Forensic medical characteristics of murder victims autopsied at the Department of Forensic Medicine and criminology in Zagreb in the periods 1991 - 1995 and 2010 - 2014

Ubojstvo je protupravno, nasilno, svjesno i namjerno oduzimanje života nekoj osobi. Namjeru se dokazuje posredno, utvrđivanjem objektivno manifestnih radnji, manifestnih situacija i okolnosti slučaja. Ubojstvo predstavlja vrlo složen čin te uvelike ovisi o interakciji počinitelja, žrtve i okoline. Na ubojstva utječu brojni psihički, somatski i socijalni čimbenici. Kao jedan od najbitnijih pokazao se alkohol. Pod utjecajem alkohola često je i ubojica, ali i sama žrtva. Kao najčešća sredstva izvršenja ubojstava navode se tupo-tvrda trauma, vatreno oružje, oštri predmeti, asfiksija i eksplozija. Republika Hrvatska je od svojeg osnutka prošla kroz dinamičan period koji se sastojao od Domovinskog rata, procesa tranzicije pa sve do današnjeg stabilnog perioda kao članica Europske Unije. Ovaj rad zahvaća analizu žrtava ubojstava obduciranih na Zavodu za sudsku medicinu i kriminalistiku Medicinskog fakulteta Sveučilišta u Zagrebu iz perioda 1991. - 1995. i 2010. - 2014., kao usporedbu promjena stopa i načina tijekom tog dinamičnog perioda. U rad nisu uključene žrtve rata. Rezultati i analiza pokazuju promjene prema udjelima u ova dva perioda po spolu, dobi, sredstvu izvršenja ubojstva, stupnju alkoholiziranosti, danima u tjednu te kvartalima u godini kada su ubojstva izvršena.Homicide is an unlawful, violent, deliberate and intentional act of taking a person's life. The intent is proven indirectly by determining objectively manifested actions, situations and circumstances of the case. Homicide is a very complex act which largely depends on the interaction of perpetrators, victims and the environment. It is affected by numerous psychological, somatic and social factors amongst which alcohol plays an important role. Both the perpetrator and the victim are often under the influence of alcohol. Most common means of committing a homicide include blunt force trauma, firearms, sharp objects, asphyxia and explosions. Since declaring independence, the Republic of Croatia has undergone a dynamic period of the Homeland War, the transition process and, finally, the stability provided by joining the European Union.This paper analyzes homicide victims autopsied at The Department of Forensic Medicine at the Faculty of Medicine of the University of Zagreb between 1991 - 1995 and 2010 - 2014 as a comparison of the rate and mode change during that dynamic period. The victims of war have not been included in this research. Results and analysis of these two periods show changes by sex, age, means of committing a homicide, alcohol levels, days of the week, and quarters of the year when the homicides took place

T2 mapiranje hrskavice acetabuluma kod bolesnika s primarnim osteoartritisom i sekundarnim osteoartritisom induciranim razvojnim poremećajem kuka analizirano na mikro-MR uređaju snage 7 Tesla

