The facial-bone fractures among fatally injured car occupants in frontal collisions.

The retrospective study was performed of all deceased car-occupants in frontal car collisions in order to identify persons with facial-bone fractures. The sample consisted of 482 cases: 378 males and 104 females, average age of 39.59+/-16.01 years. There were 239 car-drivers, 194 front-seat passengers, and 49 rear-seat passengers. In 46 of 482 cases, single fracture of upper facial bones was established: nasal fractures were the most common, followed by zygomatic. In 118 of 482 cases, fracture of upper facial bones was established, as well as 70 cases of jawbone. The fractured facial bones either of the upper or lower face could not be a factor that predicts the position of the deceased in the motor vehicle at the moment of injury (lambda=0.989, p>0.05). The multi-fractured facial-bones were very often associated with the multi-fractured cranial bones - 85 cases (chi(2) =138.75, df=8, p<0.001), as well as jawbone fracture - 35 cases (chi(2) =20.52, df=4, p<0.001). Brain injuries were more present and more severe (coup and contrecoup-contusion and brain laceration) if more facial-bone fractures were involved (chi(2) =147.99, df=8, p<0.001). Cases with only contrecoup brain contusions, associated with multi-fractured facial-bones, were rare - 6 of 118. These fractures are very often associated with cranial fractures, as well as with brain injuries and were caused by intensive contact of the deceased's head with the car's pillar.

Concentration of carbon-monoxide in carbonized bodies--forensic aspects.

The aim of this paper is to determine the correlation between carbonized fire victims' carbon-monoxide (CO) blood concentration and the cause of death. We have reevaluated and analyzed the causes of death over a 10-year period regarding CO concentrations and atherosclerosis. We have considered the possible usefulness of low CO concentrations as a vital sign in smokers and non-smokers. The study included the retrospective analyzes of 73 autopsy reports of carbonized bodies. All the autopsies were carried out in the Institute of Forensic Medicine in Belgrade over a 10-year period (1990-1999). The investigation included 53 men and 20 women (chi(2)=19.83, p<0.001) with an average age of 41.40+/-21.35 years. We found 10 cases of deadly carbon-monoxide poisoning, but further analysis of CO concentrations revealed 6 more cases in which CO poisoning could be considered. We found a statistically significant relationship between carboxyhaemoglobin concentration above 10% and the aspiration of soot (chi(2)=6.41, p<0.01). In five cases with serious atherosclerosis, the concentration of carboxyhaemoglobin was above 20%, although these concentrations can be accepted as the cause of death. Half of the deceased, in the moment of death were under the influence of alcohol and 19 of them had a blood alcohol concentration above 1 pro mille.

Characteristics of chest injury in falls from heights.

This study included 660 victims injured due to high fall. All cases are with injuries caused by the free-fall model of high fall. The range of the heights was from 0 to 70 m. The sample was divided into three groups of growing height: low falls up to 7 m, high falls from 7 to 30 m, and very high falls above 30 m. Statistical analysis was performed using two way ANOVA according to Scheirer-Ray-Hare in complete uneven block. Males were 71% (469), females 29% (191). In the analyzed sample, apart from the height of fall, the number of accidents is about 44% (290 cases) and suicides about 56% (370 cases). Thirty six percent, i.e., 238 of 660 victims had consumed alcohol before death (alcoholemia >0.5 per thousand). The objective of our study was to analyze characteristics of chest injuries made by falling from a height. The frequency of thoracic injuries is statistically significantly related to the height of fall (p<0.05); it increases constantly in falls from heights beyond 3m, so that the rib fractures were present in all falls from heights beyond 40m. The aortic ruptures were found in 21%, and the heart injuries in 16% of all cases. The frequency of aortic and heart ruptures was not statistically significantly related to the height of fall (p>0.05). A rupture of the aorta was the most commonly located on its arch (82%). The heart ruptures were the most commonly located on the atrial posterior wall (70%).

[Splenic injuries and mortality in polytrauma]. / Povrede slezine i mortalitet u politraumi.

Severe trauma is the leading cause of death in the working population. Traffic accidents are the most frequent etiological factor, with substantially more male than female victims. In this paper we have analyzed 53 cases of dead patients, among 240 severe traumatized treated in Center of emergency surgery, Emergency Center, CCS from January, 2000-June 2002. Spleen is the most frequent injured abdominal organ. In 34% surviving period was less than 72 hours. One-third of patients required at least two surgeries, including laparotomy. The most preciously diagnosis were performed in the cases of spleen injuries. The most common cause of death was cariopulmonal insufficiency, according both clinical diagnosis and forensic findings.

