Determination of the effects of alcohol dehydrogenase (ADH) 1B and ADH1C polymorphisms on alcohol dependence in Turkey.

Alcoholism is a complex genetically influenced disorder which refers to alcohol abuse and alcohol dependence. There are controversial results on the role of gene polymorphisms in alcohol dependence in the literature. Differences in population groups and selective inclusion criteria for alcohol dependence may affect results. In this study, we investigated the role of ADH1B Arg48His (rs1229984) and, ADH1C Ile350Val (rs698) gene polymorphisms in Turkish population. 100 healthy volunteers and 75 patients who were admitted to Ege University Alcohol Dependence Unit enrolled in the study. We found significant increase both in ADH1B (Arg48His) polymorphism Arg allele and Arg/Arg genotype frequency in patients. No profound connection between alcohol dependence and ADH1C Ile350Val gene polymorphism was detected. Alcohol dependence is an important health problem that depends on many genetic and environmental factors but we think that it is possible to interpret genetic risk for developing early diagnostic methods and treatment strategies by comprehensive linkage and association studies.

Sex determination from the sternal end of the rib by osteometric analysis.

BACKGROUND: The aim of this study was to establish a sample group of Turkish population to determine sex from the sternal end of the ribs. Sex determination from the human skeleton bones is a simple and specific method. MATERIALS AND METHODS: The specimens consisted of right fourth (4th) ribs of 78 females and 173 males of known age, sex and race during 1994-1997 in Izmir, Turkey. A discriminant function analysis showed that the most helpful parameter in the young group was superior-inferior height (SIH), and both SIH and anterior-posterior breadth (APB) in the older group. Modified discriminant score formulae for both young and old groups to determine sex for Turkish population was calculated. RESULTS: The results indicated that the accuracy of sex determination was 88.6% in the young group (phase 1-4, age 15-32), 86.5% in the older group (phase 5-8, age 33-89). CONCLUSIONS: This study indicates that sexual dimorphism can be assessable by using a single rib, right fourth rib in a Turkish population from ages 13 to 89. SIH of the rib is the most reliable parameter; APB follows it.

Structure of the human tricuspid valve leaflets and its chordae tendineae in unexpected death. A forensic autopsy study of 400 cases.

OBJECTIVE: Congenital variations are known to be potential candidates for mechanical trauma leading to tricuspid valve lesions. For this reason, a detailed examination of heart valves as well as chordae tendineae should carefully be performed to clarify the reason of sudden death with no apparent cause. The aim of this study is to investigate the relationship of valvachordal anatomy in tricuspid valve in sudden deaths, and mainly cardiac disease in connection with its structure as well as leading congenital changes. METHODS: The 400 human hearts were collected between 2000 and 2002 from 400 autopsy cases during a medicolegal autopsy with permission from the Council of Forensic Medicine, Izmir, Turkey. Morphometric and morphological data were obtained in Ege University Faculty of Medicine, Department of Anatomy from each valve namely area, basal width, depth of leaflets, depth of commissure, number of chordae tendineae and their relation to the leaflets. These data were correlated for cardiac and noncardiac death cases. RESULTS: The results of this anatomical study may explain the increased incidence in wide variations of chordae tendineae in deaths of cardiac origin. In 40 hearts, we found 2 leaflets (20%), in 140 (70%) 3 leaflets and in 20 hearts there were 4 leaflets (10%) in deaths of noncardiac origin. We found 2 leaflets in 36 hearts (18%), 3 leaflets in 130 hearts (65%) and there were 4 leaflets in 34 hearts (17%) in deaths of cardiac origin. Although chordal abnormalities were extremely rare in cardiac death cases, some chordae tendineae retained a normal or near-normal appearance, while others were thickened and shortened in cardiac death cases. Higher ratio of abnormal chordae that were too short and too thick was also significant. CONCLUSION: This condition negatively affects the feeding of chordae and leaflets and acts as a culprit of cardiac deaths, since aging starts at an early stage. This situation changes the verdict in legal affairs. For this reason, the valvachordal structure should be carefully examined prospectively in autopsies.

Variations in the papillary muscles of normal tricuspid valve and their clinical relevance in medicolegal autopsies.

OBJECTIVE: In our study, tricuspid valves in cases of sudden death secondary to congenital differences of the tricuspid valve with significant papillary muscle anatomy were investigated. No studies of papillary muscle anatomy of the tricuspid valve have been found in medicolegal autopsies in literature. The purpose of our study is to investigate the relationship of papillary muscle in tricuspid valve in cases of sudden deaths, especially those resulting from cardiac disease, with the muscle structure, as well as the number of the muscle leading congenital changes. METHODS: The study was carried out in the Department of Anatomy, Faculty of Medicine, Ege, University, Izmir, Turkey and comprised of 400 human hearts obtained between 2000 and 2002 from 400 autopsy cases during a medicolegal autopsy with permission from the Council of Forensic Medicine, Izmir. Quantitative and morphological aspects of the papillary muscles of the right ventricle were evaluated. The criteria such as number, incidence, length and shape of the anterior, (APM) septal (SPM) and posterior papillary muscles (PPM) have been observed. RESULTS: Although the papillary muscle presented great variability in numbers, with a minimum of 2 and a maximum of 9 papillary muscles in the right ventricle, there were usually 3 papillary muscles in the right ventricle; APM, PPM and SPM. The one headed APM was found to be more often in cardiac deaths. However, observing more frequent conical and flat topped configurations in all PPM was striking. The absence or lower ratio, or both of attachment bridges of SPM and APM/PPM in deaths of cardiac origin is also significant. We have found that the presence of this attachment is higher in deaths of noncardiac origin. CONCLUSION: This anatomical study may explain the increased in incidence wide variations of papillary muscle tricuspid valve in deaths of cardiac origin. The verdict in legal affairs may change with this. The knowledge regarding wide variations and minor anatomical abnormalities of papillary muscle helps forensic examiners not to get confused at unexpected deaths.

