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The number of cases with spontaneous coronary artery dissection (SCAD) is considered to be being underestimated because of a large amount of SCAD leading to sudden death without previous diagnosis. Besides, not only in clinics but also in autopsy practice, correct diagnosis of SCAD is important to prevent forensic malpractice. The article is intended to discuss the pathological findings through the forensic point of view for improving the malpractice expertise in scope of clinicians- timely antemortem diagnosis according to risk factors and in scope of forensic pathologists- the cause of death determination ability according to macroscopical and microscopical findings of the autopsy. In 3 cases reported, the main characteristics were the female sex, pregnancy history and a sudden death without any trauma. However, although there are many women giving birth or using oral contraceptives, only some of them are facing with SCAD. This suggests the possibility of some hereditary factors, whereas hereditary characteristics may be understood in many different ways like hormone-releasing regulating mechanisms as well as immunity, morphology, or any other mechanism. For instance, autoimmunity has been also a hereditary underlying factor for vessel injury considered in presented cases.

AMAÇ: Bu çalışmada demiryolu ile ilişkili ölümlerde saptanan travmatik değişimlerin ağırlığı ile olayın orijini arasındaki ilişkinin değerlendirilerek demiryollarında meydana gelen ölümlere ait verilerin tartışılması amaçlanmıştır. YÖNTEMLER: Demiryollarında intihar ve kaza orijinli ağır travma kaynaklı ölümlere adli otopsi serilerinde sık olmasa da rastlanmaktadır. İstanbulda 2005-2011 yılları arasında yapılan adli otopsilerde saptanan 114 demiryolu ölümü retrospektif olarak incelenmiştir. BULGULAR: Olgular toplam otopsilerin % 0.39unu oluşturmakta olup, olguların %85,1i (n=97) erkek, %14,9u (n=17) kadındır. Ortalama yaşın 38,32±19,35 yıl olduğu bu ölümlerde en sık orijin kaza (% 80.7) olarak belirlenmiştir. Kaza orijinini % 10.5 ile intihar orijini izlemektedir. Elektrik akımı kaynaklı 2 olgu dışında diğer tüm olgularda ağır genel beden travması bulguları saptanmış olup, olguların %6,1inde (n=7) izole üst, %11,4ünde (n=13) izole alt, %5,3ünde (n=6) kombine ampütasyon ve %5,4ünde (n=5) ise dekapitasyon gözlenmiştir. Olguların %51,8inde büyük damar yaralanması saptanmıştır. SONUÇ: Travmatik bulguların dağılımı ile olayın niteliği arasındaki ilişki değerlendirildiğinde; trenden düşme sonucu meydana gelen ölümlerde beyin kanaması sıklığı önde gelen bulgu iken, intihar olgularında vücudun gövde kısmında ağır genel beden travması bulguları daha fazla görülmüştür OBJECTIVE: In this study aiming to discuss the data of deaths occurring on the railways by evaluating the relationship between the severities of the traumatic changes and to determine the origin of the event according to the findings of trauma. METHODS: Suicidal or accidental origin deaths on the railways caused by severe trauma are encountered in the forensic autopsy series even though they are not frequent. 114 railway deaths detected in the forensic autopsies performed in Istanbul between 2005 and 2011 were investigated retrospectively. RESULTS: The cases comprised 0,39% of all autopsies, 85,1% (n=97) of the cases were males and 14,9% (n=17) of them were females. The mean age was 38,32±19,35 years in these deaths and the most common origin was determined to be accident (80,7%). The accidental origin is followed by suicidal origin with a rate of 10,5%. Multiple traumas to the body were determined in all of the cases except 2 cases with electrical current origin. Isolated amputation of upper extremity, isolated amputation of lower extremity, combined amputation and decapitation were observed in 6,1% (n=7), 11,4% (n=13), 5,3% (n=6) and 5,4% (n=5) of the cases, respectively. Great vessel injury was determined in 51,8% of the cases. CONCLUSION: When the relationship between the distribution of traumatic findings and the nature of the event was evaluated; while cerebral bleeding was the leading finding in the deaths due to fall from train, findings of multiple trauma to the body were observed much more in the suicide cases.