Knowledge and attitudes of Polish prosecutors and general Polish population in regard to post-mortem computed tomography in 2019.

Post-mortem computer tomography (PMCT) is an imaging technique that is gaining popularity both worldwide and in Poland. It provides certain benefits in death investigation that a conventional autopsy is not able to, however, it has significant limitations. As PMCT and post-mortem computed angiography (PMCTA) continue to develop in this country, it is critical to become aware what people know and think about these imaging techniques, especially the prosecutors who officially order such examinations to be performed. In 2019, two concurrent surveys were administered to Polish prosecutors and general Polish population, respectively, regarding their current knowledge and opinions on PMCT. The results were collected both online and on paper, and then subjected to analysis. In total, 92 prosecutors and 227 non-prosecutors responded to the survey. The present authors observed that while prosecutors were more likely to have heard of this examination than the general public, their knowledge was often inadequate or incorrect. Conventional autopsy was still held as the gold standard in death investigation. However, a good popular sentiment towards PMCT was shown, and a desire to learn more about it - not just among prosecutors, but among the general public as well. The present authors' recommendation is that more courses and training should be organised for Polish prosecutors to compensate this knowledge gap.

No-Touch Automated Room Disinfection after Autopsies of Exhumed Corpses.

Autopsies of exhumed bodies pose a risk of infections with environmental bacteria or fungi, which may be life-threatening. Thus, it is important to use effective methods of disinfection in forensic pathology facilities. In this study, we investigated the effectiveness of no-touch automated disinfection (NTD) system after autopsies of exhumed bodies. Directly after 11 autopsies of exhumed bodies, we used an NTD system based on a peroxone vapor to disinfect the air and surfaces. We measured microbial burden in the air and on surfaces before and after NTD. The NTD system reduced the mean bacterial burden in the air from 171 colony forming units (CFU)/m3 to 3CFU/m3. The mean fungal burden in the air decreased from 221 CFU/m3 to 9CFU/m3. The mean all-surface microbial burden was 79 CFU/100 cm2 after all autopsies, and it decreased to 2 CFU/100 cm2 after NTD. In conclusion, the peroxone-based NTD system was effective for decontamination of the air and surfaces in a dissecting room after autopsies of exhumed bodies.

Transverse process fractures of the thoracic vertebrae-the significance of this injury in the context of medicolegal opinions on high-energy trauma cases.

Thoracic transverse process fractures (TTPFs) are injuries that go unnoticed during traditional autopsies, as demonstrated by a lack of medicolegal publications regarding TTPFs. However, postmortem computed tomography (PMCT) has made detection of this type of injury easy. Thus, the goal of our study was to analyze the significance of TTPFs in the context of medicolegal opinions. Forensic autopsy reports and PMCT scans of 116 people who had died from high-energy trauma were analyzed. TTPFs were found in 34.48% (n = 40) of the total test group. The highest proportions of TTPFs were found in drivers (50%, n = 8) and in victims of falls from heights (41%, n = 14). Among seven car passengers, only one victim had suffered TTPFs. In comparison with persons without TTPFs, persons with TTPFs demonstrated more severe general injuries, especially to the chest and abdomen, and more often (in 90% of cases) died at the scene of injury (all these differences were statistically significant; p < 0.0001). Pedestrian TTPFs were present only in victims struck from their front or back. TTPFs in victims of falls were found only in those cases in which the height of the fall was at least 9 m. The presence of TTPFs indicates that the application of a very strong force leads to injuries that, in most cases, result in death at the scene of the event. Detecting TTPFs provides additional information about the mechanism of trauma, especially in pedestrians, drivers, passengers, and victims of falls from heights.

Significance of intracranial gas on post-mortem computed tomography in traumatic cases in the context of medico-legal opinions.

