Osman Celbis

Reduced neuronal innervation in the distal end of the proximal esophageal atretic segment in cases of esophageal atresia with distal tracheoesophageal fistula

BackgroundEsophageal dysmotility is a common occurence after surgical repair of proximal esophageal atresia (EA) and distal tracheoesophageal fistula (TEF). The etiology of this motility disorder, however, remains controversial. Esophageal dysmotility also is present in isolated TEF or EA before surgery, suggesting a congenital cause. However, there is no information available in the literature with regard to the intramural nervous system of the human esophagus in EA-TEF.Patients and MethodsWe examined the distal end of proximal esophageal atretic segment of neonates undergoing EA-TEF repair for intrinsic neuronal innervation. Using specific antibodies, we studied neuronal markers of specimens from nine cases of EA-TEF and 9 cases of normal esophagus by immunohistochemistry using neurofilament (NF), synaptophysin (SY), S100, and glial cell line-derived neurotrophic factor (GDNF).ResultsIn the atretic segment, specimens staining with hematoxylin and eosin showed that there were marked hypoganglionosis and immature ganglion cells in the myenteric plexus. GDNF immunoreactivity in the atretic esophagus were markedly reduced in both the muscular layer and myenteric plexus. SY and NF-immunorective nerve fibers were distributed throughout the myenteric plexus of the normal esophagus, but the scarcity of these immunoreactive nerve fibers in the atretic esophagus was apparent. In contrast, the density of immunorective nerve fibers for S100 in the myenteric plexus and muscular layer was increased in the distal end of the atretic esophagus.ConclusionWe concluded that the distribution of ganglion cells and some nerve fibers in the distal end of the atretic esophageal segment is deficient. Inadequate and abnormal neuronal innervation of the esophagus could be related to the esophageal dysmotility seen in EA. Because GDNF is a survival factor for central and peripheral neurons, defective expression of GDNF could have an important role in the defective and/or abnormal neuronal innervation of atretic esophageal segment.

How safe is the use of herbal weight-loss products sold over the Internet?

Background: In recent years, the use of herbal weight-loss products sold over the Internet has rapidly increased; however, the safety of these products has not been well documented yet. More importantly, the declared ingredients in these products could be different than the marketed contents. Methods: Nine different herbal weight-loss products sold over the Internet were obtained. The ingredients of each product were analyzed in the Laboratory of Forensic Medicine and the Scientific and Technological Research Laboratory of Inonu University. Results: Although all studied weight-loss products were presented as pure herbal, three of them contain sibutramine, three contain caffeine, and three contain caffeine + temazepam. The amount of sibutramine in each capsule was found to be over 10 mg. We analyzed toxic and trace element levels of nine herbal products and found that these herbal products, even in low amounts, contain Pb, Al, Ni, and Ba. Conclusions: Our results indicate that herbal weight-loss products available without prescription and claimed to be purely herbal may contain pharmaceutical substances like sibutramine or temazepam in high doses. Moreover, they also may become contaminated with toxic metals. Since people commonly use these products unaware of its real constituents and without the suggestion or control of a physician, they might cause various health problems some of which might be harmful. Strict legal rules and control mechanisms must be established to minimize their possible harmful effects.

Cut throat injuries and honor killings: Review of 15 cases in eastern Turkey

Throat cuts could be of homicidal, suicidal or accidental origin. In the cases of death from cut throat, suicide can be distinguished from homicide based on the type and location of the wound and crime scene investigation. The purpose of the current study is to attract attention to the instructive findings for origin determination in deaths by cut throat according to the number and characteristics of the wounds and crime scene investigation. We have reviewed the files of autopsies performed between the years of 2000 and 2010, and compared with previously published case reports; all results were summarized in the current study. The results showed that 60% of cases were male, 40% were female, with 27.9 years of average age. The mean number of wounds was calculated to be 34.3 per case for honor homicides, 7.4 per case for other homicides, and 2.0 per case for suicides. Numbers of wounds were approximately 5 times higher in the honor homicides compared to other homicides. If the number of wounds were excessive, possibility of honor killings should be taken into account. When the killer was a parent not in psychosis, hesitation cuts were detected. Additional lesions were present in 46.7% of the cases, and they were assessed as homicide. Presence of vertebral notch and spinal cord cuts, which require a substantial amount of force and pressure via sharp tools, indicates homicide.

Forearm bones and sexual variation in Turkish population.

Abstract Forensic anthropologists are aware that there are considerable differences between human populations and therefore develop study models for each skeletal population. The purpose of this study was to analyze forearm bones obtained from forensic settings in Turkey. The sample consists of 42 males and 38 females with an average age of 40 and 36 years, respectively. Numerous measurements were taken from the radius and ulna including lengths (in millimeters), midshaft diameters, and epiphyseal breadths (0.01 mm). Individuals with any anomaly and pathology were not included in the investigation. A stepwise analysis, when applied to individual bones, selected only length and midshaft transverse dimension in the radius and length only in the ulna. When the length was excluded from the statistic, head diameter and distal breadth of the radius and distal minimum head and midshaft anteroposterior diameters of the ulna provided the best predicting functions. Classification results were 92% for the radius and 91% for the ulna. For the incomplete bones, the accuracy rates were about 92% and 83%, respectively. In conclusion, a sex determination was made, in different rates of accuracy, in the human skeleton. Correct assessment can vary among populations. Dimorphism in our region forearm bones is greater than American whites. This supported the hypothesis that human variation is diverse, and population difference should be taken into account when osteometric standards are applied to others. Further studies are needed to understand why the forearm is more dimorphic in Turks.

