Partial detachment of the aorta: a fatal complication of CPR chest compressions

Abstract Background Partial aorta detachment is a rare and fatal complication of mechanical chest compression. Case presentation The paper describes a patient in cardiac arrest who died despite receiving CPR using mechanical chest compression. After death, an autopsy showed the presence of a partial rupture of the aortic wall in the intra-pericardial section. Discussion In the discussion, for this case, we propose to deepen our knowledge of post-resuscitation complications, which may help to understand the need to maintain the recommended parameters of chest compressions, respond more confidently to changes in the patient's condition during CPR, to interpret the results of bedside examinations better, and to understand the autopsy results better. In our opinion, the best method of diagnosing internal injuries, which we provide with Point-of-Care (POCUS) ultrasound, allows for therapeutic interventions that maximize the chances of spontaneous circulation. Education and skill development are also indispensable aspects of CPR. Particular attention should be paid to the same quality of chest compressions performed. Conclusions As conclusions drawn from the analysis of this case, we propose paying particular attention to the difficulty of explaining changes in the patient's condition during CPR, the widespread use of POCUS, and considering the use of compressions performed by staff in situations where it is possible and safe

Health state assessment in people sentenced to the penalty of restriction of liberty

Background: Assessment of the health state of people sentenced to the penalty of restriction of liberty makes up a significant percentage of cases annually elaborated in the Department of Forensic Medicine, Poznan University of Medical Sciences. The analysis of such cases was accomplished to point out the difficulties that expert physicians could encounter in formulating their opinions. Material and Methods: The analysis involved 1051 medico-legal opinions issued in the years 2004–2013, considering the health state of people performing the duty of free, controlled social labor. The authors collected data on age, sex, type of diseases and the ability to control social work of convicted subjects. Results: Among those sentenced to the penalty of restriction of liberty the men aged 51–60 were in the majority. Individuals able to work only in specified conditions were the most numerous group (56.3%). People able to work in all conditions were the smallest set (9.5%). Light work was the type of work most frequently recommended to the persons able to work only in specific conditions (58.4%). The largest group of diseases comprised spondylopathies and osteoarthropathies (51.4%). It was followed by the group of cardiac diseases and angiopathies, including hypertension (38.7%). Conclusions: The number of cases concerning the ability of the sentenced persons to serve the penalty of restriction of liberty annually elaborated in the Department of Forensic Medicine, Poznan University of Medical Sciences and the number of sentences imposed on the national scale indicate that medical experts may be obliged to provide opinions of this kind. Assessment of the health state of people sentenced to the penalty of restriction of liberty in some cases can be a difficult task for the expert physicians because of frequent lack of information about a specific type of work performed by the sentenced persons having only the data about their diseases. Med Pr 2016;67(6):765–77

Cases of fatal electrocution due to contact between carbon fibre fishing rods and overhead power lines

Abstract Background Electrocution caused by electricity conducted via overhead power lines carries a high risk to health and life. With the introduction and proliferation of conductive carbon fibre fishing tackle, severe and fatal electrocution occurs due to accidental contact with overhead transmission lines. Case presentation The paper presents three cases of men who died due to electrocution from a conductive fishing rod, which occurred in the same fishery over several years. The deaths occurred on the spot in two cases despite rapid rescue efforts. One of the men died in the hospital the following day due to developing severe complications. Additionally, all of the victims were under the influence of alcohol at the time of the incident. During postmortem diagnosis, skin lesions were identified as signs of electric shock on the hands and feet in each case. To the best of the authors’ knowledge, there is no similar case series available in the literature where several almost identical fatal electrocutions occurred in the same place as a result of contact of a fishing rod with overhead power lines. Conclusions Action is needed to avoid similar incidents and to increase safety in the vicinity of power lines

The Other Face of Insulin—Overdose and Its Effects

Insulin is the most effective glycemic-lowering drug, and for people suffering from type 1 diabetes it is a life-saving drug. Its self-dosing by patients may be associated with a higher risk of overdose, both accidental and deliberate. Insulin-induced hypoglycemia causes up to 100,000 emergency department calls per year. Cases of suicide attempts using insulin have been described in the literature since its introduction into therapy, and one of the important factors in their occurrence is the very fact of chronic disease. Up to 90% of patients who go to toxicology wards overdose insulin consciously. Patients with diabetes are burdened with a 2–3 times higher risk of developing depression compared to the general population. For this reason, it is necessary to develop an effective system for detecting a predisposition to overdose, including the assessment of the first symptoms of depression in patients with diabetes. A key role is played by a risk-conscious therapeutic team, as well as education. Further post-mortem testing is also needed for material collection and storage, as well as standardization of analytical methods and interpretation of results, which would allow for more effective detection and analysis of intentional overdose—both by the patient and for criminal purposes

Causes of Death during the Intravenous Infusion of Dimethylsulphoxide and Hydrogen Peroxide in the Course of Alternative Medicine Therapy

