الفهرس 
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Abstract
for 9% of global mortality, which is nearly 1.7 times the number of fatalities that result from HIV/AIDS (human immune-deficiency virus/ acquired immune deficient syndrome), tuberculosis and malaria combined (Global Health Estimates, 2000 - 2012).
In addition, tens of millions of people suffer nonfatal injuries that require treatment and may result in temporary or permanent disability (Global Health Estimates, 2000 - 2012). Trauma is reported to be the leading cause of death, hospitalization, and long-term disabilities in the first four decades of life (Lema et al., 2011).
Chest trauma is a major cause of morbidity and mortality worldwide. It is second only to head injury as the leading cause of death from trauma (Okugbo et al., 2012).
The causes and pattern of chest injuries have been reported in literature to vary from one part of the world to another partly because of variations in infrastructure, civil violence, wars and crime. Road traffic crushes (RTCs) are the commonest cause of chest injuries in civilian practice accounting for up to 70% in some series (Lema et al., 2011).
Typically chest injuries are caused by blunt mechanisms such as motor vehicle collisions or penetrating mechanisms such as stabbings (Segers et al., 2001; Feliciano et al., 2012).
With increasing use of firearms, arrows and spears the incidence of penetrating chest injuries increased in civil society. They are often associated with other extra-thoracic injuries particularly to the abdomen and long bones (Lema et al., 2011).
The medico-legal autopsy also is a research potential as many cases of interest to society are examined by the forensic expert who will achieve an overview of a lot of case categories, such as sudden unexpected death, intoxication road traffic accidents, child abuse, battered women, homicides, various types of accidents, occupational disease and work accidents amongst others (Catanese, 2010).
Multiple-trauma patients developing multiple organ failure (MOF) show rates of thoracic trauma significantly higher than patients with head or limb injuries. In most cases, the lung is the first organ to fail, and it is the most frequently affected organ system with highest mortality. In the literature, respiratory failure is called the “pacemaker” of MOF (strecker et al., 2002; Hagen et al., 2014).
The importance of chest trauma as “pacemaker” of posttraumatic MOF is generally acknowledged. Unfortunately, early diagnosis of chest trauma severity remains insufficient not only by clinical means but also by plain radiographs and even by CT scan (strecker et al., 2002).
With advances in molecular medicine, new information has emerged regarding the response to injury and shock at the molecular level. Several mechanisms have been proposed for the development of post-traumatic complications such as release of different cytokines including interleukin-6 (Giannoudis et al., 2004). So this study is to highlight the pattern of chest injuries and evaluate the value of the existing inflammatory marker (interleukine – 6) in cases of trauma in living &dead cases.
The study performed on one hundred cadavers with chest trauma sent to Egyptian forensic medicine authority (EFMA) (Zeinhom governmental mortuary), as well as one hundred living cases with chest trauma arrived at Menoufia university hospital, non-traumatic dead cadavers died in Menoufia university hospital (20 cases) and healthy persons for control group (10 cases) were taken.
The results concerning autopsied cadavers; declared that the distribution of different causes of death among the chest traumatic dead cases; assault by firearm, by sharp instruments, by blunt instruments, by falling from height and by road traffic accidents represented by (44%), (37%), (12%), (4%) and (3%) of the studied chest trauma dead cases respectively.
Regarding body regions affected; the distribution of the associated different body regions trauma among studied chest trauma dead cases; where abdominal trauma had the highest percentage (43%) to accompany chest trauma, followed by head trauma (40%) then upper limb trauma (29%) and lastly lower limb trauma (23%). In this study, one cadaver could have more than one affected region.
Penetrating injuries (either by sharp or blunt instrument) represents most of chest traumatic dead cases (80%) then non-penetrating one (either by sharp or blunt instrument) represents (20%). 93.2% of isolated trauma cases were of penetrating injuries and 69.6% of combined trauma cases had also penetrating injuries.
All chest traumatic dead cases had vascular tear and haemothorax, 88% of the cases had lung and bronchial tear, cardiac tear represented by 32% among the cases then lung contusions were 20%, ribs fractures were 15%, spine fractures were 5% and bullets and shots were entrapped in 11% and 3 % respectively.
All chest traumatic dead cases of isolated chest injury had lung and bronchial tears and 59.1% of them had cardiac tear whereas multi-regional affection group had lung contusions 35.7%, fracture ribs 26.8% and fracture spine that presented by 8.9% of multi- regional affected cases.
Regarding to chest traumatic living cases; (79%) of the chest trauma living cases were homicidal then (17%) of the cases were self-inflicted and (4%) of the cases were accidental.
Concerning to causative instrument; 35% of living chest trauma cases were due to sharp instruments, (23%) of cases were due to firearm injuries, (18%) of cases were due to road traffic accident and lastly falling from a height and blunt injuries constituted (12%) for each.
Abrasion represented (41%) among living chest trauma cases, stab wounds were (36%) among that cases, contusions represented (33%) then firearm wounds (23%) and lastly cut wounds were (12%) among study living cases.
In the present study, the abdominal trauma represented (37%) of the chest trauma cases, followed by upper limbs (28%) then head trauma (10%) and lastly lower limbs (8%). Taking in consideration that one patient can have more than one region affected beside chest affection.
According to the legal classification of the studied living chest trauma cases the study revealed that; simple wounds were (24%), dangerous wounds were (54%) and finally, fatal wounds were (22%).