Forensic investigation of complex and complicated suicides in Attica, Greece: a 12-year retrospective study.

The purpose of this study was to examine the prevalence and characteristics (victims' profiles, circumstances surrounding the incidents, and methods employed) of complex and complicated suicides over a 12-year period in the broader area of Athens, Greece. A retrospective analysis of 5,568 autopsy cases performed at the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens from January 1, 2011, to December 31, 2022, was carried out. Out of a total sample of 5,568 autopsies, 360 suicide cases were identified, among which 14 (3.9%) were classified as complex suicides, and one case (0.3%) was identified as complicated suicide. Among the victims, 78.6% were males. The age range of the victims varied between 25 and 82 years old. The most prevalent method of complex suicide was the use of sharp objects followed by jumping from a height (42.8%). The next most common combination of methods was poisoning (21.4%) along with hanging. Prior suicidal attempts and suicide note were mentioned in 16.7% and 8.3% of the cases respectively. Overall, a total of 9 different methods were used in the above 14 cases. Only half (50.0%) of the victims had an established psychiatric diagnosis. In determining the cause of death in cases of a complex or complicated suicides, it is of utmost importance for the forensic pathologist to gather and analyze all available information provided by the police, the victim's relatives along with a thorough investigation of the scene, a detailed autopsy and a toxicological analysis.

Serum concentrations of BDNF in adolescents with metabolic syndrome: a case-control study between normal - BMI adolescents and adolescents with obesity.

Brain-Derived Neurotrophic Factor (BDNF) has been linked to various conditions of the cardiovascular and nervous systems. Scarce data exist about the concentrations of BDNF in children and adolescents in relation with obesity and metabolic syndrome (MetS). The aim of this study was to examine the serum BDNF concentrations in adolescents with metabolic syndrome and according to their body mass index (BMI) status. This was a case-control study, assessing BDNF concentrations between adolescents with MetS (with obesity vs. normal-BMI), in relation to sex, anthropometric, metabolic and endocrine parameters. Participants included male and female adolescents, whose anthropometric and metabolic panel, as well as serum BDNF concentrations were measured. A total of 59 adolescents (obesity: 29; normal-BMI: 30) were included in the study. Increased serum BDNF concentrations were observed in MetS adolescents with obesity when compared with normal-BMI adolescents (p < 0.001). Males exhibited higher concentrations of BDNF than females (p = 0.045). The sample was further divided into four categories by sex and BMI status, with normal-BMI females exhibiting significantly lower BDNF concentrations than females and males with obesity(p = 0.005). In the entire study sample, serum BDNF concentrations correlated positively with BMI z-scores, however, this statistical significance was preserved only in the females of the sample. No statistical difference was observed between males of different BMI z-scores categories.  Conclusion: Obesity appeared as a major factor for increased serum BDNF concentrations in adolescents with MetS (vs. normal-BMI), with a higher impact on BDNF concentrations in females than males. What is Known: • The brain-derived neurotrophic factor (BDNF) is involved in metabolic syndrome in adults but data in adolescents are scarce. What is New: • Obesity (vs. normal BMI) was a major factor for increased serum BDNF in adolescents with metabolic syndrome. • Obesity had a higher impact on BDNF concentrations in females than males with metabolic syndrome.

A comparative autopsy study of the injury distribution and severity between suicidal and accidental high falls.

Falls are the second cause of accidental deaths worldwide. Falls from height are also a common method of suicide. The aim of this study is to compare the characteristics of the victims, the circumstances of the fall and the severity and distribution of the injuries reported in an autopsy case series of falls from height. This study is a retrospective analysis of consecutive autopsy cases of suicidal and accidental falls from height which were investigated in the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens during the period 2011-2019. The recorded variables included demographic data of the victim, height of fall, length of hospital stay, toxicological results, the existence and location of injuries and Injury Severity Score (ISS). Victims of suicidal falls were younger (55.53 vs. 62.98, p = 0.001), they fell from higher heights (12.35 vs. 5.18 m, p < 0.001), and they sustained more severe injuries compared with victims of accidental falls (ISS 51.01 vs. 40.88, p < 0.001). Injuries in the thorax, abdomen, pelvis, upper and lower extremities were more frequently observed after a suicidal fall (93.6% vs. 67.3%, 72.1% vs. 21.4%, 72.1% vs. 27.6%, 42.9% vs. 15.3%, 45.7% vs. 13.3%, respectively-p < 0.001), probably due to the higher height of fall. Our study outlines the differences in the profile of the victims and in the severity of injuries caused by falls from height depending on the intention of the victim to fall. However, a distinctive injury pattern in victims of suicidal falls was not demonstrated.

