Browsing by Author "Bogdanović, Milenko (57203508508)"

A 79-year-old man with a history of arterial hypertension, insulin-dependent diabetes mellitus, renal insufficiency and thoracic endovascular aortic repair (TEVAR) was brought to the emergency department, following an episode of oliguria and urine retention. During chest X-ray he suddenly collapsed and died. Autopsy revealed a large atherosclerotic saccular thoracic aortic aneurysm whose right lateral wall firmly adhered to the right lung. There was more than 2.5 l of blood with fibrin deposits in the right part of the thoracic cavity. The right bronchus contained a cast of blood; blood was also present in the trachea and the distal airways of the right lung. Further dissection revealed that the aneurysm had eroded the tissue surrounding it and made a fistulous canal into the lower lobe of the right lung, causing the lung to fill with fluid blood. The cause of death was hemorrhage from the aortopulmonary fistula caused by pressure necrosis from the thoracic aortic aneurysm. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.

We present a case of transmesenteric hernia resulting in the death of a 3-month-old female infant, the seventh such autopsy case reported so far. A three-month-old female infant, who initially presented with two episodes of vomiting, cramps, and constipation, was admitted to the hospital. She received symptomatic therapy and was released home. Immediately after she had been put to bed at home, she stopped breathing. There was no record of previous illnesses in the infant's medical history. At autopsy, a necrotic segment of ileum and jejunum, length about 50 cm, was found herniated through an oval defect in the mesentery and multiply strangulated. The shock caused by small intestinal obstruction with consequent intestinal necrosis due to strangulation of the small intestine through a congenital mesenteric defect was considered to be the cause of death. In clinical practice, cases of transmesenteric hernias are uncommon, especially in the population of infants and toddlers; however, these can potentially be the cause of serious intestinal obstruction, with a high mortality rate in cases left untreated. Despite the low incidence of this condition, we believe that the clinicians should keep this diagnosis in mind as a potential cause of acute abdomen and pay special attention to revealing the cause of presented symptoms. © 2024 Elsevier B.V.

We present a case of transmesenteric hernia resulting in the death of a 3-month-old female infant, the seventh such autopsy case reported so far. A three-month-old female infant, who initially presented with two episodes of vomiting, cramps, and constipation, was admitted to the hospital. She received symptomatic therapy and was released home. Immediately after she had been put to bed at home, she stopped breathing. There was no record of previous illnesses in the infant's medical history. At autopsy, a necrotic segment of ileum and jejunum, length about 50 cm, was found herniated through an oval defect in the mesentery and multiply strangulated. The shock caused by small intestinal obstruction with consequent intestinal necrosis due to strangulation of the small intestine through a congenital mesenteric defect was considered to be the cause of death. In clinical practice, cases of transmesenteric hernias are uncommon, especially in the population of infants and toddlers; however, these can potentially be the cause of serious intestinal obstruction, with a high mortality rate in cases left untreated. Despite the low incidence of this condition, we believe that the clinicians should keep this diagnosis in mind as a potential cause of acute abdomen and pay special attention to revealing the cause of presented symptoms. © 2024 Elsevier B.V.

In Europe, the first case of coronavirus disease (COVID-19) and the first COVID-19-related death were reported in France on January 24th and February 15th, 2020, respectively. Officially, the first case of COVID-19 infection in the Republic of Serbia was registered on March 6th. Herein, we presented the first case of retrospective detection of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the post-mortem-obtained vitreous humor (VH), which took place on February 5th, 2020. This is the first death in Europe proven to be caused by COVID-19 by means of post-mortem histopathological and molecular analyses. Based on this finding, it appears that SARS-CoV-2 has been spreading faster and started spreading much earlier than it had been considered and that COVID-19 was probably the cause of the much-reported pneumonia of unknown origin in January and February 2020. © Copyright © 2021 Bogdanović, Skadrić, Atanasijević, Stojković, Popović, Savić, Mihailović, Radnić, Aćimović, Damjanjuk, Despotović and Barać.