Unconventional (alternative, natural) medicine in Poland and worldwide includes hundreds of non-scientifically verified “treatment” modalities. Among the most popular are biological therapies using chemical or natural compounds administered with injection or drip infusion. The latter has found the most excellent use in treating rheumatological and dermatological diseases and certain types of cancer. Vitamin infusions, curcumin, glutathione, perhydrol and dimethylsulphoxide (DMSO) have gained popularity among clients of natural medicine clinics. The present study aims to analyse the case of a 37-year-old woman who was administered infusions containing perhydrol and DMSO (0.5 mL 0.04% hydrogen peroxide/0.5 mL p.d.a DMSO in saline) due to a MTHFR A1298C mutation. After having the next infusion, the woman complained of nausea and then became unconscious. Subsequently, she suffered respiratory and cardiac arrest. Adequate resuscitation was undertaken. After being taken to the hospital, the patient was in critical condition and died due to increasing multiple-organ failure. Initially, there was suspected DMSO poisoning as it was the only compound to have been administered as an intravenous infusion. However, it was not until the analysis of the secured evidence that it became clear that the patient had also been given an intravenous solution of hydrogen peroxide, H2O2, and that there had been a mistake in preparing the intravenous perhydrol solution. The autopsy concluded that the immediate cause of death was an acute cardiopulmonary failure due to the toxic effects of intravenously administered hydrogen peroxide. This conclusion was established after the toxicological testing of the evidence and biological material secured during the patient’s treatment and autopsy. Products containing DMSO and perhydrol are not included in the lists of medicinal/therapeutical forms and preparations and thus are not authorised for marketing in Poland. In the case of perhydrol, apart from the topical use of diluted preparations for washing and cleansing wounds, no data on therapeutic use exist in the available scientific literature. Furthermore, “DMSO and perhydrol therapy” cannot even be considered a placebo effect, as both are toxic compounds which could, at most, cause poisoning symptoms rather than improve health

Badania populacji Wielkopolski w zakresie 17 markerów Y-STRs oraz 8 Y-SNPs

Celem pracy było określenie zróżnicowania genetycznego populacji Wielkopolski w zakresie 17 loci Y-STR i 8 loci Y-SNP oraz porównanie z populacją polską i innymi wybranymi populacjami. Badano 201  niespokrewnionych mężczyzn z regionu województwa wielkopolskiego. Uzyskano 184 pojedyncze haplotypy w zakresie 17 Y-STR, co dało siłę dyskryminacji 0.96. Najczęściej występujący haplotyp, Ht-50 zaobserwowano w 3 próbach, natomiast 7 różnych haplotypów zauważono podwójnie w analizowanej populacji. Tę samą grupę badawczą poddano analizie z wykorzystaniem 8 markerów Y-SNPs. Uzyskano 40 różnych haplotypów z siłą dyskryminacji wynoszącą 0.20. Najczęściej występujący haplotyp zaobserwowano u 38 mężczyzn. Uzyskane haplotypy zostały przypisane do 4 następujących haplogrup: K=19%, IJ=7%, R1a1=59% i R1b=15%. Wartość wskaźnika polimorfizmu genomowego dla badanych loci Y-SNP/Y-STR wyniosła 0,9883

Przyczyny trudności interdyscyplinarnej analizy śladów ugryzień

Powodzenie analizy śladów ugryzień zależy od wielu czynników, dlatego tak ważne jest, aby każdy z etapów poprzedzających analizę był przeprowadzony możliwie najstaranniej. Błędy interpretacyjne w analizie śladów ugryzień wynikają przede wszystkim z ich skomplikowanej natury, ale mogą być także spowodowane błędami technicznymi podczas zabezpieczania i rejestracji śladów, błędnymi założeniami, nieprawidłową metodyką badań. Kluczową rolę odgrywają kwalifikacje, wiedza i doświadczenie ekspertów wykonujących badania. W przypadku ujawnienia śladów ugryzień zaleca się konsultacje z odontologami sądowymi lub członkami interdyscyplinarnego zespołu posiadającymi doświadczenie w analizie śladów ugryzień. Uzyskane informacje pozwolą na przygotowanie materiału dowodowego w najlepszy możliwy sposób gwarantując rzetelność opinii

Diagnostic difficulties and legal analysis of potential claims to occupational medicine specialists based on a case of unrecognizable cardiac angiosarcoma

Przedstawiono przypadek nagłego zgonu w miejscu pracy 56-letniej kobiety, którego przyczyną był rzadki pierwotny guz serca. Rodzina zmarłej złożyła doniesienie do prokuratury, sugerując udział osób trzecich w spowodowaniu zgonu lub nieprawidłowości w badaniu lekarskim poprzedzającym zgon. Przedstawiono przegląd dostępnych w bazach elektronicznych (m.in. Web of Science i PubMed) informacji klinicznych dotyczących naczyniakomięsaka serca przydatnych w praktyce lekarza medycyny pracy oraz analizę prawną potencjalnych roszczeń w stosunku do lekarza medycyny pracy w przypadku nierozpoznania nowotworu.The article presents a case of sudden death of a 56-year-old woman at the workplace, caused by a very rare primary cardiac tumor. The patient’s family reported a crime to the prosecutor’s office suggesting participation of third parties in causing the death or malpractice in physical examinations before the death. A review of clinical data concerning cardiac angiosarcoma, available in electronic databases (e.g., Web of Science, PubMed), was presented, which could be useful in the practice of occupational medicine specialists. A legal analysis of potential claims to occupational medicine specialist in the case of failure to recognize primary cardiac tumors was also included in the article