Legal and ethical responsibilities of physicians in coercive situations, such as natural disasters.

BACKGROUND: The relationship between the physician and the patient is based on the provisions of the proxy agreement. The attitude of the physician and the legal and ethical responsibilities of this attitude in an event of force majeure, such as severe natural disaster (earthquake), during a risky operation should be discussed. The aim of the present study was to present the opinions of the related professions about the subject and to discuss the subject on an ethical and legal ground. METHODS: A total of 207 volunteers including 121 physicians working at the Cerrahpasa Faculty of Medicine at Istanbul University and 86 lawyers registered at the Istanbul Bar Association completed the questionnaires. Statistical analysis of data acquired from the questionnaires was performed using SPSS 21.0. RESULTS: Of the participants, 76.8% stated that abandoning the patient by the physician considering his/her own safety during a severe natural disaster is ethically problematic. However, 68.1% of the participants stated that physicians would not be facing any criminal sanctions in response to his/her attitude. When the answers from both occupational groups were compared separately, it was found that 26.4% of the physicians and 39.5% of the lawyers stated that the act in question has both legal and ethical liability. CONCLUSION: In the present study, no complete consensus was observed either between or within two occupational groups. It was concluded that the meetings in which the subject is discussed and is based on a concrete ground by both occupational groups should be held.

Role of bite mark characteristics and localizations in finding an assailant.

The location, size, and number of bite marks can be used as a beneficial indicator of the crime type and feasible group of suspects. This study aims to present information about the bite mark locations, the bite mark characteristics, and the perpetrator's profile based on three cases which were carried out by the same biter. The attack bites, which observed in all of the three cases, were characterized by serious wounds and tissue loss. Analysis of bite mark characteristics and bite mark localizations of these three cases by the relevant experts provided helpful information for the police units which searched for the assailant. But, in order to conduct criminal profiling from bite marks objectively, the number of case series is advised to be expanded.

Development of dental charts according to tooth development and eruption for Turkish children and young adults.

PURPOSE: In this study, we aimed to develop dental charts for Turkish children and young adults of both genders within the age group of 4.5-22.5 years according to tooth mineralization and eruption in a format similar to that proposed by AlQahtani et al. MATERIALS AND METHODS: In total, 753 digital panoramic radiographs from 350 males and 403 females were assessed. The permanent teeth were evaluated according to the classification system described by Demirjian et al. The eruption stage was assessed with Bengston's system, which was modified by AlQahtani et al at four points. RESULTS: Teeth generally developed earlier in females than in males. This was particularly notable in the age group of 5-14 years. However, this difference was usually visible in only one stage, not in all teeth. It has been determined that the mixed dentition period ended with the shedding of the second deciduous molars in both genders. CONCLUSION: The dental charts presented here included information that could be beneficial to dental clinicians in making appropriate diagnosis and planning orthodontic and surgical procedures. These charts also provided datasets for preliminary dental age estimation in Turkish children and young adults.

Radiological age estimation: based on third molar mineralization and eruption in Turkish children and young adults.

Radiographic evaluation of mineralization and eruption stages of third molars using dental panoramic radiographies can be an efficient tool for chronological age estimation in both forensic sciences and legal medicine. The third molar tooth is utilized for dental age estimation about the age span of 15-23 years because it represents the only tooth still in development. The aim of this study is to obtain and analyze data regarding third molar development and eruption in Turkish population for dental age estimation. A total of 744 dental panoramic radiographies of 394 female and 350 male subjects aged between 8 and 22 years were examined. Third molar development was determined according to the Nolla classification system, and eruption was assessed relative to the alveolar bone level. Mandibular and maxillary third molars were generally found at similar stages of development on both sides. Nolla stage 6 (completed crown calcification) was reached at around the age of 15 in both maxillary and mandibular third molars in both sexes. Alveolar emergence was at around the age of 16 in males and around age of 17 in females. Although third molars' eruption shows greater variability than development of third molars, data which were obtained from this study about eruption of these teeth can be supportive to development data for age estimation.

