Browsing by Author "Djonić, Danijela (6504271198)"

The burden of hip fractures in elderly population has been growing worldwide. A particular focus has been directed towards identifying persons at high risk of fracture. However, bone mineral density (BMD), which is currently used in clinical settings as an indicator of risk of age-related fracture, cannot explain all fracture cases in the elderly. In fact, the risk of hip fractures in the elderly is associated with numerous bone features that degrade bone strength. This review focuses on complexity of bone features that could account for increased bone fragility in advanced age. Besides a decrease in BMD, various macroscopic and microscopic structural parameters, as well as the material of which the bone is composed, are subject to age-related changes. Therefore, in order to have a more thorough assessment of the fracture risk, it is essential to provide integrative approaches that combine BMD measure with other relevant bone features.

Introduction In contrast to numerous reports on long-term psychological consequences of disasters, the literature addressing the acute impact of intentional collective disaster is limited. Objective This research aimed to examine the impact of the bombing campaign on the behavior of people living in Belgrade during the air attacks in 1999. Methods The questionnaire was designed and administered to 231 participants. Psychological distress symptoms were assessed using the Symptom Checklist-Revised (SCL-90-R). Results Participants reported fear and anger as dominant feelings, and the majority of them complained about sleep disturbance, body weight change, and loss of interest for sexual activity. Regression analysis of the scores of the SCL-90-R revealed significant effects of the duration of living under the stress of air attacks, age and gender of the participants and living in the risky areas of the city, upon the scores on Anxiety and Depression dimension. Conclusion The results of the study contributed to our understanding of the processes through which individuals pass during a long lasting bombardment. It can be beneficial for mental health services in evaluating which actions of care and support could be most suitable.

Anatomical or morphological variations of the skull bones usually do not attract much attention among forensic pathologists. However, these variations can sometimes be an important marker in forensic identification of a person or represent a missing piece when solving a cranial trauma puzzle. In this article, we were interested in peculiar presentation of the thinning of both parietal bones (biparietal osteodystrophy). The course and etiology of this condition still remain unknown. In three autopsy cases with biparietal osteodystrophy (three females aged 95, 90 and 83) and no head trauma, we used conventional (CT) and microcomputed tomography (micro-CT) imaging of the skull and parietal bone specimens containing normal bone, transitional zone and thinned bone with osteodystrophy. CT images demonstrated an oval-shaped resorptive parietal bone depression with smooth contours, without marginal osteosclerotic changes or involvement of cranial sutures. In the transitional zone, micro-CT scans showed a decrease in total bone thickness and the thickness of diplöe, while inner and outer tables showed increased porosity. At the site of maximal thinness of the parietal bone, inner and outer tables fused and formed a thin layer of cortical bone. Skull thinning appeared due to the reduced thickness of diplöe, leading to egg-shell thinning in the central area of the parietal bones. A forensic pathologist should be familiar with this benign condition in order not to confuse it with resorptive bone diseases. © 2022 Elsevier B.V.

Anatomical or morphological variations of the skull bones usually do not attract much attention among forensic pathologists. However, these variations can sometimes be an important marker in forensic identification of a person or represent a missing piece when solving a cranial trauma puzzle. In this article, we were interested in peculiar presentation of the thinning of both parietal bones (biparietal osteodystrophy). The course and etiology of this condition still remain unknown. In three autopsy cases with biparietal osteodystrophy (three females aged 95, 90 and 83) and no head trauma, we used conventional (CT) and microcomputed tomography (micro-CT) imaging of the skull and parietal bone specimens containing normal bone, transitional zone and thinned bone with osteodystrophy. CT images demonstrated an oval-shaped resorptive parietal bone depression with smooth contours, without marginal osteosclerotic changes or involvement of cranial sutures. In the transitional zone, micro-CT scans showed a decrease in total bone thickness and the thickness of diplöe, while inner and outer tables showed increased porosity. At the site of maximal thinness of the parietal bone, inner and outer tables fused and formed a thin layer of cortical bone. Skull thinning appeared due to the reduced thickness of diplöe, leading to egg-shell thinning in the central area of the parietal bones. A forensic pathologist should be familiar with this benign condition in order not to confuse it with resorptive bone diseases. © 2022 Elsevier B.V.

