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.

[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.

[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.

[Evaluation of visualization of biological stains with the use of alternative light source (ALS) for the purpose of genetic identification. Part II. Semen samples analysis]. / Ocena wizualizacji sladów biologicznych z uzyciem alternatywnego zródla swiatla (ALS) w aspekcie identyfikacji genetycznej. Czesc II. Analiza sladów nasienia.

Detection of seminal stains on items such as clothing and bedding is a significant element of investigation in sexual assault cases. The use of alternative light source may assist in their identification. The objective of the investigation was the evaluation of human semen visualization with the use of alternative light source for the purpose of genetic identification. The tests demonstrated that experimentally prepared semen stains on the bright base could be best seen in the natural light and white light when the semen was diluted at a ratio 1:10. The complete typeability of AmpFISTR SGM Plus kit loci was evaluated in semen which was diluted at a ratio 1:1750 and typeability of AmpFISTR SGM Plus kit loci was incomplete in semen diluted at a ratio 1:2000. After washing with laundry detergents, semen stains were still recognizable under ALS wavelength 455 nm, while wearing orange goggles.

[Evaluation of visualization of biological stains with the use of alternative light source (ALS) for the purpose of genetic identification. Part I. Blood and saliva stains analysis]. / Ocena wizualizacji sladów biologicznych z uzyciem alternatywnego zródla swiatla (ALS) w aspekcie ich identyfikacji genetycznej. Czesc I. Analiza sladów krwi i sliny.

The objective of the investigation was evaluation of visualization of human blood and saliva stains with the use of alternative light source for the purpose of genetic identification. Experimental bloodstains on the bright base were the most clearly seen in the natural light and white light, up to blood dilution of 1:600. Complete typeability of AmpFISTR SGM Plus kit profiles was obtained from bloodstains at dilution 1:1500. Partial AmpFISTR SGM Plus kit profiles were typed from bloodstains at dilutions 1:1750 and 1:2000. Experimental saliva stains on the light-colored base were completely invisible in the natural light and white light, while they were visualized at wavelength range 300-415 nm through yellow goggles, and at wavelength range 300-455 nm through orange goggles at saliva dilution 1: 600. Complete typeability of AmpFISTR SGM Plus kit loci was obtained from saliva stains at dilution 1:1750. Partial AmpFISTR SGM Plus kit profiles were typed from saliva stains at dilution 1:2000. The wavelength of 455 nm and orange goggles were the optimal set for visualization of bloodstains on various, noncontrasting materials. Other useful wavelength/combinations of goggles were CSS light/red goggles. In case of saliva, the most useful general condition for visualization of stains on various, non-contrasting materials was with the wavelength set to 300-415 nm, while wearing yellow goggles. Other useful combinations of wavelength/goggles were 300-455 nm/orange or red goggles, and also CSS light/orange or red goggles.

[Deaths during asphyxia induced to escalate sexual experience. Case reports]. / Zgony w przebiegu asfiksji wywolanej w celu eskalacji doznan seksualnych. Opisy przypadków.

The authors present two cases of deaths resulting from asphyxia of one of the partners in the act of intercourse to escalate their experience. The first case involved a heterosexual intercourse, in which a 30-year-old woman was led to state of hypoxia through choking and closing respiratory orifices. The other case represented a homosexual intercourse between two men, in which the victim's hands and legs were tied. Moreover, the partner put an open knot around the victim's neck and was holding it controlling the state of asphyxia, while performing an anal intercourse. Both presented victims practiced such paraphilia-associated behaviors in the past. The fact of sexual intercourse was confirmed in both cases by genetic analysis of the man's anus and the woman's oral cavity and vagina. This resulted in finding the genetic material of their partners. Escalating of sexual experience through inducing asphyxia of the nervous system is extremely dangerous and may result in death of one of the sexual partners, what has been proven by the present investigation.

[Analysis of traffic accident fatalities in autopsy material collected in the years 2007-2008 at the Department of Forensic Medicine, Medical University of Bialystok]. / Analiza ofiar wypadków komunikacyjnych w swietle materialu sekcyjnego Zakladu Medycyny Sadowej w Bialymstoku w latach 2007-2008.

The objective of the paper was an analysis of traffic accident fatalities in autopsy material collected at the Department of Forensic Medicine, Medical University of Bialystok in the years 2007-2008. The analysis was carried out in 209 traffic accident victims included in the total number of 876 autopsies. Based on autopsy reports, the main criteria included gender, site of death (urban area, rural area, non-built-up), mode of movement (driver, passenger, pedestrian, biker and cyclist), age, location of fatal injuries (head, thorax, abdomen and pelvis, upper and lower limbs, multiorgan injuries) and blood alcohol level. The collected data were analyzed statistically according to the above listed criteria and presented as a text and graphs. In the years 2007-2008, 209 individuals died in traffic accidents in Podlasie Region, with the mortality rate of 24%. Male victims accounted for 76% of fatalities, while females constituted 24%. Drivers predominated among traffic accident fatalities in Podlasie Region, with the mortality rate of 38%. In the years 2007-2008, the mortality rates for pedestrians, passengers, motorbike drivers and bikers were 29%, 26% and 7%, respectively. Regardless of the time period, the fatalities were predominant in non-built-up areas, with the percentage amounting to 48.5%. The location of fatal injuries in respective groups was similar, with a preponderance of multiorgan injuries. The mean age of traffic accident fatalities was 41 years, predominantly due to an increasing number of fatal cases among young individuals. In the years 2007-2008, the percentage of traffic accident victims being under the influence of alcohol was 45% in males and 12% in females. The mean blood alcohol level of traffic accident victims was 2.1% per hundred in males and 1.6% per hundred in females.

[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.

[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.