Rıza Yılmaz

Postmortem findings after anaphylactic reactions to drugs in Turkey.

Aims: To determine the frequency of anaphylactic deaths at autopsies performed in Turkey between January 2001 and June 2006 and to review the circumstances of death and autopsy findings. Methods: The Council of Forensic Medicine database in Istanbul was searched for anaphylactic deaths. Postmortem reports and medical records were reviewed to determine the circumstances of death. Data about basic demographics, medical history, drugs responsible for allergic reactions, and pathologic findings at autopsy were collected. Results: A total of 36 anaphylactic deaths from drugs were identified for the study period. Death was due to antibiotics in 26 cases, analgesics in 7 cases, an intraoperative drug in 1 case, an H2 receptor in 1 case, and intravenous contrast medium in 1 case. Out of 36 cases, 19 were male and 17 female. They were aged between 1 and 74 years with the median age of 26.7 years. Death occurred within 1 hour of the onset of anaphylaxis in 27 cases. Findings at autopsy included nonspecific pulmonary edema and congestion, upper airway edema, cerebral hypoxia, and cutaneous edema. Serum tryptase levels were not measured in all cases. Conclusion: Anaphylactic reaction is an uncommon cause of sudden death. In many cases, no specific macroscopic or microscopic findings were detected at autopsy. When serum tryptase levels cannot be determined, in the presence of typical clinical records, eye witness reports and autopsy findings can be useful diagnostic aids.

Childhood deaths due to suicide

Suicide has been reported as the second or third most common cause of death in children and adolescents all over the world. The aim of the study was to investigate the general properties of suicide in childhood and adolescents, and to evaluate the results in the light of literature. Reports of autopsies performed between 2001 and 2005 in the Morgue Department of the Council of Forensic Medicine in Istanbul (n = 16853) were examined retrospectively. Deaths between 0–18 years of age doubtlessly considered as suicide were included in the study. Childhood and adolescent (0–18 years) deaths comprised 10.4% (n = 1761) of all medico-legal autopsy cases. 136 cases of suicidal origin were evaluated in terms of age, gender, and method of suicide. The ages ranged between 7 and 18, with a mean of 15.54 ± 2.691(SD). The most common method of suicide was hanging (59.2%) in both genders. Older adolescents (16–18 age group) constituted the overwhelming number (63.2%, n = 86) of all cases. Seven cases of 10 years of age and below were determined, and hanging was the method of suicide in five of these cases. In order to prevent childhood suicides, families and society should be aware of their responsibilities.

Autopsy evaluation of coal mining deaths in the city of Zonguldak, Turkey

Background In this study, our aim was to evaluate the fatal occupational accidents that occurred in Zonguldak coal mines between the years 2005–2008. Material/Methods We retrospectively evaluated 42 fatal coal mine occupational accidents in Zonguldak (Turkey) between the years 2005–2008. The forensic records of autopsies referred to the chief prosecutors’ office during 2005–2008 were reviewed retrospectively. There were 42 cases. The cases were evaluated with respect to age, mechanism of injury, body region of wound, cause of death, and legality of the mine. Results Ages of the deceased ranged between 17 and 52 (median: 32.9 yrs). Deaths were mostly in the 21–30 (35.8%), and 31–40 (30.9%) age groups. Only 1 case was younger than 18 years of age. Review of occupational fatalities has revealed that fatal accidents occurred mostly (76.2%) in the private, and fewer (23.8%) in the public mining enterprises. Crime scene investigation findings have demonstrated that of all occupational deaths (total n=42), 27 (64.3%) were due to subsidence, followed by methane gas poisoning (n=6, 14.2%), tram crash (n=3, 7.1%), log falls (n=2, 4.8%), electrocution (n=2, 4.8%), and methane explosion (n=2, 4.8%). Conclusions Despite laws and regulations concerning mining and because of problems in their implementation, Turkey leads the world in work-related accidents, occupational injuries, and deaths. Evaluation of autopsy findings of deaths in fatal occupational accidents occurring in coal mines is quite important in planning to decrease rates of occupational fatalities.

Evaluation of social and demographic characteristics of incest cases in a university hospital in Turkey.

Background Incest is defined as any sexual activity between close blood relatives including step relatives and family members who are forbidden by law to marry. It is a problem that can be seen in all the social classes in developed and undeveloped societies. The World Health Organization classifies this problem as a silent health emergency. Father-daughter incest is reported to be the most common incest type followed by the other types like brother-sister, sister-sister and mother-son incest. Material/Methods Subjects for this study were recruited from a sample of incest cases referred to Forensic Medicine Department of Gaziosmanpasa University Medical Faculty Hospital between 2008 and 2012. Data involved social and demographic characteristics and clinical features of victims, perpetrators and the families. The ethical committee of the faculty of medicine approved the study. Results The study sample consisted of 43 incest cases (36 females and 7 males) with an age rage 4–40 years. Two third of the victims were under 18 years old. All perpetrators were males. Father – daughter incest (34.9%) was found to be most common incest type followed by brother – sister incest (14%). 75% of the perpetrators were family members and relatives with consanguinity while 25% of them were not consanguineous but faithful and intimate relatives to victims. Conclusions Increasing awareness about incest and its damaging effects is so important and clinicians should keep in mind sexual abuse or incest when examining the risky population. Multidisciplinary approach is necessary for determining short term or long term results and preventing the negative consequences of incest.

Validity of Pathologic Comment with Macroscopic and Microscopic Findings of Infant Lung Regarding Live or Still Birth

Objective: In the case of a newly born infant, either stillborn or found dead, the state of the lungs is of particular forensic interest. The aim of this study was to determine whether lungs are adequate for pathological comment about stillbirth or live birth of infant. Material and Methods: In order to evaluate the relevance of totally 171 autopsy reports of infants, macroscopic and microscopic findings, and body measures at autopsy, microscopic investigations on the degree of alveolar expansion performed on the lung specimens, were obtained. Results: The lung filled the thoracic cavity and covered the anterior surface of the heart in 45 (26.37%) cases and didn’t fill the thoracic cavity and presented at the back side of the thoracic cavity in 56 (32.7%) of the cases. In total 40 histological sections, 19 (47.5%) uniform, 10 (25%) semi-collapsed, 11 (27.5%) collapsed alveoli sections in shape, 11 ( 28.2 %) amnion aspiration, 9 (23.1%) mild amnion aspiration, 9 (23.1%) moderate amnion aspiration, 10 (25.6%) evident amnion aspiration, 22 (57.9%) pulmonary emphysema were determined. Conclusion: Macroscopical findings of infant lungs with combination of histological findings were more formative than their histological findings alone in the assesment of still or live birth of an infant.

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.