Homicide mechanisms, weapon types and causes of death in the autopsy material of the Department of Forensic Medicine Medical University of Gdansk Poland in the years 2010-2019.

The study objective was the analysis of homicides based on reports of 107 medicolegal autopsies of victims, which were carried out in 2010-2019 at the Department of Forensic Medicine of the Medical University of Gdansk, Poland. The study focused on the analysis of homicide mechanisms, on the weapon type, injuries characteristics, and both pathomechanisms and causes of death. Alcohol and illicit drugs abuse, which is a predisposing factor, was also assessed. In the analysed cohort, 70.1% were males and 29.9% females. The most frequently used weapon was a blunt instrument (accounting for 47.7% of homicides), while the least common was a firearm (accounting for 4.7% of homicides). There were significant differences in homicide mechanisms related to victims' gender. In males, blunt or sharp instruments predominated, while in females violent suffocation and chop injuries were more frequent. Fatal head injuries and their consequences predominated in the pathomechanisms of death (32.7% of cases). It was shown that the highest blood alcohol concentration (BAC) was found in homicides due to violent strangulation and sharp instrument use, while the lowest BAC was found in gunshot victims. Toxicological tests were performed in 18 cases and in 7 cases showed positive results for illicit drugs. The analysis of various elements involved in homicide may contribute to a conceptual framework for preventive measures aiming at the reduction of homicides number.

Selected Political Criminal Poisonings in the Years 1978-2020: Detection and Treatment.

Criminal poisonings are among the least frequently detected crimes in the world. Lack of suspicion of this type of event by police officers and prosecutors, clinical symptoms imitating many somatic diseases and technical difficulties in diagnostics, as well as high research costs make the actual frequency of these events difficult to estimate. The substance used for criminal poisoning is often characterized by: lack of taste, color and smell, delayed action, easy availability and difficulty to detect. The aim of the study was to analyze selected cases of political poisoning that took place in the years 1978-2020, to describe the mechanisms of action of the substances used and to evaluate the diagnosis and treatment. The analyzed cases of criminal poisoning concerned: Georgi Markov (ricin), Khalid Maszal (fentanyl), Wiktor Yushchenko (TCDD dioxin), Jasir Arafat (polonium 210Po isotope), Alexander Litvinenko (polonium 210Po isotope), Kim Jong-Nam (VX), Sergei Skripal (Novichok) and Alexei Navalny (Novichok). Contemporary poisons, to a greater extent than in the past, are based on the use of synthetic substances from the group of organophosphorus compounds and radioactive substances. The possibility of taking appropriate and effective treatment in such cases is the result of many factors, including the possibility of quick and competent rescue intervention, quick and reliable detection of the toxic substance and the possibility of using an antidote.

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.

Fatal haemorrhage from an aortoesophageal fistula secondary to button battery ingestion in a 15-month-old child. Case report and literature review.

Small children put various objects into their mouths, which is one of their ways of exploring the surrounding world. Apart from toy parts, e.g. Lego® bricks or magnetic spheres, such objects include coins, small stones, as well as batteries used for different electric devices. Such batteries, especially the flat, round button type, may be ingested and become impacted in one of the physiological narrowing sites of the oesophagus, leading to serious complications. The case of a 15-month-old child is presented, who died due to a massive gastrointestinal haemorrhage from an aortoesophageal fistula that developed at the site of a pressure ulcer caused by an impacted button battery. The presented case shows that ingestion of even a small battery may lead to death. The asymptomatic course of the battery ingestion significantly hinders both the assessment of circumstances and the time of the battery ingestion. Sudden death may result from a massive haemorrhage from a pressure-induced injury to a big blood vessel.

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.

Ribosomal DNA transcription in the anterior cingulate cortex is decreased in unipolar but not bipolar I depression.

The anterior cingulate cortex (AC) is consistently implicated in the pathophysiology of depression. However, it is not clear whether unipolar and bipolar depression display distinct neuropathological features. Therefore, the objective of this post-mortem study was to re-evaluate this important issue. Brains from 9 patients with major depressive disorder (MDD) and 11 patients with bipolar disorder (BD) subtype I depression as well as 24 matched controls were analysed. The argyrophilic nucleolar organiser region (AgNOR) silver-staining method was applied on paraffin-embedded brain sections in order to assess the transcriptional activity of ribosomal DNA (rDNA) in layer III and V pyramidal neurons of the dorsal and ventral AC in both hemispheres. An AgNOR area decrease suggestive of a diminished transcriptional activity of rDNA was found in the MDD group both versus controls and versus the BD group. The effect was specific for the right hemisphere and dorsal AC and was restricted to layer V pyramidal neurons. The results suggest that only patients with MDD display region-specific chronic hypoactivity of these output neurons, which are critical for mood regulation. Furthermore, in our cohort, unipolar and bipolar I depression could be differentiated relative to the presumed AC hypoactivity and psychotropic medication did not counteract the observed effect.

[Estimation of medical protocol correctness in the light of opinions issued as ordered by the judiciary or prosecution authorities]. / Ocena prawidlowosci postepowania lekarskiego w swietle opinii wydanych na zlecenie wymiaru sprawiedliwosci lub organów scigania.

