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The complex anatomy of the aortic root is of great importance for many surgical and transcatheter cardiac procedures. Therefore, the aim of this study was to provide a comprehensive morphological description of the nondiseased aortic root. We morphometrically examined 200 autopsied human adult hearts (22.0% females, 47.9 ± 17.7 years). A meticulous macroscopic analysis of aortic root anatomy was performed. The largest cross-section area of the aortic root was observed in coaptation center plane (653.9 ± 196.5 mm 2 ), followed by tubular plane (427.7 ± 168.0 mm 2 ) and basal ring (362.7 ± 159.1 mm 2 ) (p < 0.001). The right coronary sinus was the largest (area: 234.3 ± 85.0 mm 2 ), followed by noncoronary sinus (218.7 ± 74.8 mm 2 ) and left coronary sinus (201.2 ± 78.08 mm 2 ). The noncoronary sinus was the deepest, followed by right and left coronary sinus (16.4 ± 3.2 vs. 15.9 ± 3.1 vs. 14.9 ± 2.9 mm, p < 0.001). In 68.5% of hearts, the coaptation center was located near the aortic geometric center. The left coronary ostium was located 15.6 ± 3.8 mm above sinus bottom (within the sinus in 91.5% and above sinutubular junction in 8.5%), while for right coronary ostium, it was 16.2 ± 3.5 mm above (83.5% within sinus and 16.5% above). In general, males exhibited larger aortic valve dimensions than females. A multiple forward stepwise regression model showed that anthropometric variables might predict the size of coaptation center plane (age, sex, and heart weight; R 2  = 31.8%), tubular plane (age and sex; R 2  = 25.6%), and basal ring (age and sex; R 2  = 16.9%). In conclusion, this study presents a comprehensive analysis of aortic-root morphometry and provides a platform for further research into the intricate interplay between structure and function of the aortic root., (© 2024 The Authors. Clinical Anatomy published by Wiley Periodicals LLC on behalf of American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

Objective: This study investigates mitral annular disjunctions (MAD) in the atrial wall-mitral annulus-ventricular wall junction along the mural mitral leaflet and commissures., Methods: We examined 224 adult human hearts (21.9% females, 47.9±17.6 years) devoid of cardiovascular diseases (especially mitral valve disease). These hearts were obtained during forensic medical autopsies conducted between January 2018 and June 2021. MAD was defined as a spatial displacement (≥2 mm) of the leaflet hinge line towards the left atrium. We provided a detailed morphometric analysis (disjunction height) and histological examination of MADs., Results: MADs were observed in 19.6% of all studied hearts. They appeared in 12.1% of mural leaflets. The P1 scallop was the primary site for disjunctions (8.9%), followed by the P2 scallop (5.4%) and P3 scallop (4.5%). MADs were found in 9.8% of all superolateral and 5.8% of all inferoseptal commissures. The average height for leaflet MADs was 3.0±0.6 mm, whereas that for commissural MADs was 2.1±0.5 mm (p<0.0001). The microscopical arrangement of MADs in both the mural leaflet and commissures revealed a disjunction shifted towards left atrial aspect, filled with connective tissue and covered by elongated valve annulus. The size of the MAD remained remarkably uniform and showed no correlation with other anthropometric factors (all p>0.05)., Conclusions: In the cohort of the patients with healthy hearts, MAD is present in about 20% of all studied hearts. The MADs identified tend to be localised, confined to a single scallop. Moreover, MADs in the commissures are notably smaller than those in the mural leaflet., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

In the etiology of discogenic pain, attention is paid to the role of neurotrophic factors, which include classic neurotrophins (NTs). This study aimed to assess changes in the concentrations of NT-3 and NT-4 in the intervertebral discs (IVDs) of the lumbosacral (L/S) spine depending on the advancement of degenerative changes, pain severity, habits, and comorbidities. The study group included 113 patients who underwent microdiscectomy due to degenerative IVD disease of the L/S spine. The severity of degenerative IVD changes was assessed using the five-point Pfirrmann scale, and the pain intensity was assessed according to the visual analog scale (VAS). In turn, the control group included 81 participants from whom IVDs of the L/S section of the spine were collected post-mortem during forensic autopsy or organ donation. At the mRNA level, we noted NT-3 overexpression in the test samples compared with the controls (fold change (FC) = 9.12 ± 0.56; p < 0.05), while NT-4 transcriptional activity was decreased in the test samples compared with the controls (FC = 0.33 ± 0.07; p < 0.05). However, at the protein level, the concentrations of NT-3 (134 ± 5.78 pg/mL vs. 6.78 ± 1.17 pg/mL; p < 0.05) and NT-4 (316.77 ± 8.19 pg/mL vs. 76.92 ± 4.82 pg/mL; p < 0.05) were significantly higher in the test samples compared with the control samples. Nevertheless, the concentration of both proteins did not statistically significantly change depending on the advancement of degenerative changes and the pain intensity ( p > 0.05). In addition, higher levels of NT-3 and NT-4 were noted in IVD samples from patients who consumed alcohol, smoked tobacco, were overweight/obese, or had comorbid diabetes compared with patients without these risk factors ( p < 0.05). Our analysis confirmed that differences in the degenerative process of IVD, energy metabolism, and lifestyle are related to changes in the concentration profiles of NT-3 and NT-4.

A total of 76 articles published within the last twenty years, indexed in the PubMed and ResearchGate databases, were reviewed in order to compare medical imaging-based methods of age estimation of children, adolescents and young adults. The evaluated studies were analyzed for any statistically significant differences between the sexes and sides of the body, sample sizes, and population age. Irrespective of the evaluation method, there were some studies that showed a statistically significant differences in ossification stages between the male and female groups. Most of the studies whose authors conducted a statistical analysis demonstrated no significant differences between the left and right side of the body., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Overkilling in the Forensic Medicine is known as a specific type of homicide where the number of inflicted injuries greatly surpasses the number of fatal ones. Conducted research aimed to create a unified definition of the phenomenon and its classification criteria by analysing a vast majority of variables concerning its various characteristics. From the population of homicide victims autopsied in the authors' research facility a number of 167 cases were chosen consisting of both overkilling and other homicides. 70 cases were thoroughly analysed based on the completed court files, autopsy protocols and photographs. Second part of the research concerned the facts regarding the perpetrator, used weapon and the circumstances of the act. Conclusions of the conducted analysis allowed to add further characteristics to the overkilling definition: the perpetrators were almost exclusively men, around 35 of age, not related to the victim but might have been in a close relationship with them, often a conflicted one. They did not threaten the victim before the incident. Mostly perpetrators were not intoxicated, and they tried to cover up the homicide in various ways. Perpetrators of overkilling were in most cases mentally disturbed (and thus stated insane), had different levels of intelligence but also a low level of planning before the act - rarely taking actions as preparing the weapon in advance, choosing the scene or luring in the victim., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Aortic valve fenestrations are defined as a loss of aortic valve leaflet tissue. They are a common but overlooked finding with unclear significance. The aim of this study was to investigate the varied functional anatomies of aortic valve fenestrations. A total of 400 formalin-fixed autopsied human hearts were macroscopically assessed and the function of the aortic valve of 16 reanimated human hearts were imaged using Visible Heart® methodologies. Aortic valve leaflet fenestrations were present in 43.0% of autopsied hearts (in one leaflet in 24.0%, in two leaflets 16.0%, in all leaflets 3.0%). Fenestrations were mostly present in left (25.5%) followed by right (23.3%) and noncoronary leaflet (16.3%). In 93.8% of cases, the fenestrations form clusters and were mainly located at the free edge of the leaflet in the commissural area (95.4%). Hearts with aortic valve fenestrations had significantly larger aortic valve diameters and aortic valve areas (p < 0.001). The average surface area sizes of fenestrations were 23.8 ± 16.6 mm 2 , and the areas were largest for left followed by right and noncoronary leaflet fenestrations (p < 0.001). The fenestration areas positively correlated with donor age (r = 0.31; p = 0.02). Significant hypermobility and subjective weakening of the leaflet adhesion levels of the fenestrated regions were observed. In conclusion, fenestrations of the aortic leaflets are frequent, and their sizes may be significant. They occur in all age groups, yet their size increase with aging. Fragments of leaflets with fenestrations show different behaviors during the cardiac cycle versus unchanged areas., (© 2023 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

