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Slobodan Nikolić

Publications and source records attributed to Slobodan Nikolić.

12 recordsLinked to original sources
PubMed2007

Evaluation of the Suchey-Brooks method for aging skeletons in the Balkans.

This study has been carried out to examine whether the Suchey-Brooks (S&B) methods could be successfully applied in age assessment of populations from the Balkans. The known-age sample consists of 33 females and 52 males pairs of pubic bones collected from the autopsy cases. Age estimation by S&B method showed an accuracy of 89.74% in males and 72.0% in females. Statistical analysis showed a positive correlation between the actual age of the investigated individuals and age phases obtained by the S&B method, although the mean values of the sixth age category differed significantly compared with the original model. The most reliable indicators in both sexes were the relief of the symphyseal surface, lipping, symphyseal rim, and dorsal margin. The discriminating power of these indicators was the least reliable in distinguishing S&B phases 2 and 3. Based on these results, the appropriate recommendations for aging Serbian populations are made. There was a good agreement between two observers (kappa=0.726).

Adolescent↗
PubMedDate not supplied

[Analysis of causes of death in long-term survivors of injuries sustained in traffic accidents].

INTRODUCTION: The manner of death, i.e. if death is moros or violent, is the most important fact for the court and therefore, the most important part of the finding of autopsy reports [1]. To recognize the manner of death in cases with long outliving period after injury could be difficult for forensic pathologists. In such cases, the dissector should be able to point out the direct relationship between initial injury and death by using his (her) own experience and medical knowledge. Could the deaths provoked by low injuries be prevented? These injuries have score of 3 by Abbreviated Injury Scale (AIS) i.e. 12-20 by injury Severity Score (ISS) [3-5]. PURPOSE: The purpose of this paper is to suggest the measures for improvement of postmortem autopsy diagnosis of causes of death in cases with long outliving period (more than 15 days) after initial traffic injury. MATERIAL AND METHOD: A retrospective autopsy study was performed. It included the material of the Institute of Forensic Medicine in Belgrade for 1998. The autopsy report and accessible clinical medical data were analyzed for persons fatally injured in traffic accidents who outlived trauma more than 15 days. The sample was statistically prepared (chi 2 test, correlation coefficient). RESULTS AND DISCUSSION: The sample included 31 persons injured in traffic accidents with outliving period longer than 15 days: 21 males and 10 females (chi 2 = 0.047; p > 0.1). Average age was 49.90 years (SD = 18.28). All persons in our sample were over the age of 19. The most commonly injured persons were pedestrians (16). The mean outliving period was 41.19 days (SD = 12.60). There was a weak positive correlation between outliving period and age in our sample (coefficient of linear correlation r = 0.35). The authors combined the autopsy and available clinical data in order to get the ISS value for each case. The mean ISS value was 36.18 (SD = 8.70). There was no correlation between outliving period and severity of trauma (coefficient of linear correlation r < 0.14). All deaths in our sample were violent according to autopsy reports. In autopsy reports, dissectors always noted only one injured body region: head and neck injuries in 21 cases, chest injuries in 3, trauma of locomotor system in 5 and in 2 cases abdominal injuries. However, by analyzing these reports, the authors emphasized that in 22 cases one body region was severely injured, in 7 cases two body regions and three regions in 2 cases. According to the authors severe injury has score 3 or more by 3. In four cases the dissectors pointed no complication of initial injuries as a competitive cause of death. In 15 cases they mentioned it as general, and in the rest of cases as decided (e.g. pneumonia, sepsis, thromboembolism, etc.). In five cases, the complications of initial injury were the precipitated and immediate cause of death (the initial injury in all these cases was less than 16 by ISS i.e. severe but not critical). The seven cases were treated microscopically. These microscopical findings only proved the already established microscopical autopsy findings and were not crucial for case solution. It was alarming, that one third of cases in our sample were completed without considering the clinical medical data. This is forensic vitium artis. Nowadays, there are a few syndromes which could be the cause of death i.e. fat embolism syndrome [7], multiple organ failure) [8, 9] and systemic inflammatory response syndrome [9, 10]. The diagnosis of these syndromes is possible only clinically: the autopsy and histological findings are not specific. CONCLUSION: As long as a direct chain of events can be traced from the injury to the death, then the initial injury must be considered to be the basic cause of death, and this fact may have profound legal implications for both civil compensation and criminal responsibility. Some of the most difficult problems in forensic pathology concern deaths from which posttraumatic complications are disputed as being fatal causative factors. The agony and dying are irreversible dynamic pathophysiological processes. By autopsy only the morphological consequences of these processes could be noted by dissector. The dynamics of dying, direct correlation between initial injury and death, as well as appearance and development of complications provoked by trauma could be established only by clinical medical data. Therefore, medical clinical data are crucial for forensic pathologists and for solving the problems about the mode and manner of death in cases with long outliving period. Microscopical findings have only academic and scientific importance and are less useful in daily practice. The authors suggest that all complications of injury must be generally involved in autopsy reports, and all severe injuries should separately be registered both in medical data and autopsy reports. The finding of cause of death must include all observed severe injuries and not only one of the most severe injuries and its complications.

