Medico-legal analysis of a case of mass shooting.

Despite the existence of organised crime in Slovakia, no case has ever been monitored in which one individual used a firearm against several people, as happens in the U.S. or in Western Europe. The aim of this work is to demonstrate a "unique" case in the history of Slovak criminality, when six members of one family were killed and some other accidental victims were wounded or even killed by one perpetrator using a firearm.

The motivation behind extended suicide.

The investigation of motivation of suicidal behaviour in cases of so-called extended suicide is of great importance from a forensic-psychological viewpoint. The initiator of such action is often a person suffering from endogenous depression. The motives behind successful suicide are generally not known. This paper aims to demonstrate the motives behind the successful suicide, less frequent in our conditions, of two family members - a father and a son. The case has been thoroughly analysed by morphological methods with the help of additional laboratory tests. At the centre was a suicide letter which was hidden in a very unusual way and which was elucidated only thanks to autopsy of both persons. The manner of realisation - hanging - was among the most frequent in the region and in the state too. The men were not under the influence of any toxic substances. The motivation behind the suicide was an escape from hard living conditions.

Evaluation of childhood medicolegal autopsies in Bratislava and Trnava regions, Slovakia.

INTRODUCTION: Studies dealing with analysing cases of violent, sudden and unexpected deaths in childhood are very important, as these deaths can be prevented to a high percentage. The aim of this study is to evaluate the results of analysis of cases involving childhood deaths undergoing autopsy at Bratislava medico-legal workplaces within the catchment area of Bratislava and Trnava regions. PATIENTS AND METHODS: There was performed a retrospective analysis of autopsy protocols of death cases in childhood (from 0 to 14 years) at the Institute of Forensic Medicine of the School of Medicine Comenius University and Department of Forensic Medicine of Health Care Surveillance Authority in Bratislava in the period 1999-2008. RESULTS: In the monitored period there were detected 156 childhood deaths from the total number of 10,771 autopsied cases, which accounts for 1.45 %. Violent deaths were determined in 115 cases, i.e. 73.7 %. In 70.5 % of cases there were male children. The most frequent cause of death were injuries caused by a blunt object in 44.2 % of cases, followed by deaths caused by pathological causes (25.7 %), asphyxia (14.7 %), high temperature, intoxication, electrocution, etc. The external cause of death was most frequently traffic accidents in 56 cases (35.9 %), drowning in 13 cases (8.3 %) and homicides together with assaults in 12 cases (7.7 %). There were 45.5 % of the analysed cases in school age. CONCLUSION: The results of our analysis show that Bratislava and Trnava regions fall into regions with relatively low incidence of violent deaths in childhood. Our study has shown that many deaths could have been prevented by better care and higher responsibility of parents in particular, but also those who are responsible for the care and supervision of children.

Psychoactive substances related to the deaths.

The study included all deceased who died in relation to psychoactive substances abuse in the regions of Bratislava and Trnava city districts within a two-year period of the years 2007-2008. All the cases were autopsied by the standard method completed with toxicological analyses. There were reported total 84 fatalities related to psychoactive substances. From this amount, 38 cases (45 %) belong to the group of direct deaths (poisonings) and 46 cases (55 %) to the group with other cause of death. Out of the total number, 83 % were related to men and 17 % to women. More than 50 % of the cases were related to the age up to 34 years. In the group of poisonings, the most frequently detected substances were opioids themselves or in combination with other substances in 53 %. In the group of the indirect deaths, the most frequent category of death was suicide in 39 %. The most frequently detected psychoactive substances were central nervous system stimulants in 40 % of cases (Tab. 6, Fig. 1, Ref. 16).

Psychoactive substance-related deaths in road traffic accidents in Slovakia between 2000 and 2007.

THE AIM OF THE STUDY: Our study was aimed at fatal road traffic accidents caused under the influence of psychoactive substances different from alcohol. METHODS: Retrospective analyses of fatalities in 2000-2005 road traffic accidents under the influence of psychoactive substances different from alcohol on the behalf of National Monitoring Centre for Drugs were carried out in all of 10 Slovak medical forensic workplaces supervised by Healthcare Surveillance Authority. The detected set of cases was extended by cases reported in 2006 and 2007. RESULTS: A total of 75 fatalities in road traffic accidents were reported to be incurred under the influence of psychoactive substances. Of the latter amount, 42 cases occurred in the period 2000-2005 and 33 cases in 2006 and 2007. The set involved 32 drivers, 12 pedestrians, 4 motorcyclists, 2 cyclists and 25 passengers. The most frequently detected substances in the period 2000-2005 were cannabis and benzodiazepines. In 2006 and 2007 the increase in substances classified as central nervous system stimulants was detected. CONCLUSION: The listed number of reported deaths incurred in the whole territory of Slovakia during the 8-year period is relatively low in comparison with the total number of fatal road traffic accidents. The proved reality represents only the tip of the iceberg and suggests that the monitoring of prevalence of psychoactive substances in population had some drawbacks (Tab. 4, Ref. 8).

