An Unusual Medicolegal Case of 32-Year-Old Mother and Her 29-Week Fetus With Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome: Case Report and Short Literature Review.

Forensic medicine experts are well aware of blunt abdominal trauma, which often lead to death because of serious internal organ injury with severe blood loss. Sometimes careful examination of such cases may reveal some other underlying conditions, such as an existing disease that had contributed to the death or life-threatening complications. Our article presents a rare case of spontaneous hepatic rupture and intraperitoneal hemorrhage in a 32-year-old primigravida and her 29-week fetus, which was a result of hemolysis, elevated liver enzymes, and low platelet count syndrome. The said syndrome is a life-threatening obstetric complication usually considered to be a variant or complication of pre-eclampsia, which is characterized by hemolysis with microangiopathy, elevated liver enzymes, and low platelet count.

[Morphological, microscopic changes in the thyroid gland in the cases of hanging in vertical position with open and closed noose]. / Morfologiczne, mikroskopowe zmiany w tarczycy w przypadkach powieszen w pozycji stojacej w zamknietej i otwartej petli.

The aim of the morphological study was to search for traumatic changes in the thyroid in the cases of hanging in a vertical position with an open and closed noose. These changes would constitute an additional proof of intravital hanging and they would be useful in postmortem diagnosis of the hangings in which other commonly acknowledged features of intravitality are not discovered. In 33% of all cases, petechiae were observed in the thyroid gland. They appeared in 20% of the hangings with the closed noose, and in 13% of the hangings with the use of the open noose. The study showed that there was no difference between the open or closed, hard noose in terms of changes in the thyroid gland. There was also no correlation between the body position and the injury of the thyroid gland. In all the cases, hyperemia of the thyroid was observed and segmental expansion of blood vessels. The histopathological analysis showed that in one third of all the cases with negative macroscopic examination, it was discovered that microscopic changes indicated hanging alive.

[Microscopic diagnosis of pituitary gland damages resulting from cranio-cerebral trauma with the base of the skull fracture]. / Mikroskopowa diagnostyka uszkodzen przysadki u zmarlych w nastepstwie urazu czaszkowo-mózgowego ze zlamaniem podstawy czaszki.

The aim of this research was a macro- and microscopic investigation of pituitary glands in people who died after head injuries with the base of the skull fractures in the sella turcica. No macroscopic changes in the pituitary glands were discovered during an autopsy examinations. Histopathology demonstrated traumatic changes of the pituitary glands in all the cases, which were correlated with sella trurcica fractures. The evolution of traumatic alterations correlated with survival time after the injury. In the pituitary glands of people who died directly after head injuries, hyperemia and focal hemorrhages were discovered. Apart from hyperemia, focal necrosis was found in the pituitary glands among those who survived from 48 to 72 hours after head injury. The examined pituitary glands of those people who lived from 2 to 3 weeks after head injury showed considerable necrotic changes and numerous calcificationss.

[Declaration of death in a living individual--a case report]. / Stwierdzenie zgonu u zywego czlowieka--opis przypadku.

Declaration of death in a human being is a medical diagnosis, which results in numerous legal consequences. The demise of an individual can only be recognized by a doctor on the basis of a conscientious, personally conduced examination. Declaration of death releases a doctor from the obligation to rescue and save the individual's life. In the case of an incorrect death declaration, necessary aid is neglected by omission and the threat to human life is increased. Incorrect declaration of death in a living woman provided the basis for adopting an erroneous, contrary to current medical standards in force, management strategy.

[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.

[Contribution of ethanol in apoptosis induction]. / Udziat etanolu w indukcji procesu apoptozy.

Ethanol is the most common and widespread protoplasmatic poison. The destruction of cells and tissues occurs in both addicted and nonaddicted individuals, who use alcohol occasionally or temporarily. Apoptosis constitutes a very crucial factor in the pathogenesis of acute alcohol poisoning and chronic addiction. Ethanol and its metabolites induce suicidal cell death in crucial internal organs. However, despite extensive research on the role of alcohol and its metabolites in programmed cell death induction, the problem continues to be widely discussed and has no unambiguous explanation. The aim of this study is to present a review of up-to-date literature addressing the inducing influence of alcohol in apoptosis.

[Non-accidental trauma in children. Case report]. / Urazy nieprzypadkowe u dzieci. Opis przypadku.

The aim of this study is to analyze the problem of child abuse. Non-accidental injuries of young children constitute a very important diagnostic issue, which continues to be faced by both clinicians and forensic medicine specialists. This report presents an extremely interesting case of a young boy, in which a very detailed assessment of the files allowed for determining the circumstances of his sustaining injuries.

