Browsing by Author "Savić, Slobodan (7005859439)"

Diagnosing death and issuing a Death Diagnosing Form (DDF) represents an activity that carries a great deal of public responsibility for medical professionals of the Emergency Medical Services (EMS) and is perpetually exposed to the control of the general public. Diagnosing death is necessary so as to confirm true, to exclude apparent death and consequentially to avoid burying a person alive, i.e. apparently dead. These expert-methodological guidelines based on the most up-to-date and medically based evidence have the goal of helping the physicians of the EMS in accurately filling out a medical report on diagnosing death. If the outcome of applied cardiopulmonary resuscitation measures is negative or when the person is found dead, the physician is under obligation to diagnose death and correctly fill out the DDF. It is also recommended to perform electrocardiography (EKG) and record asystole in at least two leads. In the process of diagnostics and treatment, it is a moral obligation of each Belgrade EMS physician to apply all available achievements and knowledge of modern medicine acquired from extensive international studies, which have been indeed the major theoretical basis for the creation of these expert-methodological guidelines. Those acting differently do so in accordance with their conscience and risk professional, and even criminal sanctions. © 2015, Serbia Medical Society. All rights reserved.

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.

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.

We present a case of 19-year-old female patient, who was injured in childhood and subsequently developed hydrocephalus, chronic elevation of intracranial pressure (ICP), and a copper-beaten skull appearance. Chronic hydrocephalus leads to an increase in intraventricular pressure, causing ventricular expansion and dislocation of adjacent cerebral structures. According to literature data, it has been hypothesized that chronically elevated ICP in persons with craniosynostosis, and other developmental structural abnormalities of the skull, may induce bone remodeling. In cases with copper-beaten skull appearance, increased ICP should be considered as a cause of death (after exclusion of all other obvious causes), and for that reason, careful examination of the skull appearance is suggested. This finding could be useful in cases with advanced postmortem changes, where it might indicate some medical conditions of the deceased or could even be considered unique feature for body identification, although this rationale should be used with great caution. © Wolters Kluwer Health, Inc. All rights reserved.

Fatalities related to sporting events are predominantly caused by blunt force injuries especially due to the emotional involvement of crowd, but occasionally other types of trauma are reported as well. A case of very rare trauma caused by shooting with a hand-held parachute signal rocket during a football match is presented. A 17-year-old football fan sustained fatal injuries, a combination of mechanical trauma caused by rocket penetration, as well as extensive thermal burning of the thoracic viscera. Analysis of the event was based on autopsy findings and evidence produced by medicolegal and ballistic experts. Improper use of a hand-held signal rocket, designed for marine distress signals, may cause serious injuries either mechanically, due to explosion, or as a result of thermal discharge. In the reported case, pattern of injuries is discussed, and medical finding corroborated to other available evidence. The presented case is a reminder that the forensic pathologist should be informed accordingly on the type and features of weapon suspected to produce injury, to be able to understand traumatic changes, and look for potential presence of foreign bodies at postmortem examination. © 2008 American Academy of Forensic Sciences.

Fatalities related to sporting events are predominantly caused by blunt force injuries especially due to the emotional involvement of crowd, but occasionally other types of trauma are reported as well. A case of very rare trauma caused by shooting with a hand-held parachute signal rocket during a football match is presented. A 17-year-old football fan sustained fatal injuries, a combination of mechanical trauma caused by rocket penetration, as well as extensive thermal burning of the thoracic viscera. Analysis of the event was based on autopsy findings and evidence produced by medicolegal and ballistic experts. Improper use of a hand-held signal rocket, designed for marine distress signals, may cause serious injuries either mechanically, due to explosion, or as a result of thermal discharge. In the reported case, pattern of injuries is discussed, and medical finding corroborated to other available evidence. The presented case is a reminder that the forensic pathologist should be informed accordingly on the type and features of weapon suspected to produce injury, to be able to understand traumatic changes, and look for potential presence of foreign bodies at postmortem examination. © 2008 American Academy of Forensic Sciences.

