Autopsy Files Research Articles

Insights from Autopsy: Unveiling the Pathological Landscape of Acute Pancreatitis

Abstract Introduction: Acute pancreatitis (AP) is an inflammation of the pancreas that can lead to mortality, with the risk increasing according to disease severity. It can also cause sudden unexpected death. Aims and Objectives: This study aimed to examine the clinicopathological aspects of death from AP, focusing on common etiology and postmortem histomorphological patterns. Materials and Methods: The autopsy files and hematoxylin and eosin-stained slides of all cases from January 2017 to August 2023 were studied. Results: AP was established as the cause of death in 23 (7.3%) of 315 autopsies conducted during the study period. Most deaths occurred in the age group of 30–39 years. Alcohol was identified as the cause in 9 (39.1%) patients, whereas biliary etiology was found in 3 (13%) patients. Hyperlipidemia was observed in 2 (8.7%) patients, and 5 (21.7%) cases had underlying diabetes mellitus. In 9 (39.1%) patients, no clearly defined etiologic association could be established, and they were considered “idiopathic.” Nineteen patients (82.61%) died in the early phase, primarily due to multiorgan dysfunction syndrome, whereas 4 (17.39%) patients died in the late phase, primarily due to sepsis. Hemorrhagic necrotizing pancreatitis was present in all patients with equal frequency across all etiologic subgroups. Conclusion: This study is one of the few in India to examine 23 autopsy cases of AP, providing valuable insights into the diverse manifestations and implications of this condition.

A Retrospective Analysis of Familicide in Latium (Italy): A Criminological Profile of the Victims and Offenders Involved in 29 Cases and a Comparison with the Literature.

Familicide, an extreme form of domestic violence where one family member kills another, is a complex criminological issue. We analyzed autopsy files from the Institute of Legal Medicine, University of Rome Tor Vergata (1995-2022), to understand familicide better. The study focused on victim profiles, offender characteristics, and case dynamics. From 29 analyzed cases, 31 victims emerged, with 2 instances of double homicide. The perpetrators were mostly male (79.31%) and the victims were primarily female (54.84%). The familial ties ranged from parent-child to siblings and spouses. A significant number of crimes happened at private residences (70.97%) using bladed weapons (48.39%), with the injuries being concentrated on the head and chest. Half of the cases showed struggle signs, and 24.14% of the perpetrators had identifiable psychiatric disorders, which often served as the motive. Post-crime actions included self-reporting, suicide attempts, and successful suicides. A comparison with literature confirmed the typical familicide offender as a middle-aged male with potential social stressors and a history of domestic violence, with the victims often being female family members. Mental health conditions including depression, bipolar disorder, and schizophrenia significantly impacted these events. These findings underline the need for customized approaches to comprehending and preventing familicide.

Characterization of sudden death etiologies in a Portuguese population younger than 40 years-old

Abstract Background The incidence and pathogenesis of sudden death (SD) in the young adult population in Portugal remains to be clarified. Some of the causes are known to be hereditary and a better understanding of these can have implications on the development of a national screening program for relatives of SD victims. Purpose To describe the leading causes of sudden cardiac and non-cardiac death in a young adult Portuguese population (≤40 years-old). Methods The authors retrospectively reviewed cases from a national database regarding individuals who underwent an autopsy, between 2012 and 2016, at 6 districts of mainland Portugal plus the islands. All young adults (1–40 years-old) who had a sudden unexpected death were included and violent deaths were excluded. This study was approved by the Institute Ethics Committee. We reviewed the autopsy files and collected demographic, clinical, necropsic, anatomopathological and toxicological data from each case. We performed statistical analysis using Stata 13.0 software. Results During a 5-year period, out of an estimated total of 2101 deaths in ages 1 to 40, 175 SD were identified. SD victims had a mean age of 32±9 years-old, the majority being of male gender (69%,n=120). There were 115 (66%) cases of SD of confirmed cardiac origin (see Table 1). The remaining causes were respiratory (18%), cerebral (7%), digestive (6%), endocrinologic (2%), urinary (1%), infectious (1%). The most frequent cardiac cause being coronary atherosclerosis (n=40,35%), which included lesions with estimated luminal narrowing >75% and/or documented type 1 acute myocardial infarction. These patients were older (31±8 vs 35±4, p<0.020), had a minimum age of 26 years, and more frequently male (85% vs 61%, p=0.011). There were 17 (15%) victims who had cardiopathy with histopathological hypertrophy (5 of them with associated fibrosis), and the diagnosis of hypertrophic cardiomyopathy (HCM) was possible in only 3 (3%) victims. In addition, there were 15 (13%) who died from pulmonary embolism who were predominantly women (23% vs 80%, p<0.001). There were 8 (7%) victims with a final diagnosis of cardiopathy with histopathological dilation, 2 possibly corresponding to post-partum cardiomyopathy (CMP), 1 to ethanolic CMP and 1 to ventricular dilation and fibrosis due to previous myocarditis, who had associated hepatitis with signs of activity. Six cases of acute myocarditis were identified, who were significantly younger, comparing to patients dying from other cardiac causes (23±13 vs 33±7, p=0,011). There were 2 cases of HCM with genetic data, one of which was complemented during molecular autopsy. Conclusions During a 5-year period, the cumulative incidence of SD in a region of Portugal is very low (n=175), cardiac causes being present in 66% of the cases. The most frequent cardiac cause is coronary atherosclerosis (35%). Funding Acknowledgement Type of funding sources: None.