In this cadaver-based study, we aimed to present a novel approach to pulmonary valve (PV) anatomy, morphometry, and geometry to offer comprehensive information on PV structure. The 182 autopsied human hearts were investigated morphometrically. The largest PV area was seen for the coaptation center plane, followed by basal ring and the tubular plane (626.7 ± 191.7 mm 2 vs. 433.9 ± 133.6 mm 2 vs. 290.0 ± 110.1 mm 2 , p < 0.001). In all leaflets, fenestrations are noted and occur in 12.5% of PVs. Only in 31.3% of PVs, the coaptation center is located in close vicinity of the PV geometric center. Similar-sized sinuses were found in 35.7% of hearts, in the remaining cases, significant heterogeneity was seen in size. The mean sinus depth was: left anterior 15.59 ± 2.91 mm, posterior: 16.04 ± 2.82 mm and right anterior sinus: 16.21 ± 2.81 mm and the mean sinus height: left anterior 15.24 ± 3.10 mm, posterior: 19.12 ± 3.79 mm and right anterior sinus: 18.59 ± 4.03 mm. For males, the mean pulmonary root perimeters and areas were significantly larger than those for females. Multiple forward stepwise regression model showed that anthropometric variables might predict the coaptation center plane (sex, age, and heart weight; R 2  = 33.8%), tubular plane (sex, age, and BSA; R 2  = 20.5%) and basal ring level area (heart weight and sex; R 2  = 17.1%). In conclusion, the largest pulmonary root area is observed at the coaptation center plane, followed by the basal ring and tubular plane. The PV geometric center usually does not overlap valve coaptation center. Significant heterogeneity is observed in the size of sinuses and leaflets within and between valves. Anthropometric variables may be used to predict pulmonary root dimensions., (© 2022 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

Overkilling in the Forensic Medicine field is known as a specific type of homicide where the number of inflicted injuries greatly surpasses the number of fatal ones. Conducted research aimed to create a unified definition of the phenomenon and its classification criteria by analysing a vast majority of data concerning its various characteristics. From the population of homicide victims autopsied in the authors' research facility a number of 167 cases were chosen consisting of both overkilling and other homicides. 70 cases were thoroughly analysed based on the completed court files, autopsy protocols and photographs. First part of the research concerned the facts regarding the injuries sustained and the victim's characteristics. Conclusions of the statistical analysis allowed to characterize overkilling as a type of homicide where the number of injuries (sharp or blunt) is several times higher than the number of fatal injuries. Sharp force injuries predominate, and are often localized on the torso, neck and limbs, while blunt force injuries are localized mostly on the head. There is no significant dominance between the sexes of the victims, mostly they are in their 40-50's. Victims with reduced abilities to resist predominated (mostly women), which is correlated with the position of their body (lying or sitting) at the begging of the incident. Also overkilling victims more often suffer from defensive injuries and post mortem trauma., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Recent years saw frequent media reports of young people who die while they are being arrested by the police. Death in these circumstances affects people who are agitated and restrained with the use of force, with their autopsies indicating no unequivocally traumatic cause of death. The goal of this study was to identify the mechanism and circumstances of sudden deaths in agitated individuals who are being restrained. Ten cases evaluated at our center since 2010 were included in this study: nine involved forensic postmortem examination and one involved casefile analysis. In each case there was sudden cardiac arrest or at least a loss of consciousness, and the cardiopulmonary resuscitation proved ineffective. In six cases the cause of agitation was acute psychosis, in four it was an effect of narcotics, usually in high concentration. Conjunctival petechiae were detected in only five cases. The most probable cause of death in the evaluated cases was the combination of physical exertion caused by pathological psychomotor agitation and forcible restraint, hindering the function of the respiratory system. This mechanism is known as restraint asphyxia., (Copyright © 2022 by PTMSiK.)

Background: Homicide combined with subsequent suicide of the perpetrator is a particular form of interpersonal violence and, at the same time, a manifestation of extreme aggression directed against oneself. Despite the relatively well-described individual acts of homicide and suicide, both in terms of psychopathology and law, acts of homicide and subsequent suicide committed by the same person are not well-studied phenomena. The importance of emotional factors, including the influence of mental state deviations (psychopathology), on this phenomenon, is discussed in the literature, but still there is relatively little data with which to attempt neuropathological assessments of the brains of suicide killers. This paper is dedicated to the issue based on the neuropathological studies performed., Methods: We analyzed a group of murder-suicides using histochemical and immunohistochemical methods., Results: The results of our research indicate the presence of neurodegenerative changes including multiple deposits of ß-amyloid in the form of senile/amyloid plaques and perivascular diffuse plaques., Conclusions: Neurodegenerative changes found in the analyzed brains of suicide killers may provide an interesting starting point for a number of analyses. The presence of neurodegenerative changes at such a young age in some murderers may suggest preclinical lesions that affect cognitive functions and are associated with depressed moods.

Background: The aim of our study was to investigate the presence and mutual relationships of coronary vessels within the right atrial appendage (RAA) vestibule., Methods: We examined 200 autopsied hearts. The RAA vestibule was cross-sectioned along its isthmuses (superior, middle, and inferior)., Results: The right coronary artery (RCA) was present in 100% of the superior RAA isthmuses but absent in 2.0% of hearts within the middle isthmus and in 6.5% of hearts within the inferior RAA isthmus. Its diameter was quite uniform along the superior (2.6 ± 0.8 mm), middle (2.9 ± 1.1 mm), and inferior (2.7 ± 0.9 mm) isthmuses ( p = 0.12). The location of the RCA varied significantly, and it was sometimes accompanied by other accessory coronary vessels. In all the isthmuses, the RCA ran significantly closer to the endocardial surface than to the epicardial surface ( p < 0.001). At the superior RAA isthmus, the artery was furthest from the right atrial endocardial surface and this distance gradually decreased between the middle RAA isthmus and the inferior RAA., Conclusions: This study was the most complex analysis of the mutual arrangements and morphometric characteristics of coronary blood vessels within the RAA vestibule. Awareness of additional blood vessels within the vestibule can help clinicians plan and perform safe and efficacious procedures in this region.

