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Introduction: In accordance with the Polish law, pneumatic weapons are weapons that use compressed gas to set a bullet in motion and generate a discharge energy of more than 17J. In recent years, Poland has seen an increase in crimes committed with pneumatic weapons. The research aim of the present study was to measure the velocity of selected 5.5 mm and 6.35 mm caliber shot and to create a model of a human thigh using a pig femur., Material and Methods: This study used Air Arms Hi-Power Xtra FAC cal. 5.5 mm and FX Bobcat Mk II cal. 6.35 mm carbines and Haendler& Natterman's Spitzkugel, Hollow Point and Baracuda cal. 5.5 mm and 6.35 mm lead shot and Excite Apollo cal. 5.5 mm and Black Max Lead-Free cal. 6.35 mm lead-free shot. The velocity of the shot at a distance of 10 m was measured and its kinetic energy was calculated; pig femurs were measured and CT imaging was performed., Results: The 5.5mm caliber shot reached velocities between 253 m/s and 278 m/s, obtaining energies between 27J and 44J. The 6.35 mm cal. shot reached velocities between 242 m/s and 254 m/s and energies between 52J and 59J. Pig femurs had an average weight of 410 g, a length of 239 mm, and a shaft diameter at mid-length of 30.6mm. The thickness of pig femur shaft walls was variable. A ballistic model of the human thigh was created using gelatin available in Poland., Conclusions: 1. The number of registered crimes with pneumatic weapons and the wide access to pneumatic devices with the possibility of design modifications justify the initiation of experimental studies on the assessment of gunshot injuries from pneumatic weapons. 2. The parameters of the shaft of a pig femur obtained from pigs weighing about 115 kg are similar to those of a human adult femur, which makes it possible to create a human thigh model. 3. Of the 5.5 mm cal. shot, the highest impact energies were generated by barracuda type shot, and of the 6.35 mm cal. shot, it was barracuda type and lead-free shot. 4. The thickness of the bony layer of the pig femur shaft is heterogeneous; the posterior wall of the shaft is the thickest, the lateral wall is the thinnest; however, it shows the greatest individual variability., (Copyright © 2024 Polish Society of Forensic Medicine and Criminology (PTMSiK).)

Introduction: The development of pneumatic shooting has led to the construction of technologically advanced devices with discharge energies similar to those of firearms. The pneumatic weapons ammunition market offers a variety of shot which varies in penetration properties and the extent of gunshot damage. In view of the ease of "tuning" of air rifles, a study was conducted of the inlet damage to the anterior femoral surface after pneumatic gunshots. The paper shows the differences in damage parameters depending on the type of shot., Material and Methods: In the study, Air Arms Hi-Power Xtra FAC cal. 5.5 mm and FX Bobcat Mk II cal. 6.35 mm pneumatic carbines were used and lead shot by Haendler&Natterman's Spitzkugel type, Hollow Point and Baracuda cal. 5.5 mm and 6.35 mm, as well as lead-free shot Excite Apollo cal. 5.5 mm and Black Max Lead-Free cal. 6.35 mm. Measurements were taken of the extent of inlet damage to the anterior surface of the femoral shaft with X-ray and CT imaging., Results: HollowPoint shot caused the greatest range of gunshot penetration damage in both bone and periosteum, Apollo lead-free shot caused the least. At the same time, HollowPoint shot showed the greatest susceptibility to ricocheting., Conclusions: 1. The type of shot used influences diversified morphology of the holes and the nature of gunshot damage to the femoral shaft. The differences concern both the gunshot holes and the nature, course and extent of associated fractures. 2. The smallest inlet holes and damage to the periosteum with a regular shape are caused by gunshots with pointed and pointed tip pellets. The greatest extent of bone and periosteum inlet damage was observed in gunshots with Hollow Point type shot due to its predisposition to deformation and fragmentation. 3. Radio-imaging studies are a valuable complement to macroscopic visual assessment providing a useful value for identifying the type of shot used., (Copyright © 2024 Polish Society of Forensic Medicine and Criminology (PTMSiK).)

Competing Interests: The authors declare no conflict of interest.