Accidents, Traffic↗
PubMedDate not supplied

[Sudden cardiac death caused by complicated atherosclerosis of the anterior intraventricular branch of the left coronary artery with a myocardial muscle bridge].

When coronary artery, which is located subepicardially, submerges into myocardium and then, after a short intramural course, again appears subepicardially, it is called embedded coronary, while a part of myocardium above--a myocardial bridge. Muscular bridges are usually small and have no clinical significance. In the proximal part of coronary artery, preceding a myocardial bridge, there occurs a disturbance of blood course and myocardial perfusion, turbulence, collecting of lipids and mucopolysaccharides, lesion of elastica, which all leads to atheromatous lesions of intima of the arterial proximal part and to the resultant complications of atheroma. Degenerative changes of myocardium and its blood vessels, and in connection with it myocardial vulnerability, could be a consequence of this congenital arterial variation. We report a case of a 40-year-old male, without medical data about previous diseases, who died suddenly and unexpectedly in his apartment. The autopsy and microscopical examination revealed an acute ischemic lesion, myocardial bridge in the middle part of the left coronary artery descending branch and the complicated atherosclerotic plaque proximally of this bridge.

Adult↗
PubMedDate not supplied

[Factors which could affect the severity of post-traumatic pulmonary fat embolism--a prospective histological study].

