This case report describes a case of fatal intestinal obstruction in a 4-year-old girl caused by malrotation and internal hernia, which led to distortion and necrosis of the small intestine. Although resuscitation was immediately initiated, multiorgan failure and death occurred within hours of the onset of the first symptoms. Autopsy revealed extensive ischemic changes in the small intestine and a congenital mesocolon defect as the cause of the internal hernia. This case highlights the critical importance of considering internal hernias in the differential diagnosis of acute abdomen in pediatric patients and emphasizes the need for prompt surgical intervention. Early recognition and treatment are essential to prevent catastrophic consequences in these rare but life-threatening conditions.
Whole-body post mortem CT angiography (PMCTA) is an innovative and experimental imaging technique that relies heavily on interdisciplinary collaboration, access to skilled personnel, advanced technical equipment and the financial possibilities of the workplace. Native CT examinations (PMCT) prior to autopsy are already a standard procedure in certain forensic departments in the Czech Republic (e.g., murders, suicides, deaths of children, traffic accidents etc.). Nonetheless, the progression of forensic sciences all over the world shows the necessity to integrate other advanced imaging modalities in routine forensic practice. Incorporating PMCTA into standard forensic workflows enhances the precision of forensic diagnostics, supplements traditional autopsy findings, and elevates the objectivity of forensic outputs. This paper presents technical notes on the development of PMCTA in forensic practice in a department that since 2015 until now has routinely performed native CT examinations. Institutional support was crucial in enabling the adoption of the imaging technique, which has so far been applied to more than thirty cases. The department is currently conducting a comparative study focused on the application of three different types of perfusion media - polyethylene glycol (PEG), saline, paraffin oil - and assessing the diagnostic efficacy of PMCTA relative to conventional autopsy. Based on our experience, PMCTA is suitable for all corpses except those with advanced post-mortem decomposition or extensive open injuries. The highest diagnostic yield is achieved in cases involving suspected gastrointestinal bleeding or vascular pathologies and lesions especially of large vessels (e.g., dissection/rupture of the aorta). The protocol for whole-body PMCTA can be adapted to meet the specific needs and conditions of individual forensic departments, providing a flexible yet robust framework for enhancing forensic medical investigations.
Authors describe two cases of intoxications imitating of morphological changes in the brain in this work. Initially it was meant to stem a stroke. Later, it was found that it is an intoxication by Amanita dapple. To this must be meant in practice and at the first contact with the patient.
Previous studies have reported that respiratory infections can cause sudden death in infants. In one report, many infants had mild respiratory infection symptoms before their sudden death. However, we have also seen many cases of sudden death in asymptomatic infants who were diagnosed with respiratory infections based on detailed postmortem examinations. However, no study has investigated the differences between symptomatic death and asymptomatic death in infants with respiratory infections. In the present study, the risk factors for sudden death in infants with asymptomatic antemortem respiratory infections were investigated using forensic autopsy cases in our laboratory. The investigation showed that deaths associated with asymptomatic respiratory infections were relatively more common in infants younger than one year, of normal birth weight, and fed exclusively with formula milk, as well as infants who had fallen asleep within one hour of their last meal. The results reconfirmed that such small daily changes, such as expression and behavior changes, should be carefully observed when managing infants, including those with no apparent health problems.
Fire-related fatalities often result in extensive thermal destruction of human remains, posing significant challenges for forensic analysis. Although soft tissues are generally destroyed during exposure to high temperatures, rare cases may reveal selective internal organ preservation. This case report describes two individuals recovered from a recreational cabin fire in northern Slovakia, where most bodily structures were extensively carbonized and fragmented. Remarkably, the heart exhibited an intact internal morphology despite external carbonization. Macroscopic examination revealed preserved myocardium, distinguishable valve structures and voluminous cooked blood within the cardiac chambers. The pericardial sac and epicardial layer including coronary vasculature were thermally destroyed and thus non-evaluable. The preserved state of this organ, amid widespread anatomical destruction, suggests a thermal buffering mechanism mediated by retained blood and the histomorphological structure of the heart. This case underscores the importance of thoroughly examining severely burned remains, as preserved internal tissues may yield critical insights, contributing to the accurate reconstruction of death circumstances in fire-related fatalities.
