A suicide case by hanging without fixing the end of the rope

Hanging is a method of death in which one end of a cord is tied around the neck and the other end is tied to an unmovable object and hung down, compressing the neck with weight. We have identified a rare case in which death was accomplished without tying one end of the rope. The individual was successfully hanged by the frictional force between the upward rope and the downward rope. The police concluded the case as a suicide.     

Retrospective analysis of 319 hanging and strangulation cases between 2001 and 2014 in Shanghai

In this study, we retrospectively analyzed 141 cases of hanging and 178 cases of ligature strangulation recorded in the Shanghai Municipal Public Security Bureau between January 2001 and December 2014 to explore the characteristics of hanging and ligature strangulation and to supply a scientific reference for forensic pathology. Several significant differences between hanging and ligature strangulation were found. Hanging cases were mostly suicide, with some accidental cases. Strangulation cases were mostly homicide, with a few cases of suicide or sexual asphyxia. Male hanging was more common than female hanging, with a ratio of 5:2. However, there were more female than male strangulation cases, with a ratio of 13:5. The ligature marks in hanging cases were almost all of a “U” type and above the hyoid bone. The ligature marks in strangulation cases were almost always a closed circle, but the position varied. The most common vital reactions were subcutaneous hemorrhage, exfoliation and blister, which are strong evidence of antemortem injury. Hemorrhagic spots were found on the temporalis, scalp, chest and back in strangulation cases, but were rare in hanging cases. Hemorrhagic manifestations were most common in the sternocleidomastoid muscle in hanging cases, and in the sternohyoid and sternothyroid muscles in strangulation cases. Fractures occurred in only ∼17% of victims. There are notable differences between hanging and ligature strangulation, which can help distinguish between these causes of death. These characteristics should be considered in forensic practice.     

Toxicology findings in suicides: Concentrations of ethanol and other drugs in femoral blood in victims of hanging and poisoning in relation to age and gender of the deceased

Over-consumption of alcohol and/or abuse of other drugs are closely linked to attempted or completed suicides. In this retrospective 10-year study (2001–2010), we compared the toxicology findings in hanging suicides (n = 4551) with drug poisoning (intoxication) suicides (n = 2468). The mean age of hanging deaths was 49 ± 19 y (±SD) and 80% were male, compared with a mean age of 52 ± 17 y and 47% males for the intoxication deaths. Poly-drug use was more common in poisoning suicides with an average of 3.6 drugs/case compared with 1.8 drugs/case in hangings. Moreover, 31% of hangings were negative for alcohol and/or drugs. Alcohol was detected (>0.20 g/L) in femoral blood in 30% of hanging suicides (mean 1.39 g/L) and 36% of drug poisonings (mean 1.39 g/L). The median BACs did not depend on the person's age or gender (p > 0.05). Ethanol, paracetamol, citalopram, diazepam, propiomazine, alimemazine and zopiclone were amongst the top-ten drugs detected in both methods of suicide. With the exception of ethanol, the concentrations of drugs in blood were considerably higher in the poisoning deaths, as might be expected. Regardless of the method of suicide, antidepressants and/or antipsychotics were common findings, which could implicate mental health as a significant suicide risk factor.     

Suicide in people over 65 years of age in the Australian Capital Territory

Suicide by hanging is not an uncommon event in people over the age of 65 years in the Australian Capital Territory. We will review the incidence of suicide over the last seven years, as well as discuss the characteristics of suicide in elderly people. Knowledge of local suicide patterns enables the forensic medical officer to recognise deaths that may be unexpected or unusual.     

Surgical treatment of partial tears of the proximal origin of the hamstring muscles

Background

Hamstring injuries are common especially in athletes. Partial and complete tears of the proximal origin may cause pain and functional loss.

Objective

To evaluate the results of surgical treatment for partial proximal hamstring tears.

Methods

Between 1994 and 2005, 47 athletes (48 cases, 1 bilateral) with partial proximal hamstring tears were operated on. The cases were retrospectively analysed. Before surgery, 42 of the patients had undergone conservative treatment with unsatisfactory results, whereas in five patients the operation was performed within four weeks of the injury.