INTRODUCTION: Each fracture of long or pelvic bones as well as large contusions of subcutaneous fat tissue cause releasing of fat globules that rapidly penetrate into circulation through the ruptured veins of the injured tissue, and reach the lung circulation [1,2]. During the first phase, fat emboli block the functional lung circulation by their mechanical effect in capillaries producing so called isolated post-traumatic lung fat embolism [3]. The surface layer of a fat embolus, which is practically in liquid state, behaves as a membrane of very high density, i.e., as it is under high pressure which obstruct the blood stream [4] that is finally stopped at the level of lung blood vessels with diameter of approximately 20 mu [5]. This pathophysiological mechanism produces cor pulmonale acutum, with poor pathological findings [8]. Nowadays, the post-mortem diagnosis of lung fat embolism is based on microscopical examination of tissue specimens, usually prepared with special histological staining (Sudan III) [9]. The grading of fat embolism according to Sevitt's criteria is generally accepted [10]. Taking of slices from apicoventral areas of the lungs has been recommended [11]. With longer outliving period, the total number of fat emboli in the lung circulation gradually decreases, due to their disintegration and resorption. It has been stated that fat globules completely disappear about 4-6 weeks after injury, and that they should not be searched for microscopically in this post-traumatic phase [11]. OBJECTIVES: The aim of our work was to determine whether the age of injured, their gender, total severity of trauma, outliving period, and hypovolemic shock that develops after injuring, may induce development of more severe forms of post-traumatic lung fat embolism. MATERIAL AND METHODS: A prospective histological study was performed on the autopsy material of the Institute of Forensic Medicine in Belgrade. The analyzed sample consisted of individuals with injuries that might be a source of fat emboli (fractures of long bones, large contusions of subcutaneous fat tissue). The lung slices were systematically taken and stained with special fat staining (Sudan III). In each particular case, the grade of lung fat embolism was counted on the basis of microscopical appearance, according to Sevitt's criteria. The total severity of trauma was estimated by calculation of the Injury Severity Score (ISS) [13, 14]. In no cases from the analyzed sample, the fat embolism was mentioned as either singular or plural cause of death. The obtained results were analyzed by means of appropriates statistical methods (ANOVA, LSD-test, chi 2 test. Man-Whitney test, Fischer's test of correct probability). RESULTS AND DISCUSSION: The analyzed sample included 58 fatally injured individuals, 39 males and 19 females. The average age was 54.10 years (SD = 16.56), the average value of ISS was 34.69 (SD = 5.88), and the average outliving period was 3.74 days (SD = 5.88). However, all these data look differently when the analyzed sample has been stratified and analyzed according to the estimated grade of lung fat embolism. It was not showed that severity of lung fat embolism depends on sex of the injured (chi 2 = 0.842; p > 0.05). The groups with the slightest and the most severe grade of lung fat embolism are statistically significantly different in relation to age of individuals (ANOVA, p = 0.017). By means of LSD test, it has been showed that the group with the most severe grade of lung fat embolism (grade III) is statistically significantly different comparing to other two groups (with grade I and II) in relation to the age of injured (the values are p = 0.16 and p = 0.19 respectively, and the both groups are less than p = 0.05). In the group with the most severe grade of lung fat embolism, the older individuals are statistically significantly represented comparing to other two groups. CONCLUSION: The analysis of our sample showed that the most severe grade of post-traumatic lung fat embolism (microscopical grade III according to Sevitt's criteria) was determined in older individuals, more severely injured, and with shorter outliving period. The severity of fat embolism depends neither on sex of the injured, nor on development of post-traumatic hypovolemic shock. The obtained results related to the influence of hypovolemic shock on severity of fat embolism should be accepted with a caution. Namely, sometimes there is an intention to simplify a procedure of creating of autopsy conclusion about the cause of death, so that loss of blood is not mentioned at all, in spite of fact that it could have been a concurrent cause of death, while in other cases exsanguination is designated as a sole cause of death, forgetting the possibility that fat embolism could have really been the immediate cause of death.

Adult↗
PubMedDate not supplied

[An accident after an accident--an unusual death in a hospitalized patient].

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 symptomatology (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 resuscitative 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.

Accidents, Traffic↗
PubMedDate not supplied

[Suicide by electrocution--2 case reports].

Suicides by electrocution are extremely rare in our country. In these cases, specific or characteristic external lesions caused through contact with conductors at the sites of entry and exit of the current, as well as general autopsy findings, and excluding the other possible causes of death, are important to elucidate them. Dilemma if death was suicidal, homicidal or accidental in manner, could be solved through good police investigation, and properly explained circumstantial events. Herein, we reported two cases of suicidal deaths, caused by electrocution. In the first case, it was a male, age of 32, who wrapped the electrical cord around his wrists, and killed himself by plugging it in. In second case, it was a female, age of 46, abused by her husband, who committed suicide by putting the switched hear-dryer into the water in bathtub.

Adult↗
PubMedDate not supplied

[Level of total injury severity as a possible parameter for evaluation of height in fatal falls].

