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Am J Emerg Med 2019 Apr 4;37(4):737-739. Epub 2019 Jan 4.

Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America; Department of Emergency Medicine, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373, United States of America. Electronic address:

Background: Despite rising rates of hanging injuries, few high-quality data and no national trauma guidelines are available to standardize the evaluation of these patients. We sought to identify the yield of imaging hanging patients at our institution.

Methods: This is a retrospective study at an urban Level I Trauma Center. Read More

Forensic Sci Med Pathol 2019 03 9;15(1):84-92. Epub 2019 Jan 9.

Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland.

Several articles have described the use of postmortem computed tomography (CT) and postmortem magnetic resonance imaging (MRI) in forensic medicine. Although access to CT scanners and, particularly, access to MRI scanners, is still limited for several institutes, both modalities are being applied with increasing frequency in the forensic setting. Certainly, postmortem imaging can provide crucial information prior to autopsy, and this method has even been considered a replacement to autopsy in selected cases by some forensic institutes. Read More

J Pathol Inform 2018 19;9:28. Epub 2018 Jul 19.

Department of Diagnostics and Public Health, Forensic Pathology Unit, University and Hospital Trust of Verona, Italy.

Background: Interest has grown into the use of multidetector computed tomography (CT) and magnetic resonance imaging as an adjunct or alternative to the invasive autopsy. We sought to investigate these possibilities in postmortem CT scan using an innovative virtual autopsy approach.

Methods: Twenty-five postmortem cases were scanned with the Philips Brilliance CT-64 and then underwent traditional autopsy. Read More

J Forensic Leg Med 2018 Oct 8;59:50-55. Epub 2018 Aug 8.

Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
. Electronic address:

Intramuscular bleeding of the tongue (ImBT) is occasionally found during post mortem examination. Despite its frequent reports, its cause has not yet been clarified. In this study, forensic autopsy data of 799 cadavers were examined and the relationship between ImBT and cause of death was investigated. Read More

West J Emerg Med 2018 Jul 4;19(4):707-714. Epub 2018 Jun 4.

American University of Beirut Medical Center, Department of Emergency Medicine, Beirut, Lebanon.

Introduction: Asphyxiation or suffocation injuries can result in multi-organ damage and are a major cause of morbidity and mortality among different age groups. This study aims to describe characteristics of patients presenting with suffocation injuries to emergency departments (EDs) in the United States (U.S. Read More

Sud Med Ekspert 2018;61(2):11-13

Republican Bureau of forensic medical expertise of Chuvash Republic, Cheboksary, Russia, 428017.

The objective of the present study was the evaluation of the auxiliary methods for the diagnostics of the intravital formation of the constriction marks; the secondary objective was to determine the pace at which the death and asphyxia occur.

Material And Methods: The materials on which the study was based included 17 cases of mechanical strangulation asphyxia involving 13 men and 4 women at the age from 8 to 28 years. All cases of hanging were associated with different blood alcohol levels. Read More

J Coll Physicians Surg Pak 2018 Apr;28(4):266-269

Department of Forensic Medicine and Toxicology, Faisalabad Medical University, Faisalabad.

Objective: To determine the frequency of violent asphyxial deaths in Faisalabad over a span of a decade; and assessing the age and gender vulnerability.

Study Design: Descriptive cross-sectional study.

Place And Duration Of Study: Department of Forensic Medicine and Toxicology, Punjab Medical College, Faisalabad, from January 2007 to December 2016. Read More

Int J Legal Med 2018 Sep 22;132(5):1375-1380. Epub 2018 Jan 22.

Department of Forensic Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.

In forensic practices, it is often difficult to determine wound vitality in compression marks of the neck with naked eyes. AQP1 and AQP3 are the major water channels associated with skin. Thus, we immunohistochemically examined the expression of AQP1 and AQP3 in neck skin samples to discuss their forensic applicability to determination of the wound vitality. Read More

Forensic Sci Int 2017 Sep 21;278:e24-e26. Epub 2017 Jul 21.

Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy. Electronic address:

Death by accidental mechanical asphyxia in adults is infrequent and usually results from chocking/aspiration, entrapment, ligature strangulation by clothes catching in machinery (especially as occupational deaths) and, more frequently, sexual asphyxia. Except for autoerotic deaths, accidental hanging almost never occurs in adults, and compression of the neck by solid unmovable structures is also rarely reported. The authors report an unusual case of death by mechanical asphyxia due to accidental compression of the neck in combination with suspension of the body, observed in a thief who was found hanging from the ceiling of a room, having his neck compressed by the panels of the floor and his body suspended half a meter from the ground. Read More

Int J Legal Med 2016 Sep 22;130(5):1281-5. Epub 2016 Jul 22.

Centre universitaire romand de médecine légale, Rue Michel-Servet 1, 1206, Geneva, Chemin de la Vulliette 4, 1000, Lausanne, Switzerland.

Acute pulmonary emphysema (APE) has been described in cases of mechanical asphyxia such as ligature or manual strangulation but not in cases of hanging. In this study, we wanted to verify by morphometric digital analysis of lung tissue whether APE occurs in death by hanging.We investigated 16 cases of hanging (eight complete, eight incomplete), 10 cases of freshwater drowning (positive control group), and 10 cases of acute external bleeding (negative control group). Read More

Soud Lek 2016;61(2):14-7

The otoscopy is an examination of the external auditory canal, the eardrum, and the middle ear with an instrument called an otoscope. It is a simple, inexpensive, and time-saving endoscopic method typically used by general practitioners and otorhinolaryngologists. Authors present a prospective study of otoscopic findings investigated consecutively at autopsy. Read More

Vet Pathol 2016 09 15;53(5):1037-48. Epub 2016 Apr 15.

Animal Health Laboratory, University of Guelph, Guelph, Ontario, Canada

Asphyxia in a forensic context refers to death by rapid cerebral anoxia or hypoxia due to accidental or nonaccidental injury. Death due to nondrowning asphyxia can occur with strangulation, suffocation, and mechanical asphyxia, each of which is categorized based on the mechanism of injury. Individuals dying due to various types of asphyxia may or may not have lesions, and even those lesions that are present may be due to other causes. Read More

Int J Prison Health 2016 ;12(1):39-44

Division of Correctional Medicine and Psychiatry, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.

Purpose: Prison institutional conditions affect risk for self-harm among detainees. In particular, prison overcrowding may increase the likelihood of self-harm by creating competition for resources, space, and enhancing a "deprivation state." The purpose of this paper is to examine the association between overcrowding and prisoner acts of self-harm. Read More

Int J Legal Med 2016 Jan 11;130(1):153-61. Epub 2015 Jun 11.

Sapienza University, Rome, Italy.

In a previous immunohistochemical (IHC) study, we documented the reaction of lung tissue vessels to hypoxia through the immunodetection of HIF1-α protein, a key regulator of cellular response to hypoxic conditions. Findings showing that asphyxia deaths are associated with an increase in the number of mast cell (MC)-derived tryptase enzymes in the blood suggests that HIF1-α production may be correlated with MC activation in hypoxic conditions. This hypothesis prompted us to investigate the possible role of pulmonary MC in acute asphyxia deaths. Read More

Srp Arh Celok Lek 2015 Jan-Feb;143(1-2):93-9

Hanging is a form of ligature strangulation in which the force applied to the neck is derived from the gravitational drag of one's own body weight. A furrow-dessication is the most common form of ligature mark on the skin. The furrow is a postmortem phenomenon due to ligature pressure and it is more detectable as the suspension time becomes longer. Read More

Forensic Sci Med Pathol 2015 Jun 25;11(2):177-85. Epub 2015 Feb 25.

Department of Anatomy and Neuroscience, University of Melbourne, Parkville, VIC, 3010, Australia.

