Halis Dokgöz

Pleural effusion in bodies recovered from water

Both in saltwater and freshwater drowning cases, a common autopsy sign is pleural effusion. However, the factors that determine the amount of pleural effusion have not been well established. An attempt was therefore made to correlate the amount of pleural fluid in bodies recovered from water with several parameters registered on the judicial files as well as autopsy findings from the years 1994-1998. The number of cases with pleural fluid increase was found to be very high in saltwater drowning (P<0.001). But, when the freshwater and saltwater drowning cases with pleural fluid increase were compared according to pleural fluid amount, no significant difference was detected (521+/-340 and 768+/-536 ml, respectively). Although there was a positive correlation between the decomposition degree and the fluid in the pleural cavity, a relative decrease was detected in the amount of effusion contrary to the expectations in cases of extreme decomposition. Pleural fluid amount provides significant data about the type of water and the cause of death in early postmortem interval. And there is a link between the time spent in water and the amount of pleural effusion. With the advance of the postmortem interval, decomposition level and the duration of immersion should be taken into account in differential diagnosis.

Comparison of morphological changes in white blood cells after death and in vitro storage of blood for the estimation of postmortem interval

Estimation of the time of death is one of the most important problems for forensic medicine and law. Physical and chemical postmortem changes are evaluated together while estimating the time of death. In this study, in vitro storage and postmortem changes of white blood cells were aimed to be compared within the given postmortem interval, and a follow-up study was carried out. Blood smears which were obtained from 10 non-refrigerated cadavers (experimental group) and from 40 hospital patients (control group) have been evaluated to observe and compare changes during the in vitro storage and postmortem degenerative morphological changes that white blood cells undergo throughout the given postmortem intervals. The samples were examined by using a light microscope, and blood cells were differentiated by staining blood films with May-Grunwald stain, followed by Giemsa stain. Identifiable degenerated eosinophils and monocytes were first examined at 6h of death and the in vitro storage, and they were unidentifiable beyond 72 h of storage. Identifiable degeneration of neutrophils were first examined at 6h of death and storage while unidentifiable beyond 96 h of storage. Identifiable degeneration of lymphocytes were first examined at 24h of death, and they were still identifiable beyond 120 h. Cellular changes of leukocytes can be useful in the 6-120 h for estimating the time of in vitro storage, and the findings match during the first 21 h for both experimental and control groups. Finally, this follow-up study and the comparison will also be carried out for a longer postmortem interval, and other specific hypothesis that relate cellular changes in tissues other than blood with time since death are various points that needs to be studied.

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