[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.

[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.

[The analysis of road accident victims aging between 0-18 in the selection material of the our Forensic Department, Medical University of Bialystok between 1997-2006]. / Analiza ofiar wypadków drogowych w wieku 0-18 lat w materiale sekcyjnym Zakladu Medycyny Sadowej Akademii Medycznej w Bialymstoku w latach 1997-2006.

INTRODUCTION: The authors carried out the analysis of autopsy reports of road accident victims, aging between 0-18, exposed to the post mortal studies made in the above mentioned department between 1997-2006. MATERIAL AND METHODS: The number of victims, aging between 0-18 amounts to 2.97% of all autopsies carried out in this period. Among the analysed 84 victims were male, while 41 female. The victims have been divided into age groups: 0-6, 7-10, 11-15 and 16-18. The largest number appeared in the age range 15-18 (78; 47 males and 31 females), the smallest number in the age range 0-6 (15; 10 males and 5 females) and the age range 7-10 (15; 12 males and 3 females). In the age groups 0-6 and 7-10 pedestrians prevail as victims, while 11-15 car passengers are in majority and the same percentage refers to cyclists. Group 16-18 is predominantly dominated by private car drivers and their passengers. RESULTS: In all age groups the direct causes of death were mainly head injuries, the most frequent among pedestrians, cyclists, two wheeled engine vehicle passengers, drivers and private car passengers as well as other victims of not exactly defined road accidents. The most alarming is the high percentage of road users under the influence of alcohol in the range 16-18 amounting to 21.8 % (27.7% of males and 12.9% of females respectively).

[Analysis of suicide causes in the material of Bialystok Forensic Medicine Department in the years 2004-2006]. / Analiza samobíjstw w materiale sekcyjnym Zakladu Medycyny Sadowej Akademii Medycznej w Bialymstoku w latach 2004-2006.

PURPOSE: The object of analysis were suicide cases autopsied in the department in 2004-2006. MATERIAL AND METHODS: Of the 1331 autopsies, 126 were undertaken in suicide victims. This number constituted 9.47% of the total number of autopsies, of those 87.3% were males and 12.7% females. The highest percent rate of suicide was observed among males in the ages of 19-25 year old, among females 19-25 and 31-45. The greatest number of inebriated males was found in ages of 19-25 and 36-40 years old, whereas for females the corresponding age group was 31-35 years. Among the places of suicide predominance of public places was noted. The most common method of committing suicide was by hanging.

[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.

[Medico-legal and victymology aspects of homicides in the material of Bialystok Institute of Forensic Medicine in the years 2004-2006]. / Sadowo-lekarskie i wiktymologiczne aspekty zabójstw na podstawie danych Zakladu Medycyny Sadowej Akademii Medycznej w Bialymstoku w latach 2004-2006.

The authors presented an analysis of homicides based on autopsy material collected at the Institute of Forensic Medicine Medical University of Bialystok in the years 2004-2006. Of 1331 postmortem examinations, this type of death accounted for 4.28% of cases, including 19,3% women and 80.7% men. Married persons predominated among females and men. 63.1% of victims died on the crime scene, 29.8% within 24 hours. In immediate conflicts, fights and robberies, the perpetrators most commonly employed hard, blunt or blunt-edged crime weapons. In cases of murder with sexual and robbery homicides the strangulation method was used. No seasonal character in homicide prevalence was observed.

[Comparative analysis of traffic accident fatalities in autopsy material of 1970-1986 and 1987-2006 collected at the Departament of Forensic Medicine Medical University of Bialystok]. / Analiza porównawcza ofiar wypadków komunikacyjnych w swietle materialu sekcyjnego Zakladu Medycyny Sadowej w Bialymstoku w latach 1970-1986 oraz 1987-2006.

