Hudaverdi Kucuker

Two cases of acute endosulfan toxicity

Background. Endosulfan is widely used in insect control and is absorbed by both humans and animals through the intestinal tract, the lungs, and the skin. Organochlorine insecticides are highly toxic compounds that are responsible for a number of severe intoxications worldwide, with several deaths. A 9-year analysis by one of Turkeys poison control centers reported that pesticide intoxications accounted for 8.8% of 25,572 poisoning calls, with 80.3% of them relating to insecticides and 19.7% concerning rodenticides. Case Reports. We present two cases of unintentional exposure to endosulfan, one of which presented with neurological manifestations, liver toxicity, and required mechanical ventilation and emergent hemodialysis; the other had only neurological manifestations and liver toxicity. Conclusion. In cases of endosulfan poisoning, physicians must be aware of neurological manifestations, seizures, and severe metabolic acidosis. If severe metabolic acidosis is present, we suggest that hemodialysis may be an important intervention and should be performed early.

Variations in the intracranial vertebrobasilar system

AimThe aim of our study was to demonstrate some possible variations in the vertebrobasilar system (VBS) in the Turkish population and to compare our results with the literature.Materials and methodsThe VBS samples were taken from 109 fresh forensic autopsies and one anatomic cadaver. The widths of the vertebral artery (VA), the basilar artery (BA) and their branches were measured; dominancy and hypoplastic arteries, as well as the types of variations and their locations, were determined.ResultsHypoplastic VA was observed at rates of 20.2% on the right, 14.4% on the left and 4.8% bilaterally. The vertebrobasilar junction was found to be either at the level of bulbopontine sulcus (20%), below the sulcus (67%) or above the sulcus (12%). BA variations were observed as duplications of the proximal (0.9%) and distal segments (1.8%). Anterior spinal artery (ASA) originated as a single trunk in 12.5% of the cases. ASA arose from a transverse anastomosis connecting VAs in 6.3% of the cases. Furthermore, 15.6% of ASAs were double. The observed variations in the superior cerebellar artery were early bifurcation (7.2% on the right, 12.7% on the left), fenestration (4.5% on the right, 7.2% on the left), duplication (14.5% on the right, 12.7% on the left) and origin as a common trunk (6.3% on the right, 10% on the left).ConclusionOur results show that a high percentage of variations can be seen even in a small number of cases. We believe that our data are clinically important because, for example, variations are a factor which increases the incidence of aneurism and thrombus. We also think our results will contribute to the demography of our country and to clinical medicine.

The fascial band from semitendinosus to gastrocnemius: the critical point of hamstring harvesting An anatomical study of 23 cadavers

Background Arthroscopically-assisted reconstruction of the anterior cruciate ligament with hamstring tendons has achieved widespread acceptance; however, the anatomy of these tendons may cause technical problems at harvesting. Methods We studied the anatomy of the fascial band between semitendinosus and gastrocnemius and the distance between the semitendinosus insertion and the origin of this band in 23 knees from cadavers (17 male). The length of the semitendinosus tendon and the width of the fascial band were also recorded. Results Fascial attachment was detected in all cadavers except 1. The mean width of the band was 2.6 (1–4) cm. The mean distance from the insertion of the semitendinosus to the fascial band was 7 (6–8) cm. The mean length of the semitendinosus tendon was 22 (18–26) cm. Interpretation A better understanding of the anatomy of the hamstring tendons will reduce the risk of a disappointing complication right at the start of the operation.

Pediatric condition falsification (Munchausen syndrome by Proxy) as a continuum of maternal factitious disorder (Munchausen syndrome)

Kucuker H, Demir T, Oral R. Pediatric condition falsification (Munchausen syndrome by Proxy) as a continuum of maternal factitious disorder (Munchausen syndrome).

Should Forensic Autopsies Be a Source for Medical Education? A Preliminary Study

Background: Practical anatomy sessions including dissection of cadavers are essential for anatomy courses. There are many difficulties in obtaining cadavers. In addition, hardened and discolored cadavers that are fixed with formaldehyde look unrealistic and generate apathy among students. Purpose: We considered that forensic autopsies may be used as ancillary and supportive practice in anatomy education. Methods: We invited the participation of Year 2 medical students in suitable forensic autopsy cases during the course of one year. Specialists of forensic medicine and anatomy provided theoretical support through talks in their specialized fields during the autopsy. At the end of the semester, feedback questionnaire forms were prepared and the students were asked to evaluate these sessions. Results: Forty students participated in the evaluation by completing the questionnaire. Students made positive statements about adequacy of the time of the application, consistency of the structures with theoretical and practical issues shown in anatomy lectures, and necessary explanations of the lecturers during and after the application. Conclusion: We think that forensic autopsies are an attractive supplementary educational model, and we have decided to continue the forensic autopsy practices. We believe that further studies on the evaluation of the sessions using a larger student population will lead to more conclusive results.

Fatal acute endosulfan toxicity: a case report.

