Forensic Recreation and Visual Representation of Greek Orthodox Church Saint Eftychios of Crete.

Facial reconstruction is employed in medical science and archaeology. Though quite popular as anthropological method, it has not so far been used in the orthodox ecclesiastical tradition. This work presents the facial reconstruction of St Eftychios of Crete, who lived between the ninth and tenth centuries. Computed tomography and reverse engineering methods were employed to complete the task. Reconstruction of the mandible and the missing left zygomatic arch was implemented following the Sassouni method. The American method was followed for the soft tissues, with clay deposition of appropriate thickness, on the surface of the skull model. The eyes, nose, and lips were added based on the dimensions of the underlying bone structures. Long hair and beard were added, according to the classic Byzantine tradition pattern of the time period. The final bust developed was then digitized, using a 3D non-contact laser scanner. The 3D geometry produced was employed to produce a mold with vacuum casting techniques. This mold provides the ability to produce copies of the bust, if needed. At the same time, a realistic 3D representation of the Saint's bust was developed, with the aid of special software, in order to compare the traditional forensic reconstruction to the pure digital one. This work is the first case of a Saint's facial reconstruction in the Orthodox Church. The facial reconstruction process, with all the limitations considered, offers the ability to present a realistic aspect of a Greek Orthodox Church Saint, in a form that is easily accessible. Both physical and digital facial reconstruction processes were based on scientific data, so they were as accurate as possible, considering that the mandible was missing in the skull. The facial reconstruction was entirely implemented in Greece creating the basis for similar work in the future. The final bust developed was donated to the Odigitria Monastery, to be exhibited to its visitors.

Three-Dimensional Geometry of Phalanges as a Proxy for Pair-Matching: Mesh Comparison Using an ICP Algorithm.

Forensic anthropologists are frequently faced with the challenge of individualizing and sorting commingled remains in a variety of scenarios. A number of protocols have been proposed to standardize the methodological approach to individuating commingled remains, some of which are focused on pair-matching. A recent study by Karell et al. (2016) proposed a virtual method for pair-matching humeri using a semi-automatic procedure that gave encouraging results. With regards to the phalanges, there are only a handful of studies focusing on identifying and siding phalanges, as well as exploring their directional and functional asymmetry. Yet, they are still as important as every other bone when sorting commingled human remains in various situations, such as archaeological common burials and mass graves, commingled decomposed remains resulting from atrocities, accidents or natural disasters. This study investigates a new method for pair-matching, a common individualization technique, using digital three-dimensional models of bone: mesh-to-mesh value comparison (MVC) as proposed by Karell et al. (2016). The MVC method digitally compares the entire three-dimensional geometry of two bones using an iterative closest point (ICP) algorithm to produce a single value as a proxy for their similarity. The method is automated with the use of Viewbox software 4.1 beta for a simultaneous comparison of all possible pairs. For this study, 515 phalanges from 24 individuals of mixed ancestry were digitized using CT scans and the 3D modeling program AMIRA 5.3.3. The models were also hollowed (internal information of compact and trabecular bone removed) to test the method with simulated surface scan models. The subsequent data-over 73,000 comparisons-were assessed using sensitivity and specificity rates via ROC analysis to indicate how well the automated version of MVC pair-matched phalanges. The best bone in terms of pair-matching was the proximal phalanx of Digit 3 with 87.5% sensitivity and 92.4% specificity rates at a threshold value of 0.488 for the unhollowed bones. The specificity drops slightly (91.1%) when the hollowed models are compared. To compare the performance of the method in all phalanges, the specificity was set to 95%-allowing for a 5% acceptable error-and the adjusted sensitivity was compared. The highest sensitivity, namely 68.8%, was noted for Digit 2 proximal phalanx for both unhollowed and hollowed models. Thus far, our preliminary results indicate that the MVC method performs well when pair-matching phalanges, though it is less accurate than pair-matching other types of bones. The introduction of 95% specificity threshold allows for rejecting pairs in great confidence, which could, for instance, significantly reduce the number of DNA comparisons required for the remaining possible matches. In addition, the similar results obtained from hollowed and unhollowed models indicate that the internal information included in the unhollowed models adds little to the identification of true pairs. This means that if a CT scan is not available, the method could be applied to surface models produced by light and laser scanners as well. While additional work needs to be done to verify these preliminary results, this research has the potential to expand the repertoire of individualization methods.