Higher prevalence of toxoplasmosis in victims of traffic accidents suggest increased risk of traffic accident in Toxoplasma-infected inhabitants of Istanbul and its suburbs.

Reflexes of drivers who have toxoplasmosis have been shown to deteriorate from the actions of the parasitic cysts. The cysts can change the level of the neurotransmitters such as dopamine in the brain and by doing so extend the muscle response time and change personality profiles. In this study, we aimed to determine the frequency of the latent toxoplasmosis (LT) in the driver population who were either injured or died in traffic accidents reported in Istanbul and its suburbs. We compared the results with a control group and discussed the relationship between the LT and the traffic accidents. We included 218 (89.7%) non-fatal, 25 (10.3%) fatal cases in our study as study groups. A total 243 subjects, 234 (96%) male, 9 (4%) female (who were alcohol negative) compared with 191 (95.5%) male and 9 (4.5%) female subjects (control group) who had a traffic accident before but no history of toxoplasmosis were studied. Serologic tests, enzyme immunoassay (EIA) for IgG and IgM, and microimmunoflorescence (MIF) for IgG were used as the reference test, the Sabin-Feldman Dye test (SFDT) was used. According to serologic test results, LT seroprevalence in the study groups was 130 (53.5%) and in the control group 56 (28%) (p<0.0001). A LT was present in 126 out of 234 (53.8%) males in the study groups, and 54 out of 191 (28.3%) males in the control group (p<0.0001). In the 31-44 year age group, there was a significant difference with regard to toxoplasmosis between the study subjects and control groups (p<0.0001). This difference was statistically very significant in (recent and former) cases with middle-aged men (31-44 years old). The results of this retrospective study suggest that LT in drivers, especially those who are between 31 and 44 years might increase the risk for getting involved in a car accident. In a prospective study, Toxoplasma positive and negative subjects can be monitored before they are involved in a traffic accident to clarify the cause and result relationship.

Image analysis as an adjunct to sodium rhodizonate test in the evaluation of gunshot residues: an experimental study.

It is important to investigate the clothing, as well as the body, to determine the range of fire of entry wounds in firearm injuries. Clothing can affect the amount of gunshot residues (GSR) reaching the body and their distribution. The amount and distribution of the GSR also vary according to the distance between the firearm and the target. Sodium rhodizonate test provides valuable data when clothing is available for examination. In the absence of clothing, light microscopic examinations may add additional information regarding the range of fire. In this study, a sodium rhodizonate test was done on 80 garment samples containing the bullet entrance. The 80 calfskin samples were processed histologically and were stained using Alizarin Red S. These were also evaluated with computer-assisted image analysis. Gross residues were seen on military camouflage clothing in samples from < or = 45-cm group. White flannel undershirts under the military camouflage contained rhodizonate-positive particles only around the contact wounds. With image analysis, however, the residues could be detected also in the skin samples of the 2.5-cm- and 5-cm-range groups. We suggest that the image analysis can be combined with other techniques and it can provide valuable data in the determination of entry wounds and also in the estimation of firing distance.

Sudden death in infancy due to bicuspid aortic valve.

Symptoms of bicuspid aortic valve usually occur in the age group of 50-70 years, but rarely, it can also lead to sudden unexpected death in infancy and early childhood. The autopsy of a 2-month-old baby boy, found dead in his cot, revealed the heart weight as 25 g, and the macroscopic examination showed the circumference of the aortic valve consisting of two leaflets as 8 mm. The thickness of the left ventricle, right ventricle, and septum was measured as 8, 7, and 10 mm, respectively. Microscopically, the heart revealed hypertrophic changes of myocytes. Subendocardial areas displayed necrosis of myocytes, and severe and diffuse ischemic changes characterized by loss of myofibers and vacuolization. Interstitial pneumonia was identified in the lungs. Death occurred as a result of a congenital bicuspid aortic valve obstructing the left ventricular outflow tract complicated by lung infection. As there are only a few reported cases in infancy, and congenital bicuspid aortic valve can lead to sudden unexpected death, this case is presented to the forensic community.

