Fake gunshot wounds in the skull-post-mortem artifact caused by steel probe during police search for a missing body.

The paper presents a case of a forensic autopsy of a young woman who was murdered and her dismembered body was hidden in soil and water. In the skull of the deceased, in the temporal and occipital regions, the autopsy revealed 3 round, almost identical holes, which looked like small caliber gunshot wounds. Doubts about the cause of these injuries were raised by the fact that despite the decomposition of the body, the continuity of the dura at the site of these holes remained undamaged and the absence of any trace of a bullet's wound track in the brain, the absence of a foreign body in the cranial cavity, as well as the absence of wounds on the opposite side of the skull that could be exit wounds. A thorough analysis of the investigation and the activities carried out during the search for the missing body allowed to adopt and finally confirm the hypothesis that the above mentioned skull damage occurred during the search for the cut-off head of the deceased in shallow water by means of special tapered conical steel probes used by the rescue/search teams. Due to the structure of such a spike, i.e., a sharp end and then a wide cone, only a superficial puncture of the steel probe tip three times into the skull had taken place, which caused regular, rounded bone damage without damaging the dura and brain. The presented case indicates that sometimes post-mortem artifacts may suggest a completely different origin of wounds, which emphasizes the need for a comprehensive analysis of all possible causes of their occurrence, particularly data concerning the handling of the corpse before it is delivered to the morgue, so as not to make a diagnostic error during autopsy.

Reduced ribosomal DNA transcription in the prefrontal cortex of suicide victims: consistence of new molecular RT-qPCR findings with previous morphometric data from AgNOR-stained pyramidal neurons.

Prefrontal cortical regions play a key role in behavioural regulation, which is profoundly disturbed in suicide. The study was carried out on frozen cortical samples from the anterior cingulate cortex (dorsal and ventral parts, ACd and ACv), the orbitofrontal cortex (OFC), and the dorsolateral cortex (DLC) obtained from 20 suicide completers (predominantly violent) with unknown psychiatric diagnosis and 21 non-suicidal controls. The relative level of ribosomal RNA (rRNA) as a marker of the transcriptional activity of ribosomal DNA (rDNA) was evaluated bilaterally in prefrontal regions mentioned above (i.e. in eight regions of interest, ROIs) by reverse transcription and quantitative polymerase chain reaction (RT-qPCR). The overall statistical analysis revealed a decrease in rDNA activity in suicide victims versus controls, particularly in male subjects. Further ROI-specific post hoc analyses revealed a significant decrease in this activity in suicides compared to non-suicides in five ROIs. This effect was accentuated in the ACv, where it was observed bilaterally. Our findings suggest that decreased rDNA transcription in the prefrontal cortex plays an important role in suicide pathogenesis and corresponds with our previous morphometric analyses of AgNOR-stained neurons.

Ribosomal DNA transcription in prefrontal pyramidal neurons is decreased in suicide.

Prefrontal cortical regions, which are crucial for the regulation of emotionally influenced behaviour, play most probably a dominant role in the pathogenesis of suicide. The study was carried out on paraffin-embedded brain tissue blocks containing specimens from the anterior cingulate cortex (dorsal and ventral parts), the orbitofrontal cortex, and the dorsolateral cortex obtained from 23 suicide completers (predominantly violent) with unknown psychiatric diagnosis and 25 non-suicidal controls. The transcriptional activity of ribosomal DNA (rDNA) as a surrogate marker of protein biosynthesis was evaluated separately in layers III and V pyramidal neurons in regions of interest (ROIs) mentioned above by the AgNOR silver staining method bilaterally. The overall statistical analysis revealed a decrease of AgNOR area suggestive of attenuated rDNA activity in suicide victims versus controls, particularly in male subjects. Further ROI-specific post-hoc analyses revealed decreases of the median AgNOR area in suicides compared to non-suicides in all 16 ROIs. However, this effect was only significant in the layer V pyramidal neurons of the right ventral anterior cingulate cortex. Our findings suggest that decreased rDNA transcription in prefrontal pyramidal neurons plays possibly an important role in suicide pathogenesis.

Microglia in the dorsal raphe nucleus plays a potential role in both suicide facilitation and prevention in affective disorders.