The aim of our study was to compare acetabular cartilage affected by primary and DDH-induced secondary osteoarthritis (OA) using T2 mapping, which gives us information about cartilage water and collagen content, and the orientation of collagen fibrils. Samples of the osteochondral unit were obtained intraoperatively during total hip arthroplasty from the acetabulum of 15 patients with primary OA (pOA-Ac) and 15 patients with DDH-induced secondary OA (sOA-Ac). The samples were then scanned on a 7 Tesla micro-magnetic resonance imaging (micro-MRI) machine and the T2 values of all samples were calculated. The results were compared using a t-test. The average T2 values for the sOAAc and pOA-Ac groups were 57.28±31.87 ms and 37.54±11.17 ms, respectively. The calculated p-value was 0.019, making results statistically significant at p<0.05. This is one of the first studies performed ex vivo on the acetabular cartilage of human dysplastic hips, using a 7 Tesla MRI machine. Our results show that acetabular cartilage in DDH-induced secondary OA is more damaged than in primary OA, and offer 7 Tesla T2 reference values of acetabular cartilage for both the primary and DDH-induced secondary OA.Svrha ovog rada bila je usporediti acetabularnu hrskavicu prikupljenu od pacijenata s primarnim i sekundaranim osteoartritisom (OA) uzrokovanim razvojnim poremećajem kuka koristeći T2 mapiranje, koje se koristi za analizu sadržaja vode i kolagena u hrskavici, i orijentacije kolagenih vlakana. Uzorci actabuluma prikupljeni su tijekom operacije ugradnje totalne endoproteze kuka od 15 pacijenata s primarnim OA (pOA-Ac) i 15 pacijenata sa sekundarnim OA uzrokovanim razvojnim poremećajem kuka (sOA-Ac), te su snimljeni mikro-magnetskom rezonancijom (mikro-MR) na uređaju jačine 7 Tesla. Izračunate su T2 mape svih uzoraka, a rezultati su uspoređeni pomoću t-testa. Srednje T2 vrijednosti za sOA-Ac i pOA-Ac iznosile su 57.28±31.87 ms, odnosno 37.54±11.17 ms. Izračunata p vrijednost iznosila je 0.019, što znači da je razlika između skupina statistički značajna uz razinu značajnosti p<0.05. Ovo je jedna od prvih ex vivo studija acetabularne hrskavice pacijenata s razvojnim poremećajem kuka provedenih na mikro-MR uređaju jačine 7 Tesla. Naši rezultati upućuju na to da je acetabularna hrskavica pacijenata sa sekundarnim osteoartritisom uzrokovanim razvojnim poremećajem kuka više oštećena od one pacijenata s primarnim OA. Naša studija pruža informacije o referentnim T2 vrijednostima acetabularne hrskavice zahvaćene primarnim i sekundarnim OA dobivenim na MR uređaju jačine 7 Tesla

Ossoscopy – a treatment method for juvenile bone cysts of the calcaneus

Juvenilne koštane ciste (JKC) ubrajamo u skupinu benignih koštanih lezija koje se pojavljuju u djece. Kalkaneus je prema učestalosti treća lokalizacija pojave JKC-a. Više od 60% JKC-a kalkaneusa je asimptomatsko, a kad su simptomatske, očituju se povremenom bolnošću, osjetljivošću na palpaciju te povremenim lokalnim naticanjem. Odluka o načinu liječenja JKC-a kalkaneusa donosi se na osnovi veličine ciste i bolesnikovih simptoma. Kritična veličina JKC-a kalkaneusa definira se kada cista na magnetskoj rezonanciji zahvaća 100% poprečnog presjeka kalkaneusa u koronarnoj ravnini te barem 30% u sagitalnoj ravnini. Ciste takve veličine postaju simptomatske i zbog znatno većeg rizika nastanka patološke frakture savjetuje se njihovo kirurško liječenje. Najčešće primijenjena metoda kirurškog liječenja JKC-a kalkaneusa je otvoreni zahvat, tijekom kojeg se nakon detaljnog čišćenja i kiretaže ciste preostala šupljina u kosti ispuni autolognim ili homolognim koštanim presatkom. No danas se endoskopski zahvat smatra jednakovrijednom opcijom liječenja JKC-a kalkaneusa, a budući da se taj endoskopski zahvat čini u šupljini kosti, naziva se ososkopijom. Bolesniku u dobi od 14 godina dijagnosticirana je cista u kalkaneusu koja je na magnetskoj rezonanciji zahvaćala čitav poprečni presjek kosti, i na koronarnim i transverzalnim presjecima, te više od 30% poprečnog presjeka kalkaneusa na sagitalnom presjeku. Ososkopski mu je obavljena kiretaža ciste, a preostala šupljina u kosti mu je ispunjena homolognim koštanim presatkom. U radu se detaljno opisuje primijenjena operacijska tehnika uz pregled literature radi vrednovanja uspješnosti provedene metode u odnosu na druge opisane metode kirurškog liječenja JKC-a kalkaneusa.Juvenile bone cysts (JBCs) are benign bone lesions that occur in children. Calcaneus is the third most frequent location in the body where they may present. More than 60% of JBCs of the calcaneus are asymptomatic, and when they become symptomatic, they usually cause pain, tenderness on palpation and occasional local swelling. Decision on managing JBC of the calcaneus is based on the size of the cyst and patient’s symptoms. The critical size of calcaneal JBC is defined when the cyst affects 100% of the intracalcaneal cross section in the coronary plane and at least 30% in the sagittal plane. Cysts of this size tend to become symptomatic and have an increased risk of developing a pathological fracture, therefore, it is advised to manage those cysts surgically. The most frequently used management approach for JBCs of the calcaneus is open curettage combined with augmentation using autograft or allograft bone transplantation. However, endoscopic method is nowadays considered as effective as the open approach. Because this endoscopic method is performed inside the bone cavity, it is called ‘ossoscopy’. A 14-year-old boy was diagnosed with a JBC in the calcaneus which affected the whole intracalcaneal cross section both in coronary and transverse planes, as well as more than 30% of the intracalcaneal cross section in the sagittal plane. Curettage of the cyst was performed ossoscopically, combined with augmentation using allograft bone transplant. The operative technique performed is described in this article together with a literature review evaluating this technique in comparison with other surgical techniques for the management of calcaneal JBCs

