Forensic Medicine Council Research Articles

Investigation of tuberculosis prevalence by acid-fast stain, culture and real-time PCR method in forensic autopsies

Tuberculosis (TB) is still one of the most important diseases and causes of death in the world. We aimed to investigate TB prevalence in forensic autopsy cases in Turkey by the acid-fast bacilli (AFB) staining, TB culture and real-time polymerase chain reaction (RT-PCR) methods in paraffin-embedded tissues. From January 2012 to January 2015, 1676 tissue samples were examined under AFB staining and TB culture, and 85 paraffin-embedded tissue samples under RT-PCR from 14,083 prospectively-investigated forensic autopsy cases in the Istanbul Council of Forensic Medicine. Positivity with microbiological methods (AFB staining and/or TB culture and/or RT-PCR) was detected in 43 (0.3%) out of 73 (0.5%) cases in which TB was diagnosed with histopathological findings. Acid-fast bacilli were detected in 14 tissue samples by AFB staining, and a total of 11 tissue samples were found culture-positive in the Löwenstein-Jensen medium. Mycobacterium tuberculosis DNA was positive in 36 samples with RT-PCR. Eleven (15%) cases were detected as miliary tuberculosis. Microbiological sampling should accompany autopsy findings and histopathological sampling for post-mortem identification and notification of active TB during forensic autopsies. Diagnosis of TB in forensic autopsies would contribute to clarifying the cause of death and to the collection of epidemiological data in Turkey, particularly in ante-mortem undiagnosed cases.

Effects of age, gender, BMI, settlement and smoking on lead and cadmium accumulation in heart tissue

Cadmium (Cd) and lead (Pb) are well-known risk factors for peripheral arterial and some other cardiovascular diseases. The aim of the study was to determine the level of both toxic metals, in the human heart tissue and compare the accumulation to their age, gender, body mass index, living environment and smoking habit. Heart tissues of the 112 autopsy cases, representing a sample set of population living in capital city of Turkey: Ankara Province (both in city center and suburban), were collected from Turkey Ministry of Justice, Council of Forensic Medicine in Ankara Branch. Lead and cadmium analysis was carried out by Graphite Furnace Atomic Spectrometry technique. Cd/Pb results and individuals’ information were assessed by SPSS statistically. Average value of Pb was found as 1374.99±237.01ppb and Cd was found as 287.54±66.43ppb in all heart tissue samples. Consideration of metal levels in autopsy heart tissues by age, statistically significant positive correlation in Cd was observed (p

Evidence-based Draft Guideline for Prevention of Midwifery Malpractices based on Referred Cases to the Forensic Medicine Commission and the Medical Council from 2006-2011.

Background:Medical errors are the main concerns in health systems, which considering their ascending rate in the recent years, especially in the field of midwifery, have caused a medical crisis. Considering the importance of evidence-based health services as a way to improve health systems, the aim of this study was to suggest a guideline for preventing malpractice in midwifery services.Materials and Methods:In this cross-sectional study that was conducted in 2013, we investigated 206 cases that were referred to the Isfahan Legal Medicine Organization and Medical Council of Forensic Medicine from 2006–2011. Data were collected by a checklist and were analyzed using SPSS-16 software. Descriptive statistical tests (mean, maximum, minimum, standard deviation, frequency, and percentage agreement) were used to describe the data. Then, we used the Delphi technique with the participation from 17 experts in midwifery, gynecology, and legal medicine to provide an evidence-based draft guideline for prevention of midwifery errors.Results:A total of 206 cases were reviewed. In 66 cases (32%) the verdict for malpractice in midwifery services was approved. A practical draft guideline for preventing clinical errors for midwifery in the fields of pregnancy, delivery, and postpartum period was developed.Conclusions:This evidence-based draft guideline can improve the attention of all the healthcare providers, especially midwives and physicians to prevent urgent problems and offer effective health services for mothers and infants.

Use of trauma scoring systems to determine the physician's responsibility in cases of traumatic death with medical malpractice claim.

