The Stability of Synthetic Cathinones and the Study of Potential Intake Biomarkers in the Biological Material from a Case of 3-CMC Poisoning.

The objective of the present study was to identify the metabolites of synthetic cathinone (SC), 3-chloromethcathinone (3-CMC), and to select a potential intake biomarker for this compound. The basis of the experiment was the analysis of blood and urine samples from a case of fatal poisoning with this substance. We also evaluated the stability of 3-CMC and the selected potential biomarker, the dihydro-3-CMC metabolite, depending on the time elapsed since the autopsy as well as the storage conditions of the biological material. Studies have shown that 3-CMC shows low stability in the biological material. However, acidification of the biological material or storage at low temperatures has a great impact on maintaining its stability. It is crucial to monitor the presence of the dihydro-3-CMC metabolite in the biological material during analysis, which showed high stability under all of the given storage conditions. SCs might not be detected in the biological material and, if they are, the determined concentrations at the time of testing may not correspond to the actual concentrations at the time of the event or death. Consequently, the interpretation of the results obtained for 3-CMC and dihydro-3-CMC in terms of assessing their toxicity and possible cause of death is difficult. The area of research into the search for other intake biomarkers of unstable halogen derivatives of SCs remains open.

The various pathological manifestations of a lightning strike exemplified in a single four-fatality incident - A case report and review of a literature.

The lightning strike is one of leading cases of weather-related death worldwide. We present an unusual case of four fatality-lightning strike with various pathological manifestations. All victims died from a single lightning strike in the mountains that also caused injury to 156 other people. All victims had mechanical damage and rock damage that are typical for lightning strikes in the mountainside. Another lesions indicative of lightning strike and electrical damage were, among others: burnt and torn clothes (all cases) current marks (Cases 1, 2 and 3) and Lichtenberg figures along with flashover marks on Case 1. In the review we described the pathophysiological mechanisms of lightning-induced lesions and injuries and epidemiological trends of lightning-strike deaths. Our study exemplifies various manifestations of lightning strikes on forensic examination and underlines the necessity to take lightning strike into consideration when investigating open-air deaths of unclear origin.

Post-aggression suicide under the influence of new psychoactive substances AMB-FUBINACA and U-47700.

The objective of the present study was the development and validation of the method for determining AMB-FUBINACA and its metabolite - AMB-FUBINACA O-desmethyl acid - in blood samples, followed by verification of the method in toxicological judicial and forensic medicine practice employing the example of post-aggression suicide. Most likely in consequence of development of adverse effects resulting in psychotic symptoms, a male being under the influence of the synthetic cannabinoid AMB-FUBINACA and the new synthetic opioid U-47700, mortally wounded his female partner and subsequently committed suicide. Identification and determination of the afore-mentioned xenobiotics in blood samples collected from the male and female victims were performed employing high performance liquid chromatography coupled with electrospray ionization tandem mass spectrometry (HPLC-ESI-MS/MS). The analytes were isolated from blood samples using the solid phase extraction (SPE) method. The blood samples collected from the male and female demonstrated respectively 110 and 196 ng/mL of AMB-FUBINACA O-desmethyl acid metabolite, 1935 and 357 ng/mL of U-47700, 250 and 200 ng/mL of N-desmethyl-U-47700, as well as 410 and 200 ng/mL of N,N-didesmethyl-U-47700. The concentration values of new psychoactive substances (NPS's) in blood samples originating from the male and female were within the ranges encountered in cases of poisoning, including these resulting in death. Nevertheless, the evident signs of exsanguination proof that the woman was alive when she sustained lethal injuries. The presented cases illustrate the difficult to be anticipated effect exerted on the users by NPS's.

Restraint asphyxia. An analysis of the circumstances and mechanism of death in agitated, physically restrained individuals. / Asfiksja restrykcyjna. Analiza okolicznosci i mechanizmu smierci osób pobudzonych psychoruchowo, w trakcie obezwladniania z uzyciem sily.

