The Arteries of the Central Forehead: Implications for Facial Plastic Surgery.

BACKGROUND: The forehead has substantial importance as an aesthetic unit. The central and supraorbital parts of this area are supplied by the supratrochlear (ST) and supraorbital (SO) arteries as well as the recently defined paracentral (PA) and central arteries. OBJECTIVES: The authors aimed to assess the morphometry of the vessels of the forehead in the context of plastic surgery and minimally invasive cosmetic procedures. METHODS: This research included 40 cadavers directed for forensic autopsy and subjected to postmortem computed tomography angiography. In total, 75 hemifaces were examined for the course and location of arteries relative to the bones and surrounding structures. RESULTS: The arteries were observed as follows: ST in 97.3%, SO in 89.3%, and PA in 44.0%. The PA can be expected in the 13-mm-wide zone starting 2 mm laterally from the midline. The ST should be expected in the 10-mm-wide area extended laterally from the tenth millimeter from the midline, and the SO should be expected in the slightly wider (11 mm) area extending laterally from the 20th millimeter from the midline. For the proximal main trunks of the ST and SO arteries, we observed no overlap between the zones of occurrence, whereas the zones for the PA and ST main proximal trunks did overlap. No distinctive central artery was observed in the midline region of the forehead, but instead a network of small vessels in the midline region was visible. CONCLUSIONS: The ST is the main and most conservative artery of this region and the PA is the most variable. A unique and detailed anatomical map was created to better understand the vasculature of the forehead area.

Usefulness of post mortem computed tomography versus conventional forensic autopsy of road accident victims (drivers and passengers).

Aim of the study: Deaths of in-vehicle victims (drivers and passengers) of road accidents represent a significant group of issues addressed by forensic medicine. Expressing opinions in this regard involves first of all the determination of the cause of death and the forensic pathologist's participation in the process of road accident reconstruction through defining the mechanism of bodily harm. The scope of the opinion as well as its accuracy and degree of detail largely depend on the scope of forensic autopsy. In this context, techniques that broaden the capabilities of standard autopsy are of particular importance. This paper compares the results of post mortem computed tomography (PMCT) of road accident victims (drivers and passengers) against the results of standard examination in order to determine the scope to which PMCT significantly enhances autopsy capabilities. Material and methods: The analysis covers 118 in-vehicle victims (drivers and passengers) examined from 2012 to 2014. In each case, post-mortem examination was preceded by PMCT examination using Somatom Emotion 16 (Siemens AG, Germany). Results: The results are presented in a tabular form. Conclusions: In most road accident victims (drivers and passengers), post mortem computed tomography significantly increases the results' degree of detail, particularly with regard to injuries of bones and gas collections.

Whole-body post-mortem computed tomography angiography of a newborn revealing transposition of great arteries.

The number of medico-legal post-mortem examinations referring to newborns is considerably low: In the case of the Chair and Department of Forensic Medicine of the author's origin, the autopsy rate of such cases is less than 1%. Even experienced forensic pathologists can find the technical autopsy procedure of a newborn quite difficult. Post-mortem imaging using unenhanced post-mortem computed tomography (PMCT) gives only a limited opportunity to help in conventional autopsy examination. By adding contrast medium (CA) administration, we can significantly expand diagnostic capabilities. However, the post-mortem computed tomography angiography (PMCTA) technique has already been developed mostly in adult death cases (as considerably much more frequent), and no standardised protocol for examination of children exists. The authors present the dual-phase PMCTA examination of a newborn by manual CA administration using the access to umbilical vessels (vein and artery) unveiling transposition of the great arteries (TGA). The results are presented as multiplanar reformatted (MPR) images and three-dimensional (3D) images by volume/surface-rendered reconstructions, giving a contribution towards proving the value of forensic imaging in post-mortem examinations of heart and vascular malformations in newborns.

Imaging for homicide investigations.

The authors present the opportunities of the application of post-mortem imaging, focusing on post-mortem computed tomography and post-mortem computed tomography angiography in modern forensic investigation of homicide cases. The paper is based on scientific publications related to the subject from ca. the past 10 years, supplemented by the authors' own experiences. The article is illustrated with reconstructions based on the authors' own cases related to homicide due to ballistic/sharp/blunt trauma. As is shown, the results of evaluation of post-mortem computed tomography allow better diagnosis, documentation and visualisation of forensic examinations.

Fatal traffic accidents involving electric scooters in Poland in 2019-2023.