[Multidisciplinary investigations in dead persons suspicious of AIDS]. / Multidisciplinarna istrazivanja kod osoba umrilih pod sumnjom na ejds (AIDS).

The background of AIDS is the deregulation of the cellular immune system caused by HIV infection. AIDS has proved to be entirely different from any previous known diseases. It affects practically all the tissues and organs of the human body. Clinical and autopsy diagnoses are confronted with an incomparable diversity of inflammatory, vascular, degenerative and neoplastic changes. Thanks to clinical and pathological researshes, the medical knowledge of AIDS has rapidly progressed. The Institute of Forensic Medicine is, for now, the unique medical institution organized to perform obligatory autopsies of drug-addicts, to detect the other cases suspect of HIV infection or some AIDS indicative diseases. The aim of this study is to establish the basis for multidisciplinary investigations of AIDS and to solve very important problems such as: a) to accept the diagnostic criteria for correct diagnosis of AIDS, with or without laboratory evidence of HIV infection; b) to recognize the early stadium of clinico-pathological entities associated with HIV infection; c) to improve the "indicator" of AIDS disease for daily medical practice.

[Comparative analysis of sutured and stapled colorectal anastomoses]. / Komparativna analiza savnih i stapler kolorektalnih anastomoza.

In the period of 1987-1993 at the Clinic of General and Vascular Surgery, Military Medical Academy, 364 colorectal anastomoses were performed; the group I was composed of 167 patients with sutured anastomoses, and 197 patients with stapled anastomoses were in the group II. More than half of patients were over 60, and ratio between males and females was 2:1. The reason for resection in almost 90% of the patients was adenocarcinoma of the rectum of which in 40% of the patients the process advanced up to stages C and D by Dukes. Pathologic process in the group I was localized in the lower two thirds of the rectum in 24.6% of the patients, while the percentage in the group II was tripled--76.1%. Surgical wound complications were most frequent in both groups (14.3%:9.6%), and complications associated with anastomosis were less frequent in the stapler group. Clinically clear anastomosis dehiscence appeared in 11.4% of the group I and in 10.7% of the group II. Total mortality was 3.3% (Group I 3.6%, group II 3.0%). By comparative analysis of early complications after resection of the rectum with sutured or stapled colorectal anastomosis, it is concluded that the introduction of staplers in colorectal surgery facilitated the easier accomplishment of larger number of low-lying colorectal or coloanal anastomoses, which are safer and followed by fewer complications, and with equal oncological disease control.

[Abdominal war injuries]. / Ratne povrede abdomena.

In the period of July 1, 1991-December 31, 1992, 4292 wounded were treated in the Military Medical Academy (MMA) in Belgrade. Out of 410 (9.6%) wounded with abdominal war injuries, 156 (38%) received the primary treatment in MMA and the remainder in other hospitals. One fifth of the wounded with abdominal injuries suffered combined injuries of more organs and 82.7% of the cases had multiple injuries of one organ or combined injury of two or more abdominal organs. Wounding caused by explosive devices prevailed (61.5%), and the most frequently injured organs were small intestine in 40% and colon in 30.7% of the cases. Reoperation due to complications was performed in 7% of the wounded primarily managed in MMA and 33.8% of there primarily managed in other hospitals. Total mortality due to the abdominal war injuries was 10.9%, while mortality in patients primarily managed in MMA amounted to 4.5% compared to 14.9% of those operated on in other hospitals.

[Comparative analysis of sutures and stapling for colorectal anastomosis in resection of the rectum in carcinoma]. / Komparativna analiza savnih i stapler kolorektalnih anastomoza kod resekcije rektuma zbog karcinoma.

In Clinic for general and vascular surgery - Military Medical Academy Belgrade since 1987 to 1993 in treatment of the rectal cancer it was done 326 low anterior resections. In 149 patients anastomosis was done with sutures and in 177 with stapler. Half of them were more then 60 years old, and in 40% of patients carcinoma was staged as Dukes C or D. In group I tumor was localised in the middle or distal third of rectum in 24.8% of patients while in group II this was in 75.7%. Anastomosis related complications where rare in stapler group, clinically evident anastomotic dehiscence was found in 11.4% patients in I group and in 99% in II group. Total mortality was 3.1%; 3.4% in the I group and 2.8% in the II group. In our comparative analysis of early complications after low anterior resection of rectum when colorectal anastomosis was done with suture or stapler technic we have found that stapler technic give opportunity for creating much more low colorectal anastomoses which are safe and with less complications and with the same oncologic control of disease.