Kamil Hakan Dogan

Forensic medicine explores the legal aspects of medicine, and medicolegal investigation of death is the most significant and crucial function of it. The nature of post mortem examinations are changing and the understanding of causes of death are evolving with the increase of knowledge, availability, and use of various analyses including genetic testing. Postmortem examination practice is turning into a more multidisciplinary approach for investigations, which are becoming more evidence based. Although there are numerous publications about forensic medicine and post mortem examination, this book aims to provide some basic information on post mortem examination and current developments in some important and special areas. It is considered that this book will be useful for forensic pathologists, clinicians, attorneys, law enforcement officers, and medical students.

Handling livestock is a dangerous activity. Few farm people look upon their livestock as a source of danger. However, a number of serious injuries and deaths occur every year as a result of animal-related accidents. Livestock handlers are involved in a variety of activities such as feeding, moving animals to different locations, loading animals on trucks/trailers, artificial insemination, shearing, grooming, basic animal care such as hoof care, dehorning, and cleaning animals, roping animals, applying topical insecticides, giving vaccinations, applying topical or administering oral medications, castrating, pulling teeth, ear tagging, milking, branding, shoeing, assisting with delivery of newborns, and assisting veterinarians with treatment or handling of injured animals. Other activities involving animals may include work tasks such as plowing fields; pulling equipment such as wagons to transport farm goods; riding animals, primarily horses, for farm or ranch activities such as corralling cattle; teaching others to ride; butchering animals for food; and, rarely, euthanizing or destroying sick or aggressive animals.

Asfiksi kelimesi Yunanca kökenli olup, “nabzın alınamaması-nabzın yokluğu” anlamına gelir.
Atmosfer havasında O2 %18-21 arasındadır. Bu oranın %12-16’ya düşmesi ciddi tehlike oluşturur. Yüzde beşe inmesi ani bilinç kaybı ve ölüme yol açar. Asfikside ana sorun, dokuların ani ve derin oksijen yetmezliğidir. Yetişkin bir insanda arter kanında pO2 ortalama 80-98 mmHg, pCO2 ise 40 mmHg’dır. Altmış yaş üstü kişilerde ise pO2 60-85 mmHg’dır. Genel olarak pO2’nin 60 mmHg dan düşük, pCO2’nin ise 50 mmHg dan fazla değerde olması “hipoksi” olarak kabul edilir ve solunum yetmezliğine yol açar.
Solunum sürecinde, fizyolojik olarak dört büyük mekanizma yer alır.
Bunlar:
• Havanın atmosferle akciğer alveolleri arasında girip çıkışından ibaret olan pulmoner ventilasyon,
• Oksijen ve karbondioksitin alveollerle kan arasındaki difüzyonu,
• Kan ve vücut sıvıları ile oksijenin hücrelere ulaşması ve hücrelerde oluşan karbondioksitin
uzaklaştırılması (perfüzyon).
• Ventilasyon ve solunum ile ilgili öteki faaliyetlerin regülasyonudur.
Bu mekanizmalar temel alınarak asfiksi ölümlerini şöyle sınıflayabiliriz:
I. Kanın akciğerde yeterince oksijenlenemediği ya da total oksijensizlik sonucu meydana gelen ölümler
A) Solunan havanın bileşim bozukluğu
a. Oksijenin azaldığı, yerine diğer gazların arttığı durumlar (yangın, duman, kuyu ve sarnıç gibi ortamlarda bulunma, havada (uçak) ya da denizde ani yer değiştirmeler vb)
b. Havanın normal bileşimde olmasına rağmen diğer gazların arttığı durumlar (havagazı, bütan gazı vb)
B) Mekanik olarak solunum pasajının kapandığı durumlar
a. Eksernal orifislerin kapanması (ağız ve burun deliklerinin kapanması)
b. Hava yollarının kapanması (suda boğulma, yabancı cisim aspirasyonu, elle-bağla boğma, ası, boyun kilidi, boyun hiperfleksiyonu)
C) Toraks ve karnın eksternal kompresyonu (karın göğüs basısı, diri gömülme)
D) Solunum hareketlerinin durması (elektrik çarpması, süksinil kolin, kürar, organik fosfat, botulism gibi zehirlenmeler, yüksek oranda metan, propan, karbondioksit, barbitürat, opium alımı)
II. Kanın oksijen taşıma kapasitesinin azalmasına bağlı ölümler: Anemik tip (akut masif hemorajiler, akut karbonmonoksit, hidrojen sülfid, nitrit entoksikasyonlarında olduğu gibi).
III. Dokulara birim zamanda ulaşan oksijen miktarının akut olarak azalmasına bağlı ölümler: Stagnant, staz tipi (şoklarda olduğu gibi).
IV. Dokuların oksijeni almaması ya da oksidatif süreçlerin deprese edilmesi (histotoksik hipoksi ve histotoksik anoksi): Kan dolaşımında yeterli miktarda oksijen bulunmasına karşın, bunun dokular tarafından kullanımı bozulmuştur.
a. Ekstrasellüler tip: Enzim sistemleri inhibe olur. Siyanür zehirlenmesinde, sitokrom oksidaz enzim sistemi inhibe olur.
b. Perisellüler tip: Hücrenin membran permiabilitesindeki azalma nedeni ile oksijen hücreye geçemez. Kloroform, halotan gibi halojenli hidrokarbon içeren, lipidlerde eriyen anestezik maddeler bu tip hipoksiye yol açar.
c. Substrat madde eksikliğine bağlı tip: Hücrelerde etkili ve metabolizma için gerekli maddelerde eksiklik vardır. Örnek: Serebral iskemi.
d. Metabolit maddelerin birikmesinin etkili olduğu tip: Hücre solunumundan açığa çıkan ürünlerin atılamaması nedeniyle metabolizmanın engellenmesi. Örnek: Üremi, CO2 zehirlenmesi.