Osteogenesis imperfecta – molekularna osnova i lijekovi budućnosti

Osteogenesis imperfecta (OI) or brittle bone disease is a metabolic bone disease characterized by bone fragility, low bone mass, and increased rate of bone fractures and deformities. Clinical presentation in OI patients shows wide variability ranging from mild to severe and lethal OI types. Advances in molecular biology and studies on animal OI models found at least 16 new genes involved in OI pathogenesis. The majority of mutations are autosomal dominant aff ecting COL1A1 and COL1A2 genes responsible for collagen synthesis. The remaining 10%-15% of mutations in OI are autosomal recessive and aff ect genes involved in various metabolic bone processes. Progress in understanding bone metabolism and genetic engineering off ers new potential therapeutic opportunities that are under diff erent stages of investigation.Osteogenesis imperfecta (OI) ili bolest krhkih kostiju je metabolička bolest kostiju obilježena krhkim kostima, niskom koštanom masom i povišenom stopom lomova i deformiteta kostiju. Klinička prezentacija bolesnika s OI veoma je raznolika, od blagog do teškog i smrtonosnog tipa OI. Napretkom molekularne biologije i istraživanjima na životinjskim modelima OI nađeno je najmanje 16 novih gena uključenih u patogenezu OI. Većina mutacija su autosomno dominantne i zahvaćaju gene COL1A1 i COL1A2 koji su odgovorni za sintezu kolagena. Preostalih 10%-15% mutacija u OI su autosomno recesivne i zahvaćaju gene uključene u razne metaboličke procese u kostima. Sve bolje razumijevanje metabolizma kostiju i genetski inženjering nude nove potencijalne terapijske mogućnosti koje su u različitim fazama ispitivanja

