Soudni Lekarstvi最新文献

The authors deal with a case of a double homicide, the parental murder made by their older son, which was committed by a combination of stabbing and cutting wounds. The perpetra-tor tried to hide the bodies, so he doused them with gasoline and set fire to them on a lonely forest road. Then he ran over the remains by his car. The cause of death was in both cases open wound of the neck - autopsy findings of the woman´s body testified for a blood aspi-ration, on the man´s body it was not clear for a partial charring, so the possibilities were blood aspiration, air embolism or external bleeding with haemorrhagic shock. There were also many other injuries on the bodies, especially of the post-mortem origin. During the combat, one of the victims - the mother - bit the assailant´s left forearm. So a few days after creation the injury on murderer´s left upper extremity, the police technicians took photos and during the forensic autopsies of both bodies, authors created the impressions of the teeth. The utilities were loaned from Department of Stomatology of University Hospital Královské Vinohrady in Prague and they were designed for the general adult population. The work was more difficult for the state of mortal remains, which were damaged by combination of fire and blunt violence. However finally the impressions of each arch were made, and they were given to the experts from Institute of Criminalistic Prague, who compared them with pictures of the bite mark. The results of this analysis were used in a court as evidence against the perpetrator.

Injuries of the upper cervical spine represent 1/3 of all cervical spine injuries and approximately 40 % result by the death. Every level of the cervical spine can be injured - fractures of condyles of the occipital bone (CO), atlantooccipital dislocation (AOD), fractures of the Atlas (C1), atlantoaxial dislocation (AAD) and fractures of the axis (C2). Most of cases in younger patients are caused by high-energy trauma, while by elderly people, because of the osteoporosis, is needed much less energy and even simple falls can cause the injury of the cervical spine. That´s why the etiology of injuries can be different. In younger patients are caused mainly by car accidents, motorcycle and bicycle accidents and pedestrian crashes by car and in elderly populations are the main reason falls. The mechanism of the injury is axial force, hyperflexion, hyperextension, latero-flexion, rotation and combination of all. The basic diagnostic examination is X ray in AP, lateral and transoral projection. But in the most of cases is CT examination necessary and in the suspicion of the ligamentous injury and neurological deterioration must be MRI examination added. Every injury of the upper cervical spine has its own classification. Clinical symptoms can vary from the neck pain, restricted range of motion, antalgic position of the head, injury of the cranial nerves and different neurologic symptoms from the irritation of nerves to quadriplegia. A large percentage of deaths is at the time of the injury. Therapy is divided to conservative treatment, which is indicated in bone injuries with minimal dislocation. In more severe cases, with the dislocation and ligamentous injury, when is high chance of the instability, is indicated the surgical treatment. We can use anterior or posterior approach, make the osteosynthesis, stabilisation and fusion of the spine. Complex fractures and combination of different types of injuries are often present in this part of the spine. Correct and early diagnosis with the best treatment option is necessary for successful result of the cervical spine injuries.

The otoscopy is an examination of the external auditory canal, the eardrum, and the middle ear with an instrument called an otoscope. It is a simple, inexpensive, and time-saving endoscopic method typically used by general practitioners and otorhinolaryngologists. Authors present a prospective study of otoscopic findings investigated consecutively at autopsy. Of the 250 examined persons, 50 positive findings were identified: 38 cases with petechial hemorrhages and 12 cases with tympanic membrane perforation or hemotympanon. Hemorrhages of the tympanic membrane detected through the otoscopy may serve as evidence of congestion within head and neck potentially associated with asphyxiation either in the death or in the living (similar to periorbital and conjuctival petechial hemorrhages). In our study, hemorrhages of the tympanic membrane were related to heart failure, hanging and asphyxiation. Perforated tympanic membrane and hemotympanum have been sporadically reported in victims of fatal lightning strike and rarely in strangulation. This findings were in our study associated with craniocerebral injuries: traffic accidents, falls from height and gunshot injuries. The otoscopy may help to reveal various traumatic and pathological changes within the outer and the middle ear, and, thus, provide important forensic evidence. The otoscopy is also highly recommended in the investigation of the sudden deaths in the young.

Estimation of time since death, i.e. the post-mortem interval (PMI), is one of the most problematic issues in forensic practice. Accurate determination of the PMI still remains very complicated task even for an experienced forensic pathologist.Physical changes including algor, livor and rigor mortis can be observed already during the first hours after death of an individual. Unfortunately, the estimation of PMI on the basis of these changes is often burdened with a certain degree of inaccuracy, which is caused by the temperature of surrounding environment, constitution of the body, cause of the death, location of the body, drug abuse etc.Accurate PMI estimation requires assessment of such parameters, which change constantly from the moment of death, but independently on ambient factors. According to current research in the field of molecular biology, it appears that a post-mortem degradation of nucleic acids (both DNA and RNA) will correspond to this definition.

