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Introduction. Herein we present an illustrative case from the Forensic Museum collection made by Professor Milovan Milovanović (1884–1948). Museum specimen No. 465 represents a jar containing three glass syringes and two small bottles of 10–20 ml, sealed with corks, found in the pockets of the deceased whose autopsy was performed in 1929. Case outline. It was a 30-year-old male, found dead in a tavern shed, a former medical student, lieutenant, and Russian emigre who came to Belgrade, Serbia in 1921 following the commanding general of the anti-Bolshevik White Army, Pyotr Nikolayevich Wrangel. He was an alcoholic, a drug user, and a member of the so-called Russian cocaine quartet gang. In the autopsy report, Professor Milovanović described a textbook example of a drug user: extremely malnourished body, skin covered with scabs, multiple „purulent abscesses” and „livid infiltrations,” and attenuated nasal septum with mucosa covered with scabs. Internal autopsy findings included fatty liver, pneumonia, and anemia of all internal organs. At the time, the whole brain, tissue of internal organs, and contents of the stomach and intestines were used for the analysis (“the Stas–Otto method for extraction of alkaloids”). Qualitative analyses showed “the presence of cocaine” in all the examined organs, and the analysis of the content from the “cloudy, colorless liquid” found in the dark bottle showed that it contained “0.0113 g of morphinum hydrochloricum.” Conclusion. Contemporary analyses of the material from one of the syringes and the transparent glass bottle performed 90 years later showed the presence of cocaine, morphine, and codeine, confirming that the cause of death was drug-related.

Introduction. The occurrence of gastric mucosal ruptures during cardiopulmonary resuscitation (CPR) is contributed to extensive gastric distention, either due to mouth-to-mouth resuscitation or the use of a bag and mask, or inappropriate intubation that may lead to gastric hyperinflation, which then creates gastric distension and further promotes gastric rupture. The presented case suggests that there might be another mechanism – chest compressions during CPR. Case outline. We present a case of an 84-year-old woman who died due to severe chronic ischemic heart disease after unsuccessful resuscitation. The autopsy revealed a presence of several shallow ruptures of gastric mucosa on the lesser curvature, 1–3 cm in length, with surrounding mucosal hemorrhage, and without bleeding in the gastric cavity. Conclusion. Gastric mucosal ruptures could occur due to a combination of two mechanisms: pressure propagation due to chest compression and gastric hyperinflation [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 45005]

The Institute of Forensic Medicine, as part of the University School of Medicine in Belgrade, Serbia, was founded in 1923 by Professor Milovan Milovanović (1884–1948). In addition to several medical textbooks in modern Serbian for medical students, as well as 37 original papers published in Serbian, German, and French medical journals, Professor Milovanović also published a famous monograph entitled “Suicide” in 1929. In 1948, Professor Milovanović himself committed suicide under obscure circumstances. The reason he committed suicide remains unknown. In this paper we tried to reconstruct the way he wrote his monograph using data from his hand-writing manuscripts preserved at the Institute of Forensic Medicine. Also, some new data about his suicide have been exposed. Since 2008, the Institute of Forensic Medicine in Belgrade has been named after Professor Milovan Milovanović.

Introduction. When the coronary artery, located subepicardially, submerges into the myocardium and appears again subepicardially after a short intramural course, it represents an embedded coronary artery, while the part of the myocardium above is a myocardial bridge. Objective. We investigated the frequency of the embedded left coronary artery (LAD) in the autopsy material considering the descending branch of the LAD to be the most important one in the nourishment of the myocardium and myocardial bridges to be the most frequent in its area, as well as clinically important. Methods. A prospective autopsy study of 975 cases was performed, including both, natural (21.33%) and violent (78.67%) deaths. The sample consisted of 74.56% males and 25.44% females. In order to discover myocardyal bridges and their characteristics, the hearts were examined by both transverse cuts and longitudinal openings of the LAD. Results. Myocardial bridge was found in 78 cases (8.00%), more commonly in males (9.35%) than females (4.03%). The average length of the myocardial bridge was 21.85±16.10mm and thickness 3.744±1.48 mm. The common localization of the myocardial bridge was the proximal half of the LAD (89.74%). The upper part of the artery, proximal to the bridge, was a common site of atherosclerotic changes. Myocardial bridge was found in 12.50% of natural deaths, but in 13.38% out of all cases of sudden cardiac deaths. Conclusion. Therefore, the presence of the myocardial bridge by itself is not predominant, but it is certainly a contributing factor to a sudden cardiac death. [Projekat Ministarstva nauke Republike Srbije, br. 175093]

