Alan Bosnar

Retrospective analysis of free-fall fractures with regard to height and cause of fall

Free-fall fractures represent a specific form of blunt force trauma that can be hard to interpret because of the numerous factors that affect it. The aim of this study is to focus on skeletal injury patterns resulting from free-falls and to analyse the relationship between specific skeletal fractures, and the height and cause (accidental vs. suicidal) of the fall. A total of 179 autopsy reports of fatal free-falls from known heights were analysed at the Department of Forensic Medicine and Criminalistics, in Rijeka, Croatia. The location, type and frequency of fractures, as well as the number and distribution of fractured regions were analysed with regard to height and cause of fall. Height was found to be the major factor influencing fracture patterns in free-falls. In our sample, the frequencies of thoracic fractures, fractures to the extremities and those to the pelvis increased with height. Head fractures show no such relationship. However, types of fractures recorded in different anatomical regions, including the cranium, differ between height groups suggesting different injury mechanisms in each. Victims of falls generally sustained fractures in more than one body region, and the number of injured regions correlates significantly with height. Although no statistical difference was found in the number of fractured regions or frequency of fractures between accidental fallers and suicidal jumpers, jumpers showed a significantly higher number of bilateral extremity fractures when compared to victims of accidental falls. Logistic regression analyses also demonstrate a significant relationship between lower extremity fractures, and the cause of the fall. Our results highlight the need for further investigations of the influence that behaviour and height have in free-fall fractures.

Hepatoregenerative role of bone morphogenetic protein-9

Summary Bone morphogenetic protein-9 (BMP-9) is a member of the transforming growth factor beta (TGF-β) superfamily of cytokines, which regulate cell growth and differentiation during embryogenesis. Apart of that, the hypoglycemic potential of BMP-9 is of great interest. It has been confirmed that BMP-9, like insulin, improves glycemia in diabetic mice and regulates directional glucose metabolism in hepatocytes; therefore it is proposed to be a candidate hepatic insulin-sensitizing substance (HISS). In liver fibrosis, due to the portocaval shunt, insulin bypasses the organ and the liver undergoes atrophy. Parenteral administration of insulin reverses atrophy by stimulating mitogenic activity of the hepatocytes. Because BMP-9 has a signaling pathway similar to other BMPs and insulin, it is to be expected that BMP-9 has a certain regenerative role in the liver, supporting the above-mentioned is evidence of BMP-9 expression in Dissè’s spaces and BMP-7’s mitogenic activity in mucosal cells. However, further studies are needed to confirm the possible regenerative role of BMP-9.

Suicidal drowning in Southwestern Croatia: a 25-year review.

We designed a retrospective study to analyze suicidal drowning deaths occurring between 1981 and 2005. During the study period there were 134 cases of suicidal drowning accounting 10% of all suicides, and 31% of all drowning deaths. Of the 134 drowning suicides, 76 (57%) incidents occurred in the sea, 46 (34%) in water wells, 8 (6%) in rivers, and 4 (3%) in bathtubs. During the study period, cases of suicidal drowning were not identified in males and females under the age of 20. In females aged 65 years and older, drowning represents the most common type of suicide. Commonly, the victims were sober at the time of the incident. Cases of suicidal drowning committed in water wells are unexpectedly high, considering abundance of salt water.

Evaluating sexual dimorphism in the human mastoid process: A viewpoint on the methodology

The mastoid process is one of the most sexually dimorphic features in the human skull, and is therefore often used to identify the sex of skeletons. Numerous techniques for assessing variation in the size and shape of the mastoid process have been proposed and implemented in osteological research, but its complex form still presents difficulties for consistent and effective analysis. In this article, we compare the different techniques and variables that have been used to define, measure, and visually score sexual dimorphism in the mastoid process. We argue that the current protocols fail to capture the full morphological range of this bony projection, and suggest ways of improving and standardizing them, regarding both traditional and 3D‐based approaches. Clin. Anat. 28:593–601, 2015.

