Examination of bone fractures in women exposed to domestic violence (Tokat-Turkey)

BACKGROUND

Fractures are an important symptom of physical violence that will negatively affect the woman's quality of life in the coming years. However, there is limited information in the literature about fractures in women exposed to domestic violence (DV). The aim of this study was to compare fracture development rates and age distributions in women exposed to DV and intimate partner violence (IPV), a component of DV, and women exposed to other physical violence (OV), to determine the incidence of DV cases with and without fractures, and to determine fracture locations in DV cases and to identify diagnostic lesions accompanying fractures.

METHODS

A retrospective review was made of patients injured as a result of IPV, other domestic violence (ODV) and OV. The data of cases with fracture were analyzed in terms of age groups of the victims and according to location and types of fractures.

RESULTS

Of the 854 female patients aged >18 years who were admitted to the hospital due to violence, 55.2% were exposed to DV. Most DV victims (87.9%) were assaulted by intimate partners. The incidence of fractures in IPV cases (7.2%), was nearly twice that of ODV and OV cases. The mean age of IPV cases with fractures (42.1 ± 12.1 years) was significantly higher than that of IPV cases without fractures (33.1 ± 11.8 years) (p < 0.05). Most IPV cases (61.8%) were aged <35 years. Most DV cases with fractures (75%) were aged <50 years. Facial/neck injuries (41.5%) and facial fractures (52.6%) were prominent in DV cases.

CONCLUSION

The results of this study of the presence of facial fractures, especially in women aged <50 years, is an important finding that can alert doctors to potential cases of domestic violence.

Sex estimation from the hyoid bone measurements in an adult Eastern Turkish population using 3D CT images, discriminant function analysis, support vector machines, and artificial neural networks☆

The hyoid bone is one of the bones in the human body that shows sexual dimorphism. The anthropological and anthropometric characteristics that determine sexual dimorphism are influenced by demographic differences. The aim of this study was to investigate the rate of sexual dimorphism of the hyoid bone in the adult Eastern Turkish population from the examination of the 3D computed tomography images of 240 patients, using discriminant function analysis (DFA), support vector machines (SVM), and artificial neural networks (ANN). These evaluations were based on eight hyoid measurements that have been frequently used in previous CT studies. The results showed that all eight measurements were higher in males than in females (p = 0.000). It was determined that sex could be estimated accurately at up to 93.3 % using DFA, 93.8 % using SVM and 95.4 % using ANN. The maximum accuracy rate achieved to 94.2 % in males using SVM, and 95.8 % in females using ANN. These high rates of sexual dimorphism found using DFA, SVM, and ANN in this study indicate that characteristics of the hyoid bone can be utilized to determine sex in the Eastern Turkish population.

Sex Estimation From Measurements of the Mastoid Triangle and Volume of the Mastoid Air Cell System Using Classical and Machine Learning Methods: A Comparative Analysis

ABSTRACT

Previous studies on the sexual dimorphism of the mastoid triangle have typically focused on linear and area measurements. No studies in the literature have used mastoid air cell system volume measurements for direct anthropological or forensic sex determination. The aims of this study were to investigate the applicability of mastoid air cell system volume measurements and mastoid triangle measurements separately and combined for sex estimation, and to determine the accuracy of sex estimation rates using machine learning algorithms and discriminant function analysis of these data. On 200 computed tomography images, the distances constituting the edges of the mastoid triangle were measured, and the area was calculated using these measurements. A region-growing algorithm was used to determine the volume of the mastoid air cell system. The univariate sex determination accuracy was calculated for all parameters. Stepwise discriminant function analysis was performed for sex estimation. Multiple machine learning methods have also been used. All measurements of the mastoid triangle and volumes of the mastoid air cell system were higher in males than in females. The accurate sex estimation rate was determined to be 79.5% using stepwise discriminant function analysis and 88.5% using machine learning methods.