UNLABELLED: INTRODUCTION, MATERIAL AND METHODS: The objective of the paper was a comparative analysis of traffic accident fatalities in autopsy material collected in the years 1970-1986 and 1987-2006 at the Department of Forensic Medicine, Medical University of Bialystok (624 and 1463 cases, respectively). Based on autopsy reports, main criteria included gender, site of death (urban area, rural area, non-built-up), mode of movement (driver, passenger, pedestrian, biker and cyclist), age, localisation of fatal injuries (head, thorax, abdomen and pelvis, upper and lower limbs, multiorgan injuries) and blood alcohol level. The collected data were analysed statistically according to the criteria applied and presented as text and graphs. RESULTS AND CONCLUSIONS: The number of traffic accidents increased by 4% in the years 1987-2006 when compared to period of 1970-1986. The percentage male mortality increased 72-77%. Pedestrians predominated as traffic accident fatalities in Podlasie, with mortality rate slowly decreasing 47-42%. In the years 1987-2006 mortality rate among drivers and bikers/motorbikes increased by 7% and decreased by 3%, respectively. Number of fatalities among passengers remained on constant level. Regardless of time period fatal cases were predominant in non-built-up area. Localisation of fatal injuries in respective groups appears invariable excluding pedestrian cases, where multiorgan rather, than head and neck injuries prevail. Mean age of traffic accident fatalities decreased by 3 years in the period of 1987-2006, predominantly due to the increasing number of fatal cases among young males. Mean blood alcohol level of traffic accident victims in the years 1987-2006 increased by 0.5 promille and 0.2 promille in males and in females, respectively.

[Types and incidence of intravital reactions in cases of suicidal hanging]. / Rodzaj odczynów zazyciowych i czestosc ich wystepowania w przypadku powieszen.

In the years 1980-2000 a total of 302 cases of suicidal hanging were analysed at the Department of Forensic Medicine, Medical University of Bialystok. In 140 cases (46.36%) the knot was situated on the neck. In 131 corpses 206 intravital reactions were revealed. Descending incidence of the reactions was as follows: petechial subcutaneous facial and palpebre hemorrhages (33.5%), hemorrhages of muscules sternocleidomustoideus (18.4%), hemorrhages within ligature furrow (11.6%), vertebral cervical fracture (0.7%). In overall material 71.8% were sober persons presenting intravital reactions of the cervical organs to ligature. During autopsy examination skin sections were excised from ligature furrow, muscules sternocleidomustoideus and the carotid artery and then stained with hematoxilin-eosin, orcein, Fuller staining and alcian blue. The carotid artery sections were examined in scanning electron microscope. Macroscopically revealed intravital reactions were fully confirmable by scanning electron microscopic examination. Furthermore, in cases with negative macroscopic image lesions of the common carotid arteries were detected.

[Medico-legal and victimology aspects of homicides in the material of Bialystok Institute of Forensic Medicine in the years 1982-2003]. / Sadowo-lekarskie i wiktymologiczne aspekty zabójstw na podstawie danych zakladu medycyny sadowej AM w bialymstoku.

The authors presented an analysis of homicides based on autopsy material collected at Institute of Forensic Medicine in Bialystok in the years 1982-2003. Of 8,780 postmortem examinations, this type of death accounted for 7,4 % of cases, including 31,2 % women and 68,8 % men. Married individuals predominated among females, whereas the majority of male victims were single. Fifty-seven percent of victims died on the crime scene, 5,3 % within 48 hours. In conflicts of long-standing, immediate conflicts and fights, the perpetrators most commonly employed hard, blunt or blunt-edged crime weapons. In cases of murder with robbery and sexual homicides, strangulation was the most frequently used method. No seasonal character in homicide prevalence was observed.

[Analysis of suicide in the material of the Department of Forensic Medicine, Medical University of Bialystok in the years 1990-2003]. / Analiza samobójstw w materiale sekcyjnym Zakladu Medycyny Sadowej AMB w latach 1990-2003.

The object of analysis were suicide cases autopsied in the department in 1990-2003. Of 5532 autopsies, 518 were undertaken in suicide victims. This number constituted 9.36% of the total number of autopsies, of these 81% were males and 19% females. The ratio of males to females was 4.4. The highest per cent suicide rate was noted in 1993 (54), 1995 (48), 1999 (45) and 2003 (44); the lowest rate was observed in 2001 (26). The highest per cent rate of suicide was observed among males in the ages 19-25 and 41-45 year old, among females 36-40 and 41-50. The greatest number of inebriate males was found in age groups 41-45 and 19-25 years, whereas for females, the corresponding age group was 31-35 years. Among the victims of suicide a predominance of married people and manual workers was noted. The most common method of committing suicide was by hanging.

[50th anniversary of the Department of Forensic Medicine, Medical University of Bialystok (1954-2004)]. / 50-lecie Zakladu Medycyny Sadowej Akademii Medycznej w Bialymstoku (1954-2004).

The paper illustrates the history, scientific and teaching achievements of the Department of Forensic Medicine, Medical University of Bialystok in commemoration of its 50th Anniversary.