František Novomeský

Circular saw-related fatalities: A rare case report, review of the literature, and forensic implications

Fatalities attributed to powered circular saws appear to be vanishingly rare events with highly wounding and rapidly incapacitating effects. When they do occur, they are mainly self-inflicted in nature. We report the suicide committed by a 79-year-old man using a self-made circular table saw. Autopsy confirmed that the man received multiple heterogeneously distributed saw-type impacts to the head and neck resulting in complete amputation of the upper skull and partial beheading. Homemade or modified commercial sawing instruments and the resultant injuries pose a number of forensic challenges starting from the death scene investigation, continuing with technical examinations, and concluding with determining the manner of death. As with all deaths due to sharp force injuries, fatalities involving power tools such as chainsaws, circular, and band saws warrant a high degree of suspicion of criminal activity and require diligence during all phases of the death investigation.

Gravidity complicated by abdominal neoplasmatic process

The case of 31-year-old pregnant woman in the 28th week of pregnancy is presented. She was brought in a bad condition to a small hospital by her parents. The case history of only 5 h included e.g. nausea, multiple emesis, cephalea, deteriorated respiration. Shock status was diagnosed in the hospital intensive care unit. After the patient lost her consciousness, resuscitation, intubation and artificial ventilation breath control were realised immediately, the doses of 13 mg of adrenalin were applied.

Feasibility, diagnostic validity and limits of postmortem evaluation of a newborn infant following an extremely prolonged freezing interval: A thanatological case study

In forensic assessment, denial and concealment of pregnancy has wide-ranging implications including criminal abortions, extramural deliveries, concealment of birth, newborn infant abandonment or even neonaticide. Clarification of whether a newborn was born alive is the most important factor when evaluating an abandoned neonate or concealment of birth. Other points that need to be addressed are determination of viability and maturity of the newborn infant, and the identity of the mother. A prolonged postmortem interval following illegal disposal of a dead body often leads to advanced decomposition, making postmortem elucidation difficult. We report an exceptionally uncommon autopsy case of a well-preserved female newborn, which was accidentally found after eight years in a home freezer. Despite the prolonged postmortem interval, tissue preservation was sufficient for a meaningful autopsy including a comprehensive histopathological study. The purpose of the present investigations was to expand our understanding of thanatological processes, as well as detectability of particular histological findings on the remains of a newborn after extremely prolonged storage in an artificially frozen environment. In addition, this article discusses forensically important issues regarding concealment of newborn infant under specific conditions.

Strangulation of the heart presenting as sudden cardiac death: A deadly but forgotten complication of epicardial pacing device

Strangulation of the heart appears to be an exceedingly rare mechanical phenomenon that can develop with epicardial pacing wires in individuals undergoing somatic growth. Over the passage of time, owing to size mismatch between a fixed wire length and dynamically growing heart, the epicardial wire may embed around the heart resulting in the progressive over-pressurizing of involved cardiac structures. Depending on the location of the peak constriction pressures, cardiac strangulation may damagingly affect coronary circulation, heart valves function, or physiologic filling of the heart chambers, with risk of myocardial ischemia, decreased cardiac output, acute cardiac failure, ventricular arrhythmias and death. We report a case of a 29-year-old male with sudden cardiac death owing to cardiac strangulation with epicardial pacing wire that had been retained in place almost 30 years. At autopsy, an enlarged and abnormally contoured heart was found to be strangulated by an epicardial pacing wire; histopathologic examination confirmed hypertrophy of the myocardial fibers, myofiber disarrangement, and replacement-type fibrolipomatosis. In addition, this article consolidates the available literature on cardiac strangulation by an epicardial wire and highlight relevant clinical and medico-legal features for the forensic professionals.

Vomiting and aspiration of gastric contents: a possible life threatening combination in underwater diving

Vomiting and aspiration of gastric contents into the airways and lungs is a common and well-known clinicopathological entity. This phenomenon might also occur in underwater diving, where it can lead to life-threatening or fatal situations. This article presents two incidents involving diving-related vomiting with associated aspiration of gastric contents. One case, a 39-year-old commercial diver using a full-face diving mask, was fatal and the other was a 33-year-old, female recreational scuba diver in whom underwater vomiting was complicated by pulmonary aspiration of a solid foreign body (a peanut) into the right lower lobe bronchus. The peanut was successfully removed and, following bronchoscopic pulmonary lavage, the patient made an uneventful recovery. The causes and consequences of nausea and vomiting within the underwater environment are discussed and possible interpretative problems are highlighted.

