An Unplanned Complex Suicide by Multiple Blank Cartridge Gunshots and Cutting.

Blank firing guns are readily accessible in most countries due to an absence of legal regulations. These weapons are capable of causing lethal injuries. We report a rare case of secondary (unplanned) complex suicide committed with a knife and blank cartridge pistol. A 59-year-old man was found dead with three superficial incisions in his neck and a gunshot wound to the chest. The external examination revealed an entrance wound in the left chest region consistent with contact shooting. The appearance of a muzzle imprint suggested two discharges. The autopsy showed a slightly hemorrhaged but otherwise intact pericardium, blood in the pericardial sac, and a channel-like defect in the anterior wall of the left cardiac ventricle. The cause of death was attributed to cardiac tamponade. To the best of our knowledge, this is the first reported case of unplanned complex suicide involving an unmodified blank firing gun.

Carbon monoxide-related fatalities: A 60-year single institution experience.

OBJECTIVE: Though carbon monoxide (CO) poisonings account currently for a relatively small percentage of total non-natural deaths in Europe, they represent a serious public health burden and significant component of avoidable mortality in many countries. Our aim was to investigate long-term trends and to determine epidemiologic characteristics of the CO-related deaths in the Czech Republic, recorded at the Department of Forensic Medicine in Hradec Králové. METHODS: This was an autopsy-based single-centre retrospective cohort study of all fatalities caused by CO poisoning over six decades (1947-2006). All data were numerically evaluated and processed using NCSS 10 Statistical Software. Statistical significance was defined as a p-value less than 0.05. RESULTS: A total of 1233 CO-related deaths were identified for inclusion in the study. The manner of death was ranked in order as follows: 45% accidental poisoning, 40% suicidal poisoning, 1% homicidal poisoning, 14% remained undetermined. There were slightly more male victims (59%) than female, and the mean age overall was 48 years. The majority of CO-related fatalities were attributed to coal gas inhalation, with the remainder being from inhaled motor vehicle exhaust fumes, inhaled fire smoke, and other combustion sources such as charcoal, gas and wood-burning appliances. The mean blood carboxyhemoglobin (COHb) level was 66%. A positive blood ethanol concentration was measured in 455 (37%) cases examined. Non-intentional poisonings were highly correlated with the winter months. CONCLUSION: This study shows that the prevalence of CO-related deaths has decreased significantly in the Czech Republic following the widespread detoxification of the domestic gas in the 1990-1995. Our findings suggest that acute ethanol use, poorer socioeconomic position, and inadequate education status about the danger of CO are associated with an increased risk of fatal CO poisoning. Finally, our results demonstrate the continued value of the autopsy in monitoring global public health security issues and socioeconomic situation. Further similar large-scale studies in different populations are needed to improve the targeting of interventions to the groups with the highest level of risk, and to understand the sources of variation in CO-related mortality.

Multiple Giant Coronary Artery Aneurysms: A Rare Cause of Sudden Cardiac Death.

Multiple giant aneurysms involving the coronary arteries are uncommon and rarely reported. In the presented case, a 63-year-old man with poorly controlled hypertension died suddenly. Gross autopsy examination showed multiple giant thrombus-filled coronary artery aneurysms, atherosclerotic coronary artery disease, and cardiomegaly. Histological sections of the coronary aneurysms showed atherosclerotic changes with both organized and fresh thrombus. Giant coronary aneurysm is defined as a segmental enlargement of a coronary artery with a diameter exceeding 20 mm or more. The main etiology of this nebulous entity is attributed to atherosclerosis and inflammatory or inherited connective tissue disorders with the remainder being congenital, infectious, or idiopathic. Before its cataclysmic presentation, when ruptured or thrombosed, giant coronary aneurysm usually has a silent clinical course. Sudden death owing to giant multiple coronary aneurysms is rare and mandates careful classification of the aneurysms and prudent search for autoimmune-mediated or genetically based factors for subsequent ancillary autopsy studies.

[The application of X-ray imaging in forensic medicine]. / Vyuzití RTG vysetrení v soudním lékarství

X-ray is the most common, basic and essential imaging method used in forensic medicine. It serves to display and localize the foreign objects in the body and helps to detect various traumatic and pathological changes. X-ray imaging is valuable in anthropological assessment of an individual. X-ray allows non-invasive evaluation of important findings before the autopsy and thus selection of the optimal strategy for dissection. Basic indications for postmortem X-ray imaging in forensic medicine include gunshot and explosive fatalities (identification and localization of projectiles or other components of ammunition, visualization of secondary missiles), sharp force injuries (air embolism, identification of the weapon) and motor vehicle related deaths. The method is also helpful for complex injury evaluation in abused victims or in persons where abuse is suspected. Finally, X-ray imaging still remains the gold standard method for identification of unknown deceased. With time modern imaging methods, especially computed tomography and magnetic resonance imaging, are more and more applied in forensic medicine. Their application extends possibilities of the visualization the bony structures toward a more detailed imaging of soft tissues and internal organs. The application of modern imaging methods in postmortem body investigation is known as digital or virtual autopsy. At present digital postmortem imaging is considered as a bloodless alternative to the conventional autopsy.

Black esophagus: acute esophageal necrosis in fatal haloperidol intoxication.

Herein, we present a case of 53-year-old psychotic woman with acute esophageal necrosis (black esophagus), who was found lying on the floor in the living room of her flat. Pillboxes of antipsychotic drugs were located in the bin. External examination of the body was unremarkable. On internal examination, we found acute esophageal necrosis. Histologically, there was complete epithelial necrosis with focal involvement of muscularis mucosae, dense infiltrate of leukocytes, and ulcerations without any viable cells. There was no evidence of underlying organic diseases or trauma. Toxicological analysis revealed a fatal blood level of antipsychotics (haloperidol, zotepine, and chlorprothixene). Death of the deceased was attributed to fatal intoxication with three various types of antipsychotics. As far we know, this is the first described association between so-called black esophagus and fatal blood level of neuroleptics.