Czesław Chowaniec

Publications of Czesław Chowaniec

• "Crocodile" - new dangerous designer drug of abuse from the East.

  Authors: Rafaeł Skowronek, Rafał Celiński, Czesław Chowaniec

  Clinical toxicology (Philadelphia, Pa.). 03/2012; 50(4):269.

• [Smuggling of the cocaine in the gastrointestinal tract ended in sudden death--the first case report from the Upper Silesia].

  Authors: Rafał Celiński, Christian Jabłoński, Rafał Skowronek, Małgorzata Korczyńska, Joanna Kulikowska, Joanna Nowicka, Czesław Chowaniec, Anna Uttecht-Pudełko

  Wiadomości lekarskie (Warsaw, Poland : 1960). 01/2011; 64(2):109-12.

  Fifty-year old man was found dead in the bathroom of his apartment. Forensic autopsy was ordered to determine the cause and manner of death. Autopsy revealed the presence of 55 latex "balls" in theFifty-year old man was found dead in the bathroom of his apartment. Forensic autopsy was ordered to determine the cause and manner of death. Autopsy revealed the presence of 55 latex "balls" in the stomach and foregut. In the past the victim was suspected of drug's dealing and smuggling. The content of "balls" and biological material (blood, urine, bloody fluid from internal organs) were analysed with LC MS/MS in the Chair and Department of Forensic Medicine and Forensic Toxicology, Medical University of Silesia in Katowice. The range of cocaine' concentration in the "balls" was 91.2-96.1%, whereas concentration in blood - 107.50 microg/ml, in urine - 284.60 microg/ml and in bloody fluid - 192.30 microg/ml. The cause of death was acute cocaine intoxication.

• Case-study of fatal gunshot wounds from non-lethal projectiles.

  Authors: Czesław Chowaniec, Mariusz Kobek, Christian Jabłoński, Stanisława Kabiesz-Neniczka, Weronika Karczewska

  Forensic science international. 08/2008; 178(2-3):213-7.

  The authors present a case of the death of a 60-year-old man shot using rubber projectiles that were fired by a police officer from a Mossberg smooth-bore shotgun in an enclosed space from a distanceThe authors present a case of the death of a 60-year-old man shot using rubber projectiles that were fired by a police officer from a Mossberg smooth-bore shotgun in an enclosed space from a distance of a few metres. The post-mortem examination revealed that death had been due to gunshot wounds in the chest which had caused heart and lung damage with subsequent massive internal haemorrhaging.

• [Sudden cardiac death--difficulties in passing a medico-legal opinion for a civil or insurance claim]

  Authors: Czesław Chowaniec, Małgorzata Chowaniec, Agnieszka Nowak, Mariusz Kobek

  Archiwum medycyny sa̧dowej i kryminologii. 57(1):72-7.

  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 isCases 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

• [Estimation of percentage of detriment to health in cases of chronic virus hepatitis B and C with extrahepatic lesions involving other organs]

  Authors: Czesław Chowaniec, Małgorzata Chowaniec

  Archiwum medycyny sa̧dowej i kryminologii. 57(1):67-71.

  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 ofAmong 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%.

• [The risk of medical error occurrence on holidays in the material of the Forensic Medicine Department, Medical University of Silesia, Katowice, in the years 2000-2005]

  Authors: Czesław Chowaniec, Małgorzata Chowaniec, Agnieszka Nowak, Christian Jabłoński

  Archiwum medycyny sa̧dowej i kryminologii. 57(1):95-100.

  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 ofThe 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.

• [Problems in medical certification of posttraumatic neuropsychiatric disorders for the purpose of criminal and civil law proceedings]

  Authors: Christian Jabłoński, Czesław Chowaniec, Mariusz Kobek, Dorota Kowalczyk-Jabłońska

  Archiwum medycyny sa̧dowej i kryminologii. 57(1):101-3.

  In the past several years, in the material of Forensic Medicine Department, Medical University of Silesia in Katowice, a significant increase has been noted in the number of cases associated with CNSIn the past several years, in the material of Forensic Medicine Department, Medical University of Silesia in Katowice, a significant increase has been noted in the number of cases associated with CNS dysfunctions, either as isolated conditions or in association with posttraumatic disorders. In the majority of cases, such dysfunctions were causally related to a head trauma. The Faculty of the Department are also requested with an increasing frequency to estimate the association between the observed neuro-psychiatric abnormalities and complaints and the undue exposure to a stress factor. In the present publication, the authors have emphasized difficulties in assessing the complaints reported by the claimants and the possibilities of objectivization of such complaints by neuro-psychiatric examinations. They also stress problems in application of obligatory ICD 10 terms denoting dysfunctions of the central nervous system in medico-legal opinions.