Recent years saw frequent media reports of young people who die while they are being arrested by the police. Death in these circumstances affects people who are agitated and restrained with the use of force, with their autopsies indicating no unequivocally traumatic cause of death. The goal of this study was to identify the mechanism and circumstances of sudden deaths in agitated individuals who are being restrained. Ten cases evaluated at our center since 2010 were included in this study: nine involved forensic postmortem examination and one involved casefile analysis. In each case there was sudden cardiac arrest or at least a loss of consciousness, and the cardiopulmonary resuscitation proved ineffective. In six cases the cause of agitation was acute psychosis, in four it was an effect of narcotics, usually in high concentration. Conjunctival petechiae were detected in only five cases. The most probable cause of death in the evaluated cases was the combination of physical exertion caused by pathological psychomotor agitation and forcible restraint, hindering the function of the respiratory system. This mechanism is known as restraint asphyxia.

Whole-body post-mortem computed tomography angiography of a newborn revealing transposition of great arteries.

The number of medico-legal post-mortem examinations referring to newborns is considerably low: In the case of the Chair and Department of Forensic Medicine of the author's origin, the autopsy rate of such cases is less than 1%. Even experienced forensic pathologists can find the technical autopsy procedure of a newborn quite difficult. Post-mortem imaging using unenhanced post-mortem computed tomography (PMCT) gives only a limited opportunity to help in conventional autopsy examination. By adding contrast medium (CA) administration, we can significantly expand diagnostic capabilities. However, the post-mortem computed tomography angiography (PMCTA) technique has already been developed mostly in adult death cases (as considerably much more frequent), and no standardised protocol for examination of children exists. The authors present the dual-phase PMCTA examination of a newborn by manual CA administration using the access to umbilical vessels (vein and artery) unveiling transposition of the great arteries (TGA). The results are presented as multiplanar reformatted (MPR) images and three-dimensional (3D) images by volume/surface-rendered reconstructions, giving a contribution towards proving the value of forensic imaging in post-mortem examinations of heart and vascular malformations in newborns.

Imaging for homicide investigations.

The authors present the opportunities of the application of post-mortem imaging, focusing on post-mortem computed tomography and post-mortem computed tomography angiography in modern forensic investigation of homicide cases. The paper is based on scientific publications related to the subject from ca. the past 10 years, supplemented by the authors' own experiences. The article is illustrated with reconstructions based on the authors' own cases related to homicide due to ballistic/sharp/blunt trauma. As is shown, the results of evaluation of post-mortem computed tomography allow better diagnosis, documentation and visualisation of forensic examinations.

Renal tumors in unselected forensic post-mortem material.

The frequency of clinically evident renal tumors is increasing, due to an actual increase in incidence, but also due to an improvement in detection methods. The aim of the present study was to analyze the incidence of renal tumors in an unselected autopsy series. A search for renal tumors was conducted based on the autopsy reports from the Department of Forensic Medicine. The slides were reviewed and reclassified according to current criteria. Among 14,904 autopsies, 80 renal tumors were found. The most frequent tumor types were clear cell carcinomas (41%), papillary carcinomas (18%) and cortical adenomas (19%). There were 66 males and 14 females. The average age was 57.83 for males and 62.86 for females. The characteristics of the study group were not exactly identical but similar to other autopsy series, and significantly different from surgical series.

Weapon identification using antemortem computed tomography with virtual 3D and rapid prototype modeling--a report in a case of blunt force head injury.