We hypothesized that subjects with hyperostosis frontalis interna (HFI), which represents local, endocranial thickening of the frontal bone, would express extra-calvarial manifestations of this condition. Therefore, we compared femoral bone mineral density, geometry, and microarchitecture of males and females with HFI to those without this condition as well as between males and females with HFI. The sample was taken from human donor cadavers, 38 males (19 with and 19 without HFI) and 34 females (17 with and 17 without HFI) that were age-matched within the same sex. The specimens of femoral bones were scanned using microcomputed tomography and dual-energy X-ray absorptiometry (DXA). Parameters of hip structure analysis (HSA) were calculated from data derived from DXA scans. Females with HFI had increased cortical bone volume fraction and their cortical bone was less porous compared to females without HFI. Males with HFI showed microarchitectural differences only with the trabecular bone. They had increased bone volume fraction and decreased trabecular separation compared to males without HFI, although with borderline significance. These microarchitectural changes did not have significant impact on femoral geometry and bone mineral density. The same, still unknown etiological factor behind HFI might be inducing changes at the level of bone microarchitecture at a remote skeletal site (femoral bone), in both sexes. These alterations still do not have the magnitude to induce obvious, straightforward overall increase of bone mineral density measured by DXA. HFI could be a systemic phenomenon that affects both males and females in a similar manner. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

We hypothesized that subjects with hyperostosis frontalis interna (HFI), which represents local, endocranial thickening of the frontal bone, would express extra-calvarial manifestations of this condition. Therefore, we compared femoral bone mineral density, geometry, and microarchitecture of males and females with HFI to those without this condition as well as between males and females with HFI. The sample was taken from human donor cadavers, 38 males (19 with and 19 without HFI) and 34 females (17 with and 17 without HFI) that were age-matched within the same sex. The specimens of femoral bones were scanned using microcomputed tomography and dual-energy X-ray absorptiometry (DXA). Parameters of hip structure analysis (HSA) were calculated from data derived from DXA scans. Females with HFI had increased cortical bone volume fraction and their cortical bone was less porous compared to females without HFI. Males with HFI showed microarchitectural differences only with the trabecular bone. They had increased bone volume fraction and decreased trabecular separation compared to males without HFI, although with borderline significance. These microarchitectural changes did not have significant impact on femoral geometry and bone mineral density. The same, still unknown etiological factor behind HFI might be inducing changes at the level of bone microarchitecture at a remote skeletal site (femoral bone), in both sexes. These alterations still do not have the magnitude to induce obvious, straightforward overall increase of bone mineral density measured by DXA. HFI could be a systemic phenomenon that affects both males and females in a similar manner. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

Objective: The best way to prove the protective role of myocardial bridges in the development of atherosclerotic changes in portions of the coronary beneath the bridge is to compare the morphological changes of the walls of the coronaries with and without a myocardial bridge, in those who have a so called 'dual left anterior descending coronary artery (dual LAD) type 3'. Methods: A prospective autopsy study was performed over a 12-year period and approximately 3000-3500 hearts were examined, in order to establish the presence of a dual LAD type 3. Results: A total of 10 such cases were observed and further analysed. The group entirely consisted of men, who were of an average age of 62.1 ± 20.4, and whose age ranged from 24 to 86. It could be assumed that both the short and long LAD artery were exposed quite equally to all major non-modifiable and major potentially controllable factors for atherosclerosis. Consequently, the degree of severity of atherosclerosis in the short and long dual LAD artery, as well as the difference between degrees, depends only on the presence of a myocardial bridge. This difference increased with the age of the deceased (Spearman's correlation coefficient ρ = 0.695, P = 0.026). Conclusion: If the observed subject was older, the atherosclerotic changes were more prominent and severe in the short rather than in the long dual LAD. The protective role of the myocardial bridge has been established more accurately than has been found in other 0studies; however, this didn't mean that atherosclerosis was absent in intramyocardial course of coronary artery, but it was less prominent. © 2012 Elsevier Ireland Ltd.

This study has been carried out to examine whether the Suchey-Brooks (S&B) methods could be successfully applied in age assessment of populations from the Balkans. The known-age sample consists of 33 females and 52 males pairs of pubic bones collected from the autopsy cases. Age estimation by S&B method showed an accuracy of 89.74% in males and 72.0% in females. Statistical analysis showed a positive correlation between the actual age of the investigated individuals and age phases obtained by the S&B method, although the mean values of the sixth age category differed significantly compared with the original model. The most reliable indicators in both sexes were the relief of the symphyseal surface, lipping, symphyseal rim, and dorsal margin. The discriminating power of these indicators was the least reliable in distinguishing S&B phases 2 and 3. Based on these results, the appropriate recommendations for aging Serbian populations are made. There was a good agreement between two observers (κ=0.726). Copyright © 2006 by American Academy of Forensic Sciences.