Introduction Heat stroke is the most dangerous among numerous disorders caused by elevated environmental temperature. It is characterized by an increased body temperature of over 40°C, the dysfunction of the central nervous system and the development of multiple organ failure. The aim of this paper was to highlight problems in the clinical and post-mortal diagnosis of fatal heat stroke. Case Outline A 20-year-old male was found unconscious on the street; on admission at the Emergency Center, Clinical Center of Serbia, Belgrade, he was in a coma. The body temperature of 40°C was maintained despite the applied therapy, meningeal signs were negative, tachycardia with gallop rhythm, hypotension, bleeding from the nose and mouth, and presence of skin bruises. Laboratory findings: highly elevated LDH and creatine kinase, elevated serum creatinine, AST, and signs of DIC. Lethal outcome occurred 6 hours after admission, and the case remained clinically unsolved. Autopsy showed signs of hemorrhagic diathesis, brain and pulmonary edema, and microscopic examination revealed general congestion, internal bleeding in various organs, cerebral edema, massive blood aspiration and pulmonary edema. Toxicological and bacteriological examinations were negative. Based on these findings and subsequently obtained data on the conditions at the workplace where the young man had a part-time job, it was concluded that the violent death was caused by heat stroke. Conclusion Since heat stroke is associated with a high mortality rate and high incidence of serious and permanent organ damage in survivors, it is important to make the diagnosis of heat stroke as quickly as possible and apply appropriate treatment. Misdiagnosis of heat stroke, and consequently inadequate treatment, with a potential fatal outcome for the patient, can be the reason for blaming doctors for the legal offense of medical malpractice in failing to administer first aid. © 2014, Serbia Medical Society. All rights reserved.

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.

The aim of our study was to examine all types of decapitation from forensic literature, including our own case, and to analyze the presentation of beheading in fine art, popular literature, and music. To do this, over 200 scientific articles in regard to decapitation were analyzed, as well as more than 10,000 artworks, and several hundreds of literary works and music pieces. In addition, a macroscopic examination of a decapitated victim was performed. Finally, a multislice computerized tomography (MSCT) examination of the cervical spine in two live volunteers was undertaken to present the osteological relationships. The forensic and criminal investigation revealed that a female victim was murdered by her jealous husband by applying several strikes with an axe, which resulted in an incomplete decapitation. All the main neck structures were transected, including the cervical spine, except a smaller part of the skin and soft tissue in the nuchal region. The mentioned MSCT examination in both the neutral position and flexion showed that the mandible can also be injured in a higher cervical location of the severance line. Various types of beheading were mentioned, including a homicidal, suicidal, accidental, judicial, internal, pathophysiological, and foetal ones. The status of consciousness and emotions in individuals just before and after decapitation was discussed. Finally, it was found that decapitation was the subject of many artists, and some writers and musicians. In conclusion, we presented a rare case of a homicide beheading performed with an axe. In addition, forensic importance of decapitation was discussed, as well as its great medical, social, anthropological, and artistic significance. © 2017

Introduction Consumption of alcohol may be an important causative factor in traffic accidents, particularly in categories of drivers and pedestrians. Objective Analysis of frequency and other important medicolegal characteristics of drunken state of motor vehicles drivers. Methods We analyzed autopsies performed at the Institute of Forensic Medicine Belgrade during 2008 and 2009. Data were obtained from autopsy protocols, results of toxicological examinations, and police reports about circumstances of traffic accidents. Results Out of all 84 fatally injured drivers, drunken state was proved in 31 (36.9%). The majority of them were males (30% or 97%), while only one female driver was under the influence of alcohol. The most often drunken drivers were in the third life decade (10% or 32.2%). In most cases the injured alcoholised drivers died immediately after the accident (83.8%). In most of them blood alcohol concentration (BAC) was higher than 2‰ (58.1%), most frequently (12) BAC varied between 2.1‰ and 2.5‰, and the highest determined BAC was 3.85‰. The majority of accidents occurred between midnight and 6 a.m. (54.8%), mostly during working days (77.4%). The most frequent ways of the occurrence of traffic accidents were driving by turning away from the road and striking from behind another vehicle on the road. Conclusion The obtained results point out the important role of the drunken state of the drivers of motor vehicles as a causative factor in traffic accidents in our population. The potentially effective preventive measure could be absolute prohibition of alcohol consumption for all drivers.