A frequent request of a prosecutor referring to forensic autopsy is to determine the mechanism of an injury and to identify the weapons used to cause those injuries. This task could be problematic in many ways, including changes in the primary injury caused by medical intervention and the process of healing. To accomplish this task, the forensic pathologist has to gather all possible information during the post-mortem examination. The more data is collected, the easier it is to obtain an accurate answer to the prosecutor's question. The authors present a case of head injuries that the victim sustained under unknown circumstances. The patient underwent neurosurgical treatment which resulted in alteration of the bone fracture pattern. The only way to evaluate this injury was to analyze antemortem clinical data, especially CT scans, with virtual 3D reconstruction of the fractured skull. A physical model of a part of the broken skull was created with the use of 3D printing. These advanced techniques, applied for the first time in Poland for forensic purposes, allowed investigators to extract enough data to develop a hypothesis about the mechanism of injury and the weapon most likely used.

[Validity of post-mortem computed tomography angiography (PMCTA) in medico-legal diagnostic management of stab and incised wounds]. / Przydatnosc posmiertnego badania tomografii komputerowej z angiografia (PMCTA) w sadowo-lekarskiej diagnostyce przypadków ran klutych i cietych.

The report presents an analysis of results of multi-phase post-mortem computed tomography angiography (MPMCTA) scans performed at the Chair of Forensic Medicine, Jagiellonian University Medical College, in cases of stab wounds and incised wounds, as confronted with the results of conventional medico-legal autopsies. The analysis of the material points to a validity of PMCTA scans as supplementing post-mortem medico-legal examinations and being capable of providing significant data that affect final conclusions and adding new quality to recording post-mortem observations.

[Application of hair analysis of selected psychoactive substances for medico-legal purposes. Part II. Cases of complex fatal poisonings: interactions of heroine - cocaine - amphetamines]. / Zastosowanie analizy wybranych substancji psychoaktywnych we wlosach dla celów opiniowania sadowo-lekarskiego. Czesc II. Przypadki zlozonych zatruc smiertelnych: heroina - kokaina - amfetaminy w mechanizmie interakcji.

The study represents an attempt at employing segmental hair analysis in complex poisonings with xenobiotic mixtures of heroine - cocaine - amphetamines in the context of the cause of death as a consequence of complex interaction mechanisms which occurred prior to death. Two cases of complex poisonings: heroine - cocaine and heroine - cocaine - amphetamines were analyzed and documented with macro- and microscopic examinations and complex toxicological examinations, including the analysis of classic biological material, i.e. samples of selective blood, and alternative material, i.e. hair samples. Determinations of opioids, cocaine and its metabolite and amphetamines in the hair biological matrix were performed using high performance liquid chromatography--atmospheric pressure chemical ionization--tandem mass spectrometry (HPLC-APCI-MS-MS). Segmental hair analysis of the investigated cases indicated a prolonged intake of similar psychoactive substances and a developed adaptation of the addicted to interaction mechanisms, which, however, led gradually to multiorgan anatomopathological changes, and in consequence to death.

[Histological examination of specimens obtained during autopsy of the exhumed corpse of general Wladyslaw Sikorski]. / Badanie histologiczne wycinków pobranych podczas sekcji ekshumowanych zwlok generala Wladyslawa Sikorskiego.

The authors present the results of histological examinations of tissue specimens obtained during autopsy of the exhumed corpse of general Wladyslaw Sikorski. In spite of the level of corpse decomposition, the connective tissue stroma was preserved in virtually every specimen.

Microvessel density and area in pituitary microadenomas.

Microvessel density (MVD) and area (MVA) were assessed in 53 clinically silent pituitary microadenomas and in surrounding normal pituitary tissue using CD34 immunostaining and digital image analysis system. Twenty-one microadenomas (40%) were avascular; in the others, both MVD and MVA were significantly lower than in the normal pituitary tissue. No significant differences in MVD and MVA were found between hormonally immunonegative and immunopositive tumors or between different hormonal subtypes of immunopositive microadenomas. In microadenomas and in normal pituitary tissue, MVD and MVA were not significantly influenced by age or sex. These results suggest that pituitary adenomas at early developmental stage are either avascular or significantly less vascular than normal pituitary tissue and that differences in vascularity of pituitary adenomas associated with the variables of sex, age, clinical presentation and immunohistochemical phenotype reported in the literature can evolve with tumor growth and possibly acquire statistical significance in large macroadenomas.

