Medicolegal aspects of atypical firearm injuries: a case report.

Our case was a twenty year-old man, who was injured during the military duty with G3 infantry rifle in the training area. An atypical firearm entry wound on the left side of sternum which was 4.5 cm in diameter, and was surrounded by six irregular skin burn wounds by a flash-suppressor and a 0.7 cm diameter firearm exit wound at space on the left midscapular line. Our case emphasizes that the interpretation of properties of these atypical firearm entry wounds need to be carefully assessed by physicians.

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.

Death due to Arrhythmogenic Right Ventricular Dysplasia: A case report.

UNLABELLED: Arrhythmogenic right ventricular dysplasia (ARVD) is both a myocardial disease that predominantly affects the right ventricle (RV) and one of the major causes of sudden death in the young and athletes. A 28-year-old man with no signicant medical history, applied to an emergency department with feeling very ill. After his initial examinations, electrocardiography (ECG) showed ventricular extra systoles and he was recommended for admission to a cardiology polyclinic. The next day, his condition worsened and he was dead on arrival at the hospital. A histological examination of heart samples, which were obtained from the RV and LV, revealed the massive replacement of myocardium by fibrous and mature adipose tissue in the RV. In this case, there were no symptoms, family and medical history and its clinical presentation was as an unexpected sudden death. KEYWORDS: Arrhythmogenic right ventricular dysplasia, sudden cardiac death, autopsy.

Protective effects of catechin and quercetin on antioxidant status, lipid peroxidation and testis-histoarchitecture induced by chlorpyrifos in male rats.

Mature male Wistar rats were given chlorpyrifos (5.4 mg/kg, 1/25 of the oral LD(50)), catechin (20 mg/kg),quercetin (20 mg/kg), catechin plus chlorpyrifos, and quercetin plus chlorpyrifos daily via gavage for four weeks. No statistical differences were found in the catechin-only and quercetin-only groups compared with the control group. By the end of the fourth week, chlorpyrifos alone increased the levels of malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), while decreased glutathione peroxidase (GPx) and glutathione-S-transferase (GST) activities compared with the control group in rat testis tissues. In the catechin-plus-chlorpyrifos and quercetin-plus-chlorpyrifos groups, there were statistically significantly decreased MDA levels, SOD and CAT activities, while increased GPx and GST activities compared with the chlorpyrifos-only group. Light microscopic analyses revealed that chlorpyrifos-only induced numerous histopathological changes in the testis tissues. Milder pathological alterations were observed in rats catechin-plus-chlorpyrifos, and quercetin-plus-chlorpyrifos. Thus, it appears that catechin and quercetin ameliorate chlorpyrifos induced toxicity except histopathological changes in rat testis tissues.

Malathion-induced hepatotoxicity in rats: the effects of vitamins C and E.

Mature male Wistar rats (weighing 300-320 g and each group six animals) were given malathion (27 mg/kg; 1/50 of the LD50 for an oral dose), vitamin C (200 mg/kg)+vitamin E (200 mg/kg), or both daily via gavage for 4 weeks. At the end of the fourth week, the malathion-treated group and the malathion plus vitamin-treated group both had significantly higher white blood cell (WBC) and thrombocyte counts than the control group. Compared to the control group, the two groups also had significantly higher serum total cholesterol, alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) levels, and significantly lower triglyceride and very low density lipoprotein (VLDL) levels. The malathion-treated rats also had significantly lower serum total protein and albumin levels, but the malathion plus vitamin-treated group did not differ from the control group in terms of these parameters. Moreover, concomitant vitamin treatment significantly normalized, at least partially, all of the other hematological and biochemical parameters that were altered by malathion. Light microscopic analyses revealed that both the malathion-treated and malathion plus vitamin-treated groups exhibited histopathological changes in liver tissues, although some pathological features were only observed in the malathion-treated group. Thus, vitamins C and E can reduce malathion hepatotoxicity, although the degree of protection they provide is limited.

A missed diagnosis of the cervical spine fracture. An autopsy case report and literature review.

We report an autopsy case of a 64-year-old man who was injured by a falling tree on his head, caused a cervical spine fracture and the injury was diagnosed by an autopsy. The goal of this study was to analyze the reasons for the missed diagnosis to provide recommendations for the optimal examination of patients with suspected cervical spine injuries (Fig. 1, Ref. 10).

