Publications by authors named "Igor Dvoracek"

10 Publications

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Fatal deer attack in a rutting season.

Forensic Sci Med Pathol 2019 03 27;15(1):93-96. Epub 2018 Nov 27.

Department of Forensic Medicine, University Hospital Ostrava, CZ-708 52, Ostrava, Czech Republic.

Animal inflicted fatal or near fatal injuries are well described in the forensic literature, with the most frequently described cases involving dogs, large cats and bears. To our knowledge, a deer inflicted fatality has not been described in the forensic literature previously. This article reports a case of a 64-year-old male, who was found lying in a pool of blood near an enclosure for stags and hinds at the end of October. There were mechanical defects on his jacket and trousers, which appeared to be torn or penetrated, as well as multiple lacerations and stab wounds in different parts of his body. The type and location of the injuries the man had sustained strongly suggested that another person had been involved in the incident that had led to his death. The cause of death was deemed as external exsanguination due to multiple stab wounds to large vessels. After evaluating all of the information regarding the circumstances around the death, the case was classified as a deer attack related fatality, and the manner of death was determined to be accidental. The man was most probably attacked by one of the deer while he was refilling the animal feeder. A substantial increase in the levels of selected hormones, especially testosterone, during the rutting season explains the increased levels of aggression shown by the deer that led to a fatal outcome for the decedent.
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http://dx.doi.org/10.1007/s12024-018-0048-xDOI Listing
March 2019

Fatal Hemorrhage from an Arteriovenous Fistula.

J Forensic Sci 2018 Sep 16;63(5):1577-1581. Epub 2018 Jan 16.

Department of Forensic Medicine and Medical Law, University Hospital Olomouc, Olomouc, CZ-779 00, Czech Republic.

In this study, we present two cases of sudden deaths of people with end-stage kidney with arteriovenous fistulas for long-term hemodialysis treatment. This procedure is associated with a number of known complications. While stenosis, thrombosis, and infection are well known, lethal hemorrhage from arteriovenous fistula is much less commonly encountered. Inspection of the bodies at the scene of the death by a medical examiner suggested that the deaths were due to exsanguination. Autopsies revealed visible defects on the front wall of the arteriovenous fistulas. Microscopic examination showed wall necrosis with infiltration of various inflammatory cells. Deaths were due to exsanguination from the ulcerated arteriovenous fistulas in patients with chronic renal failure. Further investigation revealed that complications in the area around the arteriovenous fistulas were known and were being treated until a sudden rupture of the vessels and hemorrhage from the arteriovenous fistulas resulted in the deaths.
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http://dx.doi.org/10.1111/1556-4029.13730DOI Listing
September 2018

[Injuries associated with cardiopulmonary resuscitation in non-survivors after out-of-hospital cardiac arrest (autopsy study)].

Soud Lek Spring 2017;62(2):18-21

The aim of the present study is to investigate incidence and seriousness of CPR-associated injuries on a cohort of CPR non-survivors after out-of-hospital cardiac arrest in the Moravian-Silesian region. In total, 80 persons were included in the study within the study period (2012 - 2015). CPR-associated injuries were identified in 75 (93.7 %) persons, multiple injuries were found in 73 persons. Spectrum of identified injuries covered skin injuries of the upper half of the body, head and neck injuries, rare abdominal injuries and very frequent thorax injuries. Sternal fractures were found in 53 (63.3 %) persons. Rib fractures were identified in 59 (73.0 %) persons; rib fractures were usually multiple (mean number of broken ribs was 7.6 per person). Intra-thoracic injuries were diagnosed in 33 (41.2 %) persons - findings of lung contusions and lacerations, transmural heart contusions, hemothorax and hemopericard. The vast majority of identified intra-thoracic injuries were considered clinically relevant (provided the fact that return of spontaneous circulation had been achieved). Intraabdominal injuries (liver and spleen injuries) were identified in 15 (18.7 %) of persons. Vast majority of these injuries was clinically irrelevant. We have found clinically serious injuries (spleen rupture and liver dilacerations) in 3 (3.7 %) persons. Outcomes of our study suggest that CPR-associated injuries are very common, usually multiple, and in some cases they might be even potentially lethal (if return of spontaneous circulation is achieved).Key words: cardiopulmonary resuscitation - cardiac arrest - injuries - autopsy study - sternal and rib fractures.
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April 2019

Fatal Ingestion of Chlumsky Disinfectant Solution.

