Death due to obstruction of the upper airways caused by edema of the laryngeal mucosa in the course of hereditary angioedema.

A rare case of death of a young man due to airway obstruction in the course of angioedema (Quincke's edema). Type I hereditary angioedema due to C1 esterase inhibitor deficiency had been diagnosed in the man while he was alive. The information concerning the man's health state was given in the Public Prosecutor's decision ordering medico legal autopsy, which was extremely helpful in recognizing the cause of death.

Left atrio-esophageal fistula of a possibly iatrogenic aetiology.

The study presents an exceptionally rare case of an esophago-left atrial fistula, which was diagnosed during a forensic post-mortem examination. Due to complex nature of the disease and many attempts to cure the patient, the authors did not manage to identify the aetiology of the fistula. It was only implied that the fistula might have been a distant complication of intraoperative endocardial ablation or it might have appeared as a consequence of perforation of the esophageal wall or left atrial wall of the enlarged heart with the end of an intubation tube or nasogastric tube.

[Accidental intoxication with methotrexate--a case report]. / Przypadkowe zatrucie metotreksatem--opis przypadku.

The report presents a case of a 49-year-old man, who was accidentally intoxicated with methotrexate. The man was admitted to a nephrology ward because of generalized erythema involving the entire body, skin pruritus, face edema, fever and difficulty with breathing. On the day of admission, additional studies demonstrated a moderate degree of anemia, considerable leucopenia, thrombocytopenia and an increased level of C-reactive protein. In the course of hospitalization, doctors suspected the condition of the patient to be possibly caused by generalized infection, toxic lesion of the bone marrow or hematological bone marrow disease. Finally it was established that the cause of the patient's disease was his erroneous taking of a total of 35 mg of methotrexate (5 mg per day for seven days). Despite intensive treatment, the patient died seven days after admission. Autopsy confirmed that the man died from acute circulatory and respiratory insufficiency caused by intoxication with methotrexate.

Experimental effect of shots caused by projectiles fired from air guns with kinetic energy below 17 J.

Pursuant to the Polish Weapons and Ammunitions Law (Legal Gazette No 53/1999 item 549 with subsequent amendments), air guns with kinetic energy of the fired projectiles below 17 J are not regarded as weapons. The aim of the study was to assess the potential effect of shots caused by projectiles of various mass and structure fired from air guns with kinetic energy below 17 J on human soft tissues. As a model of soft tissue, we used 20% gelatin blocks. After shooting, we measured the depth of gelatin block penetration by pellets fired from various distances and compared these results with autopsy findings. The results demonstrated that examined pneumatic guns may cause serious injuries, including damage to the pleura, pericardium, liver, spleen, kidneys, femoral artery, and thoracic and abdominal aorta. Experiment shown that gelatin blocks do not reflect fully the properties of the human body.

[Penetration depth of missiles fired from a pneumatic weapon with kinetic energy below 17 J, in 20% gelatine blocks as correlated with injuries found during autopsy of a 9-year-old boy]. / Glebokosc penetracji pocisków, wystrzelonych z urzadzenia pneumatycznego o energii kinetycznej ponizej 17 J, w 20% blokach zelatynowych w korelacji ze stwierdzonymi sekcyjnie obrazeniami ciala 9-letniego chlopca.

In Poland, according to the Act About Weapons and Ammunition, an air weapon which has kinetic energy of the fired projectiles below 17 J does not require registration and can be bought even on the Internet. Sport and recreation shooting with this weapon basically have to be performed in shooting ranges, but can be also carried on outside of shooting ranges, providing "particular caution" is exercised. In this study, we presented a case of fatal shooting of a 9-year-old boy; the weapon was a Chinese pneumatic device weapon with kinetic energy of the fired projectiles below 17 J. The aim of this study was to compare autopsy findings with penetration depth of missiles fired from this pneumatic weapon in 20% gelatine blocks. During the experiment, we used a Chinese pneumatic weapon with kinetic energy below 17 J, five kinds of lead projectiles with different shape and mass and 20% gelatine blocks at the temperature of 10 degrees C, which were the model of human soft tissues.

[The analysis of the causes of deaths involving fetuses, neonates and infants in the autopsy material from the Chair and Department of Forensic Medicine, Medical University of Lódz, in the years 2000-2010]. / Analiza przyczyn zgonów plodów, noworodków i niemowlat w materiale sekcyjnym Katedry i Zakladu Medycyny Sadowej UM w Lodzi w latach 2000-2010.

