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Fatal Pressure Over Neck by Strangulation
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
Ligature strangulation refers to the fatal compression of the neck by a ligature, where the constricting force is applied externally and is not the weight of the body. Majority of these cases belong to the homicide category. However, very few suicidal and accidental cases have been reported from time to time. Ligature strangulation differs from hanging mainly in the source, amount and direction of the constricting force. Generally in hanging, gravitational drag of the body constricts the vital neck structures, causing the death by different mechanisms as discussed previously. In case of ligature strangulation, the constricting force is generally lesser and insufficient to cause compression of all neck arteries, especially the well protected vertebral arteries. Ligature strangulation always produces some degree of evident congestion above the level of ligature mark unless when reflux cardiac inhibition is the mechanism of death.
Asphyxia
Published in Kevin L. Erskine, Erica J. Armstrong, Water-Related Death Investigation, 2021
Strangulation represents a type of asphyxia in which an object causes compression of the blood vessels of the neck with or without concomitant compression of the larynx or trachea. The major mechanism of death in this type of asphyxia is the impairment of O2-rich blood flow from the heart up through the carotid arteries within the neck and to the brain, giving rise to cerebral hypoxia. This also involves compression of the jugular veins within the neck, thus impeding blood flow from the head and brain back to the heart. It is the venous compression with intermittent or incomplete compression of the carotid arteries that gives rise to petechial hemorrhages of the face and conjunctivae.3 These are seen in homicidal ligature and manual strangulation deaths and occasionally in deaths due to suicidal hanging. Additional examples of strangulation are choke/bar arm hold and a carotid sleeper hold. Manual strangulations are always homicidal in manner since one would be unable to maintain compression of his or her own neck vessels after the loss of consciousness since the hand(s) would fall away at that point. Manual strangulations and homicidal ligature strangulations can be accomplished because there is some kind of disparity between the opposing individuals, such as strength or drug or alcohol impairment (i.e., adult vs. infant, male vs. female, or sober adult male vs. highly intoxicated adult male).
Malrotation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Simon Blackburn, Joseph I. Curry, Bhanumathi Lakshminarayanan
A significant number of series reporting successful laparoscopic correction of malrotation volvulus have now been published, meaning that volvulus is no longer an absolute contraindication to the laparoscopic approach. Laparoscopy in this situation should be limited to hemodynamically stable infants, and parents should be warned about the high risk of conversion to open surgery. Strangulation with necrosis and/or perforation should prompt conversion to an open procedure.
The neuropsychological outcomes of non-fatal strangulation in domestic and sexual violence: A systematic review
Published in Neuropsychological Rehabilitation, 2022
Helen Bichard, Christopher Byrne, Christopher W. N. Saville, Rudi Coetzer
Although strangulation can result in blunt force trauma to the neck, the method and physiological impact on the brain is different from most TBI. Strangulation can be defined as the external compression of the airway and/or blood vessels, leading to restricted oxygenated blood flow to, and deoxygenated blood from, the brain. This can be achieved with a ligature (garrotting), by body weight (throttling or positional strangulation), or manually. Evidence largely gleaned from autopsies, and from assessing the risk of the “choke hold” carotid restraint used by police, has been able to show the pathophysiology of strangulation, as set out below (Clarot et al., 2005; De Boos, 2019; Hawley et al., 2001; Monahan et al., 2019). Figure 1 serves as reference for the location of the relevant anatomical structures.
The Diagnostic Value of ischemia-modified albumin (IMA) and signal peptide-CUB-EGF domain-containing protein-1 (SCUBE-1) in an Experimental Model of Strangulated Mechanical Bowel Obstruction
Published in Journal of Investigative Surgery, 2022
Arif Burak Cekic, Ozgen Gonenc Cekic, Ali Aygun, Sinan Pasli, Serap Yaman Ozer, Suleyman Caner Karahan, Suleyman Turedi, Sami Acar, Ozgur Tatli, Esin Yulug
Although several pathologies may underlie the MBO in terms of the development mechanism, persistence of obstruction results in intestinal ischemia. Early and accurate diagnosis of strangulated MBO, and the decision regarding the treatment to be applied, represent an important problem for clinicians. Strangulation needs to be identified early due to the increased risk of morbidity and mortality in patients with strangulated MBO.14 In clinical practice, if peritoneal findings are not present, the approach to be adopted in intestinal obstructions thought to be associated with adhesion should involve observation with conservative methods. However, if findings of peritoneal irritation develop in these patients, or if the obstruction does not resolve with observation, then surgical methods should be applied. However, the manifestation in encountered in patients for whom surgery is required involves intestinal tissue necrosis, and is therefore concluded with necrotic tissue resection. This in turn involves numerous potential complications. This study was therefore planned around the idea that ischemic markers may be useful in deciding which patients with adhesion-related intestinal obstruction should be observed, and which should be corrected surgically. Intestinal ischemia results from impairment of intestinal circulation, and studies have investigated biomarkers that show the presence of such ischemia. The present study employed IMA and SCUBE-1 as biomarkers of intestinal ischemia in rats with experimentally induced MBO.
Penile reconstruction: An up-to-date review of the literature
Published in Arab Journal of Urology, 2021
Nicholas Ottaiano, Joshua Pincus, Jacob Tannenbaum, Omar Dawood, Omer Raheem
Penile soft tissue injury is another common means of injury. These injuries typically occur by means of strangulation or entrapment. Strangulation is a form of compartment syndrome frequently occurring in adults for means of prolonging erections for sexual gratification. Urgent treatment is required to avoid permanent damage [14]. The treatment of choice often depends on a multitude of factors such as material of the strangulating object and availability of resources. Commonly used techniques are use of cutting devices, string and aspiration method, and degloving operation. The first step in treatment typically starts with application of a lubricant with an attempt of manual removal. This process is usually performed concurrently with the string and aspiration method, where blood is aspirated from the corpora with an 18-G needle to achieve decompression followed by tightly winding string distal to the ringed object in hopes of sliding the ring over the string. If this fails, more drastic measures are taken by means of intraoperative bone or wire cutters and, possibly, power drilling machinery. After object removal, urethral inspection and possible skin grafting may be required depending on the extent of injury [14,15].