Between the hammer and the anvil: An unusual power hammer fatality.

Power hammers are mechanised forging devices that constitute a pivotal part of steel manufacturing. Power hammer-associated injuries are a rare occurrence. We report a noteworthy case of a 52-year-old man who sustained a high-energy penetrating injury while working with a power (counterblow) hammer. The man used a sizable disc-shaped metallic object to dislodge the forging wedged in the machine by applying the force of the striking ram on it. On impact, the object ejected and struck the man in the right lateral portion of the chest. The autopsy disclosed extensive damage to the thoracic and abdominal organs. The cause of death was opined to be exsanguination due to penetrating trauma of the heart and transection of the descending aorta. The investigation confirmed a breach of safety regulations. To the best of our knowledge, this is the first power (counterblow) hammer-related fatality in medico-legal literature.

Standard autopsy and diagnostic procedure in forensic departments in cases of sudden cardiac death (SCD) in individuals under 40 years of age.

Sudden cardiac death (SCD) in individuals younger than 40 years has a heritable cause in a significant part of the cases. Identification of SCD, post mortem genetic analysis, and the cardiological screening examination in victim´s relatives represent an important diagnostic tool for the primary prevention of cardiac arrest. Based on global and European recommendations, cases of sudden cardiac death in individuals under the age of 40 with negative or ambiguous autopsy findings, or findings suspicious for hereditary cardiovascular disease, should be investigated using molecular genetic methods. Based on European guidelines, the Czech Society of Forensic Medicine and Forensic Toxicology has developed its own recommended procedure, which summarizes the identification of these cases, the optimal autopsy procedure, including the collection of material, and a summary of other necessary actions for performing a post mortem genetic examination in a person who has died suddenly. Complex examination of these cases requires multicentric and multidisciplinary collaboration.

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.

A rare etiology of diffuse pulmonary hemorrhage.

We describe the case of a 36-year-old male who presented to hospital with acute respiratory distress, and hemoptysis after intravenously injecting 20 milliliters of pure gasoline. Despite maximum supportive care he died without a definitive diagnosis 4 hours after presentation to the hospital. Postmortem examination confirmed diffuse pulmonary hemorrhage as a cause of death. Our case highlights the key clinical, and pathological features of this very rare poisoning with a volatile substance and reminds clinicians to consider it as a potential cause of hemoptysis and pulmonary hemorrhage.

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.

Traumatic Decapitation of the Fetus During Birth: Criminalistic and Forensic Aspects.

Serious intrapartum fetal injuries are unfortunate events that confer severe consequences on medical personnel. Most birth traumas are noncritical and resolve for a few days. Permanent effects or fatal outcomes occur infrequently. We report an unusual case of intrapartum complete fetal decapitation. The labor was complicated by shoulder dystocia, with resultant repeated mechanical trauma to the fetal neck and, finally, decapitation. The tragic results of biological processes in human organisms do not automatically confirm medical malpractice. However, there may be grave ethical and forensic outcomes.

Overview of clinical forensic services in various countries of the European Union.

Examination of a person who has been a victim of a physical or sexual assault may be very important for upcoming legal proceedings. In the context of a clinical forensic examination, physical findings are recorded and biological trace material is gathered and secured. Ideally, all forensic findings are documented in a detailed report combined with photographic documentation, which employs a forensic scale to depict the size of the injuries. However, the integrity of such forensic findings depends particularly on two factors. First, the examination needs to be conducted professionally to ensure that the findings are properly admissible as court evidence. Second, the examination should take place as soon as possible because the opportunity to successfully secure biological samples declines rapidly with time. Access to low-threshold clinical forensic examinations is not evenly provided in all member states of the European Union (EU); in some states, they are not available at all. As part of the JUSTeU! (Juridical standards for clinical forensic examinations of victims of violence in Europe) project, the Ludwig Boltzmann Institute for Clinical Forensic Imaging in Graz, Austria created (in cooperation with its international partner consortium) a questionnaire: the purpose was to collect information about support for victims of physical and/or sexual assault in obtaining a low-threshold clinical forensic examination in various countries of the EU. Our paper provides a summary of the responses and an overview of the current situation concerning provided clinical forensic services.

Identification of a four-gene methylation biomarker panel in high-grade serous ovarian carcinoma.

Background The lack of effective biomarkers for the screening and early detection of ovarian cancer (OC) is one of the most pressing problems in oncogynecology. Because epigenetic alterations occur early in the cancer development, they provide great potential to serve as such biomarkers. In our study, we investigated a potential of a four-gene methylation panel (including CDH13, HNF1B, PCDH17 and GATA4 genes) for the early detection of high-grade serous ovarian carcinoma (HGSOC). Methods For methylation detection we used methylation sensitive high-resolution melting analysis and real-time methylation specific analysis. We also investigated the relation between gene hypermethylation and gene relative expression using the 2-ΔΔCt method. Results The sensitivity of the examined panel reached 88.5%. We were able to detect methylation in 85.7% (12/14) of early stage tumors and in 89.4% (42/47) of late stage tumors. The total efficiency of the panel was 94.4% and negative predictive value reached 90.0%. The specificity and positive predictive value achieved 100% rates. Our results showed lower gene expression in the tumor samples in comparison to control samples. The more pronounced downregulation was measured in the group of samples with detected methylation. Conclusions In our study we designed the four-gene panel for HGSOC detection in ovarian tissue with 100% specificity and sensitivity of 88.5%. The next challenge is translation of the findings to the less invasive source for biomarker examination, such as plasma. Our results indicate that combination of examined genes deserve consideration for further testing in clinical molecular diagnosis of HGSOC.

