Evaluation of the medial clavicular epiphysis according to the Schmeling and Kellinghaus method in living individuals: A retrospective CT study.

The evaluation of the medial clavicular epiphysis via CT plays an important role in the determination of age, particularly the 19th and 22nd ages. Several authors have recommended the use of the Schmeling and Kellinghaus methods in conjunction in the evaluation of the medial clavicular epiphysis. The aim of this retrospective study was to evaluate thin section CT scan images of the medial clavicular epiphysis according to the Schmeling and Kellinghaus method, and to discuss the obtained data in the light of the literature. The thoracic CT scan images (0.6mm section thickness) of 601 patients (202 female and 399 male) aged between 10 and 35years obtained by 16-detector CT were evaluated by two examiners. The stage 2 was seen between 13 and 23years of age; stage 3 was seen between 16 and 27years of age. However, 100% of the female cases with stage 3c were ⩾18years of age, and 100% of the male cases with stage 3c were ⩾19years of age. Stage 4 was first observed at 20years of age in both sexes, and stage 5 was first observed at 25years of age in both sexes. We believe that stage 3c may be used, particularly in the determination 18-year age limit for both sexes. The outcomes of our study are consistent with those of our previous study and other studies in the literature, which is important for the confirmation of the reliability of the method.

Evaluation of the ossification of the medial clavicle according to the Kellinghaus substage system in identifying the 18-year-old age limit in the estimation of forensic age-is it necessary?

The evaluation of the ossification of the medial clavicular epiphysis being part of an assigned expert approach according to standard plays an important role within civil and criminal proceedings in assessing whether a person has reached her/his 19th or 22nd year of age. Evaluation of the medial clavicular epiphysis with thin-section CT is one of the methods recommended by the Study Group on Forensic Age Diagnostics of the German Association of Forensic Medicine. In this retrospective study, we evaluated the thin-section CT (section thickness of 0.6 and 1 mm) images of 254 patients (146 male, 108 female) with an age range of 13-28 years according to the Kellinghaus substage system. The mean values of female patients were observed to be about 10 months lower for stage 2a than the mean values of the male patients, about 13 months lower for stage 2b, and about 18 months lower for stage 2c. The earliest appearance for stage 3c was at 19 years in both sexes. Our data from this study were consistent with both our previous studies and the data of other studies. We think that stage 3c is important in determining whether a person has reached the age of 18 or not and, therefore, that the Kellinghaus substage system is a requirement in the assessment of forensic age.

Evaluation of age estimation in forensic medicine by examination of medial clavicular ossification from thin-slice computed tomography images.

Forensic age estimation, a recent topic of research in forensic medicine, is of primary importance to criminal and civil law. Previous studies indicate that the observation of medial clavicular ossification allows for age discrimination along the completed 18th and 21st years of life. Experts recommend that the Schmeling and Kellinghaus methods be used together. In this study, we used these staging methods to retrospectively analyze 725 case studies (385 males, 340 females) of thin-slice computed tomography (CT) images, ranging from 0.6 to 1 mm in thickness, from individuals aged 10 to 35 years. Stage 1 was found at 18 years of age maximum for males, whereas it was found at 17 years of age for females. Stage 2a was found at 18 years of age maximum for both genders. Stage 3c was initially observed at 18 years for both genders. Stage 4 was initially found at 21 years for males and 20 years for females. Stage 5 was initially observed at 25 years for both genders. Of note, stage 3c was found close to 19 years of age for both genders (18.92 years for male, 18.99 years for female), and it may be employed to differentiate along the age majority cutoff. The data obtained from our study were consistent with previous studies. We believe that such a comprehensive database will greatly contribute to future studies focusing on medial clavicular ossification based on thin-slice CT. Moreover, we also recommend that if medial clavicular ossification based on CT is to be examined for forensic age estimation, both methods should be employed together.

Right haemothorax related to the rupture of abdominal aortic aneurysm.

