Zoran Mihailovic

Mechanisms of aortic blunt rupture in fatally injured front-seat passengers in frontal car collisions: an autopsy study

We tried to explain the mechanisms of the aortic blunt ruptures in fatally injured drivers and front passengers, unrestrained by seatbelts, by analyzing the frequencies of both aortic ruptures and concomitant injuries to 12 organs and body regions. The sample consisted of 393 subjects: 251 drivers and 142 front passengers (325 male and 68 female passengers, the mean age 41.0 ± 15.5). The total number of the complete blunt aortic ruptures in the sample was 116 (80 in the drivers and 36 in the front passengers). The weakest part of the aorta seems to be the isthmus (47 isthmus ruptures in the drivers and 27 in the front passengers). The statistically significant concomitant injured organs and body regions with the aortic ruptures were the liver, the sternum, and the diaphragm in the car drivers and the head and the neck in the front passengers. According to these results, the mechanisms of thoracic aorta rupture are different for fatally injured drivers and front passengers. For car drivers, they are associated and simultaneous with both thoracic and abdominal compression due to deceleration of the body at the moment when the drivers body slides forward and flexes across and against the steering wheel. For the front passengers, the mechanism is the caudorostral hyperextension of the thoracic aorta at the moment when the body is stopped by a dashboard, but the head continues forward with great velocity: the carotid vessels pull the aortic arch forward at the same time as the intercostal arteries fix the thoracic part of the aorta and pull it downwards.

Could lactates in vitreous humour be used to estimate the time since death

Vitreous humour (VH) is a useful medium for postmortem analysis. During the supravital period, anaerobic glycolysis that occurs results in the increased lactate concentration (L) in cytosol. We analysed the concentration of lactic acid in 567 samples of VH from 63 autopsy cases by a repetitive withdrawal of VH from the same corpse, while the outside temperature remained constant. The samples were taken from the same eye in intervals of three hours for the period of 24 hours. The subjects were divided into two groups: group 1 included individuals who died during winter and were kept for analysis at 4°C, while group 2 consisted of those who died during spring and autumn (continental climate) and were stored at 20°C. Only the cases of a sudden traumatic death of previously healthy individuals were included in the study. Statistically significant correlation of L against postmortem interval (PMI) was observed in the group 1 experiment (r = 0.675; P < 0.01), but the effect of hypothermia made the estimation of PMI practically impossible. A much stronger correlation of L against PMI was observed in group 2 (r = 0.866, P < 0.01); a functional relationship between PMI and L were demonstrated using the formula PMI = 1.696 × L − 10.562, which enabled more accurate prediction of the PMI.

Estimation of the postmortem interval by analyzing potassium in the vitreous humor: could repetitive sampling enhance accuracy?

AbstractThe relationship between the postmortem interval and the potassium concentration in the vitreous humor has been described by different authors. A limitation of most previous studies might be that all of the vitreous humor has been extracted in 1 sample from different subjects and that the sample was therefore inhomogeneous. In 32 traumatic deaths with known postmortem intervals, small quantities of vitreous humor have been sampled repetitively in 3-hour interval. The bodies were stored at 20°C. The average concentrations of potassium in relation to the postmortem interval were 6.11 to 14.46 mmol/L. An equation that allows accurate prediction of the postmortem interval was established: postmortem interval (h) = 2.749 × [K+] − 11.978.

The Role of Vitreous Magnesium Quantification in Estimating the Postmortem Interval

The use of magnesium as a parameter to estimate the time of death is controversial. In 32 traumatic deaths with known postmortem intervals (PMIs), small quantities of vitreous humor (VH) were sampled repetitively every 3 h until 24 h postmortem. The bodies were kept at the constant ambient temperature of 20°C (68°F). The concentrations of magnesium were in the range of 0.47–1.15 mM. A statistically significant correlation of the concentration of magnesium with the PMI was observed (r = 0.453, p < 0.01), but with small predictive value—coefficient of variation for regression was 45.5%; the average of the paired differences between the estimated and actual PMIs was 5.24 + 3.19 h. Although useful results might be expected due to the large transmembrane gradient for magnesium, the results of this study strongly disprove the usefulness of measuring magnesium in VH to estimate the time of death.

