The objective of the present study was to estimate the proportion of hanging victims presenting with limb lesions, to compare this rate between hanging in restraint spaces and in more open settings, and to describe the usual pattern of limb lesions associated with hanging. Two hundred and seven cases of suicidal hanging were retrospectively reviewed and compared to 45 homicidal nonhanging strangulation victims. Bruises incidence was significantly lower in hanging victims (19.8%) compared to homicidal strangulation victims (55.6%). Bruises were more commonly encountered in restraint areas such as closets and staircases (56.3% and 66.7%, respectively) than in more open settings such as barn, bridge, fence, and park. Limb bruises on hanging victims were generally located on the posterior upper limb or the anterior lower limbs, whereas strangulation victims did not display this preferential bruises concentration. Possible suspicion criteria for limb bruises distribution are discussed, in relation to physiopathology of human asphyxia by hanging.

The present study was designed to describe the evolution of forensic literature in North-American journals over more than 25 years. From 1980 to 2005, the number of articles per year and the average number of authors per article have both increased almost twofold, while the relative contribution of other countries in comparison to the United States has increased from 19.2% to 61.0%. The contributions to the forensic literature of anthropology and biology/DNA have significantly increased, while the contribution of questioned documents and ballistics decreased. Finally, the number of studies using the scientific method has significantly increased through the years, passing from 10.5% to 40.7%. This better knowledge of our body of literature as a whole could help us assess our strengths and weaknesses, and help us to position ourselves on literature ethical issues.

The distinction of a suicidal hanging from a simulated hanging following a homicidal strangulation is highly challenging. The present study evaluates the fracture of the cricoid cartilage as a potential pointer toward homicide. Despite the numerous studies on neck structures fractures in hanging, this is the first study to concentrate on the cricoid cartilage. Neck structures fractures in all cases of suicidal hanging over a 6-year period were retrospectively reviewed (231 cases) and a comparison with homicidal hangings (4 cases) and homicidal no-hanging strangulations cases (52 cases) was performed. Overall, neck structures fractures were found in 23.4% of suicidal cases (54 cases). The cricoid cartilage was intact in all suicidal hangings. The general incidence of fractures in homicidal no-hanging strangulation was 65.4% (34 cases),with an incidence of fracture of the cricoid cartilage of 20.6%. By compiling studies from the literature, only one cricoid cartilage over 2700 suidical hanging cases was found, whereas an incidence of 5 to 20% is found for homicidal strangulation. It is therefore proposed that the presence of a fracture of the cricoid in an apparent suicidal hanging should be considered highly suspicious.

Thoracic surgeons currently have multiple options and strategies to guide treatment in esophageal palliative and emergency conditions. To guide the selection of an individualized palliative approach, physicians, including thoracic surgeons, must take into consideration many factors including prognosis, performance status and comorbidities of patients. For dysphagia more specifically, esophageal stent placement is the most widely used intervention for rapidly relieving dysphagia in inoperable esophageal cancer patients. The combination of esophageal stent placement with other therapies has an impact on palliative care. Innovations including radioactive stents, drug-eluding stents and biodegradable stents will require further evaluation and validation studies. Currently, patients with inoperable esophageal cancer have access to oncological and biological therapies that are improving their prognosis. A shift toward restaging and potential curative intent is occurring in current clinical practice. In acute intrathoracic esophageal perforation cases, high index of suspicion, multidisciplinary team expertise, antibiotics and hybrid treatment strategies, have significantly improved outcomes of patients in recent years. Hybrid treatment strategies denote the combination of minimally invasive interventions for source control and endoluminal procedures to seal the esophageal perforation. Endoluminal procedures as treatment of acute intrathoracic esophageal perforation include stent placement, over-the-scope clip and endoluminal vacuum therapy. Future perspective in the management of esophageal perforation seems to be the combination of endoluminal therapies tailored to the specific clinical scenario. Thoracic surgeons benefit from mastering endoluminal therapies and advanced endoscopic techniques. An understanding of these rapidly evolving therapies, i.e., outcomes, limitations and innovations, is required to optimally manage esophageal palliative and emergency conditions.

Assessment of patients with suspected interstitial lung disease includes a complete work-up consisting of history and physical examination, laboratory studies, lung function testing, high-resolution CT scan, bronchoscopy with bronchoalveolar lavage, and cardiology workup. Presently, definitive diagnosis of interstitial lung disease is even more important because of newly available therapeutics. The high risk/ benefit ratio perceived in the literature for surgical lung biopsy motivates research for new biopsy techniques that ideally would have the same or better diagnostic yield as surgical lung biopsy with less morbidity, mortality and cost. If endoscopic transbronchial lung cryobiopsy can be shown to be associated with a low morbidity rate and high accuracy, we may be able to obtain a definitive histological diagnosis in a great majority of interstitial lung disease cases and forego complex, inefficient and inaccurate methods of disease diagnosis. Several groups have published prospective and retrospective series on endoscopic transbronchial lung cryobiopsy for interstitial lung disease with promising results and diagnostic yields up to 83% (range, 74-91%). The main complications associated with endoscopic transbronchial lung cryobiopsy are pneumothoraces and bleeding. The optimal techniques and specific settings for endoscopic transbronchial lung cryobiopsy is currently being investigated. In this paper, we present a review of the literature for endoscopic transbronchial lung cryobiopsy and future perspectives.