An unusual complex suicide involving a chainsaw and a hanging: a case report.

BACKGROUND: Suicides or suicidal attempts with power tools such as band or circular saws are rarely encountered in forensic medicine practice; in the forensic literature, only a few cases have been reported. We present the case of a "combined suicide" (self-injurious actions using different methods and involving various bodily sites) carried out with uncommon deadly methods: chainsaw and hanging. CASE PRESENTATION: A 58-year-old Caucasian man was found dead by his wife, hanging from the basement ceiling of the cellar in which he lived. During the investigation of the crime scene, external examination revealed a wide incised wound in the umbilical area showing the muscular and adipose tissues below. On inspection of the garden around the courtyard, the police found a chainsaw with blood spatter on both the blade and the handle. The blade appeared to be compatible with the abdominal injuries. CONCLUSIONS: Since the corpse presented this incised wound, it was crucial to establish the manner and the causes of death, as well as to exclude any third-party involvement. In this case, the presence of multiple injuries, potentially lethal, required a differential diagnosis between suicide or homicide. A detailed post-mortem examination, in association with a precise study of the circumstantial data, led the authors to assume that they were dealing with a "complex suicide."

Postmortem Otorrhagia in Positional Asphyxia.

Otorrhagia is generally associated with basilar skull fractures or diving accidents. In routine forensic medical practice, an accurate knowledge of the etiology of otorrhagia may have a key role to distinguish between traumatic and atraumatic causes and accidental, homicidal, or suicidal manners. The authors present the case of an unusual cause of atraumatic otorrhagia occurred in an elderly farmer found dead in a barn. He remained entrapped in a narrow tunnel created by some hay bales. The autopsy findings revealed only an intense polyvisceral congestion and subpleural petechiae, with no signs of traumatic injuries and no fractures of skull base or temporal pyramid. The cause of death was determined to be positional asphyxia, and the manner of death was deemed accidental. In fact, the head-down position resulted in diaphragm compression causing respiratory failure in combination with the stasis of the upper venous circle districts. Mechanical and gravitational forces related to upside-down position and increased vascular pressure also caused postmortem otorrhagia. In this case, the death scene investigation and circumstantial information allowed for reconstruction of the unique dynamics of the death. At the death scene, the position of the corpse must be accurately investigated because it can explain some cadaveric findings such as the ear bleeding or other markers of increased cephalic venous pressure like pink teeth, facial and conjunctival petechiae, or Tardieu spots. Therefore, forensic pathologists should consider that ear bleeding in dead bodies is not always the evidence of severe head blunt trauma or diving accidents, but it might be a postmortem phenomenon mostly related to body position.

CLEIA of humor vitreous in a case of suicidal insulin overdose.

Insulin overdoses have been mostly described in literature as accidental and suicidal deaths, especially in diabetic patients. The present case study deals with a 68 years old male found dead in his bedroom. The victim worked as health care professional in a rescue team, suffering from depression for several years. At the death scene, two ampoules of soluble insulin were recovered close to the body, one of which was empty. At autopsy, no signs of trauma and no injection marks were found at common sub-cutaneous or intravenous injection sites. No other remarkable findings, but hemorrhagic pulmonary edema along with astrogliosis and neuronal degeneration/necrosis in the subcortical regions and corpus callosum were observed. The blood specimen was inadequate due to hemolysis, since it was not centrifugated soon after sampling. Biochemical analysis was performed on bilateral samples of vitreous humor by using electro-chemiluminescence immunoassay (CLEIA). The insulin concentration was 61.11 mU/L in the right vitreous humor and 74.23 mU/L in the left one; the C-peptide concentration was 0.166 ng/mL in right vitreous and 0.157 ng/mL in the left one. The results are in agreement with levels of insulin and C-peptide detected in previous case studies. Based on these findings the cause of death was determined as suicidal insulin overdoses probably by sublingual administration. This way of self-administration was a diagnosis for exclusion as it has been demonstrated that sublingual human insulin has hypoglycemic effects similar to insulin injected. The case study emphasizes the potential role of vitreous humor as reliable alternative substrate for biochemical analysis compared to post-mortem serum or blood samples in cases of fatal insulin intoxication. Furthermore, the CLEIA is an encouraging analytical method to be considered in such cases, although still not validated to perform quantitative analysis of post-mortem fluids.

Fatal entrapment in a pool drainage system: a case report.

Swimming pool suction injuries are rarely encountered in forensic medicine. Infants under 8 years of age are most frequently involved in such accidents with high risk of serious injuries and fatal consequences due to drowning. We report, for the first time, a case of a 13-year-old boy trapped at the abdomen by an uncovered suction drainage hole. External examination of the body revealed a round ecchymosis which had the same diameter as the pool drain. Post-mortem examination established that death had occurred due to drowning, possibly in combination with traumatic shock from the suction mechanism involving the intestinal loops. Furthermore, this case may be remarkable as it raises other medico-legal issues regarding the safety standards at swimming pools, including pool management and lifeguard attendance. Preventative measures are needed in order to make sure this sort of injury or death does not occur. Moreover, the awareness of the occurrence of these accidents should be increased.

Unusual accidental decapitation in a road traffic incident.

Decapitation is an occurrence only rarely encountered in forensic medical practice. This fatality is generally most often described in pedestrians who have been run over by trains accidently or in cases of suicide, or alternatively in occupants of cars involved in high speed vehicle collisions. We report, for the first time, a case of a complete decapitation of a pedestrian as a consequence of a traffic accident. Due to a thorough medico-legal investigation of the body and the involved vehicle, we were able to reconstruct the unique dynamics of the accident and the mechanism of injury.