Congenital anomalies of the ribs: an autopsy case report.

We describe a medico-legal autopsy case of a three-day newborn girl. This was the fifth pregnancy of the mother who was 34 years at that time. Her parents were non-consanguineous. There was no family history of congenital abnormalities. Her mother did not smoke or drink and did not recall toxic exposure during the pregnancy. The birth weight and physical examination was normal. The child died postnatal on the third day, with haemoptysis at home. To clarify the exact cause of death, the child was sent to the Council of Forensic Medicine. At the autopsy, in the internal observation, the bilateral first ribs were wide, the sternal extremity of the left second rib was bifid, the eighth ribs were bilaterally connected to the sternum via costal cartilages. Microscopic pathological findings were not found. Analyses of the deceased's blood and urine were negative for drugs. In this case, genetic study was not done. Based on all information available, the cause of death was not definitely determined (Fig. 1, Ref. 9).

Malathion-induced testicular toxicity in male rats and the protective effect of vitamins C and E.

Sexually mature male Wistar rats (weighing 300-320 g and each group 6 animals) were given malathion (27 mg/kg; 1/50 of the LD(50) for an oral dose) and/or vitamin C (200mg/kg)+vitamin E (200mg/kg) daily via gavage for 4 weeks. The sperm counts, sperm motility, sperm morphology, FSH, LH, and testosterone levels, and histopathological changes in the testes of these rats, were investigated at the end of the 4th week. By the end of 4th week, rats given malathion alone, or in combination with vitamins C and E, had significantly lower sperm counts and sperm motility, and significantly higher abnormal sperm numbers, than the untreated control rats. The rats given malathion alone or in combination with vitamins also had significantly lower plasma FSH, LH and testosterone levels than the control rats. Co-treatment of malathion-exposed rats with vitamins E and C had a protective effect on sperm counts, sperm motility and abnormal sperm numbers, but not on plasma FSH, LH and testosterone levels. Light microscopic investigations revealed that 4 weeks of malathion exposure was associated with necrosis and edema in the seminiferous tubules and interstitial tissues. Degenerative changes in the seminiferous tubules were also observed in the rats which received malathion and supplemented with vitamins C and E, but milder histopathological changes were observed in the interstitial tissues. Thus, it appears that vitamins C and E ameliorate malathion testicular toxicity but are not completely protective.

Fine structure and chemical analysis of the metathoracic scent gland secretion in Graphosoma lineatum (Linnaeus, 1758) (Heteroptera, Pentatomidae).

Morphology and ultrastructure of metathoracic scent glands (MTGs) of Graphosoma lineatum (Heteroptera, Pentatomidae) were studied by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Extracts of the volatile fraction of the MTG secretion from males and females were subjected to initial analysis. One pair of the MTG is composed of a reservoir and a pair of lateral glands connected to the reservoir with a duct. MTGs are open in between the meso- and metacoxae, on evaporation areas with a mushroom-like structure. Reservoir walls embody two types of cells, type I and type II, respectively. Cells of type I have numerous organelles, while type II cells have only been found in a certain area of the reservoir wall. They have large secretory ducts lined by a cuticular intima layer. The lateral glands connected to reservoir have two further types of cells. Lateral glands are lined by type A secretory cells and secretory duct is found in their cytoplasm. Type B cells are poor in organelles and are smaller than type A cells. Coupled gas chromatography-mass spectrometry examinations revealed that both in males and females of G. lineatum MTGs 14 chemical compounds occur, among which only 10 are common. These secretions indicate information such as defensive and pheromonal activities, other functions could be attributed to the secretion of the MTG of G. lineatum by comparison with other closely related bug species. In the analyses of MTGs of females of G. lineatum, n-octadecanoic acid was observed at the most and n-undecane was determined at lowest level, while males of G. lineatum n-tridecane was determined at the highest level; and (E)-2-hexenyl acetate has been observed at the lowest.

Malathion-induced oxidative stress in human erythrocytes and the protective effect of vitamins C and E in vitro.