Purpose: Recognition of injury to the hyoid bone is intrinsic to post-mortem examination. Given its superficial location in the neck hyoid fractures are generally associated with some form of compressive neck force although they are well recognized in the peri-mortem period, in the context of manual handling and resuscitation. Hyoid fractures are variably reported to occur in manual strangulation and during hanging. Read More

Leg Med (Tokyo) 2015 Jan 28;17(1):65-9. Epub 2014 Sep 28.

Department of Forensic Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.

Previous studies have reported that thyroglobulin (Tg) concentrations in heart blood are high in cases of asphyxia caused by neck compression such as hanging, strangulation, and throttling and in those with fatal traumatic brain injuries. However, even in cases without these findings presumed to increase the Tg concentration in the previous studies, we previously reported that in some cases the Tg concentration in right heart blood (RHB) and left heart blood (LHB) exceeded the standard value for diagnosis (200 ng/mL) defined in previous studies and the Tg concentration in RHB was significantly higher than that in LHB. In the present study, in our 46 forensic autopsy cases without findings presumed to increase Tg concentration, we separately collected external iliac venous blood (IVB) and external iliac arterial blood (IAB) in addition to RHB and LHB, measured Tg concentrations in RHB, LHB, IVB, and LAB (TRHB, TLHB, TIVB, and TIAB, respectively), and investigated the appropriate blood sampling site for measuring Tg concentrations for forensic diagnosis. Read More

Am J Forensic Med Pathol 2014 Sep;35(3):218-21

From the *Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University; †Shanghai Key Laboratory of Crime Scene Evidence, Institute of Forensic Science, Shanghai Public Security Bureau; ‡Institute of Criminal Science, Pudong Branch of Shanghai Public Security Bureau; §Forensic Science Center, East China University of Political Science and Law, Shanghai, People's Republic of China; and ∥Division of Forensic Pathology, University of Maryland School of Medicine, Baltimore, MD.

The unnatural death investigation in China seems vague to the world. Shanghai is one of the largest city located in Yangtze River Delta in the East China. This study is committed to lift the veil of unnatural death investigation and describe the epitome of China's unnatural deaths. Read More

Leg Med (Tokyo) 2014 May 15;16(3):164-7. Epub 2014 Feb 15.

Forensic Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.

Previous studies have reported that the concentration of thyroglobulin (Tg) in heart blood is high in cases of asphyxia by neck compression such as hanging, strangulation, and throttling and in those with traumatic injuries to the head. However, we have experienced cases in which we observed high Tg concentrations without such findings. Therefore, we analyzed the influence of postmortem changes on Tg concentration. Read More

Sud Med Ekspert 2013 Jul-Aug;56(4):46-50

Results of the comparative analysis of structural changes in cardiomyocyte sarcomers revealed by polarization microscopy in certain fatal cases. The main causes of impaired cardiac contractility and cardiac arrest in the victims of craniocerebral injury and in the subjects with acute forms of ischemic heart disease (acute coronary artery insufficiency and acute myocardial infarction in the pre-necrotic phase), pneumonia, or mechanical strangulation asphyxia (resulting from hanging, with the loop placed around the anterior upper third of the neck and the knot in the posterolateral aspect). Read More

Med Sci Law 2014 Jul;54(3):127-31

The main aim of this study was to determine the causes and epidemiological aspects of unnatural deaths in the elderly. Data were collected on 4405 male and female victims of unnatural deaths aged 50 years or more from the total number of 21,235 autopsies performed in King George's Medical University, Lucknow, India over a 5-year period, from 2008 to 2012. There were 3165 male victims and 1240 female victims. Read More

Int J Pediatr Otorhinolaryngol 2013 Nov 13;77(11):1899-901. Epub 2013 Sep 13.

University of Pittsburgh Medical Center, Department of Otolaryngology, United States.

Introduction: Children surviving a strangulation event are unique from adults in that they are at risk for significant airway compromise due to the smaller relative size of their airways. To date, no study has specifically evaluated the laryngeal findings and management of pediatric near-hanging patients.

Methods: A retrospective chart review was performed on all near-hangings presenting to the a tertiary care children's hospital from January 2001 until June 2010. Read More

J Emerg Med 2013 Nov 30;45(5):670-3. Epub 2013 Aug 30.

