Rafał Skowronek

Pneumonia is one of the most common causes of children’s hospitalization and death. The aim of the study was a medico-legal analysis of children who died suddenly due to pneumonia undiagnosed in their lifetime. The research was of a retrospective character and consisted in an analysis of prosecution files. The study included 47 children who died between 2011-2018 in whom pneumonia after post-mortem examination was indicated as the cause of death, as well as children in whom the cause of death, despite additional post-mortem examinations, including histopathological tests, was not established. In some cases, under additional post-mortem examinations, additional targeted immunohistochemical staining of selected lung sections was performed to establish the diagnosis. In children with prodromal symptoms, histopathological examination showed significantly more frequent atelectasis than in children without prodromal symptoms. Pneumonia is a significant clinical problem. Especially in young children, it may proceed with- out any symptoms that would cause such a diagnosis to be made. A properly conducted post-mortem diagnosis supplemented by immunohistochemical examinations allows to reduce the number of unexplained deaths in children.

In medicolegal practice, rare cases involving suicidal, criminal, or accidental insulin overdose are both analytically and forensically challenging. The aim of this study is to present a model procedure in such cases, developed at the Department of Forensic Medicine and Toxicology of the Medical University of Silesia in Katowice, with particular emphasis on the possibility of additional confirmation of insulin intake by its immunohistochemical detection at the injection site. In the example case presented here, an immunohistochemical examination using FLEX Polyclonal Guinea Pig Anti-Insulin antibody (code IR002, Dako) confirmed the presence of insulin in the subcutaneous tissue of the victims. In our opinion, the method of immunohistochemical detection of insulin at the injection site can and should be used routinely in such cases.

Diagnostic imaging methods routinely used in clinical practice (mainly multi-slice computed tomography, CT) are increasingly entering forensic practice, also in Poland. Typically these exams are performed prior to an appropriate external examination and autopsy. The aim of the study is to present a case in which computed tomography examination performed only after forensic medical autopsy turned out to be useful in the diagnosis of an abused child syndrome. The CT examination showed, inter alia, nighstick injury/fracture of the ulna in its distal part, and deformation of the base of the phalanx of the distal finger of the fourth left hand, corresponding to a fracture/crush. Post-mortem imaging may be useful in the case of a suspected abused child syndrome.

Methadone is a diphenylpropylamine derivative that binds to opioid receptors and has been used in drug abstinence and substitution treatment programs. The aim of the study is to describe a case of sudden death of a prisoner during methadone substitution therapy from the authors’ medico-legal consulting practice and to review the literature. A 41-year-old male with a long history of abuse of psychoactive substances, especially heroin, serving a prison sentence, after consultation in the addiction treatment clinic, started methadone substitution therapy. In the following days he took two doses of the drug (50 mg each). The prisoner was pronounced dead during the night. Blood toxicology tests showed the presence of methadone at the therapeutic concentration of 816 ng/ml. Currently, it is believed that even the therapeutic concentration of methadone increases the risk of sudden cardiac death, especially in predisposed patients (e.g. with structural pathologies of the myocardium, cardiac arrhythmias, hypokalemia, and liver failure).

The use of an electric drill to commit suicide is rare in forensic practice. The aim of the work is to present the first case of this kind from the Upper Silesia. The results of post-mortem examinations and the results of prosecutor’s examination of case files containing medical documentation from the patient’s treatment were analyzed. People with mental disorders and diseases may choose unusual methods of taking their own lives, such as using an electric drill. This may cause investigators a lot of doubt as to whether the event was really a suicide. In addition to full post-mortem diagnostics, it is particularly important in such cases to assess the medical history of the deceased, often with the participation of a psychiatrist as a consultant.

Aim: The study aimed to examine whether volatile substances (ethanol, isopropanol, and acetone) can be detected in costal cartilage and also if concentrations of detected substances reliably reflect their concentrations in the peripheral blood – the standard forensic material for toxicological analyses. Such knowledge can be useful in cases when a cadaver’s blood is unavailable or contaminated.

Material and methods: Ethanol, isopropanol, and acetone concentrations were determined in samples of unground costal cartilage (UCC), ground costal cartilage (GCC), femoral venous blood, and urine. The samples were analysed by gas chromatography (GC) with a flame ionization detector using headspace analysis.

Results: Volatile substances were detected in 12 out of 100 analysed samples. There was a strong positive correlation between ethanol concentration in the blood and urine (r = 0.899, p < 0.001), UCC (r = 0.809, p < 0.01), and GCC (r = 0.749, p < 0.01). A similar strong correlation was found for isopropanol concentration in the blood and urine (r = 0.979, p < 0.001), UCC (r = 0.866, p < 0.001), and GCC (r = 0.942, p < 0.001). Acetone concentration in the blood strongly correlated only with its concentration in urine (r = 0.960, p < 0.001).

Conclusions: We demonstrated for the first time the possibility of detecting volatile substances: ethanol, isopropanol and acetone in a human costal cartilage. Also, the study showed that higher volatiles concentrations were better determined in ground samples.

Modern molecular biology and clinical genetics have the ability to diagnose many diseases, the presence or absence of which is important in various areas of forensic medical opinion. The aim of the study is to present examples of possible non-standard application of clinical molecular-genetic tests in forensic medicine. From among all the opinions prepared so far at the Department of Forensic Medicine in Katowice, three were selected two of which concerned post-autopsy conclusions relating to the cause of death, and in one case – opinion based on the files of a case related to the suspicion of a maltreated child syndrome in an infant. In all these cases, the results of the molecular and genetic tests were negative, which was taken into account by the experts when formulating the final conclusions of the opinion. The use of clinical molecular and genetic tests in forensic medicine is possible and always brings important additional information that broadens the possibilities of opinion-making and facilitates diagnosis. The areas in which this type of research may be particularly useful are: diagnostics of the basis of thromboembolic complications, modern integrated morphological and molecular diagnostics of neoplasms and diagnostics of genetic defects of connective tissue in children suspected of having abused child syndrome.