Medical expertise is crucial in death investigations. It begins with body examination and evidence collection at the scene and proceeds through history, physical examination, laboratory tests, and diagnosis – in short, the broad ingredients of a doctor’s treatment of a living patient. The key goal is to provide objective evidence of cause, timing, and manner of death for adjudication by the criminal justice system. Death investigation has been performed for centuries in all societies, although not always by medical professionals (Committee, 2003). The association of law and medicine dates back to the Egyptian culture as early as 3000 B.C. The English coroner system was mentioned in documentations around the 12th century B.C. (Spitz, 2006).
Although the primary goal of a death investigation is to establish the cause and manner of death, the role of the death investigation extends much further than simply answering these two questions. A common question asked is, “Why does it matter? The person is dead.” While it is true that the dead cannot benefit, the value in death investigation is to benefit the living and future generations. In a culture that values life, explaining the death in a public forum (the meaning of “forensic”) is crucial for many reasons. And this interest goes beyond simple curiosity (Wagner, 2009).
In homicide, suspected homicide, and other suspicious or obscure cases, the forensic medicine expert should visit the scene of the death before the body is removed. Local practice varies but any doctor claiming to be a forensic medicine expert should always make himself available to accompany the police to the locus of the death. This duty is often formalized and made part of a contract of service for those forensic medicine experts who are either full-time or substantially involved in assisting the police, in England and Wales, the 'Home Office Pathologists' are permanently on call for such visits and in many other jurisdictions, such as the medical examiner systems in the USA, and the European State and University Institutes of Forensic Medicine, there is usually a prearranged duty roster for attendance at scenes of death (Saukko & Knight, 2004). In many cases, the scene investigation is more important than the autopsy. A thorough and complete investigation commonly leads to the proper diagnosis of the cause and manner of death prior to an autopsy (Avis, 1993; Dix & Ernst, 1999).
Why go to the scene? The purpose of having the forensic medicine expert attend the death scene is severalfold. By viewing the body in the context of its surroundings, the forensic medicine expert is better able to interpret certain findings at the autopsy such as a patterned imprint across the neck from collapsing onto an open vegetable drawer in a refrigerator. The forensic medicine expert is also able to advise the investigative agency about the nature of the death, whether to confirm a homicide by a specific means, evaluate the circumstances to be consistent with an apparent natural death, or interpret the blood loss from a deceased person as being more likely due to natural disease than to injury. This preliminary information helps the investigative agency to define its perimeter, structure its approach, organize its manpower, secure potentially important evidence, and streamline its efforts.
Nonattendance at death scenes has been regarded as one of the classical mistakes in forensic pathology. Hospital pathologists performing forensic autopsies who are not trained to, or able to, attend death scenes should be provided with information on how, when, and where the body was found, by whom, and under what circumstances. In some deaths, the immediate environment does not contribute to death, such as in cases of metastatic breast carcinoma. In other cases, the environment plays a role although it does not cause the death; for example, consider a case in which a person with marked coronary atherosclerosis collapses with a dysrhythmia while shoveling snow. On the other hand, the scene description and scene photographs are critical in documenting that the physical circumstances and body posture are indicative of death due to positional asphyxia because the autopsy in these cases may yield very few findings. The most meticulous autopsy in all academia will provide only a speculative cause and manner of death in a 30-year-old man with a negative history, negative toxicology, and autopsy findings of visceral congestion.
Yet at the scene, a screwdriver is next to an uncovered electrical outlet on a rain-soaked patio at the decedent's house, which is undergoing renovation. The cause and manner of death are provided by the scene (Lew & Matshes, 2005).
The examination of a death scene and subsequent collection of potential evidential material requires special skill, knowledge, aptitude, and attitude. The manner in which a death scene investigation is conducted may be a critical factor in determining the success of an investigation. The thorough examination of a death scene requires a disciplined and systematic approach to recording the various observations made and collection of potential evidential material. This must be combined with the analysis of various observations and the interrelationship of potential evidentiary material (Horswell, 2005a).
If resources are sufficient and the circumstances of death so dictate, it is ideal for a forensic medicine expert to perform a scene investigation. This is particularly relevant if the body remains at the scene of death, and has not been transported to the hospital during attempts at resuscitation; however, a scene investigation can be vitally important and provide valuable information even if the body has been transported to the hospital. If a body is pronounced dead at the scene (as opposed to after transport to the hospital), many death investigation systems require a scene investigation. Others have various protocols as to which case types absolutely require a scene investigation (whether or not the body is present at the scene). Case types that should always have a scene investigation include all confirmed or suspected homicides, suicides, accidents, child deaths, traffic-related deaths, in-custody deaths, and workplace-related deaths (Prahlow, 2010).
Death scene investigation may include a combination of the following types of incidents and examinations:
• Accidental deaths, which include a multitude of circumstances, including misadventure
• Suicidal deaths, which include a multitude of circumstances
• Homicidal deaths, which include a multitude of circumstances
• Sudden deaths, with or without suspicious circumstances
• Difficult victim identification, which includes mummification and putrefaction
• Disaster victim identification dealing with multiple casualties (Horswell, 2005a)
This chapter will focus on the steps of death scene investigation and some real cases will be analyzed.

Amaç: Çocukluk çağında meydana gelen ölümler içerisinde, kaza orijinli zehirlenmeler önemli bir yer tutmaktadır. Çoğunlukla evlerde bulunan ilaçlar ya da toksik maddelerin kazara alınması ile meydana gelen zehirlenmeler, bazen ölümle sonuçlanabilmektedir. Bu çalışmada, Konya’da ölü muayene ve otopsi işlemi yapılan 5 yaş ve altındaki kaza orijinli zehirlenme olgularının demografik özellikleri, zehirlenme türleri, zehirlenmenin meydana geldiği yer, ölüm yeri, ölüm hastanede meydana gelmişse hastanede yatış süresi gibi özelliklerinin ortaya konulması amaçlanmıştır. Gereç ve Yöntemler: Bu amaçla, Konya Adli Tıp Şube Müdürlüğü tarafından 2000-2007 yılları arasında otopsisi yapılan olgular retrospektif olarak incelenmiş, 5 yaş ve altında olduğu tespit edilen 22 kaza orijinli zehirlenme olgusu çalışmaya dahil edilmiştir. Bulgular: Olguların yaşları 1 ile 5 arasında değişmekte olup, ortalama yaş 2.96 ± 1.32 bulundu. 9 olgunun erkek, 13 olgunun kız çocuğu olduğu saptandı. 8 olgunun karbonmonoksit zehirlenmesi, 3 olgunun insektisit içme, 3 olgunun mantar yeme, 2 olgunun temizlik maddesi içme, 1’er olgunun ise ilaç içme, naftalin yeme, oksijenli su içme, acı kayısı çekirdeği (siyanür) yeme, gazyağı içme ve çatapat (sarı fosfor) yeme neticesinde öldüğü
belirlendi. Karbon-monoksit ile zehirlenen olguların tamamının olay yerinde hayatını kaybettiği, diğer toksik maddeleri alan olguların tamamının ise, 4’ü aynı gün olmak üzere, hastanede kaybedildiği anlaşıldı.
Sonuç: Ülkemizde sonbahar-kış ayları döneminde belirgin artış gösteren karbonmonoksit zehirlenmesine bağlı ölüm olgularının önlenebilmesi için halka açık iletişim araçları ile soba, mangal, ocak gibi araçların bilinçli kullanımı konusunda düzenli eğitim verilmesinin önemli olduğunu düşünüyoruz. Ayrıca başta kostik maddeler ve ilaçlar olmak üzere, ölümle sonuçlanabilen zehirlenmelere yol açan tüm kimyasal maddelerin evlerde çocukların ulaşamayacakları yerlerde ve orijinal kutularında muhafaza edilmesi konusunda ebeveynlerin eğitilmesinin faydalı olacağı kanaatindeyiz.

Objective: Among the deaths occurred in childhood, accident originated poisoning cover an important place. The poisonings are generally occurred as a result of taking the drugs or toxic materials by mistake and this sometimes causes deaths. In this study, it is aimed to determine the demographic features, poisoning types, the place where poisoning took place, death place, if death occurred in hospital, the duration of hospital stay of the accident originated poisoning cases at the age of five and under it whose dead examinations and autopsies performed in Konya. Material and Methods: The cases whose autopsies were performed by Konya Forensic Medicine Branch between 2000 and 2007 were retrospectively examined and 22 cases with accident originated poisoning at the age of and below five were included into the study. Results: The age range of the cases was between 1 and 5 and mean age was found as 2.96 ± 1.32. The sexes of the cases were defined as 9 male and 13 female. It was defined that 8 of the cases died of carbon monoxide poisoning, 3 of the cases of drinking insecticide,3 of the cases died of eating mushroom, 2 of them of drinking cleaning material, 1 of them drinking medicine, eating naphthalene, drinking hydrogen peroxide,  eating cyanide, drinking gas eating firework cracker. It is understood that all the cases poisoned by carbon monoxide died at the crime scene, where as all the other cases that take toxic material lost their lives at hospital, four of whom died the same day. Conclusion: We think that it is vital to teach the public to use the stoves consciously through mass media in order to prevent the accidents related to carbon monoxide poisoning especially in fall and winter when there is a high potential of using the heating utilities such as stoves, barbecue and fireplace. We also believe that the parents should be educated on keeping the chemicals, such as caustic materials and medicine that cause poisoning resulted in death, out of the reach of the children at home.

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 AE 2.9 ng/mL vs. 5.4 AE 2.0 ng/mL), and serotonin levels were lower (10.4 AE 4.9 ng/ mL vs. 19.0 AE 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.

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.