An involvement of the central serotonergic system has constantly been reported in the pathogenesis of suicide. The dorsal raphe nucleus (DRN) is the main source of serotonergic innervation of forebrain limbic structures disturbed in suicidal behaviour, in which an abnormal microglia reaction seems to play a role. In our present study, the density of microglia immunostained for the HLA-DR antigen was evaluated in the DRN. These analyses were carried out on paraffin-embedded brains from 24 suicidal and 21 non-suicidal patients; among them, 27 depressed (15 major depressive disorder and 12 bipolar disorder) and 18 schizophrenia (9 residual and 9 paranoid) patients and 22 matched controls without mental disorders. Only the non-suicidal depressed subgroup revealed significantly lower microglial reaction, i.e., a decreased density of HLA-DR positive microglia versus both depressed suicide victims and controls. The effect was not related to antidepressant or antipsychotic medication, as the former correlated positively with microglial density in non-suicidal depressed patients, and the latter had no effect. Moreover, the comparison of these results with previously published data from our workgroup in the same cohort (Krzyzanowska et al. in Psychiatry Res 241:43-46, 4) suggested a positive impact of microglia on ribosomal DNA transcription in DRN neurons in the non-suicidal depressed subgroup, but not in depressed suicidal cases. Therefore, the interaction between microglia and neurons in the DRN may be potentially involved in opposite ways regarding suicide facilitation and prevention in the tested subgroups of depressed patients.

Decreased ribosomal DNA transcription in dorsal raphe nucleus neurons differentiates between suicidal and non-suicidal death.

An involvement of the central serotonergic system has been implicated in the pathogenesis of suicide. The dorsal raphe nucleus (DRN) is the main source of serotonergic innervation of forebrain limbic structures disturbed in suicidal behaviour. The study was carried out on paraffin-embedded brainstem blocks containing the DRN obtained from 27 suicide completers (predominantly violent) with unknown psychiatric diagnosis and 30 non-suicidal controls. The transcriptional activity of ribosomal DNA (rDNA) in DRN neurons as a surrogate marker of protein biosynthesis was evaluated by the AgNOR silver staining method. Significant decreases in AgNOR parameters suggestive of attenuated rDNA activity were found in the cumulative analysis of all DRN subnuclei in suicide victims versus controls (U test P values < 0.00001). Our findings suggest that the decreased activity of rDNA transcription in DRN neurons plays an important role in suicide pathogenesis. The method accuracy represented by the area under receiver operating characteristic curve (>80 %) suggests a diagnostic value of the observed effect. However, the possible application of the method in forensic differentiation diagnostics between suicidal and non-suicidal death needs further research.

Volumetric analysis of the diagonal band of Broca in patients with schizophrenia and affective disorders: A post-mortem study.

The human diagonal band of Broca is connected to other parts of the limbic system, such as the hippocampus, that are involved in the pathology of schizophrenia. This study aimed to characterize the volume and anterior-to-posterior distance of the human diagonal band of Broca (vertical limb) from post-mortem brains obtained from three groups: healthy control subjects (N = 17), patients with schizophrenia (N = 26), and patients with affective disorders (N = 12). There were no significant differences in the volume or anterior-to-posterior distance in the patients with schizophrenia or affective disorders compared with the healthy control subjects. To date, this is the first post-mortem investigation measuring the volume and the anterior-to-posterior distance of the diagonal band of Broca (vertical limb) in patients with schizophrenia or affective disorders compared with healthy control subjects.

Histopathological changes in lungs of the mountain snow avalanche victims and its potential usefulness in determination of cause and mechanism of death

On 28 January 2003 snow avalanche in the Polish Tatras happened, in which 8 people died and 5 were injured. We tried to determine cause and manner of death in 6 fatal victims instead of advanced late post mortem changes in internal organs. Taking into consideration the circumstances of death, we paid special attention to histopathological examination of lungs, extended by Gomori's and AZAN staining. Pattern of the changes was similar to those observed in forensic medicine in cases of asphyxia due to airway obstruction and/or immobilization of chest and abdomen (Perthes' syndrome). Histopathological study with the use of more specific staining methods has a significant diagnostic value during establishing the cause and mechanism of death of the deceased snow avalanche victims with advanced post mortem changes.

