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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.

This article provides a commentary on a case report that examines the mechanisms of fat embolism syndrome (FES) in atraumatic compartment syndrome. It discusses the different types of fat embolism, such as pulmonary and systemic, and explains the mechanical and biochemical theories of fat embolism pathogenesis. The authors highlight the importance of recognizing fat embolism as a cause of death in forensic pathology. Additionally, the article includes citations for two related articles that provide further information on post-traumatic fat embolism, which can be accessed through the Wiley Online Library. [Extracted from the article]

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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