Gürcan Altun

Firearm fatalities in Edirne, 1984–1997

During the 14-year period from 1984 to 1997 there were 85 firearm fatalities investigated by the Department of Forensic Medicine and the Department of Pathology in Edirne, Turkey. We determined the characteristics of these 85 firearm deaths which comprised 17.03% of all medicolegal autopsies. The overall incidence was 1.58 per 100,000 population. The median age was 35.5 years. Fifty-four percent of the victims were aged between 20 and 40 years. Males constituted 82% of the victims. The most frequent manner of death was homicide (68.3%). Handguns accounted for 62.4% of the weapons used. The most common sites for the firearm entrance wounds were both head-neck-nape (32.8%) and chest (32%). In conclusion, our study shows that, in spite of legal restrictions, illegal access to firearms is easy and deaths by firearms are still increasing.

Deaths among homeless people in Istanbul.

The number of the homeless people in Istanbul, one of the largest cities in the world, is at present unknown. There has been no previous study in Turkey on cases and causes of death occurring among these individuals. In this paper, documents and autopsy reports of the Mortuary Section of the Council of Forensic Medicine, Istanbul, covering the period January 1st, 1991-December 31st, 1995, were reviewed. We established that there were 126 cases of death among homeless individuals in Istanbul during this period, 120 of them being males (95%), four (3%) females, and two (2%) transsexuals. Ninety-four corpses were found outdoors, 32 indoors. No personal documents, such as identity cards, were found in 110 individuals (87%), whereas only 16 individuals could be identified. Most deaths occurred in the age group of 41-50 years. One hundred and three of the cases (82%) died in the cold season between October and April. The deaths of 98 cases were attributable to natural causes, whereas the remaining 28 cases died from unnatural causes. Respiratory tract diseases occupied the first rank among cases of death from natural causes (44%). Alcohol abuse and other infections were further striking factors contributing to the fatal outcome. This is the first retrospective study on this topic in Turkey. However, more detailed and anterospectively programmed studies on this subject, a growing social problem, should be carried out.

Hemopericardium-Related Fatalities: A 10-Year Medicolegal Autopsy Experience

Background: Patients with blunt or penetrating cardiac injury usually present with cardiac tamponade and hemorrhagic shock upon hospital arrival. Many victims die before they reach hospital. In this study, we present a detailed analysis of hemopericardium-related fatalities. Methods: We retrospectively reviewed the medicolegal autopsy records of hemopericardium-related fatalities that occurred from 1994 to 2003. The parameters investigated were demographic characteristics, hospitalization before death, the cause of death, the manner of death, the mechanism of death, the location of the entrance wound, the number of wounds reaching the target and the site of target perforation. Results: Seven women (mean age: 45 ± 23 years) and 33 men (mean age: 34 ± 12 years) were included in the study. Only 5 patients (12.5%) with cardiac activity reached the hospital. Twenty individuals (50%) were victims of stabbings, which was the most common cause of death. The most commonly encountered manner of death was homicide (79%). Thirty-one (77.5%) victims died of hemorrhagic shock and 9 (22.5%) of cardiac tamponade. Entrance wounds were frequently located on the left chest (n = 26). The perforated cardiac chambers were the left atrium (n = 1), the left ventricle (n = 12), the right atrium (n = 2) and the right ventricle (n = 15). One victim had coronary artery perforation. Nine victims had perforations on the intrapericardial part of the aorta. Conclusions: In our series, the hemopericardium-related deaths occurred predominantly in men. Stabbing was the most common cause of death. Entrance wounds were most commonly located on the left chest, and perforated sites were ventricles. Death at the scene was also frequent, and the mechanism of death was hemorrhagic shock.

Intra- and perioral shooting fatalities

Determination of the manner of death in the case of intra- and perioral firearm wounds can be difficult especially if death scene investigation is unclear and inadequate. In this study, we investigated some characteristics of these firearm wounds which were autopsied in Istanbul. During the 5-year period from 1991 through 1995, there were 15 intra- and perioral firearm fatalities investigated. In all the cases, only one shot was fired into the mouth. They constituted 1% of all the firearm fatalities. The mean age of the victims was 27 years and males constituted 73.3% of the victims. Most of the wounds were caused by handguns. Homicides accounted for 53.3% of these deaths. Three of 15 cases could not be identified as intraoral firearm wounds by general practitioners during the scene investigations.

