Soudni Lekarstvi最新文献

A new law on experts will be in force in the Czech Republic from 1st January 2021. It is an entirely new law that repeals the old law of 1967, which has already been criticized. The new regulations, of course, bring changes to which experts must respond. The main change is the legal right to appoint an expert after meeting the pre-set conditions. It is essential, it is now possible that of the two equally qualified doctors from the two counties, only one has been appointed. Furthermore, it is the appointment of the only administrative body of the managing expert, which will be the Ministry of Justice. It will be mandatory for a medical examiner to pass an attestation exam and have eight years of experience. The certificate will have to be given by the Czech Medical Chamber. The expert opinion will also be able to be in electronic form. Expert institutes, such as universities, will also have to have natural persons as appointed experts. Experts will have to pass an entrance examination, which will have a general part and a special part. The special part will be professional for each field. Current experts will not have to compose a special part, only a general one. The general exam will be based on knowledge of legal regulations in expertise. The structure of the report will be given precisely and in detail. Expert opinions for private entities will need to be detailed. Liability insurance will be mandatory. Although there were other proposals, the rule for forensic autopsy, which still has to be performed by two experts, remains valid. The law provides for severe sanctions for breaches of various duties of an expert. It may be advantageous to apply for the appointment of an expert by the end of 2020.

Study aim: The primary aim is to analyze the relationship between the reasons for reoperation after surgery for acute subdural hematoma and the injury mechanism and secondarily the relationship between the acute subdural hematoma primarily operated on and the area of reoperation.

Methods: Among adult patients operated on for acute subdural hematoma between 2013 and 2017, patients reoperated within 14 days were identified. Injury mechanisms, reasons for reoperation, and reoperated lesion location were studied.

Results: Of 86 patients operated on for acute subdural hematoma, 24 patients were reoperated (27.9%). The main indications for reoperation after uncomplicated falls as injury cause (12 patients) were recurrent/significant residual subdural hematoma (7 patients) and contralateral subdural hematoma (3 cases). In complicated falls (long staircase, 3 patients), the reasons for reoperation were expansive intraparenchymal hematoma or brain contusion. In traffic accidents (4 patients, 3 pedestrians hit by cars), the reason for reoperations was brain contusion (two cases), contralateral intracerebral and subdural hematoma and postoperative epidural hematoma. Injury mechanism was unknown in 5 patients. In 20.8% of reoperations, the reoperated lesion (mainly subdural hematoma) was contralateral to the primary subdural hematoma. Prognosis was worse in reoperated patients.

Conclusions: Recurrent/significant residual subdural hematomas are the most frequent reasons for reoperation after acute subdural hematoma surgery. The reasons for reoperations are related to the mechanism of injury. Simple falls are associated mainly with recurrent/significant residual or contralateral subdural hematomas. In complicated falls or traffic accidents (vigorous injuring force) hemorrhagic injuries of the brain parenchyma prevail.

Uterine rupture in pregnancy belongs to acute conditions in gynaecology and obstetrics. It is a life-threatening complication for both mother and foetus. The occurrence of fatal consequences in developed countries is very rare. The causes of rupture include scarring after the caesarean section, fibroid enucleation, rough curettage, muscular insufficiency in uterine developmental defects, uterine wall damage due to inflammation, uterine hypoplasia, elevated intrauterine pressure during contraction, cephalopelvic disproportion, previous fibroid, prostaglandin or oxytocin administration, etc. This paper aims at the presentation of a 32-year-old woman who died in the 35th week of gestation due to uterine rupture at home despite having been transferred to a medical facility at the terminal stage of life. At the autopsy, a complete rupture of the posterior uterine wall with bleeding into the abdominal cavity and an amniotic sac with a male foetus in the abdominal cavity was found. There were no signs of the effects of violence detected. Histopathological examination revealed no pathological changes in the uterine muscle. The immediate cause of maternal death was a haemorrhagic shock. The autopsy of the foetus revealed signs of asphyxia. The immediate cause of foetal death was intrauterine asphyxia. In this case, forensic expertise ruled out the violent causes of uterine rupture and deaths in terms of mechanical and chemical factors and supported to make a diagnosis of spontaneous rupture.

Investigation of fatal cases of falls from height as well as jumps from height in suicidal ideation makes up an integral part of forensic practice. In Slovakia, a method of suicide by jumping from height is after hanging the second most chosen method of ending life. In about one third of the cases, the influence of addictive substances is determined. The basic mechanism of injury is a sudden deceleration of body movement when hitting a solid surface. Several factors influence the nature, localization, severity, and frequency of injuries. In most cases, there occur multiple injuries to the skeleton and internal organs caused by blunt objects. The authors demonstrate the case of an unusual mechanism of injury in a 55-year-old man who committed suicide by jumping from the seventh floor of a block of flats. A stepped fall from height resulted in the through knee amputation of both legs by hitting posterior thigh area and knee joints on the railing of the terrace of the block of flats on the ground floor level. The body was found in the basement. In contact with the railing, the mans trousers and pants were pulled off. The autopsy determined the immediate cause of death as polytrauma. Additional toxicological-chemical examination of blood and urine samples collected at autopsy revealed ethanol at the concentration within the extent of laboratory error, caffeine, and nicotine in toxicologically insignificant concentrations and traces of acetone. Motivation of mans suicide remains unknown.