Arrhythmogenic Right Ventricular Dysplasia Cases in Forensic Autopsies

Arrhythmogenic right ventricular dysplasia or cardiomyopathy (ARVD or ARVC) is an increasingly recognized entity with clinical and forensic implications. This is the first series documenting ARVD in 5 separate cases in forensic autopsies from Turkey declared as natural sudden cardiac death following complete autopsy and toxicologic analysis. There was a male preponderance (M/F= 4), with a mean age of 50.

The relationship between terrorist activities and cases of malaria in the eastern and south-eastern regions of Turkey, 1984-1998.

The objective of this study was to determine whether cases of malaria are related to terrorist activities that have occurred in the eastern and south-eastern regions of Turkey. Some of the determinants related to malaria have been investigated using a national dataset for 11 provinces located in these regions of Turkey. In these regions, both terrorist activity and cases of malaria were common from 1984 to 1998. A multiple regression technique was used to identify the variables that are significantly associated with cases of malaria. Annual incidence of malaria was chosen as the dependent variable along with three independent (explanatory) variables: annual number of terrorist incidences, people per healthcare technician and number of thick blood films per 100,000 people. Based on this analysis, it is determined that the annual number of terrorist incidences has been associated with the annual number of malaria cases in these regions of Turkey since the beginning of terrorist activity in 1984.

Autopsy in sudden cardiac deaths

Sudden cardiac death is described as death that occur within the 1st hour of the onset of the symptoms or death within the 24 hours of the onset of symptoms in unwitnessesed deaths. Studies conducted in our country reveal that cardiovascular origined deaths are the most frequent, with a rate of 20% of all deaths. Although sudden deaths in young people are rare, it is important to perform a detailed autopsy and other required procedures. The etiology of the sudden death is hard to determine for the forensic doctors and in 5-1% of all cases no certain cause is determined despite the macroscopic, toxicologic and histopathologic evaluations. European Society of Cardiovascular Pathology also recommends performing molecular autopsy when the certain cardiac cause cannot be determined morphological. This review aims to offer genetical consulting to the family members of the sudden cardiac death cases and clarify the etiology of death via genetical evaluation if the macroscopic, toxicologic and histopathologic examinations fail to explain the cause of the sudden cardiac death especially in children and young adults. The most important problems in our country are the lack of multidisiplinary approach and standardized management methods. In our country molecular autopsy is only considered in rare and selected cases, but if these genetical evaluations were made more applicable and accessible via interdepartmental agreements and the application of new genetical diagnosis methods, it would be possible to develop standardized methods for the case selection of molecular autopsies in the future.

The importance of curettage in cases of sexual violence

Sexual assault is among the gravest crime against the physical and moral integrity of an individual. When sexual assault results in pregnancy it causes further psychological and social damage. This study aims to examine the reasons for delayed reporting in cases of sexual assault that result in pregnancy, and the importance of abortion in such cases. Seven cases referred by the judicial authorities to Inonu UniversityÂ’s Turgut Ozal Medical Center for uterine evacuation are included in the study. The cases were examined in terms of age, whether the parents were still alive, place of residence, assaulter characteristics, mental levels of victims, psychiatric examination results, and gestational week upon referral to the hospital. The mean age of the cases was 17.42±2.76 years. Six of the cases were referred from Malatya and one was referred from a neighboring province. Four of the cases were past their 10th gestational week. Abortions were performed in six of the cases. One of the women, in the 19th week of pregnancy, decided not to have the abortion upon consultation with her family. The women in the cases were, on average, 76 days pregnant upon referral to the center. Their medical histories indicated that five of the cases hid their pregnancy because they were concerned about their familyÂ’s reaction. None of the cases knew that they were able to end the pregnancy until week 20. Pregnancy is one of the unwanted and preventable consequences of sexual assault. The familyÂ’s attitude toward the victim plays an important role in earlier detection of the cases. In addition to legislation concerning ending pregnancies, victims and families should be informed about this topic to prevent further trauma for the victim and the to be born child.

Mercury intake by gastrointenstinal track and importance of blood level measurement method: a case report /Gastrointestinal yoldan civa alimi ve kan duzeyi olcum metodunun onemi: olgu sunumu

Mercury is found in nature in liquid form at room temperature. Because it always freely moves in nature with natural distribution, it is found in trace amounts in all living organisms. Mercury exposure can occur by inhalation, gastrointenstinal absorption, or dermal contact. Forms of poisoning change according to occupations and living conditions. After exposure, the mercury-exposed patient can show cardiac symptoms like itchy rashes, burning sensation, arrhythmia, and hypertension along with neuropsychiatric symptoms ranging from personality changes to seizures. Mercury esposure can be seen in children. Children are exposed to mercury accidentally. As it is the case in many toxic substances, methods of analysis are of utmost importance in treatment and follow-ups of such cases. There may be distruptions while conducting these analyses and passing the results of these analyses to the practitioners that will decide on the treatment. It seems difficult to enable toxicological analyses in all hospitals. We believe that there must be regional hospitals with accredited laboratories capable of carrying out such analyses in similar cases of poisoning and that these cases should be promptly referred to these designated centres.

Suicidal Death from Pseudoephedrine Sulfate Overdose: A Case Report -

Background: Upper respiratory tract infections are common in the community and pseudoephedrine preparations are widely used in the treatment as a decongestant drug. However, pseudoephedrine has serious side effects on the central nervous system and the cardiovascular system. Although cases of infant death due to overdose have been reported in literature, pseudoephedrine toxicity has not been observed in adults as a cause of suicide in literature. Case Presentation: The case is an 18-year old female who committed suicide with pseudoephedrine sulfate preparation. Care and attention must be paid as pseudoephedrine preparations are easily accessible, widely used and an overdose can cause death in adults.