UNLABELLED: Medical personnel, most commonly physicians, are held responsible for situations in which in the course of medical treatment some adverse effects develop that endanger the patient's health and life. Such effects generally include death, a severe damage to patient's health as well as the exposing of patients to the danger of such effects developing in them. The effects of the kind result either from some medical malpractice or from medical personnel's negligence. The aim of the paper was to analyse medico-legal expertises issued as ordered by the Polish Judiciary and Prosecution Authorities in cases of alleged medical malpractice that had been issued by the Chair and Department of Forensic Medicine, Medical University of Gdansk, and to compare the results with those from similar studies done by Chairs and Departments of Forensic Medicine at the Medical Universities of Katowice, Kraków, and Wroclaw. MATERIAL AND METHODS: Analysis was done of 372 medico-legal expertises issued in the years 1990-2004 by the Chair and Department of Forensic Medicine, Medical University of Gdansk. The results obtained were compared with those from a similar analysis of medicolegal expertises issued in Gdarisk in the years 1968-1977 and also with those from studies presented by Departments of Forensic Medicine at the Medical Universities of Katowice, Kraków, and Wroclaw. RESULTS: Legal proceedings were generally conducted by the Public Prosecutor's Office, less frequently by the police, and only in 7.2% were such cases subject to the civil law procedure. Most frequently assessed health care facilities included hospitals (66.1%), clinics of medical universities (16.6%), and ambulance service (13.4%). Seldom were the charges of medical malpractice brought against basic health care facilities (9.4%) or private practices (3.5%). As revealed in the analyzed material, adverse health effects of a disease or injury included death--70.5%, a severe damage to patient's health--9.1%, and the endangering of patients with development of such effects--0.4%. In 60.8% of the cases analyzed, medical protocol implemented by medical personnel was assessed as proper. Medical malpractice were found in 18.5% of the cases, including diagnostic malpractice--1.8% therapeutic malpractice--2.7%, and those of logistic nature--4%. Similar results were obtained by the above mentioned Departments of Forensic Medicine. Negligence in the rendering of health care was found in 13.4 of the medico-legal expertises analyzed. Conclusions. In the material subjected to this analysis criminal cases are predominant. Medical personnel, including medical practitioners, are more and more frequently charged with exposing patients to the immediate danger of loss of life or a severe damage to their health (Art. 160 of the Polish Penal Code). There are more and more cases in which the adverse effects endangering patient's health or life result from negligence rather than from some medical malpractice.

[Comments on histopathology examinations in forensic medicine -- the importance, indications and basic principles of preserving the tissues]. / Uwagi dotyczace badania histopatologicznego w medycynie sadowej -- znaczenie i wskazania oraz podstawowe zasady zabezpieczania narzadów.

Histopathology examinations and their usefulness in postmortem diagnosis and medico-legal expertise have always been regarded extremely important by the Faculty of the Chair and Department of Forensic Medicine at the Medical University of Gdansk. The authors postulate acceptance of indication criteria for histopathology examination in forensic autopsies and propose rules for collecting tissue samples from internal organs and the placenta. They also remind the readers of the principles of proceeding with the preserved material. The present paper may be helpful for doctors other than forensic pathologists, who perform autopsies in institutions other than university departments of forensic medicine.

[Sampling, storage and transport of biological materials collected from living and deceased subjects for determination of concentration levels of ethyl alcohol and similarly acting substances. A proposal of updating the blood and urine sampling protocol]. / Pobieranie, przechowywanie i transport materialu biologicznego zabezpieczonego przyzyciowo i posmiertnie do badania na zawartosc alkoholu etylowego oraz srodków podobnie dzialajacych do alkoholu. Propozycja aktualizacji instrukcji pobierania próbek krwi i moczu.

The present paper emphasizes the most common mistakes committed at the beginning of an analytical procedure. To shorten the time and decrease the cost of determinations of substances with similar to alcohol activity, it is postulated to introduce mass-scale screening analysis of saliva collected from a living subject at the site of the event, with all positive results confirmed in blood or urine samples. If no saliva sample is collected for toxicology, a urine sample, allowing for a stat fast screening analysis, and a blood sample, to confirm the result, should be ensured. Inappropriate storage of a blood sample in the tube without a preservative can cause sample spilling and its irretrievable loss. The authors propose updating the "Blood/urine sampling protocol", with the updated version to be introduced into practice following consultations and revisions.

[Positional asphyxia as a cause of death in a traffic accident with the driver--in the "upside-down car position"]. / Uduszenie pozycyjne jako przyczyna smierci w wypadku drogowym u kierowcy samochodu osobowego po "dachowaniu".

We demonstrate a case of positional asphyxia of the car with the driver in the upside-down position following a traffic accident. The discussion shows the confirmity of this type of death mechanism with the facts estimated during the investigation of the place of the accident and autopsy.

[The use of entomologic methods in determining the time of death--case studies]. / Wykorzystanie metod entomologicznych w próbach okreslenia daty zgonu--opis przypadków.

This paper describes a number of cases in which the determination of the time of death was based on entomological methods. These cases took place in the Pomorskie Province, and the autopsies were carried out in the Department of Forensic Medicine, Medical University of Gdansk.

[Entomological methods of determining time of death]. / Entomologiczne metody okreslania czasu smierci.

The paper contains descriptions of the entomological methods which can be used in determining time of death. It based on the knowledge of groups of arthropods (waves of succession), characteristic for stages of decomposition of the corpse as well as the biology and longevity of development of necrophagous insects.

[Cases of hanging with bound limbs--suicide, homicide or accident]. / Przypadki powieszen ze skrepowanymi konczynami--samobójstwo, zabójstwo czy wypadek.

In the paper 6 cases of suicidal hanging and 1 case of accidental hanging were presented; in each case limbs of the victim were bound. These hangings always cause a suspicion of homicide, therefore the forensic specialist should pay particular attention to them, especially during the crime scene examination, they should also be carefully investigated by police and the public prosecutor's office.