The purpose of this study was to determine the relationship between cadmium exposure and the likelihood of developing or exacerbating symptoms of inflammatory arthritis (IA). The study included 51 IA patients and 46 control subjects. Demographic and lifestyle data were collected. Haematological and biochemical parameters and blood cadmium levels (Cd-B) were determined. Cd-B correlated positively with age, smoking, living in a high-traffic area, and serum levels of inflammatory markers and negatively with mean corpuscular haemoglobin concentration (MCHC). The binary logistic regression model implied that high Cd-B (≥0.65 μg/L) is linked with an increased risk of IA in the studied population (odds ratio: 4.4). High levels of DNA oxidative damage marker (8-hydroxy-2'-deoxyguanosine) (≥7.66 ng/mL) and cyclooxygenase-2 (≥22.9 ng/mL) and frequent consumption of offal was also associated with increased risk of IA. High Cd-B was related to increased risk of disease symptoms onset in the group of IA patients, decreased the level of interleukin 10, and positively correlated with the disease activity. Increased Cd-B is associated with intensified inflammatory processes and decreased haemoglobin levels; in IA patients with decreased anti-inflammatory interleukin 10. These changes partly explain why cadmium exposure and a high cadmium body burden may raise the risk of IA and of disease symptoms exacerbation.

Although etiolated Arabidopsis thaliana seedlings are widely used as a model to study the de-etiolation process, the etiolation itself at the molecular level still needs elucidation. Here, we monitored the etiolation dynamics for wild type A. thaliana seedlings and lutein-deficient ( lut2 ) mutant between 2 and 12 days of their growth in the absence of light. We analyzed the shape of the apex, the growth rate, the carotenoids and protochlorophyllide (Pchlide) accumulation, and the light-dependent protochlorophyllide oxidoreductase ( LPOR ) transcripts. Differences concerning the apical hook curvature and cotyledon opening among seedlings of the same age were observed, mostly after day 6 of the culture. We categorized the observed apex shapes and presented quantitatively how distribution among the categories changed during 12 days of seedling growth. The Pchlide 654 /Pchlide 633 ratio, corresponding to the amount of the photoactive Pchlide, was the highest in the youngest seedlings, and decreased with their age. LPORA , LPORB , and LPORC transcripts were detected in etiolated seedlings, and their content decreased during seedling growth. Expression of SAG12 or SAG13 senescence markers, depletion in antioxidants, and excess ion leakage were not observed during the etiolation. Lack of lutein in the lut2 mutant resulted in slow Pchlide accumulation and affected other xanthophyll composition., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Jedynak, Trzebuniak, Chowaniec, Zgłobicki, Banaś and Mysliwa-Kurdziel.)

Background Inconsistent findings have been found among studies evaluating the risk of cardiovascular disease for women who have had pregnancies complicated by gestational hypertension (the new onset of high blood pressure without proteinuria during pregnancy). We provide a comprehensive review of studies to quantify the association between gestational hypertension and cardiovascular events in women. Methods and Results We conducted a systematic search of PubMed, Embase, and Web of Science in March 2019 for studies examining the association between gestational hypertension and any cardiovascular event. Two reviewers independently assessed the abstracts and full-text articles. Study characteristics and the relative risk (RR) of cardiovascular events associated with gestational hypertension were extracted from the eligible studies. Where appropriate, the estimates were pooled with inverse variance weighted random-effects meta-analysis. A total of 21 studies involving 3 60 1192 women (127 913 with gestational hypertension) were identified. Gestational hypertension in the first pregnancy was associated with a greater risk of overall cardiovascular disease (RR, 1.45; 95% CI, 1.17-1.80) and coronary heart disease (RR, 1.46; 95% CI, 1.23-1.73), but not stroke (RR, 1.26; 95% CI, 0.96-1.65) or thromboembolic events (RR, 0.88; 95% CI, 0.73-1.07). Women with 1 or more pregnancies affected by gestational hypertension were at greater risk of cardiovascular disease (RR, 1.81; 95% CI, 1.42-2.31), coronary heart disease (RR, 1.83; 95% CI, 1.33-2.51), and heart failure (RR, 1.77; 95% CI, 1.47-2.13), but not stroke (RR, 1.50; 95% CI, 0.75-2.99). Conclusions Gestational hypertension is associated with a greater risk of overall cardiovascular disease, coronary heart disease, and heart failure. More research is needed to assess the presence of a dose-response relationship between gestational hypertension and subsequent cardiovascular disease. Registration URL: https://www.crd.york.ac.uk/prosp​ero/; Unique identifier: CRD42018119031.

