Ingestion of Fireworks: Rare Cause of Poisoning in Children.

BACKGROUND: Mistaken ingestion of all manner of toxic matter is common in childhood, but poisoning with fireworks and matchsticks is rare. Fireworks usually contain 10% yellow phosphorus and 50% potassium chlorate. Potassium chlorate is an extremely reactive and toxic agent that is used in fireworks and matchstick heads. METHODS: Eleven cases (7 females and 5 males; median age, 36 months [ranging from 24 to 48 months]) of poisoning after ingestion of fireworks and matchstick(s), between February 2008 and June 2014, were reviewed. RESULTS: The most common initial symptom was vomiting except for 2 cases in this group. Biochemical tests indicated that hyperphosphatemia was present in all patients, 8 patients (72.7%) had subclinical hepatic injury, 1 (9%) had acute hepatic failure, and 2 patients had no clinical or biochemical evidence of hepatic damage. Three patients had renal impairment, but none of them required dialysis. All of the patients recovered with supportive therapy except for 2 cases. One patient underwent cadaveric liver transplantation, whereas the other died because of circulatory dysfunction and respiratory failure due to pulmonary alveolar hemorrhage. CONCLUSIONS: Without prompt intervention, poisoning with fireworks carries high morbidity and mortality in children. It can cause pulmonary hemorrhage, in addition to other organ damage, including liver and kidney. Hyperphosphatemia is common, as it was seen in all of the study patients.

Evaluation of Postmortem Cerebrospinal Fluid S100B Protein and Serotonin Levels: Comparison of Suicidal Versus Nonsuicidal Deaths in Konya, Turkey.

Although suicide is a preventable public health problem, objective assays for suicide risk are limited. In this study, it was aimed to determine levels of S100B protein and serotonin as a marker for risk of suicide. S100B protein and serotonin levels were investigated with ELISA method in the cerebrospinal fluid (CSF) in medicolegal autopsy cases, including those of suicide cases (n = 32) and nonsuicide cases (n = 56). The CSF S100B levels were higher (9.3 ± 2.9 ng/mL vs. 5.4 ± 2.0 ng/mL), and serotonin levels were lower (10.4 ± 4.9 ng/mL vs. 19.0 ± 5.7 ng/mL) in suicide group than nonsuicide group (p < 0.05). There was no correlation between S100B protein and serotonin levels with gender, age groups, postmortem interval, and cause of death. It is concluded that both S100B protein and serotonin in CSF may be useful for determination of suicide risk.

MAJOR ANATOMIC VARIATIONS OF PULMONARY FISSURES AND LOBES ON POSTMORTEM EXAMINATION.

This study was aimed at determining major accessory fissures (MAF) and absence or incompleteness of lobar or major fissures (MF) during routine forensic autopsies. Prior to starting this prospective study, forms were prepared to collect data on pulmonary lobes and fissures. In this study, 420 lungs of 210 autopsy cases were examined for incompleteness and absence of MF and complete accessory fissures. Horizontal fissures were incomplete in 18 right lungs. Incomplete oblique fissures were noted in three right and two left lungs. Unidentified abnormal fissures were determined in one left lung and five right lungs. The most common fissural abnormality was less than half complete horizontal fissure. Four right lungs had four lobes and two left lungs had three lobes because of complete accessory fissures. The number of lobes in the left and right lungs and the morphological features of both incomplete MF and MAF were determined in detail and the variations were photographed. It is concluded that, in addition to studies on computed tomography scans, autopsy series are useful for determining the variations of MF and MAF of the lungs in different populations.

Why do people hang themselves on trees? An evaluation of suicidal hangings on trees in Konya, Turkey, between 2001 and 2008.

Hanging is the most common method of suicide in the world, and many public places offer a means or opportunity to carry out the activity. Of 4,452 death examinations and autopsies, there were 378 (8.5%) suicides and suicide method was hanging in 185 (48.9%) cases. In 20 of these (10.8%), the suspension point was the branch of a tree. The incident location was the garden of the victim's house in nine cases, the woodlands in seven cases. The suicides were attributed to psychiatric disorders in nine cases, economic problems in six cases, and family problems in five cases. It is concluded that hanging on a tree as a suicide method is often committed by males and the underlying motive may be different in suicidal hangings on trees occurring at daytime and night. For preventional purposes, the reporting of such suicides in public places by the media may be restricted by local authorities.