Aim: The change of antemortem blood alcohol concentration (BAC) in inadequately processed samples was examined. Methods: The study was performed on nine healthy, sober volunteers after overnight fasting. Blood samples were divided into groups and stored, with or without NaF, for varying time periods (12, 24 and 48 h) and at different temperatures (4°C and 20°C). BAC analysis was performed by the gas-chromatography method. Result: All groups showed very low values of BAC. Conclusion: Surprisingly, this study showed no ethanol production in improperly processed antemortem blood samples in healthy and sober individuals who were subjected to overnight fasting. © The Author 2008. Published by Oxford University Press on behalf of the Medical Council on Alcohol. All rights reserved.

Aim: The change of antemortem blood alcohol concentration (BAC) in inadequately processed samples was examined. Methods: The study was performed on nine healthy, sober volunteers after overnight fasting. Blood samples were divided into groups and stored, with or without NaF, for varying time periods (12, 24 and 48 h) and at different temperatures (4°C and 20°C). BAC analysis was performed by the gas-chromatography method. Result: All groups showed very low values of BAC. Conclusion: Surprisingly, this study showed no ethanol production in improperly processed antemortem blood samples in healthy and sober individuals who were subjected to overnight fasting. © The Author 2008. Published by Oxford University Press on behalf of the Medical Council on Alcohol. All rights reserved.

INTRODUCTION Each frac ture of long or pelvic bones as well as large con tusions of subcutaneous fattis sue cause releasing of fat globules that rapidly penetrate into cir culation through the ruptured veins of the injured tissue, and reach the lung cir culation [1, 2]. During the first phase, fat emboli block the func tional lung cir culation by their mechanical effect in cap illaries pro ducing so called isolated post-traumatic lung fat embolism [3]. The sur face layer of a fat embolus, which is prac tically in liquid state, behaves as a membrane of very high density, i.e., as it is under high pres sure which obstruct the blood stream [4] that is finally stopped at the level of lung blood ves sels with diameter of approximately 20 μ [5]. This pathophysiological mechanism pro duces cor pulmonale acutum, with poor patho logical find ings [8]. Nowadays, the post-mortem diagnosis of lung fat embolism is based on micro scop i cal exam i na tion of tis sue spec i mens, usu ally pre pared with special histological staining (Sudan III) [9]. The grad ing of fat embolism accord ing to Sevitt’s criteria is gen erally accepted [10]. Tak - ing of slices from apicoventral areas of the lungs has been recommended [11]. With lon ger outliving period, the total number of fat emboli in the lung cir culation grad ually decreases, due to their disintegration and resorption. It has been stated that fat glob ules completely disappear about 4-6 weeks after injury, and that they should not be searched for microscopically in this post-traumatic phase [11]. OBJECTIVES The aim of our work was to determine whether the age of injured, their gender, total severity of trauma, out living period, and hypo volemic shock that develops after injuring, may induce development of more severe forms of post-traumatic lung fat embolism. MATERIAL AND METHODS A prospective histological study was per formed on the autopsy material of the Institute of Forensic Medicine in Belgrade. The analyzed sam - plecon sisted of individuals with injuries that might be a source of fat emboli (fractures of long bones, large contusions of subcutaneous fat tissue). The lung slices were systematically taken and stained with special fat staining (Sudan III). In each par ticular case, the grade of lung fat embolism was counted on the basis of microscopical appear ance, according to Sevitt’s cri teria. The total severity of trauma was estimated by cal culation of the Injury Severity Score (ISS) [13, 14]. In no cases from the analyzed sample, the fat embolism was mentioned as either singular or plural cause of death. The obtained results were ana lyzed by means of appropriates statistical methods (ANOVA, LSD-test, χ2 test, Man-Whitney test, Fischer’s test of correctprob ability). RESULTS AND DISCUSSION The ana lyzed sample included 58 fatally injured individuals, 39 males and 19 females. The aver age age was 54.10 years (SD16.56), the average value of ISS was 34.69 (SD5.88), and the average outliving period was 3.74 days (SD5.88). However, all these data look differently when the analyzed sample has been stratified and analyzed according to the estimated grade of lung fat embolism. It was not showed that severity of lung fat embolism depends on sex of the injured (χ2=0.842; p>0.05). The groups with the slightest and the most severe grade of lung fat embolism are statistically significantly differentin relation to age of individuals (ANOVA, p=0.017). By means of LSD test, it has been showed that the group with the most severe grade of lung fat embolism (grade III) is statistically significantly different com paring to other two groups (with grade I and II) in relation to the age of injured (the values are p0.16 and p0.19 respectively, and the both groups are less than p0.05). In the group with the most severe grade of lung fat embo lism, the older indi vid u als are sta tis ti cally significantly represented comparing to other two groups. CONCLUSION The anal ysis of our sample showed that the most severe grade of post-traumatic lung fat embolism (microscopical grade III accord ing to Sevitt’s criteria) was determined in older indi viduals, more severely injured, and with shorter out living period. The sever ity of fat embolism depends neither on sex of the injured, nor on development of post-traumatic hypovolemic shock. The obtained results related to the influence of hypovolemic shock on severity of fat embolism should be accepted with a caution. Namely, some times there is an intention to sim plify a procedure of creating of autopsy conclusion about the cause of death, so that loss of blood is not mentioned at all, in spite of fact that it could have been a con current cause of death, while in other cases exsanguination is designated as a sole cause of death, for getting the pos sibility that fat embolism could have really been the immediate cause of death. © 2014, Serbia Medical Society. All rights reserved.