The detection of intracranial gas (ICG) in people who died due to trauma became possible once postmortem computed tomography (PMCT) became available in addition to traditional post-mortem examinations. The aim of this study was to determine the importance of ICG in the context of medico-legal opinions. We assessed 159 cases of trauma-induced death. Cadavers with pronounced signs of decomposition, open skull fractures, and after neurosurgical operations were excluded. Both PMCT findings and data from autopsy reports were analyzed. ICG was found in 38.99% (n = 62) of the cadavers, 96.77% (n = 60) of which presented with pneumocephalus (PNC) and 40.23% (n = 25) with intravascular gas (IVG). There was a strong correlation between ICG and skull fractures/brain injuries, as well as chest injuries, especially lung injuries. In 13 cases, ICG presented without skull fractures; three of these cases died as a result of stab and incised wounds to the neck and chest. The mean time between trauma and death was significantly longer in the non-ICG group than the ICG group at 2.94 days (0-48 days) and 0.01 day (0-1 day), respectively (p < 0.0001). The presence of ICG is a result of severe neck and chest injuries, including stab and incised wounds. The victims die in a very short amount of time after suffering trauma resulting in ICG. The ability to demonstrate ICG on PMCT scans can be of significance in forming medico-legal opinions.

Three postmortem case reports of the excited delirium syndrome - A short comparison.

PURPOSE: The purpose of the work is to show and compare three reported cases of Excited Delirium Syndrome, which happened in Warsaw, Poland, from 2013 to 2017. We compared the results of three autopsy and toxicological findings of unexpectedly deceased males and the circumstances of their death, based on the police records. RESULTS: There were no significant findings of chronic diseases or multiple traumas leading us to the clear explanation of cause of death. We noted a rapid cardiopulmonary failure accompanied by drug abuse in all three cases, that happened following a stressful stimulus, evoked by a police restraint in prone position. All patients resembled similar external characteristics and BMI and had used drugs before death. CONCLUSION: A lack of the autopsy findings suggests the Excited Delirium Syndrome as a cause of death. The syndrome may be diagnosed after death, following the definition of exclusion of other somatic causes of death, preceded by symptoms during a stressful event. The syndrome occurs in overweight males, abusing especially stimulants. The physical restraint plays an important role in the initiation of the symptoms. The pathophysiology of the syndrome is poorly understood, but some theories underline dopamine transporters stimulation. To this day, there are no published Excited Delirium guidelines for forensic specialists or pathologists.

Joint European Society of Paediatric Radiology (ESPR) and International Society for Forensic Radiology and Imaging (ISFRI) guidelines: paediatric postmortem computed tomography imaging protocol.

Postmortem CT for investigating childhood deaths is increasingly utilised as a noninvasive adjunct or alternative to standard autopsy; however there are no standardised published imaging protocols. This article describes a standardised imaging protocol that has been developed based on current practices of international postmortem imaging practitioners and experts. This recommendation is expected to be useful for postmortem imaging centres wishing to update their existing practices and for those starting paediatric postmortem CT as a new service.

Isolated condylar fractures diagnosed by post mortem computed tomography.

Due to their anatomical location, occipital condylar fractures (OCFs) are usually not observed during traditional autopsies and are therefore considered a rare injury. The aim of this study was to determine the true frequency of OCFs using post-mortem computed tomography (PMCT) in traumatic casualties. We retrospectively analyzed 438 PMCT studies of victims of traffic accidents, falls from height, violence, and low-energy head injuries (324 males and 114 females). OCFs were present in 22.6% of cases (n = 99), mostly in victims of railway accidents (48.5%, n = 17), falls from height (26.6%, n = 29), cyclists (24%, n = 6), and pedestrians hit by cars (22.5%, n = 29). Isolated OCFs were found in 5.5% of cases (n = 24), most often in cyclists (12%, n = 3) and pedestrians (9.3%, n = 12) hit by cars. There were no OCFs in the cases of fatalities caused by violence or accidental low-energy head injury. PMCT scans revealed that OCFs are common in high-energy injury fatalities and can be useful for determining the mechanism of trauma more precisely.

Presence of Toxoplasma gondii infection in brain as a potential cause of risky behavior: a report of 102 autopsy cases.

