Endovascular Procedures in Treatment of Infrapopliteal Arterial Occlusive Disease: Single Center Experience With 69 Infrapopliteal Procedures.

BACKGROUND: Peripheral arterial occlusive disease (PAD) includes acute and chronic disorders of the blood supply as a result of obstruction of blood flow in the arteries of the limb. Treatment of PAD can be conservative, surgical and endovascular. Percutaneous transluminal angioplasty with or without stenting has become a recognized method, which is increasingly used in treatment of arterial occlusive disease. This study aimed to determine early results of endovascular treatment of critical limb ischemia (CLI) patients with infrapopliteal lesions. METHODS: The study included 69 patients (46 men; mean age 65 years, range 38-84) with CLI (class 4 to 6 according to Rutherford). The primary study endpoints were absence of major amputation of the target limb at 6 months and occurance of local and systemic complications specifically related to use of endovascular treatment. RESULTS: Major amputation was avoided in 61 patients. Through 6 months, 6 patients underwent additional revascularization. One local complication (clinicaly significant dissection of popliteal artery) occurred, and it was resolved by stent implantation. There were no cases of systemic complications and death during the follow-up period. Rates of major amputation were 12.3% for diabetics versus 8.3% for non-diabetics. CONCLUSION: Our data showed that endovascular treatment of infrapopliteal disease is an effective and safe treatment in patients experiencing CLI, provides high limb preservation and low complication rates. Study outcomes support endovascular treatment as a primary option for patients experiencing CLI due to below the knee (BTK) occlusive disease.

"Cognac alibi" as a drunk-driving defense and medico-legal challenge.

Some drivers with positive forensic ethanol analyses, offer an explanation that they consumed alcohol a short time before a traffic accident or after driving. In medico legal practice this is commonly known as hip-flask defense, but to us as "cognac alibi" defense. In these cases, the lawyers require the medico legal experts to offer as much information as possible so that the court may come to the most reliable conclusions about the driver's blood alcohol concentration at the moment of the traffic accident (BAC(Acc)). At the Institute of Forensic Medicine our own analytical approach was established to study this medico legal problem. It consists of three inter-related phases in which it combines the obtained BAC values, with testimonies of the drunk driving suspect andalso witnesses. A specific algorithm was designed for calculating absorption and elimination of consumed alcohol. All the above-mentioned elements and blood-ethanol values calculated according to Widmark's method were inserted into appropriate cells of MS Excel software in order to calculate BAC in the function of time. The result is a relevant analysis of the drunk driving suspect's BAC in 5-minute intervals, as well as a graphic representation in chart form.

Unusual cases of suicide among health care workers.

We describe three unusual cases of suicide committed by health care workers. The aim of this paper was to analyze and evaluate the evidence of general diagnostic elements of poisoning in these cases.

Brain trauma: cause-consequence connection problems.

Despite sophisticated equipment like computerized tomography, in some cases doctors have a problem with the diagnostic procedure in relation to patients with serious injuries of the central nervous system (CNS). There may be no clinical signs of disorders of the CNS, or other evidence of difficulties, but diffuse axonal lesions and demyelinisation processes often exist. This type of lesion is a special pathomorphological entity, known as the syndrome of patient who talks and dies. Macroscopical and microscopical findings are poor and rare, especially in the hours immediately following the injury. The main findings are not evidential and the problem is the explanation of sudden death from unknown causes. The following studies are based on human tissue analyses. They are based on the analyses of the CNS of patients who suffered from brain trauma. The specimens from the brain stem were taken in order to perform histological, microscopic analysis. Percentage value of surface of myelin for the control group was X1 38.62% for HE technique and X1 33.46% for Gomory's method. The value for the test group was X2 16.12% for HE technique and X2 13% for Gomory's technique. Statistical probability for both groups was 95% (P < 0.05; T = 14.9). Application of these procedures helps legal authorities to make trials more objective.

Fatal upper esophageal hemorrhage caused by a previously ingested chicken bone: case report.

Perforation of the upper esophageal wall by ingested bones can cause sudden death and death under suspicious circumstances. Perforation usually takes place at sites of physiologic and pathologic strictures. Temporary bleeding from the respiratory and digestive tracts is an important signal and may be crucial in the diagnosis of esophageal perforation and small vessel injury by ingested bone. Polymorphism and long symptomatology can cause diagnostic and therapeutic failure, thus presenting a special medicolegal problem. We present a case report of unknown cause of death and death under suspicious circumstances resulting from ingested bone perforation of upper esophagus. A chicken bone had been swallowed about 6 months before death caused by hemorrhage from a decubitus in the cervical esophagus. The patient underwent urgent surgery because of suspected bleeding of a ventricular ulcer.

[A suicide by hanging suspected to be a homicide]. / Samoubistvo vesanjem sumnjivo na ubistvo.

The paper presents a case of suicidal hanging that was suspected to be a homicide. The reasons for that were of circumstantial origin. The hanging took place in the woods, the victim had his hands tied and was with a hankerchief in his mouth. Those elements were the arguments in favor of the mentioned suspicion.

[Digitalization of histological images as a method of quantifying the demyelinating process]. / Digitalizacija histoloske slike kao metoda za kvantifikaciju procesa demijelinizacije.

The basic aim of this paper was to check the hypothesis whether after head trauma the brain tissue looses myelinic membrane which surrounds the axon, and if this possibly established loss can be quantified, that is if it is possible to determine the degree of disintegration. One of the aims was to examine this method itself. The gathered results show that both the hypothesis and the aims were justified. It has been established that the diffuse axonal lesion in the examined samples reflects in a loss of axon's myelinic membrane. The loss was 50% greater in the test group in regard to the control group. To digitalize histologic pictures we have used Laser Scanner Densitometry Station and software by Biomed. In regard to medical jurisprudence, the laser scanner densitometry offers more relevant data in cases apparently unclear and in sudden deaths after head injuries. Application of this method and further investigations will be directed to further attempts to clear up connections between the mechanism of injury and degree of biologic response of the brain tissue.