The Experts below are selected from a list of 14931 Experts worldwide ranked by ideXlab platform
Christoph A. Maurer - One of the best experts on this subject based on the ideXlab platform.
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Mandatory resection of Strangulation marks in small bowel obstruction
World journal of surgery, 2013Co-Authors: Samuel A. Käser, Niels Willi, Christoph A. MaurerAbstract:Background No evidence is available on how to treat intraoperatively detected band-shaped Strangulation marks of the bowel wall originating from an adhesive band or hernia ring. The authors prefer to resect these hazardous Strangulation marks to avoid secondary small bowel perforation. This retrospective study investigated the prevalence of intraoperatively unrecognized ulceration and transmural necrosis at the site of the Strangulation marks.
Gael B Strack - One of the best experts on this subject based on the ideXlab platform.
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recognition and documentation of Strangulation crimes a review
Archives of Otolaryngology-head & Neck Surgery, 2016Co-Authors: Michael F Armstrong, Gael B StrackAbstract:Importance Strangulation accounts for 10% of violent deaths in the United States and 15% to 20% of deaths associated with domestic violence. However, Strangulation deaths represent only a small fraction of nonfatal Strangulation assaults, which occur with daily frequency in medium to large US cities. Careful evaluation and documentation of Strangulation injuries may identify life-threatening medical conditions, and may facilitate prosecution of Strangulation crimes. Observations The most recent article on Strangulation identified in the otolaryngology literature was published in 1989, leaving a generation of head and neck surgeons without current guidance regarding this injury. However, Strangulation is a common form of intimate partner violence. Among the 300 cases of Strangulation reviewed in San Diego in 1995, most survivors (94%) were women who were strangled by a male member of their own household. Many state laws require evidence of injury to prosecute felony Strangulation, but as shown in the review of 300 cases, most survivors (97%) were strangled with the perpetrator’s hands, leaving little to no sign of injury in most cases. Survivors may seek an otolaryngology consultation with complaints of hoarseness, sore throat, respiratory disturbance, or accidental injury to the neck. A thorough head and neck examination may reveal marks on the neck, facial petechiae, and neck swelling. Fiberoptic laryngoscopy is recommended to look for petechiae and swelling in the airway. Chest radiographs may demonstrate postobstructive edema, and computed tomography of the neck may demonstrate vascular injuries. The most sensitive test for subtle Strangulation injuries is magnetic imaging of the neck. Careful examination and documentation can provide critical evidence for the prosecution of these crimes. Conclusions and Relevance Otolaryngologists should be knowledgeable of the subtle patterns of injury and potentially life-threatening complications of Strangulation and should consider domestic violence in women presenting with throat complaints or bruises on the neck.
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a review of 300 attempted Strangulation cases part i criminal legal issues
Journal of Emergency Medicine, 2001Co-Authors: Gael B Strack, George E Mcclane, Dean A HawleyAbstract:Abstract Three hundred Strangulation cases, submitted for misdemeanor prosecution to the San Diego City Attorney’s Office, were evaluated to determine the signs and symptoms of attempted Strangulation that could be used to corroborate the victim’s allegation of being “choked” for purposes of prosecution. The study reveals that a lack of training may have caused police and prosecutors to overlook symptoms of Strangulation or to rely too heavily on the visible signs of Strangulation. Because most victims of Strangulation had no visible injuries or their injuries were too minor to photograph, opportunities for higher level criminal prosecution were missed.
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a review of 300 attempted Strangulation cases part ii clinical evaluation of the surviving victim
Journal of Emergency Medicine, 2001Co-Authors: George E Mcclane, Gael B Strack, Dean A HawleyAbstract:Medical literature describing victims who survive Strangulation is scant. The majority of articles on Strangulation are found in the forensic literature, describing the post-mortem findings on autopsy. This article presents a suggested protocol for the evaluation and treatment of the surviving victim of Strangulation, based upon a review of the available literature. It also corroborates the findings of Strack et al., in the study by the San Diego City Attorney's Office, described in Part I of this series.
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a review of 300 attempted Strangulation cases part iii injuries in fatal cases
Journal of Emergency Medicine, 2001Co-Authors: Dean A Hawley, George E Mcclane, Gael B StrackAbstract:Abstract A review of 300 cases of alleged Strangulation assault, submitted for misdemeanor prosecution by the San Diego City Attorney’s Office, led to a search for medical evidence that would be useful to prosecute these cases (see Strack et al. in this issue of the Journal). The injuries identified in these non-fatal cases are similar to injuries found in fatal domestic violence Strangulation assaults. This article reviews the injuries recognizable at autopsy in cases of Strangulation in domestic violence victims.