The aim of this study was the comparison of causes of deaths of fetuses, neonates and infants based on the autopsy reports taken from the Chair and Department of Forensic Medicine, Medical University of Lódz, in the years 2000-2010, and especially establishing what the most common causes of death occurred in this age group. We evaluated 94 autopsy reports of such children from this period. It turned out that the most frequent causes of death were pneumonia in neonates delivered at term and sepsis (usually due to hospital infection) in premature neonates. Other common causes of death were trauma and violent asphyxia (smothering, or choking or positional asphyxia).

[Sudden deaths due to non-traumatic aortic aneurysms rupture]. / Nagle zgony z powodu nieurazowych pekniec tetniaków aorty.

In this work we review two cases of ruptured aortic aneurysms which arose from congenital abnormalities of the aortic wall structure. In the first case, a 16-year old, previously untreated boy died, with no previous symptoms of an aortic aneurysm. The boy was suspected of taking drugs and even of committing suicide. A young couple found the boy's body in the wood close to the bus stop. There were no signs of violence on the corpse and the body was fully and properly dressed. The autopsy revealed enlarged (true aneurysm) and ruptured ascending aorta with about 700 ml of blood in the pericardial sac. Toxicological examination was negative. Histopathology showed abnormalities in the structure of the wall of aorta in the place of the rupture. All other body organs and vessels seemed to be normal and properly developed except the thoracic aorta, and no other morphologic abnormalities were present. In the second case, the corpse of a 30-year-old man was found in his apartment (he lived with his parents). The parents claimed he did not use drugs or alcohol. The autopsy, as in the previous case, revealed a ruptured true aneurysm of the ascending aorta with 370 g of blood in the pericardial sac. The concaved thoracic cavity was also observed. After the autopsy, the man's parents reported that in childhood, their son was diagnosed to suffer from Marfan syndrome.

[Experimental effect of a shot caused by 4.5 mm cartridges fired from a Norica Dragon air-rifle and a Walther PPK/S air-pistol]. / Doswiadczalny efekt postrzalu pociskami kalibru 4,5 mm wystrzeliwanymi z karabinka pneumatycznego Norica Dragon i pistoletu pneumatycznego Walther PPK/S.

In Poland, according to the Weapons and Ammunition Act" an air weapon which has kinetic energy of fired projectiles below 17 J does not require registration and can be bought even on the Internet. Sport and recreational shooting with this weapon does not have to be performed in a special shooting-range, but can be carried on in an open terrain providing "particular caution" is exercised. In this study we presented experimental effects of shooting pneumatic weapons (Norica Dragon air-rifle and Walther PPK/S air-pistol) which had kinetic energy of fired projectiles below 17 J. The aim of this study was to assess the effects of shooting the above weapons at human soft tissues and thin bones of the temple region to empirically evaluate the degree of danger to health and life, which such shots can produce. We used 20% gelatine blocks at 10 degrees C, which were the model of human soft tissues, and fresh calf scapulas, which served as the models of the temporal bone of the human cranium. Before the experiment, we had evaluated the weight of all the projectiles and their initial velocity using a chronograph. By these measures, we calculated the kinetic energy of the fired missiles. After shooting, we estimated if projectiles of different shapes shot from air weapons characterized by different kinetic energy and from different distances penetrated the gelatine blocks and if the said missiles perforated the bones. We also measured the depth of missiles penetration in the gelatine blocks.

[Postmortem bruising]. / Posmiertne podbiegniecia krwawe.

While examining body injuries, a very important issue is to ascertain if they were made ante or postmortem. The majority of authors are of the opinion that the presence of bruises is a proof of an antemortem origin of injuries. Nevertheless, the present authors encountered more than a dozen of cases of postmortem origin of bruises, which had occurred as much as several hours after death. All the observed bruises were inflicted during external examination of bodies at the site where they were found, while examining idiomuscular reactions from biceps brachii and quadriceps femoris muscles. During autopsies carried out in the dissecting room, bruises with central ischaemia and transversal course to the long axis of a limb were noted. Following incision of the integument, we found of shiny ecchymosis (suggilation) in the subcutaneous tissue. Histopathology revealed the presence of blood extravasations in the examined tissues.

[Opinionating errors in forensic medicine]. / Bledy opiniodawcze w medycynie sadowej.