Advanced bronchogenic carcinoma presented as cardiac tamponade: a case report and a review of the literature.

Although most fatal lung tumors are well diagnosed before a patient's death, occasionally forensic pathologists encounter cases of sudden death in which the presence of a primary small cell lung carcinoma was not suspected. We present the case of a 49-year-old man asymptomatic until 2 days before his death. The autopsy revealed a huge tumorous mass originating from the central bronchus, infiltrating the large vessels, pulmonary parenchyma, pericardium, and the right ventricle of the heart. Pericardial sac was distended due to pericardial effusion (700 mL). Examination also revealed metastases to the liver, pancreas, and right adrenal gland. Microscopic examination identified the primary neoplasm as a small cell lung carcinoma after common stain of hematoxylin-eosin, and additional immunohistochemistry were performed.

Sexual dimorphism of the bony labyrinth: a new age-independent method.

Currently in physical anthropology there is a need for reliable methods of sex estimation for immature individuals and highly fragmented remains. This study develops a sex estimation technique from discriminant function analysis of the bony labyrinth as it matures before puberty and can survive taphonomic conditions that would destroy most other skeletal material. The bony labyrinth contains the organs of hearing and balance. For this reason biologists and paleoanthropologists have undertaken research in this area to understand evolutionary changes in locomotion. Prior studies have found clear differences between species, but within-species variation has not been satisfactorily investigated. 3D segmentations of the left and right labyrinths of 94 individuals from a Cretan collection were generated and measured. Mean measurements of height, width, size, and shape indices were analyzed for sexual dimorphism, bilateral asymmetry, and measurement error. Significant sexual dimorphism was detected for several measurements. For sex estimation, the single best variable was the radius of curvature of the posterior semicircular canal, which achieved 76% accuracy. Two multivariate functions increased accuracy to 84%. Although these equations are less accurate than equations for complete long bones and crania, they appear to be as accurate as or better than other techniques for sexing immature individuals and temporal bones.

Nitrogen-plastic bag suicide: a case report.

The use of pure nitrogen gas to commit suicide has recently become more popular, although suicides involving nitrogen oxide fumes have been occasionally reported in the past. The cause of death in such cases is attributed to asphyxia due to forced depletion of oxygen, a subcategory of a phenomenon dubbed environmental hypoxia. A case of a 26-year-old man who committed suicide by inhaling nitrogen through a plastic bag is reported. The exact method of suicide used here is one of the many described in detail on the Web.

IPPASOS: The first digital forensic information system in Greece.

OBJECTIVE: This article describes the first digital clinical information system tailored to support the operational needs of a forensic unit in Greece and to maintain its archives. METHOD: The development of our system was initiated towards the end of 2018, as a close collaboration between the Medical School of the University of Crete and the Forensic Medicine Unit of the University Hospital of Heraklion, Crete, where forensic pathologists assumed active roles during the specification and testing of the system. RESULTS: The final prototype of the system was able to manage the life cycle of any forensic case by allowing users to create new records, assign them to forensic pathologists, upload reports, multimedia and any required files; mark the end of processing, issue certificates or appropriate legal documents, produce reports and generate statistics. For the first 4 years of digitised data (2017-2021), the system recorded 2936 forensic examinations categorised as 106 crime scene investigations, 259 external examinations, 912 autopsies, 102 post-mortem CT examinations, 804 histological examinations, 116 clinical examinations, 12 anthropological examinations and 625 embalmings. CONCLUSION: This research represents the first systematic effort to record forensic cases through a digital clinical information system in Greece, and to demonstrate its effectiveness, daily usability and vast potential for data extraction and for future research.

Sex estimation of the Cretan humerus: a digital radiometric study.

Sex estimation based on measurements of unidentified skeletal remains recovered in crime and death scenes can be accomplished with accuracy. In mass disasters, however, the remains are often fleshed, burned, and/or commingled. As a result, osteometric methods are difficult to apply. In such cases, radiography can be of great use during the examination process. A total of 101 (53 males and 48 females) adult humeri were radiographed using digital equipment (Technix TCA 4R PLUS). Specific measurements were taken on the radiographs and then analyzed. Multivariate discriminant function analysis was applied, and the results showed up to 89.1% classification accuracy. Single variables performed equally well for both epiphyses reaching 86.1% correct group membership. The method proposed here is successful, offering an alternative sex estimation technique applicable to the identification of deceased individuals whose remains are semi-fleshed, burned, mutilated, or otherwise unrecognizable. Specifically, this method is extremely useful when maceration of the remains is not an option.

