Cases Of Strangulation Research Articles

Sentencing Guidance for Cases of Intentional Strangulation

Sentencing Guidance for Cases of Intentional Strangulation

Autopsy-Based Study of Non-accidental Violent Neck Asphyxia in Jordan: A Retrospective Study.

Background There is a global increase in the number of deaths caused by violent neck asphyxia, which includes both suicides and homicides. This research presents autopsy-based findings and analytical demographic data that are pertinent to significant medicolegal cases. Methods A retrospective examination of 113 autopsy reports of non-accidental violent neck asphyxia reported to the forensic pathology department of Al-Balqa Governorate in Jordan within the period from January 2010 to March 2023. Age, gender, and autopsy results were documented, along with medicolegal records that included toxicology reports. Conversely, information on the manner of death was derived from police inquest records. For the purpose of this research, all the cases of throttling and ligature strangulation have been determined to be homicidal, and all cases of hanging were classified as suicide. Results Males were predominant in hanging (72%), while females were predominant in ligature strangulation (82%). The mean age group in hanging was 21-35 years (51%), while the range for throttling was 36-50 years, and that in strangulation was 2-20 years. Most hanging and throttling cases showed typical external neck findings. Seventy-two percent of hanging cases (n = 68) did not exhibit any internal neck findings, while all throttling cases yielded positive results. Both hanging and strangulation by ligature cases exhibited an absence of thyroid cartilage fracture (83%). Eighty-nine cases (95%) of hanging did not exhibit any injuries to the rest of the body. However, all cases of throttling and ligature strangulation had an almost positive external body injury. In all cases of throttling and ligature strangulation, ocular petechial hemorrhage was present, whereas one-third of the hanging cases had it. Conclusion The forensic doctor must observe the pattern of ligature marks and other signs of physical assault found on the neck, meticulously examine the rest of the body, rule out other causes of death, and cooperate with the legal authorities regarding the collection of the history and death scene findings to accurately determine the manner and mechanism of death in cases of violent neck asphyxia.

Penile Strangulation: Analysis of Postextrication Follow-Up, Sequelae, and a Review of Literature.

Numerous case reports exist on penile strangulation injuries and extrication methods; however, the care and long-term consequences of penile strangulation injuries have been under-reported. Our aim is to investigate the long-term outcomes and sequalae following penile strangulation injuries. The PubMed Medline database was searched using the keyword string "penile strangulation," "penis strangulation," and "constriction" for all studies reporting outcomes of published penile strangulation injuries. Articles were evaluated for follow-up after strangulation injury, strangulating agent, extricating agent, and sequelae of injury. Fifty-six studies resulted with reports of 100 cases of penile strangulation and extrication from January 2000 to December 2019. The mean patient age was 41 (range: 3-86) years. Twenty-four (24/100) cases reported sequalae following extrication. Follow-up ranged from 2 weeks to 7 years with median follow-up time in the 7- to 12-month grouping. Metal rings comprised 36% (36/100) of strangulation agents and 50% of reported incidents were attributed to sexual activity. To our knowledge, this is the only study focusing on long-term outcomes after penile strangulation. This review provides a summary of 56 studies that document penile strangulation injuries over the last 20 years. Although a wide array of penile strangulation injuries have been documented in the literature, reports lack secondary management and long-term outcomes after removal of the strangulation device. We recommend that providers report long-term penile strangulation outcomes for future urologic evaluations after extrication.

Effectiveness on treatment of metacarpal avulsion fracture with Kirschner wire buckling combined with bone fixation