Asphyxiated while hunting for treasure: an unusual geocaching fatality.

Geocaching is a high-tech treasure-hunt game that uses GPS-enabled devices or smartphone apps to find cleverly hidden treasures marked by GPS coordinates that are shared online. Like any other outdoor activity, geocaching is associated with risks of falls, environmental injuries, asphyxia and natural events. Despite the apparent risk of serious injury and potential death, no relevant reports aiming to identify the characteristics of geocaching-related deaths have appeared in the medical literature to date. We report a case of an experienced geocacher who was found suspended from a bridge pillar with his climbing ropes and helmet straps twisted across his face and neck; he had apparently attempted to rappel from a 30-m-high railway bridge to find a geocache. A recording of the rappelling sequence from the camera found on the chest strap assisted in reconstructing what had actually happened. An autopsy confirmed that the cause of death was asphyxiation due to hanging, with the occlusion of the external airways and positional asphyxia serving as contributory factors. The salient features of this unusual case are discussed, and several forensic issues of geocaching are highlighted.

Wheelchair-Assisted Ligature Strangulation: An Unusual Suicide by a Quadriparetic.

Multiple sclerosis, currently incurable and potentially profoundly disabling demyelinating central nervous system disease, is associated with higher occurrence of suicide as affected individuals are prone to major depression and psychosis. Despite progressively incapacitating neurologic impairment, well-staffed institutions, and limited repertoire of methods of suicide, which prevents patients from purposefully ending their lives, suicide-determined patients typically commit suicide resulting from a medication overdose, sharp force traumata, self-neglect, or deliberate starvation. Here we describe a successful suicide committed by a 39-year-old wheelchair-bound, institutionalized, quadriparetic male patient with a diagnosis of multiple sclerosis with secondary progressive clinical course who utilized his motorized wheelchair to terminate his life. He tied a rope between his neck and wall bars and then propelled the wheelchair forwardly. The acceleration of the wheelchair resulted in ligature self-strangulation. This case report, with a review of the literature, is noteworthy for the rareness of the wheelchair-related fatality combined with an unusual, if not entirely unseen, suicidal mechanism in severely disabled adult.

Unique thermal destruction of the body following suicidal burning.

The concept of spontaneous combustion has huge appeal as an historical fiction but it has no scientific background. However, in some deaths involving fire, a body can burn away virtually completely with minimal thermal destruction to the neighboring environment. We report an extraordinary case of the self-immolation of an elderly woman who set herself on fire with suicidal intentions. The unusual appearance and location of the body closely resembled the phenomenon of so-called spontaneous human combustion because the upper parts of the body were almost totally destroyed by fire, while the legs and surrounding structures remained almost untouched by flames. The results of all investigations proved that the woman set fire to her body using a box of matches and accelerants (concentrated ethanol and a solid firelighter). Near-total combustion of her body subsequently occurred during the postmortem period. The development of alleged spontaneous human combustion requires the following: ignition (external heat source), fuel (molten human fat), a wick (e.g. charred and porous clothing, bedding, or ground), time, and an optimal microclimate for gradual burning.

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.

Strangulation of the heart presenting as sudden cardiac death: A deadly but forgotten complication of epicardial pacing device.

Strangulation of the heart appears to be an exceedingly rare mechanical phenomenon that can develop with epicardial pacing wires in individuals undergoing somatic growth. Over the passage of time, owing to size mismatch between a fixed wire length and dynamically growing heart, the epicardial wire may embed around the heart resulting in the progressive over-pressurizing of involved cardiac structures. Depending on the location of the peak constriction pressures, cardiac strangulation may damagingly affect coronary circulation, heart valves function, or physiologic filling of the heart chambers, with risk of myocardial ischemia, decreased cardiac output, acute cardiac failure, ventricular arrhythmias and death. We report a case of a 29-year-old male with sudden cardiac death owing to cardiac strangulation with epicardial pacing wire that had been retained in place almost 30 years. At autopsy, an enlarged and abnormally contoured heart was found to be strangulated by an epicardial pacing wire; histopathologic examination confirmed hypertrophy of the myocardial fibers, myofiber disarrangement, and replacement-type fibrolipomatosis. In addition, this article consolidates the available literature on cardiac strangulation by an epicardial wire and highlight relevant clinical and medico-legal features for the forensic professionals.