Hyperuricemia, i.e. increased serum uric acid (UA) concentration, is a common problem in clinical practice. While there are clear guidelines concerning management of symptomatic hyperuricemia in acute conditions such as gout, urolithiasis or acute urate nephropathy, less is known about their secondary prevention. Moreover, despite the ongoing debate on the role of UA in the pathogenesis of chronic kidney disease, hypertension, cardiovascular disease and heart failure, the management of asymptomatic hyperuricemia in patients with these chronic conditions is still mainly up to physicians' judgement. Individual considerations should always be taken into account when prescribing urate-lowering therapy. In this narrative review study, we attempt to present current trends concerning treatment of patients with either symptomatic or asymptomatic hyperuricemia in the light of the available knowledge on the role of hyperuricemia in the development of gout, renal, cardiovascular and other diseases., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2020 Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie.)

α-Pyrrolidinoheptiophenone (PV8) is a representative of α-pyrrolidinophenone derivatives, a new group of synthetic cathinones. PV8 was first detected in illegal products in Japan in 2013. It is closely related to α-pyrrolidinovalerophenone (α-PVP), which was one of the most popular novel psychoactive substance (NPS) in Poland in years 2013-2015. The article presents two cases of fatal poisonings of 36-year-old man and 37-year-old woman, where a new cathinone derivative - PV8 was detected in biological material collected during medicolegal autopsies. The concentration of PV8, measured with LC-MS method, was in the first case - 0.26 µg/mL in blood and 0.11 µg/mL in urine and in the second - 0.07 µg/mL and 0.13 µg/mL, respectively. In both cases medicolegal experts finally have determined that the cause of death was fatal intoxication with the main role of PV8. This substance is another synthetic cathinone which is dangerous for live of the users and requires constant monitoring and further research., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Interstitial lung disease (ILD) is a group of lung diseases characterized by thickening of the interstitium surrounding pulmonary alveolar walls. It is related to specific radiographic features in lung imaging and/or the presence of restrictive disorders in pulmonary function tests (PFTs). ILD is one of the leading causes of death in systemic sclerosis patients. Major risk factors of ILD associated with SSc (SSc-ILD) include male sex, diffuse type of cutaneous SSc and presence of anti-Scl-70 antibodies. SSc-ILD is challenging to diagnose at an early stage as the symptoms are non-specific. The greatest risk of its development is during the 4-5 years after the initial diagnosis of systemic sclerosis. Clinical vigilance at the time, including regular pulmonary function tests and/or high-resolution com-puted tomography (HRCT), is needed. The aim of this paper is to summarize the current knowledge on early diagnostic methods and progression risk factors for SSc-ILD., Competing Interests: The authors declare no conflict of interest.

Medical ethics constitutes some kind of core, which enables the physicians to decide in complicated clinical situations. This subject is taught during medical studies through only one semester. Number of teaching hours designed for this crucial in later physician's practice subject is insufficient. Additional problem in teaching process is inconsistence between the Law and the Code of Medical Ethics. As a result it causes alarmingly weak preparation of students to take practical decisions according to ethical and moral values of the Code of Medical Ethics. What is also important, in 2012 a medical studies schedule was changed, which in author's opinion had very negative effect on medical ethics teaching. In our opinion it is vital to increase number of teaching hours spent on medical ethics, create a model of gradual ethical knowledge transfer to students on every year of studies, which should be based on clinical subjects in master-student relations. Authors of this article discuss in a complex way problems of medical ethics teaching at medical studies supporting their thesis with author's survey carried out on large group of students of Medical University of Silesia in Katowice.

Creating medico-legal opinion is a sophisticated investigative, analytical, decision-making and creative process. Forensic medicine specialist in cooperation with clinical medicine consultants, on the basis of evidence analysis, which was gathered during procedures and contained in the acts has to create an objective and essential opinion. This opinion is a vital, very important and irreplaceable proof in every case. Judicial body consults with forensic medicine specialist or specialists if there are circumstances for settlement of which there is a need of classified informations - art. 193 of Penalty Code. Forensic medicine specialists face many difficulties which may have effect on quality, positiveness of opinion, compliance with the deadline, increasing expectancy of judicial body or sides. It is very difficult to find clinical specialists which except their clinical knowledge have basic knowledge about law, the role and duties of an court expert. In this article we discuss creating-opinion problems, role and position of court expert in confrontation with expectations of judicial body and the Justice with particular emphasis on medical mistakes and assessment of medical proceedings. We show the complexity of creating of medical opinions, especially these institutional.

