Hyperbaric oxygen treatment in recurrent development of complex regional pain syndrome: A case report.

A broad spectrum of conditions including neuropathic pain, complex regional pain syndrome (CRPS) and fibromyalgia, have been implicated as causes of chronic pain. There is a need for new and effective treatments that patients can tolerate without significant adverse effects. One potential intervention is hyperbaric oxygen treatment (HBOT). The case reported here is unique in describing repeated HBOT in a patient who developed recurrent post-traumatic CRPS of the lower as well as the upper limbs. In the first event, two months after distortion and abruption of the external right ankle, the patient suffered leg pain, oedema formation, mild hyperaemia, limited mobility of the ankle and CRPS Type 1. In the second event, the same patient suffered fracture-dislocation of the distal radius 1.5 years after the first injury. After the plaster cast was removed the patient developed pain, warmth, colour changes, oedema formation and limited wrist mobility with CRPS Type 1. Pharmacological treatment as well as HBOT were used with significant improvement of functional outcome in both cases. Some studies suggest that patients with a history of CRPS are more likely to develop secondary CRPS compared to the rates reported in the literature among the general population. Patients with a history of CRPS should be counselled that they may be at risk for developing secondary CRPS if they undergo surgery or sustain trauma to another extremity.

Suicidal electrocution: a report of three unusual cases.

Electricity is a modern technology that can be used as method of suicide. Authors presents three cases of suicidal electrocution. The first case is a 55-year-old man who wrapped his chest and arms with electrically active wires connected to a timer. In second case, a 69-year-old man constructed electric mechanism from a disassembled extension cord. The last case describes a 53-year-old woman who was found dead in a water-filled bathtub.

Autoerotic deaths: report of two unusual cases.

Autoerotic death is a rare but recurring phenomenon in forensic medicine. This article presents two cases of unusual autoerotic death with signs of autoerotic asphyxia. Although the first case appeared to be asphyxia, the autopsy confirmed natural cause of death during solitary sexual activity of 69-year-old man found with exposed and bandaged genitals. The other case was asphyxiation utilizing a plastic bag and multiple panties wrapped around the head of 18-year-old man disguised in women´s dress.

Wheelchair-Assisted Ligature Strangulation: An Unusual Suicide by a Quadriparetic.

Multiple sclerosis, currently incurable and potentially profoundly disabling demyelinating central nervous system disease, is associated with higher occurrence of suicide as affected individuals are prone to major depression and psychosis. Despite progressively incapacitating neurologic impairment, well-staffed institutions, and limited repertoire of methods of suicide, which prevents patients from purposefully ending their lives, suicide-determined patients typically commit suicide resulting from a medication overdose, sharp force traumata, self-neglect, or deliberate starvation. Here we describe a successful suicide committed by a 39-year-old wheelchair-bound, institutionalized, quadriparetic male patient with a diagnosis of multiple sclerosis with secondary progressive clinical course who utilized his motorized wheelchair to terminate his life. He tied a rope between his neck and wall bars and then propelled the wheelchair forwardly. The acceleration of the wheelchair resulted in ligature self-strangulation. This case report, with a review of the literature, is noteworthy for the rareness of the wheelchair-related fatality combined with an unusual, if not entirely unseen, suicidal mechanism in severely disabled adult.

[Applicability of non-invasive imaging methods in forensic medicine and forensic anthropology in particular]. / Moznosti praktického vyuzitia neinvazívnych zobrazovacích metód vo forenznej medicíne so zameraním na forenznú antropológiu.

Massive progress in developing even more precise imaging modalities influenced all medical branches including the forensic medicine. In forensic anthropology, an inevitable part of forensic medicine itself, the use of all imaging modalities becomes even more important. Despite of acquiring more accurate informations about the deceased, all of them can be used in the process of identification and/or age estimation. X - ray imaging is most commonly used in detecting foreign bodies or various pathological changes of the deceased. Computed tomography, on the other hand, can be very helpful in the process of identification, whereas outcomes of this examination can be used for virtual reconstruction of living objects. Magnetic resonance imaging offers new opportunities in detecting cardiovascular pathological processes or develompental anomalies. Ultrasonography provides promising results in age estimation of living subjects without excessive doses of radiation. Processing the latest information sources available, authors introduce the application examples of X - ray imaging, computed tomography, magnetic resonance imaging and ultrasonography in everyday forensic medicine routine, with particular focusing on forensic anthropology.