Evaluation of shotgun suicides in Konya, Turkey between 2000 and 2007.

The number of the suicides is increasing all around the world. In this study, the cases autopsied between 2000 and 2007 in The Konya Branch of Forensic Medicine Council were retrospectively investigated. Fifty-seven shotgun suicides were determined. The cases were evaluated in terms of their demographic characters, site of entrance wound, the type of the cartridge used, shooting distance, the place of incident, the place of death, motive for suicide, and the presence of previous suicide attempts. The most preferred site of entrance wound was the head with 34 cases (59.7%). Of 34 cases in which the entrance wound was on the head, there was indirect mandibular fracture in 16 cases (47.1%). In 11 cases (19.3%), there observed small ecchymosed abrasions on the finger surfaces, which are thought to have resulted from the trigger kicking back during triggering or the finger having been stuck between the trigger and the trigger guard. It is concluded that there is a need for a legal regulation that makes obtaining of shotguns more difficult and the people who have them are to be educated not to keep them in easily accessible places.

Pseudoaneurysm originating from left ventricle aneurysm: an autopsy case and review of literature.

Rupture of the free wall of the left ventricle is a catastrophic complication of acute myocardial infarction. Rarely, free wall rupture is contained by overlying adherent pericardium, producing a pseudoaneurysm of the left ventricle. In this report, a case of a left ventricular pseudoaneurysm due to a previous myocardial infarction is described. A 55-year-old woman had a severe chest pain 11 months prior to death. No cardiac investigation was performed. Three days prior to death, she suffered from fatigue and weakness, and had a witnessed sudden cardiac death. At autopsy, a 8.5 × 10 × 8 cm pseudoaneurysm of the left ventricle was found. There was severe coronary artery atherosclerosis. There were extensive adhesions between pericardium and pseudoaneurysm wall. The cause of death was attributed to heart failure and resulting arrhythmia. The case illustrates the rare event of left ventricular pseudoaneurysm first diagnosed at forensic autopsy.

Evaluation of forensic deaths during the month of Ramadan in Konya, Turkey, between 2000 and 2009.

Ramadan is a holy month for Muslim people and includes long fasting periods. During Ramadan, practicing Muslims not only fast, but they also abstain from any kind of medication, smoking, sexual intercourse, and alcohol from sunrise to sunset. In the 10-year period between 2000 and 2009, it was determined that a total of 4881 death examinations and autopsies were performed at the Konya Branch of the Forensic Medicine Council (Turkey). All of the reports were retrospectively evaluated for demographic features of the cases and the manner of death. In the studied time period, a total of 491 deaths (10.1%) occurred in Ramadan. The manner of death was accident in 369 (75.2%) of the cases in Ramadan, 3107 (70.8%) of the other cases; suicide in 27 (5.5%) of the cases in Ramadan, 367 (8.4%) of the other cases; and homicide in 28 (5.7%) of the cases in Ramadan, 375 (8.5%) of the other cases. There was a significant statistical difference in terms of the manner of death between the deaths in Ramadan and in the remaining part of the year (P < 0.05). Our study suggested that there was an increase in accidental and natural deaths and a decrease in suicide and homicides in Ramadan.

Immunohistochemical and morphometric evaluation of neuronal dysfunction in pelviureteral junction obstruction.

PURPOSE: The pathophysiology of pelviureteral junction obstruction remains unclear. In this study, we attempted to evaluate the neuronal dysfunction using immunohistochemical and morphometric parameters. MATERIALS AND METHODS: Using specific antibodies, we studied the neuronal markers and morphometry of specimens from 10 cases of pelviureteral junction obstruction and 10 normal pelviureteral junctions by immunohistochemistry using synaptophysin (synaptic vesicle membrane protein), S-100 (nerve cell fiber marker), protein gene product 9.5 (neuron specific protein) and CD-117 (transmembrane receptor with tyrosine kinase activity). RESULTS: In pelviureteral junction obstruction, smooth muscle thickness was significantly higher than in normal specimens. Cytoplasmic cells stained by synaptophysin were found in the pelviureteral junction obstruction specimens but were absent in normal pelviureteral junction specimens. In addition, significantly more intense staining for S-100 was found in the pelviureteral junction obstruction specimens compared with the normal specimens. Immunohistochemical staining for protein gene product 9.5 showed no differences between the normal and pelviureteral junction obstruction specimens. Neither the normal specimens nor pelviureteral junction obstruction groups were stained by CD-117. CONCLUSION: We propose that the cause of neuronal dysfunction in pelviureteral junction obstruction depends on the increase in number and structure of neuronal cells and smooth muscle thickness. These factors could play an important role in the pathophysiology of pelviureteral junction obstruction by affecting motility and peristalsis.