Traumatic basal subarachnoid haemorrhage or ruptured brain aneurysm in 16-year-old boy? - case report

Traumatic basal subarachnoid haemorrhage (TBSAH) represents only 1.8% of all subarachnoid haemorrhage cases diagnosed during autopsy. This report presents such a case from the current practice of the authors. Sixteen-year-old boy was beaten by the aggressors. Suddenly he lost his consciousness and fall after he received a single blow in the neck. He was resuscitated immediately, but died at the scene. During the external examination we did not find any significant external injuries. Autopsy revealed large contusion of right sternocleidomastoid muscle. In the cranial cavity we found extensive subarachnoid haemorrhage, located mainly on brain basis, in the posterior cranial fossa and covering the subtentorial structures. During the preparation of blood vessels we noticed a slight change of morphology suggesting damaged vessel or aneurysm, or vascular malformation located in the basilar artery bifurcation, which was taken to detailed microscopic evaluation using the special stainings. Histological examination showed vital interruption of the basilar artery wall with massive haemorrhage, without the presence of general microscopic pathology. From the medico-legal viewpoint, to determine traumatic background of haemorrhage it is necessary to find the coexistence of the following circumstances: a sustained trauma, post-mortem findings consistent with a time of injury, the presence of temporal relationship between injury and death, and morphological vital injury of the brain vessel, as well as the absence of prior vascular malformations. For this purpose Verhoeff-van Gieson's, Masson's, Turnbull's and Gomori' histological stainings may be successfully used.

Concurrent DNA Copy-Number Alterations and Mutations in Genes Related to Maintenance of Genome Stability in Uninvolved Mammary Glandular Tissue from Breast Cancer Patients.

Somatic mosaicism for DNA copy-number alterations (SMC-CNAs) is defined as gain or loss of chromosomal segments in somatic cells within a single organism. As cells harboring SMC-CNAs can undergo clonal expansion, it has been proposed that SMC-CNAs may contribute to the predisposition of these cells to genetic disease including cancer. Herein, the gross genomic alterations (>500 kbp) were characterized in uninvolved mammary glandular tissue from 59 breast cancer patients and matched samples of primary tumors and lymph node metastases. Array-based comparative genomic hybridization showed 10% (6/59) of patients harbored one to 359 large SMC-CNAs (mean: 1,328 kbp; median: 961 kbp) in a substantial portion of glandular tissue cells, distal from the primary tumor site. SMC-CNAs were partially recurrent in tumors, albeit with considerable contribution of stochastic SMC-CNAs indicating genomic destabilization. Targeted resequencing of 301 known predisposition and somatic driver loci revealed mutations and rare variants in genes related to maintenance of genomic integrity: BRCA1 (p.Gln1756Profs*74, p.Arg504Cys), BRCA2 (p.Asn3124Ile), NCOR1 (p.Pro1570Glnfs*45), PALB2 (p.Ser500Pro), and TP53 (p.Arg306*). Co-occurrence of gross SMC-CNAs along with point mutations or rare variants in genes responsible for safeguarding genomic integrity highlights the temporal and spatial neoplastic potential of uninvolved glandular tissue in breast cancer patients.

Ribosomal DNA transcription in the dorsal raphe nucleus is increased in residual but not in paranoid schizophrenia.

The central serotonergic system is implicated in the pathogenesis of schizophrenia, where the imbalance between dopamine, serotonin and glutamate plays a key pathophysiological role. The dorsal raphe nucleus (DRN) is the main source of serotonergic innervation of forebrain limbic structures disturbed in schizophrenia patients. The study was carried out on paraffin-embedded brains from 17 (8 paranoid and 9 residual) schizophrenia patients and 28 matched controls without mental disorders. The transcriptional activity of ribosomal DNA (rDNA) in DRN neurons was evaluated by the AgNOR silver-staining method. An increased rDNA transcriptional activity was found in schizophrenia patients in the cumulative analysis of all DRN subnuclei (t test, P = 0.02). Further subgroup analysis revealed that it was an effect specific for residual schizophrenia versus paranoid schizophrenia or control groups (ANOVA, P = 0.002). This effect was confounded neither by suicide nor by antipsychotic medication. Our findings suggest that increased activity of rDNA in DRN neurons is a distinct phenomenon in schizophrenia, particularly in residual patients. An activation of the rDNA transcription in DRN neurons may represent a compensatory mechanism to overcome the previously described prefrontal serotonergic hypofunction in this diagnostic subgroup.

Expression of TNF-α, OPG, IL-1ß and the presence of the measles virus RNA in the stapes of the patients with otosclerosis.