Diagnostics of fatal hydrogen sulfide poisonings.

INTRODUCTION: Cases of fatal hydrogen sulfide poisonings are rarely presented in forensic medicine practice. They mostly occur in occupational settings and occasionally are mass. Due to occupational poisonings caused by gases, hydrogen sulfide is ranked second regarding frequency-dependent incidence. Hydrogen sulfide at high concentrations is undetectable to human senses resulting in increased risk of fatal poisoning. Such poisonings represent a particular group with respect to their objectification by toxicological analysis. AIM: The aim of this paper is to demonstrate possibilities of laboratory diagnostics of fatal hydrogen sulfide poisonings. PATIENTS AND METHODS: The paper provides a retrospective overview of 15 cases of fatal hydrogen sulfide poisonings which occurred in the history of the Institute of Forensic Medicine of the School of Medicine, Comenius University in Bratislava. All cases were completely analysed by morphological and toxicological methods. The samples of blood and pulmonary tissue were examined in the toxicological analysis. The method of analysis of alveolar air was developed by Bauer. An experiment for detection of post-mortem production of hydrogen sulfide in the body was performed. RESULTS: Morphological findings in all autopsied and analysed cases were similar and nonspecific for poisoning diagnosis. A significant change in possibilities of toxicological analysis occurred in 1968. Since then a direct identification of toxic gas through the analysis of alveolar air has been possible. CONCLUSION: Taking into consideration summarization and comparison of the analysis results of the cases from archive materials of the authors, it is possible to claim that at the workplace in Bratislava a unique objective method of proving this gaseous poison in biological material used so far has been developed. Some negative or unconvincing results of toxicological analysis again refer to pitfalls of diagnostics of hydrogen sulfide poisonings, which must be complex and based upon an efficient collaboration particularly between a medical examiner and toxicologist-analyst together with other bodies complementing the required spectrum of investigated circumstances and clinical data.

Fatal methadone intoxication in a 11-month-old male infant.

INTRODUCTION: The number of fatal methadone intoxications in adults has been increasing in parallel with the use of methadone for opiate substitution therapy. Methadone intoxication in children occurs rarely. Its diagnostic possibilities on the basis of clinical findings are often limited. The aim of this paper is to demonstrate a case of an 11-month-old male infant, who unexpectedly died without a previous disease history. METHODS: The complex morphological analysis of the case was performed by routine methods. Toxicological analysis was aimed at detection of the presence of ethanol, psychoactive and other forensically relevant substances in available biological materials. RESULTS: Morphological findings were non-specific. Toxicological analysis of biological materials failed to reveal the presence of ethanol in body fluids. In analysed materials the presence of methadone was found at the following concentrations: in blood serum 1.3 microg/mL (calculated to 0.7 microg/mL in whole blood), in the liver 5.0 microg/g, in the kidney 2.6 microg/g and in urine 3.2 microg/mL. CONCLUSIONS: The cause of death in an 11-month-old male infant who had been referred to the autopsy with a diagnosis of sudden infant death syndrome was established as fatal methadone intoxication. With respect to determined results of toxicological analysis apart from setting the diagnosis of intoxication it is not possible to comment on the question concerning repeated administration of methadone. A high likelihood of administrating methadone to the infant by another person exists. Neither mother nor her partner who was not the infant's father is registered in the Centre for Treatment of Drug Dependencies and thus the origin and source of the methadone still remains unknown.

The utilization of tachymetry in forensic medicine.

INTRODUCTION: Tachymetry is a geodetic method enabling to measure angles and distances. The aim of the work was to demonstrate alternatives of its utilization in daily forensic medicine practice. The work is dealing with confusing cases of gunshot injuries. It is impossible to determine the trajectory of the projectile, the sequence of gunshots, to identify shooting person etc. in these cases only on the base of autopsy findings and investigated circumstances. In these cases the investigation experiments on the crime scene in collaboration with the land surveyors were realized. The work presents two case reports. METHODS: For our measurements the electronic tachymeter TOPCON 211D was used. These were performed by the means of polar method in local coordinate system with relative heights. In the first case the position of victim was simulated by a figurant according to testimonies of witnesses and the accused. The second case dealed with suicide. RESULTS: In the first case there were two gunshots. The trajectory of the first gunshot was determined and the projectile was found. Hereby the most authentic testimony could be estimated. Also high grade probability of the relative position of the victim and the accused was figured out. In the case of suicide also the projectile was found and the position of the victim in the time of gunshot was determined. CONCLUSION: In the both case reports demonstrated the projectiles were not found by ballistics expert investigations. All questions of expert opinions could be answered only with the help of tachymetry. The advantage of this method is its good regional availability even at places far from specialized criminal investigation workplaces.

