Gökhan Ersoy

Microsurgical and histomorphometric study of the occipital sinus: quantitative measurements using a novel approach of stereology.

Quantitative descriptions of the occipital sinus are lacking in the extant medical literature. Posterior fossa duras with the superior sagittal sinus, the inferior and superior petrosal sinuses were dissected and taken out from fresh human cadavers by cutting at the superior sagittal sinus, the marginal sinuses and the petrosal sinuses bilaterally. The length of the occipital sinuses was measured using calipers. A 0.5‐cm section of the occipital sinus was cut out at its midpoint and prepared for measurements of the perimeter and diameter using a stereology workstation. The sinuses were also examined qualitatively using a surgical microscope. There was no occipital sinus in 6.6% of total 30 cases. Multiple occipital sinuses were seen in 10%. In one specimen, the sinus seemed incomplete, failing to reach the marginal sinuses. Some specimens gave the impression that more than one occipital sinus was present, nevertheless, careful dissection showed connections. The breadth of the sinus steadily narrowed downward in direction of foramen magnum. The inner wall with many fibrous bridges was tight, except the lateral parts that were easily separated into two dural sheets. The length of the sinus varied from 10 to 37 mm. The inner diameter (feret maximum) varied from 0.33 to 7.06 mm at midpoint. The breadth of the multiple sinuses did not exceed the mean of our series except in one case. The occipital sinus, which is generally ellipsoid in shape, functions in the majority of cases as a thin, single midline sinus. It may have less resistant recesses laterally. Clin. Anat. 23:386–393, 2010.

Femicide in Turkey between 2000 and 2010

Although intimate partner violence (IPV) is an important problem that threatens women’s health, very few studies focus on the victim—perpetrator relationship or examine this relationship across Turkey. The aim of this study is to contribute to a better understanding of femicide cases in Turkey and to describe the socio-demographic, clinical, forensic, and criminological characteristics of femicide victims and offenders. This study analysed 162 femicide cases that occurred in 12 cities in Turkey from 1 January 2000 to 31 December 2010. Eighty women were killed by their partners (classified as intimate partner femicide, IPF), and 81 women were killed by one of their relatives, friends, or strangers (classified as non-intimate partner femicide, non-IPF). According to our results, the typical IPF victim is of child-bearing age, does not have a paid job, is married or divorced, is killed in a domestic setting due to injuries to the thorax or abdomen produced by an edged/pointed weapon or firearm, and is possibly a victim of overkill. The typical IPF perpetrator is close to his victim’s age, has a paid job, has no mental disability, owns a gun, and has threatened his partner or ex-partner previously because of jealousy/infidelity/honour or separation. The typical non-IPF victim is very similar to the IPF victim; however, her marital status can be single, married or divorced, and she is commonly killed by a relative. The surveillance and screening of femicide and IPV is an important step when analysing and attempting to prevent femicide. Second, the training and sensitization of health professionals are important. Moreover, health staff should be encouraged to participate in advocacy interventions. Third, gun ownership must be brought under control.

The pathology of lethal exposure to the Riot Control Agents: Towards a forensics-based methodology for determining misuse

The aim of this is to review deaths associated with the use of Riot Control Agents (RCAs) and to assess how the presenting pathologies is such cases may better inform cause of death conclusions upon autopsy. We also sought to present which additional steps should be added to the Minnesota protocol and the European harmonization of medico-legal autopsy rules in suspected cases of deaths associated with the use of RCAs. We included 10 lethal cases in our study. In three cases, RCAs were found to be the sole cause of death, in three cases RCAs were ruled a secondary cause of death due asphyxia or asthma subsequent to exposure to RCAs and in four cases RCAs were contributory factors to death. In three cases the responsible agents were identified as Chloroacetophenone (CN), Chlorobenzylidene malononitrile (CS) and Oleoresin capsicum (OC) and in the remaining 7 cases, the agent was OC alone. As there are no specific findings in suspected cases of death associated with RCA use, establishing cause of death and whether RCAs are the sole cause or only a contributory factor will be based on the elimination of other possible causes of death. For this reason, a specifically structured autopsy is essential. This specifically structured autopsy should contain basic principles of the Minnesota Protocol and the European harmonization of medico-legal autopsy rules with the following additional steps taken: examination of clothing, eyes, and skin; examination of pharyngeal, tracheobronchial, and eusophegeal mucosas; and a thorough recording of the steps taken by the party conducting the arrest, including other possible causes of in-custody death, as well as a detailed medical history of the deceased.

