Browsing by Author "Cukic, Dragana (53871125500)"

Current autopsy principles for evaluating the existence of brain edema are based on a macroscopic subjective assessment performed by pathologists. The gold standard is a time-consuming histological verification of the presence of the edema. By measuring the diameters of the cranial cavity, as individually determined morphometric parameters, a mathematical model for rapid evaluation of brain edema was created, based on the brain weight measured during the autopsy. A cohort study was performed on 110 subjects, divided into two groups according to the histological presence or absence of (the – deleted from the text) brain edema. In all subjects, the following measures were determined: the volume and the diameters of the cranial cavity (longitudinal and transverse distance and height), the brain volume, and the brain weight. The complex mathematical algorithm revealed a formula for the coefficient ε, which is useful to conclude whether a brain edema is present or not. The average density of non-edematous brain is 0.967 g/ml, while the average density of edematous brain is 1.148 g/ml. The resulting formula for the coefficient ε is (5.79 x longitudinal distance x transverse distance)/brain weight. Coefficient ε can be calculated using measurements of the diameters of the cranial cavity and the brain weight, performed during the autopsy. If the resulting ε is less than 0.9484, it could be stated that there is cerebral edema with a reliability of 98.5%. The method discussed in this paper aims to eliminate the burden of relying on subjective assessments when determining the presence of a brain edema. © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine

Current autopsy principles for evaluating the existence of brain edema are based on a macroscopic subjective assessment performed by pathologists. The gold standard is a time-consuming histological verification of the presence of the edema. By measuring the diameters of the cranial cavity, as individually determined morphometric parameters, a mathematical model for rapid evaluation of brain edema was created, based on the brain weight measured during the autopsy. A cohort study was performed on 110 subjects, divided into two groups according to the histological presence or absence of (the – deleted from the text) brain edema. In all subjects, the following measures were determined: the volume and the diameters of the cranial cavity (longitudinal and transverse distance and height), the brain volume, and the brain weight. The complex mathematical algorithm revealed a formula for the coefficient ε, which is useful to conclude whether a brain edema is present or not. The average density of non-edematous brain is 0.967 g/ml, while the average density of edematous brain is 1.148 g/ml. The resulting formula for the coefficient ε is (5.79 x longitudinal distance x transverse distance)/brain weight. Coefficient ε can be calculated using measurements of the diameters of the cranial cavity and the brain weight, performed during the autopsy. If the resulting ε is less than 0.9484, it could be stated that there is cerebral edema with a reliability of 98.5%. The method discussed in this paper aims to eliminate the burden of relying on subjective assessments when determining the presence of a brain edema. © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine

It is well known that atrial infarctions are rare comparing to the ventricular. They cannot easily be verified on ECG and the standard autopsy technique does not include a detailed review of the atrial wall, so the atrial infarction often remains undiagnosed. A 63-year-old male was treated and died in an intensive care unit due to decompensated liver insufficiency and cardiac disease following long-lasting alcohol abuse. At autopsy, the extreme cardiomegaly was found, severe atherosclerosis of the anterior descending branch of left coronary artery. The posterior wall of the right atrium was thickened (cca 9 mm) in diameter of cca 3 × 3 cm, and this area was yellowish in the luminal part, while the central part was filled with dark red blood. A detailed dissection of the coronary arteries showed the complete occlusion of the atrial branch of the right coronary artery wreath as far as the place of sinoatrial artery branching, which corresponded anatomically to the described area of infarction on the posterior wall of the right atrium. Histopathological examination of the previously described area of the posterior wall of the right atrium, showed four zones of heart muscle changes: 1. zone of partially preserved structure of the heart muscle, 2. zone of cellular (immature) connective tissue, 3. areas of bleeding in cellular connective tissue, and 4. zone of acellular (old) connective tissue. These histopathological changes indicated that the posterior wall of the right atrium was affected by myocardial necrosis in at least two and possibly more times. It is reasonable to think that bleeding in the third zone of the posterior wall of the right atrium contributed greatly to the death due to the anatomical proximity to the sinoatrial node. It was confirmed by the existence of bradycardia with a prolonged PR interval, PR segment elevation in D1 and aVL lead and PR depression in the D3 lead on the ECG. These ECG changes appeared immediately before asystolia and the death of the patient, but not ventricular fibrillation or electromechanical dissociation due to ventricular infarction. The presented case shows that detailed autopsy examination of atrial wall and blood vessels can sometimes be crucial in disclosing the cause and mode of death if the ischemia and necrosis attack only the atrial wall, especially in the region of the heart conduction system. © 2011 Elsevier Ltd and Faculty of Forensic and Legal Medicine.

It is well known that atrial infarctions are rare comparing to the ventricular. They cannot easily be verified on ECG and the standard autopsy technique does not include a detailed review of the atrial wall, so the atrial infarction often remains undiagnosed. A 63-year-old male was treated and died in an intensive care unit due to decompensated liver insufficiency and cardiac disease following long-lasting alcohol abuse. At autopsy, the extreme cardiomegaly was found, severe atherosclerosis of the anterior descending branch of left coronary artery. The posterior wall of the right atrium was thickened (cca 9 mm) in diameter of cca 3 × 3 cm, and this area was yellowish in the luminal part, while the central part was filled with dark red blood. A detailed dissection of the coronary arteries showed the complete occlusion of the atrial branch of the right coronary artery wreath as far as the place of sinoatrial artery branching, which corresponded anatomically to the described area of infarction on the posterior wall of the right atrium. Histopathological examination of the previously described area of the posterior wall of the right atrium, showed four zones of heart muscle changes: 1. zone of partially preserved structure of the heart muscle, 2. zone of cellular (immature) connective tissue, 3. areas of bleeding in cellular connective tissue, and 4. zone of acellular (old) connective tissue. These histopathological changes indicated that the posterior wall of the right atrium was affected by myocardial necrosis in at least two and possibly more times. It is reasonable to think that bleeding in the third zone of the posterior wall of the right atrium contributed greatly to the death due to the anatomical proximity to the sinoatrial node. It was confirmed by the existence of bradycardia with a prolonged PR interval, PR segment elevation in D1 and aVL lead and PR depression in the D3 lead on the ECG. These ECG changes appeared immediately before asystolia and the death of the patient, but not ventricular fibrillation or electromechanical dissociation due to ventricular infarction. The presented case shows that detailed autopsy examination of atrial wall and blood vessels can sometimes be crucial in disclosing the cause and mode of death if the ischemia and necrosis attack only the atrial wall, especially in the region of the heart conduction system. © 2011 Elsevier Ltd and Faculty of Forensic and Legal Medicine.