The responsibility of alcohol-impaired road users in fatal road traffic accidents.

UNLABELLED: The purpose of this paper was to identify the impact of intoxicated road users upon the degree of responsibility for fatal road traffic accidents. RESULTS: A total of 373 traffic fatalities was recorded. These cases represented 13.5% of all autopsied cases. Alcohol intoxication was determined in 35.9% of persons involved in road traffic accidents. The degree of responsibility of intoxicated persons was 87.3% of all cases, of non-intoxicated persons 56.7% of all cases. The average determined blood alcohol concentration was 1.91 g/kg. CONCLUSION: The degree of responsibility for fatal road traffic accidents was 1.5 times higher among intoxicated road users than among non-intoxicated road users. Alcohol is still the most abused psychoactive substance in Slovakia. The causes of its excessive consumption are the objectives of many larger studies. It is assumed that excessive alcohol consumption can be considerably attributed to its easy availability and lack of awareness and personal responsibility of road users (Tab. 4, Ref. 35).

Collaboration between medical examiner and toxicologist-analyst.

Negative effects of the increasing number of toxic substances in the external environment affecting the human organism are highly reflected in everyday forensic practice. In parallel with new circumstances also the methods enabling identification of heterogeneous substances have been developing. Demonstrating evidence is more challenging and sophisticated particularly in cases with proving several xenobiotics including metabolites and their possible interaction. Poison intoxications of unknown origin can represent a diagnostic problem. Consequently close collaboration between involved forensic professionals i.e. medical examiner and forensic toxicologist-analyst is inevitable. The data provided by police investigators are significant as well--investigated circumstances, testimonies and in case of hospitalization detailed data from clinicians. In everyday forensic practice the shortage of medical examiners specialised in toxicology and knowledgeable toxicologists-analysts has been increasingly experienced. The urgent requirement for more specialists arises more frequently not only in suspected fatal poisonings but also in assessing of analysis results particularly in cases of persons directly involved in road traffic accidents, work-related injuries, etc. The number of cases requiring detecting psychoactive substances is also increasing. On the other hand recent experience demands expanding the spectrum and increasing the number of indications of toxicological analyses from medical examiners involved in performing autopsies. At present the Slovak forensic workplaces are in the process of being equipped with instrumentation designed for expanding the spectrum of toxicological analyses and improving their quality. There hence emerges a need for developing the contemporary concept of Slovak forensic toxicology with respect to both organizational and methodological aspects focused on better interaction of activities carried out by medical examiners and toxicologist-analysts. The essential part of developing the coordination of both expert groups is also postgraduate education with an emphasis on improving mutual recognition principles of their work.

On the use of biochemical markers in diagnostics of sudden cardiac death.

INTRODUCTION: Medical examiners frequently examine victims of sudden death. Most often sudden deaths have a cardiovascular cause. determine the diagnosis of sudden cardiac death based only on morphological findings may be often very difficult. Measurement of blood concentrations of cardiac troponin I (cTnl) and atrial natriuretic peptide (pro-ANP) is now in clinical use in adult patients with heart failure caused by myocardial damage. AIM: The aim of the study was the estimation wheather cTnl and/or pro-ANP could be markers of sudden cardiac death. PATIENTS AND METHODS: The study was carried out on 89 necroptic cases, of which 53 were concluded as cardiac-related sudden death, and 36 cases were used as a control group being other than cardiac death cases. Concentrations of markers were determined in blood taken from the left cardiac ventricle and from the right femoral vein. The dependence between the results of biochemical studies and death causes, results of histopathological examination of myocardium, time interval between the death and taking of samples, and resuscitation data was investigated. RESULTS: Concentrations of cTnl as determined in blood samples from the left ventricle were in most cases very high, largely exceeding the cut-off level, and so were concentrations of pro-ANP. The values of both parameters were significantly lower in peripheral blood. No statistically significant dependences were found between the levels of the studied markers and the cause of death, myocardial histopathological findings, time interval between the death and taking of samples, and resuscitation data. CONCLUSION: Based on the results obtained, the study can be concluded that blood is not a suitable medium for determination of biochemical markers of cardial troponin I and atrial natriuretic peptide for post-mortem diagnostics of myocardial damage and for determining the diagnosis of sudden cardiac death in a manner similar to diagnostics of myocardium damage in living patients.

Morphological findings after intracoronary application of endothelin-1 in dog.

