Links between alcohol and external causes of deaths in males: an autopsy study.

OBJECTIVES: This study aimed to analyse deaths due to external causes in males in northwest Slovakia. STUDY DESIGN: This was a cross-sectional autopsy study. METHODS: The autopsy registry provided information on fatalities in males in northwest Slovakia due to external causes in 2015. Data were analysed by age, cause of death and blood alcohol concentration (BAC), and the contribution to overall mortality was calculated. RESULTS: From a total of 305 fatalities, the dominant cause of death was unintentional (other than traffic; 56.7%), followed by intentional (26.6%) and traffic (16.7%). A BAC of ≥0.5 g/kg was found in 43.9% of deaths. Lower levels of BACs (0.5-1.9 g/kg) were observed in relatively high proportions among the younger (aged ≤34 years) and older (aged ≥65 years) males (17.9% and 14.0%, respectively), as well as in the traffic and intentional injury cause of death categories (23.5% and 19.8%, respectively). Male deaths due to external causes had a 6.2% contribution to overall mortality in northwest Slovakia. CONCLUSIONS: Alcohol intoxication frequently co-occurs with fatalities from external causes, including at lower BACs, indicating the harmful role of alcohol at all concentrations.

Significance of transcriptionally-active high-risk human papillomavirus in sinonasal squamous cell carcinoma: Case series and a meta-analysis.

Sinonasal cancers represent a highly heterogeneous group of head and neck cancers, for which etiological and prognostic significance of high-risk human papillomavirus (HPV) infections has not yet been conclusively established. We investigated the presence of transcriptionally-active high-risk HPV in a series of 34 sinonasal squamous cell cancer (SNSCC) cases and evaluated the effect of transcriptionally-active HPV on the overall survival. In addition, we performed a meta-analysis of previously published studies, including this study, to summarize the prevalence of HPV positivity across histological subtypes of SNSCC. The presence of transcriptionally-active HPV was detected by HPV mRNA using the polymerase chain reaction (PCR) or in situ hybridization (ISH). p16 expression was evaluated as a surrogate marker for transcriptionally-active HPV infection by immunohistochemistry (IHC), the presence of high-risk HPV DNA was tested by PCR and the HPV genotypes were determined by sequencing of PCR amplicons. Transcriptionally-active HPV infections were found in ~25% of the SNSCC cases. The role of HPV infection in keratinizing SNSCC may be higher than previously reported (~32% in our study vs. ~0-6.3% in all other studies). Patients with transcriptionally-active HPV-positive SNSCCs were more likely to be diagnosed at earlier stages (p<0.05) and displayed better mean overall survival, although the difference between HPV-positive and HPV-negative groups was not statistically significant. In contrast to other non-oropharyngeal squamous cell carcinomas (non-OPSCCs) of the head and neck, in SNSCCs, p16/IHC and p16/IHC+HPV DNA displayed high specificity as surrogate markers of transcriptionally-active HPV infections. However, p16/IHC may have significantly lower sensitivity as a surrogate marker of transcriptionally-active HPV in SNSCCs compared to OPSCCs. Furthermore, in our group of SNSCCs, all cases positive for high-risk HPV DNA by PCR were also transcriptionally-active (causative) infections with positive HPV mRNA by ISH. Our results imply a possible different role of HPV-mediated carcinogenesis of squamous cell epithelium in oropharyngeal and sinonasal sites with the latter displaying a lower proportion of causative HPV infections; nevertheless, most cases positive for high-risk HPV DNA, p16/IHC or combination thereof were also found positive for transcriptionally-active HPV. The prognostic significance of HPV status in SNSCCs remains inconclusive and future studies should investigate the presence of transcriptionally-active HPV by direct HPV testing.

Human papillomavirus and Epstein-Barr virus in nasopharyngeal carcinoma in a non-endemic eastern european population.

