Jelena Micic

Analysis of neck injuries in hanging

Retrospective study of suicidal hangings was made on 175 cases (133 male victims, 42 female victims) for a 5-year period. The mean age was 47.33 ± 17.51 years. The sample was divided in 4 groups according to the position of the ligature knot (anterior, right, left, and posterior hanging). The authors analyzed all visible injuries of soft tissues and bones and cartilage of the neck, and in 150 cases (85.7%), we established that there was at least one injury of these structures (hematoma or fracture for example). The most frequent injury was to sternocleidomastoid muscles. Fracture of throat skeleton was detected in 119 cases (68%). The proportion of fractures increases with age of the deceased. There was no clear correlation between frequency of neck injuries and type of hanging.

Amount of postmortem bleeding: an experimental autopsy study.

An experimental autopsy study was performed on 64 cases (55 male, 9 female; average age 51.5 ± 16.2 years) of sudden natural (38 cases) and asphyxic deaths (26 cases). The study objective was the amount of postmortem bleeding from postmortem cutting of the thoracic aorta, related to the time since death. The amount of postmortem bleeding ranged from 100 to 1300 cm3, 440.6 ± 268.1 cm3 on average. The time since death up to the autopsy time ranged from 4 to 72 hours, 19.4 ± 12.9 in average. A statistically significant correlation between the amount of postmortem bleeding and postmortem time interval was stated: Pearson correlation test value r = −0.461 (P = 0.000): the shorter the time interval, the larger the amount of bleeding. The formula of linear regression was estimated according to this correlation: amount of postmortem bleeding (cm3) = −9.571 × time since death (h) + 626.659. This proves that the amount of postmortem bleeding (eg, from aortic blunt rupture) could be about 620 cm3.

Accident after accident - unusual death of a patient in hospital

The authors present a case of accidental fatal laryngopharyngeal obstruction with bolus of food, in hospital, in a patient who has been treated for twenty days because of injuries sustained in a traffic accident. The injuries were multiple fractures and brain contusions that were not clinically diagnosed, while their simptomatology (somnolence) was attributed to morbous lesions - multifocal brain infarction. Mechanical asphyxiation and death occurred when the patient was fed in hospital by his brother. Unofficially we got an information that whole event was very dramatical, and that medical staff tried to attempt re-suscitative measures but without any written note about that in medical documentation. The terminal phase of his chronic desompensated cardiomyopathia was clinically announced as a cause of death. For forensic pathologists it was relatively easy task to prove mechanical asphyxiation due to laringopharyngeal blockage as a real cause of death on medicolegal autopsy.

Masna embolija u forenzičkoj patologiji

Masna embolija je zacepljenje lumena krvnih sudova ili duplji srca masnim kapima dospelim putem krvotoka. U forenzickoj patologiji govorimo o prirodnoj (morboznoj, endogenoj) adipoznoj emboliji (komplikacija ili posledica bolesti) i nasilnoj (posttraumskoj, egzogeno) (nastaje usled traume i u direktnoj je vezi s njom). Posebno je interesantna masna embolija koja se javlja kao komplikacija nekih dijagnostickih ili kurativnih postupaka u lekarskoj praksi. Dok neki autori smatraju da se masni embolusi oslobađaju iz masnih depoa u organizmu (srž kosti, potkožno masno tkivo masna jetra), drugi su misljenja da embolusi nastaju aglomeracijom lipoproteina plazme (u oba slucaja bilo usled bolesti bilo usled traume). Danas se smatra da masni embolusi u prvoj fazi deluju pre svega mehanicki svojom pojavom u kapilarima (blokirajuci krvotok), a da u drugoj deluju hemijski i to putem toksicnih masnih kiselina koje se oslobađaju iz embolusa. U forenzickoj praksi razmatraju se tri mehanizma kojima masna embolija može uzrokovati smrt: kao izolovana masna embolija pluca (akutno plucno srce), sistemska masna embolija (masne kapi u kapilarima svih organa ali bez ishemijskih promena u njima) i kao sindrom sistemske masne embolije (poseban i relativno jasno definisan klinicki entitet). U svim slucajevima pored odgovarajuceg makroskopskog tanatoloskog nalaza, dijagnoza se u forenzickom smislu mora postaviti i na osnovu mikroskopskog pregleda i uvida u kompletnu medicinsku dokumentaciju. Ona, međutim, i u klinickom i u obdukcionom radu mesto ostaje nedijagnostifikovana. Danas u sudskomedicinskom smislu treba smatrati da je svaki prelom duge cevaste kosti (narocito kod starijih osoba) pracen oslobađanjem određene kolicine masnih embolusa u krvotok i da ovo predstavlju posledicu pre loma. S druge stra- ne, sistemsku masnu emboliju i sindrom sistemske masne embolije treba posmatrati kao komplikacije preloma. Potpunim shvatanjem patofizioloskih procesa moguce je i u slucajevima s dugim vremenom nadživljavanja povrede uspostaviti direktnu uzrocno-posledicnu vezu između inicijalne traume (npr. frakture) i smrtnog ishoda (usled masne embolije i njenih komplikacija), sto je s krivicno-pravnog gledista vrlo bitno.