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.
- MeSH
- asfyxie patologie MeSH
- chondrální fraktury patologie MeSH
- dospělí MeSH
- fraktury kostí patologie MeSH
- laryngeální chrupavky zranění patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- os hyoideum zranění patologie MeSH
- poranění krku patologie MeSH
- prospektivní studie MeSH
- rozložení podle pohlaví MeSH
- sebevražda statistika a číselné údaje MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- soudní patologie MeSH
- tělesná hmotnost MeSH
- věkové faktory MeSH
- věkové rozložení MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
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.
- MeSH
- dospělí MeSH
- epitelové buňky metabolismus MeSH
- erytém patologie MeSH
- hypotermie patologie MeSH
- kosterní svaly patologie MeSH
- krvácení patologie MeSH
- ledvinové kanálky patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- metabolismus lipidů MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- soudní patologie MeSH
- studie případů a kontrol MeSH
- synoviální membrána patologie MeSH
- synoviální tekutina MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
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.
- MeSH
- endokard patologie MeSH
- fatální výsledek MeSH
- hemolýza * MeSH
- lidé MeSH
- pitva MeSH
- prediktivní hodnota testů MeSH
- příčina smrti MeSH
- sebevražda MeSH
- senioři nad 80 let MeSH
- sladká voda MeSH
- soudní patologie metody MeSH
- srdeční komory patologie MeSH
- srdeční síně patologie MeSH
- úrazy a nehody MeSH
- utonutí krev patologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
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.
- MeSH
- aorta abdominalis zranění patologie MeSH
- hrudní obratle zranění patologie MeSH
- játra zranění patologie MeSH
- krvácení etiologie patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- penetrující rány patologie MeSH
- sebevražda MeSH
- soudní patologie MeSH
- zbraně MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Střelná poranění ledvin řadíme mezi poranění otevřená, která bývají často sdružena s poraněním orgánů dutiny hrudní nebo orgánů dutiny břišní (v 80 %) [1,5]. V klinickém obraze pak dominují buď příznaky poranění hrudníku, nebo břicha [6]. Rozsah poranění ledvin je pestrý, počínaje malými poraněními až po poranění tzv. velká. Celkové následky poranění závisí na mnoha faktorech, zvláště pak na razanci střely, charakteru, průraznosti a ranivosti projektilu. V dnešní mírové době prezentujeme vzácné střelné poranění ledviny.
The kidney shot injuries are counted among open injuries that are often connected with thoracic cavity organs injuries or intra-abdominal organs injuries (in 80 %). In clinical picture then dominate either abdominal or thoracic injuries symptoms. The extent of the kidney injuries is varied, from minor renal injuries to so-called major renal injuries. Overall injury repercussions depend on many factors, especially on force of penetration, nature, penetration and injureability of projectile. At this peaceful period let us present rather peculiar kidney shot injury.
