Thoracolumbar fascia in the lumbar region: anatomical description and topographical relationships to the cutaneous nerves: a preliminary study.

BACKGROUND: The study aims to determine principal topographical relations between thoracolumbar fascia (TLF) and lateral branches derived from the dorsal (posterior) rami of lumbar spinal nerves and elucidate their potential link to lumbar region pain. The research protocol involves basic TLF morphological description, evaluating its relation to the nerves, and examining general histology. MATERIALS AND METHODS: The research was conducted on four male cadavers fixed in 10% neutral buffered formalin. RESULTS: The dorsal rami of the spinal nerves branched into medial and lateral divisions. The lateral divisions were about 1 mm thick and mainly visible in the subcutaneous tissue during stratigraphic dissection. They pierced the TLF superficial layer. They descended sidewards and downwards within the superficial fascia (laterally to the erector spinae muscle) to provide sensory innervation to the skin. CONCLUSIONS: Anatomical relationships between TLF, deep (intrinsic or true) back muscles, and dorsal rami of the spinal nerves are complex and may be clinically involved in low back pain etiopathogenesis.

The Influence of the Oral Microbiome on Oral Cancer: A Literature Review and a New Approach.

In our recent article (Smedra et al.: Oral form of auto-brewery syndrome. J Forensic Leg Med. 2022; 87: 102333), we showed that alcohol production can occur in the oral cavity (oral auto-brewery syndrome) due to a disruption in the microbiota (dysbiosis). An intermediate step on the path leading to the formation of alcohol is acetaldehyde. Typically, acetic aldehyde is transformed into acetate particles inside the human body via acetaldehyde dehydrogenase. Unfortunately, acetaldehyde dehydrogenase activity is low in the oral cavity, and acetaldehyde remains there for a long time. Since acetaldehyde is a recognised risk factor for squamous cell carcinoma arising from the oral cavity, we decided to analyse the relationship linking the oral microbiome, alcohol, and oral cancer using the narrative review method, based on browsing articles in the PubMed database. In conclusion, enough evidence supports the speculation that oral alcohol metabolism must be assessed as an independent carcinogenic risk. We also hypothesise that dysbiosis and the production of acetaldehyde from non-alcoholic food and drinks should be treated as a new factor for the development of cancer.

Experimental and numerical study on failure mechanisms of bone simulants subjected to projectile impact.

Analyses of the human bones failure mechanisms under projectile impact conditions can be made through performing of a large number of ballistic trials. But the amount of data that can be collected during ballistic experiments is limited due to the high dynamics of the process and its destructive character. Numerical analyses may support experimental methodologies allowing to better understand the principles of the phenomenon. Therefore, the main aim of the study was to create and to verify a numerical model of commercially available synthetic bone material-Synbone®. The model could be used in the future as a supporting tool facilitating forensic studies or designing processes of personal protection systems (helmets, bulletproof vests, etc.). Although Synbone® is commonly used in the ballistic experiments, the literature lacks reliable numerical models of this material. In order to define a numerical model of Synbone®, mechanical experiments characterizing the response of the material to the applied loads in a wide range of strains and strain rates were carried out. Based on the mechanical tests results, an appropriate material model was selected for the Synbone® composite and the values of constants in its equations were determined. Material characterization experiments were subsequently reproduced with numerical simulations and a high correlation of the results was obtained. The final validation of the material model was based on the comparison of the ballistic impact experiments and simulation results. High similarity obtained (relative error lower than 10%) demonstrates that the numerical model of Synbone® material was properly defined.

Polyorchidism: An Up-to-Date Systematic Review.

Polyorchidism is a rare male urogenital tract anomaly characterized by at least one supernumerary testis in the scrotum or ectopically. According to data based on our systematic review, 76% of the supernumerary testes (SNTs) were located in the scrotum, and 24% were extra-scrotal (p < 0.001). Among testes located outside the scrotum, 87% were found in the inguinal canal and 13% in the abdominal cavity. In 80% of cases, the diagnosis of SNT was made based on imaging tests, and the remaining 20% of cases were detected incidentally during surgery. The imaging tests performed (US or MRI) resulted in a significantly higher rate of patients who qualified for observation vs. surgical treatment (45% vs. 35%, p < 0.001). The most common conditions associated with SNT were ipsilateral inguinal hernia (15% of cases) and cryptorchidism (15% of cases). Surgery (orchidopexy/orchidectomy) was performed on 54% of patients with SNT, and the decision to observe the SNT was made in a total of 46% of patients (p = 0.001). The therapeutic approach depends on the location of the SNT and the presence of factors that raise suspicion of neoplastic proliferation.

Medical error in treatment of Amanita phalloides poisoning in pre-hospital care.

