Search

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.

Bir kadının, gebelik sürecinde veya gebeliğinin sonlanmasından sonraki 42 gün içerisinde, gebeliğin süresi ve lokalizasyonu ne olursa olsun, gebelik sürecine bağlı ya da gebeliğin ağırlaştırdığı nedenlerle, ancak kaza veya zorlamalı bir olay ile ilişkili olmayan şekilde ölümü Dünya Sağlık Örgütü tarafından anne ölümü olarak tanımlanmaktadır. Çalışmamızda otopsi pratiğinde emboli tanısı için yapılması gerekenlerin literatür verileri eşliğinde tartışılması amaçlanmıştır. Olgunun 38 yaşında, G5 P4 olduğu ve sezaryen sonrası 24 saat içerisinde takipleri sırasında solunum sıkıntısı oluşarak, öldüğü bildirilmiştir. Yapılan otopsisinde vücut kütle indeksi 32,8 kg/m2 (obez) olarak hesaplanmış, her iki akciğerde pulmoner arterlerde trombüs tespit edilmiştir. Trombüs histopatolojik incelenmeyle de doğrulanmıştır. Sezaryen sonrası meydana gelebilecek olan pulmoner tromboemboli tanısı alan anne ölümlerinde tıbbi hikayenin irdelenmesi ve detaylı bir otopsiden elde edilen veriler, ölüm sebebinin belirlenmesi ve ileride olabilecek tıbbi uygulama hatası iddialarında hak kaybı olmasını önlemek için büyük öneme sahiptir The death of a female during pregnancy period, independent from the gestational age and localization or in a 42 day period after the end of pregnancy due to pregnancy related reasons or reasons aggravated by the pregnancy, but containing no relation with accidental or forced incidents, is defined as maternal death by the World Health Organization. Discussion of the requirements for an emboli diagnosis in an autopsy practice through literature data is aimed in our study. It has been reported that the case was 38 years old, G5 P4 and died with a respiratory distress occurred during the follow ups in 24 hours after the caesarean section. In autopsy, the body mass index was calculated as 32.8 kg/m2 (obese) and thrombus was detected in pulmonary arteries of both lungs. Thrombus was confirmed also through histopathological analysis. Evaluation of the medical history and data obtained from a detailed autopsy are of great importance for maternal deathswhich may occur after a caesarean section and involve a pulmonary thromboembolism diagnosis in order to determine the cause of death and prevent a loss of right in medical malpractice claims.

Background: Malpractice in medicine refers to the failure of a physician to meet a standard of diagnosis and treatment, damages/injuries caused by reprehensible ignorance, or negligence of a doctor. Methods: Allegedly malpractice cases of pediatricians and the cases in which causal link between malpractice and death was confirmed by the decision of the First Board of Specialization of the Council of Forensic Medicine between the dates of Januray 1, 2012 and December 31, 2014 were analyzed retrospectively. Results: The study revealed that in the majority of 286 cases, the infants were 0-28 days old (n = 115; 40.2%) and were hospitalized due to respiratory problems (n = 111; 38.8%). The allegations of malpractice cases were most frequently seen in private hospitals (n = 120; 42%). Malpractice was found in 17.5% of the cases (n = 50), in which the majority of cased were proved to be diagnostic errors (n = 24; 48%). The most common diagnostic error was the misdiagnosis of “healthy child” in medical malpractice cases (n = 11, 22%). Conclusions: In conclusion, it is considered to be important for the pediatricians to maintain proper communication with the relatives of the patients while monitoring their health condition, and pediatricians are expected to be more careful—especially in the diagnostic phase—in the cases involving 0-1 age group as children are most likely to be diagnosed as healthy in this age group.