Introduction: The aim of this study was to investigate the thickness of the left atrial wall surrounding the left atrial appendage (LAA) orifice., Methods and Results: The tissue thickness around the LAA orifice was measured at four points (superior, inferior, anterior, and posterior) in 200 randomly selected autopsied human hearts. The thickest tissue was observed at the anterior point (3.17 ± 1.41 mm), followed by the superior (2.47 ± 1.00 mm), inferior (2.22 ± 0.80 mm) and posterior (2.22 ± 0.83 mm). The chicken wing LAA type was associated with the lowest thickness at the superior point compared to the cauliflower and arrowhead shapes (p = .024). In hearts with an oval LAA orifice, the atrial wall was significantly thicker in all points than in specimens with a round LAA orifice (p > .05). Both the LAA orifice anteroposterior diameter and orifice surface area were negatively correlated with the tissue thickness in the anterior (r = -.22, p = .004 and r = -.23, p = .001) and posterior points (r = -.24, p = .001 and r = -.28, p = .005). Endocardial surface roughness was commonly in the inferior pole of the LAA orifice (75.5% of cases), while they are much less prevalent in other sectors around the orifice (anterior: 17.5%), superior: 4.0%, and posterior: 1.5%)., Conclusions: Although a significant heterogeneity in the atrial wall thickness around the LAA orifice was observed, the thickness in the respective points is quite conservative and depends only on LAA orifice size and shape, as well as LAA body shape. Thin atrial wall and endocardial surface roughness might challenge invasive procedures within this region., (© 2021 Wiley Periodicals LLC.)

Background: The left atrial appendage (LAA) is a heart structure with known prothrombogenic and pro-arrhythmogenic properties., Aim: The aim of this study was to evaluate the specific anatomy of the LAA and to create a simple classification system based on the shape of its body., Method and Results: This study investigated 200 randomly selected autopsied human hearts (25.0% females, 46.6±19.1 years old). Three (3) types of LAAs were distinguished: the cauliflower type (no bend, limited overall length, compact structure [36.5%]); the chicken wing type (substantial bend in the dominant lobe [37.5%]), and the arrowhead type (no bend, one dominant lobe of substantial length [26.0%]). Additional accessory lobes were present in 55.5% of all LAAs. Significant variations between category types were noted in LAA length (chicken wing: 35.7±9.8 mm, arrowhead: 30.8±10.1 mm, cauliflower: 22.3±9.6 mm [p<0.001]) and in the thickness of pectinate muscles located within the LAA apex (arrowhead: 1.2±0.7 mm; cauliflower: 1.1±0.6 mm; chicken wing: 0.9±0.6 mm [p<0.001]). Left atrial appendage volume and orifice size were not affected by the type of LAA shape. The age of the donor was positively correlated with LAA volume (r=0.29, p=0.005), body length (r=0.26, p=0.012), and area of the orifice (r=0.36, p<0.001). Donors with an oval LAA orifice were significantly older than those with round orifices (50.2±16.6 vs 43.7±20.4 years [p=0.014]) and had significantly heavier hearts (458.2±104.8 vs 409.6±114.1g [p=0.002])., Conclusions: This study delivered a new simple classification system of the LAA based on its body shape. An increase in age and heart weight was associated with LAA enlargement and a more oval-shaped orifice. Results of current study may help to estimate the different thrombogenic properties associated with each LAA type and be an assistance during planning and performing interventions on LAA., (Copyright © 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Introduction: The right atrial appendage (RAA) vestibule is an area located in the right atrium between the RAA orifice and the right atrioventricular valve annulus and may be a target for invasive transcatheter procedures., Methods and Results: We examined 200 autopsied human hearts. Three isthmuses (an inferior, a middle, and a superior isthmus) were detected. The average length of the vestibule was 67.4 ± 10.1 mm. Crevices and diverticula were observed within the vestibule in 15.3% of specimens. The isthmuses had varying heights: superior: 14.0 ± 3.4 mm, middle: 11.2 ± 3.1 mm, and inferior: 10.1 ± 2.7 mm (p < .001). The superior isthmus had the thickest atrial wall (at midlevel: 16.7 ± 5.6 mm), the middle isthmus had the second thickest wall (13.5 ± 4.2 mm), and the inferior isthmus had the thinnest wall (9.3 ± 3.0 mm; p < .001). This same pattern was observed when analyzing the thickness of the adipose layer (superior isthmus had a thickness of 15.4 ± 5.6 mm, middle: 11.7 ± 4.1 mm and inferior: 7.1 ± 3.1 mm; p < .001). The average myocardial thickness did not vary between isthmuses (superior isthmus: 1.3 ± 0.5 mm, middle isthmus: 1.8 ± 0.8 mm, inferior isthmus: 1.6 ± 0.5 mm; p > .05). Within each isthmus, there were variations in the thickness of the entire atrial wall and of the adipose layer. These were thickest near the valve annulus and thinnest near the RAA orifice (p < .001). The thickness of the myocardial layer followed an inverse trend (p < .001)., Conclusions: This study was the first to describe the detailed topographical anatomy of the RAA vestibule and that of its adjoining isthmuses. The substantial variability in the structure and dimensions of the RAA isthmuses may play a role in planning interventions within this anatomic region., (© 2020 Wiley Periodicals LLC.)

Background: The pulmonary veins are covered by a myocardial layer, which is often an electrical substrate for atrial fibrillation. The aim of this study was to study the morphologic characteristics of the myocardial sleeves of pulmonary veins by examining a large group of freshly autopsied human material., Methods and Results: The study macroscopically examined a total of 498 pulmonary veins draining the left atrium (120 unpreserved human hearts). In 75.0% of specimens, a classical pulmonary venous pattern was observed. The remainder of specimens either had an additional middle right pulmonary vein (20.0% of cases) or a common left pulmonary vein (5.0% of cases). Among all the veins seen in the classical pulmonary venous drainage type, the left superior pulmonary vein had the longest myocardial sleeves (9.4 ± 4.6 mm; coverage = 60.1 ± 19.4%), followed by the left inferior pulmonary vein (6.6 ± 3.5 mm; coverage = 47.6 ± 18.3%), the right superior pulmonary vein (6.0 ± 2.7 mm; coverage = 50.5 ± 13.9%) and then the right inferior pulmonary vein (5.0 ± 2.8 mm; coverage = 45.6 ± 16.2%; analysis of variance p < .001). In hearts with an additional right pulmonary vein, this vessel had the shortest myocardial sleeves (2.7 ± 1.1 mm; coverage = 36.0 ± 11.6%). In hearts with a common left pulmonary vein, the myocardial sleeves had the longest course for the common vein (13.7 ± 4.4 mm; coverage = 79.7 ± 4.9%)., Conclusions: Myocardial sleeves of the pulmonary veins were seen in each examined specimen, however, their length varied significantly. In hearts with a classical venous drainage pattern, the left superior pulmonary vein had the longest sleeves. When present, an additional middle right pulmonary vein had the shortest myocardial sleeves, while the left common pulmonary vein had the longest sleeves., (© 2020 Wiley Periodicals LLC.)