Katiller, kurbanlarını ortadan kaldırmak ya da tanınmalarını engellemek amacıyla zaman zaman cesedi yakmak, ıssız yerlere gömmek, denize ya da akarsuya atmak gibi yöntemler uygulamaktadır. Bu tür olgularla karşılaşıldığında, ölümün üzerinden ne kadar süre geçmiş olursa olsun, çok dikkatli ve ayrıntılı bir otopsi yapılmalı, kimlik tespiti ve ölüm nedenine yönelik tüm bulgular değerlendirilmelidir.
Bu çalışmada, 2000-2008 yılları arasında Konya Adli Tıp Şube Müdürlüğü tarafından Konya il merkezinde ve adli tıp uzmanı tarafından Konya’ya bağlı ilçelerde öldürüldükten sonra cesetleri yakılan olgular değerlendirilmiştir. İncelemeye alınan dönemde toplam 10 olgu tespit edilmiştir. Olguların yaşları 16 ile 58 arasında değişmekte olup, ortalama yaş 35±13 bulunmuştur. Cinayet yöntemleri açısından değerlendirildiğinde; bağla boğma üç olgu ile en fazla kullanılan yöntemdir. Altı olgu açık arazide yakılmıştır.
Yangın ortamından çıkartılan ya da dış ortamda yanmış halde bulunan cesetlerle karşılaşıldığında, kişinin yanığa ölümden önce mi yoksa sonra mı maruz kaldığının araştırılması önem taşımaktadır. Eğer kişi önce öldürülmüş, daha sonra yakılmış ise otopside solunum yollarında hiperemi ve konjesyon, is ve kurum bulaşıkları gibi yaşam sırasında yanığa maruz kalma sırasında ortaya çıkabilecek bazı özellikler görülmemektedir. Bu tür olgularda orijin tespiti için, tam ve doğru bir olay yeri incelemesi ve ayrıntılı bir otopsi yapılmalı, kimlik tespiti için genetik inceleme yapılmalı ve gerçek ölüm nedeni ortaya konmalıdır.

Killers are applying such methods like burning, burying to deserted places and throwing into the sea or the rivers the corpses in order to eliminate corpses of the victims of homicide or to avoid recognition of the victims of homicide. If such cases are encountered, regardless of how much time passed out of death, the autopsy must be done in detail and very carefully and all findings should be evaluated for identification and cause of death.
In this study, victims who were burned after homicide and whose autopsies were performed by the Directorate of Konya Branch of Forensic Medicine Konya in Konya city center and in districts of Konya by a forensic expert districts between 2000-2008 were evaluated. A total of 10 cases were identified during the period under examination. The age of victims ranged between 16 and 58 and the average age was 35 ± 13. In terms of murder methods, the most commonly used method was ligature strangulation in three cases. Six victims were burned in open land.
If burnt corpses are extracted from fire or encountered at the external environment, it should be investigated that the victim suffered the burns before or after death. If the person is first killed and then burned, hyperemia, congestion and soot in the respiratory tract may not be observed at autopsy which may arise with exposure to burn during the life. For the determination of the origin in such cases a complete and accurate death scene investigation and a thorough autopsy should be performed, genetic analysis should be done for the identification and the cause of death of has to be determined.

Etik, iyi ve kötünün araştırılması, yeni ilkelerin ve kuralların geliştirilmesi, yükümlülük, toplumsal sorumluluk gibi kavramların değerlendirilmesi olarak tanımlanmaktadır. Hekimlerin, mesleki uygulamaları ile ilgili güncel etik ve hukuki kavramları bilmesi son derece önemlidir. Hekim-hasta ilişkisindeki etik ilkeler, çocuk hastalardan aydınlatılmış onam alınması, kardiyopulmoner resüsitasyon (CPR), resüsitasyon girişiminin ne zaman sonlandırılması gerektiği, resüsitasyon sırasında ailenin bulunması ve aileye duygusal destek sağlanması, kötü haberin kim tarafından, nerede ve nasıl verileceği gibi konular pediatrik anestezi alanında uygulamada ihtiyaç duyulacak etik ve hukuki kavramlar içerisinde yer almaktadır.

Ethics is defined as investigation of good and bad, the development of new principles and rules, evaluation of liabilities, concepts such as social responsibility. It is extremely important for physicians to know current ethical and legal concepts related to their professional practices. Topics such as ethical principles in  physician-patient relationship, informed consent of child patients, cardiopulmonary resuscitation (CPR), when the resuscitation attempts should be terminated, family presence during resuscitation and emotional support of family, by whom and where bad news will be given are within ethical and legal concepts which will be needed in the field of pediatric anesthesia practice.

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.

Doğal kannabis (Δ9-THC, tetrahidrokanabinol) hint keneviri bitkisinden (Cannabis Sativa) elde edilir ve CB1, CB2 olarak ifade edilen kannabinoid reseptörler üzerine etki eder. Kannabisin tedavi edici etkileri çok eskiden beri bilinmektedir. Günümüzde tıbbi amaçla kullanılan kannabinoid içeren bazı ilaçlar bulunmaktadır. Sentetik kannabinoidlerin kimyasal yapısı doğal kannabisten oldukça farklıdır. Kannabinoid reseptör afiniteleri ve aktiviteleri doğal kannabisten yüksektir. Sentetik kannabinoid içeren maddeler genel olarak yurdışında “Spice”, “K2”, Türkiye'de ise “Bonzai” ya da “Jamaika” olarak adlandırılmaktadır. Sentetik kannabinoidleri içeren bitkisel karışımların bazı ülkelerde “head shop” ve “smart shop” denilen yerlerde yasal olarak satılması ve bunlara internetten kolayca erişilebilmesi kullanıcılar için çekici bir özelliktir. Ayrıca kannabisten daha güçlü bir etki, ekonomiklik, kolay ulaşılabilirlik ve standart madde testlerinden kurtulması, sentetik kannabinoidlerin artan kullanımına katkıda bulunmaktadır. Sentetik kannabinoidlerin referans standartları bulunmadığından tespit edilmeleri kolay değildir. Yasal engelleri aşabilmek için piyasaya sürekli olarak yeni kannabimimetik analoglar sunulmaktadır. Sentetik kannabinoid kullanımındaki artış göz önünde bulundurulduğunda, yakın zamanda en problemli uyuşturucu maddelerden biri olacağı öngörülmektedir. Sentetik kannabinoidlerin yaygın kötüye kullanımı nedeniyle, farmakoloji ve toksikolojilerinin daha iyi tanımlanması ve uygun yasal planlama ile düzenlemelerin yapılabilmesi için daha ileri düzeyde incelenmelerine gerek duyulmaktadır.

Natural cannabis (Δ9-THC, tetrahydrocannabinol) is obtained from Indian hemp plant (Cannabis sativa) and it acts on cannabinoid receptors expressed as CB1, CB2. The therapeutic effects of cannabis are known from far away times. At the present time, some drugs containing kannabinoid are used for medical purposes. Synthetic cannabinoids' chemical structure is quite different than natural cannabis. Cannabinoid receptor affinity and activity are greater than the natural cannabis.  Substances containing synthetic cannabinoids are generally called “Spice”, “K2” abroad and, “Bonzai” or “Jamaica” in Turkey. Legal sale of herbal mixtures containing synthetic cannabinoids at places called “head shop” and “smart shop” in some countries and having easily access to them from the internet is an attractive feature for users. Moreover the impact stronger than cannabis, affordability, easy accessibility and getting rid of standard material tests contribute to increasing use of synthetic cannabinoids. As there is absence of reference standards of synthetic cannabinoids, it is not easy to identify them. In order to overcome legal barriers, new cannabinomimetic analogs are presented to market constantly. When taking into consideration of the increase of the use of synthetic cannabinoids, it is expected to be one of the most problematic drugs in the near future. Due to the widespread abuse of synthetic cannabinoids, further investigation of these substances is needed for better identification of their pharmacology and toxicology and to make appropriate legal planning and arrangements.

