Cases reported "Asphyxia"

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1/9. Complex suicides by self-incineration.

    Among the few cases of suicidal self-incineration primary or secondary complex suicides are a rarity. Accordingly the number of reports on this subject in the forensic literature is small. In a retrospective analysis of the Freiburg and berlin autopsy material, four cases were found within an observation period of 11 years. These are described together with seven other cases reported in the literature. Altogether most of these suicides are primary combinations, especially with falls from a height. Other combinations include hanging or the infliction of stabs, cuts or gunshot injuries. The sex and age distribution is similar to that found for suicide by self-incineration alone.
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2/9. Suicidal asphyxiation by using pure helium gas: case report, review, and discussion of the influence of the internet.

    Suffocation by inhaled gases has been reported involving a variety of gases. We report a case of suicidal asphyxiation by forced replacement of oxygen with helium by using a complex homemade mask. In this case, a young woman researched suicide on the internet and found an advocated method of suicide using helium. To our knowledge, there is only 1 previously reported case of suicidal asphyxia by using helium.
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3/9. Elevator surfing: a deadly new form of joyriding.

    A new form of joyride, on top of an elevator as it moves up and down the elevator shaft, has surfaced on college campuses and in housing and apartment complexes with elevators. This practice is called "elevator surfing," and an illustrative case is presented, which is believed to be the first such report in the medical literature.
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4/9. Aqua-eroticum: an unusual autoerotic fatality in a lake involving a home-made diving apparatus.

    The term Aqua-eroticum was first introduced in 1984 by Sivaloganathan to describe the unusual autoerotic death of a man using submersion as an asphyxia method. This was the first case of that kind, and since then, no other case of autoerotic submersion has been reported, nor other autoerotic fatality in open water. Here we report the case of a 25-year-old man, nude under a home-made plastic body suit, overdressed for the season with winter clothes and restrained by complex bondage. He was submersed, tied underwater to a boat and was using a home-made diving apparatus for air supply. death was ruled as accidental autoerotic asphyxia from rebreathing, caused by the faulty air-supply device.
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5/9. Unusual form of accidental mechanical asphyxia.

    This brief case report shows an unusual form of accidental atypical strangulation. A 46-year-old male became trapped between the rims of an automatically closing door during his hopeless effort to enter a supermarket at night. The victim's neck was violently pressed by the edges of the automatic door. From external observation we found an incomplete ligature mark and numerous small abrasions in the neck. On autopsy we found typical signs of asphyxia and fractures of the hyoid-laryngeal complex and bruising of the soft tissues of the neck. The subsequent toxicology was negative with the exception of alcohol level. We came to the common conclusion of a double form of mechanical asphyxia - atypical violent strangulation and atypical hanging. The third highly likely contributory factor of death was direct stimulation of the baroreceptor nerve endings in the left carotid sinus and left carotid sheath. In recent literature, there have been presented only a few cases describing this manner of asphyxia and death.
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6/9. Identification of mechanical asphyxiation in cases of attempted masking of the homicide.

    Five homicides are described that had remained unexplained as to the causes of death after gross pathology. Although general signs of asphyxiation were present, they were lacking injuries specific of strangulation or oro-nasal occlusion. The diagnoses of asphyxiation were established by microscopical investigation of the lung and confirmed by subsequent police inquiries. An oro-nasal occlusion was involved in three cases, a strangulation or an oro-nasal occlusion, in another case. The victims were young and healthy. Toxicological investigations remained negative in four cases; one victim was anaesthetized by bromazepam and ether and had a blood alcohol concentration of 80 mg/100 ml. lung histology and electron microscopy revealed acute emphysema, the development of a haemorrhagic-dysoric syndrome and a microembolism syndrome. With regard to the haemorrhagic-dysoric syndrome, the development of alveolar-interstitial edema is particularly important. This finding may also be diagnosed by light microscopy in semi-thin sections. It is emphasized that the combined action of several pathomechanisms is responsible for the rapid manifestation of the pulmonary lesions. Especially, the haemorrhagic-dysoric syndrome is brought about by the combined action of inspiratory intrapulmonary vacuum and raised intracapillary pressure. The complex pattern allows to compile the diagnosis of mechanical asphyxia even if there is no corresponding injury.
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7/9. Lethal asphyxiating juvenile laryngeal papillomatosis. A case report with human papillomavirus in situ hybridization analysis.