The article is focused on the case of the death of a 75-year-old sport pilot who died when a small sport plane crashed into a hangar building. In the autopsy and subsequent toxicological analysis, the presence of cocaine and its metabolites, morphine and oxycodone, was found in the biological material collected. Based on the significant findings during the autopsy, further investigation was conducted and medical reports were submitted with information indicating changes in health for which the deceased pilot was taking opioid analgesics. Furthermore, the authors present the history of drug abuse in aviation abroad and from the experience of aviation accident investigations within the Czech Republic.
INTRODUCTION:Sudden cardiac death due to coronary atherosclerosis remains the most common cause of sudden cardiac death in the adult population. Cases of sudden death from cardiovascular causes are the most common part of autopsy forensic practice. MATERIAL AND METHODOLOGY:The study included 90 cases of sudden cardiac death caused by acute changes in atherosclerotic plaques, which were retrospectively analyzed with a focus on age, sex, seasonal and circadian influences, risk factors for atherosclerosis, type and location of coronary artery occlusion and the presence of external toxicological substances. RESULTS:The group consisted of 63 men (70.0%) and 27 women (30.0%). The average age of the deceased was 70.1 years. Most deaths occurred in the afternoon and evening hours (39.8% in total), and the least surprisingly in the morning hours (8.9%). The most common days of death were Thursday and Friday (37.8% in total). In terms of seasons, the most deaths occurred in the winter months (34.4%). In men, the accumulation of multiple risk factors was evident - 81.0% of men had 4 or more risk factors for atherosclerosis. In women, only 40.7% of women achieved the accumulation of 4 or more risk factors. Coronary artery thrombosis was detected in 55 cases (61.1%), other forms of significant coronary artery occlusion was found in a total of 35 people (38.9%). In terms of localization of the occlusion, the anterior interventricular branch (RIVA) of the left coronary artery was most often affected in both sexes, in a total of 67 people (74.4%). The most common phenomenon was the simultaneous involvement of two coronary arteries (36.7% of cases). CONCLUSION:The authors analysed the morphological findings on the coronary arteries in cases of fatal coronary atherosclerosis with special focus on acute changes in atherosclerotic plaques, anamnestic data of the deceased with an emphasis on risk factors for atherosclerosis, and circadian and seasonal influences on the incidence of fatal coronary atherosclerosis. The study confirmed an increased incidence of acute coronary events in the winter period, on working days and in the home in both sexes. An important accompanying phenomenon was the accumulation of risk factors, especially in men. Another follow-up and larger study will be suitable for an exact evaluation of the identified phenomena.
Neonatal hepatitis is a rare but serious liver disease in infants during the first year of life. The term "neonatal hepatitis" refers to infectious liver damage that develops either in utero or during the first three months after birth. The timing of disease onset varies significantly depending on the etiology and is determined by the gestational period during which the fetus was infected as well as the incubation period. Therefore, in some cases, symptoms may appear almost immediately after birth, and in others - weeks or even months later.
This article describes a method of introducing postmortem CT angiography into daily forensic medicine practice involving cases of limb stab wounds investigated at the Department of Forensic Medicine, University Hospital Ostrava. The essential preparation of the vessels as well as practical tips facilitating the subsequent performance of a classic autopsy are described in detail. Article also includes brief review of published papers dealing with PMCT angiography related issues, advantages which brings CT angiography into forensic routine work, but also its limits and pitfalls.
The forensic physician is often faced with the diagnosis of concussion or mild traumatic brain injury (mTBI). The earlier concept of cerebral concussion as a functional and fully reversible clinical entity must be considered obsolete, as concussion can lead to demonstrable structural changes in the brain. It is therefore recommended that the use of the term 'concussion' be abandoned as soon as possible. However, as these terms are still used in clinical practice in many places and there is no clear criterion to distinguish concussion from mTBI, it is pragmatic to consider these terms as synonyms. The forensic physician typically addresses three issues in the context of mTBI: the diagnosis of the injury, the severity of the injury, and the mechanism and mode of injury. He or she should always consider whether the clinician-diagnosed mTBI actually occurred, and may use consultation with a neurologist to do so. If so, it is always a medical disorder, but it may also be a severe injury. Statistics from the Institute of Health Information and Statistics (IHIS) show that the average period of incapacity for concussion is 39 days for people aged 20-65, which is longer than the previously accepted 2-3 weeks. The average period of incapacity for work for men and women is not statistically different. However, it increases with age, by almost one day for each year of age between 20 and 65 years. Post-concussion syndrome is a relatively common complication of concussion.