Persistent measles virus infections play a crucial role in the pathomechanism of otosclerosis. The study was undertaken to investigate the role of tumor necrosis factor-α (TNF-α), interleukin 1ß (IL-1ß) and osteoprotegerin (OPG) in otosclerotic bone remodeling and to assess the relation of TNF-α, OPG and IL-1ß expression levels in otosclerotic stape footplates to the occurrence of measles virus infection. 61 patients with otosclerosis were treated surgically. Thirty-one stapes obtained from cadavers of people, who had died from a sudden cause were used as a control group. The presence of measles virus RNA and the expression levels of TNF-α, IL-1ß and OPG in otosclerotic foci were assessed using one-step RT-PCR. The presence of measles virus RNA was noted in 80.3 % of otosclerotic stapes (49 out of 61) and 9.7 % of normal tissues (3 out of 31). Transcript of TNF-α, IL-1ß and OPG was detected in 40, 46 and 18 virus-positive stapes, respectively. The transcript level of TNF-α and IL-1ß was significantly higher in otosclerotic tissues comparing to normal tissue. The OPG expression level was significantly lower in otosclerotic tissues comparing to controls. The presence of measles virus RNA in the stapes may indicate its role in the pathogenesis of otosclerosis. The presence of TNF-α and IL-1ß mRNA in the virus-positive stapes could be the result of viral antigen stimulation and may be a marker of inflammation the otosclerotic focus. The lack of OPG mRNA and the presence of TNF-α and IL-1ß mRNA in the majority of otosclerotic tissues reflect the bone remodeling process occurring in the stapes.

[Intoxication of female patient with generalised cancer in hospital--a case report]. / Zatrucie pacjentki z uogólniona choroba nowotworowa w szpitalu--opis przypadku.

Medical errors are crucial factors influencing hospital mortality. We present a case of 79-year-old female, who was admitted to the hospital due to complications associated with advanced cancer disease. After several days of hospitalization, the woman died as a result of cancer as well as severe drugs intoxication. The investigation showed extremely high concentrations of chlorprothixen and tramadol in the. blood of the patient. This paper describes a number of medical errors made by hospital staff, of which the most significant was an inappropriate drugs policy.

Direct penetrating and indirect neck trauma as a cause of internal carotid artery thrombosis and secondary ischemic stroke.

The following manuscript presents two cases of ischemic stroke secondary to traumatic internal carotid artery thrombosis with concomitant middle cerebral artery thrombosis occurring very rarely in the medico-legal practice. Penetrating neck trauma due to an occupational accident and multiple head and neck trauma secondary to battery were described. The autopsy and histopathological examination as well as the analysis of available medical records, including radiological examinations, and records of investigation indicated the sustained trauma to be the cause of the thrombosis.

A unique case of malignant neoplasm--choriocarcinoma in a 24-year-old man--difficulties in differential diagnostics of intracranial injuries in the aspect of medicolegal opinion / Niezwykle rzadki przypadek nowotworu zlosliwego--kosmówczaka u 24-letniego mezczyzny--trudnosci w diagnostyce róznicowej uszkodzen sródczaszkowych w aspekcie opiniowania sadowo-lekarskiego.

Differential diagnostics of pathologic and traumatic lesions based on image techniques may in some cases cause serious difficulties or even be the cause of a medical error resulting in incorrect medicolegal opinion. The authors present a unique case of primary malignant neoplasm of the testicle (choriocarcinoma) in a 24-year-old man. Several days after the event, he was admitted to Department of Neurology with CT-confirmed traumatic intracerebral hematoma communicating with the ventricular system. Discharged in a good general condition, the patient died several days later. A postmortem examination combined with histopathology demonstrated numerous metastases of the primary carcinoma, which also involved the brain, arousing suspicions of head injury in consequence of a crime.

Differences between unipolar and bipolar I depression in the quantitative analysis of glutamic acid decarboxylase-immunoreactive neuropil.

Alterations in GABAergic neurotransmission are assumed to play a crucial role in the pathophysiology of mood disorders. Glutamic acid decarboxylase (GAD) is the key enzyme in GABA synthesis. This study aimed to differentiate between unipolar and bipolar I depression using quantitative evaluation of GAD-immunoreactive (GAD-ir) neuropil in several brain regions known to be involved in the pathophysiology of mood disorders. Immunohistochemical staining of GAD 65/67 was performed in the orbitofrontal, anterior cingulate and dorsolateral prefrontal cortex (DLPFC), the entorhinal cortex, the hippocampal formation and the medial dorsal and lateral dorsal (LD) thalamic nuclei, with a quantitative densitometric analysis of GAD-ir neuropil. The study was performed on paraffin-embedded brains from 9 unipolar and 12 bipolar I depressed patients (8 and 6 suicidal patients, respectively) and 18 matched controls. In unipolar patients, compared with controls, only the increased relative density of GAD-ir neuropil in the right LD was different from the previous results in depressed suicides from the same cohort (Gos et al. in J Affect Disord 113:45-55, 2009). On the other hand, the left DLPFC was the only area where a significant decrease was observed, specific for bipolar I depression. Significant differences between both diagnostic groups were found in these regions. By revealing abnormalities in the relative density of GAD-ir neuropil in brain structures, our study suggests a diathesis of the GABAergic system in mood disorders, which may differentiate the pathophysiology of unipolar from that of bipolar I depression.

