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Gentilomo A, Tambuzzi S, Boracchi M, Gentile G, Zoja R. Mechanical asphyxia by hanging and gunshot to the head: A series of rare planned complex suicides. Med Leg J 2024; 92:15-19. [PMID: 35650711 DOI: 10.1177/00258172221102755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A suicide where the deceased has employed more than one means of ending his or her life is defined as a complex suicide (CS). Forensic practitioners may face difficulties caused by the articulated mechanisms underlying this event. Among CS, the combination of hanging and gunshots is unusual. In this study, we present three unique cases of such planned complex suicides (PCS) that we have encountered in our 28 years of activity at the Bureau of Legal Medicine of Milan. Careful inspection of the death scene, precise analysis of the anamnestic-circumstantial data, and accurate medico-legal autopsy examination were the starting points for a better understanding of the causes and manner of death. In particular, the presence of vital reactions of tissues involved in the two different means used, the coherence of the areas involved with a self-inflicted wound, and the absence of signs of third party intervention allowed us to classify these events as suicides. As for the chronology of events, the lethality of the cerebral lesions caused by the gunshots in all cases, in accordance with the cervical lesions caused by hanging, led us to conclude that we were dealing with PCS and catalogue these three cases as unusually planned complex suicides avoiding incorrect and superficial classification.
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Affiliation(s)
- Andrea Gentilomo
- Dipartimento di Scienza Giuridiche "Cesare Beccaria" - Università degli Studi di Milano, Via festa del Perdono, 7 - 20122 Milano, Italy
| | - Stefano Tambuzzi
- Dipartimento di Scienza Giuridiche "Cesare Beccaria" - Università degli Studi di Milano, Via festa del Perdono, 7 - 20122 Milano, Italy
| | - Michele Boracchi
- Dipartimento di Scienza Giuridiche "Cesare Beccaria" - Università degli Studi di Milano, Via festa del Perdono, 7 - 20122 Milano, Italy
| | - Guendalina Gentile
- Dipartimento di Scienza Giuridiche "Cesare Beccaria" - Università degli Studi di Milano, Via festa del Perdono, 7 - 20122 Milano, Italy
| | - Riccardo Zoja
- Dipartimento di Scienza Giuridiche "Cesare Beccaria" - Università degli Studi di Milano, Via festa del Perdono, 7 - 20122 Milano, Italy
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Del Duca F, Manetti AC, Maiese A, Napoletano G, Ghamlouch A, Pascale N, Giorgio B, Paola F, Russa RL. Death Due to Anaphylactic Reaction: The Role of the Forensic Pathologist in an Accurate Postmortem Diagnosis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2184. [PMID: 38138287 PMCID: PMC10744436 DOI: 10.3390/medicina59122184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The diagnosis of anaphylaxis comprehensively depends on both situational information and laboratory investigations. For this purpose, serum tryptase concentration is examined as an indicator of systemic mast cell mediator release, linked to an underlying anaphylactic process. Increased levels of tryptase may occur in some events different from anaphylaxis, but usually information from crime scene investigations is lacking and autoptic findings are not specific. For legal reasons, it is required to achieve a definite diagnosis of mast cell degranulation that can lead to a certain diagnosis of death from anaphylaxis. Immunohistochemistry seems to be a relatively simple, reliable, and easily repeatable method that can assist the forensic pathologist in the differential diagnosis of death from anaphylaxis. Materials and Methods: This work provides an overview of the current literature on immunohistochemical methods useful in the determination process of anaphylactic-related deaths. A systematic search, according to the PRISMA statement, was performed in databases to identify studies investigating immunohistochemical targets related to anaphylaxis death. Results: This work underscores the importance of anaphylaxis mediators such as tryptase, CD117, and chymase in the immunohistochemical analysis of anaphylactic deaths. Conclusions: According to the reviewed literature, the diagnosis of death due to anaphylaxis should depend not just on the suspicion of an anaphylactic reaction but also on confirming mast cell degranulation through the identification of IHC positivity for inflammatory mediators, particularly in the respiratory tract.
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Affiliation(s)
- Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Alice Chiara Manetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Alessandro Ghamlouch
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Natascha Pascale
- Department of Forensic Medicine, Hospital ‘San Carlo’, 85100 Potenza, Italy;
| | - Bolino Giorgio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Frati Paola
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (A.C.M.); (G.N.); (A.G.); (B.G.); (F.P.)
| | - Raffaele La Russa
- Department of Clinical Medicine, Public Health, Life Sciences, and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
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Galante N, Gentile G, Tambuzzi S, Zoja R. Suicide pacts in the Milan district (Italy): A retrospective autopsy-based study with literature review. J Forensic Leg Med 2022; 86:102319. [DOI: 10.1016/j.jflm.2022.102319] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/18/2022]
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