A 69-year-old woman committed suicide by cutting her lower legs with a safety razor blade. Autopsy revealed horizontal incised wounds around the circumference of the lower legs, 24 cm above the heels, cutting superficial veins on both sides, the underlying lower legs muscles, and extending into both lower leg bones with associated hematoma formation. Also, there were a large number of superficial tentative or “hesitation” cuts ranging from 3 to 6 cm over the lower legs. Death was attributed to hemorrhagic shock following injuries to blood vessels of the lower legs. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.

Background/Aim. Suicide and homicide are crucial social problems, especially frequent among the population younger than 40 years. The aim of this study was to assess the influence of different sociodemographic factors and relevant psychoactive substances on the difference between homicide and suicide victims. Methods. A cross-sectional study analyzed autopsy reports of 714 suicide and 166 homicide cases autopsied in five years (2011–2016). Out of these, 666 suicide and 127 homicide cases met the inclusion criteria for this study. Blood-ethanol concentration was determined by headspace gas chromatography with flame ionization detection. Analysis of substances other than ethanol was accomplished by gas chromatography-mass spectrometry and liquid chromatography with tandem mass spectrometry. Results. There was a significant difference in age, level of education, and employment rate between suicide and homicide cases (p < 0.05). The distribution of suicide and homicide cases differed significantly on weekdays compared to weekends [odds ratio(OR) = 1.5; 95 % confidence interval (CI) = 1–2.3; p < 0.05]. The presence of a psychoactive substance remained a nonsignificant predictor of whether a person would become a homicide or suicide victim (p > 0.05). Homicide victims were more likely to have significantly higher blood alcohol concentration (0.2–0.3 g/dL) than suicide victims (OR = 2.2; 95 % CI = 1–5; p < 0.05). Conclusion. The age, level of education, employment status, and high blood alcohol concentration (0.2–0.3 g/dL) of the victim were significantly different between suicide and homicide cases. © 2023 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Ibogaine is a psychotropic indole alkaloid extracted from the roots of the Tabernanthe iboga shrub from the Apocynaceae family. Depending on the taken dose, it can lead to stimulant effects, euphoria, visual and auditory hallucinations, along with auditory, olfactory, and gustatory synesthesia. In addition to its historical usage in spiritual rituals of African tribes, these days iboga extract presents a prohibited, alternative drug widely used as a part of addiction treatment. Ibogaine used in opioid withdrawal is associated with serious side effects and sudden deaths. Besides its main use as an anti-addiction medication in alternative medicine, in moderate doses (from 100mg to 1g) ibogaine most commonly causes a “trance-like state”. In this paper, we report the case of a heroin addict who died suddenly 5-12 hours after oral ingestion of powder labeled Tabernanthe iboga which had been bought online and used in the process of detoxification during an addiction treatment. The man was found dead in a rented apartment, where he was undergoing the addiction treatment. External examination revealed no lesions other than nonspecific injuries on the legs. The autopsy showed congestion of internal organs and pulmonary edema. Histopathological analysis of the heart showed neither macroscopic nor microscopic abnormalities. The concentration of ibogaine was 3.26mg/L. Moreover, systematic toxicological analyses of biological samples showed the presence of morphine and codeine. These data suggest that death, which occurred unnaturally after initiation of the “treatment”, was probably the result of the cardiovascular effects caused by the ibogaine powder. The presented case highlights the worldwide problem of various products being widely available over the internet and the danger associated with consumption thereof. © 2021, Springer Science+Business Media, LLC, part of Springer Nature.

