Frantisek Novomesky

Non-traumatic and spontaneous hemothorax in the setting of forensic medical examination: A systematic literature survey

Spontaneous hemothorax is a well-known yet seldom-reported entity in forensic literature. While trauma-related hemothorax is frequently encountered in a medicolegal setting, non-traumatic and spontaneous hemothorax are relatively uncommon entities. The wide range of causes that can trigger fatal intrathoracic bleeding include thoracic aortic dissection, followed by vascular malformations, various oncological diseases, and connective tissue abnormalities. In rare instances, extramedullary hematopoiesis, ectopic pregnancy, congenital heart defects, amyloidosis, or parasitic diseases may constitute a source of bleeding. This etiological heterogeneity may, as a result, cause diagnostic difficulties during post-mortem elucidation of hemothorax. It should be borne in mind that hemothorax after low-energy trauma does not exclusively indicate traumatic hemorrhage, hence, the non-traumatic origin of bleeding must be taken into consideration. In this paper, we present a systematic review of the relevant literature enriched by the results of our observations to investigate the etiologies and recommendations for the post-mortem diagnosis of spontaneous hemothorax in an attempt to better delineate the possible medicolegal considerations. It is important that forensic pathologist as well as clinicians are aware of the diseases that could potentially give rise to fatal hemothorax.

A planned complex suicide by gunshot and vehicular crash

Complex suicide is usually defined as the application of more than one killing mechanism to ensure a fatal outcome. Herein we report an unusual case of a planned complex suicide of a 20 year old-male combining gunshot with coincidental intentional vehicular crash. The case was initially assumed to be a simple traffic accident until a rimfire pistol was found in close proximity to the deceased as well as gunshot wound of the head. This paper demonstrates the importance of careful inspection of the death scene, as well as the complex performance of autopsy examination to explain the manner of death and distinguish accidental deaths from suicides in such cases. Nevertheless, this assessment might by very difficult or even impossible. It has to be assumed that a high number of suicides in road traffic remain undetected.

Suicidal nitrogen inhalation by use of scuba full-face diving mask

A 29‐year‐old man was found dead lying on the bed in a hotel room in a famous Slovak mountain resort. He had a full‐face diving mask on his face, connected through a diving breath regulator to a valve of an industrial (nondiving) high‐pressure tank containing pure 100% nitrogen. The breath regulator (open‐circuit type) used allowed inhalation of nitrogen without addition of open air, and the full‐face diving mask assured aspiration of the gas even during the time of unconsciousness. At autopsy, we found the typical signs of suffocation. Toxicological analysis revealed 94.7% content of nitrogen in alveolar air. Following the completion of the police investigation, the manner of death was classified as a suicide. Within the medico‐legal literature, there has been only one similar case of suicidal nitrogen inhalation described (1).

An unusual case of anesthetic abuse by a full-face gas mask.

The authors report a case of sniffing of halothane (Narcotan) by a 32-year-old man, master of pharmacy, through the military full-face gas mask. The liquid halothane had been applied on the scrubber of the gas mask and voluntarily inhaled. The sniffer was found dead in his flat, with the gas mask still fixed and sealed on his face. Because the authors have not encountered any report of such a case in the literature, they present and discuss this case in this article.

Ritual suicide of Japanese girl in the Slovak Republic

The body of a young Japanese woman was found buried in the mass of snow in February 2006 near the town of Liptovsky Mikulas in the Slovak Republic. Hypothermia was declared as the cause of her death, the body of the deceased was deeply frozen. The autopsy and police investigation classified her death as a suicide, having some features of an Eastern Asian suicidal ritual. The case shows that the era of world globalization and migration of people bring together also the curious cases of human tragedies. Thus the forensic expert of nowadays must expect that s/he might be faced with cases of death unseen before.

Giant Cell Myocarditis and Endomyocardial Calcification in a 2.5-Month-Old Infant Triggered by Excessive Maternal Alcohol Abuse: Case Study of an Unusual Association

This report describes an unusual case of a 2.5-month-old infant’s sudden death secondary to giant cell myocarditis and endomyocardial calcification, both unusual entities in pediatric patients. The mother had a history of excessive alcohol consumption during pregnancy and the postnatal period. No infectious etiologies, hypersensivity, or autoimmune disorders were identified. Therefore, the authors assume that alcohol exposure might be responsible for the inflammatory giant cell process complicated with endomyocardial calcification in susceptible infants. This report is the first to describe the rare form of noninfectious myocarditis complicated with endomyocardial calcification possibly triggered by a toxic agent. The authors discuss the possible interaction between these processes that led to the infant’s sudden death.

Snow groomer vehicle-related fatality: an illustrative case study of the importance of medicolegal involvement.

AbstractThis article describes and discusses an unusual case of an accidental death of a 29-year-old female snowboarder. A snow-grooming vehicle had run over her body after she accidentally fell down during a training ride. According to the official statement, the victim was probably under the influence of alcohol or drugs, and the snowboarder caused the accident because she did not respect the safety restrictions and collided with the snow vehicle. However, forensic pathologists offered different conclusions to the police to place the responsibility of the accident by observing the characteristics of the injuries and analyzing the autopsy results. Autopsy findings led to the suspicion that the injuries on her body were a consequence of running over of the vehicle without any modifications caused by hitting. A title and abstract review of recent articles worldwide over the past 2 decades indicates that there have been no case reports that have focused on snow groomer vehicle–related fatality with a description of the characteristics of the injuries. This case study particularly focuses on wound morphology caused by an uncommon mechanism that might help forensic practitioners.