Layer-Specific Residual Deformations and Their Variation Along the Human Aorta.

This study described the regional distribution of layer-specific residual deformations in fifteen human aortas collected during autopsy. Circumferentially and axially cut strips of standardized dimensions from the anterior quadrant of nine consecutive aortic levels were photographed to obtain the zero-stress state for the intact wall. The strips were then dissected into layers that were also photographed to obtain their zero-stress state. Changes in layer-specific opening angle, residual stretches, and thickness at each aortic level and direction were determined via image analysis. The circumferential and axial opening angles of the intima were ∼240 deg and ∼30 deg, respectively, throughout the aorta; those of the adventitia were ∼150 deg and -20 deg to 70 deg. The opening angles of the intact wall and media were similar in either direction. The circumferential residual stretches of the intima and the axial residual stretches of the media showed high values in the aortic arch, decreasing in the descending thoracic aorta and increasing toward the iliac artery bifurcation, while the axial residual stretches of the adventitia increased distally. The remaining residual stretches did not vary significantly with aortic level, suggesting an intimal role in determining circumferential, as well as medial and adventitial roles in determining axial residual stretches. We conclude that the tensile residual stretches released in the intima and media upon separation, and the compressive residual stretches released in the adventitia may moderate the inverse transmural stress gradients under physiologic loads, resulting from the >180 deg circumferential opening angle of the intact wall.

Intimate partner violence in Greece: a study of 664 consecutive forensic clinical examinations.

BACKGROUND: Intimate partner violence (IPV) is a well-known phenomenon, which affects mostly women. While IPV victims may attend emergency departments (EDs) seeking medical care, not all of them will make an allegation against their abusers. OBJECTIVE: The aim of this study was to examine the prevalence and the characteristics of the victims, who had made an allegation about the violent incident and had been examined by a forensic pathologist for judicial purposes, and had attended EDs seeking medical care, before the forensic examination. METHODS: We reviewed the archives of clinical examinations that were conducted at the Department of Forensic Medicine and Toxicology of National and Kapodistrian University of Athens during a 5-year period (2012-16). RESULTS: Six hundred sixty-four clinical examinations were conducted at our Department for IPV allegations. According to our findings, women were more likely to seek medical care than men. Victims who have attended EDs were more likely to have sustained injuries located at least on the head or on the lower limbs. CONCLUSION: The majority of IPV victims in the broader region of Attica (Greece) were women, usually married, and aged between 30 and 49 years old. Despite the fact that the majority of IPV incidents are not reported to police, every person who is engaged in the process of dealing with IPV victims has to be educated and adequately informed about this phenomenon, its implications and the possible ways to deal with it. Furthermore, victims need to be educated and informed adequately in waiting rooms of EDs.

Variation of Axial Residual Strains Along the Course and Circumference of Human Aorta Considering Age and Gender.

Our understanding of aortic biomechanics is customarily limited by lack of information on the axial residual stretches of the vessel in both humans and experimental animals that would facilitate the identification of its actual zero-stress state. The aim of this study was thus to acquire hitherto unreported quantitative knowledge of axial opening angle and residual stretches in different segments and quadrants of the human aorta according to age and gender. Twenty-three aortas were harvested during autopsy from the aortic root to the iliac bifurcation and were divided into ≥12 segments and 4 quadrants. Morphometric measurements were taken in the excised/curled configuration of rectangular strips considered to be under zero-stress using image-analysis software to study the axial/circumferential variation of axial opening angle, internal/external residual stretch, and thickness of the aortic wall. The measured data demonstrated: (1) an axial opening angle peak at the arch branches, decreasing toward the ascending and to a near-constant value in the descending thoracic aorta, and increasing in the abdominal aorta; (2) the variation of residual stretches resembled that of opening angle, but axial differences in external residual stretch were more prominent; (3) wall thickness showed a progressive diminution along the vessel; (4) the highest opening angle/residual stretches were found in the inner quadrant and the lowest in the outer quadrant; (5) the anterior was the thinnest quadrant throughout the aorta; (6) age caused thickening but greatly reduced axial opening angle/residual stretches, without differences between males and females.