Autopsies have played a crucial role in human medicine, forming a key foundation of medical knowledge. These final medical-anatomical procedures remain irreplaceable, shedding light on diagnoses, optimizing treatments, preventing disease spread, educating healthcare professionals, and influencing state jurisdiction. Despite the decline in the number of autopsies performed in recent decades, their medical-social significance remains essentially unchanged. Even today, autopsies contribute indispensably to the advancement of medicine and the benefit of society as a whole. Correspondence address: Veronika Rybárová, MD, PhD Department of Forensic Medicine and Medicolegal Expertise Jessenius Faculty of Medicine, Comenius University in Bratislava University Hospital Kollárova 2, 036 01 Martin, Slovak Republic tel.: +421434132770 e-mail: veronika.rybarova@uniba.sk Delivered: July 17, 2024 Accepted: August 17, 2024 * Toto je miesto kde sa smrť raduje pomáhajúc životu….
Presented case study deals with the sudden death of a 47 years old male, shortly after a mountain bike race after reported nausea and chest pain followed by loss of consciousness and resuscitation. Cardiopulmonary resuscitation was unsuccessful. An autopsy was enacted due to the sudden death in a seemingly healthy person. An acute infarction of the anterior cardiac wall on the basis of stenosis of the anterior interventricular branch of the left coronary artery with histopathological findings of eosinophilic coronary periarteritis was assessed. Sudden death during sport activities represents a complex problem which forensic physicians have to face. An external and internal examination of the body is not always sufficient. It is crucial for the forensic physician to have sufficient knowledge and enough information about the circumstances of the death and anamnestic records. Eosinophilic coronary periarteritis occurs rarely, predominantly in males and with uncertain etiology.
Death from positional asphyxia occurs when the victim is found in a position that interferes with adequate breathing. We present an unusual case of a 67-yearold man who was found deceased trapped in a badger sett. The autopsy revealed marked congestion, cyanosis and a multitude of pinpoint hemorrhages in the face, neck and upper chest. Confluent scleral and conjunctival hemorrhage were observed and numerous petechial bleedings were found in the oral mucosa and within the reflected scalp. Death was attributed to positional asphyxia due to head-down position in a badger sett.
Avalanche fatalities are quite rare in the Czech Republic. Due to the presence of avalanche fields in the two Czech mountains, forensic pathologists at some forensic medicine departments may encounter this specific mechanism of accidental death. The authors summarize medicolegal aspects of deaths in avalanches in the territory of the Czech Republic for the twenty-three-year period between 1993-2015. Ten avalanche fatalities were recorded during study period. The studied group consisted of nine male and one female victims. The average age of the deceased was 27.9 years. Skiers or ski-alpinists died in the avalanche in five cases (50%), climbers in two cases (20%), snowboarders in one case (10%), cross-country skiers in one case (10%) and in one case it was a fatality of child playing on a snowy hill (10%). The cause of death was suffocation in four cases (40%), blunt trauma in four cases (40%), and in the remaining two cases it was the survival of trapped persons several hours after being rescued from the avalanche in the hospital; both victims subsequently died as a result of prolonged shock (20%) due to a combination of prolonged suffocation and hypothermia. The time interval from the fall of the avalanche to the rescue of the trapped person was in the range of minutes to 3 hours. The presence of alcohol or drugs was not detected in any studied case.
The authors present the case of a fatal accident of a 16-year-old skier who crashed into a tree during a downhill skiing lesson at school. Although the skier was wearing a protective helmet at the time of the accident and his condition did not appear to be too serious immediately after the accident, he later died in hospital as a result of a craniocerebral injury with cerebral contusion and intracranial haemorrhage. His life could not be saved even by immediate neurosurgery, during which fragments of the broken protective helmet were removed from his cranial cavity. By analysing the international literature, the authors identify head and brain injuries as the most common immediate cause of death in downhill skiing and provide insights into the possibilities of preventing these injuries by simple technical means on the part of ski area operators. These means are in particular protective covers for lift columns and protective nets placed in front of fixed, non-movable obstacles on the track.