With the introduction of mobile applications that allow short-term rentals, electric scooters (e-scooters) are gaining popularity as a means of micromobility in urban areas. The aim of the study was to assess the circumstances and causes of death in traffic accidents involving electric scooters in Poland. The inclusion criteria for the study were met by 9 cases (7 M,2F; mean age: 40.3 years). Accidents usually occur during working days during the warm months, especially during the morning traffic rush hour. Usually, these accidents involved another vehicle (4/9 cases). In addition, the victim was most often the driver (8/9 cases) and rarely uses a helmet (1/9 cases). In only two cases did the test reveal the presence of alcohol in the blood at the time of the accident. In studied cases, head injuries occurred in every case, and injuries to the limbs and chest occurred in more than half of the cases. Within the head, in addition to minor injuries like bruises and epidermal abrasions, skull fractures, and intracranial bleedings predominated. Similar minor injuries were also observed in the extremities, with significant fractures observed only in the lower extremities. Among chest injuries, lung contusions predominated. The most common cause of death was craniocerebral injury (6/9 cases), but there were two deaths each from chest injuries and polytrauma. To increase the safety of e-scooter users, it is recommended that measures be taken to educate users about the potential risks of using the vehicle and that measures be taken to increase the use of helmets, e.g. through legislative action. Further studies involving larger study groups are needed to assess the correlation between potential risk factors and the fatal outcome of the accident.

The evaluation of vasculature in post-mortem angio-computed tomography for anatomy research purposes: method description based on celiac trunk analysis.

BACKGROUND: Anatomical research based on deceased body specimens is a time-consuming process that requires a great deal of skill and time to perform correctly. Three-dimensional medical image analysis is an excellent tool for anatomic evaluation, but it often includes patients with comorbidities in the study group, which can skew the results. The purpose of this study was to develop and evaluate methods for anatomic research based on postmortem contrast-enhanced computed tomography angiography 3D reconstruction of the celiac trunk. MATERIALS AND METHODS: Postmortem contrast-enhanced computed tomography angiography of 105 (28.6% female, age 50.8±18.7) decedents without abdominal trauma or tumor was analyzed. The abdominal portion of the aorta and the celiac trunk with its branches were reconstructed and evaluated. The type of celiac trunk was evaluated. The results were analyzed. RESULTS: The celiac trunk, splenic artery, and common hepatic artery were visualized in all cases. The left gastric artery was visible in 97.1% of cases. The dorsal pancreatic artery was visualized in 61.0% of cases. The most common type of celiac trunk was 1 (88.6%), and the rarest types were 2, 3, and 6 (1.0%). We observed 4 morphologies of the truncus celiacus that did not fit the classification presented previously. CONCLUSIONS: This study has demonstrated that three-dimensional reconstruction of postmortem contrast-enhanced computed tomography is an excellent tool for performing accurate morphometric analyzes for anatomic research purposes. This method can serve as a source for anatomic studies in the healthy population.

Superior mesenteric artery clinical classification and morphometrical analysis.

BACKGROUND: The superior mesenteric artery is one of the most important arteries in the abdominal cavity, which is of great clinical importance, especially in surgical procedures and fatal ischemic complications. The aim of this study was to develop a clinical classification of the superior mesenteric artery. MATERIALS AND METHODS: Postmortem contrast-enhanced computed tomography of 104 (29.8% female, age 50.7±18.7) human bodies were analyzed. Based on anatomic predisposition to ischemic and iatrogenic complications, a three-tiered clinical classification of the superior mesenteric artery was developed. Type 0 was defined as standard risk for ischemic and iatrogenic complications. Type 1 was defined as increased thromboembolic risk with decreased risk of iatrogenic bleeding, and type 2 was defined as decreased ischemic risk with increased risk of iatrogenic bleeding. The supply area of the superior mesenteric artery was divided into 4 regions: pancreas, caecum, ascending colon, and transverse colon. RESULTS: Type 0 (standard risk) was found in 62.5% of cases. Type 1 was most frequently observed in the ascending colon region (15.4%). Type 2 was most frequently observed in the pancreatic region (17.3%). Regarding type, most abnormalities were found in the region of the ascending colon (18.3%), pancreas region (17.3%), and transverse colon (16.3%). CONCLUSIONS: The proposed clinical classification of SMA links anatomic variations in morphology with their clinical significance. A simple, three-level classification can be easily applied in daily practice and serve as a great support for preoperative evaluation and recognition of patients at risk of iatrogenic or thromboembolic complications.

[Validity of post-mortem computed tomography angiography (PMCTA) in medico-legal diagnostic management of stab and incised wounds]. / Przydatnosc posmiertnego badania tomografii komputerowej z angiografia (PMCTA) w sadowo-lekarskiej diagnostyce przypadków ran klutych i cietych.