Problems of medical mistake and therapeutic failure are inextricably linked with realization of medical services. In recent years, mostly by the media and increasing demanding attitude, a rapid increase of initiated cases opened by judicial body in conjunction with medical mistake made by medical staff is observed. Making medico-legal opinions is not easy task and often face many difficulties. These consist of lacks in medical documentation, time rigor, formal tightening and need to create team that consist of both forensic medicine specialist and clinicians, who together shall write complex medico-legal opinion. This article touches the essence of the opinion-making problem in the aspect of medical mistake. It shows specifics of the role of forensic medicine specialist, his challenges and difficulties in creating opinions. The article confronts real possibilities of court experts with expectations of judicial body, outlining new challenges and dangers which court experts have to face.

Erythema nodosum is the most common form of panniculitis. It may have many aetiological factors. Erythema nodosum occurs three to five times more often in female patients. It appears as erythematous painful rounded nodules, located most often on the anterior surface of the lower extremities, and may be accompanied by systemic symptoms such as fever, malaise and arthralgia. During diagnosis, oncological vigilance should be maintained, because erythema nodosum may be a paraneoplastic symptom. It requires an interdisciplinary approach and exclusion of many underlying causes.

Erythema nodosum (EN) is a well-known form of panniculitis. It may occur as an idiopathic form and also can be induced by certain clinical conditions such as infections and granulomatous diseases such as sarcoidosis. Erythema nodosum may be accompanied by general symptoms such as fever, weakness, and severe pain, but skin lesions resolve without skin damage. Erythema nodosum occurrence is for the clinician a signal for a wider diagnosis and determination of the cause of occurrence of symptoms. The article presents three cases of EN with different causes and treatment.

The aim of this study was to investigate phenolic acids and flavonoids in methanolic, dichloromethane, acetone and ethyl acetate extracts and fractions from inflorescences of Cirsium canum (L.). RP-HPLC analysis enabled identification of the following: chlorogenic acid, caffeic acid, p-coumaric acid, protocatechuic acid, p-hydroxybenzoic acid, vanillic acid, syringic acid, trans-cinnamic acid, luteolin-7-glucoside, apigenin-7-glucoside, kaempferol-3-glucoside, linarin, apigenin, rutoside, luteolin and kaempferol. The antimicrobial activity of tested extracts was determined in vitro against reference microorganisms, including bacteria or fungi, belonging to yeasts. Our data showed that the tested extracts had no influence on the growth of the reference strains of Gram-negative bacteria and yeasts belonging to Candida spp. Among them, the fractions possessed the highest activity against Gram-positive bacteria, especially Streptococcus aureus and Streptococcus pneumoniae belonging to pathogens and Streptococcus epidermidis, Bacilluscereus and Bacillus subtilis belonging to opportunistic microorganisms.

Postmortem diagnostics of anaphylactic and anaphylactoid reaction as the cause of death in cases of sudden deaths without witnesses, as well as those in which circumstances of sudden disease and then death are known, seems to be very difficult. This is caused by the lack of characteristic macro- or microscopic changes to internal organs resulting from a short, or even very short time, that elapses from the action of the etiological factor till death. In the above mentioned cases it is often impossible to establish univocally the cause of death, despite considering information on the cause of disease and its clinical symptoms. On the basis of 2 cases of sudden deaths resulted from the intake of hazel nuts, and the administration of contrast agent before radiological examination, the authors discuss the usefulness of postmortem determinations of tryptase and IgE in blood for diagnostics of deaths resulting from anaphylactic and anaphylactoid reaction, respectively.

On February 24, 1998, in the Niwka-Modrzej6w Coal Mine in Sosnowiec, a group accident occurred and, as a result, six miners died and four others were injured. Mine rescuers, proceeding to work in out of action mining excavation, separated by an isolative dam, were using oxygen escape breathing apparatuses AU-9 type and oxygen breathing apparatuses for work WU-70 type. A comprehensive evaluation of the accident circumstances, medical papers, autopsy, histopatological and chemico-toxicological reports, technical surveys of the Central Station of Mine Rescue and the Military Institution of Chemistry and Radiometry (WIChiR), taking into consideration the microclimatic conditions in the sidewalk and testimonies of the survivors allowed for determining the cause of death in the victims. The authors emphasized special difficulties in compiling the comprehensive opinion in the reviewed case and the significant evidential value of the technical survey prepared by WIChiR that showed numerous and serious abnormalities in the performance of oxygen breathing apparatuses, which in a short time led in their users to acute respiratory insufficiency due to anoxia with its further consequences.