To summarize the effectiveness of Kirschner wire buckling combined with bone fixation in the treatment of metacarpal avulsion fracture. The clinical data of 35 patients of metacarpal avulsion fracture admitted between March 2017 and June 2022 were retrospectively analyzed. There were 22 males and 13 females; the age ranged from 20 to 55 years, with an average of 31.6 years. There were 17 cases of the second metacarpal avulsion fracture, 6 cases of the fourth metacarpal avulsion fracture, and 12 cases of the fifth metacarpal avulsion fracture. The causes of injury included 21 cases of strangulation, 8 cases of sprain, and 6 cases of sports injury. X-ray film examination showed that the size of the avulsion fracture of metacarpal bone ranged from 0.30 cm×0.20 cm to 0.55 cm×0.45 cm. The total active motion (TAM) of the injured finger before operation was (154.00±17.38)°. The time from injury to operation was 3-10 days, with an average of 5.8 days. Follow-up regularly after operation, X-ray film and CT examination were performed to evaluate fracture healing and TAM of injured finger was measured. The finger function was evaluated by the trial standard of upper limb function evaluation of Hand Surgery Society of Chinese Medical Association. All the incisions healed by first intention. All 35 patients were followed up 9-36 months, with an average of 28 months. All metacarpal avulsion fractures achieved bony healing, and the healing time was 4-6 weeks, with an average of 4.8 weeks. The metacarpophalangeal joint of the patient was stable, without stiffness, and the flexion and extension activities were good. At last follow-up, the TAM of the injured finger reached (261.88±6.23)°, which was significantly different from that before operation ( t=-35.351, P<0.001). The finger function was evaluated according to the trial standard of upper limb function evaluation of the Society of Hand Surgery of Chinese Medical Association, and 33 cases were excellent and 2 cases were good, with an excellent and good rate of 100%. The treatment of metacarpal avulsion fracture with Kirschner wire buckling combined with bone fixation has the advantages of less trauma, firm fixation, and less interference to the soft tissue around metacarpophalangeal joints, which is a good alternative method for the metacarpal avulsion fracture.

Complications of permanent pacing in children depending on the method of implantation

Background. Currently pacing is the only treatment option for life-threatening bradyarrhythmias. Considering the specific factors of pediatric patients, specialists in this field should be highly professional.Aim: To present the experience and retrospective analysis of complications of permanent pacing in children and adolescents from Tomsk National Research Medical Center.Material and Methods. Complications of permanent pacing in children with structurally normal heart and children with congenital heart defects were analyzed. The follow-up was from 1999 to 2021 years. 256 patients aged from 1 month to 18 years participated in the study. Epicardial pacemaker was implanted in 173 children, endocardial – in 83 patients. Average time from primary implantation to complications was 2.1 ± 2.7 years.Results. Hemodynamic complications are the most common among patients with epicardial and endocardial permanent pacing. Hemodynamic complications with epicardial permanent pacing are associated with intraventricular dissynchrony due to stimulation in the area of the lateral wall or the right ventricular outflow tract. In patients with endocardial permanent pacing hemodynamic complications are associated with the development of pacemaker-induced cardiomyopathy due to permanent pacing of the right ventricle apex and tricuspid regurgitation. Complications such as bacterial endocarditis, infection of the pacemaker and its bed, hemopericardium, subclavian vein occlusion, pericarditis, peacemaker dislocation and lead fracture were less common. Two cases of cardiac strangulation were detected.Conclusion. Neither epicardial nor endocardial pacemaker implantation guarantee the absence of complications. Implantation of the electrode on the apex of the left ventricle (epicardial pacemaker system), in the area of the His bundle (endocardial pacemaker system), prevents the development of hemodynamic complications. The most rational is the use of a primary epicardial pacemaker system. Such approach allows the veins to be preserved for endocardial stimulation at an older age.

FRACTURE OF HYOID BONE IN CASE OF ASPHYXIAL DEATHS RESULTING FROM CONSTICTING FORCE ROUND THE NECK

The Hyoid Bone (&amp; its fractures) has enormous clinical and forensic signicance. The present study was taken up to retrospectively investigate the fractures of hyoid bone due to mechanical forces around the neck. In the present study a total of 50 cases were retrospectively investigated; 22 cases were belongs to 21 to 30 year age group followed by 18 cases belongs to 31- 40 year age group. Among patients studied, 54% were males and 46 % were females. In 80% of the cases manner of death was hanging and in 8% of cases were by strangulation and 12% of cases was throttling. Out of 40 cases of hanging, hyoid bone fracture (Anteroposterior compression fracture) was seen in 4 cases; and out of 4 cases of strangulation, hyoid bone fracture was not found; and out of 6 cases of throttling, hyoid bone fracture (Inward compression fracture) was found in all cases.

