[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.

[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.

[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.

Erroneous administration of vinblastine.

This case describes a series of errors which resulted in an avoidable death of the patient. Upon being presented with the 83-year-old patient and her complaints, the physician in charge attempted to prescribe Vasolastine (a complex preparation used, for example, in treatment of angiopathy, which is administered intramuscularly once a day). Unfortunately he misspelled the name of the medicine as Vinplastyna--a non-existent preparation. When the patient's daughter went to collect the prescription from the pharmacist she was dispensed Vinblastin (vinblastine--a cytostatic medicine used, for example, in treating Hodgkin's disease, non-Hodgkin's lymphoma, chronic lymphatic leukemia and testicular cancer). The visiting community nurses administered a dose of this medicine on seven consecutive days. Upon being given the seventh dose, the patient displayed symptoms of myelophthisis, and was admitted to an Intensive Care Ward, where despite the treatment, she died.

[Autopsy--legal basis (Part I)]. / Sekcja zwlok--podstawy prawne (Czesc I).

This paper discusses the legal basis for performing forensic autopsies, questions involving the appointment of experts to perform them, and principles of reporting their results. Attention is also given to Recommendation R (99) 3 of the Committee of Ministers, Council of Europe, on the harmonization of regulations for medico-legal autopsies approved February 2 1999 at the 658th sitting of ministerial representatives which recommends member-state governments' acceptance of the principles and rules as their internal standard, as well as the setting up of quality-control programs to assure proper introduction of the principles and regulations. Poland however has not--to date--conformed in any way to these recommendations, and according to the European Law Section of the Department of International Cooperation and European Law at the Ministry of Justice "questions" related to the performance of autopsies are in the hands the Ministry of Health".

[Autopsy--legal basis (Part II)]. / Sekcja zwlok--podstawy prawne (Czesc II).

This paper discusses the legal regulation of the performance of anatomico-pathological (clinical), hygienico-administrative (coroner's) and other types of autopsies. It is emphasized that in line with current regulations there is the obligation to perform autopsies on deceased persons in hospitals when the cause of death cannot otherwise be clearly determined, even if there is adequate expression of the individual's (or legal representative's) opposition. It is also pointed out that by current regulation it is no longer necessary to perform autopsies on deceased persons in hospital within 12 hours of their hospital admission. The paper also deals with the problem of autopsies performed at the request of private parties or insurers, by explaining that in the present legal setting there is no possibility of compliance with such requests--in spite of which certain insurers contractually reserve the right, in accidental deaths, to perform autopsies on or view the insured person's remains.

[Accidental intravenous injection of formaldehyde]. / Omylkowe dozylne podanie roztworu formaliny.

BACKGROUND: Formaldehyde can be found in operating theatres where it is used for preservation of biopsied tissues. Several misuse accidents have been described previously.We present a case where formaldehyde was mistakenly injected intravenously. CASE REPORT: A 33-year-old man, scheduled for excision of a knee meniscus under spinal anaesthesia, was to receive an intravenous antibiotic at the end of surgery. The attending anaesthesiologist received a vial of cephazolin, marked with the patient name from a scrub nurse and injected its contents intravenously. Immediately after injection, the patient complained about strong pain at the site of injection and started to cough.The vial was checked again and a piece of meniscus preserved with 4% formaldehyde was found inside. It was intended to be offered to the patient on departure. The possible amount offormaldehyde injected was 400 mg (a lethal dose has been described as 12 g). The patient, despite the lack of cardiorespiratory failure, was intubated, ventilated and dialysed for six hours, and then extubated without further consequences. His biochemical markers remained in the normal range. Based on the case as described, the possible medico-legal consequences of poor organisation and preventive measures are discussed.

[Part II. The use of entomological methods in determination of the time of death -- case presentations]. / Czesc II. Wykorzystanie metod entomologicznych do oceny czasu zgonu -- opis przypadków.

The paper presents two cases, in which medico-legal determination of the time of death was supplemented by entomological studies. In Case 1, the possible time of death was determined by a combination of the method based on the sum of effective temperatures with assessment of species composition of insects found on the body. In Case 2, the method based on sum of effective temperatures was combined with an analysis of the isomegalen diagram. The authors demonstrate problems that may be encountered while determining temperature conditions at the site where the corpse stayed prior to its discovery, as well as the effect of local temperature variability on the results of entomological studies.

[Part I. The use of entomological methods in determination of the time of death -- case presentations]. / Czesc I. Wykorzystanie metod entomologicznych do oceny czasu zgonu -- opis przypadków.

The report presents two cases, in which medico-legal assessment of the time of death was supplemented by entomological studies. In Case 1, where the corpse was completely mummified, insects found on the body allowed for determining that death had occurred 1-1.5 years prior to discovery of the victim, thus making it possible to determine the upper limit of the relevant time range, what could not have been accomplished based solely on medico-legal examinations. In Case 2, where highly advanced postmortem changes rendered precise determination of the time of death by medico-legal methods impossible, and the insect species living on the body suggested that death had occurred approximately 3-6 months prior to discovery of the corpse, non-scientific data demonstrated that death might have occurred not earlier than slightly more than two months before the body was found.

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.

[Cardiovascular diseases in medico-legal opinions on work disability]. / Schorzenia ukladu krazenia w orzecznictwie sadowo-lekarskim dotyczacym niezdolnosci do pracy.

