A concise history of forensic medicine in 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.

[Taxus baccata poisoning].

Common yew poisoning occurs by per oral application of needles or extracts of needles usually. The determination of the cause of death is more difficult in the latter case. In our article, we advise of circumstances which could be helpful in diagnostic.

[3,5-dimethoxyfenol--marker intoxication with Taxus baccata].

Autopsy findings of fatal intoxication with yew (Taxus baccata) are nonspecific. A presence of plant residues in the digestive tract can signalize yew intoxication. If yew decoction is consumed, plant residues are not found.

Correlation of ultrastructural changes of endothelial cells and astrocytes occurring during blood brain barrier damage after traumatic brain injury with biochemical markers of BBB leakage and inflammatory response.

Focal cerebral contusion can be dynamic and expansive. It has been proved that subsequent expansive contusion is caused by brain parenchyma damage, especially BBB damage. We investigated a group of patients with traumatic brain injury.

[Evaluation of relevance in concussion and damage of health by monitoring of neuron specific enolase and S-100b protein].

Introduction: Proteins released to the circulation from affected glial (neuron specific enolasis, NSE) or ganglial cells (S-100b protein) during traumatic brain injury might be used in diagnosis of traumatic brain injury in cases with negative finding on computer tomography scan (concussion) or in patients where the serious clinical status does not corresponde with mild changes on CT scan (diffuse axonal injury, DAI). Classification of DAI according Gennarelli considered the concussion as lower degree of DAI.

Materials And Method: 15 patients were divided into group I of mild conccussion (n=3) with 1-day duration of hospitalisation, group II of serious concussion (n=4) with more days duration of hospitalisation with negative findings on CT scan and group III of patients with diagnosis of DAI (n=8).

[Correlation among clinical and morphological findings in a diffuse axonal injury].

In a man of 56 years--a victim of traffic accident, contusions in both temporal lobes of the brain and a small subdural and subarachnoid haemorrhage were diagnosed by CT and MR examination. According to the findings of petechial haemorrhages in the corpus callosum a diffuse axonal injury was clinically diagnosed. After 2 months the patient died.

Diagnosis of traumatical and hypoxial changes of the CNS--immunohistochemical study.

The immunohistochemical detection of neuron-specific enolase and b-amyloid percursor protein were used in the group of deceased on craniocerebral injury and those who died of prolonged hypoxy without mechanical injury of the brain. Neuron-specific enolase (NSE) is produced by nerve cells and is a suitable marker for both the damage of neurons and axons. While undamaged nerve cells show immunoreactivity with the antibody anti-NSE, a significant decrease of this protein substance was noticed within two hours both in mechanical injury and in cases of prolonged hypoxy.

[Immunohistochemical findings in the central nervous system in sudden infant death].

In a group of 7 infants suddenly dying at the age up to 1 year a histological and immunohistochemical investigation was performed aimed to prove possible chronic hypoxic and latent traumatic changes. Presence of ubiquitin and neuron-specific enolase (NSE) was detected in axon and neurons. In six suddenly dying infants an immunohistochemical positivity was found with antibodies against ubiquitin in brain stem neurons.

[Detection of eosinophilic cationic protein in the lungs in sudden infant death].

In a comparative study the authors detected presence of eosinophilic protein in infant's lung at sudden death. Degranulation of eosinophillic leucocytes and extracellular foci of this protein were found in a case of such sudden death. Discussion concerned possibility that the release of eosinophilic cationic protein could represent one of the triggering moments of infant sudden death.

Early and late fatal complications of inhalation injury.

Severe inhalation injury causes a substantial deterioration in the prognosis and increases the general mortality of patients with extensive burns. Recently, in particular due to the development of invasive monitoring of patients and effective treatment of acute burn shock, we encounter with increasing frequency patients who survive the acute stage, including complications such as ARDS, and reach the stage of late complications. The latter include tracheooesophageal fistulas that develop on the basis of pressure ulcers and chondromalacia, usually at the site of the balloon of the tracheostomic cannula, and the overproduction of fibrous tissue in the area of the airways which leads to the development of stenosis, pulmonary fibrosis and bronchiectasia.

[Morphologic findings in chronic abuse of heroin and pervitine].

In a deceased 39-year-old man with a history of 10-year consumption of heroin and pervitin the authors made histological and immunohistochemical examinations of organs focused on detection of old and recent pathological changes. In the brain they detected oedema, venostasis, inflammatory infiltrates in the wall and surroundings of some vessels and hypoxic changes of neurons with a drop or disappearance of neuron-specific enolase. The myocardium was marked by oedema of the interstitium, focal diminution to disappearance of basophilia of myocyte nuclei with increased eosinophilia of some fibres and smaller and larger foci of fibrosis formed by mature and less mature connective tissue.

[Polarographic determination of metals in firearm injuries].

There was tested the use of the polarographic determination of some metals (Pb, Cu, Fe, Sb) in the skin in deceased due to multiple firearm injuries. The authors present on a real case, in which the shots through the dress of victim penetrated, the possibility to determine entry and exit wound.

[Detection of caspase as a sign of tissue damage].