Hanging is a form of ligature strangulation in which the force applied to the neck is derived from the gravitational drag of one’s own body weight. A furrow - dessication is the most common form of ligature mark on the skin. The furrow is a postmortem phenomenon due to ligature pressure and it is more detectable as the suspension time becomes longer. Vital reaction is a phenomenon that shows if the injury was premortal. Vital signs could be present at the injury site, thus it is termed as local, but they could also be remote from the injury site, and then they are termed general vital signs. The presence and recognition of any vital reaction in each pathoforensic case indicate vitality of certain injury, which is sometimes exceptionally useful in solving the case under investigation. Although in cases of hanging there is usually no question about the vitality of injury, this does not mean that one should not recognize the type of vital reactions and location of occurrence of these phenomena in such cases. Most often they can be also useful in the reconstruction of the mechanism. This paper presents most common vital reactions in hanging, with explanation of their underlying mechanisms, and their significance in forensic pathology is pointed out. [Projekat Ministarstva nauke Republike Srbije, br. 45005]

Introduction. The Institute of Forensic Medicine was founded by Professor Milovan Milovanović (1884- 1948) in 1923 as part of School of Medicine of the University of Belgrade, and also established the Institute’s forensic collection worthy of a museum. This paper illustrates the way Professor Milovanović made this collection into a teaching aid for student education. We present a case of crime of passion from the year 1931, from our Institute’s collection. Case Outline. The victim was a 30-year-old woman with multiple stab wounds of the head, neck and arms. It was noted in the case history that the deceased woman was a maid with a wealthy merchant, as well as that she had “dubious morals” for that time, with three wooers at the same time. Injuries to the forearms and the index finger prove that the victim tried to defend herself. In the autopsy record there is a drawn figure of a kitchen knife with a rounded blade tip, which explains the absence of stab wounds to the skull, and the presence of the impression skull fractures and crushed skull bones. It was concluded that the death occurred due to exsanguination, in turn due to transection of the left carotid artery, probably caused by sharp force, while the manner of death was homicide. Some of the most prominent autopsy findings were multiple mutilating overkill sharp force injuries, localized on the head, indicated sexually motivated murder. Conclusion. Combining the museum specimen, diagrams with injuries, drawn figure of the kitchen knife used, and photographs taken during the autopsy and the police investigation, Professor Milovanović was able to properly illustrate this intriguing case to students without a computer or a PowerPoint presentation. [Projekat Ministarstva nauke Republike Srbije, br. 45005]

Introduction. Subendocardial hemorrhages are grossly visible bleedings in the inner surface of the left ventricle, the interventricular septum, and the opposing papillary muscles and adjacent columnae carneae of the free wall of the ventricle. These are commonly seen in sudden profound hypotension either from severe blood loss from “shock” in the widest sense and, even more often, in combination with brain injuries. Case Outline. We present a case of a 38-year-old man, injured as a car driver in a frontal collision, who died c. 45 minutes after the accident. The autopsy revealed severe chest trauma, including multiple right-sided direct rib fractures with the torn parietal pleura and right-sided pneumothorax, several right lung ruptures, and a rupture of one of the lobar bronchi with pneumomediastinum, and prominent subcutaneous emphysema of the trunk, shoulders, neck and face. The patchy subendocardial hemorrhage of the left ventricle was observed. The cause of death is attributed to severe blunt force chest trauma. Conclusion. We postulate pneumomediastinum leading to extrapericardial tamponade as the underlying mechanism of this subendocardial hemorrhage. [Projekat Ministarstva nauke Republike Srbije, br. 45005]

Introduction. Diseases of the gastrointestinal system, and especially diseases of esophagus, are a rare cause of sudden unexpected death in any age group. Black esophagus is an acute necrotizing inflammation of the mucosa of the lower parts of esophagus, diffusely affecting its entire circumference. This inflammation could be a source of profuse bleeding and cause sudden unexpected death. Case Outline. A case of 76-year-old male was presented herein. He has been treated for hypertension and diabetes for several years. As a consequence of stroke, which happened several months prior to death, he had been hemiplegic and immobilized. He died in hospital, suddenly and unexpectedly. The autopsy showed the acute necrotizing esophagitis, as well as the acute gastric and duodenal erosions of mucosa. These were the causes of fatal blood loss. Conclusion. Acute necrotizing esophagitis should be recognized during autopsy and related to the immediate cause of death as well as to concomitant diseases of other organs, which either potentiate or facilitate presentation of this disease. [Projekat Ministarstva nauke Republike Srbije, br. 45005]