Malathion is an organophosphate (OP) pesticide that has been shown to induce oxidative stress in erythrocytes through the generation of free radicals and alteration of the cellular antioxidant defense system. We examined the effect of several different doses of malathion (25, 75, 200 microM), or malathion in combination with vitamin C (VC; 10 microM) or vitamin E (VE; 30 microM), on the levels of malondialdehyde (MDA), and superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities in human erythrocytes in vitro. Erythrocytes were incubated under various treatment conditions (malathion alone, vitamins alone, or malathion plus vitamin) at 37 degrees C for 60 min, and the levels of MDA, and SOD, CAT and GPx activities, were determined. Treatment with malathion alone increased the levels of MDA and decreased SOD, CAT, and GPx activities in erythrocytes (P < 0.05). There were no statistical differences among VC-treated, VE-treated, or VC + VE-treated erythrocyes, as compared with nontreated control cells. Treatment of cells with malathion + VC, malathion + VE, or a combination of all three agents prevented malathion-induced changes in antioxidant enzyme activity and lipid peroxidation. However, this effect was seen only at low concentrations of malathion (25 and 75 microM), and the combination of VC + VE had a more protective effect than VC or VE alone. These results indicated that the presence of vitamins at concentrations that are similar to the levels found in plasma have no effect on malathion-induced toxicity in erythrocytes at a concentration of malathion (200 microM) that is typically used in pesticides.

[Deaths from electrical current injuries in Bursa city of Turkey]. / Bursa ilinde elektrik akimi ile yaralanma sonucu ölümler.

BACKGROUND: Electrical energy has gained wide acceptance since the middle of 20th century. Rapid progress of industrialization and widespread utilization of electrical appliances lead to many electrical accidents and deaths. Aim of our study was to analyze such injuries with a forensic perspective and to draw conclusions. METHODS: Sixty-three death cases (59 males, 4 females; mean age 32.5+/-12.7; range 5 to 62 years) due to electrical current injury that underwent forensic autopsy between the years of 1996-2003 in Bursa city of Turkey were included into the study. Demographic features, origin of death, scene of the injury, localization of entry and exit lesions were examined. RESULTS: The cases were most common in between 30-39 years of age and 93.7% were male. Sixty-three point five percent of the deaths were occupational accidents. Deaths occurred usually in summer. Although homicidal and suicidal cases were rare in the literature, all of our cases were accidental in origin. CONCLUSION: The physician who performs autopsy should be thoroughly informed about the place of death due to electrocution. It is necessary to solve infra-structural problems, increase security measures and provide training about prevention of electrical injuries.

Pulmonary artery aneurysm rupture.

Pulmonary artery dissection and aneurysms ruptures are rare events, occasionally reported as a cause of sudden death. We report a 27-year-old man who was admitted to the hospital with history of a loss of consciousness and died soon after resuscitation was performed. On autopsy macroscopic examination, 2500 ml partially coagulated blood was found upon opening the right part of chest, also aneurysmal dilatation and intimal rupture of pulmonary artery distal branch were observed. The aim of this case report is to contribute to a better understanding of the pulmonary artery aneurysm rupture as a cause of sudden death and to emphasise its medical and legal importance (Fig. 1, Ref. 11). Full Text (Free, PDF) www.bmj.sk.

Road traffic collisions in Bursa, Turkey, during 2003, 2004 and 2005.

AIM: To highlight the demographic pattern of road traffic injuries in Bursa and to improve emergency care and health facility-based treatment. METHODS: Records of all registered road traffic collisions maintained by the Uludag University Emergency Department in Bursa for the period 2003 to 2005 and trauma files of 1307 road traffic collision victims were examined in this study. A form was designed to document patients' age, gender, type of trauma, time of trauma (hour, day, month and year), type and time to hospital of transport, presence of safety devices, presence of alcohol and blood alcohol concentration, localisations of wounds, trauma scores and outcomes. RESULTS: Of the 1307 cases, 418 (32%) were female and 889 (68%) were male. Ages ranged from 3 months to 87 years; mean age (+/-S.D.) was 34.8 (+/-17.3) years. The mean (+/-S.D.) ages of women and men were 35+/-17.6 and 34.7+/-17.2 years, respectively. Trauma was most commonly sustained within the motor vehicle (72.2%), followed by pedestrian injuries (21.7%), motorcycle injuries (5.5%) and bicycle injuries (0.6%). Collisions were most frequent in summer (34.7%) and on Fridays and weekends (48.5%). Seat belts were used in only 1.8% of incidents. In 90 cases (6.9%) alcohol was found in the blood; mean blood alcohol concentration was 139.2+/-88.3mg/dl. CONCLUSIONS: The identification of RTC characteristics may contribute to the development of injury prevention measures. Road travel requires extra attentiveness at peak accident times. Seat-belt use should increase, as well as use of other safety equipment such as collision helmets. Shorter transportation time of casualties to hospital would improve outcome.