Results

The mean length of the follow up was 36 months (range 6–72). The result of the operation was rated excellent in 33 cases, good in nine, fair in four, and poor in two. Forty one patients were able to return to their former level of sport after an average of five months (range 1–12).

Conclusion

In most cases, excellent or good results can be expected after surgical repair of partial proximal hamstring tears even after conservative treatment has failed.     

烧伤休克期外科切痂植皮疗法液体复苏的历史回顾

烧伤休克期能否平稳度过是影响烧伤患者全程治疗效果及预后的关键,而液体复苏则是防治烧伤休克的一种重要手段。本文回顾了烧伤休克期外科切痂植皮疗法液体复苏的发展历史,综述了液体复苏的方法及影响因素,展望了液体复苏的未来研究方向,以求为烧伤休克期外科切痂植皮疗法液体复苏治疗提供参考。     

延迟快速复苏对犬烧伤后早期肾功能的影响

目的 探讨烧伤后延迟复苏情况下,快速补液对伤后早期肾脏功能的影响。方法 利用犬 ４０％ ＴＢＳＡⅢ度烫伤模型,２４只犬被随枘发为烧伤对照组,延迟快速补液组和延迟均匀补液组进行补液,观察伤前,伤后２,６,８,１２,２４,３６和４８ｈ血浆尿素氮,肌酐,内皮素和血管紧张素Ⅱ等指标的变化。结果 烧伤后各组血浆Ｂｕｎ,Ｃｒ,ＥＴ和ＡＴⅡ逐渐升高,至伤后２－６ｈ即显著高于伤前并继续升高,但补液两组上升幅度明显     

Bone excrescence at the medial base of the distal phalanx of the first toe: normal variant,reactive change,or neoplasia?

In a review of 157 anteroposterior (AP) foot radiographs in 117 adult and pediatric patients, we observed a medial excrescence on the plantar aspect of the terminal phalanx of the hallux in 88.5% of the feet. Histologic analysis documented the presence of reactive bone. The bony outgrowth appears after closure of the adjacent physeal plate and is rarely symptomatic. Its high prevalence indirectly implies that it is not specific to any particular type of foot. Although certain types of foot may contribute to its development, we believe that repetitive forces occurring during ambulation induce this reactive bone formation.Supported in part by VA grant SA 306     

Immunohistochemical detection of Fibronectin,P-Selectin,FVIII, HSP-70 and MRP-8 in the skin of ligature marks of suicidal hangings

The determination of vitality of skin injuries is one of the most central research areas in forensic pathology for it is often necessary to discern antemortem from postmortem damage. Typical is the case of a hanging, which should be distinguished from the postmortem suspension of a body. In this study, 15 human skin samples from ligature marks (study group) of victims of suicidal hanging and 15 uninjured skin samples (negative control group) were analyzed. In addition, 15 skin samples from ecchymoses in homicide victims with short survival intervals were investigated as a positive control group. Sections were processed for immunohistochemistry in order to detect the expression of Fibronectin, P-Selectin, FVIII, HSP-70, and MRP8. Immunohistochemical reactions were classified semiquantitatively (mild - score 1, moderate - score 2, and intense - score 3). In the ligature marks, Fibronectin was significantly less expressed compared to ecchymoses. The expression was similar to hanging marks and uninjured skin. In both ligature marks and ecchymoses, the expression of P-Selectin was significantly increased compared to uninjured skin. In both ligature marks and ecchymoses, expression of HSP-70 was significantly decreased in the epidermis compared to uninjured skin. In both ligature marks and ecchymoses, the expression of FVIII and MRP8 was significantly increased in the dermis and hypodermis compared to uninjured skin. The results of this study show that the immunohistochemical study of early inflammatory and coagulation factors could help determine the vitality of ligature marks. The combined analysis of P-Selectin, FVIII, HSP-70, and MRP-8 can be considered for this purpose.     