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.

Background/Aim. During the homicidal act, a victim usually tries to defend himself/herself, and due to these attempts he/she could sustain so-called defense injuries, mostly localized on the arms. The aim of this research was to analyze important medicolegal characteristics of defense injuries, particularly regarding their importance in forensic expertise of homicides. Methods. We analyzed autopsies of all homicidal cases with defense injuries in Belgrade during a three-year period. Results. Defensive injuries were registered in 71 victims of murder. The majority (67.61%) of victims with defense injuries were males. About 25% of victims were aged from 21 to 30 years. The majority (60) of victims were not under influence of alcohol. Homicides were mostly (90.14%) performed by mechanical weapons. The highest frequency of defense injuries was noticed in the victims with multiple homicidal injuries localized on the front side of the body. In a half (50.7%) of the cases they were present on both arms of the victim, mostly on the dorsal side of hands and forearms. Bruises were the most frequent form of defense injuries (36.61% out of 71 cases), while incisions, abrasions, gunshot injuries and stab wounds were less common. Conclusion. Determination of defense injuries and their medicolegal characteristics enables collecting of facts that are important for legal estimation of homicide, as well as for adequate sentence at the end of the court procedure. © 2017, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. 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.

It is possible that sexually driven homicides are the consequence of sexual deviation, but more often than not the main cause of such homicides stems from a non-paraphilic person's emotional component. It is known that homicides which involve multiple stabbing are very often the result of the assailant's highly expressed affect. This study tries to establish whether such homicides are essentially related to the sexual motives of the murderer. This paper is conducted through a retrospective autopsy study that includes 766 cases of homicides. These were reviewed and analysed according to the motive of the homicide, as well as by method, age, and gender of the victim, and the relationship between the victim and the assailant. The motives of homicides are classified as non-sexual and sexual, including homicides related to rape, jealousy, amorous affairs outside of an established relationship, deviant sexual behaviour of psychiatric patients, paraphilia, and disturbed emotional relationships between the victim and the assailant. Cases include both hetero- and homosexual relationships. Multiple stabbing occurs significantly more frequently in sex-related homicides (≥3 stab wounds) than in other homicide types. When the criteria for multiple stabbing are changed (≥4, 5, or 25 stab wounds), the percentage of sex-related homicides rises in every group in relation to the increased number of wounds. Sensitivity and specificity are represented by ROC curves for 3, 5 and 7 stab wounds. The correlation coefficients between multiple stabbing and sex-related homicides regarding gender are all near 0.9. For female victims, all homicides committed by 25 and more stab wounds were found to be sex-related. Statistically, jealousy was the most frequent motive for sex-related multiple stabbing homicides. Regardless of age, homicides involving multiple stabbings should be considered sex-related, especially when the victim is female. © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

