[Tragedy in the Valley Jaworowa: incredible coincidence or perfect murder?]

The paper presents the case of an unexplained and the most mysterious death in the history of Polish Tatra tourism. It concerns three people of different ages and occurred on August 3, 1925 in the Valley of Jaworowa. Kazimierz Kasznica, his son Waclaw Kasznica and a newly discovered mountaineer Ryszard Wasserberger died suddenly for unknown reasons in 15 minutes during a mountain trek. This story is interesting due to the mysterious, simultaneous death of three people of different ages and due to the fact that Waleria Kasznica - the wife of Kazimierz and the mother of Waclaw Kasznica survived the journey. KEY WORDS.

Incorrect declaration of death by a physician - a case report

Incorrect declaration of death is not a frequent situation in medico-legal reports, and such cases are usually of great interest. In this study the authors present a case of improper declaration of death by a physician, despite the absence of early definitive signs of death and without a full medical examination. However, the investigation of the case was dropped, and the conduct of the physician was not assessed by experts.

Medical immobilization as impairment of bodily organ functions within the meaning of the Polish Penal Code - consultative problems and a proposal for a method of judicial and medical evaluation.

AIM OF THE STUDY: The aim of the paper is analysis of the impact of immobilization treatment of "less severe" motor organ injuries affecting soft tissues on the position of medical experts and court decisions in crimes against health. We also analysed the attitude of courts to expert opinions and present a proposal for a model of judicial and medical opinion in such cases. MATERIAL AND METHODS: In the study, we analysed judgments of the criminal divisions of common courts, in which the use of medical immobilization of a given part of the body or lack thereof could have an impact on the degree of health impairment determined by the medical expert. RESULTS: Some experts consider medical immobilization to be tantamount to an impairment of the function of a body organ, and the courts rarely reject such opinions. For some experts, the key is not the actual function of the immobilized part of the musculoskeletal system after 7 days from injury, but the immobilization treatment itself, and not the time it takes. In addition, experts determine the severity of injuries when immobilization is/is not used. CONCLUSIONS: The degree of health impairment, as defined in the Penal Code, should be determined by a medical check-up carried out 7 days after the injury, with an assessment of its "biological" effects, and not by the use of immobilization treatment and the time for which it is maintained.

[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.

Difficulties involved in the formulation of forensic opinions in cases of severe injuries to the facial and cerebral parts of the skull due to punching. / Trudnosci opiniodawcze zwiazane z ciezkimi obrazeniami czesci twarzowej i mózgowej czaszki powstalymi w wyniku uderzenia piescia.

Aim: Comparison of injuries to the facial and cerebral parts of the skull causing death and grievous bodily harm, resulting solely from punches to the facial area of the skull. Assessment and confrontation of both groups in terms of the final criminal-legal classification of the perpetrator's acts. Review of reasons for court judgements with a focus on the subjective elements of the prohibited act. Attempt to verify the hypothesis assuming that death or grievous bodily harm can be caused by a single punch to the facial part of the skull. Material and methods: Final judgements passed by criminal divisions of common courts of law in cases where death or grievous bodily harm was caused by injuries to the facial and cerebral parts of the skull resulting solely from punches to the facial area of the skull. Assessment of individual cases within each group to determine similarities and differences. Comparative analysis of both groups. Results: The cause of death in cases involving injuries to the facial part of the skull was rapid suffocation following blood aspiration into the respiratory tract. However, the criminal-legal classification of the perpetrators' actions in these cases was varied. In one case, death resulted from injuries to the cerebral part of the skull, which are extremely rare as a result of a punch to the facial area within the skull. Grievous bodily harm was due to the loss of vision in the eye, typically due to eyeball rupture. Conclusions: Even though the circumstances of the injuries were similar, different mechanisms were responsible for causing death and grievous bodily harm in the victims. The most severe consequences (death and grievous bodily harm) were not caused by injuries of the same type in any of the cases studied. A single punch to the facial part of the skull may be enough to lead to either grievous bodily harm or death, but the criminal-legal assessment of punching to the face can vary greatly.

[Fatal airgun shot]. / Smiertelny postrzal z broni pneumatycznej.