On January 28, 2006, during an exhibition of carrier pigeons, the roof of one of the buildings at Katowice International Fair collapsed. At the time of accident, there were 700 people in the building--65 died and 171 were injured. It was the biggest building disaster in the history of modern Poland. The aim of this study was to present the type (character) of the observed injuries, the cause of death of 48 fatal victims and the range of activities and medico-legal examinations performed in the Department of Forensic Medicine, Medical University of Silesia in Katowice. In the period of January 29-February 1, 2006, on February 14, 2006, and February 17, 2006, post-mortem examinations of the 48 deceased were carried out, and in some cases additional dissecting techniques were employed. During autopsies, numerous specimens for various additional examinations (histopathological, toxicological) were collected. For identification purposes, photographic material and specimens, necessary for genetic identification, were secured. Additionally, the bodies were identified by families. The post-mortem procedures eventually allowed for establishing the cause of death of all the victims. The authors emphasize the range of necessary medico-legal procedures and examinations that should be carried out in a Department of Forensic Medicine in case of a building collapse with a large number of fatalities in order to determine the type of injuries, cause and mechanism of death and to identify the deceased.

The fibula flap is commonly used to reconstruct the tibia. This has risk of postoperative fracture despite long-term non-weight bearing. A flap using noncircumferential distal femur is proposed. This study is to determine the circumference of femur required to produce greater strength than the fibular flap. Femurs and fibulas were harvested from eight cadavers. The structural strength of fibula and femur flaps was assessed using three-point bend. Compression testing was performed on osteotomized and whole femurs to assess donor site morbidity. The 35% flap (mean maximum force at fracture 869 N) was not significantly stronger than the fibula flap (626 N; P > 0.05). The 40% flap (1225 N) was significantly stronger than the fibula flap ( P < 0.01). There was no significant difference between forces at fracture for whole femurs (3978 N), femurs with 35% osteotomies (3604 N), and femurs with 40% osteotomies (3493 N; P = 0.87). Change occurred in the fracture pattern of femurs following osteotomies. Whole femurs consistently fractured at the femoral neck, and osteotomized femurs consistently fractured obliquely from the osteotomy. A flap consisting of 40% of the circumference of the distal femur exceeds the structural strength of the fibular flap. Taking such a flap changes the femur's structural integrity; fixation may be prudent following harvest., ((c) Thieme Medical Publishers.)

The report presents an unusual case of strangulation, where the loop on the neck was tightened by a runaway horse. The suspect states that during an argument with his father, he threw reins on his parent's neck. The horse got scared and ran away, dragging the victim along. During the investigation, many versions of this situation were considered: the horse running away as an accident, the horse being lashed to speed by the suspect and homicidal strangulation by the reins held in his hands.

Thromboembolic events continue to account for a high percentage of complications after orthopedic surgery. Of significance in prevention of these diseases is appropriate pharmacotherapeutic prophylaxis, both pre and postoperative, as well as orthopedic and trauma surgeons being aware of the risk of such complications and of possibilities of avoiding or minimizing thromboembolic events. The authors present some cases that were certified in Chair of Forensic Medicine, Silesian Medical University in Katowice, in which thromboembolic complications did develop after conservative or surgical orthopedic treatment, emphasizing possible difficulties in unequivocal assessment of the cause-effect relationship between the employed treatment and the thromboembolic event in the aspect of medico-legal certification.

In opinionating practice of the Department of Forensic Medicine, Medical University of Silesia, a substantial problem is posed by cases associated with qualifying an event as a work accident or a "natural" illness manifested at work, when the consequence is spinal injury, especially of the overwork (surcharge; overstrain) character. Between 1998-2007, among all 284 medicolegal opinions concerning work accidents and their consequences, 76 opinions (27%) referred to vertebral column injuries or radicular pain syndromes. This has prompted the authors to investigate the problems of spinal injuries analyzed in the context of recognizing an event as a work accident. The paper constitutes a preliminary report and material for more extensive deliberations, demonstrating problems faced by experts passing opinions in cases of this type. In addition, the authors present their observations addressing legal regulations in force and common opinionating practices.