Redefining Vascular Anatomy of Posterior Tibial Artery Perforators: A Cadaveric Study and Review of the Literature.

INTRODUCTION: Perforator flaps whether in a free or pedicled form are essential in leg reconstruction, requiring meticulous dissection based on a detailed understanding of vascular topographic anatomy. Numerous investigators have addressed this issue. However, the directionality of their fascial exit has not been greatly discussed in the literature. Subfascial course of the perforating vessel is a crucial determinant for optimal perforator selection especially when the propeller perforator flap option is considered, because an angulated fascial penetration would eventually result in perforator kinking which would additionally compromise vascular patency. The aim of the current study was to investigate the vascular anatomy of posterior tibial artery evaluating a wide range of parameters, including perforators' subfascial directionality, to precisely determine constant reliable perforator sites, in relation to surface landmarks on the medial aspect of the lower leg. MATERIAL AND METHODS: Dissections in 30 lower legs from 25 fresh cadavers were performed. The lower leg was divided into 3 equal vascular zones. Measurements were taken in reference to anatomical landmarks. Perforator clusters to 5-cm intervals from medial malleolus were recorded and analyzed. Vessels with external diameter less than 0.5 mm were excluded. Data regarding the number, distribution, type, external diameter, length from posterior tibial artery, distance, and subfascial directionality were collected and treated. RESULTS: A total of 155 perforators were identified (average number, 5 per leg; average diameter, 1.0 mm). Septocutaneous (127/155) perforators predominated, followed by musculocutaneous (19/155) and septomusculocutaneous (9/155). Most was concentrated in the middle (73/155) and distal (64/155) tertile. There were no septomusculocutaneous perforators at the distal third of the leg, whereas septocutaneous perforators were encountered into all vascular tertiles. An average of 2 comitant veins accompanied each perforator. Length and diameter related to the perforators' location. There was a significant association between perforator length and type. Cluster analysis revealed that reliable perforators were identified within the 21 to 25, 26 to 30, and 16 to 20 cm intervals. CONCLUSIONS: Clinically optimal perforators for the first time were precisely located in relation to subfascial directionality, vascular diameter, and length from the source artery. Continuous improving details of vascular anatomy will further evolve perforator flaps' applications.

The microvascular anatomy of superior and inferior gluteal artery perforator (SGAP and IGAP) flaps: a fresh cadaveric study and clinical implications.

BACKGROUND: Our study aimed to highlight anatomical similarities, differences, and variations in the microvascular anatomy between superior and inferior gluteal artery perforator (SGAP and IGAP) flaps. METHOD: Thirty gluteal flaps (15 SGAP and 15 IGAP) were studied on 22 adult fresh cadavers. We recorded the number and location of perforators, the characteristics of the main perforator (course, length, and diameter at the level of division at the greater sciatic foramen), and the anatomical variations of the submuscular venous plexus. RESULTS: The mean number of perforators was similar in both flaps (n = 7). We found a statistically significant difference in the total length of the vascular pedicle between SGAP (mean = 9.80 cm) and IGAP (mean = 13.36 cm) flaps, which correlated strongly with the difference in the intramuscular length (mean difference = 3.40 cm) of the perforator. There was no statistically significant difference in the diameter of the superior and inferior gluteal vessels at the point of pedicle division. The complex submuscular venous plexus, which is typically found on SGAP flaps deep to the sacral fascia, was never encountered on IGAP flaps. Perforators originating from the inferior gluteal artery were found on the lower half of five superior gluteal flaps. These were dominant perforators in two cases. We also report a rare anatomical communication between superior and inferior gluteal vessels deep to the piriformis muscle and a case of atheromatous disease of the inferior gluteal artery. CONCLUSION: Our findings are highly relevant to clinical practice and contribute to the understanding of the vascular anatomy of SGAP and IGAP flaps and the successful use of these challenging flaps. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Diagnostic value of cardiac troponin I in postmortem diagnosis of myocardial infarction.