It is possible that sexually driven homicides are the consequence of sexual deviation, but more often than not the main cause of such homicides stems from a non-paraphilic person's emotional component. It is known that homicides which involve multiple stabbing are very often the result of the assailant's highly expressed affect. This study tries to establish whether such homicides are essentially related to the sexual motives of the murderer. This paper is conducted through a retrospective autopsy study that includes 766 cases of homicides. These were reviewed and analysed according to the motive of the homicide, as well as by method, age, and gender of the victim, and the relationship between the victim and the assailant. The motives of homicides are classified as non-sexual and sexual, including homicides related to rape, jealousy, amorous affairs outside of an established relationship, deviant sexual behaviour of psychiatric patients, paraphilia, and disturbed emotional relationships between the victim and the assailant. Cases include both hetero- and homosexual relationships. Multiple stabbing occurs significantly more frequently in sex-related homicides (≥3 stab wounds) than in other homicide types. When the criteria for multiple stabbing are changed (≥4, 5, or 25 stab wounds), the percentage of sex-related homicides rises in every group in relation to the increased number of wounds. Sensitivity and specificity are represented by ROC curves for 3, 5 and 7 stab wounds. The correlation coefficients between multiple stabbing and sex-related homicides regarding gender are all near 0.9. For female victims, all homicides committed by 25 and more stab wounds were found to be sex-related. Statistically, jealousy was the most frequent motive for sex-related multiple stabbing homicides. Regardless of age, homicides involving multiple stabbings should be considered sex-related, especially when the victim is female. © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

When coronary artery, which is located subepicardially, submerges into myocardium and then, after a short intramural course, again appears subepicardially, it is called embedded coronary, while a part of myocardium above - a myocardial bridge. Muscular bridges are usually small and have no clinical significance. In the proximal part of coronary artery, preceding a myocardial bridge, there occurs a disturbance of blood course and myocardial perfusion, turbulence, collecting of lipids and mucopolysaccharides, lesion of elastica, which all leads to atheromatous lesions of intima of the arterial proximal part and to the resultant complications of atheroma. Degenerative changes of myocardium and its blood vessels, and in connection with it myocardial vulnerability, could be a consequence of this congenital arterial variation. We report a case of a 40-year-old male, without medical data about previous diseases, who died suddenly and unexpectedly in his apartment. The autopsy and microscopical examination revealed an acute ischemic lesion, myocardial bridge in the middle part of the left coronary artery descending branch and the complicated atherosclerotic plaque proximally of this bridge. © 2003, Serbia Medical Society. All rights reserved.

Introduction Diagnosing death represents an activity that carries a great deal of public responsibility for medical professionals and is continually exposed to the control of citizens and media. Although this is a taboo subject in medical circles, unfortunately in medical practice there are situations when the physician issues a death diagnosis form without even examining the person or for an already buried person. Such physician’s action is impermissible and it leads to the possibility of professional and criminal law punishment. Case Outline By giving examples from practice, we wish to point out the need for exceptional caution when confirming and diagnosing death in order to diagnose the true, i.e. rule out apparent death and consequently avoid the mistake of declaring dead someone still alive. Conclusion When confirming and declaring death, exceptional caution of the physician is necessary so as not to declare dead someone still alive. © 2015 Serbia Medical Society. All rightsreserved.