This study has been carried out to examine whether the Suchey-Brooks (S&B) methods could be successfully applied in age assessment of populations from the Balkans. The known-age sample consists of 33 females and 52 males pairs of pubic bones collected from the autopsy cases. Age estimation by S&B method showed an accuracy of 89.74% in males and 72.0% in females. Statistical analysis showed a positive correlation between the actual age of the investigated individuals and age phases obtained by the S&B method, although the mean values of the sixth age category differed significantly compared with the original model. The most reliable indicators in both sexes were the relief of the symphyseal surface, lipping, symphyseal rim, and dorsal margin. The discriminating power of these indicators was the least reliable in distinguishing S&B phases 2 and 3. Based on these results, the appropriate recommendations for aging Serbian populations are made. There was a good agreement between two observers (κ=0.726). Copyright © 2006 by American Academy of Forensic Sciences.

Fat embolism in the lungs can unreservedly be accepted as a vital reaction even in cases of advanced putrefaction. A case is presented herein of an 80-year-old woman, found dead in her locked flat, lying on her right side on the floor. In addition to hip fracture, an external examination of the body and a forensic autopsy revealed putrefactive changes. The histological examination of frozen Sudan III-stained sections of the lungs was performed, where orange, drop, sausage- and branchingshaped fat emboli were found. Despite advanced postmortem putrefaction changes, findings of fat emboli in the lung vessels demonstrated that the hip fracture was antemortem in origin. In this case study, the utility of a lung fat embolism is highlighted as being a vital sign even in cases where the body of the deceased has been changed by advanced putrefaction.

Fat embolism in the lungs can unreservedly be accepted as a vital reaction even in cases of advanced putrefaction. A case is presented herein of an 80-year-old woman, found dead in her locked flat, lying on her right side on the floor. In addition to hip fracture, an external examination of the body and a forensic autopsy revealed putrefactive changes. The histological examination of frozen Sudan III-stained sections of the lungs was performed, where orange, drop, sausage- and branchingshaped fat emboli were found. Despite advanced postmortem putrefaction changes, findings of fat emboli in the lung vessels demonstrated that the hip fracture was antemortem in origin. In this case study, the utility of a lung fat embolism is highlighted as being a vital sign even in cases where the body of the deceased has been changed by advanced putrefaction.

Hyperostosis frontalis interna (HFI) represents irregular thickening of the endocranial surface of the frontal bone, mostly seen in postmenopausal females. The microarchitecture of this condition is poorly studied. The aim of this cross-sectional autopsy study was to investigate and compare microarchitectural structure of the frontal bone affected with HFI in both sexes and to test whether HFI severity could be distinguished at the microarchitectural level. The sample was taken from human donor cadavers, 19 males (61 ± 15 years old) and 17 females (75 ± 15 years old). After classification of HFI severity (type A, B, C or D), samples of the frontal bone were taken and scanned using micro-computed tomography. Bone volume fraction was higher and total porosity lower only in the outer table of males with HFI, compared to females with HFI. Mean total sample thickness differed only between males with HFI type A and D. Bone microarchitecture between males and females with corresponding HFI types (e.g., male with type A versus female with type A) differed only in HFI type C regarding the fractal dimension of diploe. The degree of anisotropy differed between HFI subtypes in males, but the post hoc analysis revealed no significant differences between individual groups. Other microarchitectural parameters did not differ among males with different HFI subtypes, as well in females, in any part of the frontal bone. There is no difference in microarchitectural structure of the frontal bone between males and females with HFI, in general aspect and within corresponding HFI subtypes. HFI severity could not be distinguished at the microarchitectural level, neither in males nor in females. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