Ganglion cysts at the gastrocnemius origin: a series of ten cases

Objective To describe ganglion cysts arising close to the origin of the medial and lateral head of gastrocnemius as identified on magnetic resonance (MR) imaging. Design and patients We present a series of ten cases of ganglion cysts arising close to the gastrocnemius origin from the medial and lateral femoral condyles. These were collected over a 6-year period from our imaging database. All patients attended for routine MR imaging of the knee with a variety of clinical presentations. Data collected included patient demographics, ganglion size, ganglion site, clinical presentation and ancillary MR imaging findings. The ten patients in this series consisted of seven males and three females, five right and five left knees, age range 27–68 years, mean age 40.6 years. Results The mean maximal dimension of the ganglion cysts was 26 mm, range 15–40 mm. The medial gastrocnemius origin was involved in eight patients and the lateral origin in two patients. The MR imaging findings consisted of both uni- and multi-loculated cysts, often containing numerous septations with fluid signal characteristics. The cysts were extra-capsular with no clear communication with the joint. One patient presented with a popliteal soft tissue mass and none of the cases required surgical intervention for cyst removal. Conclusions MR imaging may identify ganglion cysts arising in an intra- or extra-articular site around the knee. This series documents the MR imaging characteristics of ganglion cysts arising close to the gastrocnemius origin and discusses the relevance of this imaging finding.     

A model for lever-arm length calculation of the flexor and extensor muscles at the ankle

A sagittal-plane mathematical model of joint mobility, including the mechanical effect of the extensor retinacula, was used to predict the lever arm lengths of the main flexor and extensor muscles of the human ankle over the range of movement. In plantarflexion, the centre of rotation lies posteriorly and distally, maximising the lever arm of the tibialis anterior. The action of the gastrocnemius and soleus is maximised in dorsiflexion. Traditional calculation of ankle joint moment based on a fixed centre of rotation is acceptable only in exercises such as level walking with a limited range of motion about the neutral position. The present model with a moving centre is particularly advised in exercises which take the joint nearer to the extremes of sagittal motion.     

烧伤外科切痂植皮疗法新复苏方案在儿童严重烧伤治疗中的应用

目的探讨烧伤外科切痂植皮疗法新复苏方案在儿童严重烧伤治疗中的临床效果。方法采用新复苏方案对39例严重烧伤儿童进行液体复苏,并对比分析其与中国烧伤儿童复苏公式的复苏效果。结果本组患儿中除1例死于多器官功能衰竭外,其余38例均平稳度过休克期,其平均补液量为1 953 mL,治愈率为97.44%。结论基于控制每小时补液量进行复苏的烧伤外科切痂植皮疗法新复苏方案,能够有效避免补液过程中水负荷对机体内环境和渗透压造成的不利影响,对提高复苏质量和复苏成功率具有重要意义。     

正常人脑标本内嗅区皮层及海马MRI测量与组织学对照研究

评价正常人脑村本ＭＲＩ与组织学测量的相关程度，比较老年前期与老年期内嗅区皮层和海马在确定层面的形态学变化。方法非中枢神经系统疾病致死的新鲜人脑标本２０例（４０５９岁１０例，６５－８７岁１０例）     

大面积烧伤延迟复苏效果探讨

目的探讨大面积烧伤患者延迟复苏的方法及其疗效。方法采用中国人民解放军第107医院提出的烧伤休克期液体复苏方案(下称"107复苏方案")对25例延迟入院的大而积烧伤患者进行复苏治疗,观察治疗效果。结果 23例患者痊愈出院,2例患者分别于伤后第6天和第34天死于多器官功能衰竭。结论 107复苏方案能够预估累积丢失量和输液速度,可用于延迟入院治疗的烧伤休克期患者。     

Reproducibility of diffusion tensor imaging in human forearm muscles at 3.0 T in a clinical setting