The injuries caused by high falls from over the seventh floor are considered mostly fatal. It is possible to survive the high fall from over 30 metres at landing on the surface of high deformity (snow or water). The Injury Severity Score (ISS) due to a high fall is influenced by the height from which the body has fallen, then, the body and surface features, and finally, the manner of body impact on to the surface. The aim of the study was determining the possibility of the height estimation that caused the fatality of the impact, considering the severity of injury expressed by ISS. A retrospective autopsy study was done on the materials of Institute of Forensic Medicine in Belgrade, during a twenty-year period: 1981-2000. The autopsy records were analyzed together with clinical medical data, of the deadly injured due to high falls on to a solid surface. ISS value was determined in each case. The height of fall was determined on the basis of police reports, i.e. death scene analysis. The results were done statistically (linear correlation). The sample included 660 cases: 469 males (71%) and 191 females (29%). The average age of the examined sample was 44.66 (SD=6.62). The number of 290 cases (44%) were accidental deaths, while 370 were suicidal ones (56%). Only few injured due to high falls up to 7 metres had ISS value below 26. Deaths in these cases were caused by complications of the injuries. The ISS value in the injured rose with the height from which the victim had fallen: ISS was 25 in all falls over 7 metres of height. In all cases were severe, critical injuries of one organic system (mostly severe head injuries). According to the analysis of our sample, we concluded that it was not possible to determine the precise height of fatal falls only on the basis of the injury severity score estimation by ISS. This determination, approximate one, was possible only in falls on to a solid surface up to 30 metres. The same determination was not possible by the analysis of the time of survival. It is obvious that determining the height of fall is more possible by types and combinations of single injuries which are, single or combined with other injuries, characteristic for single mechanisms of primary body contact with the solid surface depending on the height of fall.

Accidental Falls↗
PubMedDate not supplied

[Correlation between the survival duration and trauma severity in persons who died from posttraumatic fat embolism].

INTRODUCTION: Posttraumatic fat embolism follows the injury. The fat emboli in circulation could cause death in three ways: isolated lung fat embolism, systemic fat embolism and fat embolism syndrome (FES). In forensic pathology, only two trauma scores, based on disintegration of anatomic structures, could be used for objectivization, comparison and establishment of severity of injuries. One of them is Injury Severity Score--ISS, based on Abbreviated Injury Scale--AIS. The second one is Hannover Polytrauma Score--HPTS, based on the total sum of all injuries and age of the injured person. OBJECTIVE: The objectives of this paper were to establish the correlation between outliving period and trauma severity (based on ISS and HPTS values), in persons died from posttraumatic fat embolism and/or its complications, and to establish which of these score systems could be better for prediction of development of the posttraumatic fat embolism. METHOD: The retrospective autopsy study was performed and it included the material of the Institute of Forensic Medicine in Belgrade for period 1988-2001. The autopsy reports and clinical medical data were analyzed, for persons died from posttraumatic fat embolism and/or its complications. In all cases, the fat embolism was the single cause of death, verified by autopsy. In each case, ISS and HPTS values were obtained. The sample was statistically prepared (chi2 test, correlation coefficient, regression line). RESULTS AND DISCUSSION: The sample included 50 persons: 41 males and 9 females. The proportion of men was statistically significant (chi2 = 20.480; p < 0.001). Average age of male was 55.26 years (SD = 21.39) and of female was 55.78 (SD = 17.45). There was no statistically significant disproportion among the age distribution of the sample (chi2 = 6.4; p > 0.05). The outliving period varied from 1-14 days: the average was 5.92 (SD = 3.39; Med. 5.50; Mod. 2). The average value of 1SS was 19 (SD = 7.70; Med. 19; Mod. 14), and for HPTS average value was 28.16 (SD = 12.87; Med. 26.50; Mod. 12). In literature, there have been data about critical ISS value: 12-20. HPTS value of 20 to 35 was lethal in 25%. Each injured of our sample had, at least, one long bone or pelvic fracture. There was negligible negative correlation between outliving period and 1SS and HPTS values in our sample: coefficient of linear correlation r = -0.117, t = 0.83 and r = -0.088, t = 0.59. Our sample was representative (t = 8.37). These data pointed out that the outliving period of the observed patients, died from post-traumatic fat embolism, was not in relation to general severity of injuries but to fat embolism per se and its consequences. There was low positive correlation between ISS and HPTS values: r = 0.296, t = 2.147, coefficient of determination r2 = 0.0876 and linear regression HPTS = 18.7588+0.4948 ISS. These data indicated that direct correlation between scores was only about 9% and the rest of correlation i.e. 91% depended on other factors. CONCLUSION: There was negative negligible correlation between outliving period and severity of injury based on ISS and HPTS, in patients died from posttraumatic fat embolism. So, these score systems are useless for prediction of duration of the outliving period in the injured died from fat embolism as well as for prediction of posttraumatic fat embolism as cause of death.

