"Surgically created" excision of the back mimicking homicide: report of an unusual case.

Fatalities due to sharp force trauma, with respect to manner of death, may be homicidal, self-inflicted, or accidental in nature. This article presents a case of an unusual sharp force injury inflicted under very specific and seemingly obscured circumstances, initially suggestive of homicidal origin. A 69-year-old, socially isolated male was found dead with a strange, heavily blood-stained excision-like lesion on the right subscapular area. The autopsy confirmed that the wound led to fatal external blood loss. Toxicological analysis of the blood and urine revealed severe alcohol intoxication. The police investigation turned up that the man had suffered from a painful skin furuncle of the right upper back. As he was worried about receiving medical treatment, he voluntarily asked his two acquaintances for "surgical" assistance to remove the skin affection. Based on the circumstances surrounding death and findings at autopsy, it was concluded that the injury was inflicted without the intent to harm or cause death, as a result of simple negligence. Consequently, the manner of death was ultimately certified as an involuntary manslaughter. Our case has clearly illustrated that even highly suspicious and atypically shaped wounds created by sharp-edged instruments with localization in non-accessible body areas does not exclusively indicate homicidal activity, hence, the accidental, suicidal or even iatrogenic origin of the wounding mechanism must be taken into consideration.

The morphology of human hyoid bone in relation to sex, age and body proportions.

Morphological aspects of the human hyoid bone are, like many other skeletal elements in human body, greatly affected by individual's sex, age and body proportions. Still, the known sex-dependent bimodality of a number of body size characteristics overshadows the true within-group patterns. Given the ambiguity of the causal effects of age, sex and body size upon hyoid morphology the present study puts the relationship between shape of human hyoid bone and body proportions (height and weight) under scrutiny of a morphological study. Using 211 hyoid bones and landmark-based methods of geometric morphometrics, it was shown that the size of hyoid bones correlated positively with measured body dimensions but showed no correlation if the individual's sex was controlled for. For shape variables, our results revealed that hyoid morphology is clearly related to body size as expressed in terms of the height and weight. Yet, the hyoid shape was shown to result primarily from the sex-related bimodal distribution of studied body size descriptors which, in the case of the height-dependent model, exhibited opposite trends for males and females. Apart from the global hyoid shape given by spatial arrangements of the greater horns, body size dependency was translated into size and position of the hyoid body. None of the body size characters had any impact on hyoid asymmetry. Ultimately, sexually dimorphic variation was revealed for age-dependent changes in both size and shape of hyoid bones as male hyoids tend to be more susceptible to modifications with age than female bones.

[Two anniversaries in Czech forensic medicine]. / Dvojí výrocí v ceském soudním lékarství

The authors commemorate the 100th anniversary of the publication of Slavíks textbook Forensic Pathology for Medical and Legal Students and the 125th anniversary of the 1st Czech forensic autopsy. They introduce professor V. Slavík and describe his personal qualities and expertise. The content of the textbook is described. The topicality of Slavíks explanations and the tradition of Czech forensic pathology are discussed. Key words: forensic pathology - history of Czech forensic pathology - textbooks of forensic pathology.

[Primary and secondary complex suicide. A 30-year retrospective suicide]. / Primární a sekundární kombinovaná sebevrazda: Retrospektivní studie let 1980-2009.

UNLABELLED: Suicides are divided into simple and complex suicides. Complex suicides are further classified as primary (planned) and secondary (unplanned) complex suicides. The term "complex suicide" refers to a suicide in which more than one suicide method is applied. In primary complex suicide several methods of suicide are employed simultaneously (two and more). In secondary complex suicide additional suicide methods are involved after the initial chosen suicide method failed. Authors present a 30-year retrospective study of complex suicides (1989-2009). Of the 2753 finished suicides in the given time period, 66 complex suicides were identified: 15 primary complex suicides and 51 secondary complex suicides. Complex suicides were analyzed in terms of gender, age, methods of suicide, locality and time of suicide, presence of alcohol and of the presence of suicide note and were compared with remaining 2687 cases of simple suicides from the same time period. KEYWORDS: suicide - complex suicide - primary complex suicide - secondary complex suicide - methods of suicides.