Epidemiological, Diagnostic and Therapeutic Aspects of Inguinal Hernias in the Surgical Unit General Overview of the Reference Health Centre (CSRéf) in Fana

Inguinal hernia is the spontaneous or progressive, temporary or permanent passage of viscera or part of viscera out of the cavity that normally contains it. This passage is made through an anatomically preformed area of weakness in the inguinal canal. The diagnosis of inguinal hernia is primarily clinical (inguinal swelling). Objectives: To study the epidemiological, diagnostic and therapeutic aspects of inguinal hernias in the general surgery unit of the Centre de Santé de Référence (CSRéf) in Fana. Results: 431 surgical interventions. 147 inguinal hernias including 12 cases of strangulation, The frequency of hernia was 34.11% in relation to surgical procedures, The 15-29 age group accounted for 32.7% of cases, The sex ratio was:35.75 in favour of men, In our study, farmers accounted for 53.06% of the total, Bilateral inguinal hernia which accounted for 57.14%, Patients who underwent para-rectal inguinotomy accounted for 88.4%, The Bassini technique was used in 70.75% of our patients, The operative follow-up was complicated in 19.73% of our patients, We recorded one case of death (0.7%). Conclusion: Inguinal hernia is a common surgical condition, preferentially affecting the male subjects and farmers, with a predominance of young people aged 15 to 25 years.

Complications of permanent pacing in children depending on the method of implantation

Background. Currently pacing is the only treatment option for life-threatening bradyarrhythmias. Considering the specific factors of pediatric patients, specialists in this field should be highly professional.Aim. To present the experience and retrospective analysis of complications of permanent pacing in children and adolescents from Tomsk National Research Medical Center.Material and Methods. Complications of permanent pacing in children with structurally normal heart and children with congenital heart defects were analyzed. The follow-up was from 1999 to 2021 years. 256 patients aged from 1 month to 18 years participated in the study. Epicardial pacemaker was implanted in 173 children, endocardial – in 83 patients. Average time from primary implantation to complications was 2.1 ± 2.7 years.Results. Hemodynamic complications are the most common among patients with epicardial and endocardial permanent pacing. Hemodynamic complications with epicardial permanent pacing are associated with intraventricular dissynchrony due to stimulation in the area of the lateral wall or the right ventricular outflow tract. In patients with endocardial permanent pacing hemodynamic complications are associated with the development of pacemaker-induced cardiomyopathy due to permanent pacing of the right ventricle apex and tricuspid regurgitation. Complications such as bacterial endocarditis, infection of the pacemaker and its bed, hemopericardium, subclavian vein occlusion, pericarditis, peacemaker dislocation and lead fracture were less common. Two cases of cardiac strangulation were detected.Conclusion. Neither epicardial nor endocardial pacemaker implantation guarantee the absence of complications. Implantation of the electrode on the apex of the left ventricle (epicardial pacemaker system), in the area of the His bundle (endocardial pacemaker system), prevents the development of hemodynamic complications. The most rational is the use of a primary epicardial pacemaker system. Such approach allows the veins to be preserved for endocardial stimulation at an older age.

Analysis of the Lung’s Histopathologic Changes in a Variety of Acute Asphyxia Deaths at S.M.S Hospital In Jaipur