Hyperostosis frontalis interna (HFI) represents irregular thickening of the endocranial surface of the frontal bone, mostly seen in postmenopausal females. The microarchitecture of this condition is poorly studied. The aim of this cross-sectional autopsy study was to investigate and compare microarchitectural structure of the frontal bone affected with HFI in both sexes and to test whether HFI severity could be distinguished at the microarchitectural level. The sample was taken from human donor cadavers, 19 males (61 ± 15 years old) and 17 females (75 ± 15 years old). After classification of HFI severity (type A, B, C or D), samples of the frontal bone were taken and scanned using micro-computed tomography. Bone volume fraction was higher and total porosity lower only in the outer table of males with HFI, compared to females with HFI. Mean total sample thickness differed only between males with HFI type A and D. Bone microarchitecture between males and females with corresponding HFI types (e.g., male with type A versus female with type A) differed only in HFI type C regarding the fractal dimension of diploe. The degree of anisotropy differed between HFI subtypes in males, but the post hoc analysis revealed no significant differences between individual groups. Other microarchitectural parameters did not differ among males with different HFI subtypes, as well in females, in any part of the frontal bone. There is no difference in microarchitectural structure of the frontal bone between males and females with HFI, in general aspect and within corresponding HFI subtypes. HFI severity could not be distinguished at the microarchitectural level, neither in males nor in females. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

It is a well-documented fact that pontomedullary lacerations (PML) occur as a result of severe craniocervical injury, but their underlying mechanism has yet to be fully clarified. The aim of this prospective study has been to give greater insight into the underlying mechanism of PML through determining the site of blunt head-impact, as well as the presence of concomitant head and neck injuries in cases of brainstem PML. A total of 56 cases with partial PML have been analysed for this study. The case group was composed of 40 men and 16 women, averaging in age 44. 2 ± 19. 2 years and consisting of 7 motorcyclists, 4 bicyclists, 18 car occupants, 16 pedestrians, and 10 victims of falls from a height, as well as 1 victim of a fall from standing height. The presented study has shown that there are several possible mechanisms of PML. Impact to the chin, with or without a skull base fracture, most often leads to this fatal injury, due to the impact force transmission either through the jawbone or vertebral column; most likely in combination with a fronto-posterior hyperextension of the head. Additionally, lateral head-impacts with subsequent hinge fractures and PML may also be a possible mechanism. The jawbone and other facial bones are able to act as shock absorbers, and their fracture may diminish the energy transfer towards the skull and protect the brain and brainstem from injury. The upper cervical spine can act as damper and energy absorber as well, and may prevent any occurrence of fracture to the base of the skull. © 2011 Springer Science+Business Media, LLC.

Brainstem pontomedullary laceration (PML) in falls from a height appears as isolated cases and usually in feet-first impacts with a ring fracture. The aim of this study was to determine the frequency of PML in falls from a height, as well as the frequency of concomitant head and neck injuries. Out of 261 cases, PML was present in 40. An impact to the chin, as well as a feet- or buttocks-first impact, most often led to PML owing to transmission of the impact force. Also, a lateral, frontal, or posterior head impact, with subsequent hinge fracture, as well as the frontoposterior hyperextension of the head associated with an upper spine fracture, could be possible mechanisms of PML in falls from a height. The jawbone and other facial bones act as shock absorbers, and their fracture diminishes energy transfer toward the skull and protects the brain and brainstem from injury. © 2011 American Academy of Forensic Sciences.

Brainstem pontomedullary laceration (PML) in falls from a height appears as isolated cases and usually in feet-first impacts with a ring fracture. The aim of this study was to determine the frequency of PML in falls from a height, as well as the frequency of concomitant head and neck injuries. Out of 261 cases, PML was present in 40. An impact to the chin, as well as a feet- or buttocks-first impact, most often led to PML owing to transmission of the impact force. Also, a lateral, frontal, or posterior head impact, with subsequent hinge fracture, as well as the frontoposterior hyperextension of the head associated with an upper spine fracture, could be possible mechanisms of PML in falls from a height. The jawbone and other facial bones act as shock absorbers, and their fracture diminishes energy transfer toward the skull and protects the brain and brainstem from injury. © 2011 American Academy of Forensic Sciences.