[Frangible bullets: wounding capability and clinical aspects of their use]. / Strely frangible: ranivost a klinické aspekty jejich pouzití

The article deals with basic characteristics of the frangible bullets and it documents a very specific behaviour of chosen types of these bullets in testing blocks as a substitute materials of alive tissues. The frangible bullets have several important advantages compared to the classical sorts of firearms bullets. The highest benefit could be seen especially in the limited penetrating capability and very low ricochet hazard connected with the use of these bullets. The absence of poisonous elements in the material of frangible bullets (for instance lead) is highly appreciated from the ecology reasons nowadays as well. The cartridges assembled with frangible bullets are used most of all for the practise reasons by law enforcement units, but can be used very effectively also in combat situations. Results of own shooting experiments confirm that the wound potential of bullet can be changed in a very large extent with the change of the manufacturing technology and the bullets geometry. Newly developed frangible bullets and the already manufactured bullets available on the market are characterized by very specific terminal ballistic features. Some frangible bullets behave in a comparable way to full metal jacketed bullets while penetrating soft tissues. Another frangible bullets of different designs fragment to the pieces in soft tissues and cause very serious wounds with persistent effects. The usage of frangible bullets and a potential risk of misuse of this specific sort of ammunition require also new approaches in the medicine for the treatment of the gunshot wounds.

[Unattended fatal haemorrhage associated with spontaneous rupture of peripheral varicosity]. / Necekané vykrvácení pri spontánní rupture periferní varikozity.

Crural ulcers are found in 3-5 % of the population, venous ulcers appear in 0,15-2 % of the population. Acute hemorrhage from venous ulcer is a rare complication which can lead to unattended and rapid external blood loss. Herein we present a case of 65-year-old man who was found in the kitchen of his flat in a large pool of blood with blood-tinged simple bandage applied on the right leg. At autopsy was revealed rupture of varicose vein at the base of large venous ulcer leading to fatal haemorrhage.

[Presentation of eponymous terms in forensic medicine]. / Eponymické termíny v soudním lékarství

The phenomenon of eponymous terms used in forensic medicine is described in the paper. Their linguistic basis, advantages and disadvantages for specialists or wider circles is discussed. Their spread in various language discourses is mentioned. A list of the most important eponymous terms in forensic medicine is the papers focus.

The diagnostic value of synovial membrane hemorrhage and bloody discoloration of synovial fluid ("inner knee sign") in autopsy cases of fatal hypothermia.

We describe and discuss autopsy findings of synovial membrane hemorrhage and bloody discoloration of synovial fluid ("inner knee sign") within a study population comprising 36 cases of fatal hypothermia and 300 control cases. Synovial membrane hemorrhage and bloody discoloration of synovial fluid of the knees were seen in 27 cases of fatal hypothermia (75%). Though we are not dealing here with an obligatory autopsy finding in fatal hypothermia, the detection of the inner knee sign might be used as another corroborative sign of vital hypothermia after considering all differential diagnostic aspects. However, the absence of this finding does not exclude death due to hypothermia.

[Usage of automatic voice transcription in autopsy service]. / Vyuzití automatického prepisu reci v pitevním provozu.

The paper describes the computer program NEWTON Dictate which is used for speech recognition and transcription. The possible uses of this program in forensic medicine are discussed, especially concerning the recognition and transcription of the autopsy findings. Specific conditions of the forensic medicine are introduced, with their influence on speech recognition and translation being the focus. The authors analyze program improvement aimed at reducing mistakes in recognition and transcription which may occur during autopsy work flow. Such improvement involves appropriate vocabulary usage and special vocal adaptation. The role of the autopsy secretary is acknowledged.

[The correlation of results of breath analysers and laboratory blood examinations of blood-ethanol concentration (Czech and Slovak study)]. / Mezirepubliková Cesko-Slovenská studie korelace výsledku dechových analyzátoru a výsledku laboratorní analýzy pri zjistování hladiny alkoholu v krvi.

The target of this study was to compare the results of breath analysers and "lege artis" laboratory blood examinations when determining alcohol levels. This was then used to determine whether any differences exist between the two methods, and how large these differences are. 610 cases from 11 workplaces in the Czech Republic and Slovakia were analysed. The type of breath analyser was not taken into consideration. All cases had to be in the elimination phase. Difference of time between breath test and blood test were rectified through the use of reverse recomputation. It was detected that only 20.8% of the results of respiratory analyser tests correspond to the detected real alcohol level in blood. The maximum difference when a respiratory analyser measured more than a blood test was 1.34 g x kg(-1). and the maximum difference when the analyse measured less was 1.86 g x kg(-1).

Multiple suicidal injuries with shotgun slugs.

Shotguns are usually used to fire multiple pellets, but they are capable of firing single projectiles. Shotgun slug injuries are rare, severe, and fully comparable to those inflicted by high-velocity projectiles. A case of gunshot suicide of a 59-year-old man with a shotgun loaded with shotgun slugs is presented. The first two shots were fired into the heart region, but did not hit the vital organs of the victim's thorax and did not cause immediate incapacitation. The man was able to reload and refire. The third shot was fired into the region of right temple; the last shot caused severe cerebrocranial gunshot injury and was fatal. The victim did not pull aside his clothing to expose his skin before shooting into the heart region.