Traumatic injury is near the top of World Health Organization list of leading causes of death, and one of the major factors affecting mortality is the severity of the trauma. During medical intervention for trauma patients, some injuries may be overlooked, and this misstep may be the basis of a malpractice claim. The objective of this study was to provide a new approach to evaluating medical malpractice cases by discussing the benefits of the use of trauma scores. Cases of alleged malpractice that were discussed and concluded between 2010 and 2013 were selected from the case archive of the General Committee of the Council of Forensic Medicine (GC of CFM). Injury severity scores were calculated from the medical records of accused physicians and from the autopsy or final clinical evaluation records and compared. Between the years 2010 and 2013, 263 cases of alleged medical malpractice were discussed and concluded by the general committee. Of these, in 25 cases of patient death, the reason for admission to the hospital was traumatic injury. Various surgical specialties were involved. In these 25 cases, 34 physicians were accused of medical malpractice, and the General Committee classified the interventions of 14 physicians in 12 cases as "malpractice." Missed injuries and unrecognized diagnoses can be established by comparing the Injury Severity Score and New Injury Severity Score values in the findings of accused physicians with the subsequent findings of last evaluation or autopsy. In a medical malpractice case, calculating injury severity scores may assist an expert witness or judge to detect any unseen injuries and to determine the likely survival potential of the patient, but these values do not provide enough information to evaluate all of the evidence or draw conclusions about the entire case. All contributing factors to trauma severity should be considered along with the trauma score and other case factors.

Viral Pneumonias in Forensic Autopsies

Lower respiratory infections are commonly due to viruses and are the third largest cause of death. Respiratory tract viruses have a tendency to target the specific regions in the lung and can harm the host via direct effect of the virus and the host's inflammatory response. In this study, relationships between morphologic changes in the lung and the viral agent type isolated in the lung by the polymerase chain reaction technique were investigated. This study was performed retrospectively at 113 autopsy cases in the Council of Forensic Medicine in Istanbul. Slides from the lung tissues diagnosed as interstitial pneumonia and detected viral agent in polymerase chain reaction were evaluated and reviewed under light microscope by 2 pathologists simultaneously according to predetermined bronchiolar, alveolar, and interstitial findings. Alveolar findings were detected in 108 cases (95.6%), whereas interstitial and bronchiolar findings were detected in 91 (80.5%) and 38 (33.6%) cases, respectively. Intra-alveolar edema was the most common alveolar finding. Some findings such as multinucleated syncytial cells and smudge cells can aid the search for etiologic agent. Interstitial inflammation was the most common histopathologic finding in the lung in viral infections and the most prominent clue to viral infections in the lung histopathologically without discrimination of viral agent type.

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

Handwriting and signature comparisons are frequently performed in forensic investigations of documents. Mistakes in conclusion might be due to lack of sufficient documentation and information. Many factors can affect handwriting and signature. These factors are divided into two groups: dependent or independent of the individual at the time the handwriting or signature is made. Therefore, the situations leading to differences between individuals and in the individual’s 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. Alzheimer’s 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 affected the individual should be assessed together.Likewise, in the present case, the examiners making comparisons 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 payee’s spouse. For the assessment of handwriting and signature, the first endorsement consisting of the handwritten name and signature was used. Several expert reports regarding the same document had been commissioned; 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 declared 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 person 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 handwriting and signature examples were not collected for comparison. Consequently, the examiners reached differing opinions. Thus, the above-mentioned factors are necessary to derive a satisfactory and accurate opinion regarding the identification of handwriting or signature.Keywords: Forensic sciences, handwriting, signature, Alzheimer’s Disease.

Medicolegal Evaluation of Elderly Trauma Patients

Objective: The human body loses flexibility and durability from the pathophysiological changes of aging; therefore, trauma and the risk of injury increase in geriatric individuals. Elderly patients who have been admitted to health centers with trauma and injury require a serious treatment approach.Materials and Methods: A total of 15851 victims who were admitted to Bursa Branch of the Council of Forensic Medicine of the Ministry of Justice between 01/01/2011 and 31/12/2011 were retrospectively evaluated, and 207 of them, who were trauma patients aged 65 years and over, were included in this study. All cases were evaluated according to the cause of the injury, localization of the trauma, bone fractures and type of medical treatment. Results: Two hundred nineteen of the total 15851 forensic patients were 65 years and older. Of these 219 cases, 207 (94.5%) had been exposed to trauma. Of these 207 cases, 138 (66.7%) were male, and 69 (33.3%) were female. The most common types of trauma were physical assault (n=136) and motor vehicle accidents (n=56), which occurred at rates of 65.7% and 27.1%, respectively. For the trauma victims, head injury was the most commonly affected body region. Ninety-seven patients were treated conservatively (46.9%), and 43 patients were treated surgically (20.8%). Traumatic bone injury (31%) was detected in 64 patients.Conclusion: The results of our study indicate that most of the geriatric victims were admitted to the medical centers with traumatic causes. Thus, it is necessary to increase our social sensitivity to trauma and the ways in can be prevented in the geriatric age group.Key words: Trauma; Geriatric; Forensic case; Injury.

