Ömer Kurtaş

Gender and the lateral angle of the internal acoustic canal meatus as measured on computerized tomography of the temporal bone

INTRODUCTION Cadaveric studies yielded promising results in sexing the temporal bones by measuring the lateral angle of the internal acoustic canal meatus. In this study, we evaluated the capability of computerized tomography of the temporal bone to reproduce these results. METHODS Lateral angle of the internal acoustic canal meatus was measured in 92 patients (47 females and 45 males) on axial slices of high resolution computerized tomography scans of the temporal bone. The patients underwent computerized tomography as part of clinical work up for ear-related complaints. The measurement technique was modified from a cadaveric study in which a significantly higher mean lateral angle measurement was observed in females than in males. The mean values from females and males were compared statistically. RESULTS The mean lateral angle as measured on computerized tomography of the temporal bone is greater in females (45.5+/-7.1 degrees ) than in males (41.6+/-6.7 degrees ). The difference is significant at p<0.01, as tested by one-way ANOVA. Due to significant overlap in ranges of measurements, no single cut-off value that satisfactorily differentiates between the genders could be determined. However, measurements of 35 degrees and lesser were 93.6% specific for male gender and measurements of 60 degrees and greater were 97.7% specific for female gender. CONCLUSION Computerized tomography of the temporal bone is capable of replicating the results from the cadaveric measurements in determining the lateral angle. Due to the large range of measurements within both genders, this measurement should be regarded as supportive and not conclusive evidence for the sex of the subject.

The Evaluation of Suicide Letters in Turkey From a Cognitive Perspective

BACKGROUND Different methods are used to understand the suicidal mind. Suicide note analysis may be most direct way to do this. AIMS To study the content of suicide letters under forensic evaluation in terms of psychological and cognitive aspects. METHODS A total of 51 letters were referred to The Council of Forensic Medicine from different cities of Turkey and analyzed by a research group with ten members including forensic medicine specialists and psychiatrists. The Questionnaire of Content Analysis of Suicide Letters (The Q-CAS), developed by researchers, was used to analyze the cognitive and cultural themes of suicide letters. The cognitive distortions about the self, the world, and the future as well as cultural phenomena were evaluated including sociodemographic features. RESULTS Financial problems in males and relationship problems in females were the most frequent life events related to suicide. Hopelessness, weakness, loneliness--in decreasing order--were the most predominant cognitions and emotions. The total score of females were higher than that of males (p=.002). CONCLUSIONS These negative cognitions should be taken into consideration when therapeutic interventions are planned on individuals with suicidal thoughts.

A descriptive study of medical malpractice cases in Turkey.

BACKGROUND Medical malpractice claims in Turkey have increased. We evaluated the problem by describing medical malpractice cases assessed by the Higher Health Council between 1993 and 1998. Our recommendations should help to improve care and decrease medical malpractice claims. METHODS We reviewed 997 medical malpractice cases reported to the Higher Health Council between 1993 and 1998 and examined the decisions made by the Higher Health Council. We collected data on demographic characteristics, such as the type of the institution where the defendants worked, type of medical malpractice, and medical outcome. RESULTS There were 997 medical malpractice cases reported to the Higher Health Council in the six years between 1993 and 1998. The Higher Health Council decided that 47.7% of the physicians were liable. Malpractice cases were mostly seen in state hospitals (42.4%). Fifty-nine percent of the cases resulted in death. Among actions that led to malpractice lawsuits against all health care workers, including physicians, the most common were negligence, inappropriate treatment, and diagnostic failure. CONCLUSION We think it is necessary to revise the health system and working conditions in hospitals and to develop clinical practice guidelines. We are of the opinion that an emphasis on the use of diagnosis and therapy protocols, standards, post-graduation education, clear and informed patient consent, and improved communication with patients will drastically decrease medical malpractice claims.

Changes in Handwriting due to Alzheimer’s Disease a Case Report

and signature comparisons are frequently per- formed in forensic investigations of documents. Mistakes in conclu- sion might be due to lack of sufficient documentation and informa - tion. Many factors can affect handwriting and signature. These fac- tors are divided into two groups: dependent or independent of the in- dividual at the time the handwriting or signature is made. Therefore, the situations leading to differences between individuals and in the individuals own handwriting and signature should be determined. Currently, average life expectancy and quality have increased due to the developments in health services. Thus, an increasing number of elderly people are engaged in an active daily life and trade. Alzhei- mers Disease (AD) can develop in the elderly; this is a condition that could alter handwriting and signature considerably over time. In forensic document examination, comparing the document in question containing handwriting or signature with the original documents prepared before the document in question was prepared is important. However, if alterations have developed secondary to a disease, the documents prepared before and after the disease af- fected the individual should be assessed together. Likewise, in the present case, the examiners making com- parisons using handwriting and signatures from different periods reached entirely different conclusions. The case is a bill prepared in 1994. The payee of the bill is a male born in 1925 and diagnosed with AD shortly before his death in 1998. The indebted person in the bill is the payees spouse. For the assessment of handwriting and signature, the first endorsement consisting of the handwritten name and signature was used. Sev- eral expert reports regarding the same document had been commis- sioned; these reached different views. The document was sent to The Council of Forensic Medicine to assess the identification and the previous reports. After re-evaluation, the handwriting was de- clared to belong to the payee. In this study, the reason that the experts delivered opposing opinions on the identification of a document handwritten by a per - son with AD after being referred to court was investigated. Based on the judicial file, the document examiners did not have the opportunity to evaluate all factors affecting the handwriting or signature of the individual, and an adequate number of handwrit- ing and signature examples were not collected for comparison. Consequently, the examiners reached different opinions. Thus, the above-mentioned factors are necessary to derive a satisfactory and accurate opinion regarding the identification of handwriting or sig - nature.

Kocaeli Üniversitesi Tıp Fakültesi Adli Tıp Anabilim Daltna Başvuran Çocuklara Yönelik Cinsel İstismar Olguları 1998-2006

Child sexual abuse is the abuse of the child, who has not yet completed his/her sexual development, by an adult for sexual arousal. Misdiagnosed sexual abuse is the cause of either suspect’s being punished or harming of unguilt as well as preventing children’s protection. In this study, it was aimed to evaluate child sexual abuse cases with their characteristics and examination periods which are informed to Kocaeli University School of Medicine, Department of Forensic Medicine. Between 1998-2006, the reports and files of cases at the registers of Kocaeli University School of Medicine, Department of Forensic Medicine, examined retrospectively. Fifty cases (3,1%)under the heading of sexual abuse are included in the study. It is determined that 62% of cases are females, 38% of them are males and 60 % of the cases are under the age of 12. It is also determined that suspects are mostly the cases’ acquaintances (70%) and all of suspects are males. In the 36% (n= 18) of the cases, the questions are asked towards physical diagnosis, in 50% (n = 25) of the cases, the questions were oriented towards mental health, while 14% (n=7) of the cases are examined through both physical and mental evaluations. Impairment of mental health which can be considered as the result of sexual abuse are determined in the 60,5% (n=23) of 38 mental-oriented cases. After recent legal arrangement, a significant increase in sexual abuses is observed and recorded in Department of Forensic Medicine. The organisation and functioning of the units connected to the Ministry of Health and Ministry of Justice are considered unsuitable for the evaluation of sexual abuse. Foundation of Center of Sexual Abuse Evaluation would provide early treatment of present or probable pathologies as well as precise diagnosis.Key words: Child, sexual abuse, mental evaluation, child psychiatry