Slobodan Savic

Frequency and severity of injuries in correlation with the height of fall

The main aim of this study was to examine the correlation between the height of fall and the frequency, extensiveness, and type of injuries of certain body regions and organs. The specific objective was to determine characteristic injuries of the analyzed body regions in relation to the certain height of fall. The study included 660 cases of fatal falls from height (469 males and 191 females). Results support the hypothesis that the frequency and extent of the injured body regions and organs are related to the fall height. Head injuries are characteristic of the falls from heights up to 7 m and beyond 30 m. Brain injuries in high falls from heights beyond 30 m show an absence of contre coup contusions and macroscopically evident intracranial bleeding. The extensiveness of chest injuries is significantly statistically associated with fall height. In cases of high falls, the frequency of abdominal injuries is not significantly statistically related to the height of fall. Liver injuries are the most common abdominal injury and the critical height of fall at which the liver injury occurs is 15 m. Injuries of liver and spleen are concomitant in high falls from heights beyond 24 m, irrespective of the manner of impact. The height of fall over 15 m appears to be a reasonable boundary height beyond which the injuries of two or three body regions are generally associated.

Munchausen syndrome by proxy

This review deals with bibliography on Munchausen syndrome by proxy (MSbP). The name of this disorder was introduced by English psychiatrist Roy Meadow who pointed to diagnostic difficulties as well as to serious medical and legal connotations of MSbP. MSbP was classified in DSM-IV among criteria sets provided for further study as factitious disorder by proxy, while in ICD-10, though not explicitly cited, MSbP might be classified as factitious disorders F68.1. MSbP is a special form of abuse where the perpetrator induces somatic or mental symptoms of illness in the victim under his/her care and then persistently presents the victims for medical examinations and care. The victim is usually a preschool child and the perpetrator is the childs mother. Motivation for such pathological behavior of perpetrator is considered to be unconscious need to assume sick role by proxy while external incentives such as economic gain are absent. Conceptualization of MSbP development is still in the domain of psychodynamic speculation, its course is chronic and the prognosis is poor considering lack of consistent, efficient and specific treatment. The authors also present the case report of thirty-three year-old mother who had been abusing her nine year-old son both emotionally and physically over the last several years forcing him to, together with her, report to the police, medical and educational institutions that he had been the victim of rape, poisoning and beating by various individuals, especially teaching and medical staff. Mother manifested psychosis and her child presented with impaired cognitive development, emotional problems and conduct disorder.

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.