BACKGROUND: Endothelin-1 is a strong vasoconstrictor, high doses of which can cause prolonged vasoconstriction. MAIN PURPOSE: The aim of our study was to investigate as to whether the endothelin-induced vasoconstriction causes irreversible morphological changes in the myocardium in experimental animals and to verify the applicability of this experimental model in the study of the impact of endothelin. METHODS: Fourteen anaesthetized dogs were administered with 400 pmol of endothelin. The substance was applied into the left anterior descending coronary artery. The serum activities of AST, CK and LD enzymes, and changes in electric activity of the myocardium were monitored. The heart of one of the dogs was analyzed morphologically. RESULTS: Following the application of endothelin, vasoconstriction supervened, lasting from 25 to 27 minutes. Five dogs developed fibrillation of ventricles and died. The dogs which survived yielded changes in the activities of the investigated enzymes and changes in electric activity which were typical of focal impairment of the myocardium in sense of necrosis. Morphologically the changes represented disseminated fibrosis or minor scars in the myocardium. CONCLUSIONS: Application of endothelin into the coronary artery can cause irreversible structural changes in the myocardium. (Fig. 1, Ref. 18.).

Brown adipose tissue. III. Effect of ethanol, nicotine and caffeine exposure.

Brown adipose tissue is known to be the most important organ for generating heat in non-shivering thermogenesis. Process of thermogenesis and thermoregulation may be affected by many drugs. The paper deals with actual literary data of effect of ethanol, nicotine and caffeine on brown adipose tissue, heat production and its regulation in experimental animals and in human.

[Fibronectin and the human spleen]. / Fibronektín a l'udská slezina.

Fibronectins are glycoproteins with a function of molecular glue. The aim of the study is to encourage interest in processes in extracellular matrix of the spleen. Undigested cryostat or formol-paraffin sections and commercially available antibodies were used. We were mostly successful in extracellular localization of fibronectin in trabeculae, vessel walls and lamellae of circumferent reticulum of periarterial lymphatic sheaths and in the ring fibres of the sinuses. Changes in the amount of fibronectin occurred, for example, in circulation disturbances. In hereditary spherocytosis the ring fibres were reduced. Increase of fibronectin can suggest the development of fibrosis.

Brown adipose tissue. I. Morphology. (Review).

Brown adipose tissue appeared in mammals with the development of homeothermy. In consequence of this, their organism became able to maintain constant body temperature independent on the thermal conditions of the surroundings. This tissue-contrary to the white adipose tissue-is distributed only in certain restricted portions of the body. The paper deals with actual literary data of morphology and function of brown adipose tissue.

Brown adipose tissue. II. Effect of pathologic and environmental conditions (Review).

Brown adipose tissue is an important source of non-shivering thermogenesis. Its metabolic activity and development are regulated by adrenalin secretion. The greatest amount of brown adipose tissue in humans was observed during the first decade of life. Later it disappears from many sites, but is preserved in the neck and around the kidneys and the adrenal glands. Increased amounts of brown adipose tissue have been reported to occur in association with certain situations and diseases. A review of these literary data is presented.

Night and day differences in the food-intake of laboratory rats Wistar and Koletsky strains.

BACKGROUND: Rats have an extraordinary expressive circadian organization and prefer the dark as the optimal condition of its life environment. During darkness, the rhythm of its several parameters reaches the acrophase. MAIN PURPOSE: The aim was to establish the differences in the level of food-intake of laboratory rats of the Wistar strain and in those of the spontaneously obese rats of the Koletsky strain by means of ad libitum feeding under natural light-dark conditions. METHODS: The levels of day and night food consumptions in both strains of rats, Wistar and the spontaneously obese Koletsky strain, were studied within the period from January 10th to 20th, (males), and from April 16 to 26, 1990, (females). The animals were fed by Larsen's diet under natural light conditions. The data were evaluated by means of the t-test. RESULTS: It was detected that during the period between 5 o'clock PM and 6 o'clock AM the male rats of the Wistar strain consumed 80% and the female rats 79% of their total daily amount of food. Food consumption of the Koletsky rats during the period from 5 o'clock PM to 6 o'clock AM in males reached the value of 72% and in females 74%. CONCLUSIONS: There were detected significant differences in circadian food-intake in both strains. Besides the nocturnal preference in food-intake of Wistar rats, which is in accordance with the data gained from literature, a similar food-intake with expressive diurnal-nocturnal differences exists also in the spontaneously obese Koletsky rats. Daily food consumption in these male rats was significantly higher when compared to the Wistar strain. (Tab. 1, Fig. 1, Ref. 5.).

Prostate specific antigen and prostate specific acid phosphatase in adenocarcinoma of Skene's paraurethral glands and ducts.

An autopsy case of adenocarcinoma of Skene's paraurethral gland co-incident with renal cell carcinoma is described. The adenocarcinoma showed distinct prostate specific antigen and prostate specific acid phosphatase pointing to the equivalence between the male prostate and Skene's paraurethral glands and ducts. Skene's gland are the homologue of the prostate in females and tumours arising from them are immunohistochemically similar to male prostate carcinoma.