Karbonmonoksit (CO), tam olmayan yanma ürünü olarak oluşan renksiz, kokusuz, havadan hafif ve irritan olmayan bir gazdır. Bu gaz ile  zehirlenmeye, genellikle bacası uygun olmayan sobalar veya kapalı ortamda yakılan mangal gibi ısıtıcılara bağlı olarak kış aylarında rastlanır. CO zehirlenmesi ciddi seyreden bir durum olup, ölüm ya da ağır nörolojik bozukluklarla sonuçlanabilir. Nadir olarak CO zehirlenmesinde, akut  tedavi sonrası kısa süreli iyileşme dönemi ardından, geç nörolojik sendrom ortaya çıkabilir. Bu sendromda, tipik kraniyal bilgisayarlı tomografi veya manyetik rezonans görüntülerinde (MRG) subkortikal beyaz cevherde, özellikle bazal ganglionlarda hiperintens lezyonların eşlik ettiği çeşitli nörolojik ve/veya psikiyatrik belirtiler görülmektedir. Bu hastalarda MRG'deki beyaz cevher değişikliklerinin yaygınlığı ile olguların prognozları yakın ilişkilidir. Bu çalışmada, CO zehirlenmesi sonrası gelişen geç nörolojik sendrom bulgusu olarak kraniyal MRG'de T2 ağırlıklı görüntülerde periventriküler hiperintensite varlığı saptanan 65 yaşında kadın olgu sunulmuştur. CO zehirlenmesinin akut dönemde ciddi zararları olduğu bilinmektedir. Bu olgularda, olaydan yaklaşık bir ay sonra, olgumuzda da tanımlanan geç nörolojik sendrom bulgularının ortaya çıkabileceği akılda tutulmalıdır. Bu nedenle hastaların düzenli takiplerinin yapılması ve adli rapor açısından yeniden değerlendirilmesi gerekmektedir.

Carbon monoxide (CO) is a colorless, odorless, and non-irritant gas occurring as a product of incomplete combustion and it is lighter than air. Intoxication with this gas is usually seen during the winter months depending on unsuitable chimney stoves or heaters burned as charcoal in a closed environment. CO intoxication is a serious condition, it can result in death or severe neurological disorders. In rare cases of CO intoxication, after the shortterm recovery period after acute treatment, late neurological syndrome may develop. In this syndrome, a variety of neurological and/or psychiatric symptoms accompanied by  hyperintense lesions in the subcortical white matter especially in the basal ganglia in typical cranial computed tomography and magnetic resonance imaging (MRI) are observed. Prognosis of patients is closely associated with white matter lesions on brain MRI. In this study, the presence of periventricular hyperintensity on T2-weighted images in cranial MRI as late neurological syndrome sign that developed after carbon monoxide intoxication in a 65 year old female patient is presented. It is known that CO poisoning has serious harms in the acute period. In these cases it should be kept in mind that, as defined in our case, late neurological syndrome symptoms may occur after about a month from intoxication. Therefore, regular follow-up of patients should be performed and they need to be reevaluated in terms of forensic reports.

Isırık, hayvan ya da insan dişleri ile oluşturulan yaralanma türüdür. İnsanlar tarafından oluşturulan ısırık yaraları ile kavga, tecavüz, cinayet ve çocuk istismarı gibi durumlarda karşılaşılmaktadır. Isırık izleri genellikle kollar, boyun, göğüsler, gövde, yanaklar ve bacaklarda görülmektedir. Altında kemik ya da kıkırdak dokusunun yer aldığı bölgelerde dişler cilde penetrasyon gösterir ve doku kaybı meydana gelebilir. Isırık ile doku kaybının en sık meydana geldiği bölgeler kulak kepçeleridir. İnsan ısırığı ile parmak amputasyonu ise son derece nadir karşılaşılan bir durumdur. Bu yazıda sunulan olgu 28 yaşında erkektir. İki ay önce kavga esnasında sol el orta parmağının ısırılma öyküsü vardır. Yapılan muayenede, sol el 3. parmak distal falanks uç kısmında doku kaybı nedeniyle yaklaşık 1 cm'lik kısalık tespit edilmiştir. Çekilen sol el grafisinde 3. parmak distal falanks orta kısımdan itibaren kemik defekti olduğu görülmüştür. Olgu, literatürde nadir olarak bildirilen benzer olgular ile karşılaştırılarak tartışılmıştır.
Bite is a type of wound created with animal or human teeth. Bite wounds created by humans are encountered in situations as fighting, rape, murder and child abuse. Bite marks are usually observed on arms, neck, breasts, body, cheeks and legs. The teeth may penetrate to skin on the areas where bone or cartilage tissue lies underneath skin, and tissue loss may occur. Auricles are most frequent regions that occur tissue loss with bites. Finger amputation occurring with human bite is extremely rare. The case presented in this paper is a 28 years old man. In his medical history, the 3rd finger of his left hand was bitten during a fight two months ago. One centimeter shortness at the end point of the distal phalanx of the left 3rd finger because of tissue loss was found in the
examination. In his left hand radiograph, bone defect at the middle part of the distal phalanx of 3rd finger was determined. The case has been discussed by comparing similar cases rarely reported in the literature.

Amaç: Kardiyovasküler sistemde kalp dışından köken alan ve ani ölüme neden olan hastalıklar arasında ilk sırada anevrizma rüptürleri yer almaktadır. Aort anevrizması, aort duvarının anormal genişlemesi ile ortaya çıkan, damar şeklini ve kan akışını bozan bir hastalıktır. Genişlemeyle birlikte aort giderek zayıflar, diseksiyon, rüptür ve hatta ölümle sonuçlanabilir. Bu çalışmada, torasik damar duvarı (cidarı) anevrizma rüptürüne bağlı ölümlerin değerlendirilerek literatür bilgileri ışığında tartışılması amaçlanmıştır. Gereç ve Yöntemler: Konya Adli Tıp Şube Müdürlüğünce Konya il merkezinde ve adli tıp uzmanı tarafından Konya’nın ilçelerinde 2000-2008 yılları arasında otopsisi yapılan ve ölümü torasik aort anevrizma rüptürüne bağlı olan 26 olgu demografik özellikleri, anevrizma yeri, rüptür yeri, rüptür büyüklüğü ve eşlik eden sistemik hastalıklar, anomaliler ve sendromlar gibi özellikler açısından değerlendirilmiştir. Bulgular: Olguların yaşları 16-71 yıl arasında olup, ortalama yaş 44,9±16,6 yıl olarak bulunmuştur. Olguların 17 (%65,4)’sinde tip II aort diseksiyonu mevcut iken, olguların 22 (%84,6)’sinde rüptürün asendan aortada olduğu görülmüştür. On beş (%57,7) olguda aort anevrizmasına, hipertansiyon, koroner arter hastalığı, kronik obstrüktif akciğer hastalığı, hiperlipidemi gibi hastalıkların eşlik ettiği tespit edilmiştir. Sonuç: Torasik aort anevrizması, çoğu kez önceden semptom vermemesi nedeni ile tanı konulamayan ve rüptüre olduğunda çok kısa süre içerisinde ölümün gerçekleştiği ciddi bir hastalıktır. Ani ölüm olarak değerlendirildiği için çoğu kez adli otopsi yapılmaktadır. Pek çok torasik aort anevrizma rüptürü olgusuna tanı otopsi sırasında konulduğu için, otopsi serilerinde yapılacak çalışmalardan elde edilecek epidemiyolojik veriler ve hastalıkla ilgili yeni bilgiler, klinikte yol gösterici olacaktır.

Objective: Aneurysm ruptures are taking the first place in the cardiovascular diseases which causes sudden death and which is non-cardiac origin. Aortic aneurysm is a disease which results in an abnormal dilation of the aortic wall and disrupts the shape of blood vessels and blood flow. With enlargement, aorta increasingly weakens, may result in dissection, rupture, and even death. In this study it was aimed to evaluate deaths due to rupture of thoracic aortic aneurysm and to discuss. Material and Methods: Twenty six deaths due to thoracic aortic aneurysm rupture were determined within the autopsies performed by the Konya Branch of Forensic Medicine Council in Konya city center and by forensic pathologists in the districts of Konya between 2000 and 2008. These deaths were evaluated in terms of demographic characteristics, aneurysm location, the location of rupture, the rupture size and the accompanying systemic diseases, anomalies and syndromes. Results: The ages of the patients were between 16 and 71 and the average age was 44.9±16.6. There was type II aortic dissection in 17 (65.4%) patients and rupture was at ascending aorta in 22 (84.6%) cases. In 15 (57.7%) cases diseases like hypertension, coronary artery disease, chronic obstructive pulmonary disease, hyperlipidemia were accompanying to aortic aneurysm. Conclusion: Thoracic aortic aneurysm is a serious illness which often undiagnosed due to being asymptomatic and if it ruptures death occurs in a very short time. As it is evaluated as sudden death forensic autopsy is generally performed. In many cases the diagnosis of thoracic aortic aneurysm rupture is placed during the autopsy, epidemiological data and new information about the disease obtained from the autopsy series will be guide in the clinic.