Unenhanced PMCT in the diagnosis of fatal traumatic brain injury in a charred body.

Traffic incidents are one of the most frequent causes of death in young adults worldwide. Depending on the location of the incident, the velocity of the vehicle(s), the weather condition, traffic incidents are often complicated making the investigation of the circumstances difficult. Here we report a case of an incinerated body involved in a vehicle incident. Differential diagnosis included natural cause of death during driving, fatal traumatic injuries, death due to fire and positional asphyxia. The body was submitted to PMCT prior to autopsy as part of a research protocol (N. 1388/2016) at the Department of Medical Imaging of the University Hospital of Heraklion in Crete, Greece. Unenhanced PMCT revealed craniofacial fractures, a thin film of subdural haemorrhage and an epidural fluid collection. The findings were interpreted as consistent with an impact to the face, causing craniofacial fractures mainly on the right side, and an acute subdural hematoma. Autopsy findings corroborated the diagnosis. The epidural hematoma was deemed to be post-mortem heat-induced. This case is an excellent example of the diagnostic value of PMCT in the medicolegal investigation of death.

Sexual dimorphism of the calcaneus in contemporary Cretans.

During the past decade, several studies have been carried out using the calcaneus bone for sex estimation. This paper collected data using ten variables for metric characteristics of the calcaneus of 144 modern Cretans and examined their correlation with known sex. Secondly, the formulae developed by Peckmann et al. (2015) for modern Athenians was put to the test in order to investigate if it could be applied to this modern Cretan sample as well. Results showed a high correlation between the calcaneus metrics and the known sex of the individuals, however the formulae for Athenians do not seem to be suitable for the Cretans due to the high sex bias reported in this study. Thus, new standards were created for sex estimation from the calacanei in our sample. Bilateral asymmetry was noted in the majority of cases, thus formulae were developed for left, right and mean values. Maximum width (MAXW) was the variable that performed the best in the Cretan sample. Overall, the cross-validated accuracies for univariate and multivariate equations reached 84.2% with males most often correctly identified. The calcaneus was proved to be useful for sex estimation in this modern Cretan population. Further work will explore the suitability of the produced standards for other regions of mainland Greece and islands.

Suicidal self-stabbing: A report of 12 cases from Crete, Greece.

Sharp-force trauma is a popular cause of homicide and suicide in many countries. Characterisation of the injuries between the two is crucial for a differential diagnosis. The current paper reviews 12 self-inflicted sharp-force trauma deaths from the island of Crete in Greece. Forensic reports between 1999 and 2015 were collated, and we studied the number and location of injuries, the demographic characteristics of the deceased, the sharp object and the medical history of the deceased. One third of the cases where the forensic reports were available (3/10) involved multiple injuries, and one case involved a combination of stabbing and hanging. Most injuries involved a kitchen knife. Ninety-two per cent (11/12) of the victims involved male Greek nationals aged >50 years. The type and location of injuries were not found to be specific to suicide alone. Thus, death-scene investigation remains crucial to the differential diagnosis between suicide and homicide. This is the first report on self-inflicted sharp-force fatalities in Greece.

Accuracy and sampling error of two age estimation techniques using rib histomorphometry on a modern sample.

Most age estimation methods are proven problematic when applied in highly fragmented skeletal remains. Rib histomorphometry is advantageous in such cases; yet it is vital to test and revise existing techniques particularly when used in legal settings (Crowder and Rosella, 2007). This study tested Stout & Paine (1992) and Stout et al. (1994) histological age estimation methods on a Modern Greek sample using different sampling sites. Six left 4th ribs of known age and sex were selected from a modern skeletal collection. Each rib was cut into three equal segments. Two thin sections were acquired from each segment. A total of 36 thin sections were prepared and analysed. Four variables (cortical area, intact and fragmented osteon density and osteon population density) were calculated for each section and age was estimated according to Stout & Paine (1992) and Stout et al. (1994). The results showed that both methods produced a systemic underestimation of the individuals (to a maximum of 43 years) although a general improvement in accuracy levels was observed when applying the Stout et al. (1994) formula. There is an increase of error rates with increasing age with the oldest individual showing extreme differences between real age and estimated age. Comparison of the different sampling sites showed small differences between the estimated ages suggesting that any fragment of the rib could be used without introducing significant error. Yet, a larger sample should be used to confirm these results.