J Forensic Sci 2018 Mar 16;63(2):626-630. Epub 2017 May 16.

Department of Anatomy, Faculty of Medicine, Masaryk University, CZ-625 00, Brno, Czech Republic.

A 32-year-old pregnant woman in the 25th week of pregnancy underwent oral glucose tolerance screening at the diabetologist's. Later that day, she was found dead in her apartment possibly poisoned with Chlumsky disinfectant solution (solutio phenoli camphorata). An autopsy revealed chemical burns in the digestive system. The lungs and the brain showed signs of severe edema. The blood of the woman and fetus was analyzed using gas chromatography with mass spectrometry and revealed phenol, its metabolites (phenyl glucuronide and phenyl sulfate) and camphor. No ethanol was found in the blood samples. Both phenol and camphor are contained in Chlumsky disinfectant solution, which is used for disinfecting surgical equipment in healthcare facilities. Further investigation revealed that the deceased woman had been accidentally administered a disinfectant instead of a glucose solution by the nurse, which resulted in acute intoxication followed by the death of the pregnant woman and the fetus.
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http://dx.doi.org/10.1111/1556-4029.13539DOI Listing
March 2018

Fluid content in the pleural cavity protects internal structures against heat.

Forensic Sci Med Pathol 2016 Dec 25;12(4):497-501. Epub 2016 Oct 25.

Forensic Medicine, University Hospital Ostrava, 708 52, Ostrava, Czech Republic.

Purpose: In this paper we present a case report of two people who were found dead in a holiday cottage after a fire. The cause of death in these cases was clarified by the presence of blood in the left pleural cavity in both bodies.

Methods: An inspection of the bodies at the scene of the fire and subsequent examination by a medical examiner suggested the deaths were accidental.

Results: An autopsy showed that the bodies were those of a man and a woman with severe carbonization of the skin, soft tissues, brain, and some organs of the thoracic and abdominal cavities. There were also isolated stab injuries to the chest, as well as injuries to skeletal structures and intrathoracic organs. The accumulated blood in the pleural cavity had protected the internal organs against thermal destruction and preserved the traumatic findings.

Conclusion: To the best of our knowledge this is the first description of the protective effect of hemothorax against thermal damage of the intrathoracic organs.
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http://dx.doi.org/10.1007/s12024-016-9814-9DOI Listing
December 2016

Intra-thoracic injuries associated with cardiopulmonary resuscitation - Frequent and serious.

Resuscitation 2016 06 16;103:66-70. Epub 2016 Apr 16.

Department of Forensic Medicine, University Hospital Ostrava, 17.listopadu 1790, Ostrava 70852, Czech Republic; Department of Intensive Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic.

Aim Of The Study: The aim of the study was to evaluate prevalence, seriousness and risk factors of intra-thoracic injuries (ITI) injuries associated with CPR in non-survivors after out-of-hospital cardiac arrest.

Methods: This was a prospective forensic autopsy cohort study conducted in a single institution. Pathologists recorded autopsy data using standardized protocol which contained data from external and internal examination of the body focused on ITI.

Results: In total, 80 persons were included in this study. CPR-associated injuries were found in 93.7% of cases; majority of injuries were skeletal chest fractures (rib fractures in 73.7%, sternal fractures in 66.3%). ITI were identified in 41.2% of cases. Contusion of at least one lung lobe was found in 31.2%, lung laceration in 2.5%, and hemothorax in 5.0% of cases. Transmural heart contusion was identified in 17.5% of cases; hemopericard on the grounds of right atrium rupture of aortic rupture was revealed in 8.7% of cases. Risk factor analysis did not show any statistically significant correlation between ITI and any of general data (age, gender, BMI, cause of death, season of the year or location where the body was found) or CPR specifications (type and duration of CPR, manner of chest compressions). A strong correlation between ITI and skeletal chest fractures was proven.

Conclusion: ITI present frequent and serious complications of unsuccessful CPR. ITI could contribute to the death only provided the fact that ROSC had been achieved. Correct performance of chest compressions according to guidelines is the best way to avoid ITI.
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http://dx.doi.org/10.1016/j.resuscitation.2016.04.002DOI Listing
June 2016

[Injuries associated with cardiopulmonary resuscitation].

