Automobile door entrapment--a different form of vehicle-related crush asphyxia

Crush asphyxia involving motor vehicles usually occurs when a victim is trapped beneath a vehicle that slips from a jack while being worked on, or beneath a car that has rolled over during a crash. Two cases are reported where crush asphyxia resulted from quite different circumstances. Case 1: A 58-year-old woman was found dead trapped between her car door and frame. As she was alighting from the vehicle it had rolled forward trapping her between the semi-opened door and car frame when the door had wedged against a second parked vehicle. Case 2: A second 58-year-old woman was found dead, also trapped between her car door and frame. She had been leaning out of her car trying to pick up a newspaper when the car rolled forward. The open driver's door wedged against an adjacent pillar trapping her between the door and the frame. Both victims died from crush asphyxia. This form of automobile door entrapment represents a distinct subset of automobile-related asphyxial deaths and illustrates a particular and unusual set of circumstances that may result in unexpected traumatic death. Getting, or leaning, out of a vehicle that does not have the handbrake engaged may result in wedging of the victim between the semi-opened door and car frame if the car rolls forward and the door impacts against a nearby unyielding object. Correlation of the physical dimensions of the door and frame with markings on the victim's body will assist in reconstructing the terminal events.     

Negligent homicide by traumatic asphyxia

We presented an unusual case of negligent homicide by thorax compression, which is the expanded concept of traumatic asphyxia. A 58-year-old man was restrained in the prone position by six prison officers. They were ordered by their superiors to continue restraining him for about 15 min and the victim died. At the forensic autopsy, typical findings of thorax compression with intramuscular hemorrhages on the back and multiple fractures of the ribs were observed. No evidence of neck compression/smothering or other fatal issues likely to occur by chest compression was found. The reconstruction of the scene corresponded exactly with the localization of the injuries found in the victim. This is the first case of death by pure thorax compression without other fatal factors during intentional restraint, in which the force causing the chest compression was distinctly determined by the autopsy and reconstruction.     

Effects of three different swallow maneuvers analyzed by videomanometry

Purpose: To evaluate the manometric effects of three different swallow maneuvers on healthy volunteers.

Material and Methods: Ten healthy volunteers with no history of swallowing complaints were evaluated with simultaneous videoradiography and pharyngeal manometry (videomanometry). Three different swallow maneuvers were evaluated (supraglottic swallow, super-supraglottic swallow, and Mendelsohn's maneuver) and seven manometric and two videoradiographic variables were analyzed.

Results: The supraglottic swallow showed a significantly weaker peak contraction of the upper esophageal sphincter (UES). The super-supraglottic swallow had a significantly higher UES relaxation pressure and the Mendelsohn maneuver a significantly higher UES peak contraction. With the Mendelsohn maneuver, there was also a significantly longer duration of the pharyngeal contraction and a significantly weaker UES peak contraction. Both the super-supraglottic and the Mendelsohn maneuver had a significantly longer bolus transit time.

Conclusion: Our study did not show any significant difference in the relaxation duration of any of the swallowing maneuvers compared to a control swallow. With the Mendelsohn maneuver, we found that both the pharyngeal peak contraction and contraction duration were increased, which might result in an improved propulsion of bolus into the esophagus.     

Birth asphyxia

The term Birth asphyxia covers a number of clinical and physiological definitions. Birth asphyxia is a relatively common clinical event. In the majority of cases the outcome in terms of brain damage and future development of the child is excellent. However, a small number of children go on to develop patterns of brain damage which are then associated with disability. The article seeks to provide a basic understanding of the various mechanisms involved in producing injury.     

Primary activity standardization of 99Tc by three different absolute methods

The activity concentration of a solution of ⁹⁹Tc was absolutely determined by liquid scintillation measurements based on the triple-to double-coincidence ratio method (TDCR) and compared with the results given by 4πβ(LS)-γ(NaI) live-timed anticoincidence (with extending dead-time) and classical 4πβ(PC)-γ(NaI) coincidence counting systems based on using ⁶⁰Co as the efficiency-tracing radionuclide. The results of anticoincidence and coincidence counting are, respectively, 0.18% and 0.66% higher than the result from TDCR measurements, but they are consistent within uncertainties.     