This study was implemented to assess the opinions of forensic science experts and techni cians of The Ministry of Justice Council of Forensic Medicine on global pandemic management strategies including new technologies and future scenarios through SARSCov2 pandemic. This prospective and descriptive research was carried out with a questionnair e that was asked to 244 personnel (forensic medicine specialist, forensic medicine resident, technician, other specialist from a different field, other specialist phsician) working at The Ministry of Justice Council of Forensic Medicine. The 40question su rvey included questions about participants’ level of knowledge perception about the pandemic and attitudes on measurestheir adequacynecessity, technological applications and the future of global management strategies. 93.8% (n=229) of the participants th ought they had knowledge about the pandemic and its transmission routes, 54.1% (n=132) found the applied pandemic management strategies effective and correct, and 76.6% (n =187) stated that it is necessary to use technological infrastructures in future sce narios. As a result, through hundreds of descriptive statictics results in 80 tables classified according to education level, occupation type and occupational experience level, in general, despite the changes in group tendencies according to different fact ors, the majority of participants were found to be obeying the routine necessities of the pandemic, hesitating on the global strategies, feeling closer to habitual technologies, feeling far to technologies which have never experienced before in daily life, giving answers with a high ratio of \"no opinion\" due to feeling obliged to give decisions gropely among unproven propabibilities or due to their hesitation on sharing their opinion even if they had an opinion. Moreover according to results, it was interpr eted that social engineering could easily be performed in any spesifically designed group.

Traumatic asphyxia is a rare clinical syndrome usually caused by sudden and severe thoracic and/or thoracoabdominal compression. It presents with craniofacial cyanosis, petechiae, and subconjunctival haemorrhages. The present study employed a postmortem retrospective methodology to analyse autopsy findings and accompanying injuries in cases of death due to traumatic asphyxia. Four years of case files from a morgue department at a forensic medicine institute were searched and 53 cases of lethal traumatic asphyxia were found. These cases were then classified into groups and compared using the Injury Severity Score (ISS) and New Injury Severity Score (NISS) indices to measure trauma. Results The individuals had died due to occupational (n = 28; 52.8%), farm (n = 10; 18.9%), traffic (n = 9; 17.0%) or household (n = 6; 11.3%) accidents. At the external examination, conjunctival petechiae (60.4%) and petechiae on the face/neck (52.8%); at the autopsy, subpleural petechiae (58.5%) and petrous ridge hemorrgahe (without skull base fracture) (56.6%) were the most common findings. A finding of petrous ridge hemorrgahe was very common in the cases without any accompanying injuries (Group A in which mean Injury Severity Score was 0.83 ± 0.98). Traumatic asphyxia is usually suspected from the given circumstances before an autosopy is performed. In cases without hospitalisation, any of the following signs may lead the physician to diagnose traumatic asphyxia as the cause of death: petechiae on the upper parts of the body and conjunctiva, petechiae on serous membranes (including subpleural regions), signs of petrous ridge haemorrhage without skull base fracture.

Death resulting from burns is an important social problem and a frequent accident. However, because approximately 10% of cases are estimated to result from a fire that was deliberately started, all fire-related deaths should be treated as suspicious, and the cause of a fire should be investigated. For the bodies recovered from the scene of a fire, the manner of death could also be suicide or homicide. The objective of this study was to contribute to the clarification of controversial data present in the literature on the manner of death determination of fire-related deaths, through evaluation of autopsy findings of bodies recovered from fires. We reviewed 20,135 autopsies performed in a 5-year period, in Istanbul, as the whole autopsy data of the city and found 133 fire-related deaths. The death scene investigation reports and other judicial documents, autopsy findings, and toxicological analysis results were evaluated to determine the parameters of age, sex, level of the burn, vital signs [red flare; soot in the lower respiratory tract, esophagus, and/or stomach; and screening of carboxyhemoglobin (COHb) levels in the blood], toxicological substances, presence of accelerants, cause of death, and manner of death. The manner of death was determined to be an accident in 98 (73.7%) and homicide in 12 (9%) cases, whereas there was no suicide. In addition, it could not be determined in 23 (17.2%) cases. In accidental deaths, the most frequent cause of death was COHb poisoning with statistically significant blood COHb levels greater than 10%. Further, the presence of soot in the lower respiratory tract, esophagus, and/or stomach and the existence of at least 1 or 2 vital signs together were found to be valid deterministic criteria with statistical significance in terms of identifying the manner of death.

