Volume 25 (2019): Issue 1 (June 2019)

Introduction: Suicide by ligature strangulation has been rarely reported in literature. This case report was prepared to present this different method of suicide and to discuss the findings of this case in the framework of findings in literature.

Case: A 37-year old male was found dead in his home where he lived alone, with no signs of forced entry to the house. The body was lying supine on the dining table, with the feet hanging free and the head completely resting on the table. A thick, orange-coloured rope was wrapped three times around the neck and below the table where the head was resting was a 20kg demijohn full of water, with a broken rope with the same features wrapped around the neck of the bottle.

Discussion and Conclusion: The current case is unique in respect of showing the postmortem findings which could be created following the application of pressure with a force of 20kg on the airway and blood vessels. The necessity is emphasised for detailed examination of the scene to differentiate suicide from murder and of information from before death and from the autopsy to correctly establish the cause of death.

Diabetes mellitus is a disease caused by a deficiency in (type 1) or inability to use insulin (type 2). Untreated it can lead to diabetic ketocidosis (DKA) – state with high levels of ketone bodies (acetone, acetoacetate, beta-hydroxybutyrate (BHB)). This state can be life threatening. Measurement of ketone bodies together with vitreous/urine glucose and glycosylated hemoglobin (HbA1C) are therefore essential to diagnose DKA-related deaths.

All autopsy samples received at our department in the period 2016-2018 for toxicological investigations were analyzed for acetone, BHB, and vitreous glucose (N = 1394). In case of a high level of BHB, HbA1C and urine glucose were measured. Thirty two cases (2.3%) were concluded to be DKA-related deaths. Eleven (34%) of these had no known history of diabetes.

BHB accounts for the major part of ketone bodies and is directly associated with the acidosis effect. Therefore, BHB is preferred to acetone when evaluating DKA and other ketoacidosis-related deaths. We compared acetone and BHB levels to evaluate if the easy acetone measurement could cover our needs for screening. We found that high BHB levels (>2000 µmol/L) were detected if the acetone cut off was set to 0.01 g/L. But, many samples would have low BHB < 3-500 µmol/L with this cut off, and many samples with raised BHB (500-1,200 µmol/L) would not be detected. We therefore recommend to screen all samples for BHB. In case of a high BHB (>1,000 µmol/L) vitreous/urine glucose and HbA1C must be measured to distinguish DKA from other types of ketoacidosis.

In criminal cases where there is a lack of evidence, the authorities sometimes ask our department to make a comparison of a criminal and suspect for possible identification or exclusion. This paper provides a comprehensive overview of 113 such cases analysed by the Department of Forensic Medicine, University of Copenhagen, Denmark in 2006–2016. The aims of the analyses were to assist the authorities in identifying individuals, predominantly due to a suspicion of involvement in criminal activity. The videos comprised surveillance footage showing a criminal committing a criminal act. Based on comparisons of specific parameters, such as face, gait and general body proportions, conclusions were drawn on the plausibly of a suspect being the perpetrator of the crime in the video footage. This paper describes the most typical case: a comparison of one suspect with one criminal committing a robbery. In the majority of cases, the suspect could not be excluded from being the criminal based on the analysis of the video footage.

Background: It is stipulated in the Danish Health Act that any death which could be caused by a mistake, neglect or accident in relation to treatment or prophylaxis should be reported to the police. It is then within the power of the police to request a medicolegal autopsy. Aim: To profile the possible iatrogenic deaths in relation to different characteristics.

Methods: All cases from 1992 to 2015 registered as doctor’s malpractice were selected. Cases from 2016 were selected based on the autopsy introduction. Included cases were analyzed focusing on different characteristics: type of iatrogenic event, responsible medical professional, place of death, cause of death.

Results: A total of 275, i.e. 2.5% possible iatrogenic deaths out of a total of 11,143 autopsies were included. The most frequent type of iatrogenic event was negligence (42.2%). Most often a hospital doctor was the responsible party including surgeons (40%) and physicians (13.5%). The three most common causes of death were cardiovascular disease (22.2%), infection/inflammation (17.8%) and hemorrhage (16%).

Conclusion: The results from this study can contribute to the knowledge of what to be aware of when dealing with the death of a person who has been in contact with the health care system.

Studies report that the homicide rate has decreased considerably in most Western countries since the 1990s. However, few studies have examined the level of injury in homicides. The injury severity in homicide victims was studied in the Stockholm area using both the Homicide Injury Scale (HIS) and the number of lethal injuries per victim. Cases were included from four periods; 1976-78, 1986-88, 1996-98, and 2006-08. The number of homicides with overkill according to the HIS was significantly higher in 1996-98 compared to 1976-78. Compared with 1976-78, the number of lethal injuries per victim was significantly higher both in 1996-98 and 2006-2008. There are various possible reasons for the changes, including a brutalization of lethal violence or a more effective trauma care. More in-depth analysis of individual cases together with research on victims of attempted homicides is needed to explain these shifts in injury severity.