[Estimation of the usage of psychoactive substances in academic campus based on analysis of municipal waste water]. / Oszacowanie stosowania srodków odurzajacych w kampusie akademickim na podstawie wyników analizy chemicznej scieków komunalnych.

Important source of objective information about the nature and the scale of the usage of psychoactive substances becomes test of municipal waste water or surface water. From the analytical chemistry point of view municipal waste water are a complex mixture of substances therefore the authoritative analysis requires careful planning of both the place of sampling and the use of effective methods of research. The aim of this work was the attempt to estimate the scale of the usage of narcotic drugs in the academic campus Kortowo in Olsztyn during the students May holidays "Kortowiady". The positive results of the concentration of 11 -nor-9-carboxy-delta9-tetrahydrocannabinol (THC-COOH) and amphetamines in the samples of effluent shall indicate the need to continue research in this field and improvement methods for the determination of narcotic drugs.

[Suicidal intoxication with sodium azide--a case report]. / Smiertelne samobójcze zatrucie azydkiem sodu--opis przypadku.

Sodium azide (NaN3) is an inorganic matrix compound with a very high toxicity. Mechanism of action is not clarified, and it is assumed to interfere with the processes of oxidative phosphorylation. The acute intoxications with sodium azide are extremely rare. We described a case of 19-year-old man who was found dead. In the course of prosecution the empty container, with label "NaN3, 20 g", was found near the body. There were traces of white powder detected in the container. Azide ions were determined by derivatization, i.e. they were transformed to pentafluorobenzaldehyde azide compound. Analysis of the final extract after derivatization was performed by gas chromatography coupled with mass spectrometry GC/MS. The largest concentration of azide ions were determined in the stomach content and vitreous humour, and much less one in whole blood, urine and kidney fluid.

[Suicide and depression in the postmortem evaluation of disturbed neuronal activity]. / Samobójstwo a depresja w swietle posmiertnej oceny zaburzen aktywnosci neuronalnej.

The authors have reviewed the results of their postmortem neurohistological investigations related to the evaluation of impaired activity of brain structures relevant to pathophysiology of depression. Chronic changes in ribosomal DNA transcriptional activity have been indirectly suggested by the AgNOR staining method in neurons of the prefrontal limbic regions, the amygdala, the external globus pallidus, and the serotonergic dorsal raphe nucleus. The impact of processes leading to suicide has been clearly accentuated in contrast to the weak influence of unipolar-bipolar dichotomy. The present results support the view that suicide and depression constitute pathological phenomena with partially different neurobiology. They may be also relevant to forensic pathology.

[A case of fatal lightning stroke at an unusual site--the city center]. / Przypadek smiertelnego razenia piorunem w nietypowym miejscu--centrum miasta.

A case of a fatal lighting stroke involving a young man staying in a storm near the center of a big city is presented. The atypical character of this case lies in the fact that the lightning stroke usually occurs in open areas (mountains, fields, meadows), or involves people trying to find shelter from the storm under a tree or an isolated object in an open area. In the described case, a contributory factor to the lightning stroke was the fact that during the storm, the man was most probably standing on metal heating pipes, built in the 70's and 80's, long stretches of which were erected high above the ground. Metal used in the construction of the pipes most probably attracted lightning and generated the current which electrocuted the man standing on their surface.

[The phenomenon of hyperostosis frontalis interna--state of the art knowledge]. / Fenomen hyperostosis frontalis interna--aktualny stan wiedzy.

Hyperostosis frontalis interna (HFI) is an interesting but still a poor-known phenomenon, which may be found post-mortem. The authors have presented views on the aetiology, pathogenesis and symptomatology of HFI. The usefulness of this abnormality in the identification of sex and age has been pointed out.