Troponin I (cTnI) is a very sensitive biochemical marker for the diagnosis of myocardial infarction (MI). Cardiac troponin (cTnI or cTnT) has nearly absolute myocardial tissue specificity, thereby reflecting even microscopic zones of myocardial necrosis. The aim of this study is to evaluate the pericardial fluid levels of cTnI in medicolegal autopsy cases where patients died of MI and compare them with cases where patients died of other causes. This study included 89 cases selected during a 1-year period from medicolegal autopsies. These were classified into 4 groups: (A) myocardial infarction (n = 28), (B) salt water drowning (n = 20), (C) death resulting from injury in the respiratory system (n = 16), and (D) other causes of death (n = 25), excluding MI. The mean concentrations of cTnI were 1067.03 mg/dL for group A, 546.98 mg/dL for group B, 398.75 mg/dL for group C, and 577.47 mg/dL for group D. In cases with MI (group A), there was a significant difference in the levels of cTnI compared with the other cases. More research needs to be done in order for a cutoff level to be determined.

Extended Stanford Type-A Aortic Dissection with Multivessel Coronary and Peripheral Artery Involvement: An Autopsy Case Report.

We report the case of a 64-year-old male who died suddenly short after his admission to hospital because of strong chest pain and before any clinical diagnosis was established. His medical history included coronary disease with coronary by-pass surgery at the age of 40 years old, uncontrolled hypertension, diabetes mellitus, and elevated levels of cholesterol. The autopsy revealed quite a rare case of Stanford A aortic dissection with extension to the common and internal carotid arteries; the subclavian, axillary, brachial, and radial arteries; three coronary arteries; the superior mesenteric artery; and the iliac arteries. There was no histological evidence of aortitis or connective tissue disease. The death did not result from the rupture of the aortic dissection, but from myocardial ischemia due to coronary occlusion in combination with hemodynamic disturbance from stress caused by the extended aortic dissection.

Characterization of Domestic Violence among Patients Consulting a French Psychiatric Emergency Department.

The aim of the present study was to identify the prevalence of domestic violence among patients attending a French psychiatric emergency department and its association with psychiatric disorders. This retrospective study was performed, including all patients examined in the psychiatric emergency department of the Lapeyronie University Hospital of Montpellier (France) in the daytime from 1 July 2021 to 31 October 2021. A total of 152 patients were eligible during this study period. The prevalence of domestic violence was 38.2% (n = 58) overall. The percentage of female victims of domestic violence was higher than that of male victims (47.6% vs. 17.0%, p < 0.001). Among the 58 victims of domestic violence, 20.7% reported psychological abuse, 17.2% physical abuse, 3.4% sexual abuse, and 58.6% multiple forms of abuse. The risk of suicide attempt and anxiety disorder among the female patients was associated with domestic violence (p = 0.006, OR = 7.24, and p = 0.010, OR = 0.16). Our study showed that the psychiatric population should be identified as a population at risk for domestic violence, especially when the patient is female and suffers from anxiety disorders or if she has performed a previous suicide attempt.

The Prevalence and Characteristics of Intrafamilial Child and Adolescent Homicides in Greece over 11 Years (2010-2020).

Intrafamilial child/adolescent homicide is the murder of a child/adolescent by one or more family members. This study delves into the medical and sociological consequences of child homicide, shedding light on the broader impact beyond individual families, which extends into the local community. Two Internet search engines and the search engines of major national news websites were surveyed to identify the number of intrafamilial child/adolescent homicide cases that occurred in Greece from January 2010 to December 2020. Over the study period, 34 victims of intrafamilial child/adolescent homicides were identified. The above deaths reflect an intrafamilial child/adolescent homicide rate of 0.15 homicides per year per 100,000 inhabitants. Most of the perpetrators (51.4%) were male, and the victims were equally divided into males and females. The ages of the perpetrators ranged from 13 to 61 years, and the ages of the victims ranged between 0 and 17 years. Most perpetrators (54.5%) had a previous psychiatric history and in many cases, they committed (33.3%) or attempted (15.2%) suicide after the homicide. The most common method of homicide was strangulation (usually combined with suffocation) (25%), followed by abandonment (15.6%). The most commonly reported motives were spousal revenge (26.5%) and psychotic disorders (26.5%). Raising awareness for intrafamilial child and adolescent homicide is of the utmost importance for the prevention of this dreadful phenomenon.

Age Estimation in 0-8-Year-Old Children in France: Comparison of One Skeletal and Five Dental Methods.