Introduction. Females who have developed addiction to heroin also abuse it during pregnancy. Heroin can be detected in the fetal blood-flow already an hour after maternal i.v. injection. Heroin metabolites enter the fetal blood-flow through the placental barrier by passive transport. Case Outline. We present a 27-year-old female in the 5th month of pregnancy that had a miscarriage. Chemo-toxicological analysis (gas chromatography with mass spectrometry - GC/MS), showed the presence of morphine in the fetal liver (31.92 ng/g), placenta (27.94 ng/g) and meconium (136.33 ng/g). The analysis did not show the presence of 6-monoacetylmorphine. Conclusion. In all cases when the autopsy of fetus or newborn is performed, with mother suspected as i.v. heroin abuser, chemotoxicological placental analysis, placenta and meconium should be also done. [Projekat Ministarstva nauke Republike Srbije, br. 45005]

Introduction. Carbohydrate-deficient transferrin (CDT) has been suggested as one of alcohol abuse indicators having produced good results in forensic medicine for years. Objective. The aim of the study was to identify correlation between present methodology of alcohol abuse diagnosis at autopsy (macroscopic and microscopic findings) and CDT examination using the method of isoelectrofocusing (IEF) in polyacrylamide gel electrophoresis (PAGE). We also analyzed if the time interval between the moment of death and blood sample collection influences CDT findings. Methods The method used for CDT analysis was IEF-PAGE. Sera of 49 males and 11 females aged 14-87 years, average age 46.85±18.53, were used in this study. Control group consisted of five patients who died after medical treatment that lasted longer than 15 days, and five patients who started Disulfiram therapy in controlled hospital environment. Results. The results obtained in CDT examination in dead bodies’ sera showed sensitivity 59% and specificity 71%. A high incidence of falsely positive CDT result was noticed in liver failure and cirrhosis of non-alcoholic origin. CDT analysis is also possible to be done in samples collected postmortem up to 76 hours. Conclusion. In forensic medicine, the method of CDT determination is reliable for the diagnosis of alcohol abuse.

Introduction. Bullet embolism is a special form of embolism, where embolus is either a bullet or its fragment. Bullet penetrates through the injured part of the body into circulation and then travels to a distant part of the body, until it gets blocked in a vessel of the same diameter as the bullet. Case Outline. We are presenting a case of gunshot injury in a 26­year­old male, found unconscious on the passenger seat, with the gunshot injury of the right hand and hemithorax, who died two hours after admission to hospital. Post­mortem X­ray revealed the presence of a metallic foreign body - a bullet, in the level of the left femoral neck. The autopsy revealed entrance and exit gunshot wounds of the upper third of the right upper arm. There was a second entrance gunshot wound, and the bullet passed through the right hemithorax and the right lung, and then through the intervertebral disc between the eighth and ninth thoracic vertebrae, and also making a complete laceration of the wall of the thoracic aorta, in the right posterior semicircumference. The slightly deformed bul­ let, caliber 7.65 mm, was found embedded in the lumen of the vessel at the bifurcation of the deep femoral artery from the left femoral artery. Conclusion. Bullet embolism is a rare complication of gunshot wounds. It should be suspected in any gunshot wound victim without an exit wound, or the lack of a missile in the bullet pathway, or if there are premortem signs or symptoms unexpected for the presumed pathway of the bullet, such as distant ischemia or infection. In these cases, some of postmortem imaging techniques should be used to save time in diagnosis, treatment and at autopsy.