Autopsy diagnosis of asphyxia rests upon the identification of classical signs of asphyxia viz. cyanosis, congestion and petechial hemorrhages. In essence, interference with breathing results in asphyxia. There are several ways to asphyxia can occur as a result of hanging, ligature/manual strangulation, mugging, smothering, throttling, chocking, aspiration, suffocation, asphyxia due to chronic lung disease etc. A cross sectional descriptive observational study that was conducted at the SMS Medical College, in the department of forensic medicine in Jaipur, Rajasthan from 1st June 2018 to October 2019. After a thorough autopsy investigation, samples of the relevant lung tissue from both sides were saved for histological analysis of any pulmonary abnormalities.160 (4.90%) autopsies were of these fatalities (n=3261) were taken in the study. The most frequent cause of acute lethal asphyxia was hanging (85%). In addition, this kind of Histopathologic diagnosis of lung can serve as an additional tool for diagnosis confirmation, particularly in situations where the distinguishing characteristics required determining the cause of death may be elusive. In 100% of cases of strangulation, alveolar tissue over insufflations was identified with histopathological score 3 and 4, whereas in hanging score was recorded in nearly all cases at 2. In All cases the score in the throttling was 1. Interstitial edema, intraalveolar edema, passive congestion and intra alveolar and interstitial hemorrhages are virtually always present in hanging and drowning patients. Only in cases of aspiration related asphyxia are intra alveolar deposits of protein and amorphous debris discovered. It demonstrates how the histopathological analysis of the lungs during autopsy can be utilised as an additional histopathologic criterion to confirm the asphyxia diagnosis.

Ligature strangulation in 2001–2020 in the materials of the Jagiellonian University Department of Forensic Medicine, Kraków

Aim: The aim of the study was to analyze and compare the most common post-mortem changes which can be found in the body after ligature strangulation and compare it with the most recent literature. Materials and methods: autopsy protocols from years 2001–2020 gathered in the Department of Forensic Medicine in Kraków were investigated. 37 cases of certain and possible strangulation were found and analysed. Prevalence of ligature strangulation, age, sex, information concerning perpetrator and post-mortem changes were considered. Results: we found and analysed 37 cases, however only in 16 cases the certain cause of death was ligature strangulation. in the remaining 18 cases the mechanism of death was not precisely defined. in 3 cases advanced late post-mortem changes disturbed establishment of certain identification. Women constituted 87.5% of all victims, while men 12.5%. among 16 certain ligature strangulations we analysed the most important post-mortem changes. Both subconjunctival hemorrhagic petechiae and facial skin petechiae were observed in 93.8% of the cases, laryngeal or hyoid fracture in 56.3%, and hemorrhages in neck muscles were detected in 87.5% of the cases. Conclusions: The most frequent post-mortem changes after ligature strangulation include subconjunctival petechiae, facial skin petechiae and hemorrhages in the neck muscles which are convergent with the data found in literature. The autopsy may not indicate the circumstance of strangulation.

Histological examination of carotid artery tissue in cases of ligature strangulation and hanging

Violence against the neck can result in a range of macromorphological and micromorphological findings. However, the forensic relevance of the carotid sinus in cases of violence against the neck remains controversial. In this follow-up study of 22 cases of suicidal and accidental strangulations, carotid bifurcations were examined histologically for morphological changes implying direct trauma, including haemorrhage and immunohistochemical expression of heat-shock proteins 27, 60, and 70 and aquaporin-3. These cases were compared with a control group (82 cases) without neck compression or head trauma and with variable causes of death. No relevant histopathological findings implying direct trauma of the carotid bifurcation were found. No cases showed positive aquaporin-3 staining and only five cases showed positive heat-shock protein-27 staining, all of which were hangings. Without massive trauma of the carotid bifurcation, histological alterations cannot be expected. Without signs of rapid death, findings of acute circulatory failure, macromorphological and micromorphological findings of neck compression, and reliable markers indicating relevant impact on the carotid bifurcation the diagnosis of a lethal reflex cannot be verified. Key points Among 22 cases of strangulation causing death, there were 16 cases of hanging and 6 cases of ligature strangulation Few cases showed small haemorrhages located predominantly in the surrounding fat and connective tissues; however, the haemorrhages did not have any effects on the tissues Neck compression had minimal effects on heat shock protein 27 expression in carotid artery tissue Aquaporin-3 staining suggested it is not a useful marker for relevant neck pressure, or that there had not been any relevant neck impact Our findings suggested no direct evidence for reflex cardiac death resulting from a brief force against the neck

Surviving strangulation: evaluation of non-fatal strangulation in patients presenting to a tertiary care sexual assault and partner abuse care program.