Crow's feet as an indication of a vital reaction in a gunshot victim

A 51-year-old man and his 44-year-old wife were found dead on the floor of their family house by their two daughters after they heard several sequential shots. The female decedent was found lying on her back, with the male decedent lying over her, his stomach against her chest. A ‘‘C Zastava 88-A’’ 9 mm caliber gun was found next to his right hand. The investigation revealed that the couple were in the middle of a divorce and had been quarreling quite frequently. The case was deemed to be a murder-suicide in which the woman was killed by her husband before he committed suicide. At autopsy three entry wounds were found on the female decedent, one above the inner part of the right eyebrow, another directly below the right eye, and the third in her chest, slightly to the left of the frontal longitudinal line of the body. The path of the two wounds to her face went to the left, almost horizontally, pulverizing the brain tissue. The exit wounds were found in the left parietal area of the head. Circling both entry wounds (7 mm in diameter) was a large ‘‘gunpowder tattoo’’ measuring 15 9 10 cm, which was wider on the right side of the wound. Additionally, a thick layer of soot was located around the cheekbone wound. This soot was distributed along the left cheekbone area, the right side of the nose, the right half of the upper lip, the upper section of the right eyelid, and laterally to the right eye. The skin next to the outer angle of the right eye had areas without any soot, resulting in the appearance of ‘‘crow’s feet’’ (Fig. 1). Also, the lines that corresponded with the facial curves, such as the nasolabial fold, the fold between the nose and the cheek, and the fold around the ala of the nose, had no soot deposits. The chest wound (8 mm in diameter) was located in the left breast, 3 cm to the left of the middle longitudinal line of the body. It travelled through the heart, transected the aorta, passed superficially through the lower lobe of the left lung, and exited through the back, 7.5 cm to the left of the spine. 1,200 ccm of blood was found in the left thoracic cavity.

Polymorphisms in ACE and ACTN3 Genes and Blood Pressure Response to Acute Exercise in Elite Male Athletes from Serbia

Physiological adaptations to various types of prolonged and intensive physical activity, as seen in elite athletes from different sports, include changes in blood pressure (BP) response to acute exercise. Also, functional polymorphisms of the angiotensin I converting enzyme (ACE) and alfa-actinin-3 (ACTN3) genes are shown to be associated with BP parameters changes, both in athletes and sedentary population. In this study, an Alu insertion (I)/deletion (D) polymorphism in ACE gene, as well as nonsense mutation in the gene encoding ACTN3 have been scored in 107 elite Serbian athletes classified according to their sporting discipline to power/sprint (short distance runners/swimmers), endurance (rowers, footballers, middle-distance swimmers) or mixed sports (water polo, handball, volleyball players). Presence of nonfunctional allele in ACTN3 is associated with significantly increased maximal systolic BP (SBPmax, p = 0.04). Athletes with Alu insertion in ACE had significantly (p = 0.006) larger decline of systolic BP after 3 minutes of recovery (SBPR3), calculated as the percentage of maximal SBP response during exercise stress testing. Concomitant presence of non-functional variant in ACTN3 gene decreased this beneficiary effect of ACE mutation on SBPR3. Long term enrollment in power/sprint sports significantly increased resting diastolic BP (DBPrest: 74 mmHg) and SBPmax (197 mmHg) and improved SBPR3 (74.8%) compared to enrolment in endurance (72 mmHg; 178 mmHg; 81.1%) and mixed sports (69 mmHg; 185 mmHg; 80.0%). Lack of the effect of genotype by sport interaction on BP parameters suggests that the long-term effects of different disciplines on BP are not mediated by these two genes.