Sexual dimorphism of the metacarpals in contemporary Cretans: Are there differences with mainland Greeks?

Sex in the adult skeleton can usually be reliably determined through an assessment of features found on the pelvis and cranium. In the lack of these elements it is necessary to elaborate other methods to establish sex in skeletonised remains recovered in forensic cases. Standards for other bones (e.g. humerus, metacarpals and metatarsals) have already been established for the Greek population. The aim of this study is to determine whether the standards for metacarpals provided from a study on the Athens collection are representative of a modern Cretan population. Using a digital caliper we took 7 measurements on each one of the left and right metacarpal bones of 108 adult individuals from a modern collection from Crete. Totally twenty formulae for left and right bones created from the Athens collection were used to sex the sample of this study. The overall classification accuracy obtained for our sample was very close to the cross-validated accuracy reported by the authors. However, looking at the classification accuracy for males and females, a consistent trend for low classification rates in females was observed. New formulae were developed for the Cretan sample yielding up to 85% classification accuracy. This study clearly indicates that the standards for metacarpals developed from the Athens collection are not appropriate for application in forensic cases for the island of Crete as they do not represent the local population efficiently. This may hold true for other regions of Greece thus great caution should be taken when applying these standards. Obviously more research is needed to confirm these results.

Fatal hypernatraemia after laparoscopic treatment of hydatid liver cyst: medical and legal concerns of a rare complication.

A case of fatal hypernatraemia after laparoscopic treatment of hydatid livers cysts is presented in order to highlight the risks associated with the implementation of newer techniques and the use of hypertonic saline as a scolecocidal agent in hydatid disease. Additionally this case raises some concerns on the importance of obtaining a patient's informed consent.

Sexual dimorphism of the scapula and the clavicle in a contemporary Greek population: applications in forensic identification.

Sex estimation is the grounds for an accurate identification of unknown human skeletal elements. The need for reliable methods distinguishing males from females based upon various skeletal elements is evident in cases of commingled, eroded and/or missing remains. The aim of this work lays on establishing criteria for sex estimation from the scapula and the clavicle in modern Greeks. A total of 147 left scapulae and 147 clavicles (66 females and 81 males) were used in the study. Eight and six measurements were taken on the scapula and clavicle respectively and data were subjected to principal components analysis (PCA) and discriminant function analysis (DFA). Posterior probabilities for the classification of each individual are also calculated. Statistical analysis was carried out using the software PAST (Paleontological Statistics) and SPSS (Statistical Package for Social Sciences) 18. The results supported the existence of pronounced sexual dimorphism, which was mainly attributed to size differences among the two groups. Univariate and multivariate methods of statistical classification showed high accuracy for all scapular and most clavicular measurements, verifying their value as sex indicators in the under study population. We recommend the use of this method for sex assessment from the scapula and the clavicle in cases exhibiting over 95% probability of correct classification. This is regardless of the overall high degree of accuracy reported here, as the method of choice in forensic contexts should always be case-driven.

Suicide by pesticide poisoning: findings from the island of Crete, Greece.

BACKGROUND: The role of pesticides in suicidal acts has not yet received adequate attention in Greece despite an evident rise of 39% in pesticide use over the period 1990-1992 to 2002-2004. AIMS: To investigate the epidemiology of pesticide suicide on the Greek island of Crete, a largely rural agricultural area, and by further exploring the victim profiles, as well as patterns and trends of pesticide ingestion, to suggest probable preventive measures. METHODS: Self-poisoning suicides between 1999 and 2007 were reviewed and information gathered was entered into a computerized database. RESULTS: The overall incidence of intentional pesticide poisoning was 1.7 per 100,000, representing the second most frequently used suicide method after hanging. The victim profile was composed of the following features: middle aged male, rural habitant, who carried out a suicidal act by consuming primarily methomyl or paraquat (WHO toxicity class Ib and class II, respectively). As to the place of death, the vast majority was found dead in the place of intoxication. CONCLUSIONS: Pesticide self-poisoning accounts for a quarter of the suicides in Crete. More detailed research is required to identify aspects of these deaths amenable to prevention, but measures such as bans on the most toxic pesticides and changes in storage practice would appear to be sensible initial approaches.