Background: The oblique vein of the left atrium is of interest for electrophysiologists working in the field of both basic science and clinical practice., Aims: We aimed to examine the topographic anatomy of the oblique vein and to assess the vein's location and relationships with surrounding cardiac structures., Methods: A total of 200 autopsied adult human hearts were examined., Results: The oblique vein was observed in 71% of the hearts. Its mean (SD) total length was 30.8 (13.6) mm. In hearts with the oblique vein, a larger distance was observed between the left inferior pulmonary vein (LIPV) and great cardiac vein (mean [SD], 18.6 [5.1] mm vs 16.3 [4.8] mm; P = 0.004), between the left atrial appendage (LAA) and LIPV (mean [SD], 17.8 [6.8] mm vs 15.1 [5.2] mm; P = 0.007), and between the LAA and left superior pulmonary vein (LSPV; mean [SD], 28.5 [7.2] mm vs 21.3 [6.4] mm; P <0.001). Hearts with a classic pattern of left‑sided pulmonary veins were categorized into 4 types based on the length of oblique vein extension. In type I, the vein extended below the level of the LIPV (21.9%); in type II, to the level of the LIPV (47.7%); in type III, to the level of the interpulmonary area (17.2%); and in type IV, to the level of the LSPV (13.3%). In each type, the distance between the oblique vein and LIPV was shorter than that between the oblique vein and LAA Conclusions: The oblique vein had a variable course and differing lengths of extension. The presence of the oblique vein was connected with a greater distance between the left‑sided pulmonary veins and LAA.

A quadricuspid pulmonary valve obtained upon autopsy of a 26-year-old male was examined. The macroscopic evaluation revealed three normal (posterior, right anterior and left anterior) leaflets and one additional leaflet of the pulmonary valve. Except that, the heart showed neither other anatomical variabilities nor any signs of heart disease. The additional leaflet was located between the left anterior and right anterior leaflets and was significantly smaller in size. Under the microscope, all leaflets showed preservation of the typical, layered structure. The thickness and extracellular matrix composition of the particular layers differed between the leaflets. Right ventricular myocardium (myocardial sleeves) exceeded the level of the hinge line in all three normal leaflets, which was not observed in the additional leaflet. Autonomic nerves and ganglia were not seen in the perivalvular epicardial adipose tissue surrounding the additional leaflet. The sinus wall of all the leaflets revealed typical organization of collagen bundles as well as elastic fibers and showed no signs of disruption. The abnormality seen in the structure of the pulmonary valve is likely to be a result of disturbed embryonic development and may affect the clinical management of patients with such variation.

Background: The left atrial ridge is a structure located in the left atrium between the left-sided pulmonary veins ostia and the orifice of the left atrial appendage. Since it was commonly misdiagnosed as a thrombus, the ridge is also known as the "coumadin" or "warfarin" ridge. The left atrial ridge is a potential source of arrhythmias and can be an obstacle in ablation procedures. This study aimed to provide information about the occurrence and spatial morphometric characteristics of the left atrial ridge., Methods and Results: The macroscopic morphology of the left atrial ridge was assessed in 200 autopsied human hearts. The ridge was observed in 59.5% of specimens and was absent in the remaining 40.5% of cases. The mean length of the ridge was 22.4 ± 5.1 mm. It was wider at its inferior sector when compared to its superior sector (9.1 ± 5.0 vs 7.9 ± 3.2 mm; P = .028). The total wall thickness measured at the cross section of the ridge was significantly larger in the inferior than in superior sector (6.2 ± 3.5 vs 4.3 ± 1.8 mm; P < .001), although the myocardial thickness was significantly larger at the superior sector (3.1 ± 1.4 vs 1.9 ± 0.9 mm in inferior sector, P < .001)., Conclusion: The left atrial ridge is a variable structure, present in 59.5% of humans. The ridge is significantly wider and thicker at its inferior sector, although the actual myocardial layer present within the ridge is thinner at this location. Knowledge about the left atrial ridge morphology is key in avoiding unnecessary interventions or complications during invasive procedures., (© 2019 Wiley Periodicals, Inc.)

Background: The purpose of this study was to provide detailed topography of the left atrial medial isthmus (situated between the right inferior pulmonary vein ostium and the medial part of the mitral annulus)., Methods: Two hundred human hearts (Caucasian, 22.5% females, 48.7 ± 4.9 years old) were investigated., Results: The mean length of the medial isthmus was 42.4 ± 8.6 mm. Additionally, the medial isthmus line was divided by the oval fossa into three sections with equal mean lengths (upper: 14.2 ± 7.2 vs middle: 14.1 ± 6.1 vs lower: 14.9 ± 4.6 mm; P > .05). The left upper section of the atrial wall was thinner than the lower section (2.5 ± 1.1 vs 3.4 ± 1.6 mm; P < .0001). This study noted three separate spatial arrangements of the isthmus line. Type I (54.5%) had an oval fossa located outside the isthmus line; type II (32.5%) had an oval fossa crossed by the isthmus line, and type III (13.0%) had an oval fossa rim located tangentially to the isthmus line. In 68.5% of the examined specimens, the isthmus area had a smooth surface. Conversely, the remaining 31.5% had additional structures within its borders such as diverticula, recesses, and tissue bridges., Conclusion: This study is the first to describe the morphometric and topographical features of the left atrial medial isthmus. Interventions within the medial isthmus line should be performed cautiously, especially when they are transected by the oval fossa (32.5%). Careful navigation of the area is also recommended due to the possibility of existent additional structures. The latter could lead to catheter entrapment during ablation procedures., (© 2019 Wiley Periodicals, Inc.)

Background: Variations of the coronary sinus tributaries might result in difficulties in left ventricle electrode insertion during cardiac resynchronizing therapy. Morphometric features of tributaries, especially angulation of the coronary sinus tributaries, are crucial for coronary sinus procedures., Methods: This study was carried out on 200 formaldehyde-fixed human hearts (22.0% females, mean age of 48.7 ± 15.6 years)., Results: The inferolateral aspect of the left ventricle was accessible from the coronary venous tree in 77.0% (in 35% from one, 29% from two, and 13.0% from three tributaries). The middle cardiac vein was present in all cases, with a diameter of 1.8 ± 0.5 mm, cannulation distance of 5.3 ± 3.2 mm, and angle of 82.0 ± 12.8°. The inferolateral vein of the left ventricle varied greatly in number: single in 63.5%, multiple in 30.5%. The ostium diameter for a single vein was 1.3 ± 0.5 mm, cannulation distance was 21.1 ± 9.8 mm, and the angle was 98.1 ± 13.5°. The left marginal vein was present in 39.5% with an ostium diameter of 0.9 ± 0.5 mm, cannulation distance of 46.0 ± 12.0 mm, and angle of 92.0 ± 13.4°. Finally, the oblique vein of the left atrium was present in 71.0% with a diameter of 1.3 ± 0.8 mm, cannulation distance of 27.2 ± 9.4 mm, and angle of 136.8 ± 16.6°., Conclusions: This study shows the clinically relevant morphometric characteristic of coronary sinus tributaries. The middle cardiac vein is the most constant among coronary veins. However, it is usually not suitable for left ventricular pacing. The inferolateral vein of the left ventricle is highly variable in number, but its morphology makes it a suitable target for left ventricular lead placement., (© 2019 Wiley Periodicals, Inc.)