The investigation of deaths that are suspected to be related to medical therapy present several challenges for a forensic pathologist. We present a case of an otherwise healthy 58-year-old woman with multiple nasal polyps who underwent nasal polypectomy. The operation was initially considered successful. However, the patient had never recovered from general anesthesia and was declared deceased 24 hours after the surgery. The autopsy revealed a basilar subarachnoid hemorrhage. The examination of the basilar skull showed a perforation of approximately 15 by 7 mm in the right cribriform plate. Above the bone perforation, there was a disruption of the dura and a 20-mm-long penetrating wound within the right frontal lobe parenchyma of the brain, with associated intraventricular hemorrhage. The subsequent sectioning of the formalin-fixed brain revealed extensive parenchymal destruction. The cause of death was certified as complications of nasal/sinus surgery, with a perforation of the skull base with hemorrhagic tissue destruction, whereas the manner of death was considered accidental. Common nasal surgical procedures and known complications are discussed. © Wolters Kluwer Health, Inc. All rights reserved.

Advances in modern medicine and more accurate and precise diagnostic procedures have been considered to be the main reason for the reduction in autopsy rates. However, there is still a discrepancy between clinical and autopsy diagnoses. This retrospective study, designed as a cross-sectional study, included a sample of 931 patients who died at the Clinical Hospital Centre ‘Zemun’. We analysed sex, age, length of hospitalisation and clinical and post-mortem diagnoses, including the discrepancies between them. In 314 (34%) cases, there was complete agreement between the clinical and autopsy diagnoses, complete disagreement in the same percentage and incomplete agreement in 303 (32%) cases. In people aged >60 years, the risk of misdiagnosis was 2.5-fold higher than in the those aged <60 years (odds ratio (OR)=2.522, p<0.001), while the influence of sex on the risk of misdiagnosis was not statistically significant (OR=0.981, p>0.05). An increase in the number of autopsies would be one of the best methods to make discrepancies between clinical and post-mortem diagnoses visible, and a good method for continuous evaluation of diagnostic tests, as well as for providing a wider perspective on presentations of different clinical conditions. © The Author(s) 2019.

Advances in modern medicine and more accurate and precise diagnostic procedures have been considered to be the main reason for the reduction in autopsy rates. However, there is still a discrepancy between clinical and autopsy diagnoses. This retrospective study, designed as a cross-sectional study, included a sample of 931 patients who died at the Clinical Hospital Centre ‘Zemun’. We analysed sex, age, length of hospitalisation and clinical and post-mortem diagnoses, including the discrepancies between them. In 314 (34%) cases, there was complete agreement between the clinical and autopsy diagnoses, complete disagreement in the same percentage and incomplete agreement in 303 (32%) cases. In people aged >60 years, the risk of misdiagnosis was 2.5-fold higher than in the those aged <60 years (odds ratio (OR)=2.522, p<0.001), while the influence of sex on the risk of misdiagnosis was not statistically significant (OR=0.981, p>0.05). An increase in the number of autopsies would be one of the best methods to make discrepancies between clinical and post-mortem diagnoses visible, and a good method for continuous evaluation of diagnostic tests, as well as for providing a wider perspective on presentations of different clinical conditions. © The Author(s) 2019.

Borderline Personality Disorder (BPD) is a mental health condition marked by intense emotions, unstable relationships, and a distorted self-image, which often leads to impulsive and self-destructive behaviors. Individuals with BPD frequently engage in deliberate foreign body ingestion (DFBI), a behavior that can result in severe outcomes if dangerous objects are ingested. Herein, we present a case of 45-year-old man with a history of BPD that was found in his apartment with fatal head injuries caused by the explosion of a firecracker in his mouth. Besides extensive head injuries that undoubtedly led to lethal outcome, autopsy revealed a sewing needle deeply embedded in a cardiac muscle, with fibrinous deposits suggesting that its ingestion occurred prior to the fatal incident. Such cases are crucial because they highlight the forensic significance of autopsy findings. By integrating autopsy findings with clinical data and other relevant case circumstances, valuable information can be obtained regarding the cause and manner of death. This case underscores the importance of thorough forensic investigation in cases of unusual self-harm to accurately determine intent and underlying factors. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025.