Eosinophilic myocarditis is a rare cause of sudden unexpected death and characterized by eosinophilic infiltration in the myocardium. Clozapine is among the agents that can cause eosinophilic myocarditis. Our case is a 48 year-old female patient who was hospitalized in psychiatry inpatient unit and died unexpectedly on the 35th day of her hospitalization while on clozapine treatment. Even though the autopsy revealed an increased heart weight, fatty streaks on aorta, and thickening of epicardial fat tissue macroscopically, no pathological macroscopic features were noted in the myocardial cross sections. Eosinophilic myocarditis findings were found in the histopathological evaluation. Toxicological assessment revealed presence of clozapine in the blood (735ng/ml clozapine and its metabolite) and the bile. In the lights of these findings, it was concluded that the patient died from clozapine-induced eosinophilic hypersensitivity myocarditis. Drug-induced eosinophilic hypersensitivity myocarditis should be considered in the sudden death cases with a history of clozapine use and/or in presence of clozapine in the toxicological analysis.

WOS:000374547600001 PubMed: 27107719 Background: Female suicide is an important problem not only for women but for public health in general. Methods: Autopsy reports from the Van Chief Public Prosecutor's Office from 2005 to 2011 were reviewed retrospectively in order to analyse female deaths from suicide. Results: Sixty-six female suicide cases were recorded during 2005-2011. The mean age of the cases was 22.64 (sd = 10.09) years, and nine were below the age of 15. The most common method of suicide was hanging (44 cases, 66.7 %). Five (7.6 %) of the cases were under treatment for depression, and 12 (18.2 %) cases had a previous suicide attempt. Conclusions: Cultural suppression of females and prevention of their socialization in enclave societies are risk factors for female suicides. The number of female suicide attempts, especially recurring attempts, should be reduced via psychiatric scanning, follow-up sessions and therapy for high-risk individuals.

Introduction Sudden unexpected deaths comprise the most important and worthy investigation case profiles in both neurology and forensic medicine. Epilepsy, which is one of the neuropathological causes of sudden unexpected deaths, is an important disorder having mysterious aspects. The aim of this study is to make common the points of view between neurology and forensic medicine experts and to discuss the features of the findings together with the related clinical hypotheses, leading to the differential diagnosis of sudden unexpected death in epilepsy (SUDEP) by presenting autopsy findings and available medical data of patients who had a prior diagnosis of epilepsy. Methods In Istanbul, the cases of 20334 autopsied patients who were referred to The Ministry of Justice Council of Forensic Medicine between 2007 and 2011 were identified from the complete forensic autopsy data of the city and were retrospectively reviewed. Patients who had a prior diagnosis of epilepsy were included. Both descriptive and inferential statistical analyses were performed through the parameters of demographical data, physical properties, incident features, macroscopic-microscopic autopsy findings, and cause of death initially for all cases and then separately for SUDEP cases. Results Among the 20334 patients, 112 were determined to have a prior diagnosis of epilepsy. A possible macroscopic and/or microscopic epileptic focus was present in 23 (20.5%) of these 112 cases. The cause of death was determined to be SUDEP in 40 (35.7%) cases, while it could not be determined in 28 (25%) cases. Among patients whose death cause was considered as SUDEP, the male-to-female ratio was 1.1:1, while the mean age was 31.5±13.9 years in males and 29.6±12.9 years in females. The presence of hypertrophy and myocardial scar tissue findings in the microscopic examination were significantly more frequent among patients determined to have died from cardiovascular diseases compared to patients in the SUDEP group (p=0.001 for each finding). Besides, in 40 SUDEP cases, 38 (95%) patients underwent toxicological analysis and no antiepileptic agent was detected in 21 (55.3%) of these. Conclusion It can be concluded that there is equality in gender distribution among SUDEP patients, that the young adult population has a slightly increased risk for SUDEP, and that the inconsistent use of antiepileptic medicines is a greater risk factor for SUDEP than polytherapy. Besides, it is important to emphasize that all clinical and postmortem parameters together should be considered for the differential diagnosis of SUDEP, particularly with cardiovascular diseases.

