Browsing by Author "Strajina, Veljko (35362837200)"

Children with Congenital Heart Disease (CHD) presenting for non-cardiac surgery have various physiological and func tional abnormalities and thus pose great challenges to the anaesthesiologist. The principles of anaesthesia are to minimize pathophysiological changes which may upset the complex interaction between systemic and pulmonary vascular resistance. Knowledge of the specific cardiac anatomy, familiarity with the modifications of the cardiorespiratory physiology, the awareness of the potential risks of complications for each individual case are mandatory for the choice of the anaesthesia strategy for each patient. During the preoperative assessment, the risk-benefit ratio should be estimated and preoperative plan established in order to optimize the preoperative status. An anaesthesiologist must also understand pharmacology of drugs being used and should tailor anaesthetic management to the type of surgery. An interdisciplinary team approach is the cornerstone for the safe delivery of anaesthesia to this paediatric patient population. The team should comprise an anesthesiologist, a paediatric cardio logist, a surgeon, a cardio-surgeon and a neonatologist. This re view is meant to explain the classification of congenital heart diseases and to equip the anaesthesiologist with the necessary information about preoperative assessment, anaesthesiology management, monitoring tools important for the safe non-cardiac surgery procedures as well as therapeutic strategies during the postoperative period.

Introduction: In forensic autopsy, pathologists are not particularly interested in the anatomical morphological variations of the skull bones, especially if those variations are not very frequent. Foramina parietalia permagna are developmental benign anomalies resulting from large ossification defects of the parietal bone. Case Outline: Herein was presented a case of 80-year-old female, whose autopsy revealed congenital defect of parietal bones - enlarged parietal foramina. These defects were capped by a fibrous membrane and covered by normal scalp. This condition was completely asymptomatic. Despite the fact that the deceased was very old, the giant parietal foramina were recognized. Conclusion: The forensic pathologist must know how to recognize morphological variations of the skull bones, such as foramina parietalia permagna despite their rare occurrence. This benign anomaly could be associated with anomalies of cerebral venous development and cortical infolding, or asymptomatic as in the presented case. This anomaly of parietal bones could be a useful tool in the identification of forensic cases.

This study presents a case series of suicides carried out by self-inflicted gunshot wounds to the chest-a relatively uncommon means of suicide. The retrospective autopsy study performed included all cases of single suicidal gunshot injuries to the chest during a 20-year period and which were committed by the use of a handgun. The sample included 67 deceased persons that were an average of 44.4 ± 19.1 years old (range, 12-89 years; 58 men and 9 women). The most common region of the entrance wound was the left side of the chest (54/67), followed by the sternum (10/67), and the right side of the chest (3/67). For 9 subjects, the range of fire could not be determined, as well as whether the shot went through their clothing. In the remaining 58 subjects, only contact or near-contact wounds were found. Of the 58, only 3 subjects had their clothing removed between the chest wall and the muzzle. Three directions of the internal bullet paths were those most frequently found: downward right-to-left (27/67), downward left-to-right (20/67), and downward parallel (10/67) (χ = 101.045, P = 0.000). Also, most bullet paths were directed downward (57/67, χ = 32.970, P = 0.000). The most frequently injured organ was the heart (47/67), and the immediate causes of death were exsanguination (49/67), heart disruption (14/67), and tamponade (4/67). Copyright © 2012 Lippincott Williams & Wilkins.

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.

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.

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.

Forensic pathologists sometimes need to determine seating positions of automobile occupants after road traffic accidents as accurately as possible. That could be of essential significance particularly in regard to the question of guilt both in the criminal and civil law. So far, medical surveys have implied the specific injury which would undoubtedly point at the allocation of the seating positions of fatally injured car occupant. Some of the injuries could occur by both direct and indirect force action. Same type of injury of the specific body region in both drivers and front seat passengers could occur by different mechanism and in different phases of the accident. Sometimes neither the order of injury occurrence remains unclear, nor whether some of the injuries are post-mortal. What makes it even harder is the fact that same body regions, i.e. head and thorax, are most affected in both drivers and front seat passengers, and that these injuries are often fatal. Even if the victim survives the accident for some time and later dies in hospital, the possibility of accident reconstruction and determination of car occupants seating position at the moment of accident declines with the time length of survival period. Examining the victims' clothes, searching for biological traces, technical expert inspection of the vehicle, traffic expert analysis of the site, enables adequate reconstruction of the traffic accident. All this implies that in such cases the knowledge of underlying mechanism of car occupants' injury is insufficient, and that a close cooperation between forensic pathologists and the team of other forensic technical experts is necessary.