The Activity of N-acetyl-ß-hexosaminidase in the Blood, Urine, Cerebrospinal Fluid and Vitreous Humor Died People Due to Alcohol Intoxication.

BACKGROUND: The article aimed to assess the activity of the hexosaminidase (HEX) and its HEX A and HEX B isoenzymes in persons who suddenly died due to ethanol poisoning and explain the cause of their death. METHODS: The research involved two groups of the deceased group A-22 people (20 males, 2 females; the average age 46 years) who died due to alcohol intoxication (with the blood alcohol content of 4‱ and above in all biological materials at the time of death-blood, urine, cerebrospinal fluid, and vitreous humor), and group B-30 people (22 males, 8 females; the average age 54 years), who died suddenly due to other reasons than alcohol. RESULTS: The highest activity of the HEX was found in the serum of A and B groups. A significantly lower activity of HEX, HEX A, and HEX B was observed in the urine of group A in comparison to the sober decedents. CONCLUSION: The lower activity of HEX and its isoenzymes in the dead's urine due to ethanol poisoning may suggest its usefulness as a potential marker of harmful alcohol drinking. Damage done to the kidneys by ethanol poisoning may be one of the possible mechanisms leading to death. Kidneys may be damaged intravitally via the inflammatory agent. Thus, it is necessary to conduct further research to evaluate the diagnostic usefulness of exoglycosidases while determining the death mechanisms of people who lost their lives due to ethanol poisoning.

Analysis of the prevalence of medicines and psychoactive substances among drivers in the material of the Department of Forensic Medicine at the Medical University of Bialystok.

OBJECTIVES: To evaluate the prevalence of medicines and psychoactive substances in the blood of drivers. MATERIAL AND METHODS: The data, recorded in 2010-2011, was comprised of 274 blood samples of sober drivers (269 men and 5 women). 126 drivers within the group died immediately on the spot (mean age 29.7 years, range 19-53 years), 31 drivers survived the accident (mean age 32.4 years, range 24-69 years), and 117 drivers were stopped for traffic control (mean age 26.4 years, range 17-49 years). ELISA immuno-enzymatic blood tests detecting medicines and psychoactive substances were performed by the Neogen company. The presence of the tested substances was confirmed by gas chromatography and liquid chromatography with a mass detector (GC/MS and LC/MS). RESULTS: From the total number of 274 individuals, the presence of psychoactive substances was found in 132 cases, which accounted for 48.2% of all subjects. The drivers found to be under the influence of medicines and psychoactive substances were most often stopped for a roadside survey, among whom the percentage of positive results was 92.3% (108 cases out of 117 subjects). Among the total number of positive findings the psychoactive substances used, alone or in combination with other agents, were tetrahydrocannabinols (42.4%), amphetamines (26.5%), opiates (25.7%) and benzodiazepines (15.1%), and their concentration in the blood did not exceed toxic levels. CONCLUSIONS: In the group of psychoactive substances most often used, either alone or in combination with other agents, there were tetrahydrocannabinols, whose high percentage of positive results in drivers stopped for a roadside control may be explained by commissioning studies on early screening. Concentrations of the substances in most cases did not exceed toxic levels. Roadside examinations, on the basis of their alcohol-like effect, were performed primarily on male drivers.

[The analysis of neonatal deaths based on autopsy protocols of the Department of Forensic Medicine in Bialystok in the years 1955-2009]. / Analiza zgonów noworodków w oparciu o protokoly sekcyjne Zakladu Medycyny Sadowej w Bialymstoku w latach 1955-2009.

The authors performed an analysis of the causes of deaths of newborns with special emphasis placed on cases when neonaticide was suspected. In the discussed period, 17838 medico-legal autopsies were performed, 124 of them (0.695 per cent of all postmortem examinations) involved children who meet the WHO criteria for newborn - children under 28th day of life. The newborns were divided into two groups according to their exact age at the time of death - newborns who died within a short time after birth and newborns who died after the perinatal period. Their sex, body length and body weight were also taken into consideration. A total of 108 autopsies (87.1 per cent of all autopsied newborns) involved cases of suspected criminal infanticide within the first score of hours postnatally. In the majority of these cases, the cause of death was suffocation, rarely mechanical trauma. The case of death of older newborns was broadly understood trauma.

[Medico-legal assessment in civil lawsuits in patients with neurological disorders in the case material of the Forensic Medicine Department, Medical University of Bialystok, in the years 2004-2008]. / Opiniowanie w postepowaniu cywilnym u osób ze schorzeniami neurologicznymi w materiale Zakladu Medycyny Sadowej UM w Bialymstoku w latach 2004-2008.