Beden Çalışma Gücü Kaybı Değerlendirilen Olgularda Kurumlar Arası Karşılaştırma

Amaç: Türkiye'de hastalıkları nedeniyle emekli olmak isteyen, ilgili tüzük ve yönetmelik hükümlerince bu kapsamda değerlendirilen kişiler 'malulen emekli' olarak tanımlanmaktadır. Sigortalı (çalışan) hastalığı veya hastalıkları nedeniyle hayatım çalışarak idame ettiremeyeceğini yazılı olarak bildirdiğinde, emekli olma isteğine ait hukuki süreç başlamaktadır. Öncelikle Sosyal Güvenlik Kurumu, itiraz halinde Sosyal Sigorta Yüksek Sağlık Kurulu kişiler hakkında rapor düzenlemektedir. Davacı veya davalının oluşan kararlara itirazı sonrasında ise Adli Tıp Kurumu 3. Adli Tıp İhtisas Kurulu kişi hakkında mütalaa düzenlemektedir.Bu çalışma ile Adli Tıp Kurumu 3. Adli Tıp İhtisas Kurulu ve diğer kurumlar tarafından düzenlenen malulen emeklilik olgularındaki karar farklılıkların ortaya konulması ve tespit edilen bulgular eşliğinde uygulamada standardizasyon sağlanması amaçlanmaktadır.Gereç ve Yöntem: Çalışmamızda 1 Ocak 2009-31 Aralık 2010 tarihleri arasında, Adli Tıp Kurumu 3. Adli Tıp İhtisas Kurulu tarafından düzenlenmiş kararlar geriye dönük olarak incelenerek. Sosyal Güvenlik Kurumu-Sosyal Sigorta Yüksek Sağhk Kurulu tarafından malulen emeklilik kapsamında olmadığı bildirilen ancak kurul tarafından yapılan değerlendirmelerinde malulen emeklilik kapsamında olduğu tespit edilen olgular çalışmaya dahil edilmiştir.Bulgular: Bu vakaların yapılan ayrıntılı değerlendirmesinde; toplam 64 olgu tespit edilmiş, 57'sinin erkek, 7'sinin kadın olduğu tespit edilmiştir. Kadın olguların yaş ortalaması 50.71 olup erkek olguların yaş ortalaması 49.89 saptanmıştır. Tüm olguların yaş ortalaması 49.98 bulunmuştur.Sonuç: Kullandıkları tüzük ve yönetmelik aynı olmakla birlikte aym kişiler hakkında kurumlar arası karar farklılıkları oluşmaktadır. Tüzük ve yönetmelikler oluşturulurken uygulama prensipleri üzerinde tartışılarak alınacak ortak kararlar, farklılıkların azalmasını ve emeklilik taleplerinin daha hızlı sonuçlanmasını sağlayacaktır. Kurumlar arası ortak toplantılar düzenlenerek vakalar tartışılabilmeli, karşılıklı değerlendirmeler sunulabilmelidir.Anahtar Kelimeler: Beden Çalışma Gücü Kaybı, Kurumlar Arası Karşılaştırma, Adli Tıp.

Travma Sonrası Meydana Gelen Alt Ekstremite Amputasyonlarında Etiyoloji ve Maluliyet Değerlendirilmesi