The analysis comprised a total of 450 cases covering the period 2017-2018, in which death was a result of traffic accident, fall from a height, and crushing. Post-mortem examinations carried out at the Department of Forensic Medicine in Krakow consisted of conventional autopsy and post-mortem computed tomography (PMCT). The aims of the study were to evaluate the prevalence of pneumothorax in the study group, and attempt to identify a correlation between pneumothorax and the presence of specific types of thoracic injuries and the circumstances of trauma. Based on the PMCT data, pneumothorax was detected in 43% of cases in the study group. An important finding was the presence of tension pneumothorax with lung collapse and mediastinal shift in 16% of cadavers in the study group. The main injuries accompanying pneumothorax were found to be fractures of the rib cage (ribs, sternum, spine) and lung injuries. In 20% of cases, pneumothorax was shown to coexist with subcutaneous emphysema. In 11% of cases, marked asymmetry of the chest was noted. The circumstances of trauma resulting in the accumulation of air in the pleural cavities included primarily falls from a height and hits by a vehicle.

Objectives: To characterize morphologic variations in the papillary muscles and tendinous cords of the left ventricle and ventricular zones of the mitral valve leaflets., Methods: A total of 100 autopsied human hearts from healthy donors with classical mitral valve type were investigated., Results: In 1 heart, only 1 group of papillary muscles was found, and in the remaining 99%, we could distinguish 2 groups of muscles: Superolateral (SLPM) and inferoseptal papillary muscle (ISPM) groups. The SLPM group had 1 papillary muscle (75.8%), 2 in 20.2%, and >3 in 4.0%. In the ISPM group, the muscle percentages were 38.4%, 36.4%, and 25.2%, respectively. The apex of at least 1 papillary muscle was situated higher than the plane of the opened anterior leaflet (AML) in 47.5% and 50.5% for the SLPM and ISPM groups, respectively. The number of strut cords arising from the SLPM group was 0 (2.0%), 1 (50.5%), 2 (33.3%), 3 (12.1%), and 4 (2.0%), and from the ISPM group was 0 (6.1%), 1 (52.5%), 2 (35.4%), or 3 (6.1%). Cords to left ventricular outflow tract were present in 14 specimens. Muscular cords were found in eight hearts. In all hearts specimens AML had rough and clear zones. The classical zones (rough, clear, and basal) in the posterior mitral leaflet were observed in 38.4%., Conclusions: There is a high variability in the papillary muscles and tendinous cords in the mitral valve complex. Proper nomenclature, simple classification, and the most common variants for papillary muscle groups and tendinous cords were presented., (Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: The term "overkilling" is not clearly defined in medico-legal literature; it is used freely in reference to homicides with extremely numerous injuries., Aim of the Study: The authors' objective was to find relationships between the extent and nature of injuries, the impact of the victims' sex and blood alcohol content., Material and Methods: The authors analyzed 160 cases of homicides from 2004-2011 examined in the Department of Forensic Medicine of the Jagiellonian University Medical College in Krakow, committed with a sharp or blunt instrument., Results: The authors found differences in the location of wounds on the body, depending on the type of tool used, the differences in the number of wounds in relation to the victim's sex and disproportion of the number of fatal injuries in relation to the total number of injuries increasing with the total number of injuries. Alcohol in the victims' blood was found as frequently in cases with defensive injuries, as in other cases., Conclusions: Most of the homicide victims are men, but in cases involving particularly numerous wounds the proportion of male and female victims becomes more balanced. In the case of a very high number of wounds, the share of lethal injuries remains small. The presence of alcohol in the blood has no effect on defense attempts of homicide victims.

The study presents an experimental verification of Wagner et al.'s relationship in microscale and proposes a modification of this relationship. For this purpose, 11 cubic specimens were microcomputed tomography scanned and mechanically tested with the displacement full-field measurements using a digital image correlation system. Then, numerical simulations of the compression tests were performed using a finite elements method. The Young's modulus distributions assigned to the finite elements models were calculated using both of Wagner et al.'s relationships: original and modified. Comparison of the experimental and numerical results indicated the accuracy of numerical solutions for both relationships.

The mitral isthmus is a part of the postero-inferior area of the lateral left atrial wall located between the mitral annulus and the left inferior pulmonary vein ostium. Linear ablation lesions are created within the mitral isthmus for the invasive treatment of left atrial arrhythmias. However, the anatomy of this region is not fully understood. The aim of this study has been to provide a detailed morphometric description of the mitral isthmus region and to propose another possible isthmus within the investigated heart area that may serve as a potential new ablation target. Two hundred autopsied, non-atrial fibrillation hearts (23.5% deriving from females) whose donors were a mean of 47.6±17.6years old were investigated. We macroscopically assessed the anatomy of the postero-inferior area of the lateral left atrial wall. The mean mitral isthmus length was 28.8±7.0mm and was significantly longer than the left atrial appendage (LAA) isthmus (14.2±4.8mm) (p=.00). The distance between the LAA orifice and the left inferior pulmonary vein ostium (18.4±4.8mm) was longer than the LAA isthmus (p=.00) and shorter than the mitral isthmus (p=.00). The LAA isthmus was longer in hearts with a common left pulmonary vein (p=.037). In 65.5% of all cases the area between the right and left mitral isthmus lines was completely smooth. In the remaining hearts, crevices and diverticula (18.0%), intertrabecular recesses (7.0%), trabecular bridges (3.5%), or co-existence of these structures (6%) could be observed. The LAA isthmus line was smooth in 95.5% of all cases, with only small crevices in the remaining 4.5%. In conclusion, regardless of the anatomical variants of the left-sided pulmonary veins, the mitral isthmus area is quite uniform in size. The LAA isthmus is considerably shorter than the mitral isthmus. The mitral isthmus line has many unwanted structures that may entrap the catheter, which is not the case for the LAA isthmus. We proposed the LAA isthmus line for potential clinical use., (Copyright © 2016 Elsevier GmbH. All rights reserved.)