The paper presents the results of a study of cases judged by the District Court in Piotrków Trybunalski in 2004, in which petitioners sought permanent work-disability benefits on grounds of cardiovascular diseases. The largest group of petitioners included those with hypertension, coronary disease and a history of myocardial infarction. The largest percentage of persons judged to be work-disabled were those having suffered a myocardial infarction, but this was true also for individuals with cardiomyopathies, as well as cardiac rhythm and conduction disturbances. Disorders judged to pose the least limitation on the ability to work encompassed non-specific pain in the thoracic cavity, and hypertension.

[A fatal accident due to harvester wheel explosion--a case report]. / Smiertelny wypadek spowodowany eksplozja kola od kombajnu--opis przypadku.

A fatal accident of a 48 year old woman due to harvester wheel explosion has been presented in this paper. A faulty technical condition of the wheel and the fact that it had been pumped to a pressure exceeding the permissible limit was the reason for the explosion. The woman sustained multiorgan injuries and microscopic examination revealed inter-alveolar septa rupture and intra-alveolar haemorrhage and oedema. The microscopic changes of the lungs prove that the shock wave was released during the wheel explosion.

[Changes of the concentration of lipid peroxidation products and thiol groups in rat brains with long-term intoxication with methanol]. / Zmiany stezen produktów peroksydacji lipidów i grup tiolowych w mózgach szczurów w przebiegu przewleklej intoksykacji metanolem.

The aim of this paper was to define the influence of long-term methanol intoxication on the changes of end products of lipid peroxidation, reacting with thiobarbituric acid (TBA-reactive products) and free SH-group concentration in rat brains. The experiment was conducted on male Lewis rats. The experimental groups received a 1-molar methanol solution and the control group received tap water. The animals were killed after 4, 8 and 12 weeks of intoxication and their brains were collected for further examination, which encompassed measurement of the concentration of TBA-reactive products and free SH-groups. The revealed changes of TBA-reactive products and free SH-group concentration were not statistically significant.

[Oxidative stress parameter analysis in rat brains during long-term ethanol intoxication]. / Ocena parametrów stresu oksydacyjnego w mózgach szczurów przewlekle intoksykowanych etanolem.

The aim of this research was to define the influence of long-term ethanol intoxication on the changes in end products of lipid peroxidation, reacting with thiobarbituric acid (TBA-reactive products) and free SH-groups concentrations in rat brains. The experiment was conducted on male Lewis rats. The experimental groups received a 1-molar ethanol solution and the control group received tap water. The animals were killed after 4, 8 and 12 weeks of intoxication and their brains were collected for further examination, encompassing measurement of the concentration of TBA-reactive products and free SH-groups. A statistically significant increase in the concentration of TBA-reactive products in 4th week of intoxication and decrease in the concentration of free SH-groups in 8th and 12th week of intoxication--compared to the control group--was noticed.

[Ex post opinion on work disability in a payment decision case]. / Opiniowanie ex post o niezdolnosci do pracy dla celów rentowych.

This paper describes a case of ex post opinion in the judgement of work disability for purposes of benefit qualification, in which numerous, frequently contradictory disability certifications by KIZ, WKIZ, ZUS physician-certifiers and court medical opinions were issued. Despite the simplicity of her case, a woman underwent 17 examinations in connection with the opinions and certifications. The court, instead of verifying the opinions and clearing up all doubts through questioning legal experts, submitted subsequent opinions as evidence, and ZUS broke the law by issuing work certification in spite of a legally binding court ruling.

Penetration Depth of Projectiles Fired from a Replica of Colt Navy of 1851 in 20% Gelatin Blocks Correlated with Fatal Injuries Assessed in an Autopsy of a 78-Year-Old Man.

Pursuant to the Polish Weapons and Ammunitions Law, muzzle-loading black powder weapons, manufactured before 1885, or their replicas, as well as suitable projectiles, can be possessed legally without registration and special licenses. The aim of the study was to assess the penetration depth of projectiles fired from a black powder weapon, replica of Colt Navy of 1851, in 20% gelatin blocks and to compare the obtained results with the actual injuries found on autopsy of a 78-year-old man who had committed suicide. In the experiments, we used the black powder weapon and ammunitions, as well as gelatin blocks serving as a soft tissue model. We ascertained that solid spherical projectiles fired from black powder weapons cause extensive injuries, especially in the initial segment of the wound canal. Additionally, based on the presence and location of the wad in the wound canal, the distance from which the shot was fired can be determined.

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.

[Sobriety testing in case of lack of cooperation of the examined person--the legal basis of the physician's activities]. / Badanie stanu trzezwosci w przypadku braku wspólpracy osoby badanej--podstawy prawne dzialania lekarza.

The legal aspect of blood sample taking for alcohol concentration from suspicious, uncooperative persons is described in this paper. The Polish law allows for a possibility to take blood samples for alcohol concentration from suspects only by a physician or another skilled medical worker and only when consent is given to the medical procedure. The traffic act makes an exception for cases when the suspects are drivers and the suspicion concerns driving under the influence of alcohol. Taking blood samples is the medical worker' obligation in accordance with the law. The physician can refuse to do this only when the procedure threatens the life or health of the suspect.