Nasopharyngeal carcinoma (NPC) is a rare malignancy in the Czech Republic and Slovakia, with the standardized incidence rate of < 1:100000 person-years. Viral status of NPC in these non-endemic Eastern European regions is currently unknown. In a retrospective study, we evaluated the presence of EBV and HPV in 62 NPC cases. EBV status was determined by the use of in situ hybridization (ISH) for EBV encoded small RNA 1 (EBER1). HPV status was examined with p16 immunohistochemistry, DNA ISH and DNA polymerase chain reaction. Sixty-one studied cases showed non-keratinizing morphology and one was keratinizing squamous cell carcinoma. Only one NPC with non-keratinizing morphology was scored as p16-positive (nuclear and cytoplasmic staining ≥ 70% of tumor cells). This case was positive for high-risk HPV by ISH and the DNA PCR confirmed the presence of HPV18 type. At the same time, this case was found negative for EBV. Remaining sixty-one cases that were scored as p16-negative were all found HPV-negative by ISH and the DNA PCR. EBV was detected in 85.5% (53/62) of cases and 9 cases were EBV-negative, including the case of keratinizing NPC. In contrast with previous reports on the prevalence of EBV-positivity in Caucasian patients with NPC, the majority of patients coming from this non-endemic region show EBV-positivity; therefore, they may be candidates for novel EBV-targeting therapies. Conversely, HPV-positive NPC is very rare and HPV does not seem to play a significant role in the etiopathogenesis of NPC in these Eastern European populations.

Sebaceous carcinoma of the breast: report of four cases and review of the literature.

Sebaceous carcinoma of the breast is an exceedingly rare neoplasm. Little is known about the behavior and prognosis of this type of breast cancer. We report clinical, histological and immunohistochemical features of four cases of breast carcinoma with prominent (at least 50%) sebaceous differentiation. The tumors occurred in four women, aged 25-66, and were composed of cords, lobules and solid sheets of tumor cells with sebaceous differentiation, comprising 50-90% of the tumor mass. The second component consisted of cells with non-vacuolated cytoplasm, present mostly around the periphery of the lobules, or which formed separate tumor sheets with no evidence of sebaceous differentiation and were indistinguishable from a classical ductal carcinoma. Immunohistochemically, three tumors expressed hormone receptors; all cases were HER2-negative and had retained expression of the DNA mismatch repair proteins. Three patients had axillary lymph node metastases, and two patients had distant metastases: one in the liver, lung and bones, and one in the mediastinal and supraclavicular lymph nodes. One patient died 28 months after diagnosis, indicating that mammary sebaceous carcinoma is a potentially aggressive neoplasm. In contrast to extraocular cutaneous sebaceous carcinomas, mammary sebaceous carcinoma is probably unrelated to Muir-Torre syndrome. It should be differentiated from morphologically similar but biologically distinct lipid-rich carcinoma.

"Surgically created" excision of the back mimicking homicide: report of an unusual case.

Fatalities due to sharp force trauma, with respect to manner of death, may be homicidal, self-inflicted, or accidental in nature. This article presents a case of an unusual sharp force injury inflicted under very specific and seemingly obscured circumstances, initially suggestive of homicidal origin. A 69-year-old, socially isolated male was found dead with a strange, heavily blood-stained excision-like lesion on the right subscapular area. The autopsy confirmed that the wound led to fatal external blood loss. Toxicological analysis of the blood and urine revealed severe alcohol intoxication. The police investigation turned up that the man had suffered from a painful skin furuncle of the right upper back. As he was worried about receiving medical treatment, he voluntarily asked his two acquaintances for "surgical" assistance to remove the skin affection. Based on the circumstances surrounding death and findings at autopsy, it was concluded that the injury was inflicted without the intent to harm or cause death, as a result of simple negligence. Consequently, the manner of death was ultimately certified as an involuntary manslaughter. Our case has clearly illustrated that even highly suspicious and atypically shaped wounds created by sharp-edged instruments with localization in non-accessible body areas does not exclusively indicate homicidal activity, hence, the accidental, suicidal or even iatrogenic origin of the wounding mechanism must be taken into consideration.

[Eminent gynecologists and obstetricians from Klatovy and surroundings]. / Významní gynekologové a porodníci pocházející z Klatovska.