Toxoplasmosis was linked to impairment in brain function, encompassing a wide range of behavioral and neuropsychiatric changes. Currently, the precise localization of Toxoplasma gondii in the human brain is limited and the parasite DNA was not found in population-based screening of autopsy cases. The aim of proposed study was to identify the presence of parasite DNA within the brain and its association with risky behavior and alcohol consumption in postmortem examination. Preliminarily, 102 cases with certain circumstances of death at time of forensic autopsy was included. Due to high risk of bias, the females were excluded from the analysis and final study group consists 97 cases divided into three groups: risky behavior, inconclusively risky behavior, and control group. The obtained tissue samples for Nested PCR covered four regions of the brain: symmetric left/right and anterior/posterior horns of lateral ventricles comprising lining ependyma and hippocampus. The second type of material comprised blood evaluated for antibodies prevalence using ELISA and alcohol concentration using HS-GC-FID. Analysis demonstrated 16.5% prevalence concerning the parasite DNA presence in examined brain tissue samples without specific distribution and association with age at death or days after death until an autopsy was performed. Results have shown correlation between occurrence of risky behavior leading to death and higher proportions of positive parasite DNA presence within the brain. Correlation was not observed between parasite DNA presence and excessive alcohol consumption. Conducted screening demonstrated correlation between parasite DNA presence in the brain with risky behavior and provided new information on possible effects of latent toxoplasmosis.

Unusual case of suicide - hanging in a car using two nooses

Suicide behind the steering wheel of a car is a relatively rare discovery, particularly if the cause of death is hanging. Therefore, such events give rise to suspicions that third parties were involved. This paper presents a case of hanging on the threshold of a car door, although what was taken into consideration during the investigation was suicide, death as a result of a road accident, accidental hanging on the seat belt, and even homicide. The cause of death was determined thanks to a very thorough autopsy which also involved the dissection of extremities and was complemented by additional examinations including toxicological tests. In addition to the medicolegal opinion the Prosecutor's Office took into consideration the opinions of other experts, including experts on the reconstruction of road accidents, and questioned witnesses from the closest social environment of the deceased, as well as strangers. The presented study underlines the significance of conducting a thorough autopsy and the necessity of corroboration of autopsy results with other investigation findings.

Gas embolism as a potential cause of death by helium poisoning - Postmortem computed tomography changes in two cases of suicidal helium inhalation.

Evaluation of two suicidal helium inhalation cases is presented, comprising both conventional autopsy methods and postmortem computed tomography. Conventional postmortem examinations reveal no characteristic changes. Modern diagnostic techniques enabled to disclosethe presence of a very large amount of accumulated gas in all examined areas, including veins and arteries of the head, torso, lower extremities, heart chambers, and between muscle fibers in both cases. The changes due to possible putrefaction were taken into consideration - radiological alteration index was calculated. In forensic literature, the reported mechanism of death in helium poisoning is rapid asphyxiation due to oxygen deprivation. However, papers on clinical cases and animal studies with the use of helium report development of gas in body cavities and lethal gas embolism, comprehensible when we take into account the specific physical properties of helium: high permeability and very low solubility in blood. The results reported by the authors are consistent with massive gas embolism similar to changes presentedin cases of decompression illness. They suggest this as the cause of death in helium inhalation cases. Undoubtedly, this requiresconfirmation in further observations, taking into account differentiating diagnosis of air embolism versus oxygen deprivation.

New, previously unreported correlations between latent Toxoplasma gondii infection and excessive ethanol consumption.

A number of world literature reports indicate that a latent Toxoplasma gondii infection leads to development of central nervous system disorders, which in turn may lead to altered behavior in the affected individuals. T. gondii infection has been observed to play the greatest role in drivers, suicides, and psychiatric patients. Studies conducted for this manuscript involve a different, never before really reported correlation between latent T. gondii infection and ethanol abuse. A total of 538 decedents with a known cause of death were included in the study. These individuals were divided into three groups: the risky behavior group, inconclusively risky behavior group, and control group. The criterion for this division was the likely effect of the individual's behavior on the mechanism and cause of his/her death. The material used for analyses were blood samples collected during routine medico-legal examinations in these cases. The blood samples were used to measure anti-T. gondii IgG antibodies with an enzyme-linked immunosorbent assay (ELISA). Moreover, the following data were recorded for each decedent: sex, age, circumstances of death, cause of death, time from death to autopsy, and (if provided) substance abuse status (alcohol, illicit drugs). In those cases where blood alcohol level or toxicology tests were requested by the Prosecutor's Office, their results were also included in our analysis. Test results demonstrated a strong correlation between latent T. gondii infection and engaging in risky behaviors leading to death. Moreover, analyses demonstrated a positive correlation between the presence of anti-T. gondii IgG antibodies and psychoactive substance (especially ethanol) abuse, however, the causal relationship remains unclear. Due to the fact that alcohol abuse constitutes a significant social problem, searching for eliminable risk factors for addiction is extremely important. Our analyses provided new important information on the possible effects of latent T. gondii infection in humans.