Intercostal variation for age estimation--are the standards for the right 4th rib applicable for other ribs?

Age estimation of unknown skeletal remains is very important in forensic medicine. Morphologic methods are fast and easy to use for purpose of age determination. The sternal ends of the ribs are a reliable method of age estimation from late adolescence to old age. Iscan et al developed a phase analysis method for the right 4th rib that was sex and race specific. The purpose of this study is to determine the accuracy of the standards of age estimation from the right 4th and other rib using the phase analysis for the Turkish population. The sample consisted of right and left 3rd, 4th and 5th ribs from 34 Turkish women and 76 men. There were statistically significant variations found on the right 5th, left 3rd, 4th, and 5th ribs according to these standards in men for phases 5, 6, and 7. For women, all the right and left ribs included in this study were in concordance with right 4th rib standards in all phases.

Anatomic variability of the coronary arterial orifices.

OBJECTIVE: Anatomical differences in coronary orifices (CO) are important as they are associated with myocardial ischemia and sudden death. The location of coronary orifices to the aortic valve has been studied since it is a determining point in surgical and radiological attempts. METHODS: The number, position, and shape of the CO, and their relation to the sinotubular junction (SJ), were studied in 100 normal adult hearts. Student-t test, one- and two-way ANOVA with posthoc Tukey's HSD tests were applied for statistical analysis. RESULTS: The mean height of the right, non- and left coronary sinuses were 18.75+/- 1.71, 17.86+/- 1.55 and 16.41+/- 1.21 mm, respectively. The mean height of the right, non- and left coronary cusps were measured as 16.2+/- 1.2, 15.9+/- 1.1 and 12.3+/- 2.1 mm, respectively. The left coronary artery (LCA) was observed to arise from the lower part of the SJ in 58% of the patients, while in 29% of them it originated from the SJ, and in 13% of the cases it arose from the upper part of the SJ. The right coronary artery (RCA) arising from the lower part of the SJ was seen in 78% of the patients, while it originated from the SJ in 13% of the patients, and it was observed to arise from the upper part of the SJ in 9 specimens. The diameters of the LCA and RCA were measured as 4.22+/- 0.72 and 3.32+/- 0.82 mm, respectively. An accessory orifice was found on the left in 47 specimens, while it was seen on the right in 54 of them. CONCLUSIONS: The location of the CO should be identified according to the vertical and horizontal surfaces of the sinus. In this study, the frequency of the coronary artery orifices with different locations was provided. Such data will increase the success of coronary interventions and decrease complication rate.

Watch out for nuts in your travels: an unusual case of drug-facilitated robbery.

Among many methods to facilitate robbery is spiking unsuspected victims' food or beverage with drugs. In this short report, we would like to present a highly unusual and a very creative case of drug-facilitated robbery to highlight the possibility of this type of case in the field of travel safety.

Demonstration of ventricular myocardial extensions into the pulmonary artery and aorta beyond the ventriculo-arterial junction.

BACKGROUND: A subgroup of outflow tract (OT) ventricular tachycardias (VT) originate from the aortic sinuses or the main stem of the pulmonary artery. The anatomic substrate for these tachycardias is unknown. The aim of this study was to investigate the presence of ventricular myocardial extensions (VME) into the pulmonary artery (PA) and aorta (Ao) beyond the ventriculo-arterial junction (VAJ) and determine the anatomical and histological characteristics of these muscle extensions. METHODS: Ninety-five consecutive human hearts obtained at autopsy were studied. Longitudinal strips of tissue containing each cusp, aortic, and pulmonary artery walls and left and right ventricular outflow tracts were excised and histologically analyzed. Anatomical measurements, including length and thickness of VMEs, obtained at autopsy, were made. RESULTS: VMEs beyond the VAJ were found in 21 of 95 (22%) patients studied. VMEs were found in 16 of 95 PAs (17%) and 7 of 95 Aos (7%) were examined. VMEs were located within the adventitia in 23 (88%) and on the epicardial surface in three (12%). The majority of VMEs were in continuity with the underlying ventricular OT muscle tissue. Myocellular hypertrophy and fibrosis were present in 19 (73%) and fatty tissue between the layers of VME in 18 (69%). Clinical data were available in 14 of 21 patients with positive VME. None of the patients (clinical data available group) had history of cardiac disease or signs or symptoms (palpitations or syncope) of cardiac disease. CONCLUSIONS: VMEs into the PA and Ao beyond the VAJ are relatively common. It seems that their mere presence does not predispose to OT VTs. There are probably intrinsic arrhythmogenic properties in tissues specific to these regions in those patients who develop OT VTs.