Soudni Lekarstvi最新文献

Unlabelled: 83 pacemaker (PM)/14 implantable cardioverter-defibrillator (ICD) autopsied patients, predominantly males, deceased 4.0±3.0/2.8±2.5 years after implantation in hospital. Coronary artery disease was most frequent. Its consequences were more severe in ICD patients. Sclerotic and rheumatic heart changes were present in older PM patients group only. The immediate cause of death was mostly of cardiac etiology. Relatively short implant-death interval should be explained by rather great part of non-cardiac causes of death in hospitalised patients.

Keywords: pacemakers - implantable cardioverter - defibrillators-causes of death - heart pathology - autopsy.

Cannabis consumption has individual influence to cognitive and psychomotor functions of drivers and it has been generally accepted that driving under influence is risky in the perspective of traffic safety. However, rules how to assess fitness to drive are not quite clear. The psychoactive compound delta-9-tetrahydrocannabinol (THC) impairs cognition, psychomotor behaviour and driving performance in a dose-related manner approximately. After a single drug dose, THC blood concentration peaks within minutes, before the end of smoking, with a subsequent rapid decrease to the analytical limit of detection. Peak euphoria is delayed compared to THC peak blood concentration and physiological and behavioural effects return to baseline within 3-5 hours. In chronic users, the lipophilic THC accumulates in fat tissues, where its slow redistribution into blood is the rate limiting process in its terminal elimination. In our experimental study we have attempted to contribute to this discussion with results obtained from human volunteers - cannabis consumers in Czech Republic. Aim of our study was to document the time profile of serum THC level in occasional and chronic cannabis users. The observational interval covered the time immediately after the drug consumption (an own cigarette/joint) till 24 hours after. Our preliminary results have shown that in occasional users, THC serum levels cannot be detected already 4 hours after usual cannabis dose, whereas in chronic users measurable THC concentrations in serum persist longer. Moreover, some chronic consumers were practically with permanent THC detection during our observation period and also the chronic users consumed higher THC doses significantly related to doses in occasional ones. Presented results of the experimental study with human volunteers confirm a great individual variability of the kinetic profile of THC in blood due to complicated redistribution. The practical forensic question is how long the psychotropic effects of THC can persist after the last drug dose. In chronic users there are well documented indications of long term adverse effects to neurocognitive functions. THC blood level itself can not directly document the intensity of impairment of a driver. Moreover, the concentration of THC in blood at the time of driving is probably substantially higher than at the time of blood sampling. Therefore due to the prevention of traffic risk, some countries adopted per se traffic legislation based on analytical principle with minimum tolerance to illegal drugs in blood of drivers at driving. Low blood concentrations of THC close to the limit of detection of a specific toxicological method (GC-MS or LC-MS) are justified in an effective traffic legislation.

Our case was a twenty year-old man, who was injured during the military duty with G3 infantry rifle in the training area. An atypical firearm entry wound on the left side of sternum which was 4.5 cm in diameter, and was surrounded by six irregular skin burn wounds by a flash-suppressor and a 0.7 cm diameter firearm exit wound at space on the left midscapular line. Our case emphasizes that the interpretation of properties of these atypical firearm entry wounds need to be carefully assessed by physicians.

Unlabelled: Alcohol accounts for a great amount of deaths per year either due to the acute intoxication or due to the secondary impacts of acute or chronic alcoholism. Commonly, in large amount of such fatal cases blood alcohol concentration is low or absent and fatty liver disease is frequently the only pathological finding detected at the autopsy of alcohol consumer. We offer a short case report of a case with the following analysis of why we decided to consider alcoholic ketoacidosis in our differential diagnosis.

Keywords: metabolic disturbance - alcoholic ketoacidosis - chronic alcoholism - sudden death.

Unlabelled: Our present study was aimed to investigate time-profile kinetics of interleukins, vascular endothelial growth factor (VEGF) in acute inflammatory response following traumatic brain injury, and the influence of activated microglial cells in patients who developed severe space occupying lesion (SOL) of secondary traumatic brain injury. Interleukins IL-6, monocyte chemo attractant protein (MCP-1), and VEGF had a significant different time-profile kinetics (p<0.05) in patient with, and without expansive traumatic brain contusions (SOL). The serum VEGF was significantly higher in trauma patients with uncomplicated brain contusions, and lower in patients with SOL. The patients with septic complications developed the sudden increase of TNF alpha and IL-8 within the first 72 hours. Our data suggested PSGL and CD68 immunopositivity of microglial cells in both focal and diffuse TBI, predominantly in perivascular space correlated with telolysosome formation in cytoplasma. Polymorphism of PAI-1, MTHFR, eNOS, VEGF, and Apo E genes in TBI were in patients with SOL were bound to show up leucocyte plugging in capillaries.

Keywords: traumatic brain injury - acute inflammatory response - microglial cells - interleukins - vascular endothelial growth factor - monocyte chemoattractant protein - gene polymorphisms.

Here we report about a case of malathion (an organophosphate insecticide) ingestion. Headspace analysis of stomach content provided useful information for screening of toxic chemicals. We should pay attention to solvents used in commercial industrial products.

In this article we focus on the effects of so called non-lethal ammunition. We studied possible mechanism of firearm injury formation as a consequence of using firearm on the body, to present a more comprehensive material in wound ballistics. We pointed out possible actions of a projectile causes on human, respectively other animal organisms, as well as to a manner in which an injury is caused by rifles or shotguns using non-lethal ammunition with rubber projectiles. In the experiment, we have focused on macroscopic analysis of the tissue penetrated by a rubber projectile fired from a long firearm and pump-action shotgun while focusing on the anatomical-morphological analysis of entry wounds to determine the effectiveness respectively, the wounding potential of the projectile. The results of the experiment based on the macroscopic analysis of entry wounds, cavities and exit wounds, show that when a rubber projectile penetrates the body it causes loss of the tissue (i.e. the minus effect) and mechanical disruption of the tissue similar to lethal projectile. Based on the measures and ballistic computations we concluded that in specific cases, like for example in a close range hit, a penetration of vital organs can cause serious or even lethal injuries.

Vertebral artery aneurysm rupture is a rare cause of sudden death. The presented case was 31-year-old woman who was found dead in her bedroom. Family members stated that she had history of one year duration childhood epilepsy treatment. Autopsy investigation revealed 5 mm in diameter aneurysm, ruptured in 1 mm area, localized on the trunk of the right vertebral artery. We described an autopsy case of sudden unexpected death due to ruptured vertebral artery aneurysm.

Aortic arch blunt injury has highly lethal nature. Because the physical examination findings are subtle, immediate medical evaluation is very important. The case was a 72-year-old woman. Massive haemorrhage in the left haemotorax, contusion area in the left lung and a traumatic transection of the distal aortic arch was observed during autopsy. We described intersting autopsy case of aortic arch blunt injury.

Tracheo-brachiocephalic artery fistulas were rarely reported lesions often described in cases with tracheostomy procedures. Reported case was 26 year-old male drainage worker, trapped under the stony soil while excavating drainage canal. Rescue operation was performed, but he was reached dead. Provincial prosecutor mandated autopsy after crime scene investigation. Autopsy examination revealed traumatically formed tracheo-brachiocephalic fistula. We aimed to report an intersting case of traumatic tracheo-brachiocephalic artery fistula identified in forensic autopsy.