Fatal injury by an unmodified blank pistol: a case report and review of the literature.

In this paper, we report a fatal neck injury of suicidal origin of a 29-year-old man. A 9-mm blank pistol and several blank cartridges in a plastic bag were discovered near the victim. There was an irregular and contuse oval contact-entrance wound of 25 mm × 20 mm with a muzzle imprint on its upper medial part on the right side of the neck. The cause of death was exsanguination due to injuries to the right external carotid artery and the right jugular vein. This case confirms that blank pistols, contrary to public opinion, are dangerous and may inflict potentially fatal injuries when fired at close or contact range. In addition, previously reported 18 fatal injuries by blank cartridges caused by unmodified blank pistols between 1990 and 2009 are reviewed and summarized. It is concluded that as blank pistols may cause fatal injuries even without any modification, it is necessary to develop new standards for their production.

Modified medial Stoppa approach for acetabular fractures: an anatomic study.

BACKGROUND: The modified medial Stoppa approach is an alternative and new surgical approach to access to the internal pelvis and medial wall of the acetabulum. There is little information about the clinical anatomic specifications of exposure in the literature. In this study, the pertinent surgical anatomy that involved the modified medial Stoppa approach was further defined and the anatomic positions and variations of the structures seen in the surgical site were analyzed. METHODS: We dissected five formalized cadavers to present structures at risk in a standard modified medial Stoppa approach. The internal iliac artery and branches were colored with latex injection in formalized cadavers. Morphometrical measurements of the neurovascular structures adjacent to quadrilateral surface and their anatomic variations were noted. RESULTS: It was detected that the obturator vessels and nerve and the iliolumbar vessels were primarily the structures at risk. Obturator vessels and nerve were the most important structures to pay attention because of their direct contact to quadrilateral surface. There was communication (corona mortis) between obturator and inferior epigastric veins in 4 (40%) of 10 hemipelvises. CONCLUSIONS: Before clinical applications, performing cadaver dissection is important to minimize intraoperative complications. This study was the first anatomic study in the literature that reveals the structures that are at risk during surgical treatment of acetabular fractures, which was treated with the modified medial Stoppa approach.

The importance of oxidative stress in patients with chronic renal failure whose hypertension is treated with peritoneal dialysis.

Increased oxidative stress is a well-known phenomenon in dialysis patients. However, the contribution of hypertension to the oxidative stress in peritoneal dialysis patients has not yet been assessed. The present study aimed to investigate if hypertension had an additional effect on oxidative stress in peritoneal dialysis patients. A total of 50 patients treated with peritoneal dialysis were divided into two groups: The patients with mean of last three blood pressure results as 135/90 mmHg and above were considered hypertensive, the patients with lower blood pressure were considered normotensive. The control group included 25 healthy individuals. Serum malondialdehyde (MDA), advanced oxidation protein product (AOPP), myeloperoxidase (MPO), catalase (CAT) and glutathione peroxidase (GSH-Px) levels were measured in all groups. MDA level, an indicator of lipid peroxidation, was significantly higher in the hypertensive group compared to the control group, while the increase in the normotensive group was not significant. However, the difference between the hypertensive and normotensive groups was significant. The levels of AOPP, an indicator of protein oxidation level, and MPO, an indicator of neutrophil activation, were not different between the groups, while the activities of antioxidant CAT and GSH-Px decreased in both normotensive and hypertensive groups compared to the control group, and there was no significant difference between the patient groups. This study shows that both normotensive and hypertensive peritoneal dialysis patients have increased-oxidative stress and decreased antioxidant levels and hypertension might have an additional effect on oxidative stress by increasing MDA level in peritoneal dialysis patients.