Amaç: Beslenmesi bozulan doku veya uzvun kesilmesi işlemine amputasyon denilmektedir. Daha çok travmaların sonucu ve % 80-85 oranında alt ekstremitede meydana geldiği bilinmektedir. Bu çalışma ile maluliyet değerlendirmesi istemiyle mahkemeleri tarafından Adli Tıp Kurumu 3. Adli Tıp İhtisas Kurulu’na gönderilen dosyalardaki travma kaynaklı amputasyonların tespiti, etiyolojilerinin değerlendirilmesi, amputasyon seviyelerinin travma ile olan ilişkisi, amputasyona kolaylaştırıcı faktör bulunup bulunmadığı incelenerek, maluliyet değerlendirmesinin ve alınabilecek önlemlerin sunulması amaçlanmıştır.Gereç ve Yöntem: Adli Tıp Kurumu 3. Adli Tıp İhtisas Kuruluna 01 Ocak 2014- 31 Aralık 2014 tarihleri arasında maluliyet değerlendirilmesi amacıyla gönderilen ve dosya incelemesinde travma kaynaklı alt ekstremite amputasyonu geliştiği tespit edilen olgular retrospektif olarak değerlendirilmiştir.Bulgular: Belirtilen tarihlerde travma kaynaklı alt ekstremite amputasyonu gelişen 119 olgu tespit edilmiştir. Olguların 100’ünün erkek, 19’unun kadın olduğu görülmüştür. Amputasyonların etiyolojisi; en sık 60 olgu ile trafik kazası, 31 olgu ile iş kazası olduğu tespit edilmiştir. Amputasyon seviyelerine bakıldığında, en sık 32 olgu ile kruris proksimalinden, ikinci sıklıkta ise 21 olgu ile parmak seviyesinden olduğu görülmüştür.Sonuç: Gelişen amputasyonların, kişide protez ihtiyacını doğurması ve olayın niteliğine göre bireysel veya kurumsal tazminat hesabına konu olması önemlidir. Dava haline gelen olay sonrası, tespit edilen maluliyet değerleri üzerinden kişilere ödeme yapılmaktadır. Bu tür olguların önlenmesi, sağlığın korunması ve tazminat gibi maddi yüklerin azaltılması açısından değerlid ir.Anahtar Kelimeler: Travma, Maluliyet, Adli Tıp, Tazminat, Amputasyon, Kaza.

Immunohistochemical Determination of HIF, TSP-1, ADAMTS1, and ADAMTS8 Expressions in the Brains of Alzheimer’s Disease Patients: A Preliminary Autopsy Study

Objective: Alzheimer’s disease (AD) is a progressive neurodegenerative disease that mostly affects the elderly population. Recent studies performed in AD highlight the pathophysiological relevance of disintegrin and metalloproteinase with thrombospondin type 1like motifs (ADAMTS) genes and their products, namely hypoxia inducible factor-1 (HIF-1) and thrombospondin-1 (TSP1). Thus, the aim of this study was to describe and identify the distribution, characteristics, and any changes in the expression and immunoreactivity for HIF-1, TSP-1, and ADAMTS1 and 8 in AD brains. Materials and Methods: Nine patients who were autopsied in the Council of Forensic Medicine, Bursa Morgue Department in 2013, were selected. All patients were sent for autopsy to the Morgue Department within 8 h after death. At the autopsy, tissue samples of the organs were obtained for histopathological examination for determining the cause of death. Among these, two patients were clinically diagnosed with AD. Results: Immunohistochemical staining was performed, and the staining intensity/extensity was evaluated using a semiquantitative scoring system. Median distribution (extensity) scores of the immunohistochemical staining were estimated as 2 for HIF-1, 0.67 for TSP-1, 3.11 for ADAMTS1, and 2.78 for ADAMTS8. Intensity scores were estimated as 1.22 for HIF-1, 0.56 for TSP-1, 3 for ADAMTS1, and 2.11 for ADAMTS8. Conclusion: Our study suggests that ADAMTS1 and ADAMTS8 expressions are not specific for AD. To understand and provide definitive data on all aspects of metalloproteinases, extracellular matrix proteins, and transcriptional factor effects to AD, further studies are needed, where other metalloproteinases and related molecules/enzymes should be studied.

ADAMTS4, 5, 9, and 15 Expressions in the Autopsied Brain of Patients with Alzheimer's Disease: A Preliminary Immunohistochemistry Study