Pericardial lipoma: an autopsy case and review of the literature.

Postmortem examination performed on a 70-year-old man revealed a thinly encapsulated, ovoid, large mass in the right hemithorax. The tumor was attached with its pedicle to the atrioventral pericardium and adjoined the diaphragm with compression of the right lower lobe of the lung. There was no adhesion between the tumor and the surrounding organs. Light microscopy showed a lipoma consisting of mature adipose tissue, and no malignancy was found.

Fine structure and chemical analysis of the metathoracic scent gland of Eurygaster maura (Linnaeus, 1758) (Heteroptera: Scutelleridae).

The morphology and ultrastructure of the metathoracic scent glands (MTG) of Eurygaster maura were studied by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Also, extracts of the volatile fraction of the MTG secretion from males and females were analyzed by capillary gas chromatography-mass spectrometry (GC-MS). In SEM investigations, MTG are composed of a reservoir and a pair of lateral glands connected to the reservoir by a duct. MTG are open in between the meso- and the metacoxae. These areas, called evaporation areas, are composed of mushroom-like elements. In TEM investigations, the reservoir walls contained two types of cells. Generally, a reservoir is lined by a single layer of epithelial cells, type I cells, which have numerous organelles. Type II cells are found only in a certain area of the reservoir wall. These cells have large secretory ducts lined by a cuticular intima layer. The lateral glands are lined by secretory cells and a secretory duct found in their cytoplasm. Nuclei of secretory cells are closed to the basal region of the cells and circular-shaped. In GC-MS investigations, the MTG exhibited a typical scutellerid composition. In general, (E)-2-hexanal, (E)-2-hexenyl acetate, n-tridecane, n-hexanoic acid, octadecanoic acid, and n-dodecane compounds were present, while diisooctyl acetate and 14-Beta-H-Pregna were detected only in the male extracts of Eurygaster maura.

A distant-range, suicidal shotgun wound of the back.

The case being reported is one of a shotgun fatality with a thoracic back wound. A 23-year-old man was shot from a distance with trajectories going from back to front and on a nearly horizontal level. These findings observed in the autopsy could represent homicide, but scene investigation and police records were interpreted and it became clear that the case was suicide. Thus, this case shows that the determination of the manner of death requires a careful forensic investigation including autopsy findings, scene investigation, and reconstruction of the events.

Fatal blunt trauma of the larynx in a child.

We report an autopsy case of an 11-year-old girl who suffered mechanical asphyxia from falling off the metal bars in the playground. This autopsy case is interesting because of the atypical trauma and lesions. To our knowledge there has been no similiar published case reports in the forensic literature. The young age of the victim, the setting and the pattern of the injuries are rare in a fall at playground by a child.

Fatal traumatic heart wounds: review of 160 autopsy cases.

BACKGROUND: Despite many published retrospective analyses on cardiac injuries in treated patients, there is a striking scarcity of population-based studies that include autopsies. OBJECTIVES: To provide data on fatal traumatic heart wounds in autopsied cases. METHODS: We reviewed 2,487 medico-legal autopsy records from the morgue of the Bursa branch of the Turkish Council of Forensic Medicine for the period 1997-2001. RESULTS: Of these cases, 160 (6.4%) had cardiac injury; 13.8% were females and 86.2% males, and the mean age was 35.9 years (range 4-65). The most common cause of heart wounds was penetrating trauma (87.5%), namely sharp injuries (48.1%) and firearm injuries (39.4%). The two most common causes of blunt heart wounds were traffic accidents (5.6%) and falls from a height (5%). Rupture was present in 96.9% of the cases, and isolated left ventricle and isolated right ventricle were ruptured in 31.3% and 23.8%, respectively. In penetrating injury the risk of ventricle rupture was higher than of atrium rupture. Alcohol was detected in 16.3% of cases. Only 3.5% of the penetrating cardiac injury cases and 5% of the blunt cardiac injury cases were admitted to hospital. CONCLUSIONS: Given that only a very low percentage of the patients who sustain cardiac injury reach hospital alive, population-based studies, especially autopsy results, should be conducted to define the characteristics of cardiac injuries.

