"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 year 1989 and its reflection in the forensic medicine.

The countrys current social and political situation is always reflected in the character of crime through specific laws and encoded rules in the country. This relationship is evident especially in historical turning points - events marking radical changes of the social regime. During the years following 1989, an increase in crime was noticed in the Slovak Republic, which seemed to be influenced not only by ideological and political factors, but also by economical and juridical ones. This increase can be noticed up to the present, as the annual number of violent criminal acts and brutal murders still remains high. Violent crime contributes by 14 percent to the crime counts in the Slovak Republic. The aim of presented study was the comparative analysis of chosen forms of violent crimes and the consequences of the most serious crimes in the Middle Slovakia region during the era of political regime changes within the period from 1985 to 2006.

[Pohoda no. I (death on music festival)]. / Pohoda I. (Smrt' na hudobnom festivale).

A fatal accident of a young man, visitor of the summer music festival, shocked the whole Slovak society. Many unanswered questions concerned a causality of the incident arose immediately. Altough most questions have been focused to technical experts concerning the cause of a tent fall, the forensic medicine can bring some important reflections and conclusions, too. An absence of natural defense mechanisms of the accident's victim should be explained only through malignant affection of the body reflectoris reactions by exogenous substance, which might depress natural senzoric or motoric response while being in acute danger from falling tent's construction.

[Pohoda no. II (delayed death--following music festival)]. / Pohoda II (smrt' po hudobnom festivale).

A mass tragedy on the Slovak biggest music festival "POHODA", caused by a windstorm, shocked whole society, even abroad. Many questions concerned a causality and a circumstances of the incident arose immediately. The forensic autopsies of victims (29-aged man and 19-aged woman) represented a very special expertise act in police investigation of the case.

[Homicide, suicide or fatal accident?]. / Vrazda, samovrazda alebo náhodný úraz?

A forensic explanation of womandrinker's death is presented in the article. Exsanguination from multiple cut wounds was cause of death. Origin of wounds was unable to explain due to its atypical character and localisation on body surface. Only a subsequent exact allocation of wounding object made clear biomechanical aspects of wounds. A hard ethanol alteration of psychical, senzorical et motorical functions with strong posttraumatic et toxometabolic changes of the body took share on mechanism of death.

[Atypical maxillofacial shot wound]. / Atypické strelné poranenie maxilofaciálnej oblasti.

Maxillofacial shot wounds belong to the relatively less frequent injuries. The soft tissues might be affected in particular, however the most of injuries are combined with infliction of hard tissues. Shot wounds by the bow or crossbow are very rare. They might result as a consequence of either accident or suicide. In the literature some cases of a suicidal experiments had been published, all of these cases were due to arrow from the crossbow. There was no injury being documented due to arrow from the bow. The authors present a case of maxillofacial injury done by shoot of arrow from the bow in the course of a child's play.

The interdisciplinary cooperation of forensic medicine, clinical medicine and palaeozoology: a case of cave bear (Ursus speloeus) bones.

Three pathologically modified bones (cranium, left mandible, iliac bone) of a cave bears (Ursus spelaeus) were found in the Last Glacial deposits (OIS 3) in the caves of the Vel'ká Fatra carst, Slovak republic. Despite of thorough paleontological examination, the bear bones were examined by experts in forensic medicine, traumatology and stomatology, too. The pathological changes were found in the tooth bed on the right side of the maxilla at the place of M1, being interpreted as a result of odontogenic purulent inflammation of soft tissues of tooth bed and surrounding bone. The iliac bone has an abnormally formed acetabulum with damaged and deformed osseous upper border, which could be a result of immoderate pressure of the head of femur, following with the mineral dysbalance (decalcification) or fracture of limbus acetobuli caused by injury. The mutual cooperation of all the abovementioned experts was declared as a very fruitful.

[The forensic-anthropological expertise of a historically important person's relics, destroyed by fire--the contribution of forensic experts to the preservation of a historical heritage]. / Forenzne-antropologická expertíza termicky poskodeného tela historicky významnej osoby--prínos k zachovaniu historického dedicstva.