Acute Myocardial Infarction Due to Disulfiram (Antabus)–Alcohol Interaction

Disulfiram is an irreversible inhibitor of the aldehyde dehydrogenase enzyme (ALDH). It is used since 1940 for the treatment of chronic alcoholism [1]. However, it is not a safe drug. It may cause severe harmful adverse effects secondary to ingestion of disulfiram and alcohol [2, 3]. We here present a young man who suffered an inferoposterior myocardial infarction that probably be caused by disulfiram–alcohol interaction. A 36-year-old man was admitted to local hospital because of severe epigastric and retrosternal pain with radiation down to his left arm that is accompanied with nausea and sweating. He was then referred to our hospital 20 h after onset of his complaints. He was diagnosed as having inferoposterior myocardial infarction and commenced conventional therapy including heparin, aspirin, metoprolol, atorvastatin, and enalapril. The past medical history revealed chronic alcoholism and smoking. He had no previous history of any cardiac disorder. He was taking disulfiram (0.5 g/daily) and quit alcohol intake for 7 months. Additionally, he revealed that he had not taken any alcoholic beverages before his symptom onset. Approximately 12 h before his symptoms began, he consumed salad with fermented vinegar for dinner and used aftershave lotion in the morning. On his admission to our hospital, physical examination was unremarkable. He had normal spontaneous breathing. His blood pressure and heart rate were 110/70 mm Hg and 60 bpm, respectively. An ECG showed acute inferoposterior myocardial infarction (Fig. 1a and b). Laboratory findings were within normal limits except myocardialspecific isoenzyme of creatine kinase 200 U/l (normal range: 0–25) and troponin-I 5.67 ng/ml (normal range: 0–0.4). Blood alcohol and acetaldehyde (AcH) levels were not measured. Blood haemostatic and coagulation parameters such as platelets, fibrinogen, factors V, VIII and others, protein C and antithrombin III were found to be within normal limits. His coronary angiogram revealed normal coronary arteries. Disulfiram is therapeutically used as a pharmacologic adjunct in the treatment of chronic alcoholism. Disulfiram is rapidly and completely absorbed from the gastrointestinal tract although a period of 12 h is required for its full action. Its elimination rate from the body is relatively slow, therefore its effect may persist for several days after the last dose. It is a relatively nontoxic substance. It acts by inhibiting ALDH and subsequently AcH accumulates in the blood. In addition, many other drugs, eg, metronidazole, certain cephalosporins, sulfonylurea, hypoglycemic drugs, and chloral hydrate, have disulfiram-like effects on ethanol metabolism. Disulfiram has little effect on nondrinkers. However, the ingestion of alcohol by individuals previously treated with disulfiram gives rise to marked signs and symptoms such as flushing, throbCardiovasc Drugs Ther (2006) 20: 391–392 DOI 10.1007/s10557-006-0493-8

The Economic Losses of University Hospitals due to the No Payment System for Forensic Reports

Bu calismada; Trakya Universitesi Hastanesi orneginde, universite hastanelerinde duzenlenen adli raporlarin ucretlendirilememesi nedeniyle ortaya cikan ekonomik kayiplara dikkat cekmek amaclanmistir. Calisma kapsamina alman Ocak 2003- Aralik 2004 donemine ait kayitlardan, rapor talebinde bulunan kurumlar ve raporlarda yanitlanmasi istenen sorular belirlenmistir. Rapor talebinde bulunan resmi makamlar Cumhuriyet Savciliklari ve Mahkemeler, Emniyet Mudurlukleri, Jandarma Teskilati ve diger makamlar (cezaevi mudurlugu, noterlikler) olarak ayrilmistir. Trakya Universitesi Hastanesi’nde 2003 yilinda 471 ve 2004 yilinda 653 adet adli rapor duzenlenmistir. 2003-2004 doneminde rapor taleplerinde %39’luk ve birim fiyatlarda %50-60’lik yillik artis meydana geldigi saptanmistir. Adli raporlarin ucretlendirilememesi nedeniyle ortaya cikan ekonomik kayip, 2003 ve 2004 yillari icin sirasiyla 9.647.500.000 TL ve 19.420.000.000 TL olarak hesaplanmistir. Her iki yil icin toplam kayip 29.067.500.000 TL’dir. Universitelerce verilen/verilecek olan adli tip hizmetlerinin ucretleri Adli Tip Kurumu doner sermaye fiyat listesi esas alinarak tahsil edilebilmelidir. Cozum saglayacak en kalici uygulama, universitelerin adli tip hizmetlerinin Butce Uygulama Talimatinda yer almasi icin. Yuksekogretim Kurulu araciligiyla Maliye Bakanligi nezdinde girisimde bulunmasidir. Anahtar kelimeler: Adli rapor, ucret, universite hastanesi

Rupture of the Thoracic Aorta due to Blunt Chest Trauma a Case Report

Kunt toraks travmalarinda, aortta travmatik ruptur meydana gelebilir. Incelenen olgu, arac ici trafik kazasi sonucu yaralanma nedeniyle hastanemize getirilmis; yaklasik sekiz saat sonra nazogastrik sonda takilmasi sirasinda olmustur. Otopside, kafa travmasi bulgularina ek olarak, boyun ve mediasten yumusak dokularinda yaygin kanama, her iki gogus boslugunda toplam 1700 cc serbest kan, aortta sub- klavian arterin 2.5 cm altinda, tam ayrilma tarzinda ruptur, sol femur diafizinde parcali kirik ve etrafinda hematom bulundugu belirlendi. Bu olgu isiginda, kiint toraks travmalarinda aort yaralanmalarinin da olusabilecegine dikkat cekilmistir. Anahtar Kelimeler: Trafik kazasi, Gogus travmasi, Aort rupturu, Tipta yanlis uygulama, Otopsi.