The meaning and classification of tattoos in the context of their suitability to identify corpses of unknown identity.

AIM OF THE STUDY: To present the most popular types of tattoos, their meaning and classification, and to assess the suitability of different forms of tattoos in the process of identification of corpses of unknown identity. MATERIAL AND METHODS: The tattoos found on 729 cadavers who underwent post mortem examinations at the Department of Forensic Medicine in Warsaw in the years 2012-2015 were analyzed. The tattoos were photographed and identified in terms of their meaning domain and classified into groups. RESULTS: Tattoos belonging to all groups were found, according to the most popular tattoo classification, which is based on their nature and includes: criminal and prison tattoos (defining the prison hierarchy, criminal profession as well as intentions and goals, erotic tattoos, environmental, penitentiary), military and artistic. The novel classification, focusing on the utility of certain kinds of tattoos for identyfying corpses of unknown identity, was also developed. According to the above mentioned classification the following kinds of tattoos are distinguished: individual (artistic), group (e.g. penitentiary - indicating the fact of being imprisoned in a penitentiary institution or belonging to a "prison kites" subculture, or presenting criminal profession; group confined tattoo (indicating a staying in a specific penitentiary institution), group tattoo with individual data (indicating the fact of staying in a penitentiary institution as well as dates of imprisonment), and others (e.g. names of relatives, military tattoo, etc.). CONCLUSIONS: Analysis of individual types of tattoo can accelerate the process of identification of the cadavers. The proposed classification allows to quickly determine whether a particular tattoo can be helpful in initial individual identification (in the case of individual tattoos) or whether it can be used to reduce the group of people considered (in cases of different types of group tattoos).

Postmortem computed tomography with the use of air for blood vessel enhancement--Early experience.

Postmortem computed tomography (PMCT) is gaining popularity in forensic medicine. Computed tomography routinely performed in clinical medicine involves intravenous contrast administration. Unfortunately, postmortem examinations are typically limited to uncontrasted CT scans, where blood vessels and their potential injury sites are invisible. One serious problem is the fact that due to the process of decomposition, contrast agents used for vessel visualization in the living cannot be used in cadavers. Therefore, a special contrast agent designed for cadavers has been developed. This contrast agent has a high density and is lipophilic. Its use ensures very good visualization of blood vessels it is, however, associated with high costs and may alter findings of a later histopathological examination. This study presents early experience with the air as negative contrast agent to enhance all blood vessels in the body. The carbon dioxide (CO2) gas has been used as a contrast agent in live individuals with contraindications against the use of iodinated contrast. In corpses with advanced postmortem changes, putrefaction gases also considerably enhance the visibility of blood vessels and organs they fill. There have also been some positive effects with the use of gas in postmortem angiography of coronary vessels. These findings encouraged us to attempt air administration via catheters introduced into the femoral artery or a central venous access site in the superior vena cava. The gas distributed easily throughout the body and surprisingly well contrasted both arteries and veins of various caliber. The presence of the air administered into vessels did not cause any apparent, significant alterations in autopsy findings. Although optimization of the gas administration technique requires further studies, we can already say that this is a promising direction in postmortem angiography.

The use of 3D computed tomography reconstruction in medico-legal testimony regarding injuries in living victims - Risks and benefits.

