Methods for quantitative assessment of femoral antroposcopic landmarks using hand-held laser scanner

Purpose : This study is focused on an innovative approach to the numerical assessment of gluteal tuberosity through 3D visualization and its use as sex discriminant.Materials and methods : The study was based on an aggregate of 40 right femora, male and female in equal proportion. The surface of tuberositas glutea femoris is captured in a 3D image, using a Hand-held Laser Scanner (FastSCAN). Afterwards, the assessment contains three ways. Firstly, the result is a 3D shape comprising two tetrahedrons with common base. Therefore, the volume of the roughness is approximately equal to the total of the volumes of these two tetrahedrons (volume). Secondly, several points /markers/ are placed on the surface of the roughness of the 3D image. After that we create two-dimensional shape which is a function of the three-dimensional one. The area of the formed shape is measured (area) as well as its greatest elevation (elevation). Thirdly, we assess the position angle of gluteal tuberosity (angle C). The results were processed with SPSS 17.0 using Discriminant Function Analysis.Results : If the predictors (volume, area, elevation and angle) are included in the model, than the percentage of cases classified correctly is 95%.Conclusion : This score coincides with world results based on various anthropometric indices of the femur

Axillary Fossa Variations

Knowledge of muscular, vascular, and neural variations in the axilla is of great clinical importance, especially in mastectomies, breast reconstruction, and axillary bypass operations. The aim of our study is to emphasize on multiple variability of the axillary structures and its clinical importance. In this paper we report some varieties of the axilla, found in two cadavers, including: the axillary arch muscle of Langer; atypical inflow of cephalic vein into external jugular vein; variations in branching of brachial plexus. In one of the axillae we discover an availability of muscular fibers bridging between pectoralis major and latissimus dorsi muscles. The second finding though more rare than the first one is of particular importance for cardiac implant techniques still treating the cephalic vein as a target for venesection. The branching varieties of the nerves in the axilla are presented by musculocutaneus nerve starting from median nerve. Identification of the axillary arch and its variations may help avoid accidental injury to axillary vessels and the brachial plexus during surgical procedures. Some device implanters still prefer to cut down the cephalic vein as the initial approach to venous access for transvenous placement of pacemaker or defibrillator leads out of concern for the risk of pneumothorax, subclavian crush, and other possible complications. Anesthesiologists administering local anesthetic blocks and surgeons operating in the axilla should be aware of nerve varieties to avoid iatrogenic injury. We conclude that more wide concern of the pattern of the axillary fossa structures is necessary to escape inadvertent accidents

Sex Estimation from the Upper End of Bulgarian Femur Using 3D Hand-Held Laser Scanner

The present study aimed to establish standards for determining sex from the upper end of the femur in a modern Bulgarian population focused on an innovative approach to the numerical assessment of gluteal tuberosity through 3D visualization and its use as a sex predictor. The sample is composed of 156 femora. Seven measurements were taken: vertical head diameter, transverse head diameter, maximum head diameter, head circumference, sagittal subtrochanteric diameter, transverse subtrochanteric diameter and supero-inferior neck diameter. The surface of gluteal tuberosity was captured in a 3D image, using a hand-held laser scanner. A 3D shape comprising two tetrahedrons with a common base was constructed. The volume of the rough area of muscle insertion was approximately equal to the sum of the area of volumes of these two tetrahedrons (volume). Several points were placed on the surface of the area of roughness on the 3D image. Based on these points a two-dimensional shape was created which was a function of the three-dimensional one. Thus, volume, area of the newly-formed shape, its greatest elevation and the three angles between the constructed planes were used as sex predictors. The mean values of all metric and 3D measurements showed significant differences between genders p<0.001, volume p=0.02. According to stepwise discriminant analysis the combination of head circumference, sagittal subtrochanteric diameter, transverse subtrochanteric diameter and supero-inferior neck diameter provided 88.5% accuracy. Using the same analysis the combination of volume, elevation and angle b1 provided the best result with 93.0% accuracy

Sex -related differences in the lips and mouth area of Buglarians - an investigation by 3D laser scanning

Purpose : The objective of this study was to supply information about normal sex-related dimensions of the mouth area and lips among contemporary Bulgarian population (linear distances, ratios, angles, area, volume) and compare the results with other populations.Materials and methods : The three-dimensional coordinates of several soft-tissue landmarks on the lips and mouth were obtained by a non-invasive method with FastSCAN in 16 male and 23 female healthy subjects aged 21-35 years. From the landmarks, linear distances (mouth width, width of the philtrum, vermilion heights of the upper, lower and total lips, total lip height), the vermilion height-to-mouth width ratio, areas (vermilion of the upper, lower and total lip) and volumes (upper, lower, and total lip volume) were calculated and averaged for sex.Results : Comparisons were performed by SPSS 17.0. Data collected in the present investigation could serve as a database for the quantitative description of human lip morphology during normal growth, development and aging. Conclusion. Forensic applications (evaluations of trauma, craniofacial alterations, teratogenic- induced conditions, facial reconstruction, aging of living and dead persons, personal identification) may also benefit from age- and sex-based data banks