Immunohistochemical surfactant protein-A expression: Fatal drowning vs. postmortem immersion

The postmortem diagnosis of drowning continues to be one of the most difficult in forensic pathology because of unspecific autopsy findings. It must be always remembered that disposal of a victim body in water is not unknown in homicide. The most important physiological consequence in fatal drowning is hypoxemia. The air-liquid interface of alveoli and distal airways of the mature lung are lined with a thin layer of lung surfactant, composed of phospholipids, proteins and neutral lipids. Surfactant components are synthesized and/or incorporated into lung surfactant in alveolar type II cells, and secreted to form an airspace lining film. The composition and function of lung surfactant is disturbed in cases od acute lung injury (ALI) including drowning. Surfactant protein-A (SP-A) is the most abundant surfactant protein. Surfactant protein-A (SP-A) is secreted by type II alveolar cells and cells. Its immunohistochemical distribution is observed in two different pathways: a linear membranous staining and a granular intra-alveolar staining. We hypothesize the significance of immunohistochemical detection of SP-A and its help in determination of the time of death, and possibly distinguishing of death by immersion vs. postmortem immersion using the morphological analysis applied on SP-A immunohistochemical stained lung tissue samples. We also argue in favor of routine use of SP-A staining in selected forensic cases where pathogenesis includes mechanical asphyxia and lung pathology. Although some studies reached conclusions to define the mechanisms involved in pathogenesis of mechanical asphyxia and aspiration necessity of additional studies arose. The mechanism of the production of massive aggregates remains to be determined. In the mean time the detection of SP-A (immunohistochemical) as well as biochemical is potentially useful tool in the forensic practice with possible application in daily practice.

Sex determination in skeletal remains from the medieval Eastern Adriatic coast - discriminant function analysis of humeri.

Aim To investigate the usefulness of humerus measurement for sex determination in a sample of medieval skeletons from the Eastern Adriatic Coast. Additional aim was to compare the results with contemporary female population. Methods Five humerus measurements (maximum length, epicondylar width, maximum vertical diameter of the head, maximum and minimum diameter of the humerus at midshaft) for 80 male and 35 female medieval and 19 female contemporary humeri were recorded. Only sufficiently preserved skeletons and those with no obvious pathological or traumatic changes that could affect the measurements were included. For ten samples, analysis of DNA was performed in order to determine sex using amelogenin. Results The initial comparison of men and women indicated significant differences in all five measures (P < 0.001). Discriminant function for sex determination indicated that as much as 85% of cases could be properly categorized, with better results in men (86%) than women (80%). Furthermore, the comparison of the medieval and contemporary women did not show significant difference in any of the measured features. Sex results obtained by anthropological and DNA analysis matched in all 10 cases. Conclusion The results indicate that humerus measurement in Croatian medieval population may be sufficient to determine the sex of the skeleton. Furthermore, it seems that secular changes have not substantially affected contemporary population, suggesting that the results of this study are transferable to contemporary population as well.

Increased Suicide Rate Before and During the War in Southwestern Croatia

BACKGROUND This paper analyzes the impact of war, with special regard for the intensity of changes in the suicide rate in wartime in the southwestern region of Croatia. The investigated region has an area of 7,993 km2 with a population of 322,964. Most of the population lives in the city of Rijeka, the regional center. METHODS During the 10-year period from 1986-1995, a total of 4,172 deaths were investigated at the Institute of Forensic Medicine in Rijeka. Official reports based on forensic autopsies performed on the corpses note 602 cases of suicide, which have been confirmed by police investigation and forensic examination. As the investigated 10-year period encompasses two distinctly specific intervals-the peacetime 1986-1990 interval and wartime 1991-1995-the differences in respective quantitative and qualitative features of suicides during these two intervals were analyzed. RESULTS A total of 262 suicides were committed in peacetime at the rate of 16.22/100,000 inhabitants, as opposed to 340 suicides in wartime at a rate of 19.61/100,000 inhabitants. This increase in the wartime suicide rate was primarily due to the 83% increase in the number of suicide victims <40 years of age. The number of suicides by firearms in wartime was almost fourfold the number in peacetime. CONCLUSIONS Wartime conditions had a direct impact on the change of quantitative and qualitative features of suicides.