UNLABELLED: Theres hardly any party of Czech Republic (and Im not afraid to say, that it is a rarity worldwide), that became the birthplace of so many personalities involved in building the foundation and development of any medical field, as in the case of Klatovy town and its surrounding and gynecology and obstetrics. During the five decades of the nineteenth century in this region were born five individuals, that still more or less unscientifically developing branch of medicine formed in a modern and progressive perfecting medical discipline. Franz Kiwisch (born 1814 in Klatovy), August Breisky (born 1832 in Klatovy), Karel Pawlík (born 1849 in Klatovy), Václav Rubeska (born 1854 in Chudenice) and Václav Pitha (born 1865 in Polen at Klatovy) are names, that have become known not only in Czech, but also in gynecology worldwide. They were outstanding personalities not only for their medical knowledge and skills, which as respected teachers were able to devolve on their students, but they also excelled extraordinary human qualities. This article is not to be scientific work, my aim was to remind the genius of these doctors and their contribution to the field of gynecology and obstetrics and add some lesser known facts pertaining to their private life. Many materials are not in this article for their scope and format to publish unfortunately, though at least it is worth mentioning, that still remains as school notebook with notes on history written by his own hand, the original school-leaving certificate or even funeral notice of prof. Karel Pawlík, in the contemporary press the interview with prof. Václav Rubeska too. I hope, that the following lines will be a pleasant change among the scientific ones. KEYWORDS: Pawlík, Rubeska, Pitha, Breisky, Kiwisch, Klatovy, origins of gynecology and obstetrics.

Inflammatory pseudotumour of urinary bladder - a rare cause of massive macroscopic haematuria.

PURPOSE: Authors analyzed their experience with urinary bladder tumours. This article discusses clinical and histopathological diagnostics and treatment procedures, and follow up of patients with rare benign urinary bladder tumours. METHODS: 406 patients with bladder tumours were treated in our department between January 2000 and December 2008. 322 patients had superficial tumours and 84 had primary invasive tumours. All patients who underwent transurethral resections of these tumours were operated under general or spinal anaesthesia. The resected specimens were histologically examined in the department of Pathology. RESULTS: 399 of the 406 patients had urothelial bladder cancer, 7 patients had a histologically uncommon type of bladder tumour, one female was diagnosed with sarcomatoid bladder cancer, one patient had a histologically confirmed feochromocytoma of the urinary bladder. Two males had epidermoid carcinoma. One female had a histologically described uncommon benign pseudoneoplastic lesion, chararacteristic for endosalpingiosis. Another two patients were diagnosed with inflammatory myofibroblastic tumour of the urinary bladder. Both patients presented with gross macroscopic haematuria. Authors performed complete transurethral tumour resections, which required several sessions and the deliberation of a blocked ureter through nephrostomy in one case. CONCLUSION: More than 98 % of all treated patients had urothelial bladder cancer in different stages and grades. Two patients had rare benign inflammatory proliferation of the bladder wall which formed large tumorous bleeding masses obstructing the ureter in one case. These types of bladder tumour could be treated conservatively with meticulous long term follow up similarly to patients with bladder cancer (Tab. 1, Fig. 4, Ref. 15). .

The year 1989 and its reflection in the forensic medicine.

The countrys current social and political situation is always reflected in the character of crime through specific laws and encoded rules in the country. This relationship is evident especially in historical turning points - events marking radical changes of the social regime. During the years following 1989, an increase in crime was noticed in the Slovak Republic, which seemed to be influenced not only by ideological and political factors, but also by economical and juridical ones. This increase can be noticed up to the present, as the annual number of violent criminal acts and brutal murders still remains high. Violent crime contributes by 14 percent to the crime counts in the Slovak Republic. The aim of presented study was the comparative analysis of chosen forms of violent crimes and the consequences of the most serious crimes in the Middle Slovakia region during the era of political regime changes within the period from 1985 to 2006.

[Primary and secondary complex suicide. A 30-year retrospective suicide]. / Primární a sekundární kombinovaná sebevrazda: Retrospektivní studie let 1980-2009.