Intussusception is one of the most common causes of intestinal obstructions in younger children, especially infants. Though rare, fatalities due to intussusception are known to be caused by intestinal obstruction associated with peritonitis, generalized sepsis and shock from intestinal infarction due to disruption in blood supply or electrolyte and fluid imbalance. An eight-month-old female infant, who initially presented with a single episode of vomiting and fever (37.8 °C), was examined as an outpatient at the department of pediatrics of a general hospital. Clinical examination revealed no characteristic features of acute abdomen, so the child was sent home. Nine to ten hours later her condition deteriorated: she became hyperpyretic and stuporous. On her way to the University Children’s Hospital, the infant died; the death was confirmed upon admission, i.e. some 15 h after the onset of symptoms. The autopsy revealed an 8 cm long intussusception of the distal part of the ileum to the cecum. There was no gross or microscopic evidence of peritonitis at autopsy. The shock caused by intestinal obstruction with consequent intestinal necrosis was considered to be the cause of death. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.

Gastrointestinal causes of sudden and unexpected death in the elderly represent significant problem concerning the fact that it may be present without observable symptoms and signs. Two cases of unexpected deaths due to small intestinal obstruction from adhesional hernias are reported. In both cases pre-existing dementia and Alzheimer’s disease probably influenced communication ability, and type II diabetes with consequential autonomic neuropathy could affect visceral pain levels in these patients. These cases demonstrate two unrecognized intestinal herniation associated with fatal outcomes in the elderly. The underlying lethal gastrointestinal disease in both cases was only identified at autopsy. © 2019 Romanian Society of Legal Medicine.

Introduction. Even though lipomas are the most common benign tumors, they are rarely found in the pericardial cavity. Although histopathologically benign, they can cause life-threatening complications by rapid growth and may therefore be clinically considered malignant. Case report. We present an 80-year-old female who was injured during a syncopal episode when falling from a standing height and suffered bodily injuries for which she was hospitalized. In the further course of her short-term hospital treatment, death occurred, and the cause of death was marked as “unknown”. At the autopsy, a dilated and tense pericardium filling up a large part of the chest cavity was noted. A well-encapsulated soft tissue mass, 20 × 18 × 3 cm in size, weighing 820 g, was visualized in the pericardial cavity. Histopathological examination revealed that the mass was a lipoma and showed acute myocardial necrosis; therefore, it was assumed that the cause of death was probably due to the compression of lipoma on coronary arteries. Conclusion. Even though intrapericardial lipomas are benign tumors, they can cause life-threatening complications and sudden cardiac death. There are numerous diagnostic methods capable of detecting intrapericardial lipomas, and with timely treatment, the patient can be cured. © 2023 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

The article describes a case of gunshot suicide to the head in a 51-year-old man. The entrance wound was located in the left temple and exit wound in the right temple. The entrance wound had the characteristics of a hard-contact gunshot wound. The most interesting finding in this case was cherry-red discoloration of the right temporal muscle surrounding the exit wound. This finding could make the determination of the entrance versus exit gunshot wound challenging, especially if the wounds are of atypical appearance. In addition, the finding described in the presented case could be the proof that carbon monoxide may follow the missile through the body and may be prominent in the soft tissue at the exit. © 2019 Wolters Kluwer Health, Inc. All rights reserved.

We believe that forensic medicine should play a significant role in the COVID-19 pandemic. Forensic pathologists should ask and answer various questions through autopsy cases during the COVID-19 period, thus providing a significant contribution to science. Some of the potential roles of forensic medicine in this issue include: determining the exact cause of death among the deceased who were SARS-CoV-2 positive, contribution to the accuracy of mortality statistics, understanding pathological mechanisms of COVID-19, tracking the presence of the virus over time, survival of the virus after death as well as dealing with medicolegal issues. A detailed multidisciplinary analysis of autopsy samples would undoubtedly help understand this new illness and its clinical management. Therefore, autopsies during the COVID-19 pandemic should not be an exception, but certainly a rule. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

