Autoerotic asphyxia (a case report).

The authors report the case of a young man, 18 years of age, who died as a result of autoerotic asphyxia. In the practice of forensic medicine such cases are presented as deaths from mechanic asphyxia in which, using various means and devices, the neck is constricted or the external respiratory orifices are obstructed with the purpose of achieving sexual gratification as a result of the induced hypoxia. These cases pose serious difficulties to the forensic medicine expert and the coroner because of the difficulties of distinguishing it as homicide, suicide or accident. The young man was found hanging by the neck, suspended on a leather belt attached on the door of his room. A mirror was placed in front of the door, reflecting him in full height. He was dressed in women's clothing (a skirt, a blouse, bikini) and a brassiere padded to resemble female breasts. Pornographic pictures from newspapers and magazines were spread on the floor. The young man had no known history of mental disorders, but there was evidence for bisexual tendencies and behaviour. On the basis of a comprehensive evaluation of the data it was accepted that the death was accidental and was attributed to autoerotic asphyxia. All the characteristic features for an act of autoerotic asphyxia, described in the forensic medicine literature, were found in this case. Autoerotic asphyxia is almost unknown as a distinctive psychopathological entity in this country's forensic medicine practice. The deficiency of theoretical knowledge in this field, as well as the lack of personal practical experience in most of the legal physicians and pathologists could result in erroneous interpretation of such case.

Acute poisoning mortality rate in Plovdiv Region, Bulgaria.

The severe recession in Bulgaria which followed the collapse of the totalitarian regime in 1989 had an unfavourable impact on the health status of the population. Systematic studies of acute poisoning mortality rate in the transitional period (1990-98) are scarce in the post-totalitarian Eastern European countries and are lacking in Bulgaria. This retrospective study analysed 1,150 deaths due to acute poisoning in Plovdiv Region for the period 1961-98. Acute poisoning mortality rate was moderately high in the period between 1990 and 1998 with respect to the average of 4.99 per 100,000 a year. It grew steadily during rapid socialist industrialization (1961-90) and showed a trend of slight decrease during transition (1991-1998). The decrease may largely be accounted for by the foundation of the regional toxicological centre and to a certain degree by a drop in industrial and agricultural production and exposure to hazards.

Characteristics of adult acute poisoning mortality in a large industrial-agrarian region of Bulgaria during socioeconomic transition and crisis (1990-1998).

The severe socioeconomic crisis in Bulgaria, accompanying the transition after the collapse of the totalitarian regime affected unfavorably the health status of the population, increasing the incidence of socially important diseases by making poverty, unemployment, emigration, alcoholism and drug addiction widespread. Systematic studies of acute poisoning suicide and poisoning mortality still lack. To analyze acute poisoning (AP) characteristics during this period in a large industrial-agricultural region of Bulgaria, we retrospectively examined 327 adult AP deaths in Plovdiv region 1990-1998. Males (73.1%) prevail in all age categories. As a caseload men predominate in "working age" categories, women in "pre/retirement age". Mortality rates tended to increase with age, more marked in men. The main cause of death from AP was alcohol intoxication in men (30.1%) and drugs in women (33.7%). Suicides prevailed over accidents (54.1% vs. 45.9%). Accidents were significantly higher in men, suicides in women; 57.5% received no medical aid for more men than women (61.9% vs. 45.5%). Untapped resource for decreasing AP mortality rates are patients who do not receive medical aid and die at home, although that is difficult to correct in a period of crisis.

Use of orthopantomography in forensic identification.

The authors present a case of identification of a severely burnt corpse belonging to an unknown person by means of antemortem orthopantomography performed with a diagnostic purpose during a treatment of the person. A short review is made of the literature concerning the scope and use of orthopantomography for the purposes of forensic identification. Some practical aspects of the postmortem orthopantomography of both maxillary are given.