An assessment of the usefulness of routine histological examination in hanging deaths

The forensic application of the Glycophorin A on the Amussat's sign with a brief review of the literature

Even if the Amussat's sign is known since the mid-19th century, few studies have been made in order to assess its real occurrence. In particular, the histopathologic examination of the Amussat's sign lacks in the medicolegal literature. The review of the literature shows indeed a significant range of variability (from 1.1 % up to 25 %) regarding the macroscopic detection of the Amussat's sign. In this study, the authors report that the identification of a vital Amussat's sign is important and may require the immunohistochemical staining for the Glycophorin A (a marker of vital reaction). The victim was a 63-year-old man, who was found suspended from the staircase with a rope. Both the carotid arteries were opened in situ by using fine scissors with blunt tips. A horizontal lesion (length 4 mm) of the intima of the left common carotid artery was documented. A sample was obtained; then, a standard post-fixative histopathologic examination and immunohistochemical staining for the Glycophorin A were carried out. The standard histopathologic examination only revealed the intimal laceration with a poor hemorrhagic infiltration. However, the immunohistochemical staining for the Glycophorin A allowed the clear identification of the hemorrhagic infiltration, which was documented both in the intimal laceration and in the periadventitial soft tissues. The immunohistochemical staining for the Glycophorin A can identify the vitality of an Amussat's sign. When an Amussat's sign is documented, the Glycophorin A may therefore help the forensic pathologist to differentiate a hanging death from a postmortem suspension of the body.

Petechial Hemorrhages in Suicide by Hanging: Possible Contributing Variables in Petechial Development

Hemorrhagic petechiae in the conjunctiva and the skin have been related to type of suspension and body height of the victims of hangings. In 265 cases of hanging, we retrospectively examined whether petechiae relate to type of suspension, body weight and height, body mass index (BMI), age, sex, type and thickness of the ligature, and blood alcohol content. The type of suspension was divided into completely suspended, incompletely suspended, and found with feet touching the ground. There was no significant difference in the frequency of petechiae between the feet touching the ground and complete suspension, and they were therefore considered as one group (complete suspensions). Incomplete suspensions had more (58.7%) petechiae than the complete suspension group (30.2%). Statistical analysis showed that incomplete suspension was significantly stronger related to the development of petechiae than complete suspension. Body mass index was the only variable able to add information to the type of suspension. In victims of incomplete hangings, high BMI yielded 2.58 times higher probability of developing petechiae than low BMI. These findings suggest that body size may contribute to the development of petechiae in hangings.

The Utility and Scope of Forensic Histopathology

Forensic histopathology is the use of histology to aid in the identification of disease and injuries in forensic pathology practice. The value of routine microscopy has been challenged in various studies and discussions have taken place in forensic journals about how useful microscopic diagnosis is in medicolegal autopsies. This paper reviews the literature on the value of histological examination in forensic practice and discusses routine histochemical stains that can be used in postmortem examinations to aid in the diagnosis and add value by confirming or refuting macroscopic findings.

Micro computed tomography features of laryngeal fractures in a case of fatal manual strangulation

Cases of subtle fatal neck compression are often complicated by the lack of specificity of the post-mortem signs of asphyxia and by the lack of clear signs of neck compression. Herein we present a forensic case of a 45-year-old schizophrenic patient found on the floor of the bedroom of a psychiatric ward in cardiopulmonary arrest and who died after two days in a vegetative state. The deposition of the roommate of the deceased, who claimed responsibility for the killing of the victim by neck compression, was considered unreliable by the prosecutor. Autopsy, toxicological analyses, and multi-slice computed tomography (MSCT), micro computed tomography (micro-CT) and histology of the larynx complex were performed. Particularly, micro-CT analysis of the thyroid cartilage revealed the bilateral presence of ossified triticeous cartilages and the complete fragmentation of the right superior horn of the thyroid, but it additionally demonstrated a fracture on the contralateral superior horns, which was not clearly diagnosable at MSCT. On the basis of the evidence of intracartilaginous laryngeal hemorrhages and bilateral microfracture at the base of the superior horns of the larynx, the death was classified as a case of asphyxia due to manual strangulation. Micro-CT was confirmed as a useful tool in cases of subtle fatal neck compression, for the detection of minute laryngeal cartilage fractures, especially in complex cases with equivocal findings on MSCT.