Forensic pathologists sometimes need to determine seating positions of automobile occupants after road traffic accidents as accurately as possible. That could be of essential significance particularly in regard to the question of guilt both in the criminal and civil law. So far, medical surveys have implied the specific injury which would undoubtedly point at the allocation of the seating positions of fatally injured car occupant. Some of the injuries could occur by both direct and indirect force action. Same type of injury of the specific body region in both drivers and front seat passengers could occur by different mechanism and in different phases of the accident. Sometimes neither the order of injury occurrence remains unclear, nor whether some of the injuries are post­mortal. What makes it even harder is the fact that same body regions, i.e. head and thorax, are most affected in both drivers and front seat passengers, and that these injuries are often fatal. Even if the victim survives the accident for some time and later dies in hospital, the possibility of accident reconstruction and determination of car occupants seating position at the moment of accident declines with the time length of survival period. Examining the victims’ clothes, searching for biological traces, technical expert inspection of the vehicle, traffic expert analysis of the site, enables adequate reconstruction of the traffic accident. All this implies that in such cases the knowledge of underlying mechanism of car occupants’ injury is insufficient, and that a close cooperation between forensic pathologists and the team of other forensic technical experts is necessary. [Projekat Ministarstva nauke Republike Srbije, br. 45005]

Anatomically, brainstem is constituted of medulla oblongata, pons and mesencephalon. Traumatic lesions of brainstem most commonly occur on pontomedullary junction. There are several possible mechanisms of pontomedullary lacerations. The first mechanism includes impact to the chin, with or without a skull base fracture, and most often leads to this fatal injury, due to impact force transmission through the jawbone and temporomandibular joint. The second mechanism includes lateral and posterior head impacts with subsequent hinge fractures, where occurrence of pontomedullary lacerations in these cases may depend on the energy of impact, as well as on the exact position of the fracture line, but less so on the head’s movement. The third mechanism includes frontoposterior hyperextension of the head, due to frontal impact, concomitant with fractures or dislocations of upper spine. In the fourth mechanism, there is an absence of direct impact to the head, due to the indirect force of action after feet or buttocks­first impact. Most of these cases are accompanied by ring fractures as well. In situations such as these, the impact force is transmitted up the spinal column and upper vertebrae, and telescopically intruded into the skull, causing brainstem laceration. The jawbone and other facial bones can act as shock absorbers, and their fracture could diminish the energy transfer towards the skull and protect the brain and brainstem from injury. In all the cases with pontomedullary laceration posterior neck dissection should be performed during the autopsy, since upper spine injuries are often associated with this type of injury. [Projekat Ministarstva nauke Republike Srbije, br. 45005]

Introduction. In forensic autopsy, pathologists are not particularly interested in the anatomical morphological variations of the skull bones, especially if those variations are not very frequent. Foramina parietalia permagna are developmental benign anomalies resulting from large ossification defects of the parietal bone. Case Outline. Herein was presented a case of 80-year-old female, whose autopsy revealed congenital defect of parietal bones - enlarged parietal foramina. These defects were capped by a fibrous membrane and covered by normal scalp. This condition was completely asymptomatic. Despite the fact that the deceased was very old, the giant parietal foramina were recognized. Conclusion. The forensic pathologist must know how to recognize morphological variations of the skull bones, such as foramina parietalia permagna despite their rare occurrence. This benign anomaly could be associated with anomalies of cerebral venous development and cortical infolding, or asymptomatic as in the presented case. This anomaly of parietal bones could be a useful tool in the identification of forensic cases. [Projekat Ministarstva nauke Republike Srbije, br. 45005]

Introduction. Hanging usually ends in death, and about 80% of victims are found dead at the scene of the hanging. However, sometimes the hanging victims overlive for some time, and sometimes even survive the hanging. Objective. The aim was to determine the causes of death in nearhanging cases, in people who have been outliving hanging for some time, to explain the pathophysiological mechanisms leading to death, and to identify prognostic factors for this outcome. Methods. Retrospective autopsy study was performed for a twelve-year period. There were only seven cases of near hanging. The sample was analyzed according to gender, age, circumstances of death, and autopsy findings of all observed subjects. The relevant data were collected from autopsy records, police reports and heteroanamnestic interviews. Results. The sample consisted of five men and two women, average age 48.3±19.9 years (29-81 years). The average outliving period was 3.8±2.6 days (from 7 hours to 7 days). Six people were admitted to hospital in the state of deep coma. In six cases cardiopulmonary arrest occurred after the hanging attempt and all were reanimated for a shorter or longer time until admission at hospital. Conclusion. Survival after attempted suicide by hanging occurs extremely rarely. In all the cases, the immediate cause of death after attempted hanging was ischemic brain injury, with a significant and pronounced oedema. In all the cases observed, regardless of the presence or absence of injuries of soft and hard structures of the neck, there was a ligature mark on the neck skin. Acute hemorrhagic gastritis with melaena was present in a significant number of reported cases of near-hanging.