Cardiac disease and driver fatality.

To determine the role of cardiac disease in driver fatalities, a retrospective review of autopsy files at Forensic Science SAin Adelaide, Australia, was undertaken over a 13-year-period January 2005-December 2017 for individuals aged ≥ 40 years who had died while driving a motor vehicle. The incidence of significant coronary artery atherosclerosis (CAA) and cardiomegaly was evaluated with comparisons between drivers and a control group of passengers. Autopsy examinations were performed on 303 drivers and 72 passengers who died of trauma and on 63 drivers who died of a cardiac event while driving. The average age for drivers dying of trauma was 58.5 years (range 40-93 years) with 48 (15.8%) having CAA and 31 (10.2%) having cardiomegaly. This was not statistically different to passengers (aged 63.3 years; range 40-93 years; 20.8% having CAA; 11 (15.2%) cardiomegaly; (p > 0.2). Drivers with significant cardiac disease did not, therefore, have increased rates of death in crashes, although a distinct subgroup of drivers consisted of those who had died from cardiac events and not trauma, while driving. The latter may be increasing in number given the aging population.

Major organ loss from post-mortem animal predation: Issues arising from emptied body cavities.

The feeding of animals on bodies after death - so-called post-mortem animal predation - may complicate autopsy interpretations when there has been removal of significant amounts of skin and tissues. An extreme situation which sometimes arises is the complete evisceration and/or consumption of all major cavity organs. Search of autopsy files at Forensic Science South Australia was undertaken for examples of this phenomenon. Although such a finding at autopsy may suggest the actions of larger animals such as dogs or sharks, it may also occur when groups of smaller animals, such as cats, act in concert. Complete loss of organs may also occur if significant insect activity accompanies decomposition. Empty body cavities may therefore result from of a wide variety of animal activities involving a range of species in quite different environments. A significant problem once organs have been removed or consumed is in identifying or excluding natural diseases or injuries that may have played a role in the lethal episode.

Increasing age and methamphetamine use

Analysisof autopsy files at Forensic Science SA was undertaken over a 20-year period (2000–2019) in five representative time periods to determine the average ages for all adults (≥18 years) where methamphetamine was detected. There were 239 cases with statistically significant increased mean ages over the time of the study ranging from 32.6yrs in 2000 to 42.2yrs in 2019 (p < 0.0001). Although methamphetamine use may be considered predominantly a feature of younger individuals this does not appear to be the case. Whether this apparent increase in the age of methamphetamine users was due to natural aging of methamphetamine users, an increase in use of methamphetamine by older individuals, or to an increased capture of older cases due to wider toxicological screening is uncertain. However, the importance of these results is to alert practitioners to the presence of methamphetamine use in older individuals which may predispose to death given the increased incidence of underlying cardiovascular diseases with age. In addition, in clinical settings there exists a cohort of older individuals who may be at risk of exacerbating their heart disease and precipitating cardiac events by using methamphetamine.

Geographic variability in homicide rates following the COVID-19 pandemic.