The forensic-anthropological expertises of the human remains being destroyed by the external heat are rather rare in general practice of the medical examiner (burned body remains in the fired houses, in traffic accidents, air crashes, explosions in coal mines etc.). In the aim to restore the identity of the burned person, such an expertises have to solve a complex set of problems, which--on the site of a forensic expert--need the application of a very specific approaches and know how. The authors describe a rare case of forensic and anthropological expertise of the 400 years old relics of a person, being important in the slovak history, whose body in the coffin was intentionally exposed to open fire.

[Forensic interpretation of postmortal ethanol neogenesis in blood samples of cadaverously decomposed bodies]. / Forenzná interpretácia postmortálnej neogenézy etanolu v krvných vzorkách z kadaverózne dekomponovaných tiel.

There is no real possibility for detail knowledge of postmortal changes of blood alcohol concentration in the near future, so that it is necessary to comment alcoholaemia with special aspect on empirical practice. Potential use of alternative (more resistant to putrefaction) body fluid or tissue can help to distinguish ratio of endogenous and exogenous ethanol. It seems that using of vitreous (eventually urine) is the best way to avoid desinterpretation mistakes of alcoholemia in cadavers. In cases where these fluids are missing we are not able to comment alcoholaemia of saprogenic blood.

[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).

Vomitus as a cause of fatal diving accident of a commercial diver.

The forensic expertise of the victim of fatal diving accident (commercial diver), who died in depth of 41 mts due of unknown reasons, had been realised by the authors. One of the authors of the paper was present on site of the diving accident as a diving medicine specialist. The autopsy revealed, that the cause of death of the diver was suffocation due to vomitus and massive aspiration of gastric content to the airways. The commercial diving technology (full-face diving mask with oro-nasal inner mask) was used. The authors point out some peculiarities in interpretation of such a fatal diving accident.

Ritual suicide of a 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.

Gravidity complicated by abdominal neoplastic 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.

[Impact of acute alcoholism on the women's mortality in the northern region of Slovak Republic]. / Dopad akútneho alkoholizmu na mortalitu zien v regióne severného Slovenska.

Problem of women's alcoholism doesn't belong among main topics of Slovak or Czech public discussions. Though everyone meeting the phenomenon of women's alcoholism can feel the fatal consequences of this mistake, our society used to perceive alcoholism as a men's problem. The authors performed the complex analysis of the mortuary files with particular focusing on the cases of women's deaths caused by alcohol intoxication, and the cases of deaths where an alcohol played the dominating role, in the northern regions of Slovak republic. Submitted article is author's next referring to urgent need of public discussion concerning the alcohol consumption in Slovakia, the phenomenon being widely tolerated by the society.

[The taphonomic aspects of cadaverous changes in corpses, buried in the plastic foils]. / Tafonomické aspekty kadaveróznych zmien u mrtvol ulozených do zeme v plastových obaloch.

The forensic expertise of the 6 human bodies, being murdered in organised crime activities, had been realised by the authors. All the cadavers were packed in plastic bags or plastic foils, then buried to the illegal graves, being prepared in advance. The detail overlook and autopsy of the bodies had disclosed, that due of almost airtight sealing of the cadavers in plastic materials, the postmortal cadaverous changes went on much slower and were manifested under a different picture, as seen in the human cadavers being buried in the standard wooden coffins. The authors point out the peculiarities of such a postmortal changes, with particular focusing on the estimation of postmortal period.

[The technological screening of beers, made in Slovak Republic, in the view of forensic alcohology]. / Technologický skríning pív, vyrábaných v Slovenskej republike, z pohl'adu forenznej alkohológie.

The questions connected with forensic alcohology are closely bounded with the legal norms and actual production of alcoholic beverages, incl. the breweries. The presented work, dealing with the beers being made in Slovak republic, had been stipulated by the Slovak Society of Forensic Medicine, in the aim to inform the forensic experts about the beers being produced in the country mentioned.