Soud Lek 2014 Jul;59(3):28-33

Introduction: Therapeutic procedures performed during cardiopulmonary resuscitation on patients in cardiac arrest or unconsciousness from any other cause can have serious adverse effects. Scale of injuries scale is very wide - from simple skin lacerations up to serious injuries which can even thwart possibility of successful resuscitation and cause death.

Materials And Methods: Comprehensive review of current literature aimed at injuries associated with cardiopulmonary resuscitation.

Results: Authors of this paper offer up-to-date review of possible cardiopulmonary resuscitation associated injuries, which are discussed depending on the method of performed resuscitation - airway management, chest compressions without tools or with automated mechanical devices, and defibrillation. Airway management is frequently associated with subcutaneous hematomas of the neck and head, mucosal membrane lacerations, teeth fractures and airway aspiration. Autopsy findings after cardiac massage are: rib and sternal fractures (very frequent); pleura, lung and cardiac injuries (frequent); cervical spine injuries, pericardial tamponades due to cardiac or aorta rupture, liver, spleen or stomach lacerations (rare). Defibrillation can create skin burns, cardiac or renal injuries due to rhabdomyolysis.

Conclusion: Forensic pathologists as well as clinical practitioners should be aware of the relevance of possible injuries associated with cardiopulmonary resuscitation. The injuries should be avoided if possible, or distinguished from injuries of other origin if they cannot be prevented.
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July 2014

Successful kidney transplant from methanol-intoxicated donors.

Prog Transplant 2014 Jun;24(2):199-205

University Hospital Ostrava, Ostrava, Czech Republic.

The well-described disparity between the need for and the supply of organs suitable for transplant is growing. Because of this disparity, mortality of patients listed for transplant is increasing. Donors who die of intoxication (including victims of methanol poisoning) represent less than 1% of suitable donors and might be used to increase the supply of organs. They are often not accepted as donors by transplant specialists, because of concerns about patients' outcomes with these grafts. Three cases of fatal methanol intoxication that resulted in transplants of 6 kidneys are evaluated.
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http://dx.doi.org/10.7182/pit2014111DOI Listing
June 2014

A concise history of forensic medicine in Czech Republic.

Acta Med Hist Adriat 2013 ;11(2):349-58

Institute of Forensic Medicine, Faculty of Medicine Masaryk University and St. Anne's University Hospital Brno, Brno, Czech Republic.

This paper presents the most important historical facts about all forensic medicine workplaces in the Czech Republic since the beginning till present day, including a perspective on how to establish a new one. Each of the University Forensic Medicine Institutes or district Departments is covered by at least one author. The oldest institute is in Prague and in Brno, the youngest is in Pardubice.
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March 2014

Detection of nano- and micro-sized particles in routine biopsy material - pilot study.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015 Mar 10;159(1):87-92. Epub 2012 Dec 10.

Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech RepublicbFaculty Hospital Ostrava, 17.listopadu 1790, 708 52 Ostrava cNanotechnology Center, VSB - Technical University Ostrava, 17. listopadu 15, 70833 Ostrava.

Background: Nanotechnology is receiving enormous funding. Very little however is known about the health dangers of this technology so far. Chronic tonsillitis is one of a number of diseases called idiopathic. Among other factors, the tonsils are exposed to suspended particles in inhaled air including nano particles. The objective of this study was to detect and evaluate metallic particles in human tonsil tissue diagnosed with chronic tonsillitis and in amniotic fluid as a comparison.

Methods: . Scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDX) was used for identification of solid particles in a total of 64 samples of routinely analyzed biopsy and cytologic material.

Results: Almost all samples were found to contain solid particles of various metals. The most frequent, regardless of diagnosis, were iron, chromium, nickel and aluminium. The size, determined using SEM, varied from around 500 nm to 25 µm. The majority formed aggregates of several micrometers in size but there were a significant number of smaller (sub-micrometer or nano-sized) particles present. The incidence of metallic particles was similar in child and adult tissues. The difference was in composition: the presence of several metals in adults was due to occupational exposure.

Conclusions: The presence of metallic particles in pathologically altered tissues may signal an alternative causation of some diseases. The ethiopathogenic explanation of these diseases associated with the presence of nano-sized particles in the organism has emerged into a new field of pathology, nanopathology.
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http://dx.doi.org/10.5507/bp.2012.104DOI Listing
March 2015