It has been demonstrated in a number of communities that the rates of serious crimes such as homicides and intimate partner violence have increased as a result of lockdowns due to COVID-19. To ascertain whether this is a universal trend the electronic autopsy files at Forensic Science South Australia, Adelaide, Australia, were searched for all homicides occurring between January 2015 and December 2020. There were 92 cases with 17 homicides in 2015 out of a total of 1356 cases (1.3%),18 in 2016 (18/1340 = 1.3%), 23 in 2017 (23/1419 = 1.6%); 14 in 2018 (14/1400 = 1.0%), 15 in 2019 (15/1492 = 1.0%) but in 2020 there were only 5 (5/1374 = 0.4%) (p < 0.02). Thus the incidence of homicides has fallen significantly in South Australia since the beginning of the pandemic. As the occurrence of serious crimes of violence and homicide has not followed a standard pattern in different communities it will be important to evaluate specific populations and subgroups rather than merely relying on accrued national data or extrapolating from one country to another. Pathologists, epidemiologists and health officials will need to specifically monitor local trends to understand more clearly what effects, if any, the pandemic has had on particular subgroups of deaths in order to more clearly understand causal relationships.

Forensic issues arising in the assessment of chlorine-related deaths in a domestic setting.

A retrospective review of autopsy files at the Forensic Science South Australia, Australia, was undertaken over a 20-year period from January 2000 to December 2019 for all cases where chlorine had caused or contributed to death. Two cases were identified out of a total of 25,121 autopsies (0.008%): a 53-year-old man who committed suicide in a cellar with granulated chlorine, and a 49-year-old woman with asthma who died of acute bronchospasm due to exposure to chlorine gas while mixing swimming pool chemicals in her kitchen. Chlorine-related deaths are uncommon in domestic situations. However, the absence of biomarkers and non-specific findings at autopsy complicate the diagnosis, particularly as environmental levels are not stable. While accidents with cleaning agents or swimming pool reagents are the most common event in the literature in domestic settings (exclusive of industrial or transportation accidents), suicide may also very rarely occur. Individuals with asthma and chronic respiratory diseases are at higher risk of an adverse outcome upon exposure to chlorine gas, with inattention to proper storage conditions and handling protocols being additional risk factors.

Typology of murder-suicides in Berlin according to a longitudinal study based on autopsy files

Murder-suicides are defined as the murder of at least one person and the suicide of the offender following the murder. The intention to commit suicide must be primary. In most cases, a male offender kills a female victim after a separation. The current analysis was the first analysis of the typology of murder-suicides in Berlin. We analyzed the autopsy files of the Institute for Forensic Medicine of the Charité University Medicine Berlin and of the City Institute for Forensic Medicine Berlin. We performed descriptive and statistical analyses of cases between 2005 and 2013. We identified 17 murder-suicides. All 17 offenders were male, and 20 of the victims (90%) were female. The offenders used firearms in the majority of the cases. In seven cases, the victims and offenders were at least 80 years old. The average age of the offenders was 63 years. Disease was the motive in 6 cases involving older offenders. Our study might support the development of prevention strategies. In this regard, it is important to build a database for murder-suicides in Germany and other countries, to formulate a uniform definition of murder-suicide, to carry out nationwide interdisciplinary studies on this topic and to improve the existing health care structures, especially for older adults and people with depression.

Renal Neoplasia in Tuberous Sclerosis: A Study of 41 Patients

ObjectiveTo study the clinical features and identify unique renal neoplasia subtypes and their prognostic implications in individuals with tuberous sclerosis complex (TSC). Patients and MethodsThe Mayo Clinic nephrectomy registry included 37 patients with TSC diagnosed between 1970 and 2018. Four additional patients were identified from the pathology consultation and autopsy files. All available renal tumors were further characterized using immunohistochemistry and fluorescence in situ hybridization. Clinicopathologic features and follow-up were obtained from the medical record. The American Association for Cancer Research Project GENIE registry was accessed using cBioPortal for molecular profiling of angiomyolipoma (AML). ResultsA total of 276 renal tumors from 41 patients were analyzed. Renal tumors were classified into 9 distinct morphological subtypes, with AML predominating (238 [86%]). Interestingly, all these tumors acted in a benign fashion except one renal cell carcinoma with clear cells and fibromyomatous stroma and one epithelioid AML that metastasized. Molecular profiling studies revealed that epithelioid AMLs were enriched for alterations of TP53, RB1, and ATRX. Eight patients died of direct complications of TSC, including 3 of end-stage renal disease. To date, none have died of a renal epithelial neoplasm. ConclusionThe identification of unique renal neoplasia subtypes may provide important clues to establish a diagnosis of TSC, and in the somatic setting, this finding has important implications for accurate prognostication. These tumors tend to be indolent, and only 2 of 276 tumors in our study exhibited metastatic behavior. Our results support multidisciplinary management with a focus on preservation of renal function.