Opinionating in civil proceeding is difficult and carries much responsibility, especially in the period of increasing claiming for damages. The authors analyzed civil opinions issued by the Forensic Medicine Department, Medical University of Bialystok, in the years 2004-2008. The above-mentioned opinions addressed neurologic diseases and symptoms. The victims were invited to the Department for examinations which were performed by a forensic medicine expert and a neurologist, alternatively also by other specialists depending on the reported ailments. The paper presents an analysis of the victims' age and sex, type of the event, injuries and ailments, duration of physical and mental suffering, percentage of health impairment. The study comprised 126 civil opinions issued. Occupationally active persons were predominantly subject to injuries. The most common symptoms reported were headache, vertigo and pain in the C, L-S spine.

[Opinionating in cases referring to estimation of ability to participate in legal proceedings and estimation of ability to serve a sentence of imprisonment or restriction of freedom in the material of Department of Forensic Medicine in Bialystok in the years 2005-2009]. / Opiniowanie w sprawach dotyczacych oceny zdolnosci do udzialu w czynnosciach procesowych oraz oceny zdolnosci do odbywania kary pozbawienia lub ograniczenia wolnosci w materiale Zakladu Medycyny Sadowej w Bialymstoku w latach 2005-2009.

In the last years in Poland, the number of medicolegal opinions issued concerning the health status of defendants or convicts with regard to their ability to participate in legal proceedings (taking part in trial) and serve a sentence of imprisonment or restriction of freedom (doing free social labor) has been increasing. In the years 2005-2009, in our department, 115 opinions about defendants, convicts, one witness and one sufferer were issued. In this number, 37 opinions were associated with estimation of ability to serve a sentence of imprisonment, 22--estimation of ability to serve a penalty of restricted liberty or possibility of alternative serving a sentence of imprisonment, 56--estimation of ability to take part in legal proceedings. In 8 cases the experts estimated if the health status allowed a defendant to be detained awaiting trial and be detained in custody pending inquiry. The age, sex, place of residence, diseases the opinioned persons suffered from and the judicial organ that commissioned the opinion were taken into consideration in the analysis. The opinions were issued on the basis of court files and medical documentation only--18 opinions, or on the basis of court files, documentation and medical examination--97 opinions. In 52 cases, only specialists of forensic medicine issued the opinions, but in 63 instances, participation of experts in other medical specialties was necessary. Most often, the opinions of cardiologists were sought.

[The Polish helicopter crash in Belarus--an analysis of the accident]. / Wypadek polskiego smiglowca na Bialorusi--analiza zdarzenia.

The subject of analysis was the crash of a helicopter of the Polish Border Guards, which happened on October 31, 2009, in the Byelorussian territory about two hundred meters from the Polish border. In the accident, three crew members perished: the pilot, navigator and operator. Based on the accounts obtained directly after the crash on the site of the tragedy, it was established that the pilot tried to land, but the impact was so strong that the aircraft sank about one meter into the ground. On November 3, 2009, a committee consisting of two prosecutors from the County Prosecutor Office in Bialystok, a forensic science expert and a representative from the Border Guards, went to Department of Forensic Medicine in Brzesc. The prosecutors and forensic science expert took part in recovering the bodies. During the process of internal and external examination, severe body injuries were noted, without any surviving tissue and intestines. Samples of blood, urine and fragments of internal organs were collected for chemical, biochemical, toxicological and histopathological examinations. Muscle DNA was also taken.

[Posttraumatic cerebrasthenia and posttraumatic encephalopathy--difficulties in opinionating]. / Cerebrastenia pourazowa i encefalopatia pourazowa-- trudnosci opiniodawcze.

Post-traumatic cerebrasthenia and post-traumatic encephalopathy are the effects of a head trauma. Most physicians overuse these diagnoses. They do not perform differential diagnostic management, what leads to issuing erroneous opinions. The aim of this report is to show the symptoms of posttraumatic cerebrasthenia and posttraumatic encephalopathy and diagnostic investigations, which could be helpful for diagnosing these conditions. Cerebrasthenia (the subjective posttraumatic syndrome, subjective syndrome, posttraumatic neurosis) is usually a functional--"unorganic" disorder. It happens in the cases of many people who had brain concussion. The most common symptoms are: headache, vertigo, irritability, insomnia, attention deficits, fatigability. Posttraumatic encephalopathy is a persistent brain tissues injury which could be caused by more severe trauma (brain contusion, endocranial bleeding). The clinical picture of this disease entity is not unambiguous. The most frequently encountered form is a simple (common) form, which is similar to cerebrasthenia, but with differences in the neurological examination (focal signs) and with persistent changes in EEG.