UNLABELLED: Suicides are divided into simple and complex suicides. Complex suicides are further classified as primary (planned) and secondary (unplanned) complex suicides. The term "complex suicide" refers to a suicide in which more than one suicide method is applied. In primary complex suicide several methods of suicide are employed simultaneously (two and more). In secondary complex suicide additional suicide methods are involved after the initial chosen suicide method failed. Authors present a 30-year retrospective study of complex suicides (1989-2009). Of the 2753 finished suicides in the given time period, 66 complex suicides were identified: 15 primary complex suicides and 51 secondary complex suicides. Complex suicides were analyzed in terms of gender, age, methods of suicide, locality and time of suicide, presence of alcohol and of the presence of suicide note and were compared with remaining 2687 cases of simple suicides from the same time period. KEYWORDS: suicide - complex suicide - primary complex suicide - secondary complex suicide - methods of suicides.

[Unattended fatal haemorrhage associated with spontaneous rupture of peripheral varicosity]. / Necekané vykrvácení pri spontánní rupture periferní varikozity.

Crural ulcers are found in 3-5 % of the population, venous ulcers appear in 0,15-2 % of the population. Acute hemorrhage from venous ulcer is a rare complication which can lead to unattended and rapid external blood loss. Herein we present a case of 65-year-old man who was found in the kitchen of his flat in a large pool of blood with blood-tinged simple bandage applied on the right leg. At autopsy was revealed rupture of varicose vein at the base of large venous ulcer leading to fatal haemorrhage.

PTEN mutations as predictive marker for the high-grade endometrial cancer development in slovak women.

Endometrial carcinoma (ECa) is one of the most common neoplasia of the female genital tract. The phosphatase and tensin (PTEN) homolog is the most frequently mutated tumor suppressor gene in endometrial carcinoma. PTEN encodes a phosphatase, a key regulatory enzyme involved in a signal transduction pathway that regulates cell growth, migration and apoptosis. The study evaluates an association between the morphological appearance of endometrial hyperplasia and ECa, and the presence of PTEN variations, PTEN protein´s level and intracellular localization. A total of 67 archived formalin-fixed and paraffin-embedded human biopsy tissue specimens with normal proliferative and secretory endometrium, endometrial hyperplasia without atypia and endometrial atypical hyperplasia, endometrioid the grade G1 and G3 and serous subtype of ECa were evaluated by sequencing for the presence of mutations in coding regions of PTEN gene of endometrial epithelial cells. The PTEN gene expression and intercellular localization of PTEN protein were evaluated immunohistochemically by immunoreactive score (IRS). PTEN mutation spectrum in endometrial carcinoma was identified for Slovak population. 28 non-silent mutations were identified in PTEN, twelve of them were novel, not annotated in Catalogue of Somatic Mutations in Cancer. Higher frequency of PTEN mutations was observed in serous carcinoma compared to global average. No correlation was observed between samples´ IRS, PTEN cellular localization and identified mutations. PTEN sequencing can be beneficial for patients considering prognosis of disease and sensitivity to treatment.

[Breath alcohol analysis]. / Vysetrovanie alkoholu vo vydychovanom vzduchu.

Alcohol in drivers remains a major threat to traffic safety. Forensic breath alcohol measurement remains a prominent tool for on-site detection of the alcohol-impaired drivers thoughout Europe, North America, and Australia (Gullberg, 2005). Despite significant advancements in the technology of detection devices, many challenges still remain, seen from the medical and legal aspects in particular.

[Pohoda no. II (delayed death--following music festival)]. / Pohoda II (smrt' po hudobnom festivale).

A mass tragedy on the Slovak biggest music festival "POHODA", caused by a windstorm, shocked whole society, even abroad. Many questions concerned a causality and a circumstances of the incident arose immediately. The forensic autopsies of victims (29-aged man and 19-aged woman) represented a very special expertise act in police investigation of the case.

[Atypical maxillofacial shot wound]. / Atypické strelné poranenie maxilofaciálnej oblasti.

