Soudni Lekarstvi最新文献

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).

Massive progress in developing even more precise imaging modalities influenced all medical branches including the forensic medicine. In forensic anthropology, an inevitable part of forensic medicine itself, the use of all imaging modalities becomes even more important. Despite of acquiring more accurate informations about the deceased, all of them can be used in the process of identification and/or age estimation. X - ray imaging is most commonly used in detecting foreign bodies or various pathological changes of the deceased. Computed tomography, on the other hand, can be very helpful in the process of identification, whereas outcomes of this examination can be used for virtual reconstruction of living objects. Magnetic resonance imaging offers new opportunities in detecting cardiovascular pathological processes or develompental anomalies. Ultrasonography provides promising results in age estimation of living subjects without excessive doses of radiation. Processing the latest information sources available, authors introduce the application examples of X - ray imaging, computed tomography, magnetic resonance imaging and ultrasonography in everyday forensic medicine routine, with particular focusing on forensic anthropology.

After the new Civil Code had come into force, the Compensation Statute lost the efficiency. The injury compensation should not have been provided according medical report with respect to the Compensation Statute but according decency basis. So the Highest Court has accepted the Methodology of compensation. The article deals with the first reflection of the Methodology in the judicature of the Constitutional Court as well as the opinion of the Constitutional Court of the Government Statute which regulates the injury compensation in labour law. The Metodology of compensation is based on the ICF (International Classification of Functioning, Disability and Health), while the Compensation Statute was based on the etiology principe. ICF is a classification of health and health-related domains. As the functioning and disability of an individual occurs in a context, ICF also includes a list of environmental factors. ICF is the WHO framework for measuring health and disability at both individual and population levels.

The aim of the present study is to investigate incidence and seriousness of CPR-associated injuries on a cohort of CPR non-survivors after out-of-hospital cardiac arrest in the Moravian-Silesian region. In total, 80 persons were included in the study within the study period (2012 - 2015). CPR-associated injuries were identified in 75 (93.7 %) persons, multiple injuries were found in 73 persons. Spectrum of identified injuries covered skin injuries of the upper half of the body, head and neck injuries, rare abdominal injuries and very frequent thorax injuries. Sternal fractures were found in 53 (63.3 %) persons. Rib fractures were identified in 59 (73.0 %) persons; rib fractures were usually multiple (mean number of broken ribs was 7.6 per person). Intra-thoracic injuries were diagnosed in 33 (41.2 %) persons - findings of lung contusions and lacerations, transmural heart contusions, hemothorax and hemopericard. The vast majority of identified intra-thoracic injuries were considered clinically relevant (provided the fact that return of spontaneous circulation had been achieved). Intraabdominal injuries (liver and spleen injuries) were identified in 15 (18.7 %) of persons. Vast majority of these injuries was clinically irrelevant. We have found clinically serious injuries (spleen rupture and liver dilacerations) in 3 (3.7 %) persons. Outcomes of our study suggest that CPR-associated injuries are very common, usually multiple, and in some cases they might be even potentially lethal (if return of spontaneous circulation is achieved).Key words: cardiopulmonary resuscitation - cardiac arrest - injuries - autopsy study - sternal and rib fractures.

We present an autopsy case involving benzodiazepines and diphenidine. Quantitative toxicological analysis showed concentrations of 7-aminoflunitrazepam (a flunitrazepam metabolite), 7-aminonimetazepam (a nimetazepam metabolite), chlorpheniramine and diphenidine in femoral blood of 0.086 µg/ml, 0.027 µg/ml, 0.066 µg/ml, and 0.073 µg/ml, respectively. Death was attributed to combined toxicity due to the influence of multiple drug interactions.

Malignant neoplasms represent the second most common cause of death in men and women in the Czech Republic after cardiovascular diseases. The incidence, prevalence and mortality is recorded in the Czech National Cancer Registry. The most recent data available is from 2013, in this year there were 81 541 patients newly diagnosed with cancer and 26 944 people died of cancer. From a long-term perspective, the incidence of neoplasms is increasing and the mortality is decreasing. In the Institute of Forensic Medicine in Brno there were 480 cases of newly reported malignant tumors during the period 2010-2015, which were not known before the autopsy. 71.4 % of these cases were men and 28.6 % were women. In 212 cases the tumor was advanced and was the immediate cause of death. The total number of deadly cases in men was 149, the age average was 66.2 years. The most common malignant tumor leading to death was of bronchi and lungs (39.6 %), large intestine (9.4 %), pancreas (6.7 %), liver (4.7 %), stomach (4 %) and prostatic gland (4 %). In women the total number of deaths resulting from malignant tumor was 63, the age average was 72.6 years. The most common malignant tumor leading to death was of bronchi and lungs (33.3%), ovary (11.1 %), large intestine (9.5 %), gall bladder (6.3 %) and kidney (6.3 %). Some of the autopsy findings are shown on the photographs at the end of the article.

Our case describes an innocuous snowball fight arising into a life-threatening condition. Patient with progressive left-sided abdominal pain was brought by ambulance to the hospital. According to history he was not aware of any trauma, just a snowball fight with his wife 5 days ago. Clinical examination finding was: hint of peritoneal irritation, Kehr´s sign and left-subchondrium palpation pain. The spleen trauma suspicion was high. After clinical examination an ultrasound examination was performed, revealing inhomogeneous structure of the spleen surrounded by hypoechoic collection and free fluid in the pelvic area. The patient added information about the possible trauma - it was not an ordinary snowball, but a piece of ice about 40cm. Computed tomography was subsequently performed, with the findings: spleen laceration, intraparenchymal hematoma, subcapsular hematoma and haemoperitoneum. The patient was urgently transferred to the operating room and splenectomy was performed. The intraoperatively findings corresponded to the imaging methods and the amount of blood and clots in the abdominal cavity was approximately 1000ml. The post-operative condition and rehabilitation was uncomplicated and one week after splenectomy the patient was released from hospital, with no subjective difficulties. This case shows spleen susceptibility to injury, even in trauma which can be considered not so severe at the first sight. It is important to correlate clinical and imaging methods findings and check the patient´s condition over a longer period, if necessary.

The authors present a case of a complex suicide of a 60-year-old woman found dead on her bed. A blank pistol Umarex caliber 9-mm, several blank cartridges and a lot of drug packages were discovered near the body. The woman suffered from a psychiatric depression. There were three gunshot wounds on the body: in the right temporal region, on the palatum of the mouth and on the left chest wall. The gunshot wounds in the right temporal region and in the mouth had central circle defects with the margins of stellate or star-like appearance and blackening. In the right temporal region the temporal muscle was contused but skull and intracranial tissues were without any injury. On the palatum of the mouth there was neither facial skeleton nor skull injury. The numerous small tears of lips and contusions of buccal mucosa were observed. On the left chest wall there was an abrasion with a bruise on the skin and contusion of thoracic muscles. Neither ribs nor intrathoracic organs were inflicted. At autopsy blood in the amount of 600 ml and a few tablets were found in the stomach as well as an insignificant blood aspiration into lungs. In spite of the fact that all the gunshot wounds were caused by shots fired at contact range they were not lethal. The woman died of lethal intoxication with tramadol and dibenzepin. Although this report differs from the ones published in literature, the authors believe that can contribute to the issue of gunshot wounds caused by gas weapons.