Metals and Trace Elements in Calcified Valves in Patients with Acquired Severe Aortic Valve Stenosis: Is There a Connection with the Degeneration Process?

BACKGROUND: Acquired calcified aortic valve stenosis is the most common valve disease in adulthood. In the etiopathogenesis of this complex pathology, the importance of inflammation is mentioned, in which non-infectious influences represented by the biological effects of metal pollutants may participate. The main goal of the study was to determine the concentration of 21 metals and trace elements-aluminium (Al), barium (Ba), cadmium (Cd), calcium (Ca), chrome (Cr), cobalt (Co), copper (Cu), gold (Au), lead (Pb), magnesium (Mg), mercury (Hg), molybdenum (Mo), nickel (Ni), phosphorus (P), selenium (Se), strontium (Sr), sulfur (S), tin (Sn), titanium (Ti), vanadium (V) and zinc (Zn)-in the tissue of calcified aortic valves and to compare them with the concentrations of the same elements in the tissue of healthy aortic valves in the control group. MATERIAL AND METHODS: The study group consisted of 49 patients (25 men, mean age: 74) with acquired, severe, calcified aortic valve stenosis with indicated heart surgery. The control group included 34 deceased (20 men, median age: 53) with no evidence of heart disease. Calcified valves were explanted during cardiac surgery and deep frozen. Similarly, the valves of the control group were removed. All valves were lyophilized and analyzed by inductively coupled plasma mass spectrometry. The concentrations of selected elements were compared by means of standard statistical methods. RESULTS: Calcified aortic valves contained significantly higher (p < 0.05) concentrations of Ba, Ca, Co, Cr, Mg, P, Pb, Se, Sn, Sr and Zn and-in contrast-lower concentrations of Cd, Cu, Mo, S and V than valves of the control group. Significant positive correlations of concentrations between the pairs Ca-P, Cu-S and Se-S and strong negative correlations between the elements Mg-Se, P-S and Ca-S were found in the affected valves. CONCLUSION: Aortic valve calcification is associated with increased tissue accumulation of the majority of the analyzed elements, including metal pollutants. Some exposure factors may increase their accumulation in the valve tissue. A relationship between exposure to environmental burden and the aortic valve calcification process cannot be ruled out. Advances in histochemical and imaging techniques allowing imaging of metal pollutants directly in valve tissue may represent an important future perspective.

Comparative analysis of two almost identical traffic accidents.

In the Czech Republic, 1 500 suicides are committed in average per year approximately. Only in a small percentage has been used vehicle as a tool. Prove suicidal intent in a fatal road accident has been difficult, but mostly these accidents have similar characteristics - impact with tree or similar fixed obstacle, non - use of seat belt, absence of brake traces, etc. The aim of this paper is to present and analyse two almost identical traffic accidents - identical location, identical vehicle type. While one of these was fatal (but not proven suicide), the second accident was not fatal, but with suicidal intent. Data were obtained as a part of the Czech In-depth Study conducted by Transport Research Centre. Data from In-depth Accident Analysis provide a comprehensive view of all the factors related to a particular accident and serve to identify the characteristics leading to the crash occurrence.

[Oncology secrets of suddenly deceased individuals]. / Onkologická tajemství zemrelých.

Malignant neoplasms represent the second most common cause of death in men and women in the Czech Republic after cardiovascular diseases. The incidence, prevalence and mortality is recorded in the Czech National Cancer Registry. The most recent data available is from 2013, in this year there were 81 541 patients newly diagnosed with cancer and 26 944 people died of cancer. From a long-term perspective, the incidence of neoplasms is increasing and the mortality is decreasing. In the Institute of Forensic Medicine in Brno there were 480 cases of newly reported malignant tumors during the period 2010-2015, which were not known before the autopsy. 71.4 % of these cases were men and 28.6 % were women. In 212 cases the tumor was advanced and was the immediate cause of death. The total number of deadly cases in men was 149, the age average was 66.2 years. The most common malignant tumor leading to death was of bronchi and lungs (39.6 %), large intestine (9.4 %), pancreas (6.7 %), liver (4.7 %), stomach (4 %) and prostatic gland (4 %). In women the total number of deaths resulting from malignant tumor was 63, the age average was 72.6 years. The most common malignant tumor leading to death was of bronchi and lungs (33.3%), ovary (11.1 %), large intestine (9.5 %), gall bladder (6.3 %) and kidney (6.3 %). Some of the autopsy findings are shown on the photographs at the end of the article.

[Experimental stab wound]. / Experimentální bodné poranení

Stab wounds caused by knives and daggers are usually of different appearances. The knife wound has one edge sharp while the second one is blunt. The wound caused by blow of dagger has both edges sharp. The forensic expert must very often decide whether the knife or dagger was used. The aim of this experimental work was to show how a single-edged knife penetrates the skin and causes the wound typical for the double-edged dagger. The fact was verified. The wound typical for dagger can be found if the knife is used only according to the scheme. The forensic expert can say that a one cutting edge knife was used if the one edge of wound is squared and the other one is sharp. If the both of them are sharp, forensic expert must be very careful in his decision.Key words: stab wounds - knife - dagger - forensic expertise.

Unusual way of suicide by carbon monoxide. Case Report.

OBJECTIVES: Authors discuss the case of a suicide of a 29-year-old man caused by carbon monoxide (CO) intoxication. What the authors found interesting was the unusual way of committing suicide that required good technical skills and expert knowledge. METHODS: The level of carboxyhemoglobin (COHb) in the blood of the deceased man was routinely determined by the modified method by Blackmoore (1970), using gas chromatography/thermal conductivity detection. The level of saturation of the hemoglobin by CO in the collected blood sample is determined relatively to the same sample saturated to 100%. RESULTS: In the blood sample of the deceased man the lethal concentration of COHb of 76.5% was determined. Within the following examinations the blood alcohol concentration of 0.05 g.kg(-1) was determined. Further analysis revealed traces of sertraline, its metabolite N-desmethylsertraline, omeprazole and caffeine in the liver tissue, traces of N-desmethylsertraline, ibuprofen and caffeine in urine sample, and only traces of caffeine in the stomach content and blood samples were proved. To commit suicide the man used a sophisticated double container-system equipped with a timer for controlled generation of CO based on the chemical reaction of concentrated sulphuric acid and formic acid. The used timer was set by an electromechanical timer switch that triggered the fatal reaction of the acids while the man was sleeping. CONCLUSIONS: The authors discuss an unusual case of suicide by CO intoxication rarely seen in the area of forensic medicine and toxicology that is specific due to its sophisticated way of execution.