[Postmortem CT examination in a case of alleged drowning--a case report]. / Posmiertne badanie obrazowe TK w przypadku domniemanego utoniecia--opis przypadku.

The authors present an analysis of postmortem CT examination in a case of drowning in fresh water of a young male. Both the results of conventional forensic autopsy and radiologic examination have been compared. The analysis is illustrated by two-dimensional and three-dimensional reconstructions based on the DICOM files obtained during postmortem CT examination.

[Immunohistochemical diagnostic management of early stages of myocardial infarction for the purposes of postmortem medicolegal examinations]. / Diagnostyka immunohistochemiczna wczesnego zawalu miesnia sercowego dla celów posmiertnego badania sadowo-lekarskiego.

A postmortem diagnosis of a "well developed" myocardial infarction is not difficult. In the initial stages of infarction, however, at the stage of gross examination it is impossible to discriminate between the infarcted zone and the undamaged cardiac muscle. When a cardiogenic cause of death is suspected, this fact determines the method of material collection and the amount to be collected, as well as further examinations to be performed. The histopathological diagnosis of a "fresh" myocardial infarction employing a basic routine staining method (hematoxylin/eosin) is not sufficient either. This makes it necessary to use additional special staining techniques to resolve diagnostic problems, thus verifying the precise diagnosis. The aim of this research was to introduce the immunohistochemical C9 staining technique as a postmortem diagnostic method of detecting recent myocardial infarctions for the purpose of postmortem medicolegal examinations, to develop the principles of result interpretation and to compare the said technique with the previously used Nielsen-Selye staining method. The specimens examined were collected from the heart muscle in 90 autopsy cases: cases of myocardial infarction positively diagnosed during autopsies and verified by routine staining examination (5); clinically positively diagnosed cases of myocardial infarction, without autopsy verification and examined microscopically using the routine staining method (5); sudden deaths with symptoms of acute circulatory failure due to cardiac causes (50) and the controls (30). The investigation demonstrated the specificity of the immunohistochemical C9 staining method in cases of myocardial damage associated with focal ischemia. It also confirmed the higher usefulness of the immunohistochemical method as compared to the Nielsen-Selye staining method in postmortem diagnostics of recent stages of myocardial infarction.

Incidence of pituitary necrotic lesions in autopsy material.

Pituitary necrosis is mostly a result of pituitary haemorrhage or infarct. The frequency of pituitary necrosis in the Polish population has not yet been investigated. Hence, the aim of this study was to estimate the incidence of pituitary necrotic lesions in forensic autopsy material and to assess possible correlations of pituitary necrosis with sex, age, other pituitary pathologies, endocrine disorders and atherosclerosis. Serial sections of 100 human pituitary glands stained with hematoxylin-eosin were examined microscopically. Pituitary necrosis was found in 19 cases (19%), all of them in persons aged > 40 years. The majority of the lesions had relatively large size, occupying 10-50% of the gland. According to family interviews, none of the subjects manifested any clinical symptoms related to pituitary insufficiency, hence al the detected cases can be regarded as subclinical. There was no association of pituitary necrosis occurrence with sex, other pituitary pathologies found upon autopsy, endocrine diseases or cause of death. Only correlations with age and atherosclerosis were statistically significant. This study has shown that subclinical pituitary necrosis is a relatively frequent phenomenon in elderly persons, probably resulting from age-related deterioration in the vascular status.

Ethanol-related death of a child: an unusual case report.

The report describes a fatal outcome in a 5-year-old male who died after drinking a fatal dose of ethanol at the party held by his parents. Urine and blood alcohol level of the deceased was 0.4 and 0.5 g/dL, what might explain the sudden death of the child. In addition, the analysis of the boy's hair demonstrated the presence of ethyl glucuronide (EtG), a marker of alcohol consumption; hair EtG concentration levels indicated that the boy might have occasionally imbibed alcohol prior to death. Pathological lesions of the liver observed in histopathology did not contradict such a hypothesis.