An unusual case of suicidal asphyxia by smothering

A case is presented of a 30-year-old man suffering from borderline personality disorder who committed suicide by means of smothering. He was hospitalized at the psychiatric department of a public hospital for several months and was found dead in the seclusion room. The death resulted from an obstruction of the upper aerodigestive tract after ingurgitation of pellets of toilet paper. A literature review revealed several cases of suicidal asphyxia by smothering of patients with a history of psychiatric illness. Our patient's operating process had not been reported before to our knowledge.     

Mechanical vs. ischemic mechanisms for decompression sickness.

We used 20 kangaroo rats to investigate the effect of exposure to low oxygen levels (0.11 Atm 02 inspired partial pressure) prior to decompression from a steady-state condition. This hypoxia was found to afford significant protection against limb bends as simulated in those animals by tail biting. Yet, it potentiated neurologic symptoms compared with a control exposure on air with the same level of nitrogen supersaturation. However the incidence of simulated limb bends in the same animals was the same with hypoxia as with another control exposure at a pressure estimated to give extravascular bubbles of the same size upon decompression. The results are, therefore, consistent with a simple mechanical basis for limb bends, but are difficult to explain by any ischemic mechanism since a general hypoxia exacerbates any pain produced by oxygen deficiency in the tissues. However, the reverse may be true for some forms of neurologic decompression sickness and the two such cases reported here are consistent with that view, although not statistically significant.     

Fatal asphyxia by a thyroglossal duct cyst in an adult

Thyroglossal duct cysts arise from remnants of embryonic thyroglossal duct that connects the foramen cecum at the base of the tongue to the thyroid gland. The remnants enlarge secondary to secretions from the epithelial lining. Usually, thyroglossal cysts present as non-tender masses. However, they may also become infected, produce fistulas or give hoarseness and dysphagia. Rarely, especially if the mass is located at the base of the tongue, airway obstruction and dyspnea can ensue. This unusual presentation has been mainly seen in very young children and has caused death in about half of these cases. Nevertheless, in the adult population, very few cases of airway obstruction by thyroglossal duct cysts have been reported, only one being fatal. We present the case of a 55-year-old man who died from fatal asphyxia caused by a thyroglossal cyst.     

The variability in likelihood ratios due to different mechanisms

Recently there has been a drive towards standardisation of forensic DNA interpretation methods resulting in the uptake of probabilistic interpretation software. Some of these software solutions utilise Markov chain Monte Carlo techniques (MCMC). They will not produce an identical answer after repeat interpretations of the same evidence profile because of the Monte Carlo aspect. This is a new source of variability within the forensic DNA analysis process. In this paper we explore the size of the MCMC variability within the interpretation software STRmix™ compared to other sources of variability in forensic DNA profiling including PCR, capillary electrophoresis load and injection, and the makeup of allele frequency databases. The MCMC variability within STRmix™ was shown to be the smallest source of variability in this process.     

Killing tools in mechanical asphyxia

In homicidal deaths, many countries, including Jordan, used to differentiate between an intention to kill some person and whether or not this intention is preceded by premeditation or planning in advance. A retrospective review of 42 homicidal mechanical asphyxial deaths was carried out with special regard to the types of tools used and their impact on the intention and premeditation to kill. Two major causes of homicidal asphyxia-hand and ligature-accounted for 95% of the deaths (35.7% and 59.3%, respectively). Many of the victims of homicidal asphyxia were women (40.5%) and infants under the age of one year (26%). Most of the women were killed by their in-laws (24%). A sexual motive or unlawful sexual relationship outside the bonds of marriage was proven in 14 out of 17 adult female victims. This suggests how difficult it can be to support a criminal charge in cases of mechanical asphyxial deaths.     

新生儿窒息的临床研究

目的探讨与新生儿窒息发生有关的危险因素。方法对不同健康状况孕妇、不同分娩方式、不同怀孕时间分娩的新生儿的窒息发生率进行对照研究。结果患病孕妇分娩的新生儿窒息发生率明显高于正常孕妇组,剖宫产和助产分娩新生儿窒息发生率明显高于自然分娩新生儿,早产儿和过期产儿窒息发生率明显高于足月新生儿。结论加强孕期保健、避免孕期疾病、选择恰当的分娩方式等,对降低新生儿窒息发生率具有重要的临床意义。     