It is not easy to characterize a problem patient or bereaved relatives because identifying a patient or his bereaved family as a “problem” is not considered quite ethical. The approached emergency medical service employees and coroner service physicians were asked to complete a specific targeted anonymous survey. 100 % of survey questionnaires were returned. The questionnaire with a request for filling and returning was submitted to forty employees working full-time, twenty of whom were physicians, ten paramedics and ten lower-level healthcare professionals. The questionnaire comprised ten questions aimed at obtaining clear answers to questions about personal experience with problem patients, specifically aggressive patients, and more specifically whether the health care professionals (HCP) has ever felt immediately threatened by a patient in their work, whether they were exposed to verbal or even physical attack in the context of the patients basic diagnosis established during pre-hospital care. Seventy-five percent of respondents answered Yes to Question No. 5: “Have you ever felt threatened by a patient or bereaved relative in your work?” Eighty percent of respondents answered Yes to Question No. 6: “Have you ever been exposed to a verbal attack by a patient or bereaved relative?” Seventy-five percent of them answered Yes to Question No. 7: “Have you ever been exposed to a physical attack by a patient?” The rate of cases in which emergency medical service employees are exposed to verbal or physical attacks is high. The primary experience hypothesis that this happens has been proven as well as the fact that it is a highly topical and therefore unresolved issue that threatens the whole society with its social implications.

We present an autopsy case involving ingestion of methidathion, an organothiophosphate pesticide. A headspace gas chromatography mass spectrometry system was used for screening of volatile compounds. Subsequent toxicological analysis was performed using liquid chromatography tandem mass spectrometry. Xylene and ethylbenzene were detected in stomach contents. We also identified methidathion at concentrations of 3.07 and 2240 µg/ml in femoral venous blood and stomach contents, respectively. We concluded that the victim ingested methidathion insecticide, with an estimated dose of at least 9.2 g.

Alcohol-affected road users - pedestrians or drivers are a significant risk factor for road accidents and injuries. Therefore, the issue of alcohol-related traffic accidents is logically a subject of great attention. However, the statistics results of the General Prosecutor's Office of the Slovak Republic and of the Police Force of the Slovak Republic clearly confirm the fact that in the Slovak Republic the above-mentioned problem of the whole society is not sufficiently eliminated. The legislation implemented since 2011 should therefore lead to more substantial and effective prevention in this area. From the point of view of the current knowledge from the Forensic Medicine Department, the current legislative regulation of the Slovak Republic is still insufficient and will require some changes. It can be assumed that the issue of controlling the influence of alcohol on road users will be a subject of harmonization throughout the European area. The aim of this thesis is to analyse individual aspects of the present state and their epicritical evaluation. Keywords: alcohol - driver - prevention - forensic medicine - legislation.

Spinal subdural hematoma is a rare and potentionally life-threatening condition associated with trauma and other pathological conditions. In this paper we report the autopsy findings of a 64 year old male who was repeatedly hospitalized with traumatic head injuries in the past. In this case spinal subdural hematoma was diagnosed post-mortem and later comfirmed by ante-mortem CT scan revaluation. Keywords: intracranial subdural hematoma - recurrent spinal subdural hematoma - diffuse axonal injury - autopsy findings.

Scientific bloodstain pattern analysis was appeared at the end of the 19th century in Kraków. Nowadays, bloodstain pattern analysis is the forensic science involving analysis of blood traces on the crime scene. One topic is an estimation of the point of origin of given blood spatter. The processes behind the formation of the blood spatter are quite complicated, some simplifications are necessary. For example, the true trajectory of the blood drop is rather the ballistic curve than the line, though the line is often used as a sufficient model of the trajectory. Next, the blood is a non-Newtonian complex fluid, it differs from common fluids like water. Moreover, qualities of the surface are also involved in the formation of the final spatter. Some of these properties of blood must be neglected in order to make the modeling of the formation of the spatter possible. The crucial question is how to determine the angle of impact of the blood drop. The widely used method is the ellipse fitting method which is based on the assumption that the blood drop is ball-shaped and the spatter is chiefly the ellipse-shaped imprint of the falling drop. Other methods are using rather in experiments than in practice. Unfortunately, all these simplifications lead to the increasing uncertainty and, therefore, the point of origin is rather estimated than determined. Selection of an appropriate model of the behavior of the blood drop and estimation of uncertainty of obtained results should be based on related knowledge close to the physics of blood. Keywords: bloodstain pattern analysis - biomechanics.

Authors Poprad, since the establishment of the Department of Forensic Medicine in Poprad in 1991 up to now. As mountainous environment is considered an area above the border of Tatranská magistrálna (a tourist footpath which leads across the High Tatras and partially Western Tatras). The file discusses the causes and mechanisms of death and their causal relationships, shows the nationality, age, gender or place of death of deceased people, amounts of deaths in the months of year and also in the days of week. Some results are shown in the graphs, the percentage results are described in a text. Valuable and complete results were reached only in cases with describe statistically a group of people who died in the mountainous environment of the High and Belianske Tatras for the last 25 years and who were dissected on the Department of Forensic Medicine in complete documentation (and also after autopsy, not every case of death was autopsied). At the same time, the authors describe the system of cooperation between the Department of Forensic medicine and Pathological Anatomy of Health care surveillance Poprad with Mountain rescue components and the Police force of Slovak Republic, operating in the territory of the High and Belianske Tatras. These components help us to gain information about the case, which are not usually known during the first inspection of dead body in a mortuary or at the moment of an autopsy (hikers and climbers are often alone in the mountains, so their accidents are without witnesses).