[Carbon monoxide poisoning in the autopsy material of the Department of Forensic Medicine, Medical University Of Bialystok in years 1998-2008]. / Zatrucia tlenkiem wegla w materiale sekcyjnym Zakladu Medycyny Sadowej UM w Bialymstoku w latach 1998-2008.

The objective of the paper was to present the observations and conclusions based on the review of autopsy records collected at the Department of Forensic Medicine, Medical University of Bialystok. The criteria under evaluation included gender, age, alcohol level, carboxyhemoglobin concentration and site of poisoning. A seasonal distribution of CO intoxication and a possible relationship between carboxyhemoglobin concentration and ethanol blood level was confirmed. In the years 1998-2008, carbon monoxide poisonings were the cause of death in 219 (4.74%) of a total of 4615 autopsy reports reviewed. Males accounted for more than 79% of all the victims. The highest concentration of carboxyhemoglobin was found in the age group of 41-50 years. A protective effect of low ethanol concentration was noted in persons exposed to CO. The COHb level was determined by the Wolff's method.

[Cases of acute fatal alcohol poisoning in the material of the Department of Forensic Medicine, Medical University in Bialystok, in the years 1984-2004]. / Ostre smiertelne zatrucia etanolem w latach 1984-2004 w materialach wlasnych Zakladu Medycyny Sadowej w Bialymstoku.

The paper presents the analysis of acute fatal ethanol poisonings in the material of the Forensic Medicine Institute in Bialystok. Our study has shown that a predominant majority of the deceased died during the phase of alcohol elimination. Moreover, these people were often in good health and generally fit. In view of the immense material analyzed by the present authors and the 20-year time span under investigation, it may be concluded that middle-aged men constitute a group the highest risk of death resulting from acute alcohol poisoning. The assessment of alcohol concentration in blood and other body liquids, for example in urine, allows for defining the phase when death of an alcohol-imbibing individual occurred. In medico-legal and clinical practice, such a determination is very important in terms of initiating appropriate treatment or specifying the mechanism of death.

[Cases of fatal para methoxy amphetamine (PMA) poisoning in the material of the Forensic Medicine Department, Medical University Of Bialystok, Poland]. / Przypadki smiertelnych zatruc p-metoksyamfetamina (PMA) w materiale Zakladu Medycyny Sadowej Uniwersytetu Medycznego w Bialymstoku.

The issue of sudden deaths due to acute para methoxy amphetamine (PMA) poisoning is presented in the report. The analysis included three cases autopsied at the Forensic Medicine Department in Bialystok at the beginning of 2009. The toxicological analysis of samples of blood and urine did not confirm the presence of MDMA, also known as ecstasy, but it revealed the presence of para methoxy amphetamine (PMA). During post-mortem examinations, the cause of the death was not established in either case. Based on the above investigations it may be said that the common cause of death was acute para methoxy amphetamine (PMA) poisoning.

[Determinations of the presence of drugs in traffic users in the material of the Department of Forensic Medicine, Medical University of Bialystok]. / Badania nad obecnoscia srodków odurzajacych i substancji psychotropowych w organizmach uczestników ruchu drogowego w materiale Zakladu Medycyny Sadowej UM w Bialymstoku.

In recent years, there has been observed an increasing number of traffic users being under influence of psychoactive substances that affect the central nervous system. A total of 198 blood samples and 23 urine samples collected from traffic users (drivers, passengers and pedestrians) suspected of having ingested psychoactive substances were examined. The analysis included blood samples collected from living individuals and blood or urine from the deceased. Ethyl alcohol levels were determined by gas chromatography, while body fluids were examined by Elisa tests for determination of cannabinoids, amphetamines, opium narcotics, cocaine (benzoiloecgonine), benzodiazepines, barbiturates and tricyclic antidepressants. The confirmation of positive results was carried out by gas chromatography with mass detector. Twenty-nine blood samples were positive, what constituted 14.6% of the total number of investigated cases, including 12 (7.8%) of samples originating from living individuals and 17 (37.8)--from the fatalities. In both groups, the most commonly detected substances were cannabinoids (THC and its metabolite carboxy-THC) and amphetamines and its analogues.

[Malpractice in neurology in the case material of the Forensic Medicine Department, Medical University of Bialystok]. / Bledy medyczne z zakresu neurologii w materiale Zakladu Medycyny Sadowej UM w Bialymstoku.

