Browsing by Author "Nikolić, Slobodan (7102082739)"

[No abstract available]

Introduction The occurrence of gastric mucosal ruptures during cardiopulmonary resuscitation (CPR) is contributed to extensive gastric distention, either due to mouth-to-mouth resuscitation or the use of a bag and mask, or inappropriate intubation that may lead to gastric hyperinflation, which then creates gastric distension and further promotes gastric rupture. The presented case suggests that there might be another mechanism – chest compressions during CPR. Case outline We present a case of an 84-year-old woman who died due to severe chronic ischemic heart disease after unsuccessful resuscitation. The autopsy revealed a presence of several shallow ruptures of gastric mucosa on the lesser curvature, 1–3 cm in length, with surrounding mucosal hemorrhage, and without bleeding in the gastric cavity. Conclusion Gastric mucosal ruptures could occur due to a combination of two mechanisms: pressure propagation due to chest compression and gastric hyperinflation. © 2018, Serbia Medical Society. All rights reserved.

A case is reported of a 36-year-old male, found dead in his locked room, lying on a bed, dressed in his mother's clothes, with a plastic bag over his head, hands tied and with a barrel wooden cork in his rectum. Two pornographic magazines were found on a chair near the bed, so that the deceased could see them well. Asphyxia was controlled with a complex apparatus which consisted of two elastic luggage rack straps, the first surrounding his waist, perineum, and buttocks, and the second the back of his body, and neck. According to the psychological autopsy based on a structured interview (SCID-I, SCID-II) with his father, the deceased was single, unemployed and with a part college education. He had grown up in a poor family with a reserved father and dominant mother, and was indicative of fulfilling DSM-IV diagnostic criteria for alcohol dependence, paraphilia involving hypoxyphilia with transvestic fetishism and anal masturbation and a borderline personality disorder. There was no evidence of previous psychiatric treatment. The Circumstances subscale of Beck's Suicidal Intent Scale (SIS-CS) pointed at the lack of final acts (thoughts or plans) in anticipation of death, and absence of a suicide note or overt communication of suicidal intent before death. Integration of the crime scene data with those of the forensic medicine and psychological autopsy enabled identification of the event as an accidental death, caused by neck strangulation, suffocation by a plastic bag, and vagal stimulation due to a foreign body in the rectum. © Medicinska naklada.

Domestic animal attacks are not common; their fatal attacks are even rarer. Herein, a case of a 78-year-old woman attacked by a ram is presented. She sustained multiple head and chest injuries. The autopsy findings and the inspection of the scene revealed that the fatal aortic injury had been caused by direct force from the front, which subsequently caused a powerful anteroposterior chest compression, resulting in an incomplete tear by flexion and compression of the aortic arch. The aortic dissection propagated in both an ante- and retrograde direction, with intact adventitia. However, due to a rise in pressure in the formed false lumen, dissection propagated downward to the base of the heart, and further into the subepicardial adipose tissue, forming a subepicardial hematoma. This hematoma gradually compressed the proximal sections of the coronary arteries, impairing their filling, and producing a myocardial ischemia. In addition, circulation had probably been already disturbed by the right-sided pneumothorax, as well as a possible pneumomediastinum. © 2013 American Academy of Forensic Sciences.

Domestic animal attacks are not common; their fatal attacks are even rarer. Herein, a case of a 78-year-old woman attacked by a ram is presented. She sustained multiple head and chest injuries. The autopsy findings and the inspection of the scene revealed that the fatal aortic injury had been caused by direct force from the front, which subsequently caused a powerful anteroposterior chest compression, resulting in an incomplete tear by flexion and compression of the aortic arch. The aortic dissection propagated in both an ante- and retrograde direction, with intact adventitia. However, due to a rise in pressure in the formed false lumen, dissection propagated downward to the base of the heart, and further into the subepicardial adipose tissue, forming a subepicardial hematoma. This hematoma gradually compressed the proximal sections of the coronary arteries, impairing their filling, and producing a myocardial ischemia. In addition, circulation had probably been already disturbed by the right-sided pneumothorax, as well as a possible pneumomediastinum. © 2013 American Academy of Forensic Sciences.