BACKGROUND: Geopolitical and climate changes form the background of the current migration crisis. It has many faces. One of them are the tragic cases of poisoning of refugees due to eating wild forest mushrooms for socioeconomic reasons in the Western and Northern European countries. The most serious food poisonings in Europe, but not only, are caused by lamellar mushrooms, the most dangerous being Amanita phalloides. Its poisonous properties can be attributed to α-amanitin, an RNA polymerase II inhibitor. Unfortunately, as it is characterized by a delayed onset of symptoms, A. phalloides poisoning has a high risk of complications. CASE PRESENTATION: Our article presents a case of A. phalloides poisoning in a 28-year-old man, in which the responding medical emergency unit made errors in diagnosis and treatment. Since the correct diagnosis was made too late, the typical treatment of A. phalloides poisoning was ineffective. The patient suffered a life-threatening liver failure and needed liver transplant from a deceased donor. CONCLUSIONS: Mushroom poisoning is a particularly important problem not only in countries with a mushroom picking tradition, but also-due to the inflow of refugees-in countries where mushroom poisoning was very rare until recently. In such cases it is crucial to quickly implement the correct procedure, as this can prevent the need for liver transplant or even death. This is a particularly important consideration for the first medical professionals to contact the patient, especially in cases where the patient reports mushrooms consumption and presents alarming symptoms of the gastrointestinal tract. Such situations cannot be underestimated and ignored.

Oral form of auto-brewery syndrome.

Although previous cases of ethyl alcohol production by microorganisms present in the intestines, referred to as auto-brewery syndrome (ABS), have been reported, a recent case in our practice was characterized by the production of alcohol in the oral cavity. Our research indicates that legally significant levels of ethyl alcohol can be detected in exhaled air in cases where there has been no alcohol consumption but where the subject has oral candidiasis. In such cases, following the consumption of foods containing carbohydrates, a fermentation process occurs in the mouth, the first stage of which is glycolysis, proceeding according to the Embden-Meyerhof-Parnas pathway, which is typical in eukaryotes. The main organic substrate in this case is glucose, which is formed in the oral cavity from disaccharides (maltose, sucrose) by the activity of α-amylase. Some mutated fungal strains of the genus Candida acquire the ability to break down sucrose and produce glucoamylase. Glucose is converted into glyceraldehyde 3-phosphate and then into pyruvate. The next stage of fermentation is the decarboxylation of pyruvate into acetaldehyde, a reaction catalyzed by pyruvate decarboxylase. The final stage is the reduction of acetaldehyde to ethanol by alcohol dehydrogenase. Such endogenous production of alcohol can be confused with its consumption, which can cause not only legal, but also social and medical problems.

The age profile of court-appointed physicians in Poland. Status at the end of 2021. / Profil wiekowy lekarzy bieglych sadowych w Polsce. Stan na koniec 2021.

The problems with obtaining expert opinions from court-appointed physicians in Poland have been known for a long time and are well-diagnosed. The reasons for this state of affairs are: an overall insufficient number of physicians compared to the general needs, uncompetitive remuneration levels, and the difficulty of reconciling professional and court-appointed expert duties, while taking into consideration the availability expected of experts. The ongoing generational transition may further exacerbate these problems. The purpose of this study was to investigate the latter phenomenon by comparing the age profile of court-appointed physicians with that of physicians in general. Information on the age of court-appointed physicians was obtained from the presidents of regional courts and the Central Register of Physicians, while general statistics on physicians were also acquired from the latter. Research allowed us to formulate the following conclusions: only 0.8% of all physicians in Poland serve a court-appointed expert function. Almost two-thirds of court-appointed physicians belong to the Baby Boomer generation (born in 1946-1964), nearly one-third to Generation X (1965-1980), and only one-sixteenth (6.10%) to Generation Y (1981-1996), or Millennials. The results obtained, as well as data from the literature, suggest that the current bad state of affairs regarding access to the opinions of court-appointed physicians will further deteriorate in the coming years due to generational changes, i.e., the replacement of Baby Boomers and Generation X, currently dominant among court-appointed experts, by Generation Y, i.e., Millennials, with a different attitude to life.

Suicide committed by a paramedic using a cocktail of drugs: Morphine, etomidate, diazepam and rocuronium. Case report and review of literature.

