Patient's death as a result of mistakenly injection of pancuronium.

Pancuronium is a typical non-depolarizing, curare-mimetic, very potent muscle relaxant. Besides application in anesthesiology and intensive care, it is used in execution as a part of lethal injection. In medico-legal practice, there are cases of using this substance in order to commit suicide or to deprive other people of their lives. Accidental pancuronium intoxications are very rare. The authors present such case ended in sudden death of hospitalized woman after mistakenly injection of the drug. 57-year-old female alcoholic was admitted to the Acute Poisoning Centre after ethylene glycol ingestion. During the fifth day of treatment the nurse by mistake, instead of furosemide, intravenously administered her pancuronium. Sudden respiratory and circulatory arrest occurred, so she was intubated and resuscitation with artificial ventilation were undertaken, however within 1 hour and 45 minutes the patient died. Due to the vague background of a sudden deterioration in the patient's condition, the case was brought for prosecution. The autopsy and histopathological studies did not reveal the cause of death, but undertaken chemico-toxicological examinations identified the presence of pancuronium in blood, liver and kidney (190 ng/ml, 70 ng/g and 125 ng/g, respectively). Chemico-toxicological analysis proved that the cause of death of the 57-year-old hospitalized woman was pancuronium intoxication due to evident medical error during drug administration. In our case the concentration of pancuronium in blood was in therapeutic range (200-600 ng/ml). However, even a therapeutic pancuronium dose administered to patient the breath of whom is not supported and monitored can be a threat to his life.

[Assessment of exposure to hydrogen cyanide in fire fatalities in the aspects of endogenous hydrogen cyanide production as a result of putrefaction processes in the deceased]. / Ocena ekspozycji na cyjanowodór u smiertelnych ofiar pozarów w aspekcie powstawania w zwlokach endogennego cyjanowodoru w procesach gnilno-rozkladowych.

On account of endogenous hydrogen cyanide (HCN) production in the deceased, it is not easy to assess exposure to HCN in people who died in fire involving closed rooms (flats, garages, cellars, etc). In the paper, the authors present the results of blood determinations of hydrogen cyanide in fatalities of explosions and fires occurring in coal-mines, as well as fires in closed rooms. It has been demonstrated that the time of exposure to a high temperature and the temperature itself hamper autolysis processes that lead to production of endogenous HCN in fire fatalities.

[Medico-legal assessment of the injuries of fatal victims of building collapse at Katowice International Fair in Katowice/Chorzów on January 28, 2006]. / Sadowo-lekarska ocena obrazen u smiertelnych ofiar katastrofy budowlanej na terenie Miedzynarodowych Targów Katowickich w Katowicach/Chorzowie w dniu 28.01.2006 roku.

On January 28, 2006, during an exhibition of carrier pigeons, the roof of one of the buildings at Katowice International Fair collapsed. At the time of accident, there were 700 people in the building--65 died and 171 were injured. It was the biggest building disaster in the history of modern Poland. The aim of this study was to present the type (character) of the observed injuries, the cause of death of 48 fatal victims and the range of activities and medico-legal examinations performed in the Department of Forensic Medicine, Medical University of Silesia in Katowice. In the period of January 29-February 1, 2006, on February 14, 2006, and February 17, 2006, post-mortem examinations of the 48 deceased were carried out, and in some cases additional dissecting techniques were employed. During autopsies, numerous specimens for various additional examinations (histopathological, toxicological) were collected. For identification purposes, photographic material and specimens, necessary for genetic identification, were secured. Additionally, the bodies were identified by families. The post-mortem procedures eventually allowed for establishing the cause of death of all the victims. The authors emphasize the range of necessary medico-legal procedures and examinations that should be carried out in a Department of Forensic Medicine in case of a building collapse with a large number of fatalities in order to determine the type of injuries, cause and mechanism of death and to identify the deceased.

Case-study of fatal gunshot wounds from non-lethal projectiles.

The authors present a case of the death of a 60-year-old man shot using rubber projectiles that were fired by a police officer from a Mossberg smooth-bore shotgun in an enclosed space from a distance of a few metres. The post-mortem examination revealed that death had been due to gunshot wounds in the chest which had caused heart and lung damage with subsequent massive internal haemorrhaging.

[Opinionating on the cause of poisoning and death in fire victims]. / Opiniowanie o przyczynie zatrucia i smierci w przypadku badania zwlok wydobytych z pozaru.

In the years 1995-2005, 273 cases of fatalities resulting from a fire were investigated in the Chair of Forensic Medicine, Medical University of Silesia, Katowice. To explain the circumstances and determine the cause of death, in each case, autopsies, as well as toxicological determinations of toxic gases, such as carbon monoxide or hydrogen cyanide, were carried out. Alcohol intoxication status of the victims was also determined. Based on the obtained results, comprehensive toxicological and medico-legal opinions on the cause of death of all the examined fire-associated fatalities were done.