    Chronic, progressive, and recurrent laryngeal papillomatosis is an uncommon problem that primarily occurs in children and has been shown (in the pediatric age group) to be caused by human papillomavirus (HPV) types 6 and/or 11. Juvenile laryngeal papillomatosis is hallmarked by recurrences, necessitating repeated surgical procedures to maintain airway patency, and is rarely encountered cause of sudden and unexpected death. This case describes a 22-month-old girl who had been treated for laryngeal and pharyngeal papillomata that were diagnosed 3 months prior to her death, and who died in her sleep the night before she was to be again laryngoscoped and reevaluated. The autopsy disclosed exuberant, complex exophytic papillomata that essentially obliterated the laryngeal lumen. in situ hybridization analysis was performed on paraffin-embedded tissue, which revealed HPV type 6/11 positivity. This is the first time that in situ hybridization studies have been performed on autopsy tissues from someone who died suddenly and unexpectedly from upper-airway obstructive papillomatosis. The pathology and clinical characteristics of juvenile laryngeal papillomatosis are also presented and discussed.
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8/9. Automatic garage door openers: hazard for children.

    OBJECTIVES: Despite significant advances in automatic garage door opener design, automatic garage door openers continue to severely injure or kill children. In this investigation, we sought to determine the frequency and circumstances of accidents that have caused severe injury or death to children. We also tried to develop a means by which homeowners can evaluate their door openers. methods: We present the histories of three children severely injured or killed by automatic garage door openers. We reviewed national data of similar accidents primarily published by the US Product safety Commission and Underwriters laboratories. Also, we evaluated 50 automatic door openers for safety of operation. The reversing mechanisms of door openers were tested using a cardiopulmonary resuscitation mannequin, a roll of paper towels, and a block of wood. RESULTS: In the united states, at least 85 children have had permanent brain injury or have died since 1974 as a result of accidents involving automatic door openers. A review of circumstances of the accidents illustrates that accidents are caused both by use of the openers by children and by faults in design. Most accidents have occurred when children have found access to the activation devices and have been entrapped under closing doors that failed to reverse. However, in one case, an adult activated the opener and left the premises before the door completely closed. Our evaluation of 50 garage door openers showed that although 88% percent reversed when encountering a block of wood, 40% failed to reverse when coming down on a supine, child-sized cardiopulmonary resuscitation mannequin. CONCLUSIONS: Automatic garage door openers pose a serious risk of severe injury or death to children. It is probable that many doors would not reverse if they came down on a young child. Therefore, we have devised a way for homeowners to test their door openers that closely mimics our evaluations using the mannequin by using a large roll of paper towels. If the door fails to reverse using this test, we suggest that homeowners disconnect their openers and operate the doors manually until the openers are serviced or replace their automatic openers with one that meets the latest Underwriters Laboratory standards. We also have other recommendations regarding the safe operation of the doors, including improving the safety standards for openers in apartment complexes. compliance with these recommendations should reduce the number of injuries to children caused by garage door openers.
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9/9. Clinical and morphological aspects of death due to liquid nitrogen.

    A 24-year-old student died while filling flasks with liquid nitrogen. The arms, legs and back were frozen and the face, ears and neck showed a dark red and livid colour with horizontal lines of demarcation. In the electrocardiogram, the heart showed asystolia followed by wide ventricular complexes. The patient was intubated orally as the situs of the larynx and pharynx showed no pathology findings. cardiopulmonary resuscitation was carried out and terminated after 90 min. Unfortunately, the body temperature was not measured. The gas analysis of venous blood showed metabolic acidosis and oxygen deficiency. The student had worked alone with nitrogen, without opening the windows and without a working ventilation system. While filling the third flask he lost consciousness. As nitrogen does not cause characteristic prodromal signs he laid on the floor and was unable to help himself. The liquid nitrogen which was still escaping spread over the floor and vaporized. The student died from asphyxia due to oxygen deficiency in an atmosphere of nitrogen.
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