Objective: Recent studies performed in the central nervous system highlight the pathophysiological relevance of A disintegrin-like and metalloproteinase with thrombospondin motifs (ADAMTS) genes and their protein products. The determination of alterations in expression profiles of ADAMTS family genes in Alzheimer’s disease (AD) patients may contribute to the explanation of tissue pathology and also new ideas for remedial approaches for this incurable but preventable disease. Therefore, the goal of this study was to describe and identify the distribution, characteristics, and any changes in the expression, in other words, immunoreactivity, for aggrecanases (ADAMTS4, 5, 9, and 15) proteins in AD brain. Methods: Nine cases that were autopsied in the Council of Forensic Medicine, Bursa Morgue Department in 2013, were selected. All of the cases were sent for autopsy to the institution within 8 hours after death. At autopsy, tissue samples were obtained for histopathological examination of organs for determining the cause of death. Out of these, two cases were diagnosed with AD by neurologists when they were alive. Immunohistochemical staining was performed on the brain slides by using relevant primary and secondary antibodies against aggrecanase proteins. All images were acquired using a X200 objective of a microscope (Olympus BX53) and evaluated by the staining intensity using a semi-quantitative scoring system. Results: ADAMTS4 and 5 were slightly under-expressed in the brains from autopsied AD cases compared to those of control brains and suggested that extracellular matrix (ECM) degradation was not endorsed in AD brain. On the other hand, ADAMTS9 and 15 aggrecanases were not found to be expressed in correspondent brain sections of AD and control cases. Conclusion: The current study demonstrated that some aggrecanases were found to be under-expressed in AD brains. Additional studies in which all ADAMTS enzymes will be studied in terms of mRNA and protein levels are needed to understand the relative contributions of ADAMTS genes and proteins in AD brains.

Head Trauma-Related Deaths Among Preschool Children in Istanbul, Turkey.

Head trauma takes place among the leading causes of mortality in children. This study aimed to determine the risk factors of head trauma-related deaths among children younger than 5 years in Istanbul, Turkey. This study was conducted using the records of the Morgue Department of the Council of Forensic Medicine in Istanbul. The records of cases autopsied between 2008 and 2012 were retrospectively investigated. Of all preschool children deaths, 203 head trauma-related deaths were included in the study. Of all, 117 (57.6%) were males and 86 (42.4%) were females. Most cases (107, 52.70%) were between the ages of 12 and 36 months. The most common mechanism of injury was "fall from a height" with 97 cases (47.78%), followed by "traffic accidents" (67, 33%) and "hit by falling objects" (19, 9.35%). Skull fracture was detected in 176 cases (86.69%), of which 81 (46.02%) were characterized with linear fracture. Furthermore, skull fracture was accompanied by 1 or more skeletal bone fracture in 64 cases. Retinal hemorrhage was investigated in 5 cases of suspected physical abuse and only 2 of them showed retinal hemorrhage findings. Obtained findings revealed that fall from a height was the leading cause of death among unnatural deaths in children younger than 5 years. Domestic accident was found to be a significant risk factor in childhood deaths. Traffic fatalities were among leading causes of death in childhood in our country, likewise in all around the world. Children were found to be more vulnerable to traumas when they start to move around with incomplete motor skills. Therefore, education of parents in terms of child supervision and installing safety precautions toward preschool children will be helpful in preventing such injuries. On the contrary to some findings in the literature, more severe lesions were also prominent even in case of short-range falls from a height.

Parricide cases of adult offenders from Turkey: A descriptive study

The aim of this study was to examine and compare similarities and differences among types of parricide committed by adult offenders. The forensic psychiatric evaluation reports of the 4th Specialization Board of the Council of Forensic Medicine from 2009 to 2011 in Turkey were screened retrospectively. One hundred thirty-five adult perpetrators of parricide (125 male, 10 female) were detected, 51.9% of whom committed patricide, 40% of whom matricide and 8.1% of the perpetrators committed double parricide. Most of the perpetrators used sharp instruments as the killing method. No mental disorders were detected in 58.5% of the perpetrators, while psychotic disorders were identified in 30.4% of the cases. This study supported the predominance of sharp instruments as the killing method and a preponderance of matricide among the offenders with psychotic disorders. Although psychotic disorders were the most commonly detected mental disorders in the parricide offenders, most of them did not suffer from mental disorders.

Evaluation of Nursing Neediness Process as a Part of the Law on the Execution of Sentences and Security Measures in Terms of the Council of Forensic Medicine

Evaluation of Nursing Neediness Process as a Part of the Law on the Execution of Sentences and Security Measures in Terms of the Council of Forensic Medicine