Background: The atrial septal pouch (SP) is a new anatomical entity within the interatrial septum. The left-sided SP may be the source of thrombus and contribute to ischemic stroke. The aim of this study was to provide a detailed morphometric description of the SP., Methods: Two hundred autopsied hearts (23% deriving from females) with a mean age of 46.7±19.1years were investigated. We assessed the morphology of the interatrial septum. We obtained measurements and casts of the SPs, and we conducted histological staining of the left-sided SPs., Results: Patent foramen ovale was observed in 25% of hearts. We found a left SP in 41.5%, right in 5.5% and a double SP in 5.5% of hearts. We found the patent foramen ovale (PFO) more often in younger hearts, and the SP and smooth septum were more prevalently found in older hearts (p=.0023). The mean volume of the left-sided SP was 0.31±0.11ml, which represented 13.6±9.4% (range: 3.1-44.9%) of the left atrial appendage volume. The SP shape resembled a cone or a cylinder with some smaller diverticula originating from the main body. The SP free wall was composed of two layers of endocardium, transverse muscle fibers and connective tissue., Conclusions: A left-sided SP was present in 47% of individuals. The SP arises as a result of PFO channel closure. The anatomy of left-sided SP may promote blood stasis and thrombus formation. The universal formula for SP volume was calculated., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

The aim of this study was to provide useful information about the cavotricuspid isthmus (CTI) and surrounding areas morphology, which may help to plan CTI radio-frequency ablation. We examined 140 autopsied human hearts from Caucasian individuals of both sexes (29.3% females) with a mean age of 49.1±17.2 years. We macroscopically investigated the lower part of the right atrium, the CTI, the inferior vena cava ostium and the terminal crest. The paraseptal isthmus (18.5±4.0 mm) was significantly shorter than the central isthmus (p<0.0001), and the central isthmus (24.0±4.2 mm) was significantly shorter than the inferolateral isthmus (29.3±4.9 mm) (p<0.0001). Heart weight was positively correlated with all isthmus diameters. Three different sectors of CTI were distinguished: anterior, middle and posterior. The middle sector of the CTI presented a different morphology: trabeculae (N = 87; 62.1%), intertrabecular recesses (N = 35; 25.0%) and trabecular bridges (N = 18; 12.9%). A single sub-Eustachian recess was present in 48.6% of hearts (N = 68), and a double recess was present in 2.9% of hearts (N = 4) with mean depth = 5.6±1.8mm and diameter = 7.1±3.4mm. The morphology of the distal terminal crest was varied; 10 patterns of the distal terminal crest ramifications were noted. There were no statistically significant differences in any of the investigated CTI parameters between groups with different types of terminal crest ramifications. The presence of intertrabecular recesses (25.0%), trabecular bridges (12.9%) and sub-Eustachian recesses (48.6%) within the CTI can make ablation more difficult. We have presented the macroscopic patterns of final ramifications of the terminal crest within the quadrilateral CTI area., Competing Interests: The authors have declared that no competing interests exist.

Unlike amphetamine, amphetamine-like substances accessible on the drug market are less expensive and more easily available; they also produce hallucinogenic effects expected by the users. Such properties render them more attractive as compared to amphetamine. On the other hand, the knowledge of the toxicity of these compounds is very limited, what in consequence generates problems that create ever-expanding research areas, including analytical, clinical and medicolegal issues, thus leading to development of systemic databases. An example here is paramethoxyamphetamine (PMA), which appeared on the drug market in recent years as a result of creative inventiveness of producers of psychoactive substances, who aimed at PMA replacing the popular ecstasy (MDMA) as a less expensive and more available product. It is more potent than MDMA, but has a slower onset of action, which encourages users to take more. The problem is illustrated in the present paper by three fatal cases involving PMA, which were comprehensively investigated taking into consideration case histories, pathological and toxicological findings obtained with the use of LC-MS-MS method. In blood samples taken from all the three victims, very high concentrations of PMA were found (in the range of 10-27mg/L) and thus the cause of deaths was determined as overdoses of PMA with the underlying mechanism of acute cardiorespiratory failure., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Aim of the study: To determine the circumstances which can be useful for offenders profiling in homicide cases with victim's body dismemberment. Material and methods: Study of all homicide cases with victim's corpse dismemberment examined in Krakow Department of Forensic Medicine over the last 50 years. Results: Within the past 50 years, a total number of 30 cases of homicides with dismembered bodies were examined in Krakow. 22 cases represent defensive mutilations performed by offender, 3 cases can be classified as offensive muti-lations and 3 cases represent aggressive mutilations - decapitation as a method of committing homicide. In this period the only 1 case of necrophilic mutilations was examined, when the body was dismembered without murder. In most cases the background of homicide was the family conflict, 6 was cause of mental illness of perpetrator and in 3 was sexual motive. Only in 3 cases (from 25 when the offender was known) perpetrator kill a stranger. In the other the offender belonged to the family or friends of the victim. In all cases where the perpetrator was determined, homicide and dismemberment was performed in his place of residence. The findings of the Police investigations indicate that in most cases homicides were not planned, occurred under the influence of emotion, only two have been previously scheduled. Conclusions: Homicides with corpses dismemberment usually are committed by offenders who is in close relationship with victim (family or friend). Dismemberment is almost always performed in the same place as murder - home of perpetrator. This type of homicide usually is not planned.

Aim of the Study: Determination whether injuries identified on the victim's head were caused by a blow made by another person or by a fall resulting in hitting a surface., Material and Methods: An analysis of archive photographs taken routinely at the Forensic Institute in Krakow, Poland, to document post-mortem examinations in the years 2004-2012., Results: A comparative analysis of the images clearly shows that certain areas are much more vulnerable to contact with the surface and thus to injuries; other areas are clearly protected in the case of a fall on a flat surface., Conclusions: In the case of a fall on a solid, flat surface, injuries are located first of all on brow ridges, nasal bridge and nasal apex, on the malar area and on the front surface of the chin. The following areas are clearly protected: eyelids, eyebrows, medial and upper parts of the cheeks, lips and the lower part of the chin.

According to the literature, there are many mathematical relationships between density of the trabecular bone and mechanical properties obtained in macro-scale testing. In micro-scale, the measurements provide only the ranges of Young׳s modulus of trabeculae, but there are no experimentally tested relationships allowing the calculation of the distribution of Young׳s modulus of trabeculae within these experimental ranges. This study examined the applicability of relationships between bone density and mechanical properties obtained in macro-scale testing for the calculation of Young׳s modulus distribution in micro-scale. Twelve cubic specimens from eleven femoral heads were cut out and micro-computed tomography (micro-CT) scanned. A mechanical compression test and Digital Image Correlation (DIC) measurements were performed to obtain the experimental displacement and strain full-field evaluation for each specimen. Five relationships between bone density and Young׳s modulus were selected for the test; those were given by Carter and Hayes (1977), Ciarelli et al. (2000), Kaneko et al. (2004), Keller (1994) for the human femur, and Li and Aspden, 1997. Using these relationships, five separate finite element (FE) models were prepared, with different distribution of Young׳s modulus of trabeculae for each specimen. In total, 60 FE analyses were carried out. The obtained displacement and strain full-field measurements from numerical calculations and experiment were compared. The results indicate that the highest accuracy of the numerical calculation was obtained for the Ciarelli et al. (2000) relationship, where the relative error was 17.87% for displacements and 50.94 % for strains. Therefore, the application of the Ciarelli et al. (2000) relationship in the microscale linear FE analysis is possible, but mainly to determine bone displacement., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Fatal carbon monoxide poisoning is relatively often encountered in medico-legal practice. Although we usually deal with events of an accidental nature, cases of suicidal character are also quite common, both in Poland and in other European countries. The source of a poisonous gas that is used by a suicide to take his life are usually exhaust fumes from cars and home gas water-heaters that are released in closed spaces. In the present report, the authors present an atypical case--the only such instance in the history of the Krakow Department--where a high carbon monoxide concentration level was achieved by burning briquetted coal in a typical portable barbecue grill. A 65-year old male lit the grill in a room locked from inside, where he had previously sealed all cracks and vents; he left a written message by the entrance where he warned his flatmates about the presence of gas. The investigation determined that the predominant underlying reason of his committing suicide were health problems. As it follows from the analysis of literature on the subject, despite extensively available materials, such a suicide method is exceptionally rare in the European or American culture, where isolated cases only are presented. On the other hand, the authors emphasize the fact that within the last score of years, using barbecue grills in suicidal poisoning has become exceedingly common in the Far East countries. The present report points to certain historical and cultural determinants that may affect such a distinct geographical polarization of the discussed method being used in some Asian countries and refers to a widely discussed by specialists significant role of mass media in popularization of such a suicide method.