Sex Estimation From the Paranasal Sinus Volumes Using Semiautomatic Segmentation, Discriminant Analyses, and Machine Learning Algorithms

ABSTRACT

The aims of this study were to determine whether paranasal sinus volumetric measurements differ according to sex, age group, and right-left side and to determine the rate of sexual dimorphism using discriminant function analysis and machine learning algorithms. The study included paranasal computed tomography images of 100 live individuals of known sex and age. The paranasal sinuses were marked using semiautomatic segmentation and their volumes and densities were measured. Sex determination using discriminant analyses and machine learning algorithms was performed. Males had higher mean volumes of all paranasal sinuses than females ( P < 0.05); however, there were no statistically significant differences between age groups or sides ( P > 0.05). The paranasal sinus volumes of females were more dysmorphic during sex determination. The frontal sinus volume had the highest accuracy, whereas the sphenoid sinus volume was the least dysmorphic. In this study, although there was moderate sexual dimorphism in paranasal sinus volumes, the use of machine learning methods increased the accuracy of sex estimation. We believe that sex estimation rates will be significantly higher in future studies that combine linear measurements, volumetric measurements, and machine-learning algorithms.

Assessment of the COVID-19 Pandemic's Impact on Physical Intimate Partner Violence Against Pregnant Women in Ankara (Turkey): A Hospital-Based Study

Purpose

A significant increase in physical intimate partner violence (IPV) cases has been reported from many countries during the COVID-19 pandemic, and particularly during lockdown periods. The current study's objectives are to define the COVID-19 pandemic's impact on physical IPV against pregnant women in Ankara.

Patients and Methods

During the one-year pre-pandemic and two-year pandemic, records of patients who sent by the judicial authorities to the Obstetrics and Gynecology Emergency Room (ER) at Ankara City Hospital were reviewed, and pregnant women who had been subjected to IPV were identified.

Results

Of pregnant women 19.1% in the pre-pandemic period, 29.4% in the first year and 51.5% in the second year of the pandemic period exposed to IPV. The mean age of IPV victims was 28.8 ± 6.5 years. Most ER applications were in the evening hours (48.5%), and majority of assailants were the victim's husband (77.9%). Vast majority of victims were multigravida women (89.7), and most of the traumas were localized in abdomen and genitalia (50%). Three of the women (4.4%) had miscarriage.

Conclusion

The increase in cases of IVP against pregnant women during the pandemic was striking, according to the current study. We think that this first study from Turkey on the IPV that pregnant women are exposed to during the pandemic can lead to extensive research focused on measures against IPV during pandemics, such as dissemination of telephone applications for IPV victims, increasing home visits by marriage therapists, and intensifying of education campaigns against violence.

Sex estimation using foramen magnum measurements, discriminant analyses and artificial neural networks on an eastern Turkish population sample

BACKGROUND

Although many studies have been conducted using the foramen magnum for sex estimation, recent findings have indicated that the discriminant and regression models obtained from the foramen magnum may not be reliable. Artificial Neural Networks, was used as a classification technique in sex estimation studies on some other bones, did not used in sex estimation studies on the foramen magnum until now. The aim of this study was sex estimation on an Eastern Turkish population sample using foramen magnum measurements, discriminant analyses and Artificial Neural Networks.

METHODOLOGY

The study was performed on the CT images of a total of 720 cases, comprising 360 males and 360 females. For sex estimation, discriminant analysis and Artificial Neural Networks were used.

RESULTS

The accuracy rate was 86.7% with discriminant analysis and when sex estimation accuracy was determined according to cases with posterior probabilities above 95%, the accuracy ranged from 0% to 33.3%. With the use of the discriminant formulas of 2 other studies, obtained from different Turkish samples, sex could be determined at a rate of 84.6%. Some formulas were found to be unsuccessful in sex estimation. Sex estimation accuracy of 88.2% was achieved with Artificial Neural Networks.

CONCLUSION

In this study, it was found that sex could be determined to some extent with discriminant formulas from other samples from the same population, although some formulas were unsuccessful. With the use of image processing techniques and machine learning algorithms, better results can be obtained in sex estimation.