Estimation of stature from upper extremity.

With the increasing frequency of mass disasters, identification of an isolated upper extremity and determination of the stature of the person it belonged to have created problems for investigation of the identity of some victims. Despite a need for such a study, there is a lack of systematic studies to identify fragmented and dismembered human remains. The purpose of this study was to analyze anthropometric relationships between dimensions of the upper extremity and body height. Analyses were based on a sample of middle class male (n = 202) and female (n = 108) Turks residing in Istanbul, Turkey. Five variables were entered into the analyses. For male subjects, forearm length was selected as the first factor, followed by hand length and finally upper arm length. For female subjects, upper arm length was selected first, followed by forearm length and finally hand length. There were also individually calculated formulae for some of these measurements that provided smaller R2 values. The study suggested that estimation of a living height could be made possible by using various dimensions of the upper extremity. One must consider differences between populations to apply such functions to other populations.

Subvalvular aortic stenosis as a cause of sudden death: two case reports.

Sudden death is defined as a death that occurs suddenly, develops during an unpredictable course, and is due to natural or unnatural causes. Although there is no universally standardized definition on how "sudden" a sudden death is, WHO defines sudden death as a death that occurs within 24 hours after the onset of symptoms. The aim of this study is to present 2 rarely reported autopsy cases and to emphasize the importance of systemic autopsy at sudden death. On macroscopic examination, crescent-shaped, thick, fibrous membranes, located 5 mm and 3 mm away from the aortic valves, were detected. Fibrous membranes extended from the ventricular septum to the left ventricular outflow tract, thus apparently narrowing this region. Left ventricular wall and septum were slightly thickened, and there were scattered grayish-white areas of a small diameter. These became more intense in the septum and myocardium of the left ventricle on the anterior plane of the myocardial sections. In both cases, the aortic valves of were thickened and also markedly narrowed on one of them. In this case, the fibrous membrane adhered to the aortic valve and extended to the anterior leaflet of the mitral valve at one side. Both aortic valves comprised 3 leaflets. Other valves and coronary arteries showed no macroscopic pathologic findings. Microscopic examination of both cases demonstrated that the fibrous membrane comprising abundant collagen fibers was situated on the ventricular septum. Hypertrophy, moderate to severe interstitial fibrosis, and focal areas of scarring were observed in the specimens taken from the septal and ventricular myocardium. No abnormality was found on the conduction system examinations. Toxicologic analysis results in blood were negative. Based on the findings, membranous-type (discrete type) subvalvular aortic stenosis, diagnosed during the autopsy, was considered as the cause of sudden death in both cases.

Estimation of stature from body parts.

Anthropometric technique commonly used by anthropologists and adopted by medical scientists has been employed to estimate body size for over a hundred years. With the increasing frequency of mass disasters, the identification of an isolated lower extremity and the stature of the person it belonged to has created problems for the investigation of the identity of some of the victims. In spite of a need for such a study, there is a lack of systematic studies to identify fragmented and dismembered human remains. The purpose of the paper is to analyze anthropometric relationships between dimensions of the lower extremity and body height. Analysis is based on a sample of middle class male (N=203) and female (N=108) adult Turks residing in Istanbul. The participants are mostly students and staff members of a medical school, and military personnel. Measurements taken are stature, trochanteric height, thigh length, lower leg length, leg length, and foot height, breadth, and length. Of the five variables entered into the regression analysis, all but foot breadth participate in the analysis with leg length as the first and followed by thigh and foot lengths, and finally foot height in males (R(2)). There were also individually calculated formulae for some of these measurements which provided smaller R(2)-values. Student's t-test to assess if there was any intraobserver error in measurements take by individual anthropometrist did not show such any statistically significant difference. In conclusion, the study suggested that estimation of a living height can be made possible using various dimensions of the lower extremity. One must consider differences between populations in order to apply functions as such to others.