Reported case was 63 years old forester died suddenly in the village. Autopsy examination revealed massive coagulated haemorrhage filling the right hemithorax, neither free fluid nor blood were observed in the abdominal cavity. Abdominal aortic aneurysm 20x15x15 cm in size was examined. We aimed to report the rare case of abdominal aortic aneurysm presented with transdiafragmatic rupture and bleeding in the right hemithorax.

The study of cases with post mortem blood ethanol concentration of 2.00 g/kg and higher was performed at the Institute of Forensic Medicine in Martin, covering the region of North Slovakia. The aim of the study was to quantify the fatal consequences of acute ethanol administration reflecting in the annual mortality range, establish the causes of death, age and gender distribution of the deceased population, place and time parameters of deaths. The analyzed period was throughout the years 1993-2012.

The authors deal with a case of suicidal attempt resulting in a fatal head injury. A young man shot himself with a serially produced mechanical sports crossbow. The young man with a critical intracranial injury, a penetration, was nevertheless capable of basic locomotive activity, as well as of coherent communication with another people present at the scene. The critically injured patient was transported from the scene directly to medical centre where he subsequently underwent a neurologic surgery. On the eight day after the incident he died in the hospital as a result of sustained wounds. During the autopsy, a penetrating arrow-shot wound head injury was certified, occurring in the right and left temple area. Signs of a complex decompressive craniectomy were established too. The shooting channel was generally horizontally oriented, extending from the right to the left side, from behind in a 10 up to 15 degrees angle to the frontal plane, penetrating the brain from the right temple lobe and the frontal lobe, thereby pervading also frontal horns of lateral ventricles, and from the left afflicting the frontal lobe on the left side of the brain. In the course of the shooting channel, brain contusion occurred, accompanied by intraventricular haemorrhage. In addition, a heavy cerebral oedema, multiple secondary malacias, Durett haemorrhages and extensive thrombosis of cerebral sinuses were stated. In the course of police investigation, based mainly on the information given by the wounded man right after he had been found at the scene, it was revealed that another person might have been involved. The forensic autopsy, the investigation of the Police and the subsequent criminalist-ballistics expert investigation, supported by a series of experimental substitutive target shots, didnt, however, decidedly prove that any other culprit had been involved.

Determination of time of death belongs to the most difficult and also the most important issues for the medical examiners, especially those who deal with violent death. Besides the most frequently evaluated postmortal changes it is sometimes possible to perform the evaluation on the basis of less frequently observed findings. One of such findings is for example the fungal multiplication on the body or in the very close vicinity. Knowledge of moulds as well as information about their speed of growth should contribute to confirmation or negation of some information gained during police investigation. In this case report authors describe the macroscopically visible fungal intracardiac multiplication in heart chambers and aorta in an almost totally carbonised body which was missing for only ten days. Based on the molecular examination it was detected that the body belonged to the 64-year-old man who was repeatedly hospitalised in psychiatry for depression with suicidal tendencies. The last hospitalisation was six weeks before death and there was no organic disability. The cause of fire was a naked flame. The cause of death was burn injury or asphyxia. The almost total carbonisation did not allow to perform toxicological investigation. By histological investigation we found the presence of wide long non-septate moulds growing in the heart muscle, which belonged to the order Mucor. Since there was no obvious inflammatory response, we suppose their growth started on the congealed blood after death.

In the article there is the repeatedly submitted experience detailing how death is a fundamental element of our lives, including by ones own hand - suicide, cases of which forensic pathologists are confronted with every day. The subject of suicide has been treated by the public as taboo, while in reality we are confronted by it every day, particularly in forensic medicine, where we are not only obliged, but also find it our duty to inquire as to the reasons, motivation and other factors that have led someone to take their own life voluntarily. The author was required to investigate the sociogenesis and psychogenesis of suicidal acts, the influence of successive social and cultural changes within society on suicides focusing on the psychiatric-biological, as well as the wider socio-cultural and philosophical connections. All major religions were and continue to be strongly against the act of suicide, which affects any who attempt suicide, but also their relatives. This state of affairs continued to develop until Durkheim, who initially established scientific research of suicides, primarily from a psychologicalsocial viewpoint. Suicide has been the final act of many world-renowned, as well as national, personalities, such as writers, artists, musicians and actors.

Coronary artery anomalies rarely detected in autopsy series and angiograms can be a component of complex malformations, besides, can be also associated with sudden cardiac death. Presented case was 22-year-old male, who had suddenly fainted during a football match played on artificial turf, he was transferred into the hospital, however had died during intensive care therapy. He had been evaluated by local prosecutor, and sent to our center for autopsy. At autopsy, internal macroscopic examination revealed absence of the right coronary artery. A total of two coronary artery ostia were observed. One of them originated from the left aortic sinus, and the other one stemmed from 8 mm above the sinotubular line. Besides, Chiari network formation was seen in the right atrium. This case with coronary artery anomaly associated with formation of Chiari network was discussed from the perspective of forensic medicine in the light of the literature information.