HPV 6-positive giant keratoacanthoma in an immunocompetent patient.

Keratoacanthoma (KA) is a clinically distinct, rapidly growing lesion that generally presents as a solitary crateriform nodule in sun-exposed areas in elderly, fair-skinned individuals. A KA larger than 20-30 mm is referred to as giant keratoacanthoma, a relatively rare lesion especially in young patients. Such lesions grow rapidly with possible destruction of underlying tissues. In addition to ultraviolet exposure, KAs have also been associated with chemical carcinogens, chemical peels, genetic factors, chronic skin conditions that produce scarring, trauma and thermal burns. Immunosuppressed patients, especially after transplantation, also develop KAs. A viral etiology has been suggested but not confirmed. We encountered a case of giant keratoacanthoma (greater than 50 mm in diameter) with induration of underlying structures on the upper lip of a 39-year-old male sailor. The patient reported sudden appearance and rapid enlargement of the lesion in only three weeks. Biopsy of the cutaneous lesion and the characteristic clinical history suggested the diagnosis of keratoacanthoma. Total excision with primary closure of the defect by a nasolabial advancement flap was performed. Histological examination of the tumor mass confirmed the diagnosis of KA with infiltrative growth and perineural invasion. Immunosuppression was excluded by blood analyses, as were HIV, syphilis and hepatitis infections. Only low-risk genital HPV type 6 was detected in the lesion, suggesting a possible cocarcinogenic effect of HPV and UV light in a chronically sun-exposed patient.

Dive‐Related Fatalities Among Tourist and Local Divers in the Northern Croatian Littoral (1980–2010)

BACKGROUND The aim of the study was to retrospectively analyze diving fatalities occurring in Primorje-Gorski Kotar County (northern Croatian littoral), Croatia between 1980 and 2010 in order to identify differences between fatally injured tourist and resident divers, as well as temporal changes in the frequency of diver deaths. METHODS Medico-legal and police reports of 47 consecutive fatal diving cases were reviewed to determine the frequency of death among divers in relation to year and month of death, age, sex, nationality, organization of diving, diving type, and health condition. RESULTS The majority of victims were foreign citizens (59.6%) most of whom fell victim to scuba diving (70.4%). It was found that 79% of resident divers succumbed during free-diving. The number of diving fatalities increased significantly in the last three decades, especially among free-divers. Of the victims, 93% were males, usually belonging to younger age groups with tourist divers being significantly older than local divers. And 31.9% of divers, mostly tourists, showed signs of acute, chronic, or congenital pathological conditions. CONCLUSION Fatally injured foreign divers differ from resident diver fatalities in diving method and age. Tourists are the group most at risk while scuba diving according to the Croatian sample. Occupational scuba divers and free-divers are the group most at risk among resident divers. This study is an important tool in uncovering the most common victims of diving and the related risk factors. It also highlights the problems present in the legal and medical monitoring of recreational divers and discusses possible pre-event, event, and post-event preventive actions that could lead to reduced mortality rates in divers.

Homicide–suicide events in Southwestern Croatia, 1986–2009

The aim of this study was to investigate the occurrence and characteristics of homicide-suicide events in Southwestern Croatia from 1986–2009 relying on autopsy reports of the Department of Forensic Medicine and Criminalistics, Rijeka and police records. A total of 17 cases involving 19 victims were identified. The perpetrators were most often men (82%), living in a spousal relationship with the victim. In 76.5% cases, suicide was committed immediately after homicide, and the same mean (most often an illegal firearm) was used for both. After examining the belongings of those involved in homicide-suicides, two factors differentiated our study from others, i.e. more victims and perpetrators were from the lower socioeconomic class and explosives were used in two homicide-suicide (12%) cases. The greater frequency of explosive used in homicide-suicide events may be a result of factors associated with the recent war fought in Croatia. These data prove the influence of sociological, historical and also political factors on the characteristics of a rare event such as homicide-suicide.