The value of the post mortem analysis of carboxyhemoglobin concentration in the blood: A 15-year study

Online fi rst: October 3, 2017 SUMMARY Introduction/Objective The purpose of this retrospective study was to assess carboxyhemoglobin (HbCO) concentration in all autopsy cases of fire and non-fire victims – all those who have been suspected to be under the influence of carbon monoxide (CO) in the Belgrade area during a 15-year period (1990–2005). Methods Correlations between the concentration of HbCO, circumstances of death, vital signs, and prior health conditions, smoking and history of alcohol-abuse, have been particularly analyzed in 192 autopsy cases. Results The investigation included 52 (27%) females and 140 (73%) males, their average age being 50.78 years. CO poisoning has been established as the cause of death in 74 cases (38%). The manner of death in 170 cases (89%) was an accident, in eight (3%) suicide, in two (1%) murder, in 11 (6%) natural death, and in one case the manner of death hasn’t been established. Such distribution of the manner of death differentiates this study from others of similar type, and it is conditioned by the specificity of life in this region. Conclusion The predictors of a high HbCO concentration are the sex, cause of death, manner of death, soot aspiration, lower-degree burns. According to the results, we profiled a typical victim of CO poisoning.

The training type influence on male elite athletes’ ventilatory function

Background/aim To assess and compare measured ventilatory volumes (forced expiratory volume in 1 s (FEV1), peak expirium flow (PEF) and maximal voluntary ventilation (MVV)), ventilatory function capacities (forced vital capacity (FVC) and vital capacity (VC)) and FEV1/VC ratio in a sample of power and endurance elite athletes and their age-matched and sex-matched sedentary control group. Methods A cross-sectional study was applied on male elite athletes (n=470) who were classified according to the type of the predominantly performed exercise in the following way: group 1: endurance group (EG=270), group 2: power athletes group (SG=200) and group 3: sedentary control group (CG=100). The lung VC, FVC, FEV1, FEV1/FVC ratio, PEF and MVV were measured in all of the observed subjects, who were also classified with regard to body mass index (BMI) and the percentage of the body fat (BF%). Results The CG had the highest BF% value, while the endurance group had the lowest BMI and BF% value, which is significantly different from the other two groups (p<0.05). The observed values of VC, FVC and FEV1 in the EG were significantly higher than those from the other two groups (p<0.05). There were no differences concerning the observed FEV1/FVC ratio. Conclusions A continued endurance physical activity leads to adaptive changes in spirometric parameters (VC, FVC and FEV1), highlighting the fact that there is a need for specific consideration of different respiratory ‘pattern’ development in different types of sport, which also has to be further evaluated.

Analysis of closed soft tissue subcutaneous injuries-"impact décollement" in fatal free falls from height-forensic aspect

Abstract The aim of this study was to assess the frequency of “décollement,” traumatic lesions of subcutaneous soft tissue, among victims fatally injured because of falls from different heights. Three hundred seventy-five cases of fatalities due to injuries acquired when falling from various heights onto a solid, flat surface, in which the complete forensic autopsy was performed, were analyzed. Décollement was noted in 125 (33%) of the cases. Comparative analysis of groups with and without décollement and observed factors has shown that the height of fall and the manner of death have statistically significant influence on décollement appearance. With regard to suicidal, accidental, or undefined origin of death décollement is statistically more common in accidental deaths. Décollement provides important clues for forensic reconstruction and could be a significant indicator of the bodys position at primary impact and the height from which the victim has either jumped or fallen.

A Case of a Fatal Himalayan Black Bear Attack in the Zoo

Abstract:  We present a case of a 22‐year‐old male, who was found inside the cage of Himalayan black bears in the Belgrade Zoo. The victim attended the Belgrade Beer festival the previous night, drinking a lot of beer and acting aggressively. A medico‐legal autopsy was performed at the Institute of Forensic Medicine in Belgrade. Autopsy findings showed numerous excoriations all over the body surrounded by bruises, as well as spindle‐shaped, oval, and partly irregular wounds of variable size, large defects of skin and subcutaneous soft tissue, fractures of the thyroid and cricoid cartilage, and fracture of ribs. Postmortem toxicological analysis revealed the presence of ethanol in vitreous humor and urine and 11‐nor Δ9 tetrahydrocannabinolic acid found in the urine. We discussed similar cases from the available literature in different regions of the world. In conclusion, we pointed out that the presented case does not follow the general pattern of Himalayan bear attacks.