Fat embolism is markedly underdiagnosed, even though it is a well-known phenomenon following fractures of the long bones, injury to subcutaneous fat tissue, rupture of a fatty liver, surgical operations on fatty tissues, septicemia, burns and barotrauma. Forensic pathologists tend to “simplify” autopsy report conclusion in cases with multiple injuries where fat embolism and exsanguination could be considered to be the concomitant causes of death. Herein we present a case of 24-year-old male who was beaten with a metal rod by several persons. On admission to hospital his vital signs and laboratory findings indicated hemorrhagic shock with gradual respiratory failure; he died 17 h after injury. On internal autopsy examination the subcutaneous tissue of the limbs and back was severely bruised, corresponding to about 35% of the body surface area. He had fractures of several small bones. Injuries of the internal organs were absent, there was no free blood in the body cavities, and all other autopsy findings were unremarkable but suggestive of a significant blood loss. Microscopic examination showed a massive pulmonary fat embolism (grade III according to Sevitt), without systemic fat embolism. The cause of death was attributed to pulmonary fat embolism combined with severe blood loss, following extensive and severe bruising of the subcutaneous tissues and bone fractures. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.

Anomalous papillary muscle (APM) insertion into the anterior mitral valve leaflet is often associated with hypertrophic cardiomyopathy (HCM) but is reported in other cases as a rare finding. Mere presence does not strictly imply hemodynamic disturbance, and several types exist, with various impacts on left ventricular outflow tract (LVOT) obstruction. The interpretation of isolated anomaly is challenging at autopsy because significant LVOT obstruction is dynamic. We analyzed autopsy cases with APM regarding the site of PM insertion and origin, number of PM bellies, anomalous insertions, heart weight, left ventricle (LV) thickness, LV endocardial fibrosis, subjects' age, sex, cause, and manner of death. A total of 20 cases were identified. Fourteen were identified incidentally, while in 670 systematically examined hearts, the APM was identified in six cases, indicating a prevalence of 0.9%. In eight cases, the manner of death was natural (one case with HCM), and in 12 non-natural. Type II anomaly of PM was most frequent (n = 8), followed by Type III (n = 7) and Type I (n = 5). Subjects who died of natural causes were significantly older and had heavier hearts (median 455 g vs. 330 g; p < 0.05) without difference in LV thickness (median 16 mm vs. 15 mm; p > 0.05). Histology performed in four cases showed a pattern of direct insertion of cardiomyocytes into the leaflet's thick fibrous tissue with a narrow overlapping zone. The APM is rare, can be easily overlooked, and does not imply significant pathology per se. We discussed proper assessment of the significance of this anomaly at autopsy. © 2022 American Academy of Forensic Sciences.

Anomalous papillary muscle (APM) insertion into the anterior mitral valve leaflet is often associated with hypertrophic cardiomyopathy (HCM) but is reported in other cases as a rare finding. Mere presence does not strictly imply hemodynamic disturbance, and several types exist, with various impacts on left ventricular outflow tract (LVOT) obstruction. The interpretation of isolated anomaly is challenging at autopsy because significant LVOT obstruction is dynamic. We analyzed autopsy cases with APM regarding the site of PM insertion and origin, number of PM bellies, anomalous insertions, heart weight, left ventricle (LV) thickness, LV endocardial fibrosis, subjects' age, sex, cause, and manner of death. A total of 20 cases were identified. Fourteen were identified incidentally, while in 670 systematically examined hearts, the APM was identified in six cases, indicating a prevalence of 0.9%. In eight cases, the manner of death was natural (one case with HCM), and in 12 non-natural. Type II anomaly of PM was most frequent (n = 8), followed by Type III (n = 7) and Type I (n = 5). Subjects who died of natural causes were significantly older and had heavier hearts (median 455 g vs. 330 g; p < 0.05) without difference in LV thickness (median 16 mm vs. 15 mm; p > 0.05). Histology performed in four cases showed a pattern of direct insertion of cardiomyocytes into the leaflet's thick fibrous tissue with a narrow overlapping zone. The APM is rare, can be easily overlooked, and does not imply significant pathology per se. We discussed proper assessment of the significance of this anomaly at autopsy. © 2022 American Academy of Forensic Sciences.