The paper presents an analysis of legal opinions compiled by the Forensic Medicine Department, Medical University of Bialystok in the years 2003-2008. The above-mentioned opinions addressed medical treatment in the area of neurology. During this period, opinions were given in 142 cases, the majority of them representing idiopathic diseases (such as strokes, cerebral aneurysms, cerebral infections), followed by falls from high altitudes and traffic road accidents, further followed by fights, medical treatment and work accidents. In sixteen (11.27%) of such cases, the employed medical procedures were found to be incorrect; what might be qualified as medical decisive errors, committed in emergency ambulances or in admission rooms. Incorrect medical treatment consisted in negligence to perform necessary diagnostic examinations. In ten of the analyzed cases, the patients ultimately died.

[Sudden death caused by an oleoresin capsicum spray]. / Zgon po uzyciu aerozolowego miotacza pieprzu.

The report presents rare case of a sudden death of a young man, caused by an oleoresin capsicum spray. In consequence, the victim developed acute laryngeal edema and death by asphyxiation.

[Medico-legal assessment of medical malpractice in ambulance service based on the casework material collected at the Department of Forensic Medicine, Medical University of Bialystok]. / Opiniowanie ssdowo-lekarskie w sprawie bledu medycznego pracowników pogotowia ratunkowego w materiale Zakladu Medycyny Sadowej Akademii Medycznej w Bialymstoku.

INTRODUCTION: Emergency medical personnel is particularly concerned about medical malpractice. The objective of the paper was the analysis of casework material assessed at the Department of Forensic Medicine, Medical University of Bialystok in the years 2001-2006 for medical malpractice by ambulance service staff. MATERIAL AND METHODS: A total of 80 opinions assessing improper treatment and diagnostic procedures and the problem of withdrawal and organizational malfunction was reviewed. RESULTS: Medical malpractice was concluded in 38 (47.5%) cases analysed. In 22 cases malpractice of ambulance staff resulted in patients' demise. Most of cases included improper diagnosis of patient's condition. Predominantly, misdiagnosed cases were related to circulatory, nervous and respiratory malfunctions. Diagnostic errors caused by young and inexperienced medical doctors accounted for most of malpractice in the material analysed. CONCLUSIONS: It is concluded, that medical doctors are inadequately prepared to differential diagnostics of pathologies. Errors caused by ambulance dispatchers included denials of service in life threatening cases.

[Medico-legal assessment in neurosurgical malpractice based on the material collected at the Department of Forensic Medicine, Medical University of Bialystok]. / Opiniowanie sadowo-lekarskie w sprawie bledu lekarskiego z dziedziny neurochirurgii w materiale Zakladu Medycyny Sadowej Akademii Medycznej w Bialymstoku.

INTRODUCTION: Medical malpractice results from inadequate professional knowledge, incompliance to the present state of medical knowledge or negligence and inattention. The aim of the paper was the analysis of diagnostic and therapeutic malpractice based on casework material in the field of neurosurgery. MATERIAL AND METHODS: Medical malpractice cases were assessed according to the number and type in 25 medico-legal opinions issued by the Department of Forensic Medicine, Medical University of Bialystok in years 2001-2006. RESULTS: Majority of cases were craniocerebral injuries related to delayed diagnostics, incorrect treatment including withdrawn or improper surgery. In 5 cases (20%) medical malpractice was concluded. In 2 cases the death of patients was pronounced. In most cases medical malpractice was attributed to lacked or delayed diagnostics and improper technique during spinal surgery. CONCLUSIONS: Relatively limited number of malpractice concluded may support correct knowledge and competence of medical doctors. Maximum attention should be kept during the examination of patients after general trauma, with special consideration of potential intracranial injuries. Diagnostic difficulties result from acute supradural hematomas.

[Medico-legal assessment in neurological malpractice based on casework material collected at the Department of Forensic Medicine, Medical University of Bialystok]. / Opiniowanie sadowo-lekarskie w sprawie bledu lekarskiego z dziedziny neurologii w materiale Zakladu Medycyny Sadowej Akademii Medycznej w Bialymstoku.