Penetrating Brain Trauma due to Air Gun Shot – a Case Report

Cases of severe injuries caused by air guns are really uncommon, but they can lead to a fatal outcome. Usually, these injuries occur in children due to their not fully developed skull bones or in adults through less resistant and thin regions of the cranium. Most of them are accidental events, followed by low percentage of suicidal attempts.In this paper, we present the case of a 68-year-old man suffering from severe depression, with self-inflicted air gun injury to the head. The patient was admitted to the hospital in a coma with a Glasgow Coma Scale (GCS) score of 8, with severe penetrating head injury manifested with brain contusion and intraventricular bleeding seen at the CT examination. Metal particles from the projectile were seen inside the brain. The entry wound had inverted margins, abraded collar and skin defect. The additional neurological examination of the patient showed symptoms of increased intracranial pressure. The treatment started with the air gun wound care. Craniotomy surgery was also done and bone fragments around the entry wound were successfully extracted with subsequent debridement and duraplasty. The patient was treated with new-generation combined antibiotics for preventing inflammatory complications. On the nineteenth day, the patient was discharged with mild hemiparesis on the left side and with GCS score of 15.Air-gun traumatic cases with head injury or with injury to other parts of the body are often mistaken for firearm accidents, because air guns are seriously underestimated devices. Nevertheless, they could lead to severe health consequences and severe disability. This case highlights the necessity of strict monitoring of air guns by the responsible government institutions which should apply the same regulations in controlling these weapons as they implement in controlling the firearm guns. Presence of severe depression, mental illnesses, and neoplasms are risk factors for committing suicide with this type of weapons and the control over the air weapons in this group of people should be stricter

Posttraumatic Parinaud’s syndrome as a contrecoup injury in a case of closed head trauma

The purpose of the study was to present a rare case of post-traumatic Parinaud’s syndrome with a history of closed head injury. The clinical characteristics, examination, and management are presented in a 12-year-old boy who was a victim of physical violence at the hands of a young boy who punched him in his chin with his fists, with associated paralysis of the upward gaze of the left eyeball, and convergence nystagmus with pupillary involvement. CT examination indicated posttraumatic lesions in the dorsal midbrain and in the cavity of third ventricle, suggestive of acute hemorrhages. Posttraumatic Parinaud’s syndrome is a rare phenomenon that can occur in a case of closed head trauma as contrecoup injury

Elderly abuse – a forensic case of homicide-suicide as act of intimate partner violence

Homicide-suicide as a criminal act is a distinct subcategory of homicide in which the assailant kills his wife and/or her children in a relationship that has been broken down. The present case is about the dyadic deaths of an 89-year-old male and an 82-year-old female who are in a relationship as intimate partners (as husband and wife). In the early autumn of 2020, an event report was received in the Police District of Plovdiv about a woman who was found dead in her home. Her husband’s body was found next to hers in the same building, with the clinical features of a coma – the man was breathing but unresponsive. Unfortunately, he passed away immediately before the arrival of the emergency crew. The elderly are one of the most vulnerable subgroups of intimate partner violence victims, largely because of their growing social isolation, lack of social support, and reliance on family members and caregivers. The aforementioned renders these individuals helpless to fend off the attack and, in some cases, unable to report it. If we want to prevent this type of violence, we have to understand the risk factors and be able to differentiate between accidental injuries and injuries due to any form of elderly abuse

Assessment of traumatic leptomeningeal cyst in forensic anthropology – A case report

Paleopathology is a very extensive subject. Sometimes some pathological changes of bones may mimic trauma. This paper demonstrates a rare complication of cranial fractures which may be mistaken with gunshot injury in skeletonized remains

Child abuse syndrome – a forensic case of fatal impulsive act of violence

Child abuse syndrome is a medico-social problem widely spread around the world, which includes a complex of clinically manifested forms of violence against children. This syndrome includes different forms of physical violence, sexual violence, neglect, and emotional violence against children. The main problem with this type of violence continues to be the large number of unregistered “hidden” cases. The consequences of violence against children are serious and have a lasting negative effect on the physical and mental health of the victims. Child abuse is often a result of impulsive violent behavior with minimal provocation and may have a fatal outcome. We present a case of a 3-year-old boy, admitted to the Emergency Department of the Municipal Hospital in Asenovgrad, Bulgaria, in a state of biological death. Case circumstances during the police investigation were unclear and the body was transported for forensic examination. During the forensic autopsy, many traumatic injuries were observed over the whole body – bruises of different ages, fractures of bones, abdominal trauma with bucket-handle tear of the mesentery, thoracic trauma with contusions and ruptures of the lungs, rupture of the diaphragm, and many other injuries that are specific predictors for this type of child physical abuse. The main aim of the present report is to enrich the knowledge of medical workers in their routine practical work in the identification and determination of child abuse syndrome. It could prevent the fatal outcome and reduce the mortality from this specific type of violence