Accessory spleens at autopsy.

Accessory spleens (AS) may be formed during embryonic development when some of the cells from the developing spleen are deposited along the path from the midline, where the spleen forms, over to its final location on the left side of the abdomen. An accessory spleen is usually near the spleen's hilum, but it may be embedded partly or wholly in the tail of the pancreas. The aim of this study was to investigate the incidence and distribution of AS during routine forensic autopsies. AS were investigated in 720 consecutive autopsy cases. Fifty-four AS were found in 48 (6.7%) cases. AS were found in hilum of the main spleen in 28 cases, the great omentum in 13 cases, the pancreas in 5 cases, and the pelvis in 2 cases. There were two AS in two cases and three AS in another two cases. Awareness of the possible presence of AS is important because when splenectomy is performed for some conditions such as immune thrombocytopenic purpura, failure to remove the AS may result in the failure of the condition to resolve. Additionally, during medical imaging, AS may be confused for enlarged lymph nodes or neoplastic growths. In conclusion, autopsy series are useful for determining the incidences and the other features of AS in different populations, in addition to those studies using CT scans and those studies obtained during laparoscopic or open surgeries.

Accidental hanging deaths in children in Konya, Turkey between 1998 and 2007.

In general, hanging cases are the result of suicide, and accidental and homicidal hanging cases are rarely seen. This study retrospectively investigated 4571 death examinations and autopsies that were performed at The Konya Branch of the Forensic Medicine Council (Turkey) between 1998 and 2007; hanging was involved in 201 (6.5%) of the cases. There were a total of 13 accidental hanging cases, where 12 of these involved children. In seven of the cases, the accidental hanging involved a scarf that wraps around swing-like cradles and is intended to prevent infants from falling down. It was concluded that accidental hanging deaths can be reduced by replacing swing-like cradles with cribs that are designed for children, removing ropes in and around the house, and preventing children from reaching and/or playing with rope-like objects.

Dead bodies found in wells.

Corpses found in wells or lime pits must be identified and the cause and manner of death must be determined. There are several circumstances that may lead to the presence of corpses in wells. In this study, 3940 death examinations and autopsies, performed at the Konya Branch of Forensic Medicine Council (Turkey) between 2000 and 2007, were retrospectively investigated, and it was found that 18 (0.46%) of the bodies had been recovered from wells. The cases were evaluated in terms of their demographic features, manner of death (accidental, suicidal, or homicidal), autopsy findings, cause of death, and the characteristics of the wells in which they were found. The ages of the victims ranged from 4 to 74 years, and the average age was 40. 4 +/- 20.6 years. Of total, 16 cases were males and 2 were females. The manner of death was determined to be accidental in 10 of the cases, suicide in 6 of the cases, and homicide in the remaining 2 cases. In 7 of the cases, death had occurred as a result of drowning in water. A comprehensive scene investigation and autopsy must be performed for corpses recovered from wells and pits for both identification and determination of the cause and manner of death. Wells should be covered and kept closed at all times to reduce the number of accidental deaths resulting from falls into wells.

Decapitation and dismemberment of the corpse: a matricide case.

Dismemberment of a corpse has always been viewed by society to be a more hideous crime than the homicide itself. In this study, we present a case of a 57-year-old woman who was decapitated and her right arm and both hands were dismembered. It was determined that the victim was murdered and dismembered by her 33-year-old daughter, who had been receiving treatment for schizophrenia for 15 years. On the victim's head and back there were 71 incised and stab wounds in total. They were superficial, except the five stab wounds which were connected to the right chest cavity and which incapacitated the victim. Although there is not a regulation for the act of dismembering the corpse in the Turkish Penal Code, since this type of case is rare, the crime scene and the autopsy findings were evaluated together with other pertinent data available in the literature.

Evaluation of farm tractor-related fatalities.