This case represents a planned complex suicide in which the victim combined gunshot to the head and hanging. The most interesting finding in the presented case was pale face, but without any visible injury to it at the time the body was found (more than 24 hours after death), whereas at autopsy (20 hours later), black eyes were prominent. The removal of the ligature led to the decompression of the neck and its blood vessels with consequential blood redistribution, which, alongside the liquid state of blood, resulted in the aforementioned finding. Considering the described postponed appearance of periorbital ecchymosis, this kind of finding suggests that great caution is necessary when interpreting hematomas in terms of their vitality. © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The purpose of this study was to analyze the presence of interleukins 6, 8, and 18 in post-mortem lung tissue of subjects deceased due to polytrauma. In addition to this, we have described different micromorphological features of lung tissue in ARDS cases associated with fatal traffic trauma. A total of 18 autopsy cases with ARDS after polytrauma and 15 control autopsy cases were analyzed in this study. From every subject, we collected one sample for each lung lobe. All of the histological sections were analyzed by using light microscopy, and for the purpose of ultrastructural analysis, we used transmission electron microscopy. Representative sections were further processed by way of immunohistochemistry analysis. Quantification of IL-6, IL-8, and IL-18-positive cells was conducted by applying the IHC score. We noticed that all samples of ARDS cases exhibited elements of the proliferative phase. Immunohistochemical analysis of lung tissue in patients with ARDS showed strong positive staining for IL-6 (2.8 ± 0.7), IL-8 (2.2 ± 1.3), and IL-18 (2.7 ± 1.2), while staining of the control samples resulted in no positivity to low/moderate positivity (for IL-6 1.4 ± 0.5; for IL-8 0.1 ± 0.4; for IL-18 0.6 ± 0.9). Only IL-6 correlated negatively with the patients’ age (r = −0.6805, p < 0.01). In this study, we described microstructural changes in lung sections of ARDS cases and control cases, as well as interleukins’ expression, demonstrating that autopsy material is as informing as tissue samples collected by performing open lung biopsy. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023.

Introduction Without a comprehensive postmortem investigation it is impossible to determine the cause of death among the SARS-CoV-2-suspected and-positive patients. We present two cases to discuss the postmortem detectability of SARS-CoV-2 virus and RNA stability in biological samples. Outline of cases Case No. 1: a 40-year-old man on whom the autopsy was performed four days after death. The body was stored at 4°C. Bilateral pneumonia was confirmed grossly and histopathologicaly. Molecular testing was positive for IgM antibodies, but negative for SARS-CoV-2 RNA. Case No. 2: a 28-year-old profes-sional basketball player who suffered from SARS-CoV-2 about a month earlier. The autopsy was performed two days after death. The body was stored at 15°C. Gross autopsy findings revealed advanced putrefactive changes and an enlarged heart, with visible fibrotic focuses. The histopathological finding corresponded to the sudden cardiovascular death due to the cardiac dysrhythmia most probably formed in one of the fibrotic focuses. Tests for SARS-CoV-2 RNA and antibodies (IgM, IgG) were positive in the analyzed samples. Conclusion This report suggests that SARS-CoV-2 virus can be isolated in the biological samples even after a long post-mortem prolongation of molecular analyses. We emphasize the necessity of wider studies that will define the infectiveness and biological stability of the virus in postmortem tissues. © 2023, Serbia Medical Society. All rights reserved.

It is well known that the quality of death certificates determines the accuracy of public health mortality data. In the light of a pandemic, forensic pathologists must understand the true definition of a COVID-19 death and the requirements for filling out the death certificate, as these are critical for maintaining accurate and trustworthy mortality data. To determine the scope and evolution of the COVID-19 epidemic, accurate death certification is critical. We believe that COVID-19 should be enlisted under part II or section “note” (if it exists in DC form in a particular country) of the DC in all suicide instances and putrefied bodies with positive autopsy swabs for SARS-CoV-2. In addition to our suggestions for the completion of the DC in some COVID-19 instances, we feel that forensic pathologists should follow the WHO criteria for proper DC completion in COVID-19 cases. Better physician education at this stage of the pandemic would increase adherence to existing (WHO and CDC) standards. As a result, forensic pathologists with competence in death certification could help by teaching treating physicians in this area. © 2022 Bogdanović et al.