Burkhard Madea - One of the best experts on this subject based on the ideXlab platform.
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Cable tie used for suicidal ligature Strangulation--a case report
Archiv fur Kriminologie, 2009Co-Authors: Elke Doberentz, Lars Hagemeier, Burkhard MadeaAbstract:Based on a case of self-Strangulation committed with two connected cable ties, criteria for the differentiation of homicidal and suicidal ligature Strangulation are discussed. Differentiation may be difficult and demands close cooperation between the police and the forensic experts. Apart from the history and general circumstances of the case, not only the kind of Strangulation, but also the presence of any concomitant injuries, the degree of congestion and any internal injuries are of relevance for the criminalistic evaluation. As self-Strangulations are rare, these cases demand special attention.
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Pulmonary micromorphology in fatal Strangulations
Forensic science international, 1994Co-Authors: W. Grellner, Burkhard MadeaAbstract:Pulmonary histopathology was studied in a group of 106 fatal Strangulations including cases of hanging (n = 55; typical, n = 20; atypical, n = 35), ligature Strangulation (n = 12), throttling (n = 15), combinations of throttling and ligature Strangulation (n = 7) and other compressing force against neck (n = 17). The control group (n = 10) consisted of cases of sudden cardiovascular death. The following results were obtained: intra-alveolar edema of different degree and strong hyperemia could be regularly observed in nearly all cases, especially in fatal hanging (apart from the control cases, in this group the highest mean lung weights were observed). Further frequent histological patterns were perivascular and intra-alveolar hemorrhages, local dystelectasis and focal emphysema. Alterations of the lung vessel contents could be detected in a varying extent: fat embolism (n = 7), mainly of minor degree, embolism of bone marrow tissue (n = 5) and intravascular cell accumulations (n = 22). Embolism of fat and bone marrow tissue was nearly always restricted to cases with accompanying blunt force or resuscitation measures. Whereas only 4 out of 55 cases of hanging revealed intravascular cell accumulations (including different types of leukocytes and immature bone marrow cells), 18 out of 51 cases with the other forms of Strangulation exhibited this phenomenon. These accumulations mainly occurred in a discrete and widely scattered manner, appeared in 3 out of 10 control cases (resuscitation measures) as well, and were limited to cases with either protracted courses or accompanying blunt violence. The following conclusions are drawn: the regularly observed general changes of lung microstructure (e.g. edema, hyperemia) are undoubtedly non-specific for Strangulation; the alterations of blood vessel contents may serve as a general vitality marker, if resuscitation measures are excluded, but not as an evidence of strangulating force. In cases without signs of blunt force they point to protracted agony courses (shock equivalents).
Hans-gerd Lenard - One of the best experts on this subject based on the ideXlab platform.
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Tourniquet syndrome—accident or abuse?
European Journal of Pediatrics, 2004Co-Authors: Anne Klusmann, Hans-gerd LenardAbstract:The tourniquet syndrome describes severe Strangulations of appendages by hair, cotton or similar material mainly observed in young infants. The painful swellings of digits or external genitals are surgical emergencies because the Strangulation can cause ischaemia and tissue necrosis. More than 100 cases of the tourniquet syndrome have been reported in most of which the aetiology was unclear. We have treated five patients with a tourniquet syndrome. Four of them presented with Strangulations of one or more toes by hair or threads and one girl was diagnosed with a clitoral tourniquet syndrome. In each case the strangulating material could be removed in time avoiding permanent damage. The lack of any reasonable explanation and the meticulous wrapping made a non-accidental course very likely. Due to the lack of convincing explanations in our cases as well as in most of those described in the literature, we suggest that the tourniquet syndrome is often the result of child abuse, an aetiology overlooked for decades. Conclusion: the tourniquet syndrome in childhood should be included in the list of possible forms of child abuse and should be considered as a differential diagnosis until another aetiology can be convincingly proven.
Michael J Thali - One of the best experts on this subject based on the ideXlab platform.