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Introduction. Lethal exanguination due to haemorrhage from ruptured peripheral varicose veins of the lower leg usually in the elderly are exceptionally rare in clinical, and particularly in forensic medicine. In persons with varicosities there are two types of lower leg ulcers (acute perforated and chronic) that can be associated with spontaneous bleeding. Ulcer exanguination can occur spontaneously or after a minor injury. Injuries in the ulcer region are rarer. Case Outline. We present a case of fatal exsanguination due to a ruptured varicose vein in a 77-year-old woman. The body was found on the porch floor, beside a sink, lying on the back, with bent knees, so that the lower legs were almost in the standing position, with the feet in a pool of blood. The entire interior of the house floor was covered with various bloodstains; blood-drops in form of spilling and spattering, foot-prints, as well as larger pools of blood. Death was attributed to massive external haemorrhage due to the acute perforated ulcer of the right lower leg with the rupture of the varicose vein wall surface along the entire depth. Conclusion. Although death due to haemorrhage from ruptured peripheral varicose veins is an uncommon complication of this disease, it should be taken into consideration by the forensic medicine examiner. In such cases autopsy should determine both the origin of bleeding (varicosities and venous wall damage) and other underlying conditions, primarily ischemic cardiac disease. To resolve such cases, full cooperation with investigators and police is necessary.

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Introduction. In forensic autopsy, pathologists pay attention to skull fracture lines. They are not much interested in the anatomical morphological variations of the skull bones, as long as the variations are not present. The interparietal bone is one of the anatomical variations that could be of interest for forensic pathologists. Case Outline. We present a case of a 54-year-old man who, after a fall overlived a head injury for six weeks. By chance, autopsy revealed an undivided interparietal bone. Its lateral sutures were fused with parietal bones and unrecognizable from the anterior skull bones, while the sutura mendosa was clearly visible. Conclusion. The forensic pathologist should be able to recognize anatomic morphological variations, including those of skull bones. The interparietal bone could be interpreted wrongly as belonging to the fractured occipital bone, i.e. as a broken fragment. This is of particular significance in the cases, for example, of murder or child abuse. Its inferior suture can be seen by X-ray and possibly wrongly interpreted as a fracture line. The presence of this variation may be occasionally useful in the identification of an unknown or lost person.

Introduction The term complex suicide refers to suicides in which multiple suicidal methods are utilized, as opposed to simple suicide successfully done after one attempt. In planned complex suicides two or more methods are employed simultaneously in order to make sure that death will occur after failure of previous attempt. In unplanned complex suicides, several other methods of suicide tried after the first chosen method either failed or was too painful. Outline of Cases We report two cases of unplanned complex suicides. The first case was a female who first tried to commit suicide by cutting the wrists, and then hanged herself. In the other case, a male first tried to commit suicide by stubbing his chest with a knife, and then jumped into a well and drowned himself. In both reported cases the second, successful suicidal method was of higher lethality score. Conclusion From the forensic point of view, the presence of several injuries of different origin strongly suggests infliction by other person. The event could be reconstructed, based on autopsy findings and traces found at the scene. .

Introduction. Sudden natural death occurs unexpectedly in apparently healthy subjects, or in persons during an apparent benign phase in the course of disease. The most common cause is sudden cardiac death, which is sometimes the first and last manifestation of coronary heart disease. Alcohol directly influences excitation of myocytes, and therefore provokes arrhythmias and possibly, sudden cardiac death. Objective. To establish the frequency of sudden cardiac death in cases of acute alcohol intoxication, to determine blood alcohol concentration at the moment of death, and to determine frequency and level of ethanol intoxication in chronic alcohol abusers, as well as causes of sudden death in those cases. Method. Retrospective autopsy study was performed for a three-year-period. We analyzed cases of sudden natural death, in relation to age and gender, cause of death, and blood alcohol concentration (at least 0.5 g/L). We considered the person to be a chronic alcoholic abuser if gross examination of organs during autopsy showed changes typical for excessive and habitual alcohol consumption. Results. Our sample consisted of 997 cases: 720 men and 277 women, average age 62.0±15.2 years (min=11; max=98). Total of 753 of them died of sudden cardiac death: much more men (χ2=167.364; p=0.000), significantly younger than women (t=6.203; p=0.000). We determined acute alcohol intoxication in 73 persons - average blood alcohol concentration 1.85±1.01 g/L (min=0.55; max=3.85), and 61 of them died of cardiovascular diseases (χ2=236.781; df=5; p=0.000). Conclusion. In our observed sample, not many persons were under acute alcohol intoxication (around 7%). Most commonly, they were chronic alcohol abusers who died due to exacerbation of chronic heart disease, mildly or moderately intoxicated - the younger, the drunker.