The paper presents selected evident opinionating errors committed by experts in the field of forensic medicine who issued medico-legal opinions in criminal cases, aiming at determining causes of death. The authors analyze the causes of such errors and possibilities of avoiding them, as well as the impact of the said errors on the course of criminal proceedings and the legal position of the suspects or victims. The report emphasizes the potential effect of these opinions on the fate of individuals who have been found suspected or guilty based on such opinions should they be accepted by the court without verification by summoning another expert.

[Tako-tsubo cardiomyopathy in a man with cerebral haemorrhage]. / Podejrzenie zespolu tako-tsubo u mezcyzny z krwawieniem sródczaszkowym.

BACKGROUND: The Tako-Tsubo syndrome is characterized by a transient left ventricular dysfunction in the absence of obstructive coronary disease, typically precipitated by severe emotional or physical stress. It is characterized by a balloon-like left ventricular appearance on angiography, ECG changes, and elevated cardiac biomarkers. We describe a case, where Tako-Tsubo cardiomyopathy was diagnosed in a patient with subarachnoid haemorrhage. CASE REPORT: A 57-year-old man was brought to the hospital after cardiac arrest and successful resuscitation. After admission, echocardiography was performed that revealed marked impairment of contractility of the left ventricle with akinesis of the apex, interventricular septum, and anterior wall. Subsequent coronary angiography revealed neither coronary pathology nor pulmonary embolism; however, ventriculography showed typical dynamics of the Tako-Tsubo syndrome. Because of a deep cerebral coma (GSG 3), a CT-scan was performed that revealed subarachnoid haemorrhage with a haemotoma in the left temporal lobe, together with symptoms of massive cerebral oedema. The patient died eight days later despite vigorous intensive care. During the autopsy, a ruptured aneurysm of the left central cerebral artery was found. CONCLUSIONS: The Tako-Tsubo syndrome may occur not only during serious stress but also after resuscitation of cardiac arrest following cerebral bleeding.

[Cases of myocarditis and their effect on the mechanism of death]. / Przypadki zapalenia miesnia sercowego i ich wplyw na mechanizm zgonu.

In this study, we describe two cases with autopsy findings of interstitial myocarditis. They show that supplementing the autopsy with histopathological examination, even when the cause of death is thought to be clear and obvious, is extremely important as it can contribute valuable information to the case, including the circumstances of death. In the first case, we discussed a tram accident in which its driver was killed. The family of the deceased reported that he had been suffering from consciousness disturbances for some time, and additional radiological examinations demonstrated abnormalities in his neck blood vessels. In the second case, a pregnant woman was admitted to hospital after a cardiac and respiratory arrest. A cesarean section was carried out but the fetus was already dead. The woman was declared dead shortly after the operation.

[Pulmonary contusion and acute respiratory distress syndrome (ARDS) as complications of blunt chest trauma]. / Stluczenie pluc i zespól ostrych zaburzen oddechowych ARDS jako powiklania tepego urazu klatki piersiowej.

Blunt chest traumas are common nowadays due to development of motor transport. They are associated with high mortality rates because of serious injuries of internal organs. The mechanisms of injuries are complex and may cause damages ranging from small ones, such as bruises or abrasions, to life-threatening trauma. Among typical injuries there are rib fractures, sternal fractures, pneumothorax, hemothorax, diaphragm lacerations, pulmonary contusions, cardiac tamponade, cardiac rupture and many others. The authors of the article would like to emphasize the pathophysiology and diagnostic difficulties in such blunt chest trauma complications as pulmonary contusions and acute respiratory distress syndrome, for which no causal treatment is available and only early diagnosis and administration of symptomatic treatment may increase the patients' chances to survive. In Forensic Medicine Department, Medical University of Lódz, an opinion was issued on a case which illustrates the clinical problem.

[Sudden suffocation by clogging up of the respiratory tract with foreign bodies--case report]. / Uduszenie gwaltowne przez zatkanie dróg oddechowych cialami obcymi--opis przypadku.

The study presents a case of death by clogging up of the respiratory system by foreign bodies. The autopsy revealed among others the presence of a cigarette lighter and a piece of an aluminum spoon in the throat, and a cut-and-stab wound on the front surface of the neck with accompanying trial incisions, penetrating into the respiratory tract, clogged by a substantial amount of blood, focuses of aspiration in the lungs, and symptoms of lung distension. Histopathological examinations of inner organ samples revealed the presence of extravasations of blood in the air space as well as symptoms of acute lung distension, confirming the autopsy diagnosis. Toxicological examinations revealed that the victim in the moment of death was in a state of deep alcoholic intoxication. The conducted interrogations of possible witnesses/suspects of the incident turned out insufficient for the reconstruction of events. The authors of the study therefore attempt a reconstruction of the incident based on executed examinations.