Suicides in Turkey: 25-year trend (1995-2019)

The assessment of national suicide risks is considered critical in many countries for the establishment of suicide prevention initiatives aimed at considerably lowering suicide rates. The aim of this study is to identify at-risk suicide populations by reviewing the suicides in Turkey over a 25-year period. The Turkish Statistical Institute's suicide statistics for 1995-2019 in Turkey was retrospectively reviewed in current article. The data collected in the study was statistically analyzed using the MINITAB vn 14 software. Between 1995 and 2019, the total number of suicides in Turkey was 66,819, and suicide rates, especially in males, showed an increasing trend in this period. Males comprised 68.3% of the total cases, and most (27.2%) were aged 15-24 years. Suicides mostly occurred between May and July (27.7%), of individuals with a primary school level of education (51.7%) and who were married (6.0 per 100,000). Illness was most important risk factor for suicide (36.8%) and hanging (47.5%) was the leading suicide method in all age groups and in both genders. Despite the fact that Turkey's suicide rate is lower than many other countries, the growth in male suicide rates is concerning. Suicides are likely to become a severe problem in Turkey in the near future unless measures like education, psychiatric evaluations, the reactivation of psychological counseling service phone lines, and the establishment of youth counseling centers, as described in this paper, are taken.

An investigation of the effect of the COVID-19 (SARS-CoV-2) pandemic on occupational accidents (Tokat-Turkey)

The aims of this study were to compare the incidence of occupational accidents during one-year periods of the COVID-19 Pandemic and before the COVID-19 Pandemic, and to determine in which sectors occupational accidents occurred and what types of injuries were sustained in the population of Tokat, Turkey. A retrospective review was made of the records of Tokat State Hospital of patients injured in occupational accidents between 12.03.2019 and 11.03.2021. The patients injured in occupational accidents were classified according to age, gender, sector, accident type, trauma localization and type, time of the accident, and outcome of the injuries. Of 608 patients injured in occupational accidents, 384 (63.2%) were injured in the period before the pandemic and 224 (36.8%) were injured in the period during the pandemic (p < 0.001). Most work-related injuries occurred in the industry sector (n = 287; 47.2%; p < 0.001). Occupational accidents increased in the service sector (p < 0.001), but decreased in other sectors. The increase in occupational accidents in the health sector (p < 0.001) and transportation sector (p < 0.05) within the service sector caused a general increase despite the decrease in other service sectors (p > 0.05). In current study, the increase in the number of injuries in the transportation sector due to the increase of motor courier accidents, in health sector, and in pandemic quarantines were remarkable. It was evaluated that this narrow-scoped study pioneered comprehensive studies on the measures that can be taken to prevent occupational accidents in such pandemics in the future.

Investigation of effective factors on traumatic amputations due to road traffic accidents

AIM

To determine factors associated with the locations, types and levels of traumatic limb amputations caused by road traffic accidents.

MATERIALS AND METHODS

The files sent by the courts to the expert committee chaired by the authors for the determination of applicants' disability rate over the 10-year period between 2011 and 2020 were examined retrospectively.

RESULTS

Of the 27 cases with traumatic amputations caused by road traffic accidents, 63% of them were male and the mean age of the cases was 29.0 ± 20.0 years. The cases comprised 12 passengers, 10 pedestrians, and 5 drivers. Of all, 66.7% of the amputations were caused by automobile accidents, 59.3% of them were in lower limbs, 51.9% of them were on the right side, and most of them occurred below the elbow/knee levels. Amputations occurred more frequently in lower limbs that are contralateral to the side of the traffic flow, in drivers, and in front seat passengers.

CONCLUSION

The findings in this preliminary study need to be confirmed in studies to be conducted in larger series. The findings of these studies will shed light on technological developments that can be used in the prevention of serious injuries that lead to post-accident traumatic amputations.

Neck vascular lesions in hanging cases: A literature review

The aim of this review was to investigate the types and rates of vascular lesions occurring in cases of completed hanging and near-hanging, defined in literature. In the literature to date, 6 specific types of vascular injuries have been defined in cases of death as a result of hanging. These are Amussat's sign, Etienne Martin's sign, Dominguez-Paez sign, Friedberg-Lesser sign, Ziemke-Otto's sign, and Lupascu sign. As a result of this study, it was determined that the most defined finding was the Amussat sign, and it was concluded that the other findings were not sufficiently recognized. Likewise, considering that the proportional differences are due to the differences in the rates of autopsy practice and autopsy protocols between countries, it can be suggested that international joint autopsy protocols should be developed at the meetings in which national professional associations participate.

The effect of the presence or absence of skull fractures on intracranial lesion development in road traffic accidents

OBJECTIVE

The aim of this study was to investigate the effect of the presence or absence of skull fractures on the development of intracranial lesions in cases of head trauma associated with traffic accidents.