Strangulation of the heart presenting as sudden cardiac death: A deadly but forgotten complication of epicardial pacing device.

Strangulation of the heart appears to be an exceedingly rare mechanical phenomenon that can develop with epicardial pacing wires in individuals undergoing somatic growth. Over the passage of time, owing to size mismatch between a fixed wire length and dynamically growing heart, the epicardial wire may embed around the heart resulting in the progressive over-pressurizing of involved cardiac structures. Depending on the location of the peak constriction pressures, cardiac strangulation may damagingly affect coronary circulation, heart valves function, or physiologic filling of the heart chambers, with risk of myocardial ischemia, decreased cardiac output, acute cardiac failure, ventricular arrhythmias and death. We report a case of a 29-year-old male with sudden cardiac death owing to cardiac strangulation with epicardial pacing wire that had been retained in place almost 30 years. At autopsy, an enlarged and abnormally contoured heart was found to be strangulated by an epicardial pacing wire; histopathologic examination confirmed hypertrophy of the myocardial fibers, myofiber disarrangement, and replacement-type fibrolipomatosis. In addition, this article consolidates the available literature on cardiac strangulation by an epicardial wire and highlight relevant clinical and medico-legal features for the forensic professionals.

Vomiting and aspiration of gastric contents: a possible life-threatening combination in underwater diving.

Vomiting and aspiration of gastric contents into the airways and lungs is a common and well-known clinicopathological entity. This phenomenon might also occur in underwater diving, where it can lead to life-threatening or fatal situations. This article presents two incidents involving diving-related vomiting with associated aspiration of gastric contents. One case, a 39-year-old commercial diver using a full-face diving mask, was fatal and the other was a 33-year-old, female recreational scuba diver in whom underwater vomiting was complicated by pulmonary aspiration of a solid foreign body (a peanut) into the right lower lobe bronchus. The peanut was successfully removed and, following bronchoscopic pulmonary lavage, the patient made an uneventful recovery. The causes and consequences of nausea and vomiting within the underwater environment are discussed and possible interpretative problems are highlighted.

Circular saw-related fatalities: A rare case report, review of the literature, and forensic implications.

Fatalities attributed to powered circular saws appear to be vanishingly rare events with highly wounding and rapidly incapacitating effects. When they do occur, they are mainly self-inflicted in nature. We report the suicide committed by a 79-year-old man using a self-made circular table saw. Autopsy confirmed that the man received multiple heterogeneously distributed saw-type impacts to the head and neck resulting in complete amputation of the upper skull and partial beheading. Homemade or modified commercial sawing instruments and the resultant injuries pose a number of forensic challenges starting from the death scene investigation, continuing with technical examinations, and concluding with determining the manner of death. As with all deaths due to sharp force injuries, fatalities involving power tools such as chainsaws, circular, and band saws warrant a high degree of suspicion of criminal activity and require diligence during all phases of the death investigation.

[Alcohol congeners and their implications for medicolegal assessment of drunkeness]. / Pribudliny v alkoholických nápojoch a ich význam pre súdnolekárske posudzovanie opitosti.

