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PubMed2005

Fulminant hepatic failure following halothane anaesthesia.

The forensic pathologist is responsible for determining the cause, manner and approximate time of death and injury. After recording the detailed description of the external and internal appearances, a short summary should be offered of the major positive findings and their relationship to the cause of death. In many cases this will be obvious, however when the findings are less clear-cut, or are multiple, then the alternatives should be discussed detailing the possible sequence of events and interpreting the findings in concluding the cause of death. It is essential to causally connect the autopsy findings to the cause of death. We present a case report wherein a person who sustained avulsion injury to his left hand in an industrial accident, died due to, fulminant hepatitis, hepatic encephalopathy and acute renal failure, having undergone six operations under general anesthesia with halothane during his stay in the hospital.

Acute Kidney Injury↗
PubMed2005

Cerebrospinal fluid: postmortem biochemical study.

UNLABELLED: Postmortem phenomena can change and alter biochemical components in body fluids such as blood and as cerebrospinal fluid (CSF). AIMS OF THE STUDY WERE: (a) to analyse urea, glucose, potassium, chloride, protein, creatinine, calcium, alkaline phosphatase and cortisol in CSF fluid and (b) to compare results between two age groups, between groups with or without mental or degenerative neurological illness and between a group reported as dying from natural causes and a group that had a violent death. MATERIALS AND METHODS: The study was carried out in Hospitalet de Llobregat (Barcelona) of 55 corpses. Samples were obtained following section of the corpus callosus, through the lateral ventricles and frozen to -80 degrees C until processed. RESULTS: Significant differences were found in urea levels between the two age groups, in protein between natural and violent death groups and in alkaline phosphatase between the two age groups and between the natural and violent death group. Cortisol levels revealed significant difference between the two age groups and is those supplying natural and violent death. CONCLUSIONS: The study indicates to the need for further studies designed to include groups with defined diagnose of mental or degenerative disorders as well as different age groups.

Age Factors↗
PubMed2005

A study of the in vitro interaction between ethanol, and triazolam and its two metabolites using human liver microsomes.

AIM: Triazolam is widely used as an ultrashort-acting anxiolytic drug and hypnosedatives and its effect appears at very low doses. Ethanol is used as a social drug worldwide. Sometimes, toxic interactions occur following combined administration of these two drugs. In this study, we have investigated the interaction between alcohol and triazolam in vitro. METHODS: The interaction effects between alcohol and triazolam were examined by a mixed-function oxidation reaction using a human liver microsomal preparation. Triazolam and its two metabolites (alpha-hydroxytriazolam: alpha-OH triazolam, 4-hydroxytriazolam: 4-OH triazolam) were measured by HPLC/UV. RESULTS: The production of alpha-OH triazolam and 4-OH triazolam was shown to be weakly inhibited by 13-29% (p < 0.05) and 8-14%,respectively, by ethanol (20-80 mM). CONCLUSIONS: These results using a human liver microsomal preparation show that the formation of both metabolites of triazolam is weakly inhibited by ethanol. Toxic levels may be reached by simultaneous administration of ethanol and triazolam.

Anti-Anxiety Agents↗
PubMed2005

Estimation of early postmortem intervals by a multiple regression analysis using rectal temperature and non-temperature based postmortem changes.

Five general methods based on rectal temperature and a multiple regression analysis using rectal temperature and non-temperature based postmortem changes were applied to 212 postmortem cases of within 24h postmortem (PM) intervals. Non-temperature based postmortem changes of rigidity, hypostasis and corneal turbidity were numerically categorized and used with rectal temperatures as four statistical variables in the multiple regression analysis. The correlation coefficient values between true and calculated postmortem intervals were 0.78-0.82 in the five general methods based on rectal temperature. The multiple regression analysis produced a multiple correlation coefficient value of 0.89 and according to the error ranges of the PM intervals, 72% of the cases were estimated within the error of +/-1.0 h and 92% within +/-5.0 h. Although assessments of non-temperature based PM changes are mostly subjective and have a wide variation, the present study demonstrated a usefulness of non-temperature based PM changes in the estimation of PM intervals.

Adolescent↗
PubMed2005

Sudden death with clinically undiagnosed pulmonary hypertension.

Four cases of sudden unexpected death associated with pulmonary hypertension are described. In all cases, the presence of pulmonary hypertension had not been clinically detected. In each case, the underlying etiology of the pulmonary hypertension was different with one case each of occult adult congenital heart disease, pulmonary sarcoidosis, pulmonary tumour microembolism from gastric adenocarcinoma, and familial primary pulmonary hypertension. These cases indicate that the forensic pathologist must be aware of occult pulmonary hypertension as a cause of sudden unexpected death in a variety of age groups.