Age estimation in juveniles is a critical procedure in judicial cases for verification of imputability or for civil reasons when adopting children. Several methods based both on skeletal and dental growth have been performed and applied on different populations; nevertheless, few articles have compared different methods in order to test their reliability in different conditions and age ranges, and this is a clear obstacle in the creation of common guidelines for age estimation in the living. A comparison of five dental methods (Anderson, Ubelaker, Schour and Massler, Gustafson and Koch, Demirjian) and one skeletal method (Greulich a Pyle atlas) was performed on a population of 94 children aged between 0 and 8 years. Results showed that, whereas under 2 years all the methods have the same inaccuracy, over 2 years the diagram methods, such as Schour and Massler and Ubelaker's revised one, have a lower error range than the most frequently used Greulich and Pyle atlas and Demirjian method. Schour and Massler, Gustafson and Koch, and Ubelaker methods showed, respectively, a mean error amounting to 0.40, 0.53, and 0.56 years versus the 0.74 and 0.88 years given by Demirjian and the Greulich and Pyle atlas. An in-depth analysis of the potential of several methods is necessary in order to reach a higher adherence of age estimation with the complexity of growth dynamics.

Sudden cardiac death in the young: A consensus statement on recommended practices for cardiac examination by pathologists from the Society for Cardiovascular Pathology.

Sudden cardiac death is, by definition, an unexpected, untimely death caused by a cardiac condition in a person with known or unknown heart disease. This major international public health problem accounts for approximately 15-20% of all deaths. Typically more common in older adults with acquired heart disease, SCD also can occur in the young where the cause is more likely to be a genetically transmitted process. As these inherited disease processes can affect multiple family members, it is critical that these deaths are appropriately and thoroughly investigated. Across the United States, SCD cases in those less than 40 years of age will often fall under medical examiner/coroner jurisdiction resulting in scene investigation, review of available medical records and a complete autopsy including toxicological and histological studies. To date, there have not been consistent or uniform guidelines for cardiac examination in these cases. In addition, many medical examiner/coroner offices are understaffed and/or underfunded, both of which may hamper specialized examinations or studies (e.g., molecular testing). Use of such guidelines by pathologists in cases of SCD in decedents aged 1-39 years of age could result in life-saving medical intervention for other family members. These recommendations also may provide support for underfunded offices to argue for the significance of this specialized testing. As cardiac examinations in the setting of SCD in the young fall under ME/C jurisdiction, this consensus paper has been developed with members of the Society of Cardiovascular Pathology working with cardiovascular pathology-trained, practicing forensic pathologists.

Regional delamination strength in the human aorta underlies the anatomical localization of the dissection channel.

Aortic dissection is a life-threatening event, during which a primary tear propagates along the aorta causing catastrophic delamination of the inner (intima with most of the media) from the outer layers (leftover media with adventitia). Our understanding of mode-I fracture resistance at different aortic regions is incomplete, although the anatomical localization of the dissection channel may be assigned to this factor. To determine whether the susceptibility to dissection propagation varied with aortic region, the average and standard deviation of peel tension (indices of adhesive strength between layers when pulled apart and its fluctuation) were measured in 24 cadaveric subjects. Measurements were made in the inner and outer quadrants of 9 consecutive regions. Strong regional heterogeneity was established that was age-related based on the following evidence: (1) the average and standard deviation of peel tension peaked in the ascending aorta, decreasing to almost constant values in the descending thoracic aorta, but increasing across the abdominal aorta; (2) axial differences were more pronounced in the inner quadrant, with differences among quadrants reaching significance proximally; (3) the average peel tension was greatly impaired from <40 to 40-60 but much less to >60-year-old subjects at most regions/quadrants, leading to non-uniform axial variations in all age groups; (4) gender affected little the data. This comprehensive series of delamination tests explains the clinical observation of most dissections initiating in the ascending aorta to extend distally and of few dissections initiating in the descending thoracic aorta to extend proximally, while supporting the increased vulnerability in aged subjects.

A rare case of complicated suicide: Self-immolation and subsequent stab heart injury due to fall into a glass door.

Complicated suicides can be defined as incidents where death is caused by a subsequent trauma rather than the primary injury. Deaths which occur as a complication of the suicidal act are very rare with few reports in the literature. We present the case of a 60-year-old man who was found at his home while still alive. His body was burning and he was lying on his back impaled by shards of glass that had come from a broken glass door. An ambulance was called but the man died before arrival at hospital. The autopsy showed stab heart and lung injuries in thorax and an abdominal stab trauma which resulted in the protrusion of the small intestine. Homicide was excluded and the sequence of events was reconstructed to reveal a complicated suicide intended to result from self-immolation but which resulted in a fall against a glass door which in turn resulted in shards of glass piercing his body and a fatal stab wound to the heart.