UNLABELLED: Ethanol is the main psychoactive ingredient of alcoholic beverages. Together with water it makes their major part. The other substances contained in alcoholic beverages are called congeners. Some of them come from the original substance of the beverage, some come from the fermentation or mellowing process. Except giving the drink its specific taste, scent and colour, congeners also have a non-negligible direct influence on the alcohol consumer. Nowadays, methods of identification thousands of alcohol congeners are available. Analyzing chemical compounds of alcoholic beverages have only recently gained its importance, when it helped to estimate the basic chemical composition of the particular alcoholic beverages. Mentioned method is able to identify an exact type of alcoholic beverage which a man consumed before the blood sample necessary for the detection had been taken from him. It becomes irreplaceable especially in forensic assessment of the drunkenness in case an alcoholised person, responsible for any crime, excuses himself that he was drinking only after the act/crime (e.g. traffic accident) had happened. It can also help to aprove/disprove a testimony of an accused person that he/she was unaware of being given alcohol into his/her non-alcoholic beverage. Development of the new chemical methods analyzing alcohol congeners are of a great benefit for any forensic expert-medical doctor dealing with the field of forensic alcohology. However, he/she must be aware that interaction of alcohol congeners with the human organism follows different laws in comparison to alcohol/ethanol itself. KEYWORDS: alcohol - congener - alcohol congener analysis - forensic alcohology.

Feasibility, diagnostic validity and limits of postmortem evaluation of a newborn infant following an extremely prolonged freezing interval: a thanatological case study.

In forensic assessment, denial and concealment of pregnancy has wide-ranging implications including criminal abortions, extramural deliveries, concealment of birth, newborn infant abandonment or even neonaticide. Clarification of whether a newborn was born alive is the most important factor when evaluating an abandoned neonate or concealment of birth. Other points that need to be addressed are determination of viability and maturity of the newborn infant, and the identity of the mother. A prolonged postmortem interval following illegal disposal of a dead body often leads to advanced decomposition, making postmortem elucidation difficult. We report an exceptionally uncommon autopsy case of a well-preserved female newborn, which was accidentally found after eight years in a home freezer. Despite the prolonged postmortem interval, tissue preservation was sufficient for a meaningful autopsy including a comprehensive histopathological study. The purpose of the present investigations was to expand our understanding of thanatological processes, as well as detectability of particular histological findings on the remains of a newborn after extremely prolonged storage in an artificially frozen environment. In addition, this article discusses forensically important issues regarding concealment of newborn infant under specific conditions.

Non-traumatic and spontaneous hemothorax in the setting of forensic medical examination: a systematic literature survey.

Spontaneous hemothorax is a well-known yet seldom-reported entity in forensic literature. While trauma-related hemothorax is frequently encountered in a medicolegal setting, non-traumatic and spontaneous hemothorax are relatively uncommon entities. The wide range of causes that can trigger fatal intrathoracic bleeding include thoracic aortic dissection, followed by vascular malformations, various oncological diseases, and connective tissue abnormalities. In rare instances, extramedullary hematopoiesis, ectopic pregnancy, congenital heart defects, amyloidosis, or parasitic diseases may constitute a source of bleeding. This etiological heterogeneity may, as a result, cause diagnostic difficulties during post-mortem elucidation of hemothorax. It should be borne in mind that hemothorax after low-energy trauma does not exclusively indicate traumatic hemorrhage, hence, the non-traumatic origin of bleeding must be taken into consideration. In this paper, we present a systematic review of the relevant literature enriched by the results of our observations to investigate the etiologies and recommendations for the post-mortem diagnosis of spontaneous hemothorax in an attempt to better delineate the possible medicolegal considerations. It is important that forensic pathologist as well as clinicians are aware of the diseases that could potentially give rise to fatal hemothorax.

Suicidal nitrogen inhalation by use of scuba full-face diving mask.

A 29-year-old man was found dead lying on the bed in a hotel room in a famous Slovak mountain resort. He had a full-face diving mask on his face, connected through a diving breath regulator to a valve of an industrial (nondiving) high-pressure tank containing pure 100% nitrogen. The breath regulator (open-circuit type) used allowed inhalation of nitrogen without addition of open air, and the full-face diving mask assured aspiration of the gas even during the time of unconsciousness. At autopsy, we found the typical signs of suffocation. Toxicological analysis revealed 94.7% content of nitrogen in alveolar air. Following the completion of the police investigation, the manner of death was classified as a suicide. Within the medico-legal literature, there has been only one similar case of suicidal nitrogen inhalation described.

