Lenka Zátopková

The ability to act: Multiple suicidal gunshot wounds

Multiple self-inflicted gunshot wounds are rare and usually present a challenge to the forensic pathologist in determining the manner of death. Determining a persons capability to act following a gunshot wound can be of major importance in crime scene reconstruction and in differentiation between homicide and suicide. Questions concerning the possibility of physical activity following a given gunshot wound are repeatedly raised in court. We report herein three unusual cases of suicide involving multiple gunshot wounds; all the victims suffered gunshot wounds of the head without immediate incapacitation. In the first two cases, the head was target for two gunshots. Third case was a combination of two gunshots to the head and chest. In the text, we focus on the victims ability to act after the first shot, with regards to the character and localization of the gunshot wound. Also, we focus on findings that are typical for a repeated suicidal shot.

The diagnostic value of synovial membrane hemorrhage and bloody discoloration of synovial fluid ("inner knee sign") in autopsy cases of fatal hypothermia.

We describe and discuss autopsy findings of synovial membrane hemorrhage and bloody discoloration of synovial fluid (“inner knee sign”) within a study population comprising 36 cases of fatal hypothermia and 300 control cases. Synovial membrane hemorrhage and bloody discoloration of synovial fluid of the knees were seen in 27 cases of fatal hypothermia (75%). Though we are not dealing here with an obligatory autopsy finding in fatal hypothermia, the detection of the inner knee sign might be used as another corroborative sign of vital hypothermia after considering all differential diagnostic aspects. However, the absence of this finding does not exclude death due to hypothermia.

Complex suicide with black powder muzzle loading derringer

Planned complex suicide is defined as the combination of more than one method of suicide, previously planned by the victim, to prevent failure of the first method. Herein, we present a case of planned complex suicide, committed by a black powder muzzle loading handgun and hanging. A 39-year-old man was found dead in the bathroom of his flat, hanging by the neck with a huge atypical gunshot entrance in the right temporal region of his head with extensive backspatter. The skin defects, as well as soft tissues in the subcutaneous pocket undermining, were heavily burnt. Along the wound canal were multiple bone fragments, and at the end of the path at the left temple was an embedded lead ogival projectile with a cross shaped artificial incision at its tip. The hanging was incomplete. There were no fractures of the hyoid bone and laryngeal cartilages. Cervical muscles and vessels were intact. Simon’s sign was negative. Signs of asphyxia were not present. This is the first reported case of complex suicide with a black powder derringer and manipulated projectile.

Significance of hemorrhages at the origin of the sternocleidomastoid muscles in hanging.

Abstract Hemorrhages at the periostal-clavicular origin of the sternocleidomastoid muscles are part of the indirectly induced autopsy findings in death by hanging. In a prospective study of 178 cases of hanging, clavicular hemorrhages were found in 110 cases (a relative frequency of 62%). A statistically significant association between occurrence of hemorrhages and completeness of the victim’s body suspension was discovered (P = 0.046) as well as a significant association between the occurrence of hemorrhages and the location of the ligature knot on the neck (P = 0.008). The occurrence of hemorrhages at the clavicular origin of the sternocleidomastoid muscles was independent of age, sex, and weight. This article renews the knowledge of this important vital sign described mainly in the German medicolegal literature.

The morphology of human hyoid bone in relation to sex, age and body proportions

Morphological aspects of the human hyoid bone are, like many other skeletal elements in human body, greatly affected by individuals sex, age and body proportions. Still, the known sex-dependent bimodality of a number of body size characteristics overshadows the true within-group patterns. Given the ambiguity of the causal effects of age, sex and body size upon hyoid morphology the present study puts the relationship between shape of human hyoid bone and body proportions (height and weight) under scrutiny of a morphological study. Using 211 hyoid bones and landmark-based methods of geometric morphometrics, it was shown that the size of hyoid bones correlated positively with measured body dimensions but showed no correlation if the individuals sex was controlled for. For shape variables, our results revealed that hyoid morphology is clearly related to body size as expressed in terms of the height and weight. Yet, the hyoid shape was shown to result primarily from the sex-related bimodal distribution of studied body size descriptors which, in the case of the height-dependent model, exhibited opposite trends for males and females. Apart from the global hyoid shape given by spatial arrangements of the greater horns, body size dependency was translated into size and position of the hyoid body. None of the body size characters had any impact on hyoid asymmetry. Ultimately, sexually dimorphic variation was revealed for age-dependent changes in both size and shape of hyoid bones as male hyoids tend to be more susceptible to modifications with age than female bones.