Suicide is still an important issue in developed countries. The problem affects all age groups and both sexes, although usually more commonly middle-aged men. Attempted suicides committed by taking drugs ended in death are rare (regardless of gender, age, social group) except among health professionals who have easy access to medications and the knowledge of their use. This paper describes a case of a paramedic's suicide and discusses the literature on the issue of suicides in terms of statistics. The paramedic, who is the subject of this case story suffered from depression and alcohol dependence and committed suicide at work using the medicines available in the Medical Air Rescue service: morphine, diazepam, etomidate and rocuronium. Toxicological studies revealed that the man had also been taking sertraline, a commonly used antidepressant. The reasons for suicide among healthcare professionals are the same as for the general population; however, given the extremely high work-related stress and easy availability of drugs that can be effectively used to commit suicide, a special approach to the issue is necessary.

Black powder handgun shots-Cases analysis and literature review.

Black powder weapons are rarely used in countries where access to firearms is easy. Poland has a fairly restrictive law regarding possession of firearms but under the Weapons and Munitions Act of May 21, 1999, as further amended, the possession of black powder weapons using separate loaded ammunition and manufactured before 1885, or replicas thereof, is legal without a permit. When the amendment was introduced, forensic pathologists anticipated a rush of cases involving such weapons, mainly suicides, but also accidents and homicides, but in our own practice in Lodz over the past 10 years (2010-2019) we have encountered only 7 such cases. Although the number is not particularly high, it does nevertheless account for nearly one-fifth of all gunshot deaths in the area. The aim of this paper is to present a series of deaths involving the use of black powder handguns. In analyzed cases, the victims were mostly men, they were sober, and their manner of death was suicide. As far as age was concerned, no regularity was found. All black powder handgun shots were characteristic enough in comparison with those from conventional firearms that they could be identified easily-the entrance wounds were larger than usual, there was a lot of gunpowder around them and in the wound canal, the bone fractures were extensive. Analysis of the literature and of our own material indicates that easy availability is not the only factor affecting the choice of a weapon; ease of use and reliability are also important.

The notion of grievous bodily harm and the legal obligation to notify law enforcement authorities.

The obligation of physicians and other health professionals under Art. 240 § 1 of the Criminal Code instructs them to notify the law enforcement authority responsible for prosecuting crimes (in particular the Police or public prosecutor's office) when prohibited acts are committed, attempted, or prepared. The list of such acts is enumerative, indicating the numbers of the relevant articles and paragraphs. On 13th July 2017 Art. 156 of the Criminal Code extended the list, adding grievous bodily harm as a prohibited act. Accordingly, this act introduced the legal obligation of denunciation, which outweighs medical privacy in such situations. As it can be difficult for a clinician to identify which injuries meet the criteria of grievous bodily harm, the authors of the paper have described in detail all of its forms with specific examples, since failure to comply with that obligation is punishable by up to three years of deprivation of liberty.

Helium suicide - A suffocation or a barotrauma?

Helium is a chemically inert gas present in atmospheric air that is used in various branches of industry and in medicine. In the case of its improper use, various complications may occur, affecting mainly the respiratory tract and, in extreme cases, even result in death. Helium has also been used for committing suicide. Helium suicide is a method that does not leave characteristic macro- and microscopic post-mortem changes. A large amount of information on how to commit suicide with the use of helium can be found on the internet, which contributes to the popularization of this method in the world. In the case of incompetent use of the equipment theoretically dedicated to such suicide, death may occur not because of the suffocation, which is the most common mechanism in such cases, but because of a pressure injury of the respiratory tract, resulting in rapid damage to the alveoli in the rupture mechanism, causing massive bleeding. Helium dissipates quickly in the ambient air, and usually, its presence cannot be detected either in the blood or in the tissues. Thus, even if the material for toxicological tests is handled properly, detection of the presence of helium in a relatively short period of time after death is usually impossible or very difficult. If death due to inert gas inhalation is suspected during an autopsy, samples of biological material can be collected to be tested later by gas chromatography combined with mass spectrometry (GC-MS), but the results of the investigations are usually not helpful from the point of view of a forensic pathologist.

Firearm Injury From Hunting .30 Caliber Bullet Passing Through an Intermediate Target (Binoculars): A Reconstruction of Events.

This article presents the results of research relating to the ricocheting of hunting ammunition and the application of these results to the investigation of a specific gunshot death, which occurred during a hunt for boars. The scene and autopsy findings revealed that a bullet had first struck a pair of binoculars around the victim's neck before entering his body. As the investigation proceeded, however, questions were raised as to whether the shot was a direct one or a ricochet. The case was thus referred to forensic medicine experts for their opinion. Experiments were conducted, which demonstrated that, although test ammunition could ricochet, the rebound fragments possessed insufficient kinetic energy to pierce the binoculars. On the basis of the experiments, it was determined that the victim had been killed by a direct shot and that the bullet had pierced the intermediate target of the binoculars before entering his body. The possibility of a ricochet producing the injuries found, that is, the victim being struck with a bullet or fragments rebounding from an obstacle, was considered unlikely.