Electron Microscopic Description of the Sylvian Arachnoid Membrane

Background:The aim of this study was to investigate the potential role of the arachnoid membrane of the Sylvian cistern in the secretion and absorption of cerebrospinal fluid (CSF). Materials and Methods:Arachnoid specimens including the Sylvian cistern were obtained from the widest portion of the limen insulae region and were taken from 6 human cadavers within 12 hours postmortem. For electron microscopic examinations, specimens were fixed immediately in a solution of 2.5% cacodylate-buffered glutaraldehyde. Postfixation was performed with 2% osmic acid. After fixation, the tissue was dehydrated through a graded series of alcohol and blocked with Epon 812. Thick sections of the Epon-blocked tissue were stained with toluidine blue and examined under light microscopy. Ultrathin sections of 400 to 600 Å were obtained using an ultramicrotome. The thin tissue sections were then processed with lead citrate and uranyl acetate for contrast and examined under transmission electron microscopy. Results:The Sylvian arachnoid membrane is composed of 3 main layers. Neuroepithelial cells richly occupy the outermost layer. Ultrastructural analysis revealed electron-lucent cells, electron-dense cells, cells with cytoplasmic processes, numerous tight junctions, desmosomes, and gap junctions. There were macrophage-like cells, pinocytotic vesicles, intercellular clefts, and interdigitation. These findings suggest the potential for fluid transport. The inner layers were composed of collagen fibers and fibroblasts and separated from the outer layer by a basement membrane. Conclusions:Our study suggests that CSF might be transported across the Sylvian arachnoid membrane. Our findings demonstrate the potential of CSF transport to function in a secretory and/or absorptive manner.

The Approaches of Physicians Working in the Field of Pathology Regarding Forensic Pathology Practice and the Training Process Patoloji Alaninda Çalişan Hekimlerin Adli Patoloji Pratiği ve Eğitim Sürecine Yaklaşimlari