[Limitations in medico-legal appraisal of sobriety or alcohol intoxication in drivers and the use of retrospective calculation. Practical comments based on an analysis of the files investigated in the chair of forensic medicine, Medical University of Silesia, Katowice, in the years 2000-2004]. / Ograniczenia w opiniowaniu sadowo-lekarskim dotyczacym oceny stanu trzezwodci lub nietrzezwosci kierowców i zastosowaniu rachunku retrospektywnego. Uwagi praktyczne na podstawie analizy spraw aktowych Katedry Medycyny Sadowej w Katowicach w latach 2000-2004.

In case of a driver who was involved in and survived a traffic accident, the analysis of expired air or blond sampling for alcohol determination is usually done within a shorter or longer time interval after the event. Thus, that the obtained analytical results are to be referred to the time when the examination or sampling was done, whereas the courts are interested in the driver's sobriety of alcohol intoxication at the critical moment, i.e. at the moment of the accident. Knowledge of alcohol toxicology allows for performing some simplified calculations to determine estimated blood alcohol concentration levels similar to those at the critical moment by using the so-called retrospective analysis. The authors performed a statistical analysis of the court files investigated at the Chair of Forensic Medicine, Medical University of Silesia, Katowice, in the years 2000-2004, especially focusing on difficulties encountered in cases of alcohol intoxication in perpetrators of traffic collisions.

[Permanent essential defacement--remarks on the possibilities of verification of the accepted criteria in medico-legal certification in criminal and civil law proceedings]. / Trwale, istotne zeszpecenie - uwagi o mozliwosci weryfikacji kryteriów w opiniowaniu sadowo-lekarskim w sprawach karnych i cywilno-odszkodowawczych.

Despite the fact that some criteria of medico-legal certification in criminal and civil proceedings have been established, there are still some topics which are controversial and thus require modification. This is also true of the notion of "permanent essential defacement". In the opinion of the authors, changes in social conventions that are occurring nowadays, as well as a highly diversified, subjective perception of esthetic values indicate the need for discussing a possible modification of the presently obligatory criteria. Apart from the assessment of posttraumatic changes, an important problem is posed by defining the notion of "a part of the body customarily open to the view ". Additionally, the authors bring up for discussion the issue of experts taking into consideration the age and sex of the victims while assessing damages. A separate problem lies in difficulties in assessing the degree of detriment to health because of defacement due to the fact that official tables for evaluating permanent or long-term detriment to health do not include relevant information.

[Double ritual murder by the Satanist cult members based on the casuistry of the Forensic Medicine Department in Katowice]. / Przypadek rytualnego, podwójnego zabójstwa popelnionego przez wyznawców szatana.

In recent years, an increased activity of various sects, especially Satanist ones, has been observed in Poland. This is associated with an increase in the number of various crimes, including offences against life and health. The ideology of Satanism came to Poland in the early eighties of the last century, along with heavy metal music and its variants. In 1999, two cases of the murders of a 21-year-old woman and a 19-year-old man committed by Satanist cult members during their ritual mass were reported at the Forensic Medicine Department in Katowice. In the report, the authors present some issues associated with Satanism, the circumstances of these two murders and the results of medico-legal examinations of the victims.

[Diagnostic importance of formic acid detection in methyl alcohol poisoning]. / Znaczenie diagnostyczne oznaczania kwasu mrówkowego w zatruciu alkoholem metylowym.

In the paper the authors have presented a possible use of formic acid detection in biological specimens in the diagnosis of methanol poisonings. Formic acid was determined as a volatile methyl formate ester by the gas chromatographic head-space method. Based on opinions relating to methanol poisonings, formulated in the Forensic Medicine Department, Silesian School of Medicine, Katowice a potential application of the method mentioned above to forensic medicine was shown, especially in cases of late deaths after methanol intoxication and also a possibility of its use in clinical evaluation of the poisoning phase as well as monitoring the course of treatment.

[Comprehensive medico-legal examination of an unidentified burnt victim NN with regard to individual identification]. / Kompleksowa ekspertyza sadowo-lekarska dotyczaca NN zwlok spalonych, z uwzglednieniem ich identyfikacji osobniczej.

In the paper the authors present results of the postmortem examination of the burnt body of an unidentified young man NN, who was suspected of being kidnapped, held in custody and finally burnt. During the autopsy dental identification was carried out and its results were compared to the dental card of the chosen man. Toxicological examinations of alcohol, CO, drugs and medicines were negative. Additionally, for individual identification, the analysis of blood DNA polymorphism was carried out in the following loci: CSF1PO, TPOX, TH01, F13A01, VWA, F13B, HPRTB, D16S539, D7S820, D13S317 (STR systems), D1S80 and also DQA1, LDLR, GYPA, HBGG, D7S8, GC. The results of the DNA polymorphism in the deceased were compared to those obtained in putative parents. Statistical analysis of the obtained results of the DNA analysis allowed to find out that the man NN was the son of H.E. and R.E. This comprehensive medico-legal examination allowed for identification of the deceased.