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postmortem magnetic resonance imaging and postmortem computed tomography in ligature and manual Strangulation
American Journal of Forensic Medicine and Pathology, 2020Co-Authors: Eva Deiningerczermak, Michael J Thali, Jakob Heimer, Carlo Tappero, Dominic GaschoAbstract:PURPOSE: The aim of this study was to evaluate magnetic resonance imaging (MRI) findings in cases of fatal manual or ligature Strangulation. Verification of Strangulation by computed tomography (CT), MRI, and at autopsy as well as its detectability in each modality was assessed. METHODS: We retrospectively analyzed 6 manual and ligature Strangulation cases between 2013 and 2019 who all underwent a whole-body CT, head and neck MRI, and an autopsy. Two radiologists examined head and neck imaging data and compared the data to autopsy findings. RESULTS: Magnetic resonance imaging showed a high efficiency in verifying intramuscular hemorrhages, which were confirmed in autopsy. Moreover, in one case without a visible Strangulation mark, soft tissue injuries associated with Strangulation were detected. Fractures, especially thyroid cartilage fractures, were successfully diagnosed by CT. CONCLUSIONS: As MRI showed a successful detection of soft tissue lesions in relation to Strangulation, it can serve as an alternative method or provide additional value to an autopsy. Intramuscular hemorrhages are a common finding in manual and ligature Strangulation, providing a useful sign of applied pressure on the neck. However, to evaluate fractures, an additional CT or autopsy is recommended.
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life threatening versus non life threatening manual Strangulation are there appropriate criteria for mr imaging of the neck
European Radiology, 2009Co-Authors: Andreas Christe, Harriet C Thoeny, Steffen Ross, Danny Spendlove, Dechen W Tshering, Stephan A Bolliger, Silke Grabherr, Michael J Thali, Peter Vock, Lars OesterhelwegAbstract:The aim of the study was to determine objective radiological signs of danger to life in survivors of manual Strangulation and to establish a radiological scoring system for the differentiation between life-threatening and non-life-threatening Strangulation by dividing the cross section of the neck into three zones (superficial, middle and deep zone). Forensic pathologists classified 56 survivors of Strangulation into life-threatening and non-life-threatening cases by history and clinical examination alone, and two blinded radiologists evaluated the MRIs of the neck. In 15 cases, Strangulation was life-threatening (27%), compared with 41 cases in which Strangulation was non-life-threatening (73%). The best radiological signs on MRI to differentiate between the two groups were intramuscular haemorrhage/oedema, swelling of platysma and intracutaneous bleeding (all p = 0.02) followed by subcutaneous bleeding (p = 0.034) and haemorrhagic lymph nodes (p = 0.04), all indicating life-threatening Strangulation. The radiological scoring system showed a sensitivity and specificity of approximately 70% for life-threatening Strangulation, when at least two neck zones were affected. MRI is not only helpful in assessing the severity of Strangulation, but is also an excellent documentation tool that is even admissible in court.
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Strangulation signs initial correlation of mri msct and forensic neck findings
Journal of Magnetic Resonance Imaging, 2005Co-Authors: Kathrin Yen, Michael J Thali, Peter Vock, Emin Aghayev, Christian Jackowski, Wolf Schweitzer, Chris Boesch, Richard Dirnhofer, Martin SonnenscheinAbstract:PURPOSE: To evaluate multislice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) findings in hanging and manual Strangulation cases and compare them with forensic autopsy results. MATERIALS AND METHODS: Postmortem MSCT and MRI of nine persons who died from hanging or manual Strangulation were performed. The neck findings were compared with those discovered during forensic autopsy. In addition, two living patients underwent imaging and clinical examination following severe manual Strangulation and near-hanging, respectively. For evaluation, the findings were divided into "primary" (Strangulation mark and subcutaneous desiccation (i.e., soft-tissue thinning as a result of tissue fluids being driven out by mechanical compression) in hanging, and subcutaneous and intramuscular hemorrhage in manual Strangulation) and "collateral" signs. The Wilcoxon two-tailed test was used for statistical analysis of the lymph node and salivary gland findings. RESULTS: In hanging, the primary and most frequent collateral signs were revealed by imaging. In manual Strangulation, the primary findings were accurately depicted, with the exception of one slight hemorrhage. Apart from a vocal cord hemorrhage, all frequent collateral signs could be diagnosed radiologically. Traumatic lymph node hemorrhage (P = 0.031) was found in all of the manual Strangulation cases. CONCLUSION: MSCT and MRI revealed Strangulation signs concordantly with forensic pathology findings. Imaging offers a great potential for the forensic examination of lesions due to Strangulation in both clinical and postmortem settings.