Abstract Objective: Forensic autopsies are performed by the forensic medicine department and the microscopic examination processes by pathology specialists within the forensic medicine practice in Turkey. This disconnection in the process raises problems in the training of both branches. The aim of this study was to determine the awareness of pathology staff on forensic medicine practices and responsibilities and their opinion on the pathology training model in the forensic medicine specialty and to discuss the matter within the framework of the present situation and global applications. Material and Method: A 15-item questionnaire form distributed to the participant physicians during registration at the 21st National Pathology Congress held in 2011 was evaluated. Results: 94 participants responded. A negative opinion was expressed by 72% about the interest in the general post-mortem process. The view that pathology specialists should undergo a separate training to perform autopsies was predominant and there was a general lack of interest in all kinds of autopsy processes. The percentage who said they knew the legal responsibility of a pathology specialist regarding forensic autopsies correctly was 37%. The questions “what are the necessary factors to contribute to the pathology training in forensic medicine” and “if anything is required, which of them would take priority” were respectively answered as “for me to be interested (46%)” and “a system guaranteeing that training will always be given by pathology specialists (67%)”. Despite the possibility of becoming a forensic medicine specialist in two years, the mean answer score of the participants to the phrase “I do not consider becoming a forensic medicine specialist” was 4.1 (out of 5). Conclusion: A reluctance among the pathologists in our country was seen regarding forensic medicine specialists being able to perform post-mortem microscopic examination. However, despite their legal responsibilities, their interest in forensic pathology practice was low. There seems to be rational factor that would increase this interest in the near future. Cooperation is necessary to enable forensic medicine specialists to perform post-mortem pathology procedures. This cooperation should be based on improving the training of pathology research assistants. Öz Amaç: Türkiye’deki adli tıp pratiğinde otopsiler adli tıp, mikroskobik inceleme süreçleri ise patoloji uzmanlarınca yapılır. Süreçteki bu kopukluk her iki branşın eğitiminde sorunlar oluşturmaktadır. Bu çalışmanın amacı, patoloji çalışanı hekimlerin adli tıp pratikleri ve sorumlulukları konusundaki farkındalıklarını ve adli tıp uzmanlığında patoloji eğitim modeli konusundaki görüşlerini saptamak; mevcut durum ve dünyadaki uygulamalar çerçevesinde tartışmaktır. Gereç ve Yöntem: 2011’de düzenlenen 21. Ulusal Patoloji Kongresi’nde kayıt esnasında katılımcı hekimlere dağıtılan 15 soruluk bir sorgulama formu değerlendirilmiştir. Bulgular: 94 katılımcı yanıt vermiştir. Genel otopsi sürecine olan ilgi hakkında %72’ oranında olumsuz görüş belirtilmiştir. Patoloji uzmanının adli otopsi yapması için ayrı bir eğitimden geçmesi gerektiği görüşü hâkimdir ve otopsi süreçlerinin tüm çeşitlerine karşı genel bir ilgisizlik mevcuttur. Adli otopsilerde patoloji uzmanının yasal sorumluluğunu doğru olarak bildiğini ifade edenlerin oranı %37’dir. Adli Tıpta patoloji eğitimlerine katkı sağlamaları için “gerekli faktörlerin ne olduğu” ve “şartlar öne sürmesi gerekse, hangisini öne süreceği?” sorularına sırasıyla, “ilgi duyuyor olmam (%46)” ve “eğitimin daima patoloji uzmanları tarafından verileceği bir sistem garanti edilmeli (%67)” cevapları verilmiştir. Katılımcıların iki yılda adli tıp uzmanı olabilme imkanına rağmen “adli tıp uzmanı olmayı düşünmem” seçeneğine verdikleri cevap puan ortalaması 4.1’dir (4.1/5). Sonuç: Adli Tıp uzmanlarının post mortem mikroskobik incelemeleri yapabilmesi konusunda ülkemizdeki patologlar arasında bir gönülsüzlük izlenmektedir. Oysaki yasal sorumlulukları olmasına rağmen kendilerinin adli patoloji pratiklerine ilgileri düşüktür. Yakın gelecekte bu ilgiyi arttıracak rasyonel bir sebep gözükmemektedir. Adli tıp uzmanlarının postmortem patoloji pratiklerinde yetkinleştirilmesi için işbirliği yapılmalıdır. İşbirliği, patoloji araştırma görevlilerinin eğitiminde de yarar sağlama üzerine kurulmalıdır

Why did the patient die? The relationship between ambulance accidents and death of patients: Forensic medical issues

This articles aim is investigating traumatic consequences of ambulance accident on patients and discussing difficulties to give a decision about the relation between death and accident at these cases. The cases were selected among the forensic medical reports concluded between 1996 and 2005 years. They were documented for age, sex, causes of urgent call, localization and extent of traumatic lesion, properties of events and board decisions. A total of 21 cases were found. 15 cases died on the day of the accident. Skin injuries at head (8 cases) and legs (6 cases) were most common traumatic lesions. Totally 6 deaths were found related with ambulance accident. Death of patient after ambulance accidents may not be associated easily to the accident. Delay due to accident or concomitant contributing medical conditions may also facilitate the death in this type of cases. Reliable medical records were needed for accurate medicolegal evaluation.

Interinstitutional review of slides for forensic pathology: types of inconsistencies.

Because of the specific structure of forensic medicine in Turkey, reexamination of histopathologic specimens is a frequent practice. The aim of the present study is the assessment of microscopic diagnostic consistency in forensic pathology between different laboratories. Reports of the Council of Forensic Medicine between 2001 and 2004 were examined, and 150 cases with second pathologic examination were found. Results of histopathologic reports from peripheral laboratories were compared with those made by the Council pathologists with regard to diagnostic consistency. Consistency was assessed in 3 groups and 1 subgroup. Group 1, consistent and minor inconsistency; includes a major consistency subgroup. Group 2, major inconsistency, is the second diagnosis which is lethal; group 3, major inconsistency, is the first diagnosis which is lethal. The lung was found to be the organ with the highest frequency of diagnostic major inconsistency (group 2 and 3) and major consistency. Bronchopneumonia was the most common diagnosis. The brain had the highest frequency of intercenter diagnostic overall consistency (90.2%, group 1). Myocardial infarction was the diagnosis most frequently rejected on reevaluation (group 3). In conclusion, forensic pathology requires different experience than surgical ones. In cases of discrepancy between the anamnesis of the lethal event and pathologic findings, reevaluation of specimen is mandatory to avoid any diagnostic errors. Quality assurance systems with all include internal and external control mechanisms will improve the diagnostic reliability.