Reported case was 63 years old forester died suddenly in the village. Autopsy examination revealed massive coagulated haemorrhage filling the right hemithorax, neither free fluid nor blood were observed in the abdominal cavity. Abdominal aortic aneurysm 20x15x15 cm in size was examined. We aimed to report the rare case of abdominal aortic aneurysm presented with transdiafragmatic rupture and bleeding in the right hemithorax.

A case of cerebral hypoplasia/dysplasia detected at autopsy.

UNLABELLED: Presented case was a 2-year-old baby girl who had been treated for nearly one year with the indication of multifocal epileptiform anomaly. She was found dead in her bed in morning hours, autopsy was planned after prosecutors investigation. On internal autopsy examination, shrinkage of gyral structures in the frontal, and parietal lobes of the left hemisphere, markedly enlarged sulci, and a hypoplastic appearance were noted. Histopathological examination revealed evidence of pneumonia, brain exposed microgyral formations, disordered cortical stratification, hypercellularity, dysmorphic neuronal structures, balloon cells with diagnosis of cortical dysplasia. Pneumonia was reported as a cause of death. We aimed to discuss in the light of the literature a case with cerebral hypoplasia which is rarely seen at forensic autopsies. KEYWORDS: cerebral hypoplasia/dysplasia - autopsy - congenital malformation - sudden death.

Medicolegal Approach to Diogenes Syndrome: a Case Report.

Because of the way of life Greek philosopher Diogenes lived, in the medical literature some older individuals characterized with collection of symptoms and the psychopathology associated with the lack of concern about a person's living conditions were called as Diogenes Syndrome. In this study we presented a case in terms of Diogenes Syndrome. We aimed to discuss by using the recent medical literature. Our case was a 62 year old male living alone and there were a variety of diseases he had. Diogenes Syndrome was previously identified in 30 elderly patients for the first time in 1975. As well as the typical clinical features of Diogenes Syndrome were defined, for being of potential forensic value, case characteristics belonging to the crime scene, and also probable changes that may be encountered at autopsy were discussed.

Wischnewsky Spots in Fatal Hypothermia: Case Report.

69-year-old male was found dead at the roadside in October month, death was declared suspicious by local prosecutor and autopsy was mandated. At autopsy, a large number of dark brown colored, ovalshaped lesions ranging from 1-15 mm under the mucosa defined as Wischnewsky spots, when stomach was dissected were observed. For the formation mechanism of Wischnewsky spots, there has no definite conclusions; more studies are needed on a case series.

Retroperitoneal Liposarcoma: an Autopsy Case.

Liposarcoma is very rare mesenchymal tumor that occurs in deep soft tissue and mostly seen in limbs and retroperitoneum, accounts for 24% of extremity and 45% of retroperitoneal soft tissue sarcomas. Retroperitoneal liposarcomas are typically present with advanced disease and often carry a poor prognosis. Retroperitoneal liposarcomas grow slowly in the very expandable retroperitoneal space in the deeply hidden and clinically silent therefore diagnosis is usually made late. Liposarcomas have five histological subtypes; well-differentiated liposarcoma (WDLS), dedifferentiated liposarcoma (DDLS), pleomorphic, myxoid and round cell liposarcoma. Our case is 81-year-old male who was found dead in the village homeless shelter. This was classified as a suspicious death and transferred to our service for autopsy. The external examination revealed rectal prolapse, abdominal distension and scrotal swelling. The internal autopsy showed green membrane on the peritoneum, brown smelly contents in the abdominal space, a perforation area 1.5x1 cm in size that in the first part of the duodenum and the dimension of tumor was 48x30x6 cm in the retroperitoneal space. The pathological report was dedifferentiated liposarcoma. We present a rare case of a dedifferentiated retroperitoneal liposarcoma with duodenal ulcer perforation.

Death Due to Myocardial Bridging.