Pontomedullary lacerations (PMLs) have often been reported in car occupants and pedestrians, are less frequently described in motorcyclists, and are very rarely described in bicyclists. The aim of this study was to determine the frequency of brainstem PMLs among fatally injured motorcyclists and bicyclists as well as the frequency of concomitant cranial, facial, and cervical spine injuries in such cases. A possible underlying mechanism of PML in fatally injured motorcyclists and bicyclists might thus be established. Of 443 cases of fatally injured motorcyclists and bicyclists, a sample of 381 cases of fatally injured motorcyclists and bicyclists with head injury of Abbreviated Injury Scale score of 3 or greater was formed and further analyzed. This group was composed of 345 men and 36 women. The average age was 48.8 ± 20.8 years (range, 15-99 years). In the analyzed sample group, there were 158 motorcyclists and 223 bicyclists. Partial PMLs were present in 44 cases (12%) within the sample of 381 head injuries, which breaks down to 40 men and 4 women. In our study, the impact area on the head and the specific skull base fracture type were good predictors of either PML occurrence or absence (B = -2.036, Wald = 161.312, P < 0.01, for the whole model). Impact to the chin, with or without a skull base fracture, most often led to this fatal injury due to impact force transmission, either through jawbone or vertebral column. Also, lateral head impact, the most frequent in bicyclists, with subsequent hinge fracture, PML, and frontoposterior hyperextension of the head that is associated with upper spine fracture, could be possible mechanisms of brainstem injury in fatally injured motorcyclists or bicyclists. Our study showed that the jawbone, as well as other facial bones, could act as shock absorbers, and their fracture could diminish energy transfer toward the skull and protect the brain and brainstem from injury. Copyright © 2012 Lippincott Williams & Wilkins.

The aim of our study was to determine rate of occurrence and appearance of hyperostosis frontalis interna (HFI) in females and correlation of this phenomenon with ageing. The sample included 248 deceased females: 45 of them with different types of HFI, and 203 without HFI, average age 68.3 ± 15.4 years (range, 19-93), and 58.2 ± 20.2 years (range, 10-101), respectively. According to our results, the rate of HFI was 18.14%. The older the woman was, the higher the possibility of HFI occurring (Pearson correlation 0.211, N = 248, P = 0.001), but the type of HFI did not correlate with age (Pearson correlation 0.229, N = 45, P = 0.131). Frontal and temporal bone were significantly thicker in women with than in women without HFI (t = -10.490, DF = 246, P = 0.000, and t = -5.658, DF = 246, P = 0.000, respectively). These bones became thicker with ageing (Pearson correlation 0.178, N = 248, P = 0.005, and 0.303, N = 248, P = 0.000, respectively). The best predictors of HFI occurrence were respectively, frontal bone thickness, temporal bone thickness, and age (Wald. coeff. = 35.487, P = 0.000; Wald. coeff. = 3.288, P = 0.070, and Wald. coeff. = 2.727, P = 0.099). Diagnosis of HFI depends not only on frontal bone thickness, but also on waviness of internal plate of the frontal bone, as well as the involvement of the inner bone surface. Copyright © 2010 by Lippincott Williams & Wilkins.

A fat embolism is a known and common complication of blunt force injuries, especially pelvic and long bones fractures. The aim of this study was to determine the importance of a patent foramen ovale (PFO) in developing systemic fat embolism (SFE) and eventually fat embolism syndrome (FES) in patients suffering from orthopaedic blunt injuries and consequent lung fat embolism. The sample was divided: 32 subjects with a sealed foramen ovale (SFO), and 20 subjects with a PFO. In our sample, there was no difference in either the incidence of renal fat embolism in subjects with PFO compared to those with SFO (Fisher's exact test 0.228, p = 0.154) or in the grade of renal fat embolism (Pearson Chi-square 2.728, p = 0.435). However, there was a statistically significant correlation between the grade of lung fat embolism and the number of fractured bones for the whole sample (Spearman's rho 0.271, p = 0.052), but no correlation between the grade of lung fat embolism and the ISS or NISS (Pearson correlation 0.048, p = 0.736, and 0.108, p = 0.445, respectively). In our study, the presence of fat emboli in the kidney, i.e. SFE, could effectively be predicted by the grade of lung fat embolism (the moderate and slight grades of lung fat embolism were better predictors than the massive one: logistic regression - Wald. Coeff. = 11.446, p = 0.003, Wald. Coeff. = 10.553, p = 0.001, and Wald. Coeff. = 4.128, p = 0.042), and less effectively by presence of PFO (Wald. Coeff. = 2.850, p = 0.091). This study pointed out that lung and SFE are not pure biomechanical events, so the role of a PFO is not crucial in developing a lung fat embolism into a systemic embolism: the fat embolism is more of a biochemical and pathophsyiological event, than a biomechanical one. The appearance of a patent foramen ovale associated with a systemic fat embolism should be less emphasised: maybe arteriovenous shunts and anastomosis between the functional and nutritive, i.e. systemic circulation of lungs play a more important role in developing a SFE than a PFO. © 2010 Elsevier Ltd. All rights reserved.