Despite the fact that some criteria of medico-legal certification in criminal proceedings have been established, there are still some areas that--parallel to changes occurring in contemporary society--have started to be controversial. This phenomenon has prompted the authors to attempt establishing new criteria for certification in total/major permanent inability to work in profession. This work is a continuation of a cycle devoted to interpretation of article 156 of the Penal Code to meet the needs of medico-legal opinionating.

On February 23/24, 2003, in Zabrze-Bielszowice coal mine, 840 m below the surface, a methane blast occurred twice. In group accidents, a total number of 35 miners were injured; the majority of them experienced extensive thermal injuries. The authors compiled a list of body injuries, including their character, severity, initial clinical assessment and types of employed medical procedures, taking into consideration also medical certification of the Social Insurance and results of medico-legal examinations of the miners. Department of Forensic Medicine in Katowice prepared comprehensive medico-legal opinions during preparatory prosecuting proceedings followed by precise, individualized opinions for the court, concerning legal qualification of the injuries, their underlying mechanisms, but also mental and physical suffering, treatment-associated hardships and prognosis for the future.

Among all investigations aiming at assessing medical management carried out in our department between 2000 and 2006, the cases of "chest pain" constituted the largest percentage. In 70% of such cases, the employed medical procedures were found to be incorrect; what might be qualified as medical decisive errors, committed in rescue ambulances, outpatient clinics or in admission rooms. The authors present some examples of causes of such incorrect management strategies, such as neglecting proper and profound clinical examination (with medical history taking); lack or incomplete differential diagnosis; failure to observe appropriate critical attitude and prudence; focusing only on one, most common disease.

The authors analyzed the medico-legal opinions on medical management issued by the Chair and Department of Forensic Medicine Katowice between 2000 and the end of June 2006. Among 101 cases, in which medical errors were recognized, in 82 instances inappropriate medical management was associated with direct life-threatening conditions, such as acute cardiac syndrome, cerebrocranial injuries, cerebral an aortic aneurysms, pulmonary embolisms, acute abdominal diseases, such as perforated gastric and duodenal ulcers, appendicitis, post-traumatic rupture of the spleen, and acute metabolic disorders. The majority of errors was diagnostic in character and involved the staff of emergency services, admission rooms and detoxification centers. The investigators also drew attention to factors affecting the degree of risk of medical error commission and the most common causes of inappropriate medical in life-threatening conditions.

The issue of medical error is relatively often discussed at forensic congresses or conferences. The authors carried out a medico-legal analysis of records of proceedings related to the appraisal of medical procedures investigated in the Forensic Medicine Department, Medical University of Silesia, Katowice, in the years 2000-2005. In 88 cases, where expert teams from the Department recognized medical errors to have been committed, 90% of such errors were demonstrated to have occurred on weekends and holidays. The majority of errors were associated with the decision-making process or diagnostic management and committed in hospital admission rooms or the so-called operative departments (orthopedic surgery, general surgery, gynecology, obstetrics). Evaluating the above presented cases, the authors drew attention to factors affecting the risk of medical error and the most common causes of inappropriate patient management.

Frequent changes in organization of the Polish health care sector observed over the past few years may lead to disruption of work in health care institutions, particularly in tertiary, highly specialist centers. Such a situation may result in decreasing the quality of services, what may potentially cause exposing the patient to the risk of death or severe detriment to health. To illustrate the problem, the authors present a case of a 45-year old man, where some organizational errors led to a delay in rendering medical care and in consequence to a poorer therapeutic outcome and poorer prognosis.

Cases of sudden death without prior noticeable clinical symptoms and morphological indicators found at autopsy pose serious problems in medico-legal opinionating. Developing an expert opinion is practically impossible if the body has not been autopsied, as well as in cases, when no histopathological and chemical-toxicological tests have been performed. In the course of proceedings aiming at establishing a given event as a work accident and address the issue of compensation claim, courts of labor and insurance claims, as well as civil courts often demand determination of the cause of death by answering whether the demise resulted from a myocardial infarction or whether the death may be regarded as an accident at work. The authors present problems associated with opinion formulation that are faced by the expert and propose their own model of establishing an opinion in the above mentioned cases