A review of deadly accidents involving fireworks in Denmark.

The aim of this study was to describe the circumstances surrounding firework-related deaths in Denmark, locate similarities and compare findings to the other known literature. Autopsy files, including police reports, located through searches in the archives of the three Danish institutes of forensic medicine were accessed. Data describing the age, gender, toxicology findings, circumstances of the accident, cause of death, autopsy findings and type of fireworks were examined. Eight cases involving firework-related deaths matched the search criteria, two of which occurred on New Year's Eve. An unknown number of cases that had not been autopsied were confirmed to exist. Data from the included cases suggested that using illegal fireworks, being male and handling fireworks directly played a key role in deaths. Most notably, illegal fireworks account for few injuries overall but caused the most deaths found in this study. Firework-related deaths are a rare occurrence. Autopsy findings often reveal blast wave injury to be the cause of death. Only one of the eight decedents included in this study were intoxicated with alcohol. Thus it can be assumed that powerful illegal fireworks are, by themselves, a risk factor for a deadly accident, independent of alcohol intoxication.

Medicolegal Aspects of Decomposition and Factors Affecting Its Occurrence in Qena and Luxor Governorates

Decomposition problems have existed since the first autopsy and persist to this day. Decomposition depends on intrinsic and extrinsic factors; temperature is the most important one.Objective: To study the medicolegal aspects of decomposition and factors affecting its occurrence in Qena and Luxor governorates. Subjects and methods: A retrospective (from 1/1/2011 to 31/12/2015), in which the decomposed cases were collected and reviewed from autopsy files, and prospective (from 1/10/2016 to 31/3/2017) study conducted in Qena Medicolegal Department (Qena and Luxor governorates), Ministry of Justice.Results: The decomposed cases in the retrospective periods ranged from (13.5 %) in 2011 to (15.7 %) in 2015 and represented (14 %) in the prospective period. Males outnumbered females, where the ratio in the retrospective periods ranged from (8.25:1) in 2013 to (2.23:1) in 2014 and represented (5:1) in the prospective period. Most cases were in the 3rd, 4th decades and full terms. Incised injuries, pathological conditions, starvation and firearm injuries were the most common causes of death, while the highest percentages of undetermined deaths were (50 %) in the retrospective periods and (33.33 %) in the prospective period. The most common sites of death were homes in 2015 (60 %) and water in the prospective period (66.67 %). The fewer layers of clothes, the more accelerated decomposition. The highest percentages of cases were found in June, 2015 (31.4 %), and in March and October of the prospective period (27.8 %).

Obesity and age as factors in leg amputations in fatal motorcycle crashes.

The autopsy files at Forensic Science South Australia were searched over an 11-year period from January 2008 to December 2018 for all cases of motorcycle fatalities in which there had been lower-limb amputations. Six cases were identified, consisting of five male riders and one female pillion passenger. The age range was 48–67 years (average 59 years), which was significantly older than the control group (40.6 years; p &lt; 0.01). All the decedents were overweight, with a body mass index (BMI) of 28.7–43.5 kg/m2 (average 34.9 kg/m2), which again was significantly greater than the control group (28.8 kg/m2; p &lt; 0.05). Five of the incidents involved a collision between a motorcycle and a motor vehicle; the remaining case involved a collision with a tree. Five of the amputations were on the right side in the motorcycle-vehicle impacts, and they varied in severity from loss of a foot to a hind-quarter amputation. There was a single left lower-leg amputation which occurred during the collision with a tree, which was beside the road on the motorcyclist’s left. This study has shown that motorcyclists at greatest risk of lower-limb/pelvis amputations are older than the average rider with higher BMIs. This may be significant information given the increase in both BMI and age in many populations.

Correlation Between Telomere Attrition of Zona Fasciculata and Adrenal Weight Reduction in Older Men.

