Hakan Kar

Homicidal poisoning by injection of methidathion: The first ever report

We present the first ever case of homicidal poisoning due to injection of methidathion, an organophosphate insecticide. Case: A 4-month-old baby presented to the emergency department with chief complaints of unconsciousness and irregular respiration. A bitter odour and an injection site with a greenish blue colouration and two bullaous lesions were noticed by the emergency department physicians. Postmortem examinations revealed a wide shiny blue colouration of the antecubital region with oedematous muscular fascia and focal liquefaction necrosis. Blood and tissue levels were positive for methidathion. Our case report emphasizes the necessity of a detailed crime scene investigation and postmortem examination for the possibility of homicide in such cases. Although injection sites may be the expected results of medical treatment, dermal lesions also may be associated with injections of toxic substances.

Deaths Due to Corrosive Ingestion: A 10-Year Retrospective Study

Objectives: Evaluation of the substances used, macroscopic and microscopic autopsy findings, and the manner of corrosive ingestion deaths in Istanbul are aimed in this study. Methods: The autopsy records of the corrosive ingestion cases in Istanbul, Turkey, between 1992 and 2001 are investigated in our retrospective descriptive study. Results: The cause of death was determined as “corrosive injury” in 23 (0.089%) cases among 25,763 autopsy cases. Among these cases one was in the child age group and the corrosive substance ingestion was accidental, whereas all the other cases were adults and the ingestion was for suicidal intent. Sixteen (69.6%) of the cases were female. Nitric acid was the most frequent agent with 13 cases (56.5%). Necrosis of esophagus was determined in 19 cases (82.6%) and perforation of stomach in 11 cases (47.8%). Conclusion: Guidance and education are important tools for prevention from corrosive injuries, but we believe that the best weapon is to restrict easy access to corrosive agents by prohibiting the free commercialization of these most potent agents.

Deaths During Sport and Recreational Activities in Istanbul

Abstract Sudden deaths can be simply explained as the rapid loss of heart functions of the individuals and recently an increase in sports-related sudden deaths is observed in forensic practice in Turkey. Reported here are six cases of sports-related sudden deaths to emphasize the pathological mechanisms with optimal screening strategies where a detailed postmortem examination were carried out for all. Except for one case, all cases occurred while playing soccer where coronary artery disease was established as the cause of death in four cases and as arrthymogenic right ventricular dysplasia in the other case. Toxicological analyses revealed 60 ng/ml benzodiazepine concentrations in one case. Sports activities should be undertaken cautiously, particularly in the presence of risk factors. Beside professionals, screening of the recreational athletes is also important. By this way, early diagnosis of most cardiovascular abnormalities can be provided.

Aspiration Deaths Among Adults in Istanbul

Massive aspiration of food is rare, but most common in people under the influence of alcohol or a drug and comatose patients who have impaired functioning of the central nervous system. The finding of small amounts of food material in the airway at autopsy does not indicate the true vital aspiration because of agonal or even early post-mortem overspills. Occlusion of the small airways, mainly the membranous and respiratory bronchioles, partial or total filling of bronchiolar lumen and the alveolar spaces with food or gastric content were typical morphologic findings. In our 10 year retrospective study we presented the data of 21 male and 4 female cases with a final diagnosis of fatal aspiration in age from 23 to 78 years (45.43±14.61) from the records of Morgue Specialization Department of the Council of Forensic Medicine. 13 cases found death at the scene without an eyewitness. All deaths were accidental in manner except one homicide. Toxicological analysis revealed blood alcohol concentration levels between 161 and 339 mg/dL in 7 cases. Morphine metabolites, benzodiazepine and barbituric acid derivatives, toluene and acetone were detected in 5 subjects. Aspirated materials were food in 14 cases, chewing gum in 3 cases, gastric content in 7 cases and a fabric gag in one case. The history, other evidence of external vomit on the clothing or immediate surroundings and toxicological analysis are by no means as significant as autopsy findings especially in cases of aspiration. Key words : adult; aspiration; death; autopsy

Beyin Ölümü Gerçekleşmiş Adli Olgularda Organ Transplantasyonunda Adli Tıp Uzmanlarının İnisiyatifi

We aimed to discuss organ transplantation of brain death legal cases due to high benefits of patient with forensic and legal points of view. Case: 16 years old, entubated male patient who was intoxicated from inhalation of bottled gas with unconsciousness, bilateral fix-dilated pupils and GCS:3 was admitted to Mersin University Faculty of Medicine and hospitalized in intensive care unit. Subarachnoidal hemarrogie and brain edema were detected in Computerized Cerebral Tomograpy and given medical teraphy. But there was no answer to the treathment and the family was given consent of organ transplantation. Brain death was occured in 04.18.2007 and the case is consulted with our Department of Forensic Medicine. After discussing the case with public attorney we concluded that the organs which was planned to be transplantated had no influence on cause of death and the medicolegal autopsy can performed after transplantation operation. The public attorney approved the procedure and the medicolegal autopsy was performed after operation. There are serious problems in organ transplantation for legal cases. Sheduling of legal notification and pastmortem examination is not clear in such cases. It’s not obvious that these procedures must before or after transplantation operation. The article 11 of the law code numbered 2238 describes the priority of urgent transplantation for patient survive due to the principle of high benefits of the patient. The legal cases who becomes doneur for organ tranplantation must be consulted and evaluated with Forensic Medicine Departments.Key words: Brain death, organ transplantation, legal case