[Problems on Czech anatomical nomenclature in forensic medicine]. / Prolematika ceské anatomické nomenklatury v soudním lékarství.

The paper describes the medico-legal language style of texts which are often meant for non-medical scholars. Traditionally, the Czech language has been used in forensic medicine, instead of Latin (words with Latin roots). The paper also presents requirements for the language style of medico-legal texts as we have found them in academic publications. The core of the paper is an analysis of the anatomical terms extracted from autopsy protocols. We focus on designation of those anatomical structures which do not have their established Czech equivalents. Possibilities of a future research of the Czech anatomical nomenclature standardization for speech recognition (e.g., autopsy protocols) are mentioned.

[Suicide with home-made gun]. / Sebevrazda podomácku vyrobenou strelnou zbraní.

Three cases of suicide by single bullet injury to head by home-made guns with immediate incapacitation are reported in following article. Zip gun (home-made gun) is a improvised firearm, usually a handgun. Home-made guns are almost always single-shot, as the improvised construction sometimes makes them weak enough to be destroyed by the act of firing. Zip guns are mostly smoothbore. Zip gun injuries, although unique today, represent a special category of missile injury with atypical low velocity terminal ballistics.

[Shotgun injury--multiple pellets]. / Poranení brokovou zbraní-hromadná strela.

Both typical and less frequent features of gunshot wounds caused by shotguns are reported in the following article. The pattern of shotgun injury predominantly depends on gauge, choke, number and diameter of used pellets, muzzle-victim distance and on character of the afflicted area of the body. Characteristic ballistic properties of shotgun pellets, their wounding potential and significance in forensic patology are presented.

[Shotgun gunshot injury--shotgun slugs]. / Poranení brokovou zbraní--jednotné strely.

Injuries caused by a shotgun belong to the group of less frequent gunshot wounds. Shotguns are usually used to fire multiple pellets, but they are capable of firing single projectiles. Shotgun slug injuries are rare and severe, and fully compareable to those inflicted by high-velocity projectiles. Thanks to great slug's mass and size can create more tissue destruction than the high-velocity missiles. Characteristic ballistic properties of shotgun slugs, their wounding potential and significance in forensic pathology are presented.

[Prior exposure of the entrance wound region from clothing in suicides]. / Odstranování odevu a místa budoucího vstrelu u sebevrahu.

According to an old empiric rule related to suicidal gunshot wound still in use, suicides will rarely shoot through their clothing, but will put it aside to expose the nude skin. A bullet defect in victim's clothing was often interpreted as a suspicious finding. In our article, which is based on retrospective consecutive study of gunshot fatalities from 1980 to 2004, where all autopsies were performed in Department of Legal Medicine in Hradec Králové, there were 38 cases with suicidal gunshot wound of trunk. In file of 38 cases only 3 victims exposed the entrance wound region from their clothing (relative frequency of only 8%). Thus a bullet defect in clothing should not be interpreted as an absolute criterium, which could exclude the possibility of suicide or suggest homicide or an accident. But in case when gunshot victim has bared the region of the entrance wound from textile can this finding be interpreted as a typical indication for suicide.

Unusual form of accidental mechanical asphyxia.

This brief case report shows an unusual form of accidental atypical strangulation. A 46-year-old male became trapped between the rims of an automatically closing door during his hopeless effort to enter a supermarket at night. The victim's neck was violently pressed by the edges of the automatic door. From external observation we found an incomplete ligature mark and numerous small abrasions in the neck. On autopsy we found typical signs of asphyxia and fractures of the hyoid-laryngeal complex and bruising of the soft tissues of the neck. The subsequent toxicology was negative with the exception of alcohol level. We came to the common conclusion of a double form of mechanical asphyxia - atypical violent strangulation and atypical hanging. The third highly likely contributory factor of death was direct stimulation of the baroreceptor nerve endings in the left carotid sinus and left carotid sheath. In recent literature, there have been presented only a few cases describing this manner of asphyxia and death.

[Death due to fatal hypothermia in victims dissected in Department of Forensic Medicine in Hradec Králové between 1992-2003]. / Smrt prochlazením u osob pitvaných na USL Hradec Králové v letech 1992-2003.

Death due to hypothermia is diagnosed on the base of the unspecific morphological lesions. These lesions such as Wischewski spots, haemorrhage into the pancreas and haemorrhage into the skeletal paravertebral muscles etc. are not found periodically and regularly. We must know the anamnestic settings and the results of laboratory tests for final complete evaluation. Fatal hypothermia is under climate condition of our country quite often with the exception of summer months.