Signature is a handwriting type which reflects the personal characteristics and which is legally accepted to be exclusive. Various methods can be used for signature forgery and copying through carbon paper use is one of these methods. In this study, to show ‘overlapping’ with the method of superimposition of the signatures in computer media through analyzing the case of a signature forgery which includes the method of copying through carbon paper use and to discuss the role of computer technologies together with the differential diagnosis of ‘overlapping’ in document examination have been aimed. With regards to contemporary document examination expertise, besides personal experience, also computer technologies are becoming important in the analysis. In the evaluation of forgery components between two signatures or signature groups being identical to a degree which seems to be impossible in the nature of things (overlapping), this case and the way of its analysis is found to be worth being scientifically shared in order to show that not only expensive computer programs but also free, open source softwares can be used for carrying out superimposition method in a way possible to present through linear mathematics data instead of only personal observation results.Keywords: Document examination, Signature examination; Computer technology, Superimposition, Overlapping.

The death of a female during pregnancy period, independent from the gestational age and localization or in a 42 day period after the end of pregnancy due to pregnancy related reasons or reasons aggravated by the pregnancy, but containing no relation with accidental or forced incidents, is defined as maternal death by the World Health Organization. Discussion of the requirements for an emboli diagnosis in an autopsy practice through literature data is aimed in our study. It has been reported that the case was 38 years old, G5 P4 and died with a respiratory distress occurred during the follow ups in 24 hours after the caesarean section. In autopsy, the body mass index was calculated as 32.8 kg/m2 (obese) and thrombus was detected in pulmonary arteries of both lungs. Thrombus was confirmed also through histopathological analysis. Evaluation of the medical history and data obtained from a detailed autopsy are of great importance for maternal deathswhich may occur after a caesarean section and involve a pulmonary thromboembolism diagnosis in order to determine the cause of death and prevent a loss of right in medical malpractice claims., Bir kadının, gebelik sürecinde veya gebeliğinin sonlanmasından sonraki 42 gün içerisinde, gebeliğin süresi ve lokalizasyonu ne olursa olsun, gebelik sürecine bağlı ya da gebeliğin ağırlaştırdığı nedenlerle, ancak kaza veya zorlamalı bir olay ile ilişkili olmayan şekilde ölümü Dünya Sağlık Örgütü tarafından anne ölümü olarak tanımlanmaktadır. Çalışmamızda otopsi pratiğinde emboli tanısı için yapılması gerekenlerin literatür verileri eşliğinde tartışılması amaçlanmıştır. Olgunun 38 yaşında, G5 P4 olduğu ve sezaryen sonrası 24 saat içerisinde takipleri sırasında solunum sıkıntısı oluşarak, öldüğü bildirilmiştir. Yapılan otopsisinde vücut kütle indeksi 32,8 kg/m2 (obez) olarak hesaplanmış, her iki akciğerde pulmoner arterlerde trombüs tespit edilmiştir. Trombüs histopatolojik incelenmeyle de doğrulanmıştır. Sezaryen sonrası meydana gelebilecek olan pulmoner tromboemboli tanısı alan anne ölümlerinde tıbbi hikayenin irdelenmesi ve detaylı bir otopsiden elde edilen veriler, ölüm sebebinin belirlenmesi ve ileride olabilecek tıbbi uygulama hatası iddialarında hak kaybı olmasını önlemek için büyük öneme sahiptir.