Forensic pathologists are often called upon to determine the mechanism and severity of injuries in living individuals. Such expert testimony is often based solely on hand-written clinical notes. The victims' injuries may also be visualized via three-dimensional (3D) reconstruction of computed tomography (CT) images. This method has certain benefits but is not free from limitations. This paper presents two case reports. The first case is that of a female who was brought to the hospital with a knife thrust into her body. The prosecutor's questions focused on the wound channel. The information obtained from the patient's medical records was very general with many contradictory statements. A re-evaluation of the available CT scan data and a subsequent 3D reconstruction helped determine the exact course of the wound channel. The other case was that of a young male, hospitalized based on CT evidence of bilateral rib fractions, who claimed to have been assaulted by police officers. Court expert witnesses were already in possession of a 3D reconstruction showing symmetrical fractures of the patient's lower ribs with bone fragment displacement. An expert witness in radiology definitively excluded the presence of any actual fractures, and explained their apparent visibility in the three-dimensionally reconstructed image as a motion artifact. These two cases suggest that a professionally conducted 3D CT reconstruction is a very useful tool in providing expert testimony on injuries in living victims. However, the deceptive simplicity of conducting such a reconstruction may encourage inexperienced individuals to undertake it, and thus lead to erroneous conclusions.

Prevalence of Toxoplasma gondii parasite infection among people who died due to sudden death in the capital city of Warsaw and its vicinity.

BACKGROUND: It has recently been shown that the behavioural effects resulting from latent T. gondii infection in immunocompetent people could pose as a threat to their welfare. AIM. The aim of the study was to evaluate the prevalence of T. gondii infection in a group of people who died suddenly in Warsaw and its vicinity. MATERIAL AND METHODS: The studied group (n = 169 people) included 42 road traffic accident victims who were driving a vehicle (bicycle (n = 6), a motorbike (n = 3), a motorcycle (n = 13), a car (n = 20)) prior to sudden death and 41 people whose death resulted from suicide. Blood samples were collected post-mortem and examined for the presence of T. gondii, IgG antibodies and ethyl alcohol. RESULTS: Of the 169 people tested, T. gondii IgG antibodies were found in the serum of 93 (55%) of which 25 (59.5%) were drivers and 26 (63.4%) people who died as a result of suicide. With respect to the prevalence of T. gondii infection no statistically significant differences were found between the study (61.4%) and control group (49.4%); (p = 0.09). A statistically significant result was recorded in the 38-58 age group between suicide and control groups (71.4% vs. 44.4%; p < 0.05). Positive test results for the presence of ethyl alcohol in the blood were reported among 49.7% of the studied population: 25.7% among drivers, 67.6% among suicides and 51.8% in the control group. To a statisctically siginificant degree, IgG T. gondii antibodies were found to occur more frequently in people with positive blood alcohol test results among suicides (72% vs. 50%; p < 0.05) and among the control group (60% vs. 40%; p < 0.05) than in their equivalents with negative test results. CONCLUSIONS: Our work confirmed the usefulness of serologically testing samples collected post-mortem for epidemiological purposes. The small size of the study group made it impossible to evaluate the potential associations between exposure to T. gondii infection and the probability of sudden death. The significance of Toxoplasma gondii infection as a risk factor for self-destructive behaviour merits further study.

Expectations towards forensic professionals conducting external examinations of dead bodies on the crime scene--results of a questionnaire distributed among public prosecutors in the Mazovian Voivodeship / Oczekiwania wobec uczestnictwa medyków sadowych w ogledzinach zwlok na miejscu ich ujawnienia--wyniki ankiety przeprowadzonej wsród prokuratorów w województwie mazowieckim.

UNLABELLED: The purpose of this study was to determine expectations of public prosecutors towards forensic professionals participating in external examinations of dead bodies performed at the site of finding the corpses. The presence of forensic physicians on the crime scene was recognized as advantageous by all prosecutors; however, expectations associated with corpse inspection did not correspond to capabilities of modern medicine or necessitated repeating activities performed during autopsies. Homicides (99%), deaths of children (86%) and "media" deaths (73%) were indicated as cases when the presence of forensic professional was especially important. Definition of injuries with indication of the causative object made by forensic physicians on the crime scene was the advantage most often chosen by respondents (82%). Almost one third of respondents expected forensic physicians to evaluate the length and direction of wound tracts, more than half of them--to provide a detailed description of injuries, one fifth wanted physicians to determine the exact time of death. Description of post mortem changes was not indicated as the most important benefit by any prosecutor. CONCLUSIONS: Public prosecutors recognized the presence of forensic professionals on the crime scene as advantageous, but their expectations associated with dead body examinations did not correspond to capabilities of forensic medicine or forced physicians to perform activities normally made during autopsy. An algorithm of dead body examination on the crime scene including aims and advantages of such a examination should be developed jointly by prosecutors and forensic medicine specialists.