Gender differences in alcohol affection on an individual.

UNLABELLED: It is a well-known fact that after drinking the same amount of alcohol, women show more signs of the effects of alcohol than men of the same weight. It seems that the main factors responsible for sex differences in alcohol metabolism and influence are the relatively lower amount of body water related to body fat in women than men and lower gastric ADH activity in women, both of which enable women to reach higher BAC after drinking equivalent amounts of alcohol with men. On the other hand, first-pass metabolism of alcohol during passing through the liver is more rapid in women, probably due to bigger liver mass in women than in men. It is proven that alcohol and sex hormones have bilateral influence on each other. Women with more rapid alcohol elimination ability show higher levels of sex hormones in blood than the rest. It seems that the specific body constitution of the female organism as well as the unique combination of their sex hormones is responsible for the gender differences in alcohol influence. KEYWORDS: alcohol metabolism - gender differences - gastric ADH - blood alcohol concentration.

Snow groomer vehicle-related fatality: an illustrative case study of the importance of medicolegal involvement.

This article describes and discusses an unusual case of an accidental death of a 29-year-old female snowboarder. A snow-grooming vehicle had run over her body after she accidentally fell down during a training ride. According to the official statement, the victim was probably under the influence of alcohol or drugs, and the snowboarder caused the accident because she did not respect the safety restrictions and collided with the snow vehicle. However, forensic pathologists offered different conclusions to the police to place the responsibility of the accident by observing the characteristics of the injuries and analyzing the autopsy results. Autopsy findings led to the suspicion that the injuries on her body were a consequence of running over of the vehicle without any modifications caused by hitting. A title and abstract review of recent articles worldwide over the past 2 decades indicates that there have been no case reports that have focused on snow groomer vehicle-related fatality with a description of the characteristics of the injuries. This case study particularly focuses on wound morphology caused by an uncommon mechanism that might help forensic practitioners.

A planned complex suicide by gunshot and vehicular crash.

Complex suicide is usually defined as the application of more than one killing mechanism to ensure a fatal outcome. Herein we report an unusual case of a planned complex suicide of a 20 year old-male combining gunshot with coincidental intentional vehicular crash. The case was initially assumed to be a simple traffic accident until a rimfire pistol was found in close proximity to the deceased as well as gunshot wound of the head. This paper demonstrates the importance of careful inspection of the death scene, as well as the complex performance of autopsy examination to explain the manner of death and distinguish accidental deaths from suicides in such cases. Nevertheless, this assessment might by very difficult or even impossible. It has to be assumed that a high number of suicides in road traffic remain undetected.

Giant cell myocarditis and endomyocardial calcification in a 2.5-month-old infant triggered by excessive maternal alcohol abuse: case study of an unusual association.

This report describes an unusual case of a 2.5-month-old infant's sudden death secondary to giant cell myocarditis and endomyocardial calcification, both unusual entities in pediatric patients. The mother had a history of excessive alcohol consumption during pregnancy and the postnatal period. No infectious etiologies, hypersensivity, or autoimmune disorders were identified. Therefore, the authors assume that alcohol exposure might be responsible for the inflammatory giant cell process complicated with endomyocardial calcification in susceptible infants. This report is the first to describe the rare form of noninfectious myocarditis complicated with endomyocardial calcification possibly triggered by a toxic agent. The authors discuss the possible interaction between these processes that led to the infant's sudden death.

An unusual case of anesthetic abuse by a full-face gas mask.

The authors report a case of sniffing of halothane (Narcotan) by a 32-year-old man, master of pharmacy, through the military full-face gas mask. The liquid halothane had been applied on the scrubber of the gas mask and voluntarily inhaled. The sniffer was found dead in his flat, with the gas mask still fixed and sealed on his face. Because the authors have not encountered any report of such a case in the literature, they present and discuss this case in this article.