The etiology and autopsy findings in Colchicine intoxication-related deaths

Colchicine is a drug which has a very narrow therapeutic range. This drug has been commonly used for Familial Mediterranean Fever (FMF), Behcet’s disease, gout arthritis and acute pseudo gout attacks. In this study, the investigation reports and autopsy reports written by the Council of Forensic Medicine of Ankara between the years 2010-2014 were retrospectively analyzed to find out presence in the cases related to colchicine. Six cases were identified as colchicine intoxication, while three of them used colchicine for medical purpose. In four cases, colchicine was found to have been used for suicidal purpose. Among these four cases, two used colchicine for treatment. In all of our cases, colchicine was detected in bile specimen. Alveolar pulmonary edema and petechial hemorrhage were observed in the lung in all cases. Colchicine was detected in blood in four of the cases. In two cases, the concentration was found to be in therapeutic ranges (0,012 mg/L and 0,018 mg/L), while the other two, in lethal levels (0.099 mg/L and 0,264 mg/L). The most frequent histopathological finding is alveolar pulmonary edema in colchicine intoxication autopsies. Colchicine is widely used alkaloid drugs with narrow therapeutic ranges. More than 0.8 mg / kg in the acute high dose has usually fatal effects. The deaths resulted from colchicine intoxication are mainly suicide-oriented. Similar to other suicides with medicines, they are common among women. In our cases, colchicine was used for intention of suicide in four incidents (66, 66%).

Lira ve Euro Kelimeleri ile Bunlara Ait Simgeler Arasindaki Benzerliğin Adli Belge İncelemesi Açısından Değerlendirilmesi

Amaç: Türkiye'de 1 Mart 2012 tarihinde kullanılmaya başlanan Türk Lirası simgesi olan ''₺'' nin Avrupa Birliği ortak para birimi olan Euro'nun simgesi olan ''€''ya benziyor olması ve ''Lira'' yazısı ile ''Euro'' yazısının da birbirlerine kolayca dönüştürülebilirliği adli belge inceleme uzmanları açısından önemli bir sorundur.
 Gereç ve Yöntem: Adli Tıp Kurumu Fizik İhtisas Dairesi Adli Belge İnceleme Şubesi, yıllık ortalama 10.000 dosya ile Türkiye'de en fazla adli belge incelemesi yapan kurumlardan biridir. Adli Belge İnceleme Şubesi'nde yukarıda bahsedilen şekilde bir sahteciliğe bugüne kadar rastlanmamış olmakla birlikte ileride böyle bir sahteciliğin oluşması kuvvetle muhtemel öngörüldüğü için sanal olarak oluşturulan örnekler ile konuya dikkat çekilmesi amaçlanmıştır. 
 Bulgular ve sonuç: Sanal olarak oluşturulan çek ve senet örneklerinde ''Euro'' ve ''Lira'' kelimeleri ile ''₺'' ve ''€'' simgelerine yapılan eklemeler veya silintiler ile bu kelime ve simgeler birbirlerine kolaylıkla dönüştürülmüştür. VSC 6000 HS'de değişik dalga boylarında infrared ışık altında sened'in sahtecilik yapılmadan önceki ilk hali ortaya çıkarılmıştır. ''Euro'' ve ''Lira'' kelimeleri ile bunlara ait simgelerinin birbirilerine dönüştürülebilme kolaylığı çek, senet vb. belgelerde miktar bölümlerindeki rakam ve yazılara müdahale etmeden para birimini değiştirmek suretiyle tahrifat yapılma olasılığını artıracağını düşünmekteyiz.

Application of a validated LC–MS/MS method for JWH-073 and its metabolites in blood and urine in real forensic cases

Synthetic cannabinoids, which were synthesized to improve the therapeutic effects of cannabis, have become a major issue when they are abused. They have different chemical structures from tetrahydrocannabinol (THC) but similar effects on endocannabinoid receptors. “Spice” named products have more serious side effects than cannabis and can even cause death. These mixtures are prepared by spraying chemicals onto small pieces of herbs and are being dishonestly sold as “natural” and “legal” products over the internet. Their popularity is continuously increasing. Studies on detecting synthetic cannabinoids in biological samples as well as pharmacology and toxicology studies of these chemicals are very limited.A fast, specific and robust method for the detection and quantification of JWH-073, JWH-073 N-butanoic acid, and JWH-073 N-(4-hydroxybutyl) in blood and urine has been developed that uses solid-phase extraction (SPE) followed by UPLC–MS/MS analysis. This method has been validated in terms of its linearity (0.1–50ng/mL), selectivity, intra-assay and inter-assay accuracy and precision (CV<10%), recovery (75-95%), limits of detection (LODs) (0.08-0.13ng/mL), and limits of quantification (LOQs) (0.11-0.17ng/mL). Matrix effects, stability, and process efficiency parameters of this method have also been assessed. This method was applied to 2596 authentic samples received by the Department of Toxicology (Istanbul) in the Presidency of Council of Forensic Medicine (Turkey) between September 1, 2012, and February 28, 2015.