The report presents an analysis of results of multi-phase post-mortem computed tomography angiography (MPMCTA) scans performed at the Chair of Forensic Medicine, Jagiellonian University Medical College, in cases of stab wounds and incised wounds, as confronted with the results of conventional medico-legal autopsies. The analysis of the material points to a validity of PMCTA scans as supplementing post-mortem medico-legal examinations and being capable of providing significant data that affect final conclusions and adding new quality to recording post-mortem observations.

Restraint asphyxia. An analysis of the circumstances and mechanism of death in agitated, physically restrained individuals. / Asfiksja restrykcyjna. Analiza okolicznosci i mechanizmu smierci osób pobudzonych psychoruchowo, w trakcie obezwladniania z uzyciem sily.

Recent years saw frequent media reports of young people who die while they are being arrested by the police. Death in these circumstances affects people who are agitated and restrained with the use of force, with their autopsies indicating no unequivocally traumatic cause of death. The goal of this study was to identify the mechanism and circumstances of sudden deaths in agitated individuals who are being restrained. Ten cases evaluated at our center since 2010 were included in this study: nine involved forensic postmortem examination and one involved casefile analysis. In each case there was sudden cardiac arrest or at least a loss of consciousness, and the cardiopulmonary resuscitation proved ineffective. In six cases the cause of agitation was acute psychosis, in four it was an effect of narcotics, usually in high concentration. Conjunctival petechiae were detected in only five cases. The most probable cause of death in the evaluated cases was the combination of physical exertion caused by pathological psychomotor agitation and forcible restraint, hindering the function of the respiratory system. This mechanism is known as restraint asphyxia.

Post-aggression suicide under the influence of new psychoactive substances AMB-FUBINACA and U-47700.

The objective of the present study was the development and validation of the method for determining AMB-FUBINACA and its metabolite - AMB-FUBINACA O-desmethyl acid - in blood samples, followed by verification of the method in toxicological judicial and forensic medicine practice employing the example of post-aggression suicide. Most likely in consequence of development of adverse effects resulting in psychotic symptoms, a male being under the influence of the synthetic cannabinoid AMB-FUBINACA and the new synthetic opioid U-47700, mortally wounded his female partner and subsequently committed suicide. Identification and determination of the afore-mentioned xenobiotics in blood samples collected from the male and female victims were performed employing high performance liquid chromatography coupled with electrospray ionization tandem mass spectrometry (HPLC-ESI-MS/MS). The analytes were isolated from blood samples using the solid phase extraction (SPE) method. The blood samples collected from the male and female demonstrated respectively 110 and 196 ng/mL of AMB-FUBINACA O-desmethyl acid metabolite, 1935 and 357 ng/mL of U-47700, 250 and 200 ng/mL of N-desmethyl-U-47700, as well as 410 and 200 ng/mL of N,N-didesmethyl-U-47700. The concentration values of new psychoactive substances (NPS's) in blood samples originating from the male and female were within the ranges encountered in cases of poisoning, including these resulting in death. Nevertheless, the evident signs of exsanguination proof that the woman was alive when she sustained lethal injuries. The presented cases illustrate the difficult to be anticipated effect exerted on the users by NPS's.

The various pathological manifestations of a lightning strike exemplified in a single four-fatality incident - A case report and review of a literature.

The lightning strike is one of leading cases of weather-related death worldwide. We present an unusual case of four fatality-lightning strike with various pathological manifestations. All victims died from a single lightning strike in the mountains that also caused injury to 156 other people. All victims had mechanical damage and rock damage that are typical for lightning strikes in the mountainside. Another lesions indicative of lightning strike and electrical damage were, among others: burnt and torn clothes (all cases) current marks (Cases 1, 2 and 3) and Lichtenberg figures along with flashover marks on Case 1. In the review we described the pathophysiological mechanisms of lightning-induced lesions and injuries and epidemiological trends of lightning-strike deaths. Our study exemplifies various manifestations of lightning strikes on forensic examination and underlines the necessity to take lightning strike into consideration when investigating open-air deaths of unclear origin.

[Usefulness of preliminary evaluation of postmortem CT as an extension of diagnostic capabilities of conventional forensic autopsy]. / Przydatnosc wstepnej analizy danych z posmiertnego badania TK dla poszerzenia mozliwosci diagnostycznych sadowo-lekarskiej sekcji zwlok.

Based on material from their studies, the authors discuss how the initial evaluation of data obtained through the acquisition of postmortem CT prior to autopsy may point to traumatic changes that could be difficult to find in conventional medico-legal autopsy.

[Value of postmortem CT examinations in cases of extensive mechanical injuries causing considerable corpse destruction]. / Wartosc posmiertnych badan TK w przypadkach urazów mechanicznych powodujacych znacznego stopnia destrukcje zwlok.