• [Permanent essential defacement--remarks on the possibilities of verification of the accepted criteria in medico-legal certification in criminal and civil law proceedings]

  Authors: Czesław Chowaniec, Agnieszka Nowak, Christian Jabłoński, Stanisława Neniczka

  Archiwum medycyny sa̧dowej i kryminologii. 57(1):111-4.

  Despite the fact that some criteria of medico-legal certification in criminal and civil proceedings have been established, there are still some topics which are controversial and thus requireDespite the fact that some criteria of medico-legal certification in criminal and civil proceedings have been established, there are still some topics which are controversial and thus require modification. This is also true of the notion of "permanent essential defacement". In the opinion of the authors, changes in social conventions that are occurring nowadays, as well as a highly diversified, subjective perception of esthetic values indicate the need for discussing a possible modification of the presently obligatory criteria. Apart from the assessment of posttraumatic changes, an important problem is posed by defining the notion of "a part of the body customarily open to the view ". Additionally, the authors bring up for discussion the issue of experts taking into consideration the age and sex of the victims while assessing damages. A separate problem lies in difficulties in assessing the degree of detriment to health because of defacement due to the fact that official tables for evaluating permanent or long-term detriment to health do not include relevant information.

• [Iatrogenic biliary ducts lesions after laparoscopic cholecystectomy: a medical technical error or a therapeutic failure in a routinely performed procedure. A medico-legal evaluation of selected cases]

  Authors: Czesław Chowaniec, Małgorzata Chowaniec, Mariusz Kobek, Agnieszka Nowak

  Archiwum medycyny sa̧dowej i kryminologii. 57(1):11-8.

  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 limitedLaparoscopic 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.

• [Exposure to the risk of loss of life or detriment to health as a consequence of an organizational error--a case report]

  Authors: Czesław Chowaniec, Christian Jabłoński, Mariusz Kobek, Małgorzata Chowaniec

  Archiwum medycyny sa̧dowej i kryminologii. 57(1):78-80.

  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, highlyFrequent 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.

• [Thromboembolic complications in orthopedic surgery--medico-legal assessment in evaluation of correctness of medical treatment in selected cases]

  Authors: Christian Jabłoński, Mariusz Kobek, Czesław Chowaniec, Małgorzata Chowaniec

  Archiwum medycyny sa̧dowej i kryminologii. 58(2-3):93-5.

  Thromboembolic events continue to account for a high percentage of complications after orthopedic surgery. Of significance in prevention of these diseases is appropriate pharmacotherapeuticThromboembolic 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.

• [A remarkable case of diagnostic difficulties in chronic hepatic pathology caused by a metabolic disorder (Wilson's disease)--evaluation of medical management]

  Authors: Christian Jabłoński, Czesław Chowaniec, Mariusz Kobek, Agnieszka Nowak

  Archiwum medycyny sa̧dowej i kryminologii. 58(2-3):126-8.

  Wilson's disease is a rare genetic disorder. It is characterized by excessive copper deposits--mainly in parenchymal organs--leading to their damage and serious dysfunction. Because of itsWilson's disease is a rare genetic disorder. It is characterized by excessive copper deposits--mainly in parenchymal organs--leading to their damage and serious dysfunction. Because of its uncommonness, slow and insidious course and diversified clinical manifestation, diagnosing the condition is not easy, even for experienced physicians. As it is indicated by medical practice, such a situation may occur even in tertiary care centers, which have at their disposal extensive and highly specialist diagnostic tools and vast clinical experience in diagnosing such diseases. As an example, the authors present a case of a 38-year-old man, suffering from Wilson's disease, who was misdiagnosed and treated for another metabolic disease. Although the presented case was difficult and diagnostically complex, it should be emphasized that a diagnostic error led to inappropriate therapeutic decisions and in consequence delayed proper treatment.

• [Total permanent or major permanent inability to work in profession. Remarks about the possibility of criteria verification in medico-legal opinionating in criminal cases]

  Authors: Agnieszka Nowak, Czesław Chowaniec, Małgorzata Chowaniec, Krystian Rygol

  Archiwum medycyny sa̧dowej i kryminologii. 58(2-3):96-9.

  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 contemporaryDespite 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.

• [Medico-legal assessment of medical management in "chest pain" cases based on the review of cases analyzed in the Chair and Department of Forensic Medicine, Medical University of Silesia, Katowice, in the years 2000-2006]

  Authors: Mariusz Kobek, Czesław Chowaniec, Agnieszka Nowak, Małgorzata Chowaniec

  Archiwum medycyny sa̧dowej i kryminologii. 58(2-3):73-9.