Laparoscopic cholecystectomy due to cholelithiasis is associated with a higher risk of intraoperative lesions of biliary duct in comparison to classic surgery. Technical difficulties, a limited access to operating area, the presence of cholecystic adhesions and inflammatory lesions, as well as possible anomalies or anatomical variations of the extrahepatic biliary ducts pose the risk of damaging the biliary tract. At times, laparoscopic procedures are performed by surgeons with insufficient operator skills and qualifications. The medico-legal evaluation of intraoperative damage to the biliary tract with resulting complications--the so-called "biliary damage"--is very difficult. The presented analysis included six cases of intraoperative biliary ducts lesions evaluated by the Forensic Medicine Department, Medical University, Katowice. Three instances were associated with investigations carried out by public prosecutors in medical error cases, and in three others, civil cases were brought in the court, with the plaintiffs advancing a claim. While defining the scope of the management--both diagnostic, therapeutic and decision-making--in the pre-, intra- and postoperative period, attention was drawn to the prescriptive character of patient management in such cases, including indications for laparoscopic surgery, an increased potential therapeutic risk that also included a possibility of the patient developing "normal, typical" complications, referring the above factors to the scope and limits of the physician's professional and criminal liability and analyzing them to assess whether a medical error had been committed, or else the events had represented a therapeutic failure within the limits of the accepted therapeutic risk. A separate problem emphasized by the authors focused on difficulties in objective evaluation of health-associated consequences that might be defined in a tabular manner as long-term or permanent detriment to health.

Among problems that are faced by the expert while passing opinions in civil cases regarding claims for compensation in infections by HBV and HCV, one of the most important issues is the estimation of the percentage of detriment to health. The analysis of records of proceedings in these cases shows considerable latitude on the part of experts and a high divergence of expert opinions. In their practice, the authors have encountered 12 documented and clinically confirmed cases of chronic virus hepatitis B and C associated with extrahepatic conditions that were causatively associated with chronic infections. Such extrahepatic manifestations included thyroid dysfunctions, renal failure due to glomerulonephritis, dermatoses, hematological conditions or periarteritis nodosa. The authors point out that in spite of a high risk of the development of extrahepatic complications in HBV/HCV patients, or even in view of an existing justified suspicion of the patient suffering from such complications, as a rule no detailed diagnostic management is carried out aiming at detection of possible late health-associated effects resulting from a chronic HBV and HCV infection. As a rule, such complications are diagnosed very late in the-course of the underlying disease and in the majority of cases are regarded as independent of hepatitis. Extrahepatic lesions undoubtedly significantly increase the percentage of detriment to health. In the investigated cases, the percentage of detriment to health was assessed as ranging between 40 to 100%.

In the monograph 'Medico-legal opinions--essays on theory', prof. K. Jaegermann wrote that 'the use of an expert requires theoretical or fairly clear knowledge about the mutual relationship between judge and expert'. In his opinion knowledge of this kind plays a significant role in estimating the usefulness of so-called expert evidence. Practical knowledge about the relationship between the judge and expert is necessary but not a decisive condition not only for a lawyer to be a judge but also for a physician to be a medico-legal expert. An expert can be not only a person appointed by the court but must also possess proper knowledge in a particular field, namely, the required professional and specialist qualifications and must also considered to be impartial. On the basis of the analysis of law in force and imperative regulations in Penal and Civil Codes, the authors have presented remarks relating to the expert's status as well as the lack of judicial control over the activity of experts appointed by court. Verification of professional qualifications in court experts and a reduction of those appointed 'ad hoc' are suggested. In the authors opinion co-operation between lawyers and experts should be improved. It is also essential to introduce statutory legal protection of court experts as well as to undertake activities leading to equaling the status of Polish court experts to that of other European countries.

The aim of this paper was to pay attention to the difficulties and possible differences between the experts in medico-legal opinions. The problems are due to the lack of equality in opinion criteria about the extent of impairment. According to the authors the enclosure available to the Minister of Labor and Social Politics needs modifications. The document gives too much freedom to the experts in defining the extent of permanent or long lasting impairment. The amount of damages paid has forced the Insurances Companies to make the table more detailed. Considering the existing differences between the enclosure available to the Minister of Labor and Social Politics and tables of Insurances Companies we propose a possible direction of changes. The modification of the table will make the unification and objectivity easier.

