A correct definition of sepsis is extremely hard due to an increased etiological and pathologic heterogeneity, a large number of medical specialties involved in the detection and treatment, etc. If, in clinical practice there are specific guidelines in diagnosing it in legal medicine the diagnostic is often very difficult to prove as the microbiological results are often misleading, a personal history is not always available, gross and pathological signs are often unspecific. Recently the use of immunohistochemistry and recent advances in tanatochemistry were proven to be able to increase the accuracy in diagnosing the sepsis at the autopsy. This review summarizes a few recent advances in diagnosing the sepsis at the autopsy focused on the lungs, the earliest and most frequently affected organ in sepsis.

In the modern history of our country, the subject of psychoactive substances was banned as being against the socialist-communist political ideology, and consequently the research and knowledge on the historical evolution of the use of plants and substances for medical, hedonistic and/or ritual purposes in our country was not given any encouragement. In this context of a diluted and outdated knowledge on the psychoactive substances which had been maintained for decades, the explosion of the drug addiction phenomenon encountered an idealistic perception ("it is a problem of the Western world", "we are just a transit country", etc.), which lead to a fast increase in the number of young people who tried to consume illegal drugs. The political/administrative organisations, the civil society, the NGOs and particularly the scientific experts in Romania had all a very slow and laggard response, which has lead to the current situation when drug addiction is finally recognized as a very serious issue. Particular features of the Romanian phenomenon-surprisingly not due to the local tradition or spontaneous flora (as long as currently marketed products are imported)-are presented in this publication, giving examples from the criminal investigation experience. An alarming issue which has been highlighted by our research points to the fact that "classical drugs", such as opioids, methadone, ketamine, MDMA, are likely to be used in Romania for "spicing up" the so-called "legal" marketed products. In the following, we shall trace the historical evolution of the use of plants and substances for medical, hedonistic and/or ritual purposes in our country. We shall also reflect on the related legislative and medical issues, and the suggested measures.

A 39 years old male with osteogenesis imperfecta type I presented to an emergency clinic accusing pain and movement limitations in his left arm appeared after a traumatic event. Clinical and radiological examinations revealed a fracture of the distal end of his left humerus, but also an underlying pathologic condition: osteogenesis imperfecta. Osteogenesis imperfecta patients may represent a chalange for forensic evaluation, particularly when trying to differentiate between spontaneous and traumatic fractures. Most of the recent published data regarding osteogenesis imperfecta focused mainly on the association or differential diagnosis with battered children syndrome. The authors review the particularities of adult OI and the possible pitfalls in medical legal interpretation.

The atrioventricular node (AVN) is the relay station for electrical impulses passing from the atria to the ventricles. The arterial resources of the AVN are functionally relevant and may be interfered by various surgical procedures which deal with the cardiac valves. Our study aim to bring detailed evidences on the arterial supply of the AVN. We dissected and microdissected 50 human adult hearts without any known history or evident cardiac pathology, in order to evidence the arterial suppliers of the AVN; subepicardial dissections were continued in the interatrial septum (the triangle of Koch). We were able to define 5 morphological types (each with distinctive subtypes) of the atrioventricular node artery (AVNA) emerged at crux cordis: type I (22%, AVNA from the U-turn of the right coronary artery (RCA), the left retroventricular artery (RVA) absent), type II (18%, AVNA from PIVA, left RVA present), type III (34%, AVNA from the left RVA, PIVA from the RCA), type IV (AVNA from the bifurcation of the RCA into the PIVA and the left RVA-trifurcated RCA) and type V (AVNA from the circumflex artery). In 18% of specimens we found duplicated AVNA. In 22% of specimens, the AVN area was additionally supplied by the descending septal artery (right descending superior artery) originating from the sinoatrial artery, on the right side of the aorta. The origin of the AVNA, which is variable, and the accessory resources, such as the descending septal artery, can explain the possible individual occurrences of the cardiac rhythm alterations determined by coronary ischemia. Our AVNA types are all related to the atrioventricular and aortic valves and thus liable to damage during specific surgical procedures, interfering with the respective valves. Duplicated AVNAs must be kept in mind during the selective atrioventricular nodal artery catheterizations and AVNA must be evaluated angiographically prior to the interventions. Our study demonstrates that classical dissections combined with microdissections can still offer valuable informations for a pathologist assigning not only the mechanisms but also the morphological conditions of the cardiac arrest. A seek and search investigation is launched in every sudden cardiac death: the forensic pathologist make a good team with the anatomist retrieving very useful etiological data.

Hyperthermia, characterized by a core temperature of over 40 o C, occurs when the body's thermoregulatory mechanisms are no longer able to dissipate heat. From a clinical point of view hyperthermia can be of three main types: (1) a consequence of an imbalance between anti and pro-inflammatory agents (usually in septic conditions), (2) heatstroke and (3) malignant hyperthermia. Death caused by hyperthermia, either heatstroke or malignant hyperthermia, is diagnosed at the autopsy mainly using seric, histopathological and imunohistochemical methods. Even though unspectific morphological lesions are found in almost every organ, the most affected are skeletal muscles, gut, kidneys and brain. We present here a case of severe hyperthermia leading to heatstroke and discuss the main diagnostic methods available to the forensic pathologist.