Adenocarcinoma↗
PubMed2005

Paternal and sibling incest: a case report.

A case is reported of a female victim of paternal incest, who had also been raped repeatedly by her elder brother for two years. A survey of the literature showed no other report of such a case from Turkey. This does not necessarily mean that the incidence of paternal and sibling incest does not happen, but may indicate that incestuous abuse is not reported or handled without making it known to legal authorities. The victim was first raped by her 16 year-old brother when she was 9 years old. He raped her repeatedly over a period of two years, until he left home. Her father began raping the victim when she was 13 year-old, leaving her pregnant at age 15. He took her to a doctor for a termination of pregnancy. The father continued abuse after the termination. The victim left home to marry a man. The father filed a lawsuit against the man for taking the victim away from home. More openness and awareness of incest in Turkey may encourage the victims to seek help from medical and legal authorities.

Adolescent↗
PubMed2005

The brassiere 'sign' - a distinctive marker in crush asphyxia.

The diagnosis of crush asphyxia typically relies on a history of chest or abdominal compression with the finding of skin petechiae and congestion. The following three cases of crush asphyxia demonstrate a distinctive pattern of petechiae and congestion associated with close-fitting clothing: Case 1, a 49-year-old woman who was crushed under a large hay bale; Case 2, a 35-year-old woman who was crushed between a wall and a car; Case 3, a 49-year-old woman who was crushed between a crane and the side of a truck. At autopsy in all three cases there were facial, conjunctival, neck and upper anterior chest petechiae. However, few or no petechiae, and reduced congestion, were observed in areas beneath the victims' brassieres. Deaths in these cases were all due to crush asphyxia, with the pattern of petechiae on the chests of the victims influenced by close-fitting clothing that had compressed cutaneous vasculature. This brassiere 'sign' provided a readily observable and easily recordable sign of crush asphyxia due to chest compression, and illustrated that vascular engorgement is necessary for the development of petechiae in these circumstances.

Accidents↗
PubMed2005

Review of forensic assessments of female referrals to the branch of legal medicine, Malatya region, Turkey--1996-2000.

It is well recognized that the most pervasive form in gender violence is violence against women by their intimate male partners. Domestic violence (DV) crosses all cultures, races, and socioeconomic levels, affecting people of all ages and both sexes, but particularly women and children. DV refers to the chronic physical, sexual and psychological maltreatment of one family member against another in order to control. DV represents a significant health threat to women. It may also be an important precipitating factor of female suicide. As the literature has begun to document the extent of interfamilial violence, attention has focused on forensic documentation. The aim of this study is to review female victims presented at the Branch of Legal Medicine of Malatya, Turkey, regarding gender-based violence and DV in relation towards sexual offenses and suicide attempts. Accordingly, recommendations were presented to increase the awareness of DV by setting policies and in response legislative recommendations. The legal reports of women (n=2245) were reviewed. In respect of the Turkish Penal Code (TPC), paragraph 456/1, 2, 3 and 4, which covers the act of assault and battery, the severity of the injuries have been categorized into three groups according to the Turkish Injury Scale (TIS) covered by TPC 456/1, 2 and 4, into the issues of functional incapacitation according to TPC 456/2 and 3, and with regard to the presence of a mark of an injury on the face according to TPC 456/2 tables. Because of incomplete data, not all results be categorized as positive for DV. Despite the large number of blunt force injuries (699 cases out of 2245) and the high percentage of external lesions, 76% of 1796 files, found, recognition of DV was uncommon. According to TPC 456/4, in cases of small trauma-related injuries, legal proceedings are dependent upon a victim's making a complaint. The percentage of 80.4% (n=2245) represents the need for information regarding legal requirements. The frequency of sexual assault cases, 144 victims out of 162, and in suicide attempts, 95 women out of 145, in the 15-24 year age span may also reflect a society's accusative approach towards women based on moral values. Unless prosecuting DV cases purely on the evidence in regard to victim's safety, withdrawal of complaints will continue. It is essential to identify to 'name' DV when it occurs. Recognizing the serious immediate and future long-term implications for health, multifaceted intervention is important. DV has to undergo some fundamental and far-reaching reformation in Turkey regarding how the legal system deals with it appropriately.

Adolescent↗
PubMed2006

Overview of the ossified stylohyoid ligament based in more than 1200 forensic autopsies.

The human stylohyoid chain presents considerable anatomic variability. In a personal series of 1215 forensic autopsies, eleven cases of complete ossification of the stylohyoid ligament have been revealed. Nine cases were bilateral and two cases were unilateral ossifications. A fractured ossified stylohyoid ligament was found in one case. The embryology and clinical significance of this condition has been mentioned briefly.

Adult↗
PubMed2005

Invasive aspergillosis in association with criminal arsenic poisoning.