Farm tractors are the major cause of occupational fatalities in agricultural regions. Fatalities typically result from being run over or crushed by the tractor, becoming entangled in the moving parts of the tractor, accidents on roadways, and tractor rollovers, which involve the tractor tipping sideways or backwards and crushing the operator. In this study, tractor-related fatalities in the Konya province of Turkey are retrospectively evaluated. Out of the 3940 cases on which a death examination and/or autopsy was performed between the years 2000 and 2007 at The Konya Branch of Forensic Medicine Council, 86 (2.2%) of the death cases were caused by tractor accidents and are included in this study. The ages of the victims varied between 3 and 80 years old with a mean age of 31.7 + or - 22.3. Sixty-eight (79.1%) of the cases involved males, while 18 (20.9%) of the cases involved females. In 32 (37.2%) of the cases, the deaths due to tractor accidents occurred when the tractor overturned. In 37 (43.0%) of the cases, the tractor-related fatalities involved the passengers and the drivers were involved in 34 (39.5%) of the cases. In conclusion, tractor accidents are preventable and deaths from tractor accidents can be significantly reduced if drivers are required to wear safety belts and helmets and frequent checks are implemented to enforce the ban on carrying passengers.

Accidental ligature strangulation by an ironing machine: an unusual case.

In this paper, we present a case of a 53-year-old woman who had her headscarf catch on the cylinder ironing machine in the laundry of the hospital where she worked. The hospital workers found the woman dead with her head stuck to the ironing machine. After the death scene investigation and autopsy were completed, it was determined that the death occurred as a result of accidental ligature strangulation. Accidental ligature strangulation in which an article of clothing is caught in such an electrical machine and strangles the wearer is very rare. This case highlights the fact that these kinds of machines can be hazardous to work around and that increased safety measures should be taken to insure worker safety; additionally, the people who use these machines should be educated on the potential hazards.

Homicide-suicide in Konya, Turkey between 2000 and 2007.

Homicide followed by the suicide of the murderer is a relatively rare lethal incident in which an individual kills another person and subsequently dies by suicide. Cases involving a homicide and a suicide in which death examinations and autopsies were performed at The Konya Branch of the Forensic Medicine Council between 2000 and 2007 were retrospectively investigated. During the studied time period, there were 10 homicide-suicide cases identified with 10 perpetrators killing 12 victims. Nine of the perpetrators were men and eight of the victims were women. The precipitating motive was an impending divorce in four of the cases. Two perpetrators were described as severely depressed, one had a diagnosis of antisocial personality disorder, and one was a pedophile who had reactive depression. Firearms were used in eight of the homicide cases and seven of the suicides. Constricting the use of firearms may reduce/prevent future homicide-suicide cases, as it is the most commonly used method to carry out homicide-suicides.

Suicide by ligature strangulation: three case reports.

Suicide by ligature strangulation, which gives the initial impression of a homicide, is very rare. In this article, 3 suicidal death cases caused by ligature strangulation in Konya between 2001 and 2006 are presented. The first victim was a 68-year-old man who suffered from depression and lived alone in a cottage house. He terminated his life by applying a tourniquet to his neck after leaving a suicide note. The second victim was a 70-year-old woman who was found dead on the floor of the living room in her house. After she cut the vessels in her wrist, she tied pantyhose with 3 knots around her neck. It was reported that she had been intermittently receiving treatment for bronchial asthma and depression for 20 years. The third victim was a 30-year-old woman who suffered from schizophrenia for 6 years. She tied a scarf around her neck with 3 knots and died in the hospital after 1 day due to "hypoxic brain syndrome." As a result of the death scene investigations, autopsies, and judicial inquiries, it was concluded that death was by suicide in all 3 cases. Because the use of the ligature strangulation method, and particularly the tourniquet method, in suicidal cases is extremely rare in the literature, our aim is to present and discuss these cases.

Accidental decapitation: a case report.

We report a case of an accidental decapitation of an agriculture worker in a field. The scene investigation revealed that the worker had loosely tied a scarf tied over his face in an attempt to diminish his exposure to barley dust, to which he was allergic, while distributing the barley loads with a shovel upon a trailer. The trailer was simultaneously being loaded by a helix elevator machine and its rotating shaft suddenly caught the victim's scarf and pulled it down to the victim's neck. The rotating motion immediately tightened the scarf around the neck resulting in hanging/strangulation noose that, by continued tightening, caused decapitation of the victim. The victim's body was found on the ground by the trailer and the victim's head was discovered in the barley load in the trailer. Examination revealed that the neck was severed at the level of the second and third cervical vertebrae.