Reconstruction of devastating head injuries: a useful method in forensic pathology

Crushing head injuries usually do not allow direct visual identification of individuals, and above all, it constitutes an obstacle to comprehensive evaluation of discrete traumatic changes of the skin and soft tissues. We present our experience with the plastic adaptation of devastating head injuries in the two exemplary cases. The principal of the reconstruction is manual repositioning of bone fragments of the cranial and facial parts of the skull and careful approximation of the wound edges and their gradual suture using suture material. The reconstruction method can be recommended as an auxiliary technique in the identification of unknown victims with crushing head injuries and in the evaluation of devastating gunshot wound of the head.

A Fatal Elephant Attack

Abstract:  A rare case of an elephant attack is presented. A 44‐year‐old man working as an elephant keeper was attacked by a cow elephant when he tripped over a foot chain while the animal was being medically treated. The man fell down and was consequently repeatedly attacked with elephant tusks. The man sustained multiple stab injuries to both groin regions, a penetrating injury to the abdominal wall with traumatic prolapse of the loops of the small bowel, multiple defects of the mesentery, and incomplete laceration of the abdominal aorta with massive bleeding into the abdominal cavity. In addition to the penetrating injuries, the man sustained multiple rib fractures with contusion of both lungs and laceration of the right lobe of the liver, and comminuted fractures of the pelvic arch and left femoral body. The man died shortly after he had been received at the hospital. The cause of death was attributed to traumatic shock.

Suicidal decapitation by guillotine: case report and review of the literature.

Abstract:  Suicidal decapitation is seldom encountered in forensic medicine practice. This study reports the analysis of a suicide committed by a 31‐year‐old man with a self‐fabricated guillotine. The construction of the guillotine was very interesting and sophisticated. The guillotine‐like blade with additional weight was placed in a large metal frame. The movement of the blade was controlled by the frame rails. The steel blade was triggered by a tensioned rubber band after releasing the safety catch. The cause of death was immediate exsanguination after complete severance of the neck. The suicide motive was most likely emotional distress after the death of his father. In medico‐legal literature, there has been only one similar case of suicidal complete decapitation by a guillotine described.

The asymmetry and modularity of the hyoid bone

Morphological variation is a result of interplay among multiple intervening factors. For hyoid bones, the shape and size differences have been scarcely covered in the literature and in majority limited to studies of sexual dimorphism or age dependency. To our knowledge, the human hyoid bone, in complete opposite to other cranial bones, has not been fully utilized to address developmental questions in terms of asymmetry or modularity. In the present paper, we used landmark-based methods of geometric morphometrics and multivariate statistical approach to study human hyoid morphology represented by the hyoid body and greater horns in a sample of 211 fused and non-fused bones. Within a sample variation analysis, we showed that the hyoid bone is, by nature, asymmetrical bone which exhibit both directional and fluctuating types of asymmetry and is composed of well-integrated anatomical elements for which the biomechanical load of attached muscles is the most determining factor of variation. Yet, the covariance and evidence of unequal amount of fluctuating asymmetry among modules suggests a certain degree of independence during early stages of development.

Hypothermia provokes hemorrhaging in various core muscle groups: how many of them could we have missed?

The postmortem diagnosis of hypothermia remains problematic even in the era of molecular and digital diagnostic advances. Gross hemorrhages in iliopsoas muscles have been regarded as a helpful diagnostic sign in hypothermia fatalities; nevertheless, they have received marginal attention since their original description. The present study attempts to fill that void by examining occurrence, localization, and diagnostic significance of the bleeding into the core muscles as evidence of death due to hypothermia in a series comprising 51 consecutive hypothermia autopsy cases. Hemorrhages into the core muscles were identified in 33 cases of fatal hypothermia (65%). Hemorrhages were present in iliopsoas muscles (19 cases; 37%), deep back muscles (18 cases; 35%), and in other core muscular groups such as the diaphragm, cervical, pectoral, and intercostal muscles (11 cases; 22%). The results of the study offer an attractive diagnostic opportunity and reaffirm the potential of the careful core muscle dissection for the clarification of hypothermic deaths. Centers lacking high-end imaging technologies and molecular postmortem programs may especially benefit, which may have implications in broader autopsy practice.