"Suicides are divided into simple and complex, the complex one referring to suicide by a combination of more than one method. In general, unplanned complex suicides occur where several different methods are used consecutively because the first method has not achieved the desired effect.
In this study, we present a unique unplanned complex suicide case where corrosive ingestion and stabbing were the suicide methods.
A 50-year-old woman was found unconscious by her husband and daughter in the garden of her house in the middle of the night. She was transported to the hospital, where she was pronounced dead upon arrival. The investigation revealed that there was a half-filled bottle of scale dissolver containing nitric acid in the kitchen of the house. The deceased was said to have been suffering from depression for two weeks. There were corrosive burns around the lips, on the chin and on the right side of the neck, three stab wounds and six tentative cuts above the umbilical region.
This is the first case report of unplanned complex suicide by corrosive ingestion and stabbing in the literature. It is thought that the woman first swallowed nitric acid, and after feeling unbearable pain around her epigastric region, she stabbed herself in the abdomen. A brief discussion about the methods used in this case and an overview of the complex suicide entity is presented."

Suicide is an important cause of death among patients with epilepsy. In this report, we describe two patients with epilepsy whose brain examinations revealed cystic degeneration areas. The first case was a 42-year-old man who had been treated for epilepsy for five years. It was reported that his epilepsy attacks had increased over the six months prior to his suicide, and that he had severe conflicts with his wife during the last two months. He  committed suicide by hanging. An autopsy revealed two cystic degeneration areas on the left temporal lobe, and one cystic degeneration area on the right parietal lobe. The second case was a 30-year-old man who had been receiving epilepsy treatment for 10 years. It was reported that his epilepsy attacks had increased in the four months prior to his suicide, and his wife had left home because of continuous arguments. He committed suicide by drinking rodenticide (aluminum phosphide). An autopsy revealed a cystic degeneration area on the right temporal lobe. Neither of the two cases had a history of head injury, and the cystic areas are evaluated as border zone infarcts due to prolonged hypoxemia caused by recurrent status epilepticus attacks. In conclusion, in case of the determination of the cystic degeneration areas in patients with epilepsy in computed tomography or magnetic resonance imaging examinations, it will be beneficial to follow these patients in terms of epileptic attacks and psychiatric defects.

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.

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.

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.

Ventriküler septal defektin nadir görülen bir formu olan Gerbode tip defektlerde sol ventrikül çıkış yolu ile sağ atrium arasında defekt vardır. Bu defekt konjenital olabileceği gibi, travma, bakteriyel endokardit, myokard enfarktüsü veya aort kapak replasmanı sonrasında da gelişebilir. Bu çalışmada, ilki doğum yaptıktan bir gün sonra, ikincisi ise doğum yaptıktan iki gün sonra ölen iki olgu sunulmuştur. Olguların her ikisinde de otopside Gerbode defekti saptanmış ve her ikisine de yaşamları esnasında tanı konulmamıştır. Konjenital kalp hastalıkları gebeliği engellememekte, ancak gebelik ve postpartum dönemde maternal mortalite yanında kalp yetersizliği, inme ve kardiyak aritmi gibi çeşitli morbiditelere neden olabilmektedir. Gebelik öncesi annenin kardiyak yönden muayenesinin yapılarak, gebeliğin uygun olup olmadığının belirlenmesi bu tür ölümleri azaltacaktır. Ayrıca, gebelik ve postpartum dönemde meydana gelen anne ölümlerinde otopsi sırasında konjenital kalp hastalıklarının ölüme neden olabileceği akılda tutulmalıdır.

Gerbode type defect is a rare form of ventricular septal defects in which there is a defect between left ventricular outflow tract and the right atrium. This defect may be congenital or it may be due to trauma, bacterial endocarditis, myocardial infarction, or may develop after aortic valve replacement. In this study, two cases, the first died on the day after giving birth, and the latter died two days after giving birth are presented.  In both of the cases Gerbode defect was determined during autopsy and in both cases this defect could not be diagnosed during their lives. Congenital heart diseases do not prevent pregnancy, in addition to maternal mortality, they may cause morbidities such as heart failure, stroke, and cardiac arrhythmia during pregnancy and postpartum period. The mother's pre-pregnancy cardiac examination for determination of pregnancy suitability will reduce such type of deaths. Furthermore, the knowledge of congenital heart disease may be the cause of death should be kept in mind during the autopsy of maternal deaths that occur during pregnancy and the postpartum period.

Raylı ulaşım sistemi, ekonomik olması nedeni ile tercih edilen bir ulaşım şeklidir. Ülkemizde her yıl ortalama 165 kişi raylı ulaşım sistemi ile ilişkili kaza ve olaylar nedeniyle ölmektedir. Bu çalışmada, Konya’da raylı ulaşım sisteminde meydana gelen ölümlerin özelliklerinin ortaya konulması amaçlanmıştır.
Konya Adli Tıp Şube Müdürlüğü tarafından 2000-2007 yılları arasında ölü muayene ve otopsi işlemi yapılan olgular içerisinde, raylı ulaşım sistemi ile ilişkili ölümler retrospektif olarak incelenmiştir. Olgular; demografik özellikleri, olayın türü, orijini, olayda ölen kişi sayısı, olayın meydana geldiği yer, yaralanan vücut bölgeleri, ölümün meydana geldiği yer ve ölüm hastanede meydana gelmişse hastanede yatış süresi açısından değerlendirilmiştir.
Raylı ulaşım sistemi ile ilişkili 51 olayda toplam 63 kişinin öldüğü, bunlardan 45’inin (%71.4) erkek, 18’inin (%28.6) kadın olduğu saptanmıştır. Olguların yaşları 2 ay ile 80 yıl arasında değişmekte olup, ortalama yaş 36.1 ± 19.6 bulunmuştur. Orijinin, 56 (%88.9) olguda kaza, 7 (%11.1) olguda intihar olduğu saptanmıştır. En fazla ölümün 14 (%22.2) olgu ile 2002 yılında meydana geldiği, 43 (%68.3) olgunun tren, 20 (%31.7) olgunun tramvay çarpması neticesinde
öldüğü görülmüştür. Olgulardan 37’sinin (%58.7) tren ya da tramvayın direkt olarak yayaya çarpması neticesinde, 26’sının (%41.3) ise tren ya da tramvayın motorlu-motorsuz bir ulaşım aracına, hemzemin geçitte çarpması sonucunda öldüğü belirlenmiştir.
Şehir merkezi içerisinden ulusal demiryolu geçmesi ve tramvay hattı bulunması nedeniyle, Konya’da raylı ulaşım sistemi ölümleri sık görülmektedir. Kaza orijinli ölümlerin genellikle hemzemin geçitlerde meydana geldiği göz önüne alındığında, hemzemin geçitlerde yapılacak köprüler ya da modern bariyer sistemlerinin, bu tür kazalar için etkili bir önlem olabileceği düşünülmektedir.



Demiryolu, Demiryolu ölümleri, ölüm, adli tıp, otopsi, tren, kaza, tren kazası


Summary
The railway is preferred since it is economical. In our country, approximately 165 people die of accidents and events related to railways every year. In this study, we aimed to determine the characteristics of deaths that occur on the railways in Konya. The deaths related to railways were examined retrospectively among the cases of external examination and autopsy performed by Konya Branch of Council of Forensic Medicine between 2000 and 2007. The cases were evaluated according to their demographic characteristics, types of incidents, their origin, number of people died in the cases , locations of incidents, injured parts of the bodies, places where deaths occurred, durations of staying in hospital if deaths occured at the hospital.
It was found that 63 people had died in 51 cases related to railways;  45 of them (71.4%) were male and 18 of them (28.6%) were female. Their ages were between 2months and 80 years; and average age was 36.1±19.6. 56 of them (88.9%) was accident and 7 of them (11.1%) was sucide. Most of the deaths (14, 22.2%) occurred in 2002. 43 of the deaths (68.3%) was the results of train crashes while 20 of them (31.7%) were caused by trams. In 37 of the deaths (58.7%) people died when the train or tramway hit them directly and 26 of the deaths (41.3%) occurred when the train or tramway crashed to motorized or motorless vehicles.
The cases of death related to railways are often seen in Konya  since the national railway passes through the city center and there is a tramway line that goes across the city. When we consider that deaths related to the railways occur at the level crossings, we think that bridges or modern barrier systems that will be constructed at level crossings can be effective precautions for such accidents.