Introduction. The body cooling process goes through few clinical phases. These are followed by some morphological thanatological changes such as frost erythema and Wischnewsky's spots, which are used in diagnosis of death due to hypothermia. In such cases there is no any specific autopsy finding. Objective. To establish the frequency of hypothermia as the cause of death for a ten-year-period, and to analyze the sample according to gender and age, risk factors and autopsy findings of subjects. Methods. A retrospective autopsy study was performed for a ten-year-period (total of 12,765 forensic autopsies). The relevant data were collected from autopsy records, police reports and heteroanamnestic interviews. The sample was analyzed according to gender, age, scene of death, blood alcohol concentration, risk factors, and autopsy findings of all observed subjects. Results. The sample included 67 subjects, 42 males and 25 females (χ2=4.31; p

Introduction. Forensic expertise has not specified with certainty any specific injury among fatally injured frontal car-occupants in frontal car collisions. Objective. To establish if blunt injuries of thoracic aorta, heart, and pericardium could be used as predictors where the fatally injured car-occupant was at the moment of car-collision. Methods. A retrospective autopsy study was performed. The subjects were fatally injured car-drivers, front-seat and rearseat passengers in head-on car collisions. In each of them we analyzed the injuries of thoracic aorta, heart and pericardium. Results. 492 subjects were analyzed (378 male and 104 female): 239 car-drivers, 194 front-seat and 49 rear-seat passengers. The isthmus of aorta was the commonest site of simple blunt rupture among car-drivers and front-seat passengers. Among more than half of the observed subject, there was aortic blunt rupture as concomitant injury with heart and pericardium injuries. Heart and pericardium ruptures were most common among fatally injured car-drivers. Most frequently injured part of the heart was the right atrium. Injuries of thoracic aorta, heart and pericardium indicated a higher probability that the fatally injured would be the car-driver (λ=0.818; df=2; p=0.011, λ=0.906; df=2; p=0.000, and λ=0.951; df=2; p=0.000); this was also pointed out by the rupture of the right atrium and multiple ruptures of the thoracic aorta (λ=0.966; df=2; p=0.000 and λ=0.918; df=2; p=0.009). The concomitant injuries of the thoracic aorta with thoracic spine, sternum and heart pointed out that the injured person was the car-driver (λ=0.971; df=4; p=0.007, λ=0.974; df=4; p=0.013 and λ=0.958; df=4; p=0.000), as well as the concomitant injuries of heart and sternal fracture (λ=0.960; df=4; p=0.001). The probability of about 80% that the fatally injured person in head-on collisions was a car-driver was pointed out by concomitant blunt thoracic aorta rupture with fractured sternum and ribs (Wald. coeff.=8.611; df=1; p=0.003, and Wald. coeff.=3.875; df=1; p=0.049). Conclusion. The basic mechanism of the injury of thoracic organs is deceleration, as well as anteroposterior compression with caudorostral hyperextension. That is why thoracic organ injuries are mostly concomitant. Fatally injured car-drivers suffered more often of these injuries than other car-occupants. The probability that the fatally injured was the car-driver rises with the number of concomitant injuries of thoracic aorta, heart and pericardium, as well as with the fractured thoracic-cage bones.

INTRODUCTION Skull-face photograph superposition is one of the methods of identification. Digitally recorded and stored within the computer, the images of the skull and face could be superimposed on the monitor. The method requires cooperation among the anthropologist, odontologist, forensic pathologist and the computer technician so as to avoid objective and subjective errors in the identification. CASE OUTLINES We present two cases of positive identification by superimposition. In the first case, it was a 65 year-old male with several brain operations, thus surgical skull bonetrepanations could be seen as the irregularities on the forehead, and were used as the antropological identificational figure. In the second case, it was an 83 year-old female, whose positive identification was made according a photograph taken at least 26 years before death. CONCLUSION Face identification by computerized superposition method is useful in all cases where both the skull and the photograph of the missing person are present, and where other methods of identification have failed due to multiple reasons.