Sexual asphyxia by hanging--a case report and a review of the literature

A case of sexual asphyxial death by hanging is presented. A 35-year-old male, found dead lying on his face in a bed of a truck cab, had hanged himself from a window frame using a leather belt. He was completely naked. There were pornographic and sadomasochistic magazines beneath his face, opened to pages depicted nude photographs of a woman. Autopsy findings revealed a ligature mark on the neck and petechial hemorrhages in the conjunctivae, but there were no hemorrhages in the neck muscles or fractures of the hyoid bone or the thyroid cartilage. The alcohol levels in the blood and urine were 0.78 and 0.45 mg/ml, respectively. The circumstances suggested that his death was accidental, and due to asphyxia by hanging performed to enhance sexual gratification during masturbation. Sexual asphyxia is reviewed and discussed.     

Standardisation of 89Sr using three different methods.

Three independent methods were used to standardise a 89Sr solution within the frame of an international comparison organised by BIPM/CCRI(II): 4pi liquid scintillation (LS) spectrometry, based on the CIEMAT/NIST efficiency tracing method, and direct activity measurements with a windowless 4pi CsI(Tl)-sandwich spectrometer and a 4pi pressurised gas proportional counter. Quantitative solid point-like sources were prepared paying special attention during the source drying phase. The impurities in the original solution were measured and corrected for in the results of all three methods. The activity concentration of 89Sr was found to be 26.21 +/- 0.08 kBq g(-1). A new half-life value for 89Sr of 50.61 +/- 0.05 days was determined from the LS measurements. The measurement methods, including the impurity measurements, are described and the results compared. considering the advantages and disadvantages of each method.     

乳腺癌术后放疗3种治疗计划的剂量学研究

目的 评估螺旋断层调强放疗(helical tomotherapy,HT)、常规直线加速器逆向调强放疗(IMRT)和三维适形放疗(3D- CRT)3种治疗计划对乳腺癌术后胸壁照射的剂量影响和正常组织受照剂量体积对比。方法 选择10例早期乳腺癌改良根治术后患者CT定位图像,由同一医生勾画PTV,统一处方剂量50 Gy/ 25次。每例图像分别做HT、IMRT和3D- CRT 3种治疗计划,并对心脏、健侧肺和患侧肺受照射剂量体积、靶区适形度指数、剂量均匀指数和处方剂量所覆盖的靶体积等物理参数进行比较。结果 95%和100%的处方剂量覆盖的PTV体积在HT、IMRT和3D- CRT组分别为99.13%和95.87%、97.80%和94.05%、96.37%和87.29%。HT、IMRT 和3D-CRT组的适形指数和靶区均匀指数分别为0.80±0.10和1.09±0.03、0.65±0.07和1.14±0.02、0.40±0.08和1.17±0.04。心脏V₅~V₂₀以3D- CRT组最少,其次是HT组。患侧肺V₅接受的照射剂量体积以3D- CRT组最小,与HT和IMRT两组相比差异均有统计学意义。健侧肺V₅和V₁₀以3D- CRT组最少。结论 乳腺癌术后胸壁照射的靶区适形度和剂量均匀指数HT组最好;心脏、健侧肺和患侧肺低剂量区最小的依次是3D-CRT、HT和IMRT组。     

Correlation of three different knee joint position sense measures

ObjectiveThe purpose of this study was to investigate correlation during concurrent measurement among three knee joint position sense (JPS) measures in sitting position and between two measures in standing position.MethodsIsokinetic dynamometer, electrogoniometer, and two dimensional (2D) video analysis were used for measuring knee JPS. The JPS was measured both in sitting and standing positions. All three measures were employed concurrently to measure knee JPS in sitting position; however, only the electrogoniometer and 2D video analysis were concurrently used in the standing position. The knee JPS was recorded in sitting position at 15°, 30°, and 45° and in standing at high, mid and low knee flexion positions.ResultsThe results of the study suggest excellent correlation (0.94–0.98) between the electrogoniometer and 2D video analysis measures in standing position. In sitting position, good to excellent correlation (0.63–0.92) was found between the isokinetic dynamometer and electrogoniometer; however, fair to good correlation was found between 2D video analysis and either of the two measures (electrogoniometer [0.52–0.57] and isokinetic dynamometer [0.41–0.63].ConclusionEither 2D video or an electrogoniometer may be used to measure JPS in standing position; however, in sitting position 2D video should not be used if the camera is required to be placed at 10° from the plane of motion.