Persons whose occupations are in animal husbandry may be seriously injured or killed while tending to animals. Bulls are among the most dangerous of these animals. In this study, seven deaths and 23 traumatic injury cases caused by bull attacks and treated in the General Surgery and Chest Surgery Department of Selcuk University Meram Medical Faculty Hospital are presented. Of the 30 total cases, 24 were male and 6 were female. The ages of the cases ranged from 33 to 86 years and the average age was 60.3 +/- 12.4 (mean +/- standard deviation). All of the death and injury cases occurred while engaged in the care of bulls. It was also determined that the injuries were in the chest region of five (71.4%) and in the head of two (18.6%) out of seven death cases; and in the abdominal region of 14 (60.9%) and in the chest region of nine (39.1%) out of 23 traumatic injury cases. Of the 14 cases that were in the abdominal region and treated surgically, 11 were perforation of small/large intestines, whereas hemorrhages involving the intestinal mesentery, intraabdominal hemorrhage due to perforation of the abdominal wall, and splenic laceration were determined in one case each. There were one or multiple costal fractures in all nine chest injury cases, flail chest in five cases, and hemothorax, pneumothorax, or hemopneumothorax were determined in six cases. Of the chest injury cases, tube thoracostomy was performed in six whereas the other three cases were discharged from the hospital after supportive care. It was concluded that animals such as bulls might be the cause of serious trauma ending with death for those working in the animal husbandry. For this reason, caution is required while feeding and working with bulls. Risk can be reduced by chutes, gates, restraints, special housing, and confinement facilities. Also, wearing protective helmets would be useful especially for preventing head injuries.

"Amaç: Sistemik hipotermi terimi insan vücudunun 35° C’den daha aşağı düşecek kadar soğuduğunu belirtmek için kullanılır. Bu durum,    vücudun ısı kaybının ısı yapımını aştığı zaman meydana gelir. Kaza sonucu meydana gelen hipoterminin en sık nedeni ısı derecesi düşük    olan bir ortama maruz kalmadır. Hipotermi tehlikeli fizyolojik değişikliklere ve hatta ölüme neden olabilir. Bu çalışmada hipotermiye bağlı ölüm olgularının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: 2000-2008 yılları arasında Konya Adli Tıp Şube Müdürlüğü tarafından ve Konya’ya bağlı ilçelerde adli tıp uzmanı tarafından otopsileri yapılan olgular retrospektif olarak taranmış ve ölümü hipotermiye bağlı olan olgular çalışma kapsamına alınmıştır. Bulgular: Çalışmaya dahil edilen dönemde 12 hipotermiye bağlı ölüm olgusu saptanmıştır. Olguların 11’i erkek, 1’i kadındır. Olguların yaşları 41 ile 85 arasında değişmekte olup, ortalama yaş 57.0±15.4 bulunmuştur. Ölümler en sık 5 olgu ile Ocak ayında meydana gelmiştir. Olguların 4’ü tarlada, 3’ü metruk binada bulunmuştur. 6 olguda psikiyatrik hastalık öyküsü mevcuttur. Histopatolojik incelemede 5 olguda enzimatik yağ nekrozu bulguları tespit edilmiştir. Sonuç: Hipotermiye bağlı ölümler, toplum sağlığı açısından önemli olduğu gibi, adli tıbbi açıdan da önemlidir. Bu tür olgularda, olay yeri incelemesi, olgunun tıbbi özgeçmişinin ayrıntılı bir şekilde incelenmesi, dikkatli bir şekilde yapılacak otopsi ve histopatolojik inceleme tanı konulmasını kolaylaştırır."



Objective: Systemic hypothermia is used to specify the human body has cooled down to 35 ° C more. This occurs when the body’s heat loss exceeds heat production. The most common cause of accidental hypothermia is exposure to an environment with low temperature. Hypothermia can cause dangerous physiological changes and even death. This study aimed to evaluate cases of death due to hypothermia. Material and Method: The autopsy cases performed between the years 2000-2008 by the Directorate of Konya Branch of Forensic Medicine in Konya and by a forensic medicine expert in districts of Konya were retrospectively investigated and death cases by hypothermia were included in the study. Results: In the studied time period, 12 cases of death were due to hypothermia. 11 cases were male and 1 female. The age of patients ranged between 41 and 85 and the average age was 57.0 ± 15.4. Deaths occurred most frequently in January with 5 cases. 4 cases were found in the field, 3 were in abandoned building. 6 patients had a history of psychiatric illness. In histopathological examination enzymatic fat necrosis findings were found in 5 cases. Conclusion: The hypothermia-related deaths, as it is important for public health, forensic medical point of view is also important. In such cases, death scene investigation, a thorough examination of the medical history, a carefully performed autopsy and histopathological diagnosis makes it easy to diagnose the cause of death.

"A nine-month-old infant was transported to hospital where he was pronounced dead upon arrival. He was diagnosed with Smith-Lemli-Opitz Syndrome (SLOS) when he was three months old and he had been treated since then. A week ago, he was discharged from hospital after having had treatment for acute renal failure.His
parents were relatives. Chromosomal analysis revealed a normal male karyotype (46, XY). His 7-dehydrocholesterol level was extremely high (848 μg/ml, Ref: <0.1), androstenedione level was high (0.565 ng/ml, Ref: 0.08-0.5) and anti-Mullerian hormone level was low (4.2 ng/ml, Ref: 35.1-91.1). In renal scintigraphy, effective renal plasma flow was measured 80.6 ml/min for right kidney, but 24.1 ml/min for left kidney. He was taking malnutrition therapy. Infantile-type myelination of the brain was determined in cranial magnetic resonance imaging.
At autopsy, he was cachectic, weighing 2880g, and was 55 cm tall. He had failure to thrive as both his weight and height were below the third percentile. Also his body mass index was calculated as 9.5 and it was below the fifth percentile. He was noted to have micrognathia,
small palpebral fissures, depressed nasal bridge, a small upturned nose and missing helix rims of auricles. Anterior fontanel was large (4.3x5.5 cm) but posterior fontanel was closed. There was polydactyly of both hands and cutaneous syndactyly of the second and third toes. The external genitals were ambiguous. Examination of heart revealed a bicuspid aortic valve. Left kidney was hypoplastic. Vagina and internal female genital organs were absent and a perineal ectopic testis was observed. SLOS is an autosomal recessive disorder of cholesterol biosynthesis and characterized in the classical form by mental retardation, growth deficiency and such congenital anomalies as: microcephaly, cutaneous second and third toe syndactyly, external genital anomalies in males, and various central nervous system and internal malformations. There are few reports of autopsy cases of SLOS in the literature. In these reports, in addition to dysmorphic facial features and ambiguous genitalia, polydactyly, bilateral syndactyly of second and third toes and congenital heart defect were reported similar to our patient. In the presented case, missing helix rims of auricles, very large anterior fontanel and ectopic perineal testis were unique and these findings are described for the first time in the literature."

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.

Objective: This experimental study was designed to determine postmortem changes in element levels in rat skeletal muscle tissue and to evaluate its relation with the postmortem interval.
Material and Methods: Fifty-two three-month-old male Sprague-Dawley rats were sacrified by cervical dislocation, and four rats were set aside for dissection; the remaining 48 rats were divided into two groups to determine the effect of temperature on the levels of tissue elements. One group of rats was kept at 4ºC and the other group was kept at 18 ± 2ºC. The four rats that had been set aside were dissected immediately after sacrifice; the remaining 48 rats that were kept at two different temperatures were dissected 6, 12, 24, 48, 72, and 96 hours after death, with four rats in each group. The levels of elements in skeletal muscle tissue were determined by inductively coupled plasma-atomic emission spectrometry. The values for calcium (Ca), cupper (Cu), firon (Fe), potassium (K), magnesium (Mg), sodium (Na), phosphorus (P), sulphur (S) and zinc (Zn) were evaluated by the Kruskal-Wallis test and Mann-Whitney U test with Bonferroni’s correction.
Results: Considering the results for both temperatures, Fe, Na, and K showed significant changes at 4ºC and 18 ± 2ºC.
Conclusion: Our results suggest that these three elements in skeletal muscle tissue may be useful for determining postmortem interval. For this reason, a more detailed study on the levels of Fe, Na, and K in rat skeletal muscle tissue including a larger number of rats is planned in the near future.