Non-fatal strangulation is a dangerous mechanism of injury among survivors of intimate partner violence and sexual assault, with inadequate evidence to guide investigation in the emergency department (ED). The primary objective is to identify the proportion of intimate partner violence and sexual assault where non-fatal strangulation occurs, and to describe the sequelae of injuries. Health records review of patients treated at the Sexual Assault and Partner Abuse Care Program (SAPACP) and/or Trauma Program at a tertiary level hospital between January 2015 and December 2018. Eligible patients were greater than 16years old, seen by the SAPACP or trauma team for intimate partner violence and sexual assault, and had a non-fatal strangulation injury. Data were abstracted from the standardized assessment completed by the SAPACP nurse. Descriptive statistics were used. We identified 209 eligible cases of non-fatal strangulation, among 1791 patient presentations to the SAPACP. Median patient age was 27years, and 97.6% were female. Computed tomography (CT) of the head was obtained in 22.5%, and CT angiography (CTA) of the head and neck in 6.2% of cases. Eleven significant injuries were identified. Two cases of vascular abnormalities: internal carotid artery indentation with possible intramural hematoma and possible internal carotid artery dissection. Other injuries included delayed bilateral subdural hematomas, a depressed skull fracture, and six nasal fractures. We found over 10% prevalence of non-fatal strangulation in survivors of intimate partner violence and sexual assault. There was a low rate of clinically important injury on the index ED visit secondary to non-fatal strangulation. Severe injury was primarily secondary to concomitant trauma, and utilization of CTA in this cohort was low. Increased awareness is needed among ED physicians regarding the need to consider CTA head and neck.

Microscopic analysis of compression injury over neck: One-year prospective study

The present study was conducted in Department of Forensic Medicine and Toxicology of a Government Medical College and Hospital in year 2017. Total 2781 postmortem examinations were conducted in 2017. Out of that total 2781 cases, 176 compression of neck cases came for postmortem and amongst these 105 cases were studied in detail as per inclusion criteria. Out of 105 cases of compression around neck, which were studied, there were 93 cases of hanging, 10 cases of ligature strangulation, 01 case of manual strangulation and 01 case of accidental strangulation studied. On gross in total 11 cases of strangulation hemorrhage in subcutaneous tissue, strap muscle and sternocleidomastoid muscle observed and in only 20 cases of hanging there was hemorrhage observed in subcutaneous tissue and no hemorrhage observed in strap and sternocleidomastoid muscle in hanging cases. In this present study on histopathology vascular congestion and extravasation of red blood cells observed in 28 cases of compression of neck. These findings indicate the importance of histopathology of underlying neck structure in neck compression cases in documenting antemortem nature of hanging and strangulation in doubtful cases.

Abdominal free flap carrying bilateral superficial circumflex iliac arteries for repairing large skin and soft tissue defects of foot and ankle

To investigate the effectiveness of abdominal free flap carrying bilateral superficial circumflex iliac arteries for repairing large skin and soft tissue defects of foot and ankle. Between June 2016 and June 2019, 15 patients with large skin and soft tissue defects of foot and ankle were admitted, including 10 males and 5 females with an average age of 30 years (range, 10-60 years). The causes of injury included 6 cases of traffic accident, 3 cases of machine strangulation, 3 cases of heavy object injury, 2 cases of fall, and 1 case of electric shock. The time from injury to admission was 3 hours to 10 days, with an average of 2 days. The wound located at dorsal foot in 5 cases, ankle in 6 cases, dorsal foot and ankle in 3 cases, and dorsal foot and sole in 1 case. All wounds were contaminated to varying degrees and accompanied by tendon and bone exposure, including 5 cases of extensive necrosis of the dorsal skin with infection. The area of defects ranged from 18 cm×6 cm to 25 cm×8 cm. There were 9 cases of foot and ankle fractures and dislocations, and 2 cases of foot and ankle bone defects. The wound was repaired with abdominal free flap carrying bilateral superficial circumflex iliac arteries. The area of the flaps ranged from 20 cm×8 cm to 27 cm×10 cm; the skin flaps were thinned under the microscope to make the thickness of 0.5-1.0 cm, with an average of 0.7 cm. All incisions at the donor site were sutured directly. During the operation, 1 case was replaced with an abdominal free flap carrying the superficial abdominal artery because the superficial iliac circumflex artery was thin and the superficial abdominal artery was thicker. The skin flaps of 15 cases survived smoothly, and the wounds healed by first intention; the donor incisions all healed by first intention. All patients were followed up 8-36 months, with an average of 15 months. The flap shape was satisfactory, with good texture and mild pigmentation of the flap edge, without obvious bloating, effect on shoe wear, or secondary surgical thinning of the flap. The linear scar left in the donor site and had no effect on hip joint movement. All fractures healed well, and the healing time ranged from 3 to 8 months, with an average of 6 months. The abdominal free flap carrying bilateral superficial iliac circumflex arteries has concealed donor site, with little damage, and can be sutured in one stage. The blood vessel is anatomically constant, with less variation, and reliable blood supply. It is one of the ideal flaps for repairing large skin and soft tissue defects of foot and ankle.