Maxillofacial shot wounds belong to the relatively less frequent injuries. The soft tissues might be affected in particular, however the most of injuries are combined with infliction of hard tissues. Shot wounds by the bow or crossbow are very rare. They might result as a consequence of either accident or suicide. In the literature some cases of a suicidal experiments had been published, all of these cases were due to arrow from the crossbow. There was no injury being documented due to arrow from the bow. The authors present a case of maxillofacial injury done by shoot of arrow from the bow in the course of a child's play.

[Homicide, suicide or fatal accident?]. / Vrazda, samovrazda alebo náhodný úraz?

A forensic explanation of womandrinker's death is presented in the article. Exsanguination from multiple cut wounds was cause of death. Origin of wounds was unable to explain due to its atypical character and localisation on body surface. Only a subsequent exact allocation of wounding object made clear biomechanical aspects of wounds. A hard ethanol alteration of psychical, senzorical et motorical functions with strong posttraumatic et toxometabolic changes of the body took share on mechanism of death.

The interdisciplinary cooperation of forensic medicine, clinical medicine and palaeozoology: a case of cave bear (Ursus speloeus) bones.

Three pathologically modified bones (cranium, left mandible, iliac bone) of a cave bears (Ursus spelaeus) were found in the Last Glacial deposits (OIS 3) in the caves of the Vel'ká Fatra carst, Slovak republic. Despite of thorough paleontological examination, the bear bones were examined by experts in forensic medicine, traumatology and stomatology, too. The pathological changes were found in the tooth bed on the right side of the maxilla at the place of M1, being interpreted as a result of odontogenic purulent inflammation of soft tissues of tooth bed and surrounding bone. The iliac bone has an abnormally formed acetabulum with damaged and deformed osseous upper border, which could be a result of immoderate pressure of the head of femur, following with the mineral dysbalance (decalcification) or fracture of limbus acetobuli caused by injury. The mutual cooperation of all the abovementioned experts was declared as a very fruitful.

[Benefits of sentinel lymph node examination in early breast carcinoma]. / Prínos vysetrenia sentinelovej uzliny pri vcasnom karcinóme prsníka.

INTRODUCTION: Sentinel lymph node biopsy improves staging of disease, saves the axilla, and significantly reduces the risk of complications. MATERIAL AND METHODS: The authors compare the two groups of surgical treatment of breast cancer patients--after conventional surgery with axillary exenteration with a group of patients with sentinel node biopsy using gamma probe with limited power. RESULTS: In group of 42 patients after axillary exenteration authors observed: hematoma in 2 patients, 1 postoperative bleeding that need for surgical revision, 2 patients had paresthesia and 1 patient had lymphedema, which represents 11.5% of complications. In the group of 54 patients after limited exercise with the use of sentinel biopsy and gamma probe authors reported only one complication--an infected surgical wound seroma in the axilla (1.8% complications). CONCLUSION: Examination of sentinel node biopsy in combination with exact measurement of gamma probe allows friendly operating performance in the axilla and significantly reduces the incidence of postoperative complications.

Hysteretic structural changes within five-layered modulated 10M martensite of Ni-Mn-Ga(-Fe).

Modulated structure of Ni-Mn-Ga-based alloys is decisive in their magnetic shape memory (MSM) functionality. However, the precise nature of their five-layered modulated 10M martensite is still an open question. We used x-ray and neutron diffraction experiments on single crystals to investigate structural changes within 10M-modulated martensite of the Ni50Mn27Ga22Fe1MSM alloy. The modulation vector gradually increases upon cooling from commensurateq= (2/5)g110, whereg110is the reciprocal lattice vector, to incommensurate withqup to pseudo-commensurateq= (3/7)g110. Upon heating, reverse changes are observed with a thermal hysteresis of ≈60 K. The same hysteretic behaviour was detected in the electrical resistivity and the effective elastic modulus. Scanning electron microscopy showed that the changes are accompanied by the refinement of thea/blaminate. These observations indicate that the commensurate state is a metastable form of 10M martensite. Upon cooling, this phase evolves through nanotwinning into a more irregular and more stable incommensurate structure.