169 Received August 13, 2012; accepted September 13, 2012. Published online October 2, 2012; doi: 10.1620/tjem.228.169. Correspondence: Nergis Canturk, Department of Criminalistics, Institute of Forensic Sciences, Ankara University, Ankara, Turkey. e-mail: nergiscanturk@yahoo.com *A part of the data (5 death cases) was presented as a poster presentation in the 22nd International Academy of Legal Medicine Congress held between the dates July 5-8, 2012. Letter to the Editor

Homicide-suicide is a tragic phenomenon which typically does not result in a criminal charge or trial. However, correct diagnosis and classification of homicide-suicide cases are important to determine the perpetrators and dynamics of each category properly. The deaths in the homicide-suicide acts can be divided into two categories with respect to the number of involved individuals: dyadic deaths and triple or multiple deaths. These two categories can also be divided into two subgroups according to the chronology of the incidents: simultaneous deaths and consecutive deaths. Herein, a simultaneous homicide-suicide case of a father and daughter where both deaths occurred through drowning which was not found in the selected literature review and where the victim was a child is presented. The article aims to clarify the term discrepancies about multiple death cases in the literature and to discuss the pathological and psychosocial characteristics of the simultaneous dyadic death cases. Language: en

Organ transplantation is one of the most important services of modern medicine to the humanity. In judicial death cases the interaction between judicial needs and transplantation needs is inevitable and both should be provided in a short time before the decomposition of the body. Thus, the description of this interaction and the algorithm which should be carried out to manage these cases are important. Aim of this study is to determine the problems confronted in forensic autopsies and to determine what to do for both judicial processes' and cadaveric organ donations' not becoming limited due to each other. With these aims, autopsy case archive of the Council of Forensic Medicine Istanbul Morgue Department was reviewed, between the years 2009 and 2011, to reveal the number of organ donors among autopsy cases and also to find out the judicial problems confronted during autopsies. Among 12,016 judicial death cases referred to Istanbul Morgue Department in 3 years, 35 cases were found to have undergone cadaveric solid organ harvesting procedure and 307 cases cornea-only harvesting procedure. Manner of deaths for organ donor cases were blunt trauma due to traffic accident in 20 cases, firearm injury in 3 cases, stabbing in 2 cases, suspicious criminal battery in 4 cases and fatal falls in 5 cases. Only 1 case was suspected to have died due to high dose insulin administration. Through the whole data presented in this study, it can be concluded that consulting with the Forensic Medicine Expert not only for the autopsies but also during the clinical process of a judicial case, who is a candidate to be an organ donor, is absolutely important. The early contribution of the Forensic Medicine Expert would provide help to plan both the judicial process and the transplantation process which needs urgent decisions. A Forensic Medicine Expert may be an organ harvest team member performing initial investigations on the cause of death and collecting some of the toxicological screening samples when needed.

Introduction: An earthquake occurred on October 23, 2011 at 13:41 in the Van city of Turkey. According to the Kandilli Observatory and Earthquake Research Institute, the magnitude of this earthquake was measured as 7.2 on the Richter scale. The earthquake caused deaths and injuries due to entrapment under the debris. This study has been planned in order to evaluate the features of these deaths and to discuss the obtained data comparatively with the literature. Materials and methods: External examination of the corpses and autopsy reports drawn up for Van Attorney Generalship in the city center were evaluated retrospectively. Results: Totally 51 deaths secondary to the entrapment under the debris were analyzed. Twenty-seven cases (52.9%) were females and 24 cases (47.1%) were males. All the deaths occurred in houses or workplaces. The causes of deaths were as follows: head trauma together with visceral organ laceration in 30 cases (58.8%), mechanic asphyxia in 14 cases (27.5%) and the crush syndrome in seven cases (13.7%). Deaths due to the crush syndrome occurred after victims' were rescued alive after having been under the debris. Conclusion: Traumatic findings are usually generalized and extensive in deaths related with earthquakes. Multiple fractures of cranial bones, ribs, extremities and injuries of visceral organs and major vessels are determined in the external examination. On the other hand, forensic pathologists should not disregard the diagnosis of the crush syndrome in traumatic deaths, especially if the trauma is secondary to the entrapment under the debris following an earthquake. © 2013 Production and hosting by Elsevier B.V.