Department of Emergency Medicine, University of Florida Health, Gainesville, Florida.

Background: Postobstructive pulmonary edema (POPE) is a form of sudden onset, noncardiogenic pulmonary edema that can occur after the relief of an upper airway obstruction.

Objective: Since POPE is an uncommon diagnosis made in the emergency department (ED), this case is presented to increase emergency physicians' awareness of the etiology, pathophysiology, and management of this type of edema.

Case Report: This is a case of bilateral POPE in a 40-year-old man with no history of cardiac or pulmonary disease who experienced near suffocation due to the vacuum effect of a swimming pool cover. Read More

Ann Vasc Surg 2013 Nov 22;27(8):1186.e7-15. Epub 2013 Aug 22.

Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria. Electronic address:

The management of blunt carotid artery dissections caused by hanging remains controversial, especially with regard to diagnostic work-up and treatment options. We present 2 men, 49 and 41 years of age, who were treated for bilateral common carotid artery dissection caused by strangulation. In the first patient, additional cricotracheal separation and blunt thyroid gland trauma was observed. Read More

J Forensic Leg Med 2013 Aug 24;20(6):651-4. Epub 2013 Apr 24.

Department of Forensic Medicine, Kasturba Medical College (A Constituent College of Manipal University), Mangalore, India.

Unnatural deaths in women of reproductive age (range 12-49 years) have a serious psychological and social impact on the family and community. Deaths among women of reproductive age reported as medico-legal cases were investigated to see the trend in terms of cause and manner of death. The study group consisted of a series of 328 consecutive forensic autopsies on women in the reproductive age group, performed between 2009 and 2011 at the Government Wenlock District Hospital, Mangalore, India by qualified specialist forensic medicine experts. Read More

Am J Forensic Med Pathol 2013 Mar;34(1):72-4

Department of Forensic Medicine, The Jikei University School of Medicine, Nishishinbashi 3-25-8, Minato-ku,Tokyo, Japan.

Macroscopic findings of ligature marks are mainly affected by the characteristics of the ligature, the severity of external forces acting on the ligature, and the period that the neck has been pressed by the ligature. Therefore, the appearances of ligature marks formed by ligatures with the same characteristics differ depending on 2 factors: force and time. To examine which of these factors contributes more significantly to the macroscopic findings of ligature marks, a semiquantitative and experimental study using a murine model was performed. Read More

Paediatr Child Health 2011 Dec;16(10):e78-81

Department of Pediatrics, University of Alberta, Edmonton, Alberta.

Objective: To identify early clinical factors that are correlated with death or severe disability in paediatric patients who have sustained an injury by hanging or strangulation.

Methods: A retrospective review of all patient records from January 1, 1997, to September 30, 2007, was conducted. Patient records were identified by International Classification of Diseases and Related Health Problems, Tenth Revision, Canada diagnostic codes for asphyxia, strangulation, hypoxic-ischemic encephalopathy, hanging, hypoxemia, hypoxia or anoxia. Read More

Pediatr Emerg Care 2012 Sep;28(9):924-5

Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India.

Accidental hanging in children, although uncommon, has been reported worldwide. We report a case of a toddler who was brought to our hospital with an alleged history of hanging with his head trapped in-between the railings of a balcony. He became unconscious and developed seizures secondary to asphyxial injury and survived. Read More

Am J Forensic Med Pathol 2012 Dec;33(4):339-40

Office of the Chief Medical Examiner, Edmonton, Alberta, Canada.

Despite great advances in forensic sciences in the last decades, our knowledge of the pathophysiology of ligature strangulation is still largely based on old writings from the 19th and beginning of the 20th century. The study of filmed hangings by the Working Group on Human Asphyxia has contributed to a better understanding of the agonal responses to strangulation by hanging, and judo-related studies have given some insight into the pathophysiology of manual strangulation, but the pathophysiology of ligature strangulation has remained largely unexplored so far. Three nonlethal strangulations filmed by an autoerotic practitioner are here presented. Read More