One hundred eighty-nine cases of known dead bodies brought for medicolegal autopsy with alleged history of hanging were studied at the Department of Forensic Medicine, State Medico Legal Institute, Government Medical College, Thiruvananthapuram, Kerala, India. All the findings noticed during detailed external examination and flap dissection of the neck were analyzed with special emphasis on correlation between the external and internal injuries on neck.There was a preponderance of males in the study group (70.9%), majority of them being middle-aged (64.9%). Among females, the major group was composed of adolescents and young adults (72.8%). Easily available materials were used as ligature materials. Soft materials such as saree, shawl, lungie, and so on were used as ligature by 47% of victims and hard materials such as coir rope, plastic rope, telephone cable, and so on were used by 29% of victims. Oblique ligature mark was noted in 94.2% of cases. The ligature mark was noncontinuous in 78% of cases. Horizontal ligature marks were noted in cases of partial hanging.Rupture of muscle fibers at the lower attachment of sternomastoid was seen in 19.6%, and carotid intimal tear was seen in 1.1% of cases. Fracture of hyoid bone at their greater horns was seen in 2.7% and thyroid cartilage in 5.3% of cases. Vertebral fracture and dislocation were noted between third and fourth cervical vertebrae in 1.6% of cases. Neck skeleton injuries were noted in persons older than 38 years.

Background & objectives: The burden of cardiovascular diseases is high in Kerala, India, and a considerable proportion of these occur in young people. The objective of this study was to estimate the severity of atherosclerosis in autopsies done for accidental and suicidal deaths in victims below 40 yr of age. Methods: Coronary arteries from 77 autopsies done for unnatural deaths in a population below 40 yr were graded, and the degree of stenosis, intimal thickness index (ITI) and the intima-media ratio (IMR) were measured. Results: There were 65 males and 12 females in the sample. The American Heart Association (AHA) type 3-6 (pathological intimal thickening) was seen in 55.4 per cent [95% confidence interval (CI): 42.5-67.7%] of males and 25 per cent (95% CI: 5.5-57.2%) of females and advanced lesions (type 4-6) in 44.6 per cent (95% CI: 32.3-57.5%) of males and 8.3 per cent (95% CI: 0.2-38.5%) of females. Types 5 or 6 lesions were seen in 32.2 per cent (95% CI: 21.2-45.1%) of males. The mean stenosis was 57.3 per cent in males and 40.6 per cent in females. More than 40 per cent stenosis was seen in 76.6 per cent cases, more than 50 per cent in 54.5 per cent cases and more than 75 per cent stenosis in 14.3 per of the sample. The mean ITI (MIT) was 1.85 and the mean IMR was 4.11. The degree of stenosis, MIT and IMR were significantly associated with male sex, overweight and smoking. Interpretation & conclusions: Morphometric data showed that the degree of atherosclerotic narrowing of coronary arteries in young non-diseased population was high. It portends a danger to the community unless preventive measures are taken up.

Background: Injuries of the chest causing disruption of the thoracic cage, damaging the great vessels are increasing daily. Aorta is most vulnerable to injury in deceleration trauma from road and air accidents, fall from height and penetrating injuries. Incidence of traumatic rupture of the aorta is rising with higher travel speed.  Methods: In this study we analysed the pattern of injury to great vessels and the socio-demographic pattern of the victims in trauma. 250 cases brought to a tertiary care institution for autopsy were studied from 1st January 2005 to 30th November 2005 (1st July 2005 - 30th November prospectively, and 1st January - 30th June 2005, retrospectively). A cross sectional study design including all cases of trauma to the chest was done with consecutive sampling. Data was collected in pro forma and analysed.Results: 206 victims were males. Commonest cause of chest injury was trauma. 130 (52%) were victims of road traffic accidents and the vehicle implicated the most was bus (41 cases, 16.4%). Pedestrians constituted the majority (26.4%). 15 cases (6%) involved major blood vessels of the thorax. Descending part of the thoracic aorta was vulnerable, with transection of the great vessels in 5 cases (2%). Haemothorax was observed in 102 cases on right side and 94 cases on the left side. 9 cases (4%) of bronchial or tracheal ruptures with 6 cases of severance and 3 incidences of tear were recorded.Conclusions: The wound of aorta or pulmonary artery are immediately fatal and commonly seen in case of vehicular accident or fall from height due to the intense compression to the chest with or without any sign of external injury. Most ruptures are due to automobile accidents and the mechanism of injury is sudden motion of the heart and great vessels.

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