When genetic tests fail - an attempt to identify victims of gas explosion caused by damage to a high-pressure gas pipeline, with reference to problems related to the retrieval of ante-mortem dental records.

The paper illustrates a difficult case of personal identification of the remains of two construction workers, severely charred and calcined because of very high temperatures caused by an explosion of a high pressure gas pipeline. In both cases, genetic and odontological examinations were conducted for the purpose of victim identification. Genetic tests made it possible to identify the remains of one of the casualties. In the other case, however, identification was impossible on account of complete destruction of the victim's genetic material, which is typical of long-term exposure to extremely high temperatures (similar to cremation). Ultimately, the remains were identified on the basis of odontological examinations following the retrieval of the victim's ante-mortem dental records. The presented case shows that dental examinations can be an alternative to genetic tests and dactyloscopy. Unfortunately, the value of forensic odontology is Poland is still underestimated. The paper also addresses the issue of retrieval of ante-mortem dental records in Poland.

Gunshot Wound in an 18-Year-Old Woman, Inflicted With a Hunting Weapon Through an Obstacle (Mobile Phone): Reconstruction of Events.

The article presents a case of an 18-year-old woman wounded by a shot fired from a distance with a hunting weapon. Because the location of the entrance and exit wounds initially seemed inconsistent with the reports (both wounds were described as "large and irregular in shape") and no photographs documenting the inflicted injuries were taken, the case was referred for an opinion to the Department of Forensic Medicine in Lodz. After a review of the medical records, radiology, the victim's clothing, and performance of an experiment using the gun and ammunition, it was established that the entrance wound was located on the abdomen, and the exit wound was located on the buttock. The initial problems with recognizing the entrance and exit wounds encountered by the surgical team were caused by bullet deformation. Before hitting the body, the projectile pierced a mobile phone that was in the pocket of the woman's jacket, subsequently causing a large atypical secondary entrance wound. The experiment confirmed that, when the projectile passed through an obstacle with consequent deformation, it caused more extensive gunshot wounds, both at the entrance and at the exit, as well as more severe damage to the bones.

Iatrogenic Burns of the Neckline in a Patient with Tetraparesis During Tracheotomy.

The paper presents a case of an atypical iatrogenic complication after tracheotomy analyzed on the basis of the case dossier materials submitted to the authors by the court of justice to prepare a forensic medical opinion concerning the correctness of the medical procedure. A 37-year-old woman was brought by the ambulance service to the hospital with acute respiratory failure due to post-tracheostomy tracheal stenosis. Tracheotomy was performed on an emergency basis. The patient suffered severe burns of the chest and neck. The experts concluded that the most probable cause of the incident was electrocautery-induced ignition of the disinfectant used for cleaning the skin before the surgery. It was established that with correct handling of the procedure, the aforementioned incident should not have taken place. Therefore, it cannot be regarded as a normal complication inherent in the risk associated with the procedure, but as a consequence of a medical error.

Identification of unknown corpses through odontological examination - two case reports.

The presented paper illustrates the significance of dental documentation which played a key role in the process of identification of two unknown male cadavers by means of dental features examination. Efficient operations of the district prosecutor's office, which in both cases provided ante mortem dental documentation of a missing person likely to be the victim, led to double positive identification. In the first presented case dental examination proved to be more effective than genetics and contributed to closure of the identification procedures. In the second case it confirmed identity equally with genetics. In addition, the paper discusses the basic rules of medical records handling and storage.

Special Purpose Short Stop-Type Ammunitions (Hornet, Wasp, Mosquito)-Gelatin Model Investigation.

Short Stop-type .38 Mesko Special revolver ammunitions have been designed for incapacitation of humans without causing serious bodily injuries. Three types of those ammunitions differing in increasing amounts of gunpowder in the shell chamber and, consequently, increasing kinetic energy of the projectiles can be distinguished: Komar (Mosquito), Osa (Wasp), and Szerszen (Hornet), respectively.The aim of this study was to investigate the ballistic features of such projectiles in a gelatin model. Twenty percent gelatin blocks at 10°C were shot at with a caliber .38 ROSSI Special revolver from 5-, 20-, 50-, and 100-cm distances.The deepest penetration was observed in the case of Hornet-type projectiles, which penetrated into the depth of 10 cm even when shot from 100-cm distance.The results of the research demonstrate that none of the projectiles shot at humans from firearms can be regarded as "safe" because the inflicted injuries do not depend solely on the construction of the bullet, but also on the shooting distance. The use of theoretically nonpenetrating Short Stop-type ammunitions at a distance not exceeding 1 m may cause serious injuries, at times even as extensive as those caused by penetrating projectiles.