Embolism, Fat↗
PubMedDate not supplied

[Subarachnoidal hemorrhage from saccular aneurysms as a cause of natural death].

INTRODUCTION: Subarachnoidal hemorrhage (SAH) is the fourth most common intracranial cause of death. Approximately 50 to 85 percent of non-traumatic SAH is caused by rupture of congenital berry aneurysm. Symptoms of rupture are typically sudden and without any heralds. In most SAH cases, the vasospasm following the rupture is the most probable cause of death. In forensic pathology, an isolated SAH episode after minor head trauma should be considered dubious, and as mode of death. OBJECTIVE: The objective of this paper was to establish the frequency of sudden natural death caused by SAH originating from ruptured berry aneurysm and to establish the epidemiologic characteristics of the deceased, as well as pathoanatomic characteristics of ruptured aneurysms. MATERIAL AND METHOD: A retrospective autopsy study of the material of the Institute of Forensic Medicine in Belgrade was performed over a period of eighteen years. Some risk factors were estimated: smoking habits, hypertension, alcoholism, and stress 24 hours preceding the rupture. The following pathoanatomic features of berry aneurysms were determined: localization, size, number, spread to surrounding structures and any association with atherosclerosis of brain blood vessels. RESULTS: The analyzed sample consisted of 63 examined individuals: 33 male and 30 female. Their age ranged from 9 to 89 years, with mean age of 46.2 +/- 14.5 years. In our sample, there were 47 smokers (25 male and 22 female), 41 individuals who suffered from hypertension (22 male and 19 female), and 15 alcoholics (14 male and one female). In our sample, physical or mental stress preceded the berry aneurysm's rupture in 26 cases. Most of fatal berry aneurysms were localized in the anterior part of the circle of Willis (41 of them): 20 of them were localized in bifurcations. In 46 cases, the berry aneurysms were less than 5 mm in diameter, in 10 cases with a diameter measuring 5 to 10 mm and in 7 cases the aneurysms were larger than 10 mm in diameter. The association with macroscopically visible atherosclerotic lesions of the arteries of the circle of Willis was evident in 34 cases. Nine people had multilocular berry aneurysms. Polycystic kidney disease associated with berry aneurysms was evident in nine cases. DISCUSSION: The difference between the number of males and females in our sample was not statistically significant (c2=0.014; p>0.10). The age of the deceased mostly ranged from 30 to 60 years. There was no significant difference between the mean age of the males and females in our sample (t=1.65; p>0.05). In our sample, statistically significant localization of fatal berry aneurysm was the anterior part of the circle of Willis (c2=5.74; p<0.05). The frequency of the berry aneurysms larger than 10 mm in diameter was less significant than those with smaller diameters (c2=31.10; p<0.001). The individuals in our sample with aneurysms smaller than 5 mm in diameter were not significantly younger than individuals with larger ones (t=0.98; p>0.05). The number of individuals in our sample with berry aneurysms associated with atherosclerotic lesions was not statistically significant (c2=0.32; p>0.1). CONCLUSION: Sometimes, it is not possible to detect the exact localization of the ruptured berry aneurysm: the rupture may destroy the aneurysm completely. In such case, an autopsy should rule out other possible sources of intracranial bleeding, such as vascular malformations, intraventricular spreading of intracerebral hematomas, neoplasia, hematological disorders, etc.

Adolescent↗
PubMedDate not supplied

[Suicide by intravenous injection of rocuronium-bromide--case report].

Suicides by intravenous injection of an overdose of medicaments are uncommon. In this paper, we present the case of a suicide by rocuronium-bromide injection in combination with an oral overdose of metoprolol. Unfortunately, in Belgrade, there is no toxicological laboratory capable of detecting rocuronium. The interpretation of autopsy and toxicological data in this case was made difficult due to the extreme putrefaction of the body of the deceased. So, by forensic investigation, the case was solved indirectly, through circumstantial evidence: an empty ampoule of rocuronium found near the body, as well as a plastic syringe and cloth-bandage found in the left hand of the deceased.

Adult↗