Introduction: There is no specific injury among fatally injured frontal car-occupants in frontal car collisions, used in forensic expertise. We tried to point out the usefulness of the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) for the expertise in such cases. Objective Analyzing the severity of body region injuries and total injury severity of deceased car occupants, to point out their importance in forensic expertise. Method Retrospective autopsy study was performed. Autopsy records of all deceased car-occupants in frontal car collisions were analyzed in order to establish the severity of injuries in body regions (AIS) and total severity of injuries (ISS). Statistical analysis was performed using the chi-square test, t-test, and logistic regression, with significance set at p

Introduction: Cases of sudden and unexpected deaths of criminal suspects in presence of police always have special forensic medical approach. Often, such deaths are preceded by a state of extreme psychophysical activity (excitated delirium) of suspects, when they may injure themselves. Police attempts to prevent that can inevitably lead to struggle. Immediately after the struggle ends (but also during a struggle), they abruptly become unresponsive, and develop cardiopulmonary arrest and death. Presence of drugs significantly intensifies the harmful effect of such state and leads to death. Case outline. We present a case of death of a young man brought into custody during police interrogation. Autopsy showed injuries and presence of MDMA, with suspicion that death was preceded by the state of excitated delirium. After thorough analysis of the case (complete autopsy, toxicological screening, microscopic survey of all organs, circumstances of death etc.), our conclusion is that death was related to drug consumption - ecstasy. Concentration of ecstasy found in kidneys is the minimum concentration possible that could lead to heart malfunction and death. Conclusion. Our opinion is that there are no medical data by which we could determine if, and in what dosage, undesirable effects of ecstasy were enhanced by the circumstances of the case. .

Introduction: The healed and sealed intimomedial aortic tears showed clearly defined edges and U-shaped defect of the tissue extending from intima into the media of a varying depth, filled by paler tissue with smooth surface. These tears can be solitary or multilocular, localized in different parts of the aorta, followed by limited intramural incomplete dissection. They can be provoked by diseases or injury. This part of the aortic wall filled with scar tissue is very vulnerable and could be the site of new rupture, followed by tamponade or fatal internal bleeding. Case outline. In this paper, we report a case of unexpected unknown death of a young male, 26-years-old, found on the ground, near his car. At autopsy, we established the old healed and open intimomedial tear on the posterior wall of the ascending aorta, with a remaining little dissection flap. This part of the wall with scar tissue was ruptured, causing bleeding in the pericardial sac, and tamponade. Histologically, the early stage of cystic medial degeneration was recognized. There were no injuries of the skin, soft tissue and bones. Conclusion. In the paper, we discussed the manner of death in this case, as well as the medicolegal implications. .

Suicide by injection of insulin overdose is uncommon. Insulin has been used as an agent for suicide both in diabetics and healthy subjects. The methods of postmortem forensic diagnosis of insulin overdose were reviewed. Police investigation could be crucial to document the amount and type of insulin used. In addition, the complete forensic autopsy, microscopic analysis of tissue samples, consecutive chemical-toxicological investigation and appropriate laboratory tests are required to make proper diagnosis in these cases. To assess pre-mortem hypoglycemic state at the time of dying, it is necessary to establish postmortal concentrations of glucose, lactate and potassium in vitreous humor. Since the use of insulin for medical treatment, only two cases with diagnosis of suicidal insulin overdose were confirmed at the Institute of Forensic Medicine in Belgrade. In this paper, the authors present one such case. An 84-year-old male was found dead in his flat. He had diabetes mellitus during the last fifty years, and he used insulin twenty years. A few empty insulin ampullae's and plastic syringes were found nearby deceased, on the room-table during the crime scene investigation, as well as his suicidal note. The forensic autopsy, microscopic, chemical-toxicological and biochemical analyses of tissue and body-liquid samples as well as police investigation indicated suicide due to insulin-overdose.

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 (x2 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 (x2=20.480; p0.05).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 ISS 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 ISS 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 posttraumatic 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.

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; p0.05). 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.

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.

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 µ [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 hypovole-mic 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, x2 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 (^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 othertwo 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.

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 patho-physiological 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 critical 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 registrated 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.

