Aspartic acid racemization of root dentin used for dental age estimation in a Polish population sample.

Precise age determination of unidentified bodies and human remains is one of the essential tasks of forensic science. The aim of this study was to assess the applicability of using the enantiomeric composition of aspartic acid racemization in root and crown dentin for dental age estimation using a Polish population sample. Coronal and root dentin from four teeth groups from the mandible were studied using gas chromatography with mass spectrometry. The results demonstrated a very high correlation between the chronological age and enantiomeric composition in both of the dentin samples. Individual linear equations of root dentin with correlation coefficients between 0.96 and 0.98 and a standard estimation error of ±2.95-4.84 years validated the application of aspartic acid racemization as a significant practical contribution to everyday forensic medical practice. Discrepancies in methodological aspects and modifications that simplify the protocol are presented.

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.

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.

Sudden death due to malignant hyperthermia during general anesthesia.

The authors present a case of malignant hyperthermia. The article discusses the death of a 4-year old boy who appeared to be perfectly healthy and underwent dental treatment under general anesthesia. The procedure went well at the beginning, but suddenly complications developed, such as cardiac rhythm disorders and increased body temperature, subsequently, muscle rigidity appeared. Such symptoms are characteristic for an inherited disease called malignant hyperthermia. Despite professionally performed resuscitation and help of an emergency unit, the patient died.

[Symptomless aspiration of a dental bur in the lower respiratory tract--a case report]. / Bezobjawowa aspiracja wiertla stomatologicznego do dolnych dróg oddechowych--opis przypadku.

In this study, the authors review a case of a man who asymptomatically aspired a dental bur in the lower respiratory tract during dental treatment. Lack of any symptoms of foreign body aspiration erroneously suggested swallowing of the object and its passage to the stomach. This suggestion was not excluded by a control chest radiograph. Further specialist imaging examinations allowed for establishing the definite diagnosis and the patient underwent successful retrieval of the bur using left-sided thoracotomy.

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.

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.

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.