  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 suchAmong 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.

• [A serious group accident in Zabrze-Bielszowice Coal Mine--medico-legal evaluation of health consequences for the purpose of criminal proceedings]

  Authors: Czesław Chowaniec, Małgorzata Chowaniec, Agnieszka Nowak, Mariusz Kobek

  Archiwum medycyny sa̧dowej i kryminologii. 58(2-3):100-3.

  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 themOn 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.

• [Injuries of the vertebral column--differentiating between natural illnesses manifested at work and illnesses caused by work accidents. Opinionating problems in cases associated with recognizing an event as a work accident in the analysis of materials of the Chair and Department of Forensic Medicine, Medical University of Silesia]

  Authors: Czesław Chowaniec, Agnieszka Nowak, Małgorzata Chowaniec, Christian Jabłoński

  Archiwum medycyny sa̧dowej i kryminologii. 58(2-3):80-5.

  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 aIn 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.

• [Scope and interpretation of laboratory tests in HBV/HCV infections--interpretation for medico-legal certification aspects]

  Authors: Czesław Chowaniec

  Archiwum medycyny sa̧dowej i kryminologii. 58(2-3):86-92.

  Determination of medical effects of HBV/HCV infections, assessment of detriment to health and/or evaluation of effectiveness of therapy and prognosis are essential in medico-legal certification andDetermination of medical effects of HBV/HCV infections, assessment of detriment to health and/or evaluation of effectiveness of therapy and prognosis are essential in medico-legal certification and are of a high value in civil, compensative cases. The author presents the scope of diagnostic laboratory tests, imaging examinations and determinations of HBV/HCV infection markers that are necessary for a possibly complete and objective assessment of future health consequences. The scope of the above tests and examinations and the interpretation of their results combined with clinical assessment and disease course evaluation allow for determining the degree of infection activity, intensification of the infectious-necrotic processes in the liver as well as hepatic competence and possible liver function impairment. Based on approximately 400 reviewed and evaluated cases, the author emphasizes divergences between standards imposed by contemporary diagnostic management practices and organs of hepatological supervision, recommendations of university-affiliated centers in chronic liver pathologies, and the "real-life" diagnostic practices in hospital wards and specialist outpatient clinics. The limitations (usually financial in character) that affect diagnostic management often cause severe difficulties in medico-legal opinionating.

• [About possible differences between the tables of the Minister of Labor and Social Politics and Insurances Companies regarding differences in estimating health impairment]

  Authors: Czesław Chowaniec, Mariusz Kobek, Agnieszka Nowak, Małgorzata Chowaniec

  Archiwum medycyny sa̧dowej i kryminologii. 55(4):264-7.

  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 criteriaThe 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.

• [Expert's opinion in civil proceedings for damages in cases relating to hospital infections, especially to hepatitis B and C infections]

  Authors: Czesław Chowaniec

  Archiwum medycyny sa̧dowej i kryminologii. 55(4):251-6.

  Many papers considering the role of the forensic medicine expert in legal proceedings and a probative value of medico-legal opinions have been published. Prof. Jaegermann's consideration and essaysMany papers considering the role of the forensic medicine expert in legal proceedings and a probative value of medico-legal opinions have been published. Prof. Jaegermann's consideration and essays about the theory of opinionating are particularly worth mentioning. Medicolegal opinions in civil proceedings for damages in cases relating to hospital infections, including hepatitis B and C virus infections seem to be of great importance. Legal composition of records in the civil code, especially those relating to the demandant who in agreement with art. 6 of the PC is obliged to present the facts (prerequisites of civil liability) from which the claim included in the damage suit results, and also the obligatory principles for the civil procedure which highlight the role of the forensic medicine expert and the significance of the medico-legal opinion as important evidence during proceedings. It is known that in cases of this type of expert's opinion is of decisive significance and legal decision is very often based on the conclusions drawn. The author presents consultative problems and difficulties relating to the analysis of facts and evidence material in the epidemiologic aspect which a forensic medicine expert comes across while giving his/her opinion. Questions posed by the court and expectations of the judge appointing an expert who should provide reliable information from his/her field and comprehensively explain all the doubts in the investigated question are suggested to be discussed independently. The complicated character of infections with hepatitis B and C viruses, especially their various courses and clinical pictures as well as the efficiency of all the diagnostic methods used make the provision of a medico-legal opinion more difficult.

• [Medico-legal opinions in penal cases provided by clinicians and forensic medicine specialists--comparative analysis]

  Authors: Czesław Chowaniec, Małgorzata Chowaniec, Agnieszka Nowak

  Archiwum medycyny sa̧dowej i kryminologii. 55(4):257-60.

  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 byFrom 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.