Diazinon-induced hepatotoxicity and protective effect of vitamin E on some biochemical indices and ultrastructural changes.

Diazinon, an organophosphate insecticide has been used in agriculture and domestic for several years. The aim of present study was to analyze the hepatotoxic effect of diazinon which caused biochemical and ultrastructural changes in adult male Wistar rats and to evaluate the possible protective effect of vitamin E. Vitamin E (200 mg/kg, twice a week), diazinon (10 mg/kg per day, once a day in corn oil) and vitamin E (200 mg/kg, twice a week)+diazinon (10 mg/kg per day, once a day in corn oil) combination were given to rats (n=8) orally via gavage for 7 weeks. Biochemical indices in serum [total protein, albumin, alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol, triglyceride and low density lipoprotein cholesterol (VLDL-cholesterol)] and ultrastructural changes were investigated at the end of the 1st, 4th and 7th weeks comparatively with control group (n=8). It was observed that; at the end of 1st week, there was a statistically significance in all parameters except total protein and albumin, and at the end of 4th and 7th weeks, there was a statistically significance in all parameters when diazinon-treated group compared to control group (P<0.01). At the end of 1st week, ALP, ALT, total cholesterol and triglyceride, at the end of 4th week, all parameters except VLDL-cholesterol, at the end of 7th week, all parameters were statistically significant when vitamin E+diazinon-treated group compared with diazinon-treated group (P<0.01). In our electron microscopic investigations, while swelling of mitochondria and breaking up of the mitochondrial cristae of hepatocytes in diazinon-treated groups were observing, no pathological findings were observed in vitamin E+diazinon-treated groups. We conclude that vitamin E decreases diazinon hepatotoxicity, but vitamin E does not protect completely.

Endosulfan-induced cardiotoxicity and free radical metabolism in rats: the protective effect of vitamin E.

Endosulfan is widely used in insect control and it is absorbed by both humans and animals through ingestion, inhalation and percutaneously. The aim of this work was to study antioxidant enzyme system which include superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) and malondialdehyde (MDA), the end product of lipid peroxidation and ultrastructural changes that might occur in the heart tissue of adult male Wistar rats as a result of endosulfan intoxication. Vitamin E (200 mg/kg, twice a week), endosulfan (2 mg/kg, per day, once a day in corn oil) and vitamin E (200 mg/kg, twice a week)+endosulfan (2 mg/kg, per day, once a day in corn oil) combination were given to rats (n = 10/group) orally via gavage for 6 weeks. SOD, GPx, CAT activities and MDA level increased in the endosulfan-treated group heart tissue compared to control group (P < 0.01, P < 0.01, P < 0.05 and P < 0.01, respectively). SOD, GPx activities and MDA level decreased in the vitamin E + endosulfan-treated group compared to endosulfan-treated group (P < 0.05, P < 0.05 and P < 0.05, respectively). Decrease of CAT activity was not significant statistically in the vitamin E + endosulfan-treated group compared to endosulfan-treated group. CAT activity increased in the vitamin E + endosulfan treated group compared to control group (P < 0.05). Increase of SOD, GPx activities and MDA levels were not significant statistically in the vitamin E + endosulfan-treated group compared to control group. In electron microscopic investigations while cytoplasmic edema and swelling and vacuolization of mitochondria of myocardial cells in endosulfan-treated group was observing, only a weak swelling of mitochondria of myocardial cells in vitamin E + endosulfan-treated group was observed. We conclude that vitamin E significantly reduce endosulfan-induced cardiotoxicity in rats.