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The aim of this study is to analyze the morbidity and mortality in patients with rib fractures in blunt chest trauma. The group of 212 patients with rib fractures was examined. Fractured ribs and associated thoracic injuries were established by imagine methods (plain chest radiographs and computed tomography) and pathological examination. Fractures of one or two ribs were established in 72 (33, 96 %) patients. Multiple rib fractures (≥ 3 ribs) were established in 140 patients. Lung contusion was the most common associated thoracic injury. Mortality, as an outcome of thoracic trauma, was established in 36 (16, 98 %) of patients. The level of mortality was higher in the group of patients, age > 65 years. Lung contusion was main cause of death in patients with fractured ribs. Conclusion. This study has proven that the age over 65 years, bilateral rib fractures and lung contusion are three risk factors for mortality in patients with blunt thoracic trauma.

PURPOSE. The facial artery is one of the main arteries which supply the face with blood. The different types have been researched not only for anatomical purposes but also to facilitate the different medical specialties. METHODS AND RESULTS. Our team found an unusual case of a facial artery with smaller lumen. The region, which it supplies, is partially substituted by the transverse facial artery. In the observed course the facial artery had a considerably smaller caliber than usual. After it appears on the surface of the face it divides into two untypical branches - anterior and superior. Contrariwise the transverse facial artery has a significantly bigger lumen. The separate branches, which usually originate from the facial artery, here arise from the aforementioned artery. CONCLUSIONS. These types of anatomical variations are very important for muscle and skin flaps in plastic surgery of the face. Every deviation from the normal anatomy of the main blood vessels can also lead to errors in invasive surgery procedures and medical imaging. The vascularization of the face and its variations is subject for many different disciplines.

Background: The aim of this report is to present a case of a blunt abdominal trauma with vascular and spinal involvements of an overweight man, caused by the front seat safety belt. Case presentation: It took place as a result of the car bonnet collision with a roadside pillar. During the primary inspection of the crash site, it was found that the car had collided with a roadside pillar. The driver was found dead in the driver's seat with the seat belt on. The lower part of the belt was in the inguinal region and the upper part was high on the chest, separated by the bulky midriff. The autopsy revealed a transverse fracture of the body of tenth thoracic vertebra, complicated by a torn abdominal aorta, and severe bleeding into the abdominal cavity, which was the cause of the death. The complications of the abdominal trauma result from the atypical position of the seat belt holding the upper and lower part of the body to the seat at two very distant levels, while between them the bulky, heavy midriff continued to move forward, carrying with it the vertebral column and surrounding anatomical structures. On the other hand, the forceful contact between the abdominal wall and the instrumental panel of the car generates pressure which transmits force through the adjacent organs to the aortic wall. The specific anthropometric features of the victim had an impact on the mechanism of death. The improper position of the seat belt relative to the body affected the severity of abdominal injuries, instead of protecting from them. Conclusions: The driver's body disproportion, combined with the restraining effect of the seat belt, could increase the risk of a fatal outcome. It is incorrect to think that if the victim had not worn a seat belt, he would have survived. The safest seatbelt type for occupants with a similar anthropometric data would be the 4-point seat belt system, which is used in children's car seats. This type of safety belt is crossed over the chest and abdomen and holds the entire trunk better at dynamic loads in all directions.

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.

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.