Although numerous theories are reported on sex differences in longevity, the underlying biological mechanisms remain unknown. We previously reported that telomere length in the zona reticularis cells of the human adrenal cortex was significantly longer in older than that in younger subjects. However, we could not evaluate sex differences in the telomere lengths. To compare the telomere lengths of adrenocortical and adrenal medullar cells between men and women from infancy through older adulthood. Adrenal glands of 30 male (aged 0 to 100 years) and 25 female (aged 0 to 104 years) autopsied subjects were retrieved from autopsy files. Using quantitative fluorescence in situ hybridization, relative telomere lengths were determined in the parenchymal cells of the 3 adrenocortical zones and medulla. Age-related changes in the weight of adrenal glands were also investigated. Older male subjects (aged 65 years or older) had significantly shorter telomere lengths in zona fasciculata (ZF) cells compared to the corresponding female subjects. In men, older subjects exhibited a significant age-related reduction in adrenal weight; however, no age-related changes in adrenal weight were detected in women. Telomere attrition of ZF cells was correlated with adrenal weight reduction in older men but not in older women, suggesting a decreased number of ZF cells in older men. This may help us understand the possible biological mechanisms of sex difference in longevity of humans.

Histopathological study on the prevalence of trichosporonosis in formalin-fixed and paraffin-embedded tissue autopsy sections by in situ hybridization with peptide nucleic acid probe.

Trichosporon species are some of the most common pathogenic yeasts in Asia, and many are resistant to echinocandin antifungal drugs. Effective treatment of fungal infections requires the selection of appropriate antifungals and the accurate identification of the causal organism. However, in histopathological specimens Trichosporon spp. are often misidentified as Candida species due to morphological similarities. In situ hybridization (ISH) is a useful technique for identifying fungal species in formalin-fixed and paraffin-embedded (FFPE) tissue sections. Although many novel probes for ISH are available, the practical use of ISH for identification of fungi remains limited, in part due to the lack of adequate verifications. We conducted a two-center retrospective observational study in which the ISH technique was used to differentiate Trichosporon spp. and C. albicans in FFPE tissue from autopsy specimens. The study included 88 cases with blood stream yeast infection without Cryptococci extracted from 459 autopsy files of cases with proven invasive fungal infection (IFI). Positive signals for the Trichosporon spp. protein nucleic acid (PNA) probe and C. albicans PNA probe were seen for 7 and 35 cases, respectively, whereas the remaining 46 were negative for both. For the Trichosporon spp.- positive specimens, 5/7 were reported as candidiasis in autopsy records. Our results suggested that accurate histological identification of fungal infections remains challenging, but ISH may be a suitable approach to support histological findings. In addition, this retrospective study suggested that trichosporonosis may have high prevalence among cases of bloodstream yeast infections in Japan.

Violent death in old age-an analysis of autopsy reports

More and more people in Germany reach increasingly higher ages. The risk of victimization is unclear because the lack of reliable numbers impedes assessment of the current relevance of violent death in old age. To close that gap this article presents epidemiological data obtained from autopsy reports, for the most frequent circumstances of violent death in old age and discusses the characteristics and means of prevention. All autopsy files of the Institute of Legal Medicine and Forensic Sciences at the Charité-Universitätsmedizin Berlin from 2005 to 2016 were analyzed with respect to age, circumstances of death and motive. A total of 11,381cases were included. Of all autopsied persons, 51.8% were aged 60years or older. The homicide and suicide percentages of all cases were lower within the 60+years age group in comparison to the younger group. Financial gain was the main motive in the case of 25.6% of people killed aged 60 years and over. Frequent suicide motives were diseases, particularly depression for women and malignant tumors as well as partnership issues for men. Being overburdened with taking care of the partner was aproblem for men in particular. Dyadic death, i.e. the entirety of joint suicides and homicide-suicides, gained in importance within the 60+years age group. Fatal violence against older persons is presumably underestimated. The classification of dyadic death turned out to be impractical. Therefore, areplacement by erotic-aggressive, symbiotic and parasitic death is suggested. Suicide with subsequent suicide is described for the first time and dubbed suicide-suicide. Prevention by social inclusion of old people is essential.

Sudden Infant Death After Vaccination: Survey of Forensic Autopsy Files.