Sezamoiditis - radiološka dijagnostika i konzervativno liječenje

Sesamoid bones play an essential role in first metatarsophalangeal (MTP) joint biomechanics, together with other articular surfaces, joint capsule, plantar fascia, ligaments and tendons. They are prone to different acute and chronic injuries, such as acute fracture, stress fractures, chondromalacia, avascular necrosis, bursitis degenerative changes, inflammation etc., all of which clinically manifest as a painful condition and are often diagnosed under a broad term called sesamoiditis. The mechanism of injury is most commonly associated with overuse of the anterior part of the sole of the foot accompanied by excessive dorsiflexion of the great toe. Sesamoiditis presents with pain and localized swelling in the projection of the tibial sesamoid bone, which is affected more frequently than the fibular one. Diagnostic radiology plays a key role in determination of etiology of the disease, as well as in planning of it’s treatment. Typical radiological examination includes weight-bearing dorsoplantar, lateral, oblique medial and oblique lateral radiographs of the foot, together with a direct axial radiograph of sesamoid bones. Computerized tomography is used for distinction of acute fractures and early stage of stress fractures from other pathological conditions. Magnetic resonance imaging allows differentiation between bony pathology and soft tissue conditions. Sesamoiditis management is primarily conservative and it depends on duration and severity of the condition. Orthotic insoles customized according to pedobarographic findings may be useful for solving biomechanical deformities that could have led to development of sesamoiditis. Specific pads placed under the first MTP joint in order to prevent the great toe from dorsiflexion proved to be a very effective conservative treatment option. Surgical treatment is considered if conservative methods fail to provide sufficient management of the condition.Sezamske kosti u području metatarzofalangealnog zgloba nožnog palca (hallux) dio su anatomsko-biomehaničkog kompleksa kojeg čine zglobna tijela, čahura, plantarna fascija, sveze i tetive mišića. U sklopu navedenog komplek- sa sezamske kosti podložne su raznim akutnim i kroničnim oštećenjima u smislu prijeloma, stres prijeloma, hon- dromalacije, avaskularne nekroze, burzitisa, degenerativnih promjena, upala itd., a što se sve klinički očituje kao bolno stanje i sve se podvodi pod široki pojam sesamoiditisa. Mehanizam koji dovodi do sesamoiditisa najčešće je vezan uz prenaprezanje prednjeg dijela stopala praćenog ekscesivnom dorzifleksijom nožnog palca. U kliničkoj sli- ci sesamoiditisa najčešći simptom je bol i lokalizirana oteklina i to u području tibijalne sezamske kosti koja je dale- ko češće zahvaćena u odnosu na fibularnu sezamsku kost. Radiološka dijagnostika je značajna kako u otkrivanju etiologije tako i u planiranju liječenja sesamoiditisa. Standardna radiološka pretraga obuhvaća antero-posteriornu snimku pod opterećenjem stopala, lateralnu snimku, kose snimke te aksijalnu snimku sezamskih kostiju. Komp- juterizirana tomografija pokazala se korisnom za razlikovanje akutnog prijeloma i ranog stadija stres prijeloma sezamske kosti od drugih patologija koje mogu zahvatiti sezamske kosti. MRI omogućuje diferencijaciju između koštanih promjena i promjena na mekom tkivu. Liječenje sezamoiditisa je prvenstveno konzervativno i uvelike ovisno o uznapredovalosti promjena u području cijelog metatarzofalangealnog kompleksa. Ortopedski ulošci nakon pedobarografske analize opterećenja stopala mogu otkloniti biomehaničke deformacije koje su potencijalno pridonijele razvoju sesamoiditisa. Posebni podlošci ispod metatarzofalangealnog zgloba palca u smislu sprečavanja dorzifleksije palca su vrlo korisni i efikasni u konzervativnom liječenju sesamoiditisa. Kirurško liječenje može biti preporučeno nakon neuspjelog konzervativnog liječenja

Artropatija ohronotika

Alkaptonuria (AKU) is a rare autosomal recessive metabolic disease caused by a disorder of phenylala- nine and tyrosine metabolism, resulting in accumulation and deposition of homogentisic acid (HGA) in the body. This deposition further causes progressive functional disorders in different organ systems, with the locomotor system being the most affected one. A specific triad of symptoms occurs in patients suffering from AKU: 1. at birth, a change of urine color is present when urine is exposed to air, 2. oc- currence of dark pigmentations in connective tissues becomes visible over time, 3. complications of the locomotor, urogenital and cardiovascular systems present gradually. Arthropathia ochronotica occurs in patients suffering from AKU due to precipitation and deposition of HGA in the joint tissue (cartilage, tendons, ligaments, menisci, etc.). The accumulation can be seen as small foci of blue-black pigmentations. HGA deposits in collagen fibers, causing tendons and liga- ments thickening. This causes them to be less resistant to mechanical forces, resulting in frequent rup- tures caused by minimal trauma. Also, the deposition facilitates cartilage degeneration, often requiring an operative treatment. The knees are the most commonly affected joints, while changes can be seen in the spine and other large joints. As there is no specific treatment, alleviation of symptoms is the only treatment option. It has the goal of increasing individual functionality and quality of life. As an option for end-stage treatment, joint replacement surgery proved to be effective. In the future, an enzyme replacement therapy or gene therapy may be developed to treat AKU successfully.Alkaptonurija (AKU) je rijetka autosomno recesivna metabolička bolest uzrokovana poremećajem metabolizma fenilalanina i tirozina, što rezultira nakupljanjem i taloženjem homogentizinske kiseline (HGA) u tijelu. Ovo taloženje uzrokuje progresivne funkcionalne poremećaje u različitim organskim sustavima, pri čemu je najčešće zahvaćen lokomotorni sustav. Specifična trijada simptoma javlja se u bolesnika koji pate od AKU: 1. pri rođenju je vidljiva promjena boje urina kada je urin izložen zraku, 2. pojava tamnih pigmentacija u vezivnom tkivu s vremenom postaje vidljiva, 3. postepeno se razvijaju komplikacije koje zahvaćaju lokomotorni, urogenitalni i kardiovaskularni sustav. Artropatija ohronotica javlja se u bolesnika koji pate od AKU zbog taloženja HGA u zglobnom tkivu (hrskavica, tetive, ligamenti, meniskusi itd.). Akumulacija se može vidjeti kao mala žarišta plavo-crnih pigmentacija. HGA se taloži u kolagenskim vlaknima, uzrokujući zadebljanje tetiva i ligamenata. Zbog toga su ona manje otporna na mehaničke sile, što rezultira čestim puknućima uzrokovanim minimalnom traumom. Također, taloženje ubrzava degeneraciju hrskavice, što dovodi do češće potrebe za operativnim liječenjem. Koljena su najčešće zahvaćena, dok se promjene također mogu vidjeti na kralježnici i drugim velikim zglobovima. Kako ne postoji specifično liječenje, ublažavanje simptoma jedina je opcija liječenja. Cilj mu je povećati individualnu funkcionalnost i kvalitetu života. Kao opcija za završnu fazu liječenja, ugradnja umjetnih zglobova pokazala se sigurnom i učinkovitom. U budućnosti se očekuje razvoj enzimske ili genske terapije za uspješno ciljano liječenje AKU