The authors present a case of an airgun shot. The airgun Magnum Sport 4.5 mm uses wasp-waist Diabolo style pellets. The initial velocity is 260-290 m/s. This type of guns does not need registration because the energy of the bullet is less than 17 J. In the presented case, the airgun shot could have been an accident occurring while playing with the airgun or else it could have been be feigned. The accused maintained that the victim himself had placed the gun in the subclavicular area and keeping the weapon almost vertically, released the trigger. The victim had not been aware the airgun was loaded (the pellet was left in the gun after the previous play). During autopsy, bluish-red, scanty liver mortis and a rounded wound with a fairly even margin situated in the neck was described. The track of the bullet was traced and found to penetrate the mediastinum. Having dissected the aortic arch and large arteries branching off the aortic arch, the examiner found a full-thickness V-shaped injury involving the left subclavian artery, with each arm of the V-shaped damage approximately 3 mm long. In the tunica adventitia of the vessel, profuse dark cherry-red, shiny sugillation was noted. The length of the pellet track from the skin to the subclavian artery was approximately 5-6 cm.

[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.

[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.

Fatal intoxication with new synthetic cannabinoids AMB-FUBINACA and EMB-FUBINACA.

Introduction: Synthetic cannabinoids are currently the largest group of new psychoactive substances. Those that have been subjected to legal control are replaced by newer uncontrolled substances, which causes constant and dynamic changes to the drug market. Some of the most recent synthetic cannabinoids that have appeared on the "legal highs" market are AMB-FUBINACA and EMB-FUBINACA. Case history: A 27-year-old man was found dead on a bed in an apartment. At autopsy, congestion of internal organs, pulmonary oedema and left-sided pleural adhesions were found. The medical examiner concluded that the man died due to acute respiratory failure. The autopsy materials (blood, urine, liver, kidney, stomach, intestine, lung and brain) were collected for further toxicological analyses. Methods: The synthetic cannabinoids AMB-FUBINACA and EMB-FUBINACA were isolated from autopsy materials by precipitation with acetonitrile. The quantitative analyses were carried out by LC-MS/MS. Results: AMB-FUBINACA and EMB-FUBINACA were detected and quantified in all post-mortem materials except the blood. The determined concentrations of these compounds in solid tissues were in the range of 0.2-0.9 ng/g and 0.2-3.5 ng/g. The highest concentrations of AMB-FUBINACA and EMB-FUBINACA were revealed in the stomach content (5.8 and 36.2 ng/mL, respectively). Discussion: The presented case demonstrates that even in cases of fatalities, it is possible that the parent substance will not be present in the blood, while being present in other autopsy materials. The determined concentrations of the compounds may indicate oral administration of synthetic cannabinoids. It can also be assumed that AMB-FUBINACA and EMB-FUBINACA probably contributed to death. Conclusion: The presented case shows that synthetic cannabinoids can be undetected in the blood of even seriously or fatally intoxicated people. This situation means that the analysis of only blood samples may not confirm poisoning. The presented case also suggests that AMB-FUBINACA and EMB-FUBINACA use is dangerous to health and may lead to fatal intoxication.

Medicolegal assessment in cases of zygomatico-maxillo-orbital fractures and isolated orbital floor fractures in criminal cases

AIM OF THE STUDY: The aim of the study was to evaluate the prevalence of effects equivalent to moderate and severe impairment to health within the meaning of the Penal Code in patients with zygomatico-maxillo-orbital fractures and isolated orbital floor fractures. In addition, the study addressed the possibilities of applying the presented results in the preparation of medicolegal opinions in cases provided for in Articles 158 and 160 of the PC with respect to evaluating the plausibility of inflicting such bodily injuries and causing moderate and severe health impairment. MATERIAL AND METHODS: The study covered a total of 124 patients operated on in the then Clinic of Cranio-Maxillofacial Surgery, Medical Academy of Lodz, in 1996-2001, because of fractures involving the inferior orbital wall including zygomatico-maxillo-orbital fractures (95 cases) and isolated orbital floor fractures (29 cases). The group was analyzed in a statistical and descriptive manner. RESULTS: All the study patients (100%) with both types of fractures involving the inferior orbital wall exhibit symptoms and disorders which, pursuant to the PC, would constitute at least moderate, or possibly even severe, impairment to health. CONCLUSIONS: Punches or kicks to the orbital region create a real danger of causing both types of orbital fracture under study, and resulting in at least moderate health impairment.

[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.

[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.

[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.

[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.

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.

[Iatrogenic injury of the trachea--a case report]. / Jatrogenne uszkodzenie tchawicy--opis przypadku.

The case of iatrogenic trachea injury during endotracheal intubation is reported in this article. The case concerns a 36 years old woman, with diagnosed DIC resulting from postpartum complications. Injury of the brachiocephalic trunk and the tracheoarterial fistula were found during autopsy. The authors considered the time and the mechanism of both injuries.