Introduction Volatiles are easily accessible and widely used in a form of liquid petroleum gas. Death as a consequence of inhalation of volatiles can be either accidental or suicidal. Case Outline We present a 62-year-old men who committed suicide by placing a plastic bag over the head and inhaling propane-butane mixture from a domestic gas tank. A rubber hose was attached to the tank valve and connected with the plastic bag. The body of the deceased showed signs of advanced postmortal changes. A suicidal note was found at the scene. Conclusion Propane-butane mixture, i.e. liquified petroleum gas leads to the depletion of oxygen in the air consequently causing hypoxia and anoxia, and therefore, unconsciousness and eventual death. The mechanisms of death in cases of volatile inhalation include cardiac arrhythmias, reflex cardiac vagal inhibition, and/or central nervous system depression. Similar mechanisms occur in cases of asphyxiation with a plastic bag. The reconstruction of the event in this case was based, not so much on autopsy findings (because of significant putrefaction changes), but on the police investigation and traces found at the scene. .

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.

Suicides by electrocution are extremly 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. Dilema if death was sucidal, 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 wraped the electrical cord around his rists, and kiled himself by plugging it in. In second case, it was a female, age of 46, abused by her husband, who commited suicide by putting the switched hear-dryer into the water in bathtube.

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 meters 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 meters 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 meters 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 meters. 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 primar body contact with the solid surface depending on the height of fall.

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.

Introduction: Lethal exanguination due to haemorrhage from ruptured peripheral varicose veins of the lower leg usually in the elderly are exceptionally rare in clinical, and particularly in forensic medicine. In persons with varicosities there are two types of lower leg ulcers (acute perforated and chronic) that can be associated with spontaneous bleeding. Ulcer exanguination can occur spontaneously or after a minor injury. Injuries in the ulcer region are rarer., Case Outline: We present a case of fatal exsanguination due to a ruptured varicose vein in a 77-year-old woman. The body was found on the porch floor, beside a sink, lying on the back, with bent knees, so that the lower legs were almost in the standing position, with the feet in a pool of blood. The entire interior of the house floor was covered with various bloodstains; blood-drops in form of spilling and spattering, foot-prints, as well as larger pools of blood. Death was attributed to massive external haemorrhage due to the acute perforated ulcer of the right lower leg with the rupture of the varicose vein wall surface along the entire depth., Conclusion: Although death due to haemorrhage from ruptured peripheral varicose veins is an uncommon complication of this disease, it should be taken into consideration by the forensic medicine examiner. In such cases autopsy should determine both the origin of bleeding (varicosities and venous wall damage) and other underlying conditions, primarily ischemic cardiac disease. To resolve such cases, full cooperation with investigators and police is necessary.

Introduction: Sudden natural death occurs unexpectedly in apparently healthy subjects, or in persons during an apparent benign phase in the course of disease. The most common cause is sudden cardiac death, which is sometimes the first and last manifestation of coronary heart disease. Alcohol directly influences excitation of myocytes, and therefore provokes arrhythmias and possibly, sudden cardiac death., Objective: To establish the frequency of sudden cardiac death in cases of acute alcohol intoxication, to determine blood alcohol concentration at the moment of death, and to determine frequency and level of ethanol intoxication in chronic alcohol abusers, as well as causes of sudden death in those cases., Method: Retrospective autopsy study was performed for a three-year-period. We analyzed cases of sudden natural death, in relation to age and gender, cause of death, and blood alcohol concentration (at least 0.5 g/L). We considered the person to be a chronic alcoholic abuser if gross examination of organs during autopsy showed changes typical for excessive and habitual alcohol consumption., Results: Our sample consisted of 997 cases: 720 men and 277 women, average age 62.0 +/- 15.2 years (min = 11; max = 98). Total of 753 of them died of sudden cardiac death: much more men (chi2 = 167.364; p = 0.000), significantly younger than women (t = 6.203; p = 0.000). We determined acute alcohol intoxication in 73 persons--average blood alcohol concentration 1.85 +/- 1.01 g/L (min = 0.55; max = 3.85), and 61 of them died of cardiovascular diseases (chi2 = 236.781; df = 5; p = 0.000)., Conclusion: In our observed sample, not many persons were under acute alcohol intoxication (around 7%). Most commonly, they were chronic alcohol abusers who died due to exacerbation of chronic heart disease, mildly or moderately intoxicated--the younger, the drunker.

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.

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.

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.