After amending the rules obligatory for decision making about the incapacity to work and social insurance in district courts observed in the practice of the Department of Forensic Medicine Medical University of Silesia, Katowice. Our Department is usually appointed for a second opinion in legal pension proceedings. In the first place courts appoint physicians being experts in particular fields of clinical medicine. Irrespective of all differences in the accepted conclusion a comparative analysis of medico-legal opinions given by forensic medicine specialists or groups of experts from the Department of Forensic Medicine, Medical University of Silesia, Katowice, showed flaws in the way opinions were handed down by individual experts relating to the lack of the state of general health estimation in people contesting for pensions as well as ignorance of the obligatory rules and procedures when deciding about incapacity to work in pension proceedings. It is known that physicians appointed by the court establish only whether the examined person can work or not, but do not give any information about the character of incapacity and do not consider the possibility of therapeutic rehabilitation within the extent of the pension prevention by the Social Insurance Department nor a chance to change ones profession due to the incapacity to work in the present occupation. While presenting their opinions, physicians very often suggest the need of additional opinions given by other physicians being experts in particular fields of clinical medicine. On the basis of the above mentioned remarks the authors show the necessity for greater control over all medico legal opinions and by the court decision making process as well as the verification of experts qualifications taking into consideration of economy and the need to make the proceedings shorter.

From the practice of the Forensic Medicine Department, Medical University of Silesia, Katowice it appears that in criminal cases the level of medico-legal opinions provided by experts appointed by the district court or 'ad hoc' is very low. The analysis of the chosen files shoved a divergence of opinions given to the adopted motions as well as numerous offences to regulations in the nature of a consultative error. In the paper the authors have made an attempt to appraise causes of the above mentioned problems such as: 1. the lack of medico-legal knowledge and experience in court experts. 2. excessive ease of registration to the panel of court experts and the lack of processes which verify the qualifications of experts. 3. the lack of judicial control over expert's opinions and common acceptance of their work. 4. ignorance of the obligatory penal law. 5. ignorance of the basic rules for giving medico-legal opinions (legal consequences, casual nexus). 6. excessive but groundless self-confidence in experts. 7. the lack of a correct way of thinking and conclusion making. The aim of the paper was to pay close attention to the absolute need of verification of court experts' qualifications and work.

Medico-legal estimation of therapeutic management in cases of perinatal complications, especially those resulting in death of the women during childbirth is usually very difficult. The authors have investigated medical documentation supported by the results of autopsies of cases chosen from the casuistry of the Forensic Medicine Department, Medical University of Silesia, Katowice. Considering the limits of professional liability and legal responsibility of physicians, close attention was paid to standard therapeutic management and increased risk in treatment with regard to that relating to typical salubrious complications. The presented cases of deaths of women during childbirth can be the succeeding opinion in broad discussion on medical errors as well as an attempt to standardise and differentiate the medical error from therapeutic failure which occurred within the reach of risk in the undertaken treatment.

The legal and medical opinions referring to conditions of health of the participants of penal procedures: their ability to take part in legal proceedings, their ability to stay in conditions of imprisonment, are more and more common as an advisory practice of the Forensic Medicine Department in Katowice. It concerns the people connected with so called delinquency organized and people involved with economic crime. In the available literature there are no instructions relating to the description of the health state, which would be a contraindication (temporary or permanent) for partaking in legal proceedings or staying in conditions of imprisonment. In practice we observe a full freedom in dispensing of the medical documents and medico-legal opinions. The assumptions dating from 1997-2002, issued by the Department, were analyzed making allowances for age, sex, the kind of somatic diseases and the commissioning organs. Referring to obligatory regulations of the law, the authors introduce advisory principles accepted by the Forensic Medicine Department in Katowice in the above mentioned cases and attempt to estimate the divergence between judicial medicine experts with clinical specialties and forensic medicine experts.

In years 1996 and 1997 both the Pension Act and the Social Insurance Act were changed in Poland and as a consequence of this, all the regulations relating to decision making about the inability to work. Having suppressed the so-called disability groups, such terms as permanent or temporary inability to work were introduced. Medical boards deciding on disability were replaced by predicative physicians working for the Social Insurance Department. Recently a rise in number of cases relative to the verification of the decisions passed by the SID and sent by either employer or Social Insurance Departments of district courts to the Department of Forensic Medicine Silesian Academy in Katowice has been observed. The authors have tried to analyse the cause of a rise in the number of appeals to a decision of the SID submitted by the insured.