Myocardial bridging is a congenital coronary pathology described as a segment of coronary artery which courses through the myocardial wall beneath the muscle bridge. Although the myocardial bridging prognosis is benign, have been also reported sudden death in medical literature. ¬A 30-year-old married woman was found dead at her home. After local prosecutors' investigation the death was declared as suspicious and forensic autopsy was obliged. The left anterior descending coronary artery was detected embedded deeply in the myocardium 2 cm from its coronary ostial origin. There were no other pathology to explain death. We analyzed sudden death case occurred because of myocardial bridging and the pathophysiological mechanisms in the light of medico-legal literature.

Anatomical variation of hyoid bone: a case report.

Hyoid bone is a solitary bone localized at the level of cervical 3 vertebrae, connected to the adjacent bone structures with muscles and tendons. Anatomical variations of hyoid bone can cause difficulties in the application of forensic medicine together with clinical and surgical problems. We present a case of a 81-year-old woman, reported to got sick, who died at home. In the autopsy, the neck dissection revealed prolonged right and left greater horns of hyoid bone measured 11 cm and 7 cm respectively. We aimed to present a case with long hyoid bone horns and discuss recent literature.

Spontaneous rupture of a renal cell carcinoma associated with fatal bleeding.

Spontaneous rupture of the renal parenchyma is rarely reported, usually seen as a complication of an underlying disease like the benign and malignant tumors of the kidney, also except from tumors among the causes of spontaneous renal rupture associated with bleeding, there were claimed vascular anomalies affecting the parenchyma, infections and coagulation disorders. Presented case was a 79-year-old male found dead at home. At the autopsy in macroscopic examination; all of the organs with signs of putrefaction, free blood at perihepatic and post hepatic retroperitoneal area, bloody coat at colon serous surface and 25x30x25 cm of hematoma at the right perirenal area were observed. In dissection, 5x2 cm of crescent shaped residual kidney structure was detected at the inferior pole adjacent to the 15x5x8 cm of pale yellow tumor mass settled in the upper pole of right kidney dissection associated with kidney, and 3x3 cm of tumor rupture and bleeding area in the upper part of tumoral pseudo capsule was inspected. Tumor sections were dirty yellow in color, bleeding and a large area of autolysis in appearance were also observed. Histopathological examination of the samples prepared from the tumoral mass taken from on the right kidney revealed renal cell carcinoma. Our aim was to present a rare case of spontaneous rupture of renal cell carcinoma detected at the autopsy.

Cardiac rupture due to fall: a case study

Studies have shown that cardiac ruptures due to blunt trauma are seen more often than expected. However, epicardial injuries and atrial ruptures are common findings in deaths due to falls. Our aim is to present a unique, isolated cardiac rupture in a 2 year-old child resulting from a fall from a bed, to evaluate autopsy findings among the literature from a medico-legal point of view.

The Significance of Hemosiderin Deposition in the Lungs and Organs of the Mononucleated Macrophage Resorption System in Infants and Children

Hemosiderin deposition is not often recognized on routine examination with hematoxylin and eosin staining; however, iron stains may be helpful in the evaluation of hemosiderin deposition in infant autopsies. This report describes the data obtained from autopsy of 86 infants and children whose deaths were investigated at the Forensic Medicine Council Bursa Morgue Department from January 2000 to January 2003. A histochemical technique was used to identify hemosiderin in lung, liver and spleen specimens, which was correlated with other descriptive variables such as the reported cause of death, postmortem interval, trauma history, gender, and age. There was a weakly positive but significant correlation between lung and liver hemosiderin scores (Spearman's rank correlation coefficient, rho=0.348, p=0.001); i.e., given an increase in lung hemosiderin scores, an increase in liver hemosiderin scores was also observed. Similarly, a marked positive correlation between spleen and liver hemosiderin scores (Spearman's rank correlation coefficient, rho=0.335, p=0.002) was observed. The probability of spleen hemosiderin-positive cases belonging to the age group under 6 months was found to be 4.3 times greater than those who were hemosiderin-negative (95% confidence interval, 1.6-11.8). After the major differential diagnoses were ruled out, this study demonstrated, that depending on the statistically assessed morphometric grounds, the presence of hemosiderin deposits in the liver and spleen were significantly higher in the age group under 6 months.