[Estimating the efficiency of DNA isolation methods in semen, blood and saliva stains using the QuantiBlot system]. / Ocena wydajnosci róznych metod izolacji DNA w plamach nasienia, krwi i sliny metoda QuantiBlot.

The aim of this study was to compare and select the optimal method of DNA isolation from blood, semen and saliva stains, as well as to determine appropriate conditions for employing amplification kits for identification of individual persons [brak w polskim tekscie]. The materials analyzed in this study consisted of stains of blood, semen and saliva samples stored for a year, and stains of blood stored for a month. Seven various methods of isolation were compared: the Fast DNA kit (Qbiogene), phenol/chloroform extraction, Sherlock (DNA II Gdansk), Dneasy (Qiagen), Wizard Genomic Purification Kit (Promega), Chelex 100 (Biorad) and salting out proteins method. After the isolation, the quantity of DNA was measured with QuantiBlot [brak w polskim tekscie]. The highest DNA concentration in bloodstains stored for one year and one month was observed employing the salting out proteins method. The phenol-chloroform extraction method was also found to produce reasonably good results. Isolation from blood and semen with salting-out method appeared to be the most effective. The phenol/chloroform method was dependent on the age and origin of the materials [brak w polskim tekscie]. The Sherlock kit was proven to be effective in blood samples stored for one year. DNA concentration values obtained in semen and saliva samples were very low and characterized by a low repeatability.

[Myocarditis in two cases of HIV infection]. / Zapalenie miesnia sercowego w dwóch przypadkach zakazenia wirusem HIV.

The authors present two cases of death in young persons infected with HIV virus and diagnosed with inflammatory changes of the heart muscle rarely seen in forensic medical practice. In one of the cases, only the findings revealed upon autopsy did prompt the examiner to suspect the infection, even though before death, the patient had been in several hospitals.

[A case of mutation at locus TH01--sequence analysis]. / Przypadek mutacji w locus TH01--analiza sekwencji.

In a paternity test with 21 short tandem repeats (STRs) an isolated exclusion for the TH01 locus was observed. The probability of paternity or maternity in this case turned out greater than 99,999%. The analysis of sequence indicates only the deletion character of the observed mutation event without any changes in the conservative sequence.

[Practical usefulness of the IDENTIFILER system for paternity testing in the Central Poland population]. / Praktyczna przydatnosc systemu IDENTIFILER w badaniach ojcostwa w populacji Polski centralnej.

The usefulness of the IDENTIFILER multiplex system for paternity testing in the Central Poland population was examined. One hundred excluding cases and one hundred including cases were analysed and the results were estimated for two different types of cases: trios (standard cases) and duos (motherless cases). Efficiency of exclusion and paternity index were analysed for each locus as well as for the entire set of the fifteen STR markers.

[Frequency quotient of paternity index Qf in a case of replacement of the natural father within a trio with his brother]. / Iloraz czestosci szansy ojcostwa Qf w przypadku zastapienia w trójce badanej ojca biologicznego przez jego brata.

Cases of trios in which the natural father's near blood-relative instead of the natural father are among the hardest to give an expert opinion on. The goal of this study was to determine with what frequencies specific given values of paternity index appear in trios with the natural father and with the natural father's brother, and whether these frequencies can be the basis for discovering the substitution of the natural father by a brother in a given trio examined. The study material was the population of genotypes investigated in the AmpF/STR SGM Plus system. It was seen that the higher the paternity index values, the more frequently they appear in trios with the natural father, and less frequently in trios with the natural father's brother. This dependency has a general character and obtained in all the systems studied. The frequency quotients Qf (defined as the frequency of a given PI value in trios with the natural father in relation to the "reduced" frequency of the PI value in trios with the brother of the natural father) are found in the region of c. 0.6 to c. 1.4, whereby extreme values are rare, and the most frequent are cases where Qf oscillates within modest limits around the value 1. This fact shows that the majority of cases, calculated Qf values contribute little to resolving the question of whether the defendant--or his brother--is the child's father.