Medicolegal investigation of homicides in Northern Greece from 1944 until 2008: epidemiological study

At the present dissertation the homicides in the broad region of northern Greece during the period 1944-2008 were studied. The data base of the Department of Forensic Medicine and Toxicology, Aristotle University of Thessaloniki was the material for this study. The parameters that were studied had to do with the sex and age of the victims, the type of the weapon that was used, the anatomical region which was fatally injured and the season of the year on which the homicide was committed. On close examination of more than 25000 autopsy reports, a number of 1160 homicides were found. About half of them (551) were committed during the period 1944-1949. The rest 609 homicides were normally distributed through the years with only slight fluctuations. The exception was only the last two decades (1990-1999 and 2000-2008), where a significant increase of homicides was observed. This rise was the result of a large number of “foreign-imported criminal population” which had also as a result the increase of the already existing homicides.The importance of this dissertation, apart the statistical analysis, concerns the fact that crime and in particular in our case homicide, was not a stable factor but on the contrary it was affected by time and technology development, as well as by social conditions and human activities.Στην παρούσα διατριβή μελετήθηκαν οι ανθρωποκτονίες που σημειώθηκαν στην ευρύτερη περιοχή της βόρειας Ελλάδας, την περίοδο 1944-2008. Υλικό της διατριβής αποτέλεσε η βάση δεδομένων του Εργαστηρίου Ιατροδικαστικής και Τοξικολογίας του Αριστοτελείου Πανεπιστημίου Θεσσαλονίκης. Οι παράμετροι οι οποίες μελετήθηκαν αφορούσαν στο φύλο των θυμάτων, στην ηλικία τους, στο είδος του όπλου που χρησιμοποιήθηκε για την ανθρωποκτονία, στην ανατομική περιοχή που επλήγη και στην εποχή του έτους κατά την οποία τελέστηκε το έγκλημα. Συγκεκριμένα μετά από μελέτη άνω των 25000 ιατροδικαστικών εκθέσεων προέκυψαν 1160 ανθρωποκτονίες, από τις οποίες οι μισές περίπου (551) αφορούσαν στην περίοδο 1944-1949. Οι υπόλοιπες 609 ανθρωποκτονίες ήταν διαμοιρασμένες στις δεκαετίες που ακολούθησαν με αρκετά κανονική διασπορά. Εξαίρεση αποτέλεσαν οι τελευταίες δύο δεκαετίες (1990-1999 και 2000 2008) κατά τις οποίες σημειώθηκε μεγάλη αύξηση των ανθρωποκτονιών. Η αύξηση αυτή αποδόθηκε στην εισροή “ανθρωποκτόνου αλλοδαπού πληθυσμού” στην Ελλάδα με αποτέλεσμα την περαιτέρω αύξηση του είδη υπάρχοντος ποσοστού ανθρωποκτονιών. Εκτός από τα στατιστικά δεδομένα που προέκυψαν από την παρούσα διατριβή σημαντικό ήταν και το γεγονός ότι τα εγκλήματα κατά ζωής δεν αποτελούν ένα σταθερό φαινόμενο σε μια κοινωνία, αλλά αντιθέτως επηρεάζονται και εξελίσσονται με την πάροδο του χρόνου και την πρόοδο της τεχνολογίας και της κοινωνίας όπως όλες οι λοιπές ανθρώπινες δραστηριότητες

Post-mortem computed tomography (PMCT) and PMCT-angiography after cardiac surgery. Possibilities and limits

Background: PMCT is a well-known tool of the forensic pathologist. It is employed worldwide. PMCT-angiography offers additional insights. This paper intends to demonstrate possibilities of both methods after cardiac surgery. Material and Methods: Exemplary cases with typical findings were selected from our own collection. PMCT was performed as whole body CT (1mm slice, pitch 1.5, 130kV, 180-130mAs, 16 slice MDCT). In PMCT-angiography, contrast material (1.2 litres) is injected into the arteries (arterial phase, also documented with a whole body CT). Thereafter, contrast material is injected into the veins (venous phase, also documented with a whole body CT). The final CT is obtained after circulation has been provoked with a special pump (circulatory phase). Results: PMCT visualised pseudoarthrosis and fractures of the sternum, implanted valves (TAVI) encroaching the ostia of the coronary arteries, bleeding and pericardial tamponade. PMCT-angiography showed the sources of the bleeding, vascular stenosis and obstruction and modified vascular supply. With respect to the postoperative care, malposition of tubes, drainages and complication of punctures could be seen. Conclusion: PMCT and PMCT-angiography can visualise complications and the cause of death. Such knowledge may allow for prevention of suffering and death. It may also aid in improving valve design and implantation procedures

Sex-Related Differences in Clinical Outcomes in Patients with Atrial Fibrillation and Coronary Artery Disease: A Sub-Study of the MISOAC-AF Randomized Controlled Trial

Background: There is limited “real-world” data on the prognostic role of gender in comorbid atrial fibrillation (AF) and coronary artery disease (CAD). Methods: In this post-hoc analysis of the MISOAC-AF randomized trial (NCT: 02941978), consecutive patients with AF and CAD who were discharged from the cardiology ward between 2015 and 2018 were included. Multivariable Cox-regression analysis was performed for all-cause mortality and cardiovascular (CV) mortality. Competing-risk analysis was performed for the outcomes of stroke or systemic embolism, major bleeding, AF- or heart failure (HF)-related hospitalization, adjusted for the competing risk of all-cause death. Results: Of 1098 patients with AF, 461 patients with comorbid CAD were analyzed. Women were older and more likely to have a history of diabetes mellitus and valvular heart disease, while men were more likely to have a history of smoking or myocardial infarction. Over a median follow-up of 31 months, 143 (43.4%) men and 71 (53.7%) women died. Women were at a higher risk for all-cause mortality (adjusted hazard ration [aHR] 1.65; 95% confidence interval [CI] 1.14–2.38) and stroke or systemic embolism (aHR 3.52; 95% CI 1.46–8.49) compared to men. The risks of CV mortality, major bleeding, AF-related hospitalization, and HF-related hospitalization were similar between genders. Conclusions: In recently hospitalized patients with AF and comorbid CAD, the female gender was independently associated with increased all-cause mortality and thromboembolic events

Post-mortem computed tomography (PMCT) and PMCT-angiography after transvascular cardiac intervention

Background and Purpose: During the last years, Post Mortem Computed Tomography (PMCT) has become an integral part of the autopsy. PMCT-angiography may augment PMCT. Both exams have proven their value in visualizing complications after heart surgery. Therefore, they should also show complications after transvascular interventions. This assumption initiated our project: to evaluate the possibilities of PMCT and PMCT-angiography after transvascular cardiac interventions. Material and Methods: In our archives of characteristic and typical PMCT findings, we searched for observations on preceding transvascular cardiac interventions. Additionally, we reviewed our PMCTangiographies (N=140). Results: After transvascular cardiac interventions, PMCT and PMCT-angiography visualized bleeding, its amount and its origin, cardiac tamponade, free and covered perforations, transvascular implanted valves and their position, catheters and pacemakers with fractures, abnormal loops and bending. Bubbles in the coronary vessels (indicating air embolism) become visible. Conclusion: After transvascular cardiac interventions, PMCT and PMCT-angiography show complications and causes of death. They prove a correct interventional approach and also guide autopsy. In isolated cases, they may even replace autopsy