Sudden infant deaths might be attributable to adverse reaction to vaccination, but separating them from coincidental occurrences is difficult. This study retrospectively investigated vaccination-related details and postmortem findings for 57 cases of sudden death in children 2 years or younger. Data were extracted from autopsy files at the Department of Forensic Medicine, Tokai University School of Medicine. Vaccination histories were available in 50 cases based on the maternity passbook. Of the 32 cases in which any vaccines were administered, 7 infants (21.9%) had received immunization within 7 days of death. The most frequent vaccine cited as the last immunization before death was Haemophilus influenzae B. Although a temporal association of vaccines with sudden death was present for two 3-month-old and one 14-month-old infants in whom death occurred within 3 days of receiving the H. influenzae type b and other vaccinations, a definitive relationship between the vaccine and death could not be identified. Histopathological examinations revealed pneumonia and upper respiratory infection as contributing to death in their cases. Moreover, all 3 cases showed hemophagocytosis in the spleen and lymph nodes, which are similar features to hemophagocytic lymphohistiocytosis. Judgment of the disorders as truly related to vaccination is difficult, but suspicious cases do exist. Forensic pathologists must devote more attention to vaccination in sudden infant death cases.

Nitrogen inhalation suicide pacts

Suicide pacts usually result in simultaneous deaths by mutual arrangement. While nitrogen and helium gas inhalation are being increasingly used in solitary suicide attempts, for some reason they have been rarely utilised in suicide pacts. A search of autopsy files at Forensic Science SA over a 15-year period (2003-2017) was undertaken to determine how often this method of joint suicide occurs. Only two cases were found. Case 1 comprised a 64-year-old husband and wife (who had a history of multiple sclerosis). They were found deceased in a vehicle with two empty cylinders of nitrogen gas. Case 2 comprised an 87-year-old man (who had a history of ischaemic heart disease) and his 81-year-old wife who were found deceased with plastic bags over their heads, with plastic tubes connecting the bags to opened cylinders of nitrogen. The deaths in all cases were due to nitrogen-induced asphyxiation, in the latter instance augmenting plastic-bag asphyxia. Although suicide pacts have previously usually involved carbon-monoxide toxicity or drug overdose, it is possible that dissemination of information on the use of inert gases in individual suicide attempts may alter the methods used in future.

Evaluation of fatal diving accidents in Turkey

In any kind of diving there is a risk of accidents, as the move from the topside environment to underwater can affect a diver’s physiological and psychological condition. It is important to investigate dive accidents to clarify the causative factors and determine preventive measures. In this study, autopsy files of fatal dive accident cases were reviewed to evaluate demographic data, type of diving, purpose of dive, seasonal distribution, autopsy findings, and causes of death. We reviewed 56 fatal dive accident files from autopsy units in cities where dive activities are concentrated and from the archive of the Turkish Underwater Federation. Four cases were excluded from the study since we were unable to obtain autopsy reports. Of 52 cases there were 20 scuba divers, two surface-supplied divers and 30 breath-hold divers. The majority of cases involved males (94%). The average age of 50 cases was 38.6; age estimation for two cases could not be determined due to advanced putrefaction. Of these fatal dive accidents 75% took place over a period of six months between May and October. Drowning was recorded as the primary cause of death in these cases. X-ray imaging was used in four (8%) cases. A special autopsy technique was used for nine (17%) cases, to detect possible pulmonary barotrauma and arterial gas embolism. The forensic specialist who is planning to conduct the autopsy for a dive fatality should have knowledge and experience about dive physics and physiology as well as physiopathology of dysbaric injuries.

Lethal explosions in a non-terrorist civilian setting.

A study was undertaken to investigate the range and nature of deaths that may result from explosions in a civilian population that has not been exposed to terrorist attacks or significant military activities. A search was conducted of autopsy files at Forensic Science SA, Adelaide, Australia, from July 2000 to June 2017 for all cases where death had been attributed to an explosion. Twenty cases were identified, consisting of 10 accidents, five suicides, two homicides, one murder-suicide with two decedents and one case where the manner of death was undetermined. Explosives were involved in nine deaths, petrol in seven and propane/butane/natural gas in a further four. Deaths caused by explosions were a rare event, with most cases being caused by accidents in a domestic or industrial environment. Although suicides formed the next most-common group, it is possible that explosions caused by petrol in cases of self-immolation were not intended.