The authors present three-dimensional reconstructions based on acquisition of postmortem CT examinations in cases of extensive mechanical injuries. The data may be helpful in identification of the examined fragment of the body, as well as useful for further analysis of the mechanism of injuries. An additional aspect of the analyzed data refers to possible obtaining information that may confirm the identity of the deceased.

[Postmortem CT examination with 3D reconstruction in gunshot and post explosion injuries]. / Posmiertne badania obrazowe TK z rekonstrukcja 3D u ofiar postrzalów z broni palnej i eksplozji ladunków wybuchowych.

The authors presented the results of postmortem examinations of four cases related to gunfire and post explosion injuries. Prior to "classic" forensic autopsies, the corpses were examined using CT imaging. The findings (injuries and foreign bodies) are presented in the table and in images: 3D reconstructions contrasted with actual autopsy specimens. The enclosed CD includes 3D animations.

[Postmortem CT examination with 3D reconstruction in cases referring to casualties of traffic accidents]. / Posmiertne badania obrazowe TK z rekonstrukcja 3D u ofiar wypadków drogowych.

The authors presented results of postmortem examination in five cases of victims of fatal traffic accidents (four pedestrians and one motorcyclist). Prior to "classic" forensic autopsies, the bodies were examined employing CT imaging. The results are presented in the table along with 3D and 2D CT images. The enclosed CD includes 3D animations.

[Postmortem imaging studies with data processing and 3D reconstruction: a new path of development of classic forensic medicine?]. / Posmiertne badania obrazowe z rekonstrukcja 3D: nowa droga rozwoju klasycznej medycyny sadowej?

The techniques employed in "classic" forensic autopsy have been virtually unchanged for many years. One of the fundamental purposes of forensic documentation is to register as objectively as possible the changes found by forensic pathologists. The authors present the review of techniques of postmortem imaging studies, which aim not only at increased objectivity of observations, but also at extending the scope of the registered data. The paper is illustrated by images originating from research carried out by the authors.

[Reconstruction of an air-gun injury track in the neck region--a case report]. / Rekonstrukcja kanalu postrzalu z wiatrówki w zakresie szyi--opis przypadku.

The authors present a case of an air-gun injury of the neck region with a foreign body left in situ. The DICOM files obtained during clinical CT examination (including computed tomography angiography) gave the opportunity for three-dimensional reconstructions of the location of the pellet, neighboring blood vessels and the bullet track--essential for a successful analysis of a possible version according to the testimonies related to the critical event.

[Postmortem CT examination in a case of alleged drowning--a case report]. / Posmiertne badanie obrazowe TK w przypadku domniemanego utoniecia--opis przypadku.

The authors present an analysis of postmortem CT examination in a case of drowning in fresh water of a young male. Both the results of conventional forensic autopsy and radiologic examination have been compared. The analysis is illustrated by two-dimensional and three-dimensional reconstructions based on the DICOM files obtained during postmortem CT examination.

Evaluation of usefulness of post-mortem computed tomography in the diagnosis of abdominal parenchymal organ injuries compared to medicolegal autopsy findings

INTRODUCTION: Post-mortem computed tomography (PMCT) is an examination technique which provides particular benefits in forensic medical practice in the evaluation of traumatic injuries. However, the usefulness of PMCT in the diagnosis of parenchymal structures in the human body is not obvious. AIM OF THE STUDY: To evaluate the usefulness of PMCT in the diagnosis of parenchymal organ injuries (liver, pancreas, spleen and kidneys) and the presence of blood in the abdominal cavity. MATERIAL AND METHODS: The study was conducted on a population of deceased persons who underwent medicolegal autopsy in the Chair and Department of Forensic Medicine, Jagiellonian University Medical College in Krakow. The study included cases of violent death with the presence of blunt-force trauma. In all cases studied, the autopsy examination was preceded by PMCT. Both methods were employed to identify signs of injury to parenchymal organs and the presence of blood in the abdominal cavity. Observations made during the autopsies were considered in this study as the gold standard to which the PMCT findings were compared. RESULTS: The data obtained in the study was analyzed statistically to determine a range of parameters including sensitivity, specificity, positive and negative predictive values, and reliability. The values were presented in a tabulated form. CONCLUSIONS: The evaluation of usefulness of PMCT in the detection of abdominal parenchymal organ injuries and the presence of blood in the abdominal cavity failed to yield satisfactory results that would justify the application of PMCT in medicolegal practice as a diagnostic tool comparable to autopsy. However, promising results were obtained with respect to the suitability of PMCT as a screening test to exclude the presence of such injuries.