Primjene i kritička evaluacija bloka odjeljka fascije iliace i quadratus lumborum bloka u ortopedskim zahvatima

Anterior section of the hip joint capsule is innervated by femoral nerve and obturator nerve, and posterior section is innervated by the nerve to quadratus femoris muscle and occasionally by the superior gluteal (posterolateral region) and sciatic nerve (posterosuperior region). One of the regional anesthesia options for hip surgery is the fascia iliaca compartment block (FICB) that affects nerves important for hip innervation and sensory innervation of the thigh - femoral, obturator and lateral femoral cutaneous nerve. FICB can be easily performed and is often a good solution for management of hip fractures in emergency departments. Its use reduces morphine pre-operative requirement for patients with femoral neck fractures and can also be indicated for hip arthroplasty, hip arthroscopy and burn management of the region. Quadratus lumborum block (QLB ) is a block of the posterior abdominal wall performed exclusively under ultrasound guidance, with still unclarified mechanism of action. When considering hip surgery and postoperative management, the anterior QLB has shown to reduce lengthy hospital stay and opioid use, it improves perioperative analgesia in patients undergoing hip and proximal femoral surgery compared to standard intravenous analgesia regimen, provides early and rapid pain relief and allows early ambulation, thus preventing deep vein thrombosis and thromboembolic complications etc. However, some nerve branches responsible for innervation of the hip joint are not affected by QLB , which has to be taken into consideration. QLB has shown potential for use in hip surgery and perioperative pain management, but still needs to be validated as a reliable treatment approach.Prednji dio čahure zgloba kuka nerviraju n. femoralis i n. obturatorius, dok stražnji dio čahure inervira n. musculi quadratus femoris i povremeno n. glutealis superior (posterolateralni dio) i n. ischiadicus (posterosuperiorni dio). Jedna od mogućnosti za primjenu regionalne anestezije u kirurgiji zgloba kuka je blok odjeljka fascije iliace (FICB), koji zahvaća živce bitne za inervaciju kuka te senzornu inervaciju bedra – n. femoralis, n.obturatorius i n. cutaneus femoris lateralis. FICB se može izvesti relativno jednostavno i predstavlja dobru opciju za zbrinjavanje fraktura kuka u hitnim situacijama. Dokazano je kako smanjuje upotrebu morfija preoperativno u pacijenata s frakturom vrata femura, a može biti indicirani za artroplastiku kuka, artroskopije kuka te sanaciju opeklina u regiji bedra. Quadratus Lumborum blok (QLB ) spada u blokove stražnjeg abdominalnog zida te se provodi isključivo pod kontrolom ultrazvuka. Još uvijek nije razjašnjen točan mehanizam njegovog djelovanja. Dokazano je kako prednji QLB dovodi do smanjenja trajanja boravka u bolnici i smanjenja upotrebe opioida nakon operacija kuka. Također, pokazao se kao uspješnija metoda perioperativne analgezije u bolesnika u kojih se provodi zahvat na kuku ili proksimalnom femuru u usporedbi sa standardnom intravenskom analgezijom, te omogućuje ranu mobilizaciju pacijenata, što smanjuje pojavnost duboke venske tromboze i tromboembolijskih komplikacija. S druge strane, neki živčani ogranci koji sudjeluju u inervaciji zgloba kuka nisu zahvaćeni s QLB , što također treba uzeti u obzir. QLB se pokazao kao potencijalna opcija za anesteziju u kirurgiji kuka, no tek se treba dokazati njegova pouzdanost