A 26-year-old man suffered acute arsenic poisoning after a poisoning attempt. He developed multiple organ failure including encephalopathy, bleeding disorders, pancreatitis, renal and hepatocellular impairment. Generalized erythroderma also developed within one week after admission. The developed acute respiratory distress syndrome and Aspergillus fumigatus was isolated from the endotracheal aspirate. Despite intensive care support, antidote administration and various epuration techniques, the patient died on day 26 from subarachnoid bleeding. An autopsy was obtained and the concentration of arsenic was determined in different tissues. Multiple abscesses due to Aspergillus fumigatus were seen in the lungs, myocardium and kidneys. This uncommon complication in a previously immunocompetent patient could be related to impaired immunity directly caused by arsenic poisoning.

Adult↗
PubMed2005

Brown Séquard syndrome due to cervical pen assault.

Brown Séquard syndrome is an uncommon incomplete spinal cord injury with ipsilateral motor and proprioception loss and contralateral pain and temperature loss. A 14-year-old student with classic Brown Séquard syndrome after pen assault injury by his classmate in posterior neck area presented here; with medical and supportive care, the patient was discharged with good outcome. Brown Séquard syndrome is mostly due to penetrating trauma. Several types of penetrating objects have been reported but this appears to be the first report of a pen or pencil injury.

Adolescent↗
PubMed2005

Café coronary syndrome-fatal choking on food: an autopsy approach.

To examine the characteristic features of fatal food asphyxia and to develop an autopsy approach to such cases a retrospective study of autopsy files was undertaken at Forensic Science SA (Adelaide, Australia) over a 10 year period from 1993 to 2002 for all cases of food asphyxia/café coronary syndrome. Forty-four cases were identified (M;F=21:23), with one infant (11 mths) and 43 adults (30-96 yrs; mean 68.9 yrs), with a preponderance of victims (57%) aged between 71 and 90 yrs. Deaths occurred in nursing homes (N=22) cases, at home (N=11) and in restaurants (N=4). Twenty-seven of the victims (61%) had histories of neurological or psychiatric disorders such as dementia (N=8), schizophrenia (N=6), Alzheimer disease (N=4), atherosclerotic cerebrovascular disease (N=4), mental impairment (N=2), multiple sclerosis (N=1), Parkinson disease (N=1) and obsessive-compulsive disorder (N=1). Twenty-seven cases (61%) were described as either edentulous or having significant numbers of teeth missing. Toxicological evaluation of blood revealed alcohol and a variety of psychotropic prescription medications in 19 cases. Sudden collapse during or shortly after a meal should always raise the possibility of café coronary and the autopsy examination should not only attempt to demonstrate airway occlusion by a bolus of food, but also to identify or exclude underlying neurological disease. Such cases may raise issues concerning adequacy of care and appropriateness of medication. The diagnosis of café coronary syndrome can only be made with confidence after the clinical history and circumstances of death have been clearly established, impacted material has been demonstrated in the airway at autopsy (or recorded by those attempting resuscitation), risk factors have been identified and other possible causes of death have been excluded.

Adult↗
PubMed2006

Accidental ligature strangulation due to electric grinder.

A young girl was accidentally strangled when her chunni (a piece of cloth worn around the neck by most Indian women) was caught in a moving electrical grinder. She was taken to the nearest hospital where she died within the next 9h, remaining unconscious throughout the hospital stay. Accidental strangulation of this kind due to household devices or machinery is extremely uncommon and to the best of our knowledge, this is the first case of its kind to be reported. The findings are presented.

Accidents↗
PubMed2006

Haemorrhagic complication of acute necrotizing pancreatitis presenting with sudden death.

Certain complications of acute pancreatitis may lead to death, and of these, haemorrhage caused by rupture of a peri-pancreatic vessel is among the most dangerous. The case reported here was remarkable because the onset of acute necrotizing pancreatitis was completely asymptomatic and the severe haemorrhage of the portal vein that caused the patient's death was only discovered at autopsy. The onset of abdominal pain was immediately followed by death.

Aged↗
PubMed2006

Retained intra cranial blade - medicolegal perspectives.

A fatal case of a homicidal penetrating head injury by retained blade of knife is reported. The blade of knife penetrated the skull bone after breaking from a knife handle and remained lodged in the intracranial cavity for 5 days resulting in death from intracranial bleeding and brain oedema. The need of proper and complete examination of the head injury and its medico-legal importance is emphasized.

Adult↗
PubMed2006

Hanging without knot in the noose.

Death by hanging is believed to be a painless method of committing suicide. In most cases the noose has a knot and on this basis only it can be labeled as atypical or typical hanging. A 35 year Chinese man committed suicide by hanging with a ligature material made of electric wire where there was no knot present on the noose.

Adult↗