[No abstract available]

[No abstract available]

Hanging is one of the most common suicide methods worldwide. Neck injuries that occur upon such neck compression – fractures of the thyrohyoid complex and cervical spine, occupy forensic pathologists for a long time. However, research failed to identify particular patterns of these injuries corresponding to the force distribution a ligature applies to the neck: the issue of reconstructing the knot in a noose position persists. So far, machine learning (ML) models were not utilized to classify knot positions and reconstruct this event. We conducted a single-institutional, retrospective study on 1235 autopsy cases of suicidal hanging, developed several ML models, and assessed their classification performance in a stepwise manner to discriminate between: 1. typical (‘posterior) and atypical (‘anterior’ and ‘lateral’) hangings, 2. anterior and lateral hangings, and 3. left and right lateral hangings. The variable coding was based on the presence/absence of fractures of greater hyoid bone horns (GHH), superior thyroid cartilage horns (STH), and cervical spine. Subject age was considered. The models’ parameters were optimized by the Genetic Algorithm. The accuracy of ML models in the first step was very modest (c. 60%) but increased subsequently: Multilayer Perceptron – Artificial Neural Network and k-Nearest Neighbors performed excellently discriminating between left and right lateral hangings (accuracy 91.8% and 90.6%, respectively). The latter is of great importance for clarifying probable hanging fracture biomechanics. Alongside the conventional inferential statistical analysis we performed, our results further indicate the association of the knot position with ipsilateral GHH and contralateral STH fractures in lateral hangings. Moreover, odds for unilateral GHH fracture, simultaneous GHH and STH fractures, and cervical spine fracture were significantly higher in atypical (‘anterior’ and ‘lateral’) hangings, compared to typical (‘posterior’) hangings. © 2024 Elsevier B.V.

[No abstract available]

A 32-year-old chronic drug abuser was found dead at the entrance to his home, covered in blood. Pools of blood, bloody footprints and bloodstains were found across the apartment. A double-edged razor was recovered from the scene. Autopsy revealed multiple incised wounds: two on the palmar aspect of both forearms (37 cm and 33 cm long, oriented longitudinally). The cuts extended into the subcutaneous adipose tissue, muscles and blood vessels. There was an additional 30 cm cut extending across the middle of the torso anteriorly and two more cuts on the anteromedial aspect of the lower legs, set symmetrically (about 23 and 25 cm long). These three cuts were more shallow than the upper extremity wounds. No hesitation wounds were identified. Toxicological analysis identified MDMA (ecstasy). The cause of death was exsanguination. The deceased has been using ecstasy for the previous five years and had a history of inpatient psychiatric treatment due to psychosis with delusions and hallucinations. These self-inflicted incised wounds had many atypical features: location (torso, legs and arms), longitudinal orientation and symmetrical distribution, absence of hesitation injuries, use of both dominant and non-dominant hand. The absence of previous suicide attempts and suicide note suggest that these self-inflicted injuries were not planned beforehand, but were abrupt. We hypothesize that this injury pattern is associated with both acute and chronic effects of MDMA. © 2021, Springer Science+Business Media, LLC, part of Springer Nature.

[No abstract available]

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.

Some of the fatally injured car occupants could have had both blunt rupture of thoracic aorta with great amount of intrapleural blood, and pontomedullar laceration of brain-stem as well, with both injuries being fatal. The aim of this study was to answer if all intrapleural bleeding in these cases was antemortem, or the bleeding could also be partially postmortem. We observed the group of 66 cases of blunt aortic rupture: 21 case with brain-stem laceration, and 45 cases without it. The average amount of intrapleural bleeding in cases without brain-stem laceration (1993 ± 831 mL) was significantly higher than in those with this injury (1100 ± 708 mL) (t = 4.252, df = 64, P = 0.000). According to our results, in cases of the thoracic aorta rupture with concomitant brain-stem laceration, the amount of intrapleural bleeding less than 1500 mL, should be considered mostly as postmortem in origin, and in such cases, only the brain-stem injury should be considered as cause of death. Copyright © 2011 by Lippincott Williams & Wilkins.