Endosulfan is an organochlorine pesticide. It is banned in the USA and Europe, but use is unrestricted for insect control. Endosulfan causes many intentional and unintentional toxicities in developing countries and in Turkey. Acute exposure to endosulfan has rarely been reported in deaths due to ingestion. Here, a fatality of 61-year-old woman of a family who was poisoned due to ingestion of endosulfan has been reported. Based on autopsy findings, patient history and toxicological results, the cause of death was determined to be acute intoxication of endosulfan and the manner, unintentional toxicities. Endosulfan has histopathological toxic effects on many organs and this toxic effect occurs within a short period after ingestion. To prevent endosulfan poisoning, the usage of it must be restricted and even prohibited. To prevent death and to accelerate improvement, the organs that have more apparent histopathological injury should be considered and early and intensive supportive treatment be initiated.

A reliable surface landmark for localizing supratrochlear artery: Medial canthus

OBJECTIVE: To determine the reliability of medial canthus as a surface landmark to locate supratrochlear vascular pedicle. STUDY DESIGN AND SETTING: The distance from medial canthal line to supratrochlear vascular pedicle was measured in 57 healthy volunteers (Doppler imaging study) and also in 15 fresh cadavers. RESULTS: In the Doppler study, the pedicle was found at most 3 mm lateral or medial to medial canthus (mean ± SD, 0.8 ± 0.7 mm). SVP mark tended to be medial to the medial canthus mark in females (males, 6; females, 42), whereas it was lateral to it in males (males, 20; females, 5). In the cadaver study, the pedicle was found 0.7 mm away from medial canthus on average. CONCLUSION: Medial canthus can be used as a reliable landmark for paramedian forehead flaps. When Doppler examination fails, pedicle may be found at most 3 mm away from medial canthus. SVP is more commonly located lateral to medial canthus in males and medial to it in females.

Influence of atropine therapy on fenthion-induced pancreatitis

Objective. We searched the influence of dose and timing of atropine therapy in fenthion-induced pancreatitis model. Methods. All rats were intoxicated with fenthion except the control group. Two milligrams of atropine was administered for 24 hours in a high dose atropine group while a low dose atropine group received 100 micrograms of atropine for 24 hours. One group received 2 milligrams of atropine in the first four hours of intoxication while the other group received 2 milligrams of atropine in the last four hours before sacrifice. All rats were sacrificed 24 hours after intoxication. Pseudo-cholinesterase and lipase concentrations and histopathological markers of pancreatitis were studied. Results. None of the models in this study completely prevented pancreatitis, however high dose atropine that is administered for 24 hours or the first four hours after intoxication prevented severe pancreatitis. Conclusion. Atropine administration influence on fenthion-induced pancreatitis should be studied for other organophosphates in animals and humans.

Evaluation of epithelial lesions of the bladder in an autopsy series - Urooncology

Gereç ve yöntem: Travma, ateşli silah yaralanması gibi sebeplerle hayatını kaybetmiş 125 adli vakanın (106 erkek, 19 kadın) mesaneleri otopsi ile alındı. Her bir mesaneden, anterior duvardan, trigondan ve posterior duvardan olmak üzere 3 parça örnek alındı. Parafine gömülü dokulardan hazırlanan 5 μm kalınlığındaki kesitler hematoksilen-eozin ile boyandı ve mikroskopik olarak benign ve malign epitelyal lezyonların varlığı araştırıldı.

Afyonkarahisar ilindeki Atesli Silah Yaralanmalanna Baglı Olümlerin Degerlendirllmesi

Amac: Bu calismada; Afyonkarahisar ilindeki atesli silah yaralanmasina bagli olumler analiz edilerek, atesli silah yaralanmasina bagli olumlerin sosyodemografik ve klinik ozelliklerinin degerlendirilmesi ve yapilan benzer calismalar ile karsilastirilarak tartisilmasi amaclandi. Gerec ve Yontem: Afyonkarahisar il merkezinde, 1997— 2004 yillari arasindaki sekiz yillik donemde olumu adli sorusturmaya konu olan 923 olgudan, olumun atesli silah yaralanmasi sonucu meydana geldigi belirlenen 90 olgunun kesif, olu muayene tutanaklari ile otopsi raporlari incelenmistir. Bulgular: Toplam 923 adli olum olgusunun 90’1 (%9.7) atesli silah yaralanmasina bagli olum olgusu idi. 90 olgunun 79’u (%87.8) erkek ve olgularin yas ortalamasi 33.453: (en kucuk: 9- en buyuk: 69) idi. Olgularin en sik 26 olgu (%28.9) ile 21-30 yas grubunda goruldugu belir— lendi. 56 olgunun (%62.2) cinayet orijinli oldugu ve bun— larin 51’inin (%91.1) erkek oldugu belirlendi. 32 olgu (%35.5) intihar orjiiili olup, bunlarin 26’si (% 81.2) erkek idi. En sik kullanilan silah tipinin 48 olgu (%53.3) ile yivli silah (tabanca) oldugu belirlendi. Olgularin dis muayenesinde tespit edilen oldurucu atesli silah yaralarinin, en sik bas-boyun (%51.1) bolgesinde oldugu saptandi. Olgularin 70’inde (%77.8) olumun olay yerinde meydana geldigi belirlendi. Toplam 78 olguda (%86.7) otopsi yapildigi tespit edildi. Sonuc: Atesli silah yaralanmalarinin halen basta gelen olum nedenleri arasinda oldugu, yaralanmalarin daha cok cinayet orjinli oldugu ve en fazla genc erkek nufusun etkilendigi gorulmustur