How Victims of Strangulation Survived: Enhancing the Admissibility of Victim Statements to the Police When Survivors are Reluctant to Cooperate.

Holding perpetrators accountable for family violence is challenged when survivors are reluctant to testify. In light of recent Supreme Court precedents limiting the admissibility of statements to law enforcement in victimless prosecutions, the current study examined 130 cases of nonfatal strangulation (NFS) to determine whether case characteristics and themes across survivors' on-scene statements can help prosecutors combat common legal defenses raised when victims are unavailable for trial. The history of prior violence and how only 6% of perpetrators stopped strangling victims on their own suggests that NFS complaints should be investigated as an attempted homicide until evidence suggests otherwise.

The history of the pediatric inguinal hernia repair

The history of inguinal hernia repair is a rich one. For centuries, hernia healers, doctors, anatomists, surgeons and quacks have been devoted to this pathology that has afflicted mankind throughout its evolution. The development of surgical correction mainly focused on adult pathology, with treatments that often involved the loss of the testis. Hernia management in children, however, also dates from antiquity. Described as a swelling on the surface of the belly in ancient papyri, it was treated with tight bandages by the early physicians of Alexandria. For centuries, conservative treatment had been used for the child using primordial trussess, many prayers, and often pagan rituals as the arboreal passage of children described by Marcello of Bordeaux, doctor of the Emperor Theodosius I (347-395 AD), reserving medical intervention only for cases of strangulation in which only reduction was attempted. The middle ages were characterized by an increase in cultural and scientific exchange, during which the first comprehensive surgical textbooks and atlases were written. Different approaches to the inguinal hernia were not taught and passed down through generations of surgeons. The modern era brought a better understanding of the inguinal anatomy, which led to surgical techniques associated with less post-operative complications. Today, the pediatric inguinal hernia repair is one of the most common pediatric operations performed. It is considered a safe procedure with very low complication rate.

Hypothesis on the pathophysiology of small intestinal strangulation by a pedunculated lipoma

SummaryThe current hypothesis proposed for strangulation of small intestine by a pedunculated lipoma in horses involves movement of the lipoma around the small intestine until it loops through its own pedicle. This mechanism is difficult to demonstrate during surgical correction. The objective was to examine an alternative explanation for strangulation by pedunculated lipomas that is logical and consistent with intraoperative findings by the analysis of the anatomical features of 11 cases of lipoma strangulation in horses. In the proposed hypothesis, the stalk of the lipoma is tensed by the weight of the lipoma alone or by external forces on it from adjacent intestine. This produces a slit‐like aperture formed by the stalk and the contiguous mesentery. One or more loops of intestine pass across the lateral edge of the stalk before turning into this aperture, either because of lack of space in the abdominal cavity or through the effects of peristalsis. The weight of the intestine itself causes the loop to ‘fall’ into the aperture and become entrapped. This creates a half‐hitch knot in which the loop of intestine uses the lipoma pedicle as a ‘post’ around which it becomes strangulated. It was concluded that the proposed hypothesis differs from the existing one by requiring intestinal movement to create the strangulation, which is more plausible than the current proposal that the strangulation is caused by movement of the lipoma itself. It is also more consistent with surgical findings.