The report presents an analysis of results of multi-phase post-mortem computed tomography angiography (MPMCTA) scans performed at the Chair of Forensic Medicine, Jagiellonian University Medical College, in cases of stab wounds and incised wounds, as confronted with the results of conventional medico-legal autopsies. The analysis of the material points to a validity of PMCTA scans as supplementing post-mortem medico-legal examinations and being capable of providing significant data that affect final conclusions and adding new quality to recording post-mortem observations.

Homicides committed by insane offenders have been rarely investigated from the forensic point of view in a comprehensive and detailed manner. The objective of the study was to describe and characterize the modus operandi and personal characteristics in cases when more than one victim was killed and the perpetrator was deemed insane in judicial proceedings. Differences between single and multiple-vitim homicides in the population of insane murderers were also examined. Complete dossiers and forensic examination reports of 21 homicide victims killed by 9 individuals were retrospectively analyzed. The comparative control group consisted of 41 cases with only one victim killed by a single insane perpetrator. The offence and offender variables were subjected to a comparative statistical analysis. The results indicated some specific factors that can be regarded as distinctive features more commonly observed in multiple vs. single victim killings perpetrated by insane individuals. There was a significant correlation between, psychosis with depressive delusions, emotional/affective motivation, common domicile and a positive relationship between the perpetrator and the victim, infanticide committed in the perpetrator's offspring, actions with elements of planning, attacking victims while asleep, attacking from the back rather than from the front, concentration and clustering of injuries in one region of the body and multiple psychotic homicides. The results and conclusions of this study can provide practical, useful implications for homicide investigations, offender profiling or forensic psychiatric and psychological evidence.

In contemporary civilized legal systems, sanity is a prerequisite for criminal responsibility of the perpetrator. Thus, insanity resulting from certain psychiatric and psychological disorders is a circumstance excluding the guilt. General assumptions of insanity criteria are close and similar in legal systems of the majority of countries; however, certain essential differences appear in details of their interpretation and acceptance. These differences in particular appear among systems of continental European states as opposed to these, in which the judiciary system is derived from the English law. The paper presents and discusses in detail the legal and medical considerations of insanity defense in Poland, as well as outlines the legal foundations of this issue in other countries of Europe, North America and Australia.

Forensic psychiatry and psychology were in their beginnings inseparably associated with the forensic medicine, constituting one of its related branches of knowledge. Progress and development of these disciplines, education and the practical application for the purposes of the law were a contribution of a several generations of forensic pathologists in the 19th and 20th centuries. One of the major issues of common interest was opinionating on the sanity of offenders. However, the problem of criminal responsibility of the mentally ill perpetrators dates back to much earlier times and has its roots in the distant beginnings of human civilization. In this paper, the history and evolution of the insanity concept (as a circumstance excluding the guilt of the offender) were presented, from the oldest theories to ideas underlying modern codifications.

In this study, we present 23 cases of dismembered bodies examined by the Cracow Department of Forensic Medicine in 1968-2005 period. Presented material includes 17 instances of defensive mutilation, three instances of offensive mutilation and two cases when dismemberment (decapitation) was a direct cause of death. One case is hard to classified, the perpetrator dissected free skin from the all torso. Analysis of all presented cases and other publications concentrating on the problem of dismemberment gave us the possibility to perform some conclusions. Apart from rare cases of necrophilia, the victim of dismemberment is always a victim of homicide. Homicides ending with corpse dismemberment are most commonly committed by a person close to, or at least acquainted with the victim and they are performed at the site of homicide, generally in the place inhabited by the victim, the perpetrator or shared by both. Such instances are generally not planned by the perpetrator and rarely serial in character.

In the paper 5 cases of hiding corpses after homicides were presented, in two cases corpses were buried, in two cases walled up inside buildings and in one case burned down. Time period between homicide and corpse finding was from one year to 14 years.

A case of corpse dismemberment into 850 fragments was investigated at the Cracow Department of Forensic Medicine. The perpetrator employed various tools to divide the body into fragments and subsequently boiled the pieces to reduce their volume. The thus-prepared body decreased its volume to 30 kg. Subsequently, the perpetrator placed the body fragments in 2 large pots, which were then positioned in the space under the stairs and walled in.

The authors presented a case of verification of pathological lesions as a cause of traffic accident where the driver--the culprit--was a fatal victim due to multiple injuries. Histopathological examination of postmortem samples of myocardium was conducted, using the hematoxylin-eosin, Nielsen-Selye and immunohistochemical C9 staining methods in order to verify the hypothesis about a possible myocardial ischemia triggering the accident. The results of "routine" (H&E) and--especially--immunohistochemical C9 staining showed myocardial damage due to ischemia, which was a morphological indicator evidencing the cause of "misbehavior" of the driver.

The criteria for assessment of legal capacity to stand trial have long been a significant issue in the Polish criminal law. The main problem in opinionating practice is the fact that the code of penal procedure and the executive penal code do not provide any univocal criteria of a mental disease that should be met according to the legal regulations in force. Because of their nature and lack of uniformity, depression and affective disorders pose a particularly great problem for experts who should opinionate on the legal capacity of the suspected and the accused to stand trial. On the one hand, it cannot be accepted that a mental illness renders a person unable to substantially understand legal proceedings and to make a rational defense. On the other hand, however, emotional reactions and mild-degree depression disorders that are only natural when an individual violates law should not be allowed to be regarded as a grave disease and to paralyze legal proceedings. In the present study, the authors have attempted to describe the guidelines that should be followed by court-appointed experts in psychiatry that are commissioned by the court to assess the mental state of an individual. The report emphasizes that in such cases, a thorough analysis, based on medical and legal premises and the experience of the involved court experts are necessary.