Introduction Bullet embolism is a special form of embolism, where embolus is either a bullet or its fragment. Bullet penetrates through the injured part of the body into circulation and then travels to a distant part of the body, until it gets blocked in a vessel of the same diameter as the bullet. Case Outline We are presenting a case of gunshot injury in a 26-year-old male, found unconscious on the passenger seat, with the gunshot injury of the right hand and hemithorax, who died two hours after admission to hospital. Post-mortem X-ray revealed the presence of a metallic foreign body - a bullet, in the level of the left femoral neck. The autopsy revealed entrance and exit gunshot wounds of the upper third of the right upper arm. There was a second entrance gunshot wound, and the bullet passed through the right hemithorax and the right lung, and then through the intervertebral disc between the eighth and ninth thoracic vertebrae, and also making a complete laceration of the wall of the thoracic aorta, in the right posterior semicircumference. The slightly deformed bullet, caliber 7.65 mm, was found embedded in the lumen of the vessel at the bifurcation of the deep femoral artery from the left femoral artery. Conclusion Bullet embolism is a rare complication of gunshot wounds. It should be suspected in any gunshot wound victim without an exit wound, or the lack of a missile in the bullet pathway, or if there are premortem signs or symptoms unexpected for the presumed pathway of the bullet, such as distant ischemia or infection. In these cases, some of postmortem imaging techniques should be used to save time in diagnosis, treatment and at autopsy.

Introduction: The Burn Index (BI) is a significant clinical prognostic parameter for patients with burns. It simultaneously considers major mortality risk factors: age and burns extensivity. Despite the inability to distinguish between ante- and post-mortem burns, their characteristics on autopsy might indicate if a significant thermal injury occurred before the onset of death. We investigated whether autopsy BI, burn extensivity, and severity could tell whether burns were the concurrent cause of fire-related death (FRD), even if the body remained in a fire. Material and methods: Ten-year retrospective study analyzed FRD that occurred at the scene in a confined space. Soot aspiration was the main inclusion criterion. Autopsy reports were reviewed for demographic data, burn characteristics (degree, Total Body Surface Area burned- TBSA), coronary artery disease, and blood ethanol. We calculated the BI as a sum of the victim's age and percentage of TBSA affected by 2nd, 3rd and 4th-degree burns. Cases were divided into two groups: those with COHb≤ 30% and with COHb> 30%. Subjects with burned TBSA≤ 40% were analyzed separately afterward. Results: The study included 53 males (71.6%) and 21 females (28.4%). No significant difference in age was observed between groups (p > 0.05). COHb≤ 30% had 33, and COHb> 30% had 41 victims. BI and burns extensivity (TBSA) had significant negative correlation with COHb values (ρ = −0.581, p < 0.01 and ρ = −0.439, p < 0.01, respectively). Both were significantly higher in subjects with COHb≤ 30% compared to those with COHb> 30% (140.7 ± 29.57 vs. 95.49 ± 38.49, p < 0.01 and 98 (13−100) vs. 30 (0−100), p < 0.01, BI and TBSA respectively). BI had excellent and TBSA fair performance for detection of subjects with COHb≤ 30% on ROC curve analysis (AUCs 0.821, p < 0.001 and 0.765, p < 0.001), with optimal cut-off values: BI≥ 107 (sensitivity 81.3%, specificity 70.7%) and TBSA≥ 45 (sensitivity 84.8%, specificity 70.7%). On logistic regression analysis BI≥ 107 was independently associated with COHb≤ 30% values (aOR 6; 95%CI 1.55–23.37). The same holds for the presence of 3rd-degree burns (aOR 5.9; 95%CI 1.45–23.99). In the subgroup of subjects with TBSA≤ 40% burned, those with COHb≤ 50% were significantly older than victims with COHb> 50% (p < 0.05). Here BI≥ 85 was a particularly good predictor for detection of subjects with COHb≤ 50% (AUC=0.913, p < 0.001, 95% CI 0.813–1.00; sensitivity 90.9%, specificity 81%). Conclusion: The BI≥ 107, TBSA≥ 45% burned, and 3rd-degree burns observed on autopsy point to a significantly higher odds that limited CO intoxication occurred, and burns should be considered a concurrent cause of indoor FRD. When less than 40% of TBSA was affected, BI≥ 85 indicated sub-lethal CO poisoning. © 2023 Elsevier B.V.

The underlying mechanism of cervical soft tissue emphysema (CSTE) in hanging remains unclear. The aim of this study was to determine the frequency of CSTE in cases of hanging. The sample included 83 deceased persons, average age 55.3±17.9years. CSTE was established in 44 cases. CSTE is presented as frothy air, soap bubble-like formations in superficial and/or deep connective tissue between the neck muscles up to the ligature mark, visible during gross neck examination, using special neck autopsy technique-preparation of the neck organs in layers. The interpretation of positive CSTE must be taken with caution: it could be an antemortem phenomenon possibly because of either Macklin Effect or direct or indirect trauma to the cervical airways, as well as an ante- or postmortem artifact. © 2011 American Academy of Forensic Sciences.