Fatal poisoning of chilhood in the Eastern Black Sea region of Turkey (2009–2013)

Poisoning is a major problem worldwide among children. Nonetheless, the offending agent, the associated morbidity and mortality vary from place to place and show changes over a period of time. The aim of this study was to investigate the medico-legal paediatric autopsies of childhood poisonings in the Eastern Black Sea Region of Turkey. Reports of autopsies performed between 2009 and 2013 in the Morgue Department of the Council of Forensic Medicine. All medico-legal paediatric autopsies in Trabzon (n:1049) were retrospectively examined. The study comprised an investigation into 62 deaths from poisoning in children aged 0–18 years. The parameters of age, sex, toxic substance category and origin were evaluated. Poisoning accounted for 5.9% of the deaths of children aged 0–18 years. Of the 62 cases, 32 (51.6%) were male and 30 (48.4%) were female, giving a female to male ratio of 1/1.1. The primary causes of fatal poisoning in children were carbon monoxide (64.5%, n = 40), followed by drugs (16.1%, n = 10), insecticides (9.7%, n = 6), mushrooms (6.5%, n = 4), and snake venom (3.2%, n = 2). The results of this study implicated carbon monoxide poisoning as a serious risk factor for mortality in our region. Childhood poisoning may be prevented by public education and simple precautions in general.

Visualizing biliary tracts with isosulphan blue to prevent injury during laparoscopic cholecystectomy: a preliminary cadaveric study.

Bile duct injury (BDI) as a complication of laparoscopic cholecystectomy may result in biliary cirrhosis with a high morbidity-mortality rate. Recurrent invasive procedures may be required for the optimum management. The most frequent causative factor in BDI is anatomical misidentification, particularly by inexperienced surgeons. Direct coloration of the cystic duct, bile duct, and gallbladder may decrease biliary tract injury. This study was conducted during 10 standard, fresh cadaver autopsies at the Council of Forensic Medicine, Istanbul. Following needle puncture of the gallbladder fundus and aspiration of the bile content, identical quantities of isosulphan blue were injected into the gallbladder to visualize the biliary tract. Of the ten fresh cadavers, three were males and seven were females; the mean age at death was 43 years (range 22-76 years). Successful visualization of the colored biliary tract, encompassing the gallbladder, cystic duct, and bile duct, was achieved in all of the cadavers. Visualization of the biliary tract may reduce the risk associated with dissection of Calot's triangle. Surgical BDI risk following anatomical misidentification could be reduced by intraoperative injection of isosulphan blue; further studies are required to validate the clinical utility of this technique.

The transrectal single port laparoscopic radical prostatectomy in a cadaver model.

To explore the feasibility of laparoscopic trans-rectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) radical prostatectomy in a cadaveric model and to define anatomical landmarks of this surgical route. After the ethical clearance, the study was conducted in Turkish Council of Forensic Medicine. With the cadaver in an exaggerated lithotomy position, a full thickness incision was made on the anterior wall of the rectum. The anteriorly visible Denonvilliers' fascia was incised sharply, exposing the posterior surface of the prostate. A single-port device (GelPOINT(®)Path) was inserted transanally passing the incision on the anterior wall of the rectum, into the bluntly created space between rectum and prostate. Three, 10 mm ports were placed through the GelPOINT(®)Path, at 3, 6, and 9 o'clock positions. A 5 mm, 0° degree lens was introduced at 6 o'clock position; followed by laparoscopic scissors and laparoscopic grasper. Prostatic and periprostatic anatomy was defined as encountered during each step of the procedure. Exposure of the posterior surface of the prostate and seminal vesicles was easily achieved. No additional openings of the rectal wall were made. Surgical specimen was extracted keeping its integrity. Transrectal radical prostatectomy is technically feasible in the cadaver model, being facilitated by previous experience with perineal surgery. Anatomical observations during the present experimental study suggest that the transrectal NOTES route provides good exposure of the operative field and easy access to the posterior surface of prostate, Future experimental endeavors should focus on reproducibility of this approach and feasibility of lymph node dissection using trans-rectal route.