Caspases are cysteine proteases which participate in different stages of apoptosis. Apoptosis, cell death, programmed by its nucleus is associated also with a number of diseases and tissue damage. To this process increasing attention is paid also in the sphere of forensic medicine, in particular to make use of the diagnostic contribution in investigation of cause of death, vital reaction and time when the injury developed.

[Differences in immunohistochemical findings in traumatic and hypoxic changes in the central nervous system].

The authors made in a group of deceased subjects with craniocerebral injuries and subjects with protracted hypoxia without mechanical brain injury immunohistochemical investigations of neuron-specific enolase and beta-amyloid protein precursor. Neuron-specific enolase (NSE) is produced by nerve cells and is a suitable marker of neuron as well as axon damage. While the bodies of intact nerve cells display immunoreactivity with the anti-NSE antibody, in damaged neurons already within two hours after injury a marked drop of this protein substance was observed after mechanical injury as well as after protracted hypoxia.

[Effect of autolysis on histochemical examinations of the central nervous system].

The objective of the study was to explain the effect of autolysis on immunohistochemical detection of neurone-specific enolase (NSE), beta-amyloid protein precursor (beta-APP) and ubiquitine in cerebral tissue. The examination was made in 6 deceased subjects without mechanical injury of the CNS and 6 subjects with a craniocerebral injury who survived from 6 hours to 3 days. In all deceased subjects the post-mortem examination was made within 24 hours after death.

Lethal burn trauma in children.

The aims of this retrospective study covering the years 1984-1998 were: 1. to survey burn injuries in children at the present time and 2. to compare the current results with the conclusions of an analogous study performed in the years 1964-1983.

[Glycophorin in forensic medicine].

Immunohistological evidence of glycophorin from paraffin sections of tissues fixed with formol, makes its possible to visualize membranes of preserved erythrocytes and fragments after their disintegration. This fact permits even after development of post-mortem changes to differentiate actual extravasation, manifested by a positive finding of glycophorin from mere infiltration of tissue by blood pigment after death, where glycophorin is lacking. The method is very sensitive and can reveal even very discrete haemorrhage.

[Immunohistochemical methods in the differential diagnosis of primary traumatic and subsequent secondary cerebral changes].

In a 22-year-old man, driver of a personal motor vehicle, who died within 39 hours after a traffic injury, the authors made histological and immunohistochemical examinations of the brain focused on differentiation of primary traumatic and subsequent secondary changes. In haematomas the authors revealed the presence bi- and trivalent iron by Turnbull's and Perl's reaction as well as glycophorin by immunohistochemical reactions. White matter lesions were evaluated histologically by staining according to Palmgren and immunohistochemically by detection of neuron-specific enolase, beta-amyloid protein precursor and low molecular neurofilaments.

[The effect of autolysis on the interpretation of results of immunohistochemical detection of myoglobin and fibrinogen in the myocardium].

Immunohistochemical detection of myoglobin and fibrinogen in the myocardium makes it possible to diagnose very early stages of ischaemic/hypoxic changes of the heart muscle. The authors demonstrate on the myocardium of a 58-years-old female patients who died suddenly with the finding of acute infarction of the anterior wall of the left ventricle with transmural rupture and cardiac tamponade the effect of autolysis on this examination. Tissue excision taken from the close vicinity of the rupture were subjected to autolysis at room temperature and immersed in formol for fixation within an interval of 24 hours.

[Immunohistochemical findings in the heart conduction system].

Immunohistochemical investigation of heart conductive system showed that degenerative changes described by James (9) in some cells of the system had a nature of programmed death. Extinction of certain of number of cells of a reducted part of the system was found in membranous septum. Apoptotic antigen (21) could be proved in some destructed cells by using anti-Bax and anti-bcl-2 antibodies.

[Diagnosis of early phase diffuse axonal injury using immunohistochemical methods].

Histologic and immunohistochemical investigation of the brain aimed at diagnosis of diffuse axonal injury (DAI) was performed in a group of 12 persons deceased of craniocerebral injury. Traumatic axonal change was visualized by immunohistochemical positivity of ubiquitin, low-molecular neurofilaments, beta-amyloid precursor protein and neuron-specific enolase. In addition, H-E stain and silver impregnation of axons according to Palmgren were performed.

[Immunohistochemical study of inflammatory changes in the myocardium].

A common histological investigation of the myocardium was compared with immunohistochemical testing of cardiomyocytes for fibrinogen and myoglobin in a 26-year-old man who died suddenly with a several days history of respiratory ways infection. A very discrete finding in hematoxylin eosin showed a slightly non-purulent interstitial myocarditis whereas immunohistochemistry revealed a substantially bigger lesion of heart muscle fibres. Samples from different parts of myocardium showed disseminated or confluent lack of myoglobin and corresponding deposition of fibrinogen in injured cardiomyocytes.

[Immunohistochemical methods in the diagnosis of diffuse axonal injury].

Diffuse axonal injury (DAI) was diagnoses according to axonal reaction proved as balls by Palmgren's silver impregnation and axonal lesions by immunohistochemical investigation of ubiquitin and low molecular weight neurofilaments (68 kD). Diffuse axonal injury was found in 16 cases from a group of 36 persons deceased of craniocerebral trauma (44%). Diagnosis was based on the presence of axonal retraction balls in 15 cases; the balls showed also a striking positivity with antibodies against ubiquitin and low molecular neurofilaments as well.