[The lethal alcohol intoxications and deaths due to severe drunkenness in North Slovakia regions (1994-1996, 2003-2005): a medicolegal comparative study]. / Letálne intoxikácie alkoholom a úmrtia v tazkom stupni opitostiv v regióne severného Slovenska v rokoch 1994-1996 a 2003-2005: súdnolekárska komparatívna stúdia.

The authors performed the complex analysis of the mortuary files (since 1994 to 1996 and 2003 to 2005) with particular focusing on the cases of deaths caused by alcohol intoxication, and the cases of deaths where an alcohol played the dominating role, in the northern regions of Slovak republic. Based on the analysis mentioned, authors point out the continuous rise of alcohol abuse, followed by the fatal consequences for human beings. The authors are to express the urgent need of public discussion concerning the alcohol consumption in Slovakia; the phenomenon being widely tolerated by the society, thus leading to the number of social tragedies even in 21st century.

[The use of cell cultures for in vitro decompression sickness simulation]. / Vyuzitie tkanivových kultúr pri simulovaní dekompresnej choroby.

Recreational and technical diving in the past twenty years have become extraordinary popular. Until then diving was a priority of police, army and scientists. Today more and more enthusiasts are exposed to abnormally high surrounding pressure. To the severest of all risks associated with diving, decompression sickness is the greatest threat. Even the most advanced scientific approaches yet did not reveal the complex mechanisms of decompression sickness formation. The majority of experiments use a live model for decompression sickness studies. This is associated with high fatality rate. The new approach of this scientific study is in the use of an in vitro working media as a means of visualization of gas bubbles due to decompression. The aim of this study is to bring above new approaches in in vitro gas bubble formation during decompression. Main goals are: development of in vitro inert gas bubble visualization and evaluation techniques after a real decompression dive with air a as the diving gas and EANx50 as a decompression gas. We selected cell cultures derived from human fibroblasts B-HEF-2 and cell cultures of mice N2A neuroblasts. We used two decompression profiles. "Explosive" decompression profile with a linear compression to overpressure of 50 bar with an rapid decompression to atmospheric pressure (1 bar). In simulation of a realistic decompression profile we used compressed air as a mean for compression and isocompression breathing gas and an EANx50 blend as a decompression breathing gas. This dive was planned with the use of a VPM-B decompression profile by V-Planner software v.3.62. Our latest experiments show that DNA fragmentation and apoptosis is activated during decompression shock. Use of culture cells can be of great value in further studies of decompression changes in the cellular and subcellular level.

[Possibilities of use of digital imaging in forensic medicine]. / Moznosti vyuzitia digitálneho zobrazovania v súdnom lekárstve.

Based on the daily practice with digital photography and documentation, the authors point out the achievements of the computer technologies implementation to the practice of forensic medicine. The modern methods of imaging, especially the digital photography, offer a wide spectrum of use in forensic medicine--the digital documentation and archivation of autopsy findings, the possibility of immediate consultation of findings with another experts via Internet, and many others. Another possibility is a creation of digital photographic atlas of forensic medicine as a useful aid in pre- and postgradual study. Thus the application of the state-of-the-art computer technologies to the forensic medicine discloses the unknown before possibilities for further development of such a discipline of human medical sciences.

[Fatal injuries in bicyclists]. / Smrtel'né úrazy bicyklistov.

An analysis of 58 cases of fatal bicycle accidents during the years 1991-1996. Substantial prevalence of males was a common feature among deceased persons especially in the 21-40-year and 61-70-year age groups. More fatal bicycle accidents occurred in evening hours between 6 and 12. The proportion of alcohol influence among dead cyclists was standardly high and the usage of protective helmet was not found. Further analysis concerned the types of injuries after fall on a firm base, after collision with a solid subject or with means of transformation. Craniocerebral injury was the cause of death in 65.5% of cases. Because of increase in popularity of bicycle as simple means of transportation a further increase of fatal cyclist accidents can be presumed requiring precise follow-up by forensic medicine.