ABSTRACT
A very rare case of suicide by stab wound of a fistula for hemodialysis access in an elderly woman is reported. The incidence of suicide attempts in people undergoing hemodialysis is well known. Nevertheless, suicide means do not usually include stab wounds of the arteriovenous access. Various pattern differences between homicidal and suicidal stab wounds, characteristics of suicide in the elderly, and approaches to the investigation of such cases are briefly discussed.
Subject(s)
Arm Injuries/pathology , Shock/pathology , Suicide , Wounds, Stab/pathology , Aged , Aged, 80 and over , Arteriovenous Fistula , Autopsy , Catheters, Indwelling , Female , Humans , Renal Dialysis , Shock/etiology , Wounds, Stab/complicationsABSTRACT
Sexual assaults under benzodiazepine submission have been described, since use of benzodiazepine enables non consensual sexual activity but rarely fully reported. An accurate evaluation of the phenomenon has seemed interesting. Files of 23 adult males and females examined at the Emergency Forensic Unit of an University Teaching Hospital near Paris were reviewed. All the victims had complained from sexual assault under drug submission, in the years 1996 and 1997. A complete examination for sexual assault was realised linked to clinical examination of drug intoxication. Every victim of rape under drug submission was sampled for urine screening (mean delay of 17.5 h after sexual assault) and blood alcohol level quantification. Urine was screened for benzodiazepines, cocaine, opiates and cannabinoids with qualitative immunochromatographic test. Traumatic lesions of sexual penetration were retrieved in 10 victims and sperm in 5. Clinical signs of benzodiazepine intoxication were retrieved in 12 out of 23 victims. Urine benzodiazepine screening was positive, over the cut-off values (300 ng/mL)when sampled less than 20 h after the facts. In 6 out of 23 victims, drugs of abuse and alcohol were associated to benzodiazepines. A reinforced attention can be brought to the rape under drug submission including the need of a proper examination and samplings shortly after the alleged facts to ascertain the diagnosis and to help the victim facing the Justice inquiry.