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.

Kick boxing is a martial sport which allows punching, kicking and with some special rules using knee and elbow. International Kick Boxing Federation estimates that approximately one million people are kick boxing worldwide. In this paper, a death resulted from the blows to head is presented. A 24-year-old male was deteriorated during a kick boxing match and he was hospitalized urgently. In computerized brain tomography right frontoparietal acute subdural hematoma was diagnosed and hematoma drainage was performed. At autopsy, it was concluded that death was due to intracranial hemorrhage and brain tissue damage caused by blunt head trauma. Martial arts like kick boxing may result with fatal injuries. Protective helmet has to be worn during matches. Sportsmen should be followed by physicians who work in the hall during a match and if a dangerous situation at the vital point is detected, the match must be terminated immediately.

"Aritmojenik sağ ventriküler kardiyomyopati (ARVC), sağ ventrikül duvarındaki myokardiyal liflerin yağ ve bağ dokusuna dönüştüğü, daha çok Akdeniz ülkelerinde görülen bir patolojidir. Bu patolojide, sağ ventrikül lifleri arasında, myokard liflerini adalar ya da yamalar halinde bırakan yaygın fibroadipö doku infiltrasyonu görülür. Klinikte, ileti sistemi patolojilerine bağlı bulgular (senkop, taşiaritmi, aritmi gibi) izlenebilir. Ondokuz yaşında kadın olgumuz, banyoda arkadaşları tarafından baygın halde bulunmuş ve hastaneye götürüldükten bir saat sonra ölmüştür. Otopside sağ ventrikül duvarında, aritmojenik sağ ventriküler kardiyomyopatinin makroskopisi ile uyumlu değişiklikler görülmüştür. Bu bulgular, mikroskobik olarak da doğrulanmıştır. ARVC genç populasyonda ani ölümlerin önemli bir nedenidir. Olgu, ani genç ölümlerinde özellikle aritmojenik sağ ventriküler kardiyomyopatinin akıllarda tutulmasını sağlamak amacıyla literatür bilgileri ışığında tartışılarak sunulmuştur.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a pathology in which myocardial fibers of right ventricular wall transform into fat and connective tissue and observed more in Mediterranean countries. In this pathology, there is common fibroadipose tissue infiltration which leaves myocardial fibers in islands or patches between the fibers of the right ventricle. In the clinic, findings related to conduction system pathology (syncope, tachycardia, arrhythmia, etc.) can be monitored. The patient was a 19 year old female and her friends found her unconscious in bath. She was taken to hospital where she died one hour after. At autopsy, macroscopic changes in the wall of the right ventricle compatible with arrhythmogenic right ventricular cardiomyopathy. These findings were confirmed microscopically. ARVC is an important cause of sudden death in the young population. The case is presented and discussed in the light of literature aiming to bear in mind arrhythmogenic right ventricular cardiomyopathy especially cases of sudden death of young people."

"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 G 0.05). Our study suggested that there was an increase in accidental and natural deaths and a decrease in suicide and homicides in Ramadan."

This study presents 17 cases of hanging with some preventative measures, when compared with usual hanging fatalities, between 2002 and 2006 in the province of Konya, Turkey. We observed in 4 cases that the victim had only tied together their hands, whereas in 1 case both the hands (with a clothesline) and mouth (with a plastic bag) had been fastened. In a further case, the oral orifice had been closed using a scarf and in the remaining 11 cases, soft materials such as a scarf, hood, the collar of a coat or shirt had been used as padding against the ligature loop. At first glance, the cases where the victim's hands and/or mouth were found tied were thought to be homicides. However, an investigation of the death scene, together with the autopsy findings and inquiry data, showed the cause of death was from suicide. Thus, in suicidal hanging cases certain precautions and preventative measures were observed. For example, tying the hands together was regarded as a means to make self-release impossible; closure of the oral orifice as a means to prevent the victim from calling out for help, and placing soft material against the ligature loop was thought to be an attempt to lessen the feeling of pain.

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.

This article presents 16 complex suicide cases. Complex suicide is defined as the use of more than one method to induce death. Of the victims, 10 were men and the ages ranged from 19 to 70 years. Eight victims left a suicide note. It was observed that 13 victims realized the suicidal act in the house and 5 victims had previous suicidal attempts. It was determined that 10 victims had psychiatric disorders, one of them had alcohol dependence. Six victims were housewives, 4 victims were unemployed, followed by one each victim of student, worker, farmer, tradesman, prayer leader, and animal husbandry lines of business. Ten victims were married; 3 victims were single; and 3 victims were divorced. On investigating the methods of suicide, it was seen that 9 victims preferred sharp instrument usage; 5 victims insecticide ingestion; 4 victims each firearms, medicine overdose; 3 victims each hanging, falling from a height; 2 victims self-strangulation; and 1 victim each drowning, liquefied petroleum gas and natural gas inhalation together, fungicide ingestion, rodenticide ingestion. It was determined that 2 victims used 3 methods and the other 14 victims 2 methods in company, to realize the suicide. In this article, the data obtained from our study was discussed by comparing similar data.

Objective: Mole guns are commonly used to kill detrimental animals. They sometimes cause injuries, even lethal ones, and are occasionally used in crimes. A mole gun propels pellets similar to a shotgun. Material and Methods: In this study, 24 cases of injuries in the province of Konya (Turkey) between 2004 and 2007 and four cases of death in the provinces of Konya, Burdur, Erzincan and Denizli (Turkey) that were caused by mole guns were analyzed. Results: In the cases involving non-lethal injuries, 23 victims were males and one was a female. Their ages ranged between 2 and 80 years with an average age of 50.8 ± 17.7 years. The most represented age group in the range was 60-69 years with eight cases and 19 of the cases were farmers. In three of the cases that led to death, the manner of death was an accident and one case was a homicide. Conclusion: As the mole gun can cause various disabilities and lethal wounds to humans when fired from a short distance, its production and use should be prohibited.

Colloid cysts of the third ventricle are rare benign cysts but they may be potentially life-threatening. Three cases of sudden death resulting from colloid cysts of the third ventricle are presented. The first and second cases were treated for migraine headaches. In the first case, the patient was a 24-year-old woman who presented to the hospital with a severe headache and was sent back home after medical treatment. Six hours later, she was found dead in her bed. The second case was a 21-year-old woman who experienced a severe headache, dizziness and vomiting 1 day prior to her death. She was transported to the hospital, where she was pronounced dead upon arrival. The third case was a 25-year-old man who experienced headaches and vomiting and was diagnosed with and medically treated for sinusitis. He lost consciousness and was taken to hospital, where he was pronounced dead on arrival. During the autopsy of all three cases, there was a grey transillumination area observed that occurred due to the stretching of tissue at the base of brain between the corpus mamillare and chiasma opticum. Dissection of the brain revealed a colloid cyst of the third ventricle. To avoid such fatal complications, prompt diagnosis using CT or MRI is essential in patients who have a long-standing history of intermittent headaches. During the autopsy of the sudden deaths of people with medical antecedents of headaches, if a grey color is observed between the chiasma opticum and the corpus mamillare in the base of the brain, a colloid cyst should be considered and this region should be dissected and examined carefully.

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.

