studied sample. The results showed that the hyoid shape itself is a moderate sex predictor and a combination of linear measurements is a better representation of sex-related differences. The symbolic regression was shown to exceed the predictive powers of linear discriminant function analysis when two models based on a logistic and step regression reached 96% of correctly classified cases. There was a positive correlation between discriminant scores and an individual's age as the sex assessment was highly skewed in favour of males. This suggests that the human hyoid undergoes age-related modifications which facilitates determination of male bones and complicates determination of females in older individuals. The validation of discriminant equations by Komenda and Cerný (1990) and Kindschud et al. (2010) revealed that there are marked inter-population and inter-sample differences which lessened the power to correctly determine female hyoid bones.

A fatal elephant attack.

A rare case of an elephant attack is presented. A 44-year-old man working as an elephant keeper was attacked by a cow elephant when he tripped over a foot chain while the animal was being medically treated. The man fell down and was consequently repeatedly attacked with elephant tusks. The man sustained multiple stab injuries to both groin regions, a penetrating injury to the abdominal wall with traumatic prolapse of the loops of the small bowel, multiple defects of the mesentery, and incomplete laceration of the abdominal aorta with massive bleeding into the abdominal cavity. In addition to the penetrating injuries, the man sustained multiple rib fractures with contusion of both lungs and laceration of the right lobe of the liver, and comminuted fractures of the pelvic arch and left femoral body. The man died shortly after he had been received at the hospital. The cause of death was attributed to traumatic shock.

The ability to act--multiple suicidal gunshot wounds.

Multiple self-inflicted gunshot wounds are rare and usually present a challenge to the forensic pathologist in determining the manner of death. Determining a person's capability to act following a gunshot wound can be of major importance in crime scene reconstruction and in differentiation between homicide and suicide. Questions concerning the possibility of physical activity following a given gunshot wound are repeatedly raised in court. We report herein three unusual cases of suicide involving multiple gunshot wounds; all the victims suffered gunshot wounds of the head without immediate incapacitation. In the first two cases, the head was target for two gunshots. Third case was a combination of two gunshots to the head and chest. In the text, we focus on the victim's ability to act after the first shot, with regards to the character and localization of the gunshot wound. Also, we focus on findings that are typical for a repeated suicidal shot.

Suicidal decapitation by guillotine: case report and review of the literature.

Suicidal decapitation is seldom encountered in forensic medicine practice. This study reports the analysis of a suicide committed by a 31-year-old man with a self-fabricated guillotine. The construction of the guillotine was very interesting and sophisticated. The guillotine-like blade with additional weight was placed in a large metal frame. The movement of the blade was controlled by the frame rails. The steel blade was triggered by a tensioned rubber band after releasing the safety catch. The cause of death was immediate exsanguination after complete severance of the neck. The suicide motive was most likely emotional distress after the death of his father. In medico-legal literature, there has been only one similar case of suicidal complete decapitation by a guillotine described.

Fatal suicidal crossbow injury--the ability to act.

We report a case of a 58-year-old man who committed suicide using a modern crossbow. The victim shot himself in the chest with a conical field-tip arrow from close proximity. We first presumed that this was a case of homicide committed with a firearm. We were, however, subsequently proved wrong. The reasons for the primary statement were as follows: the external morphology of the entrance wound being typical of a firearm discharged from long distance; the perforation found on the victim's clothing; the absence of the firearm at the place of death; the absence of the arrow in the wound. All of these reasons forced us initially to conclude that the case was one of homicide. In the reported case, the man, after having been shot with an arrow, was further able to act, even though the abdominal aorta and liver were seriously injured. While the arrow was in the wound, the injuries may not have led to massive bleeding because of incomplete tamponade of the defects by the arrow shaft. Pulling the arrow out of the victim's wound track initiated massive bleeding. Despite all these injuries, the man was capable of pulling the bow string again and reloading the crossbow with the arrow used in the first attempt. This case demonstrates that forensic investigations into crossbow injuries can be very difficult, especially when the bolt has been removed from the body.

The asymmetry and modularity of the hyoid bone / Asimetría y modularidad del hueso hioides

Morphological variation is a result of interplay among multiple intervening factors. For hyoid bones, the shape and size differences have been scarcely covered in the literature and in majority limited to studies of sexual dimorphism or age dependency. To our knowledge, the human hyoid bone, in complete opposite to other cranial bones, has not been fully utilized to address development questions in terms of asymmetry or modularity. In the present paper, we used landmark-based methods of geometric morphometrics and multivariate statistical approach to study human hyoid morphology represented by the hyoid body and greater horns in a sample of 211 fused and non-fused bones. Within a sample variation analysis, we showed that the hyoid bone is, by nature, asymmetrical bone which exhibits both directional and fluctuating types of asymmetry and is composed of well-integrated anatomical elements for which the biomechanical load of attached muscles is the most determining factor of variation. Yet, the covariance and evidence of unequal amount of fluctuating asymmetry among modules suggests a certain degree of independence during early stages of development.

La variación morfológica es el resultado de la interacción entre múltiples factores. Para huesos hioides, las diferencias de forma y tamaño han sido poco mencionadas en la literatura y se limitan a estudios del dimorfismo sexual o distribución etaria. Hasta donde sabemos, el hueso hioides humano, a diferencia de otros huesos craneales, no ha sido utilizado para hacer frente a interrogantes del desarrollo en términos de asimetría o de la modularidad. Utilizamos métodos basados en hitos de la morfometría geométrica y en el enfoque estadístico multivariado para estudiar la morfología del hueso hioides humano, representado por el cuerpo del hioides y astas mayores, en una muestra de 211 huesos fusionados y no fusionados. En un análisis de la variación de la muestra, se demostró que el hueso hioides es por naturaleza un hueso asimétrico, que exhibe tipos de asimetría tanto direccionales y fluctuantes, compuesto de elementos anatómicos bien integrados para los cuales, la carga biomecánica de músculos vinculados es el factor más determinante de la variación. Sin embargo, la covarianza y la evidencia de la cantidad desigual de asimetría fluctuante entre módulos sugiereun cierto grado de independencia durante las primeras etapas de desarrollo.