The study presents the results of research into completed suicide. The authors have analyzed cases of completed suicide committed in Cracow and it's environs in the years 1991-2000. The aim of the research is to describe some features of this phenomenon with it's transformations in the last periods. The presented material bases on archival data of postmortem examinations made in Cracow's Institute of Forensic Medicine. Analyses' were executed in reference of victims' sex, age and place of residence, number and frequency of suicides in Cracow population, methods, predictors and possible motives. The authors also present a sketch of the bibliography regarding the topic, and the comparison between the results of the present study and the results of earlier studies from Cracow environs of the phenomenon of suicide. 1933 cases of completed suicides were analysed, from what over a half concerned occupants of our city. The average coefficient for 100 000 occupants carried out 13.2. There were 1485 men and 448 women among victims, in age from 13 to 95 years. Male to female avarage ratio carried out 3.3:1 in the described period.. Average age carried out 45.5 years, for men 44.5, and for women 48.8 years. The superiority of men is strongly visible in groups of young persons and in "middle age". Results from archival data show that, hanging was the the most frequent way of suicide. In studied material there were more then 63% cases of suicidal hanging. Falls from height, poisonings and drownings were next in line. In very considerable number of cases (almost 60%) the presence of mental disorder in anamnesis was affirmed. This concerned particularly women where the most frequent were depression disorders. For men, first of all factors was dependence from acohol. Over one third of the victims were pensioners and unemployeds. The level of ethanol in blood in 718 cases was crossed 0.5 promille.

A typical use of hair analysis in forensic toxicology is the documentation of previous drug administration. This is illustrated in a suicidal death of a 58-year-old epileptic patient who was treated with oxcarbazepine and probably with levomepromazine. The toxicological analysis carried out by HPLC/APCI/MS included also the hair (6 cm length) besides postmortem blood. The method was validated for levomepromazine, oxcarbazepine (OXCBZ) and its two metabolites, 10-hydroxycarbazepine (CBZ-10OH) and trans-diol-carbazepine (CBZ-diOH) in various biological matrices. The analysis of the postmortem blood indicated oxcarbazepine and its two main metabolites were present at therapeutic concentrations; levomepromazine was detected at a fatal concentration. In three 2-cm segments of hair, oxcarbazepine and its two metabolites were detected; however, levomepromazine was not detected in this specimen. As a result of complex chemical-toxicological investigation it was confirmed the information that the decedent. was an epileptic patient and was treated with oxcarbazepine for at least 6 months before death. In addition, he took a toxic dose of levomepromazine in order to commit suicide. The analysis revealed differences between the concentration levels of oxcarbazepine and its active metabolite CBZ-10OH in postmortem specimens and hair, suggesting different mechanisms of penetration of metabolites and their precursors into this matrix.

This study presents five cases of completed suicides in which injures were situated in parts of the body changed by illness or in areas related to medical treatment. Following early research, physical illness has been identified as an important risk factor for suicide and for suicidal behavior. It is an unusual and rare problem when opposition to somatic disease is signified by the localization and character of suicidal injures. These cases illustrate such a phenomenon, where the body--in a symbolic way is engaged in expression of human stress and frustration. This is caused by the loss of the possibility to control one's own life. The authors also discussed this problem in the view of the literature.

The aim of the study was to present the increasingly alarming phenomenon of completed suicide in adolescents and young adults. The material analysed had been drawn from the records of post-mortem examinations conducted by the Institute of Forensic Medicine in Kraków. The analysis covered cases of completed suicide committed by 15-30 years old inhabitants of Kraków or its environs between the September 2002 and the September 2003. The group of subjects analysed comprised 47 individuals (9 females and 38 males); 57.4% of these had resided in a big city (Kraków), and the remaining 42.6%--in villages or little towns near Kraków. The data regarding cases of completed suicide were compared with the data regarding suicide attempts by self-intoxication in the period under consideration, extracted from the documentation of the Department of Clinical Toxicology in Kraków. The latter data encompassed 233 cases of suicide attempts by individuals ranging in age from 15 to 29 years, with females constituting 62.2% of these, and males--37.8%. 65% of the attempters had been residents of Kraków. The analysis of the data from the Institute of Forensic Medicine revealed that nearly half of the suicide victims concerned had been treated for mental disorders, mainly depression and addictive disorders. The occurrence of suicide attempts prior to the fatal act was established in the case of 17 subjects (18.5%). Over half of the subjects (48.9%) committed suicide by hanging themselves, 17%--by falling from a height, 8.6%--by drowning, and 19.1%--by self-intoxication with medicaments. 77.2% of the subjects committed suicide at home. In the case of 23 subjects (48.9%), the post-mortem examination revealed the presence of alcohol. The analysis of the cases of suicide attempts by self-intoxication revealed a significant percentage of depressive disorders (26%)--of high occurrence especially in the case of females, whereas alcohol addiction was the predominant diagnosis in the case of males. Furthermore, the majority of the attempters exhibited situational reactions or personality disorders. Suicide attempts constitute an essential part of the issue of suicide in adolescents and young adults and require further research. What attracts notice, is a high percentage of males among suicide victims, and a high percentage of suicide victims with earlier suicide attempts. The results of the study should be taken into consideration in suicide prevention in groups especially endangered by the risk of completed suicide, such as adolescents and young adults after suicide attempts.

The paper presents a certain biometeorological problem. The evaluation of influence of weather factors on frequency of suicidal cases by hanging in the area of Cracow City during 1991-2002 was examined. Rapid changes of air pressure, air temperature, hot, sweltering and sultry days, very frosty days, days with strong or foehn wind, days with thunderstorms, fog and haze were selected as unfavourable weather factors. They give an occasion for strong psychical stress. The results of detailed investigations are next: more frequency of cases of suicide during the advance of cold fronts, rapid decreases of air pressure during hot, sweltering and sultry days, days with thunderstorms and foehn winds in the Tatra Mountains.

The aim of the study was to estimate the risk factors for eventual suicide in the case of individuals hospitalised for a suicide attempts (or attempted suicide). The group examined comprised 238 patients, who, in the years 2000-2001, were hospitalised in the Department of Clinical Toxicology CM UJ in Kraków for suicidal self-intoxication with medical drugs. The group consisted of 63 males and 175 females ranging in age from 17 to 79 years (the mean age was 36 years). The instruments applied in the examination included a structured interview and a set of psychological tests; complementary information was obtained from the patients' case histories. In the year 2005, on the basis of the data from the Institute of Forensic Medicine in Kraków, it was established that 10 of the patients under consideration--6 females, and 4 males--had eventually committed suicide within the period concerned. The retrospective analysis of the case of each of these 10 individuals revealed that the majority of them had been treated psychiatrically for depression or alcoholic addiction, had experienced parental or marital bereavement, or had experienced serious financial difficulties. The subjects' case histories informed also about the cases of suicidal death in the families of several subjects. As should be pointed out, the results of psychological tests obtained earlier by the 10 subjects concerned did not unequivocally indicated high endangerment by the risk of eventually committing suicide. Finally, it is necessary to observe that alcoholism and depression were the most frequently diagnosed mental disorders in the case of the male suicides. In the case of the female suicides, the results of the analysis reveal a variety of psychological, psychiatric and socio-demographic factors that, eventually, could lead to suicide.