This review article highlights the crucial role of organ weights and dimensions as key indicators in forensic diagnosis. Organ weight changes serve as valuable markers for pathological conditions, aiding forensic doctors in interpreting autopsy findings. The review emphasizes the importance of precision in establish- ing organ reference values, considering factors like population-specific norms and correlations with body parameters. Furthermore, it explores the impact of obesity on organ weights, emphasizing the need for updated databases that accurately reflect diverse populations. The article underscores the inadequacy of relying on outdated sources and advocates for creating a comprehensive and updated database of organ weights and dimensions for the local population, essential for accurate forensic interpretations.
This review delves into the forensic utility of the sternum in creating a biological profile, focusing on sex, stature, and age estimation. Emphasizing the sternum's significance in challenging scenarios, the study supports the combined length of the manubrium and sternal body as a crucial indicator in sex and stature estimation. However, it highlights the need for caution in applying findings across diverse populations and questions the reliability of Hyrtl's law. Age estimation, primarily based on morphological changes and ossification ages, is explored, with one study showing promise but requiring further validation. While acknowledging the sternum's advantages, the review underscores potential limitations and the absence of specific studies on ancestry estimation, leaving this aspect open for future research. In conclusion, the review provides a comprehensive overview of the sternum's forensic applications, urging continued research to enhance accuracy and applicability.
Suicidal behavior is multifaceted and encompasses various factors. Among these, alcohol dependence and acute alcohol intoxication stand out as significant risk factors for suicide. The retrospective study aimed to record the development of suicide, also in connection with alcohol consumption, in the catchment area of the Department of Forensic Medicine and Pathological Anatomy of the Health Care Surveillance Authority in Martin, Slovak Republic, in the years 2009-2019.
BACKGROUND:Blunt trauma acting against the human body presents the fundamental cause of pulmonary fat embolism (PFE) and fat embolism syndrome. The aim of the present study was to investigate PFE in non-survivors after cardiopulmonary resuscitation (CPR). METHODS:This was a prospective cohort study conducted in University Hospital Ostrava, Czech Republic. Within a 4-year study period, all non-survivors after CPR because of out-of-hospital cardiac arrest were assessed for the study eligibility. The presence/seriousness of PFE was determined by microscopic examination of cryo-sections of lung tissue (staining with Oil Red O). RESULTS:In total, 106 persons after unsuccessful CPR were enrolled in the study. The most frequent cause of death in the study population (63.2% of cases) was cardiac disease (ischemic heart disease); PFE was not determined as the cause of death in any of our study cases. Sternal fractures were identified 66.9%, rib fractures (usually multiple) in 80.2% of study cases; the median number of rib fractures was 10.2 fractures per person. Serious intra-thoracic injuries were found in 34.9% of cases. Microscopic examination of lung cryo-sections revealed PFE in 40 (37.7%) study cases; PFE was most frequently evaluated as grade I or II. Occurrence of sternal and rib fractures was significantly higher in persons with PFE than between persons without PFE (p = 0.033 and p = <0.001). Number of rib fractures was also significantly higher in persons with PFE. The occurrence of serious intra-thoracic injuries was comparable in both our study groups (p = 0.089). CONCLUSIONS:PFE presents a common resuscitation injury which can be found in more than 30% of persons after CPR. Persons with resuscitation skeletal chest fractures have significantly higher risk of PFE development. During autopsy of persons after unsuccessful CPR, it is necessary to distinguish CPR-associated injuries including PFE from injuries that arise from other mechanisms.
The authors review the literature on the determination of post-mortem serum tryptase values and present the case of a young man who was hit by a train. However, his family believes he has no motivation to commit suicide. Collision with a train is one of the most common methods of suicide, especially among young men under 40 years of age. (1). The forensic autopsy showed that the man died due to the collision with the train, with traumatic hemorrhagic shock stated as a cause of death. Following toxicological, biochemical, and immunological tests created a supposition that the incident was not a result of suicidal action but a consequence of a possible allergic or anaphylactic reaction of the organism combined with a state of mild alcohol intoxication.