Increased incidence of pituitary microadenomas in suicide victims.

BACKGROUND: Current data suggest an influence of the hypothalamic-pituitary-adrenal axis on suicidal behavior. The frequency of pituitary adenomas in suicide victims has not yet been investigated. OBJECTIVES: The aim of this study was to assess whether the incidence of pituitary adenomas is correlated with suicide. METHODS: Serial sections of 151 human pituitary glands obtained upon autopsy were examined microscopically. The glands were collected from 70 suicide victims and 81 subjects whose deaths were classified as unexpected or accidental (nonsuicidal group). The sections were stained with hematoxylin-eosin and the presence of adenoma was confirmed by immunostaining for collagen III. RESULTS: In the suicidal group, pituitary microadenomas were found in 32 cases (47.7%), while in the nonsuicidal group microadenomas were detected in 15 cases (18.3%). The observed difference was statistically significant (p = 0.0003). The relative risk ratio of suicide in persons with pituitary adenomas was estimated at 1.9. Logistic regression analysis in a model controlled for age and sex showed that microadenomas constituted a unique risk factor in this model. The immunohistochemical phenotyping revealed a higher percentage of immunopositive (secreting) microadenomas in the nonsuicidal group as compared to the suicidal group (80.0 vs. 59.38%) and a predominance of growth hormone-secreting microadenomas in both groups. However, these differences as well as differences in the hormonal profiles of microadenomas between the groups were not significant. CONCLUSIONS: These results suggest that pituitary adenomas belong to suicide risk factors.

Neonatal death following clozapine self-poisoning in late pregnancy: an unusual case report.

The report presents a fatal poisoning of a neonate occurring in the final stage of gestational life and evoked by his mother, who, while 9 months pregnant, took a toxic dose of clozapine aiming at committing suicide. She was also severely poisoned, but ultimately was saved. The woman had been taking the medication due to schizophrenia and depression prior to conception, and the discontinuation of the drug in the course of pregnancy increased the risk of the woman attempting suicide. In the course of comprehensive toxicological analysis based on the developed analytical procedure with the use of LC-APCI-MS, clozapine and its two metabolites, norclozapine and clozapine-N-oxide, were determined in postmortem blood, liver and kidney in concentrations explaining the death of the neonate. The interpretation of the above-described case is complex and--apart from toxicological aspects--also involves issues associated with psychiatry, pharmacotherapy in pregnancy and medicolegal problems.

Fatality due to the use of a designer drug MDMA (Ecstasy).

Drugs of abuse belonging to the amphetamine derivatives, which are often taken by adolescents and young adults, pose a serious risk associated with uncontrolled ingestion that sometimes leads to fatal outcomes. The number of deaths, however, related to Ecstasy is small when compared to the frequency of its use. The report presents a fatal poisoning with MDMA--Ecstasy of a 22-year-old male with a documented history of drug abuse. The observations of witnesses to the event made within the period between the exposition and fatal outcome may document the characteristic behavior of a person in the course of progressive poisoning. Toxicological investigations of the autopsy specimens carried out by means of liquid chromatography-atmospheric pressure chemical ionization-tandem mass spectrometry (LC-APCI-MS-MS) demonstrated the presence of MDMA and its metabolite MDA in the blood of the victim, and the concentration level justified the fatal outcome (MDMA--1.42mg/L, MDA--0.17 mg/L), while the detection of high MDMA levels in a 6-cm long strand of hair separated into three segments (11.64 ng/mg in S1; 8.74 ng/mg in the S2; 15.51 ng/mg in the S3) confirmed the history of drug abuse. The report describing the results of macro and microscopic examinations aiming at assessing internal organ damage suggested a mild hepatic damage.