Foramina parietalia permagna: Case report

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

The mechanism of injuring of front-seat passengers in head-on motor vehicle collisions: Forensic issues

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

Myocarditis exacerbation in a child undergoing inguinal hernioplasty after viral infection

Introduction Immunosuppressive effects of general anesthesia and surgery could have unexpected consequences in a child with recent infection. The incidence of myocarditis in childhood is unknown. Case outline During general anesthesia for inguinal hernia repair, a seven-year-old boy suddenly developed heart failure. Clinical presentation included hypotension, pulmonary edema, drop in hemoglobin oxygen saturation, ST segment elevation and premature ventricular contractions. Homodynamic stability and adequate oxygenation were achieved with dopamine and furosemide. Preoperative history, physical examination and complete blood count were unremarkable. Moderate cardiomegaly and pulmonary edema were present on chest radiography. Diminished left ventricular contractility found on echocardiography increased troponin I and CK-MB levels suggested myocardial injury. Increased C-reactive protein with lymphocytosis suggested inflammation as its cause. Parents failed to report rubella 10 days before the operation. A clinical diagnosis of myocarditis as a complication of rubella was based on increased titer of IgM to rubella. With intravenous immunoglobulin, corticosteroids and symptomatic treatment for heart failure, his condition improved and ejection fraction reached 68 % one month after operation. Conclusion In future, we need protocols with instructions for pediatric patients undergoing elective surgery and anesthesia after viral infections