Presence of soot in the respiratory tract and esophagus as an element of consultative process addressing intravital staying in fire atmosphere.

This paper was prepared in view of consultative difficulties which occur during autopsies of bodies found at the seat of fire. The most difficult problem in such cases is establishing--in absence of typical signs of intravitality--whether the deceased was alive during the fire and inhaling the fire atmosphere; especially when the concentration of carboxyhemoglobin (COHb) in blood is higher than 10% and soot is found in the respiratory tract. The authors analyzed 241 reports of autopsies which had been performed at Institute of Forensic Medicine, Warsaw Medical University, between 2006 and 2011. The following data were analyzed: age, gender, the place where the body was found, blood concentration of COHb and alcohol and the presence of soot in the upper and lower respiratory tract, as well as in the esophagus. It was noted that if the concentration of COHb was higher, soot was more frequently present in the respiratory tract and esophagus. At the same time, the presence, as well as absence of soot was noted regardless of COHb concentration in blood, including 0% concentration. In cases of performing autopsies on bodies found at the seat of fire, examining the upper and down respiratory tract seems to be irrelevant in terms of its consultative usefulness; however, the presence of soot in the esophagus concomitant with low COHb concentration in blood is important in this context.

[The effect of alcohol consumption on the severity of injuries, prognosis and mortality--a review of literature]. / Wplyw spozycia alkoholu etylowego na ciezkosc doznanych obrazen, rokowanie i smiertelnosc--przeglad pismiennictwa.

The paper is a review of the most current academic literature published in the English language and addressing the effect of alcohol consumption on the severity of injuries, prognosis and mortality with special emphasis placed on the consultative usefulness of such publications. The report was inspired by repeated questions asked in association with expert opinions on the effects of injuries and addressing a possible effect of alcohol consumption by the victims on the severity of injuries and prognosis. In case of such questions, a valuable supplement to an opinion based on on the expert's professional experience may be found in an analysis of publications focusing on the subject. The present review was based on two databases "Web of science" and "Medline" (2000-2011). Initially, 372 abstracts were taken into account. Subsequently, 42 articles were thoroughly studied. The analyzed material represented both experimental and research approaches to the problem. The experimental approach was based on tests carried out on animals in laboratories, whereas the research approach was based on the observations of patients admitted to hospitals with injuries. The literature overview indicates a neuroprotective feature of alcohol and an improved prognosis in intoxicated people suffering from isolated head injuries, even though the severity of their injuries is much higher than in the cases of sober people. In cases of polytrauma injuries, the influence of alcohol is explicitly negative, but does not increase mortality.

[Causes of perinatal deaths in children delivered out of hospital in material collected by Chair and Department of Forensic Medicine, Medical University of Warsaw]. / Przyczyny zgonów dzieci w okresie okoloporodowym, w warunkach pozaszpitalnych na podstawie materialu ZMS WUM.

The study focused on cases of perinatal deaths of infants delivered out of hospital. The objective of the investigation was to determine the number of such cases in the Warsaw region, focusing in particular on suspected infanticides, evaluate the most frequent causes of death of children born out of hospital and determine possibilities and limitations of autopsies performed in neonates. The material comprised autopsy reports pertaining to 27 forensic perinatal postmortem examinations performed at the Chair and Department of Forensic Medicine, Warsaw Medical University, Poland, in the years 2001-2008. Determination of cause of death was possible in more than half of the cases. The most frequent cause of death was prematurity. A congenital malformation was seen in one neonate only. The most common factor that hindered determination of cause of death was advanced putrefaction, as well as unavailability of the placenta for examinations noted in more than 50% of the cases.