Adli Otopsilerde Kardiyomiyopatiye Bağlı Kalp Ölümleri

Kardiyomiyopatiler kalp kas›n›n nedeni bilinmeyen hastal›klar›d›r. Primer miyokardial kardiyomiyopatiler bafll›ca dilate, hipertrofik, restriktif, obliteratif ve ARVC alt gruplar›ndan oluflmaktad›r. Çal›flman›n amac›, genç eriflkin ani ölüm olgular›nda çok s›k olmayan bu patolojinin makroskopik ve mikroskopik özelliklerini tan›mlamakt›r. 2003-2006 y›llar› aras›nda Adli T›p Kurumu Morg ‹htisas Dairesi’nde otopsileri yap›lan 5’i erkek, 6’s› kad›n olan yafl aral›¤› 15-35 aras›nda de¤iflen 11 olgu çal›flmaya al›nd›. Otopside al›nan kalp örneklerinin patolojik de¤erlendirilmesi sonucunda 7 olgu hipertrofik kardiyomiyopati, 3 olgu dilate kardiyomiyopati, 1 olgu amiloid birikimine ba¤l› restriktif kardiyomiyopati olarak de¤erlendirildi. Olgular›n toksikolojik incelemesinde herhangi bir maddeye rastlanmad›. Ölüm nedenleri kardiyomiyopatiye ba¤l› kardiyovasküler kaynakl› ölüm olarak de¤erlendirildi. fiüpheli ani ölüm olgular›nda gerçek ölüm nedenini ortaya koymak olay›n adli boyutunu do¤ru bir flekilde de¤erlendirmek aç›s›ndan önemlidir. Genç eriflkinlerde ani ölüm olgular›nda kardiyovasküler kaynakl› ölümleri araflt›r›rken kardiyomiyopati tan›s› koymak ancak kalbin ayr›nt›l› makroskopik ve mikroskopik incelenmesi ile mümkündür. Anahtar kelimeler: Otopsi, ani ölüm, kalp, kardiyomiyopatiKardiyomiyopatiler kalp kasinin nedeni bilinmeyen hastaliklaridir. Primer miyokardial kardiyomiyopatiler baslica dilate, hipertrofik, restriktif, obliteratif ve ARVC alt gruplarindan olusmaktadir. Calismanin amaci, genc eriskin ani olum olgularinda cok sik olmayan bu patolojinin makroskopik ve mikros-kopik ozelliklerini tanimlamaktir. 2003-2006 yillari arasinda Adli Tip Kurumu Morg Ihtisas Da-iresi’nde otopsileri yapilan 5’i erkek, 6’si kadin olan yas araligi 15-35 arasinda degisen 11 olgu calismaya alindi. Otopside alinan kalp orneklerinin patolojik degerlendirilmesi sonucunda 7 olgu hipertrofik kardiyomiyopati, 3 olgu dilate kardiyomiyo-pati, 1 olgu amiloid birikimine bagli restriktif kardiyomiyopati olarak degerlendirildi. Olgularin toksikolojik incelemesinde herhangi bir maddeye rastlanmadi. Olum nedenleri kardiyomiyopatiye bagli kardiyovaskuler kaynakli olum olarak degerlendirildi. Şupheli ani olum olgularinda gercek olum nedenini ortaya koymak olaym adli boyutunu dogru bir sekilde degerlendirmek acisindan onemlidir. Genc eriskinlerde ani olum olgularinda kardiyovaskuler kaynakli olumleri arastirirken kardiyomiyopati tanisi koymak ancak kalbin ayrintili makroskopik ve mikroskopik incelenmesi ile mumkundur.Anahtar kelimeler: Otopsi, ani olum, kalp, kardiyomiyopati