Medical malpractice results from inadequate professional knowledge, incompliance to the present state of medical knowledge or negligence and inattention. The aim of the paper was the analysis of medical malpractice cases based on material in the field of neurology. The cases were assessed according to the number and type in 32 medico-legal opinions issued by specialist teams of forensic medicine and neurology in the Department of Forensic Medicine, Medical University of Bialystok in the years 2001-2006. In 11 cases (34%) medical malpractice was concluded with reference to improper treatment after head injury or brain pathology, inadequate care at neurology unit, lacked or delayed diagnostics of head pathology and injury, non-referral to hospital by neurologists. In the material analysed diagnostic errors predominated. Majority of them originated from the open health care system. Incompetence of neurologists with regard to differential diagnostics resulting in misdiagnosis and improper therapy was noted. In one third of the overall cases medical malpractice was concluded. The most common causes included misinterpretation of disease signs and symptoms, misapplication of available diagnostic potential and unjustified delay before commencing diagnostics.

[Medico-legal assessment in civil lawsuit concerning patients with neurological disorders]. / Opiniowanie w postepowaniu cywilnym u osób ze schorzeniami neurologicznymi.

INTRODUCTION: The objective of medico-legal assessment in civil lawsuit involves the assessment of health impairment due to a cause under dispute, evaluation of percentage health impairment, assessment of relationship between the cause and the impairment. The objective of the paper was the analysis of medicolegal opinions ordered by civil departments of courts in Poland involving patients with neurological disorders. MATERIAL AND METHODS: The examination criteria included age, sex, type of accident, type of injury and symptoms reported, causative relationship and ability to work. The study comprised 36 civil opinions issued by the Department of Forensic Medicine, Medical University of Bialystok in the years 2001-2003. RESULTS: State of consciousness was assessed at the moment of making important decisions or signing important documents, ability to work, causative relationship between the accident and symptoms reported. Moreover, suitability of treatment was evaluated. No significant differences regarding sex were found between plaintiffs. Occupationally active persons were predominantly subject to injuries. The most common symptoms reported were headache, vertigos and aching pain in the L-S spine. CONCLUSION: No therapeutic incorrectness was found in cases under analysis. In 7/12 cases health impairment was assessed. In 75% of the opinions no cause-effect relationship was concluded between current disorders and accident at work.

[Changes in autopsy findings related to reanimation procedures--case report]. / Zmiany zwiazane z zabiegami reanimacyjnymi--opis przypadku.

Reanimation procedures may cause changes of autopsy findings. Disregarding this condition may result in erroneous determination of the cause of death. The paper presents a case of a woman, age 77, complaining of general weakness who reported to the outpatient department. Paroxysmal tachycardia was diagnosed on EKG. The patient was referred to the internal ward. The transfer to the hospital was offered by the neighbour who had brought her to the outpatient department. In front of the department the patient fainted. Reanimation was performed by 5 persons, including non-medical staff. The patient's death was pronounced within an hour. The autopsy findings included numerous injuries within the thorax and the abdomen, which aroused suspicion about their origin during reanimation and about the cause of death. Detailed analysis of medical history, witness testimonies and histological findings, taking into account the knowledge about potential changes caused by reanimation procedures enabled correct assessment of injuries within the thorax and the abdomen.

[Cases of suspected pediatric malpractice in casework material collected at the Department of Forensic Medicine, Medical University of Bialystok in the years 2001-2006]. / Opiniowane przypadki podejrzenia popelnienia bledu medycznego w pediatrii w materiale aktowym Zakladu Medycyny Sadowej Akademii Medycznej w Bialymstoku w latach 2001-2006.

The authors analysed medico-legal opinions issued by teams of expert witnesses in the Department of Forensic Medicine, Medical University of Bialystok. In the years 2001-2006 a total of 698 opinions in cases of suspected medical malpractice, including 44 (6.3%) pediatric cases, were issued. The opinions were ordered by police (9.3%) and prosecutors (90.7%). Medical malpractice was suspected in 20% of cases involving emergency procedures, 20% of cases involving family doctor's procedures and about 60% of cases involving hospital procedures. Medical malpractice was concluded in 9 (20.4%) cases, including 4 fatal demises.

[Sole guardian's death as a cause of his handicapped mother's death--a case report]. / Smierc jedynego opiekuna powodem zgonu niepelnosprawnej matki--opis przypadku.

Finding more than one body in the place of residence brings suspicion of poisoning or action of a third party. The authors present a case of two bodies--a handicapped mother and her son--found in their own house. The son was last seen by their neighbours three days before the bodies were revealed. There was a stove in the house which was cold with no signs of penetration. No indication of a third party action was found on the corpses. The autopsy on the son revealed a heart attack with subsequent rupture and tamponade which resulted in death. The cause of the mother's death was assumed to be total starvation of the handicapped person deprived of care. In the presented case autopsy findings contributed to the assessment of the factual cause and sequence of the deaths.