The aim of the present study was to evaluate a fast clinical protocol to enable diffusion tensor imaging of the human forearm and assess the reproducibility of six diffusion tensor imaging parameters, i.e., the tensor eigenvalues (λ₁, λ₂, and λ₃), mean diffusivity, fractional anisotropy, and ellipsoid eccentricity. The right forearms of 10 healthy volunteers were scanned twice, with a 1‐week interval. Reproducibility of the diffusion tensor imaging parameters was interpreted using Bland‐Altman plots, coefficient of repeatability, repeatability index, and the intraclass correlation coefficient. Analysis was done for three regions of interest: the whole muscle volume, flexor digitorum profundus, and extensor digitorum. The Bland‐Altman analysis showed that there is good agreement between the two measurements. Based on the intraclass correlation coefficients, agreement was substantial (0.59 < intraclass correlation coefficient < 0.92) for all six parameters of the whole muscle volume and flexor digitorum profundus but only fair (0.18 < intraclass correlation coefficient < 0.64) for the extensor digitorum. Using a 7 min 40 sec scan protocol, which was well tolerated by the volunteers, the reproducibility of diffusion tensor imaging parameters was demonstrated. However, repeatability varies, depending on the region of interest and diffusion tensor imaging parameters. This should be taken into account when a longitudinal study is designed. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

Spiral CT angiography: study of stenoses and calcification at the origin of the vertebral artery

The origin of the vertebral artery may be difficult to show on sonography or conventional angiography. Our aim was to evaluate the accuracy of CT angiography (CTA) in detecting arteriosclerotic changes in the first segment (V1) of the vertebral artery. We performed CTA and intra-arterial digital subtraction angiography (DSA) on 24 patients with vertebrobasilar insufficiency. The ostium and the V1 segment were examined. Stenosis was assessed on a three-grade scale, and calcification and the degree of kinking were recorded. DSA and CTA results were compared. The ostium of the artery was seen in all cases on CTA and in 33 of 47 cases with DSA. All ostial stenoses diagnosed on DSA were seen with CTA. CTA revealed 4 stenoses in cases in which angiography proved inadequate, 11 zones of calcification and 5 cases of luminal reduction due to calcified plaques undetected on DSA. In the V1 segment DSA and CTA showed 3 stenoses, 9 cases of kinking, 1 of coiling and 4 stenoses due to kinking. CTA also demonstrated 4 additional stenoses, 2 cases of kinking and 3 stenoses due to kinking. Received: 21 June 1995 Accepted: 6 December 1995     

高压氧对激素性股骨头坏死兔血中骨保护素变化的影响

目的 研究激素性股骨头坏死( steroid - induced avascular osteonecrosis of femoral head,SANFH)兔血骨保护素(osteoprotegerin,OPG)含量的变化及高压氧(hyperbaric oxygen,HBO)对OPG含量的影响.方法 78只健康新西兰白兔按数字表法随机分为3组:正常对照组(N组)7只、制模组(M组)41只、HBO组30只.M组又分为制模完成组(M0组)10只、制模2周组(M2组)10只、制模4周组(M4组)10只、制模6周组(M6组)11只.HBO组又分为2周HBO组(HBO2组)7只、4周HBO组(HBO4组)11只、6周HBO组(HBO6组)12只.采用注射内毒素加甲基强的松龙龙的方法对M组及HBO组进行制模处理.HBO组在制模完成后予HBO处理,1次/d,并分别于制模2、4、6周抽取静脉血检测OPG含量,于相应取血时间点取血后处死动物,取双侧股骨头进行组织形态学观察.结果 M0组[(4.69±3.01) ng]较N组[(13.2 ±9.25) ng]OPG水平降低(P ＜0.05)；HBO2组较N组OPG水平升高(P ＜0.05);HBO4组与HBO2组比较OPG水平无明显变化；HBO6组OPG水平达到高峰,与HBO2及HBO4组比较差异有统计学意义(P ＜0.05)；HBO各组与其相应M各组比较OPG均提高,差异均有统计学意义(P＜0.05).结论 HBO可提高OPG含量,抑制破骨细胞成熟与分化,加速成骨细胞的增殖、分裂,促进坏死股骨头的修复.