Early results of intra-articular micro-fragmented lipoaspirate treatment in patients with late stages knee osteoarthritis: a prospective study

Aim To analyze clinical and functional effects of intra-articular injection of autologous micro-fragmented lipoaspirate (MLA) in patients with late stage knee osteoarthritis (KOA). Secondary aims included classifying cell types contributing to the treatment effect, performing detailed MRIbased classification of KOA, and elucidating the predictors for functional outcomes. Methods This prospective, non-randomized study was conducted from June 2016 to February 2018 and enrolled 20 patients with late stage symptomatic KOA (Kellgren Lawrence grade III, n = 4; and IV, n = 16) who received an intra-articular injection of autologous MLA in the index knee joint. At baseline radiological KOA grade and MRI were assessed in order to classify the morphology of KOA changes. Stromal vascular fraction cells obtained from MLA samples were stained with antibodies specific for cell surface markers. Patients were evaluated at baseline and 12-months after treatment with visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS).Results Three patients (15%) received a total knee replacement and were not followed up completely. Seventeen patients (85%) showed a substantial pattern of KOOS and WOMAC improvement, significant in all accounts. KOOS score improved from 46 to 176% when compared with baseline, WOMAC decreased from 40 to 45%, while VAS rating decreased from 54% to 82% (all P values were <0.001). MLA contained endothelial progenitor cells, pericytes, and supra-adventitial adipose stromal cells as most abundant cell phenotypes. Conclusion This study is among the first to show a positive effect of MLA on patients with late stages KOA

Immunophenotyping of a Stromal Vascular Fraction from Microfragmented Lipoaspirate Used in Osteoarthritis Cartilage Treatment and Its Lipoaspirate Counterpart

Osteoarthritis (OA) is a degenerative joint disease accompanied by pain and loss of function. Adipose tissue harbors mesenchymal stem/stromal cells (MSC), or medicinal signaling cells as suggested by Caplan (Caplan, 2017), used in autologous transplantation in many clinical settings. The aim of the study was to characterize a stromal vascular fraction from microfragmented lipoaspirate (SVF-MLA) applied for cartilage treatment in OA and compare it to that of autologous lipoaspirate (SVF-LA). Samples were first stained using a DuraClone SC prototype tube for the surface detection of CD31, CD34, CD45, CD73, CD90, CD105, CD146 and LIVE/DEAD Yellow Fixable Stain for dead cell detection, followed by DRAQ7 cell nuclear dye staining, and analyzed by flow cytometry. In SVF-LA and SVF-MLA samples, the following population phenotypes were identified within the CD45- fraction: CD31+CD34+CD73±CD90±CD105±CD146± endothelial progenitors (EP), CD31+CD34-CD73±CD90±CD105-CD146± mature endothelial cells, CD31-CD34-CD73±CD90+CD105-CD146+ pericytes, CD31-CD34+CD73±CD90+CD105-CD146+ transitional pericytes, and CD31-CD34+CD73highCD90+CD105-CD146- supra-adventitial-adipose stromal cells (SA-ASC). The immunophenotyping profile of SVF-MLA was dominated by a reduction of leukocytes and SA-ASC, and an increase in EP, evidencing a marked enrichment of this cell population in the course of adipose tissue microfragmentation. The role of EP in pericyte-primed MSC-mediated tissue healing, as well as the observed hormonal implication, is yet to be investigated