Dragan Ječmenica

Child homicide on the territory of Belgrade

OBJECTIVE This study examines the incidence and other epidemiological and medico-legal characteristics of child homicide in the territory of Belgrade, Republic of Serbia. METHODS We performed a retrospective analysis of all autopsies carried out at the Institute of Forensic Medicine in Belgrade during a 15 year period between 1991 and 2005, focusing on homicide cases of victims aged 0-14 years. These were then analyzed in terms of number of deaths, mortality rates, age, and sex of the victim, relation to the perpetrator, and cause of death and injury. RESULTS Forty-six homicides were identified where the victims were aged 0-14 years. These included 24 girls and 22 boys. In 32 cases (69.6%) the perpetrator was one of the childs birth parents, more frequently the mother. Blunt head trauma was the most frequent cause of death, followed by exsanguination. In 9 cases (19.5%) there was evidence of physical abuse; 16 children died in the setting of multiple homicide and/or murder/suicide. In 4 cases (8.7%) there was evidence of neglect which contributed to the fatal outcome. There were 10 cases of neonaticide within the 46 homicides. There were, however, 49 further cases where bodies of newborn infants were discovered after having been disposed of in suspicious circumstances. CONCLUSIONS Proportionally, the largest number of victims fell within the 1-4 years age group, with a slight preponderance of females, most of them killed at home by a close family member, usually the mother. Blunt head trauma was the single most frequent cause of death. Injury patterns consistent with child abuse were identified among 20% of the study group.

Ethical and Legal Consideration of Prisoner’s Hunger Strike in Serbia

Abstract:  Hunger strike of prisoners and detainees remains a major human rights and ethical issue for medical professionals. We are reporting on a case of a 48‐year‐old male sentenced prisoner, intravenous heroin user, who went on a hunger strike and died 15 days later. Throughout the fasting period, the prisoner, who was capable of decision making, refused any medical examination. Autopsy findings were not supporting prolonged starvation, while toxicology revealed benzodiazepines and opiates in blood and urine. Cause of death was given as “heroin intoxication” in keeping with detection of 6‐MAM. Legal and ethical issues pertinent to medical examination and treatment of prisoners on hunger strike are explored in accordance with legislation and professional ethical standards in Serbia. A recommendation for the best autopsy practice in deaths following hunger strike has been made.

Amniotic fluid embolism-apropos two consecutive cases.

Abstract:  Amniotic fluid embolism (AFE) is a sporadic, unpredictable, and usual fatal obstetric complication. The paper deals with two cases of maternal deaths because of AFE verified by medicolegal autopsy. In both the cases, several known risk factors associated with AFE, such as increased maternal age (41 and 35 years), diabetes, augmented labor, and cesarean delivery, were identified. Clinical features were typical, including sudden onset of cardiovascular and respiratory symptoms. In the patient who survived longer, both clinical and autopsy signs of disseminated intravascular coagulopathy were present, while they were absent in the case where death occurred rapidly. This paper describes briefly the particular features to look for at autopsy and stresses the importance of histology examination and staining techniques.

Traumatic Testicular Displacement in Motorcycle Drivers

Abstract:  Testicular displacement is a rare clinical presentation of blunt scrotal injury that may take place in road traffic accidents involving motorcycle occupants. We are presenting two cases of motorcycle occupant fatalities, 21 and 24 years of age, where testicular displacement and other signs of groin trauma have been determined. In both cases, discrete external signs of scrotal trauma were noted on examination, while unilateral and bilateral traumatic testicular displacement, respectively, have been documented at autopsy. For motorcycle occupants involved in collision, it is necessary to perform a thorough analysis of injuries, in particular to look for specific trauma arising from fuel‐tank impact to genitalia and/or groin. These injuries are of great medico‐legal importance both at postmortem and in clinical cases involving motorcycle occupants involved in collision.

Death Caused by a Signal Rocket—Not an Isolated Case*

Abstract:  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.

The use of gasoline in a complex suicide

This case represents a planned complex suicide in which the victim shot himself in the head after dousing his living quarters with gasoline. The spark induced ignition of gasoline vapors and led to an explosion. Liquid gasoline is not flammable, but the vapor/mixture of gases above the surface of the liquid is. In this case the victim might have counted on the resulting fire and/or explosion, but we are not able to tell that with certainty. We have assumed that the plan was for the gunshot to the head to lead to instantaneous death, and for the flame and/or explosion to lead to the destruction of the body. The explosion launched the body out of the apartment, meaning it did not get charred. It is also our assumption that the victim did not expect that the explosion would eject his body from the flames and lead to less severe burns than he had calculated, making this complex suicide “less successful” than he had planned.

Unusual venous bullet embolism – Case report

Bullet embolism is rare complication of penetrating gunshot trauma. We are presenting a case of a single gunshot with entrance wound located on external side of a left thigh. The upward directed trajectory extends to the left lateral side of the neck, but the bullet has been recovered from right external iliac vein. The bullet migration was explained due to one rare variation of the mouth of vena cava superior and inferior.

Clinical and forensic significance of hand injuries incurred through mechanisms of indirect force with users of two wheeled vehicles

Clinical and forensic significance of hand injuries incurred through mechanisms of indirect force with users of two-wheeled vehicles. Our aim is to explore and verify injuries resulting from the effect of indirect force, the clinical significance of which is small or insignificant in terms of their severity, but which have great significance in terms of expertise, primarily as a medical element in the reconstruction of the flow of traffic collisions and the complex dynamics of body movement of this unstable vehicles’ users. Hand injuries among users of two-wheelers may arise as a result of contact with the handlebars, when the hands (back of the hands) collide with the metal grips of the hand brake and clutch, or anytime the handlebars “wedge” into the space between the thumb and forefinger. In comparison with pedestrians, as a control group, a statistically significant difference was established in the incidence of hand injuries in motorcycle drivers.