Decisions of Greek Courts Securing the Right of Parent-Child Communication and Their Determinants.

BACKGROUND: There is an increasing awareness that a child's separation from one parent after the divorce places the child's development and well-being at risk. The aim of this study was to determine how Greek courts deal with the cases of parental prevention of communication with their children and which factors affect the judicial decisions. METHODS: The Greek legal databases "NOMOS" and "Isokratis" were searched, and associations between judicial decisions, as well as communication prevention ways, and several parameters, were assessed. RESULTS/CONCLUSIONS: A total of 50 parental communication prevention law cases were retrieved for the time period from 1992 to 2019. Results showed that mothers were more frequently alleged to interfere with father-child communication. Both direct and indirect methods of interfering with communication were followed. In cases of a single child, the method of indirect interference was more frequently followed. Judicial decisions were unaffected by the age and gender of the child, the gender of the parent preventing the communication, the number of children, the gender of the child and whether the child is the same gender as the preventing or prevented parent, the way of prevention, and the reference to parental alienation.

Prevalence of Homicide-Suicide Incidents in Greece over 13 Years.

Prevalence of homicide-suicides is difficult to determine in Greece due to the lack of a national tracking system. The aim of this study was to estimate the prevalence of the homicide-suicide incidents in Greece over the past 13 years, and to determine the circumstances under which they occurred, as well as the characteristics of perpetrators and victims. Two Internet search engines (google and yahoo), as well as the search engine of the major national news websites, were surveyed to identify the number of homicide-suicide cases that occurred in Greece from January 2008 to December 2020. Over the study period, 36 homicide-suicide incidents occurred in Greece, resulting in 36 suicides and 41 homicides. The above incidents reflect an annual homicide-suicide rate of 0.02 cases per 100,000 inhabitants. Most perpetrators were male (88.9%), whereas most victims were female (80.6%). Spousal-consortial cases accounted for 52.7% and familial cases for 41.7% of the total number of incidents. The use of firearms (mostly shotgun) was the most common method of homicide and suicide (58.3% and 63.9%, respectively). Women killed only their children, while men committed homicide and suicide mainly in the context of a former or current intimate partnership with the victim. Our results are in line with international homicide-suicide data. The establishment of a national surveillance system for homicides-suicides would be of paramount importance as it would facilitate accurate recording, identification of risk factors and characteristics of potential victims and perpetrators and it could ultimately be an aid to the prevention of such tragic events.

Subdural and epidural hematoma occurrence in relation to the head impact site: An autopsy study.

Blunt head injury is a major public health and socioeconomic problem causing death and disability particularly among the young population throughout the world. The purpose of the present study was to evaluate if the impact site is correlated with the subdural and epidural hematoma occurrence. A retrospective analysis of consecutive autopsy cases submitted to our Department during a 5-year period was performed. The basic criterion for inclusion in the study was death due to blunt head injury. The recorded variables included the circumstances of death, the existence, and location of head injuries, the primary impact site, age, gender, and toxicological results. A total number of 683 fatal head injury cases was recorded, with most of them being male (74.1%). In 424 cases (62.1%) fatal head injuries were due to road traffic accidents. Fall (from height or on the ground) was the cause of death in 220 (32.2%) cases followed by inflicted impact-assault in 26 (3.8%) cases. A subdural hematoma was found more frequently (26.9%) than epidural (5.0%). Epidural hematomas were found only under the primary impact site, whereas subdural hematomas were coup, contrecoup, or bilateral. An epidural hematoma was found to be almost 5 times more frequent in cases in which a subdural hematoma was present. A higher proportion of subdural, as well as epidural hematoma, was found when the site of impact was the temporal region, followed by the parietal one. Sex did not exert any influence on the probability of subdural and epidural hematoma, whereas for age, a 10% increase in the probability of subdural hematoma occurrence was observed with 10-year age increase.

A burned body with a shotgun head injury found on an "altar" made of banknotes: A case report from Greece and brief review of the literature.

We describe an unusual case of a burnt body with a shotgun head injury found on a "bed" made of wooden boards on a pile of banknotes, resembling an altar. The body belonged to a 64-year-old man, of Greek nationality, with cancer who set his house (including the room in which he was found) and vehicle on fire before shooting himself, planning this way his postmortem burning. The combination of fire with the use of an "altar" and the destruction of body and possessions creates a unique death scene that implies a suicide with a ritual character.