Extensive myocardial infarction in a 20-year-old associated with diabetic ketoacidosis

Address for correspondence: Martin Janík, MD, PhD, Department of Forensic Medicine and Medicolegal Expertise, Jessenius Faculty of Medicine, Comenius University, Kollárova 2, 036 59 Martin, Slovak Republic, e-mail: janik.mato@gmail.com Conflict of interest: none declared Kardiologia Polska Copyright

Sphacelus of the liver: an unexpected finding at autopsy.

The death of a 50-year-old man was referred to our institute for autopsy evaluation as it was sudden and unexplained. The information given to the forensic pathologist included chronic alcoholism and a 4-week history of non-specific abdominal pain, weight loss, and progressive fatigue. External examination of the body revealed a distended abdomen and an inconspicuous, well-healed, 1.2 9 0.2 cm linear scar in the lateral part of the right upper abdominal quadrant (Fig. 1a, b). Reflection of the skin and subcutaneous tissue beneath the scar revealed a pyogenic abscess of the abdominal wall with softened, darkly colored edges (Fig. 1c, d). The abscess cavity apparently communicated with the peritoneal cavity. Opening of the peritoneal cavity revealed 700 ml of cloudy fibrinopurulent liquid with fibrinous adhesions between the bowel loops and greater omentum, consistent with generalized bacterial peritonitis. Further abdominal examination showed a destructive, necrotizing, well-demarcated process within the liver tissue, extending from the capsule to the adjacent subcapsular tissue of the right liver lobe (Fig. 2a, b). These changes were highly suggestive of humid gangrene, also known as sphacelus. Additionally, the lateral aspect of the right liver lobe revealed a relatively shallow, oval defect that penetrated 1.2 cm into the parenchyma (Fig. 2b). Examination of the pleural cavities disclosed a small quantity of bloodstained serous liquid. The lung tissue exhibited diffuse mild edema and congestion. Microscopically, destructive suppurative inflammation accompanied by confluent areas of hepatocyte necrosis and parenchymal collapse were throughout the liver tissue. Neither alcohol nor any other drugs were detected via toxicological studies. As the manner of death remained unclear, the decedents relatives were interviewed. After thorough questioning, it was concluded that the deceased fell onto a sharply pointed spiral plant stick that resulted in a seemingly insignificant wound to the right abdomen several days before the onset of the first abdominal symptoms. Immediately following injury, he was taken to a local hospital, where a clinical diagnosis of abdominal wall stab-like injury was made. The wound was locally managed and as the clinically stable patient declined further diagnostic intervention, he was discharged on the same day. The cause of death was determined to be gangrene of the liver associated with generalized peritonitis due to a remote penetrating abdominal injury. The manner of death was accidental.

Tödliche Luftembolie beim Tauchen. Eine morphologische Untersuchung

SummaryTwo cases of barotrauma as a result of excess pulmonary pressure with subsequent air embolism are reported. Both cases involved serious diving safety errors. The morphology of this type of barotrauma is described, with particular reference to the etiology of the phenomena involved. Some specific points regarding the autopsy procedure in connection with such diving accidents are discussed.ZusammenfassungEs wird über zwei Fälle von Lungenbarotrauma bei Lungenembolie berichtet. In beiden Tauchunfällen waren gravierende Fehler in punkto Tauchsicherheit vorausgegangen. Die Morphologie des Lungenüberdruckunfalles mit folgender Luftembolie wird beschrieben und auf das Zustandekommen um die Ursachen dieses Geschehens näher eingegangen. Die Besonderheiten der gerichtsmedizinischen Begutachtung derartiger Tauchunfälle werden diskutiert.

Developmental trends of liver parenchyma in the terminal period of gestation: a stereological approach.

The aim of the presented study was to establish the baseline data concerning the volumes density of basic architectonic components of human fetal liver parenchyma. The stereological measuring principles of the point-counting method were used. The livers of 38 appropriate for gestational age fetuses, and 12 small for gestational age fetuses were measured. All fetuses investigated were stillborns. A lower volume density of hepatocytic population was found in full-term mature fetuses, when compared with the adults. A lower volume density of hepatocytes has been also disclosed in intra-uterine growth retarded fetuses, when compared with their physiologically developed counterparts of the same gestational age.