Thyroid cartilage asymmetry as a potential diagnostic finding for occult cartilaginous fractures for the evaluation of nonfatal manual strangulation

• In a consecutive forensic population (N = 1187), thyroid cartilage asymmetry was observed in 6.2 % of cases. • Asymmetry of the thyroid cartilage is more frequently observed in men and in older individuals. • Asymmetry of the thyroid cartilage is more frequently observed on the left side. • Asymmetry of the thyroid cartilage may be a consequence of prior trauma. This study is based on the hypothesis that occult cartilaginous fractures of the thyroid cartilage (TC) may result in asymmetry of the thyroid cartilage framework. Justification of this hypothesis was provided by an estimation of the prevalence of TC asymmetry based on a consecutive postmortem study group. The findings were then compared to three cases of nonfatal manual strangulation and one case of survival of blunt trauma to the neck. TC images from a consecutive two-year sample from the institutional postmortem computed tomography database (N= 1187) were assessed. Cases with acute TC injury were excluded. TC asymmetry, signs of prior TC trauma, sex and age, were retrieved. TC asymmetry was present in 72 cases (6.2%, 67 males). In 40 cases (3.5%), old TC fractures could be identified. The derived odds ratios were 7.48 for male sex and 1.02 for (each year of) age (p <0.001). Asymmetry of the TC laminae was observed significantly more often on the left side (N= 53, 73.6%, p <0.001). Cases 1 and 2 showed TC asymmetries following nonfatal manual strangulation. Cases 3 and 4 illustrated the limited visibility of cartilaginous fractures on computed tomography. TC asymmetry is associated with male sex and older age and is typically located on the left side. TC asymmetry in young and female cases is rare. TC asymmetry in young and/or female cases may result from occult cartilaginous fractures, as cases 1 and 2 indicated. Further research is needed to validate this hypothesis.

Penile strangulation injury by metallic ring: A study of 4 cases

Penile strangulation by metallic ring is an emergency situation which requires urgent management. Strangulation of the penis usually performed in order to increase sexual performance or because underlying mental disorder or paraphilia. It is an uncommon urological emergency, if not treated as soon as possible it can lead to complications such as gangrene and amputation of the penis. There is no standard of care that has been found to be superior, with each case managed individually according to its clinical findings and operative settings. In this study, we present four cases of penile strangulation in last two years in a tertiary care hospital.

Analysis of compression injuries over neck: One-year prospective study

In compression of neck cases with faint or absent ligature mark on the neck and with minimal internal findings it may be difficult to opine about the cause and manner of death. Many times, in forensic practice, cases occur where there is allegation from maternal side of married woman particularly in cases of dowry deaths, where relatives claim that it is a case of post-mortem hanging. In such cases there is importance of clubbing the gross findings. These findings may be helpful in arriving at conclusions in such unsolved and doubtful cases. The present study was conducted in Department of Forensic Medicine and Toxicology of a Government Medical College and Hospital in year 2017. Total 2781 postmortem examinations were conducted in 2017. Out of that total 2781 cases, 176 compression of neck cases came for postmortem and amongst these 105 cases were studied in detail as per inclusion criteria. Out of 105 cases of compression around neck, which were studied, there were 93 cases of hanging, 10 cases of ligature strangulation, 01 case of manual strangulation and 01 case of accidental strangulation studied. Out of total 105 cases, 66 were males and 39 were females. In this study maximum cases of neck compression were observed in 21 to 30 years age group (30 cases). Intimal tear of carotid artery was observed in 11 cases of hanging and no carotid artery intimal tear was found in case of strangulation. In the present study, fracture of hyoid bone alone was found in total 11 cases of which 06 cases were in hanging, 05 cases were in strangulation. Fracture of thyroid cartilage was found in 03 cases of which 02 cases were of strangulation and 01 case of throttling. No case of cricoid cartilage fracture either alone or in combination to fracture of throat skeleton was observed in the present study.