In the present study, deaths by ligature strangulation in the province of Konya (Turkey) were evaluated from the medicolegal point of view between 2001 and 2006. In total 2850 medicolegal death cases, 161 (5.65%) were resulted from asphyxia and 20 (12.4%) of the deaths due to asphyxia were cases of ligature strangulation. Male:female ratio of the victims was 1:1 with ages ranging from 1.5 to 70 years and a mean age of 37.22+/-19.28 years. 17 cases (85%) were of homicidal and 3 cases (15%) of suicidal origin. The most widely used ligature material was clothesline in 6 cases (30%). On the examination of neck structures, thyroid cartilage fracture was present in 7 (35%) cases, fracture of the hyoid bone in 3 cases (15%), fracture both of the thyroid cartilage and hyoid bone in 1 case (5%), only ecchymosis in soft tissues in 7 cases (35%). In the paper, the findings determined in our cases are discussed in the light of the literature on the subject.

Suicide notes are commonly written on some materials, such as notebooks, papers, and mirrors. Additionally, suicide plans have been communicated in face-to-face conversations, by speaking on the telephone, recording on CDs or video cassettes, and sending messages through text messaging. In this article, 2 suicide death cases are presented in which suicide notes were written on the bodies of the victims. The first case, a 32-year-old man, was a university graduate and had been unemployed for years; he committed suicide in his house by hanging. On the external examination, it was seen that there were some words on the body written with a pen; specifically "DONKEY" was written on the forehead; coursing up-and-down along the chest, "HODJA" was on the right, "DO NOT" was on the sternal region, and "WASH" was on the left; and undecipherable handwritings were on both zygomatic regions. The second case, a 39-year-old woman, was a housewife who was being physically abused by her husband and committed suicide by ingesting an insecticide. It was observed that on the left leg, a note was written with a pen saying that she could not stand being beaten by her husband on account of the inheritance dispute between him and her elder brother; there was purple ecchymoses in the periphery of the right eye and in the right gluteal area. Since we have not found any reports of suicide notes written on the body in the literature, we present and discuss our cases herein.

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.

A supplementary heater can be mounted in trucks or other transportation vehicles and used to heat the air in the cabin independent of the engine of the vehicle. This apparatus works with diesel fuel or gasoline. Combustion products burning in the pre-combustion chamber heat the fins of the engine. The air passing through the fins is heated and is transferred into the cabin. The malfunction of such an apparatus may be the cause of carbon monoxide (CO) poisoning or fire. In this study, we report two cases in which drivers died while asleep in the cabins of parked trucks. In the first case, a 43-year-old man died because of CO poisoning originating from a broken supplementary heater. In the second case, a 48-year-old man died owing to a fire that resulted from the burning of upholstery cloths in the truck cabin, and which was caused by a supplementary heater set at very high temperatures. In both cases, it was determined by a technical expert that the CO poisoning in the first case and the fire in the second case were caused by the supplementary heater in the trucks. It is emphasized in this article that the supplementary heater in the truck might be the cause of mortal CO poisoning as well as be responsible for fires in the cabins of the trucks. It aims to highlight that a detailed investigation of supplementary heaters at the death scene is required for such death cases in the trucks.

In the Islamic context, "fitrah" refers to humanity's innate disposition toward virtue and the ability to differentiate between right and wrong. A common quote regarding fitrah, from the Prophet is "The fitrah consists of 5 things: circumcision, trimming the moustache, cutting the nails, plucking the armpit hairs, and shaving the pubic hairs."In this study, our aim was to determine the status of axillary and pubic shaving in medicolegal death cases that took place in the Konya Province of Turkey and to evaluate the relationship with the origin of suicide. Of 2850 medicolegal death cases, 206 (7.2%) were of suicidal origin. It was observed that the average age in the cases of suicidal origin was 36.76 +/- 17.72 years, and 146 of 206 cases (70.9%) were men. As a method of suicide, hanging was the chosen method in 100 cases (48.5%), whereas firearm injuries occurred in 54 cases (26.2%), and intoxication was involved in 37 cases (18.0%). Daily axillary and pubic shaving was observed in 26 of 2644 (1.0%) death cases that occurred with nonsuicidal reasons, but in 65 of 206 were (31.6%) suicidal cases. Because suicidal notes were present in 25 (12.1%) of all of the suicidal cases, the ratio of daily axillary and pubic shaving was significantly higher than that of the suicidal notes.In investigating the cases of suicidal origin for medicolegal purposes, evidence showing that this action was committed by the victim, the presence of a suicide note at the death scene and, a history of a previous suicidal attempt, it was thought that the presence of daily axillary and pubic shaving on external examination of the victim's body, when of Muslim faith, could also be considered a feature of suicide.

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.

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.

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.

Hydatid cyst is a parasite disease, which is common in those countries where animal husbandry is extensive, but preventive medicine is lacking. Endemic regions are South Europe, South America, Africa, Turkey, Australia, New Zealand, and India. In the study, a sudden death case due to cardiac hydatid cyst rupture located in right ventricle has been presented with a review of the literature. The victim was a 10-year-old girl of a family who raised sheep. External examination of the body showed congestion in both the head and face but neither trauma nor evidence of violence or eruptions on the skin were found. At autopsy, through a vertical incision on the frontal surface of truncus pulmonalis, a total of 8 daughter cysts were obtained. A 6 x 5 cm cyst was observed in the right ventricular apex. In those countries where hydatid cyst is endemic, and when sudden unexpected death occurs in individuals involved in animal husbandry, cardiac hydatid cyst must be kept in mind as a cause.

Incised wounds of the neck can be accidental, homicidal, or suicidal. In this paper, a death case has been presented where a spinning circular saw of a cutting machine in a workshop came off its place and cut the throat of a 30-year-old male who was operating the machine. There was an incision (15 cm x 5 cm) that began in the middle of the neck down the thyroid cartilage, extended horizontally to the left of the neck and ended on the outer part of the neck in the outer left side of m. trapezius. Death occurred because of exsanguination caused by the cutting of carotis artery and jugular vein. In the case we presented, although the cut in the neck initially suggested homicide, it was found to have occurred as a result of an accident after the autopsy and death scene investigation.

Göğüs travmaları, künt ve penetran göğüs travmaları olmak üzere
iki ana baslık altında incelenebilir. Künt travmalar; trafik kazaları,
yüksekten düsme, künt bir cismin göğüse direkt ya da indirekt teması
neticesinde meydana gelirken; penetran travmalar kesici delici aletler,
delici aletler ve atesli silahlar ile olusmaktadır. Künt ve penetran
göğüs travmaları adli olgu olmaları nedeniyle müdahale ve tedavi
eden hekime ihbar yükümlülüğünün yanısıra, çözülmesi gereken
hukuki problemlere ısık tutacak adli rapor düzenleme yükümlülüğü de
getirmektedir. Bu yazıda, göğüs travmalı olgularda adli rapor yazımı
konusunda dikkat edilmesi gereken hususlar, raporlarda sık kullanılan
ve yara ağırlık kriterlerini gösteren kavramlar ve yazılan adli raporların
hukuki sonuçları ele alınmıstır.

"Objective: According to first article of Children’s Rights Agreement
“apart from reaching the adult age by the laws, the people before
completing the age of 18 are classified as children. In this study,
it was aimed to determine the main causes of forensic children
deaths in the age group of children between 0 and 18 years.
Material and Methods: Forensic death examinations and autopsy in
2850 subject between 2001 and 2006 in the time limit of 6 years
were performed and 642 of 2850 cases of deaths were evaluated
in view of subjects’ demographic characteristics, causes and
origins of deaths.
Results: Mean age of the subjects was 6.59 ± 6.07, and 429 (66.8%)
of them were male and 213 (33.2%) were female. Most of the
deaths were determined to be occured between 0 and 4 years of
age. The main cause of death in 493 (76.8%) cases was accident
and the other causes were natural causes in 82 (12.8%) cases,
murder in 42 (6.5%), and suicide in 15 (2.4%) respectively. 157
(24.5%) cases were in-car accidents out of total 313 (49.0%)
traffic accident cases, followed by 70 (10.9%) cases of falling
down from high places. When the natural causes of deaths were
evaluated, in 19 (20.6%) cases the reason was pneumonia or
bronchopneumonia and in 14 (15.2%) cases the reason was
cardiac pathologies.
Conclusion: Since it was determined that the main cause of death in
children is traffic accidents, some precautions should be taken to
prevent traffic accidents. Besides we think that preventive and
therapeutic health services for children should be used more
effectively in order to reduce those childhood deaths."