MATERIALS AND METHODS

A retrospective review was made of the medico-legal reports of 774 cases with injuries sustained in a traffic accident and which applied for expert examination as forensic cases at the Department of Forensic Medicine of our University between 1 January 2014 and 31 December 2019. A total of 162 cases (20.1%) were identified which were radiologically diagnosed with at least one skull fracture or intracranial lesion. These cases were evaluated in terms of age, gender, type of accident, and localization of skull fractures and/or intracranial lesions, and they were compared statistically to determine whether the presence or absence of skull fractures affected the development of intracranial lesions.

RESULTS

The 162 cases evaluated comprised 120 males and 42 females with a mean age of 25.1 ± 16.4 years. Intracranial lesions were accompanied by skull fractures in 77 cases, skull fracture alone was determined in 18 cases, and intracranial lesion alone in 67 cases. Skull fractures were mostly (64.5%) seen in the 1-20 years age group, and the intracranial lesions (90%) were mostly seen in the ≥41 years age group. Linear and diastatic fracture rates were highest in the temporal and frontal regions. The intracranial lesion/case ratio was 1.5/1 in cases without skull fracture, and 1.2/1 in cases with skull fracture.

CONCLUSION

The results of this study showed that the rate of linear or diastatic fractures was higher in females, which was associated with skull thickness. Skull fractures were found to occur most between the ages of 1 and 20 years, and the presence of skull fractures was determined to reduce the incidence of intracranial lesions by decreasing intracranial pressure.

The effect of altitude and climate on the suicide rates in Turkey

Suicide is one of the most important public health problems. There was an association between suicide and several factors such as psychiatric diseases and psychological characteristics, somatic illness, cultural, socioeconomic, familial, occupational and individual risk factors. Also, high altitude and climatic factors including high temperature, cloudiness, more sunshine and low rainfalls were defined as some of these risk factors in the literature. In this study, we aimed to investigate correlation between suicide rates and altitudes of all cities in Turkey and between suicide rates and climatic factors including Rainfall Activity Index, Winter Mean Temperatures, Summer Mean Temperatures and Temperature Difference between January and July previously defined by several authors in the broad series in Turkey. In Turkey, 29865 suicidal deaths occurred in 10 years period between 2006 and 2015. Of them, 21020 (70.4%) were males and 8845 (29.6%) were females. In this study, we found that high altitude above 1500 m, winter median temperature lower than -10 °C and hard temperature changes above 25 °C between winter and summer of settlements were important factors that affected on female suicide rates appropriate to knowledge which defined in previous studies. In conclusion, we suggested that the associations among suicide rates with altitudes and climate should be studied in wider series obtained from different countries for reaching more reliable results.

The effects of gender and age on forensic personal identification from frontal sinus in a Turkish population

Objectives:

To define the dimensions of the frontal sinus in groups standardized for age and gender and to discuss the reasons and the effects of the variations.

Methods:

Frontal sinus measurements were obtained from paranasal CT scans of 180 males and 180 females in the Radiology Department of Dursun Odabas Medical Center of Yuzuncu Yil University, Van, which is located in Eastern Turkey, between February and March 2016. The width and height of sinuses were measured on a coronal plane, and the anteroposterior length was measured on an axial plane. Volumes were calculated using the Hospital Information Management Systems and Image Archiving and Management System program. The Statistical Package of the Social Science version 13 was used for statistical analyses.

Results:

We determined differences in the frontal sinus measurements of different age groups in a Turkish adult population. Frontal sinus dimensions were usually higher in females and lower in males after 40-49 years of age than their younger counterparts, but the measurements were lower in females and higher in males in 70≤ years of age group than 60-69 years of age. Left frontal sinus was dominant in young age groups but right frontal sinus was dominant in groups 40-49 years of age or older.

Conclusion:

We observed crossing of the measurements between the different age groups, which we could not find clear explanations. The results of such studies may affect forensic identification from frontal sinus measurements.

Evaluation of Severity Score in Patients with Lower Limb and Pelvic Fractures Injured in Motor Vehicle Front-Impact Collisions

Background

Lower limb and pelvic injuries and fractures occur at a very high incidence in motor vehicle accidents. In this study, the characteristics (e.g., body side, bone location, and fracture severity) of lower limb and pelvic fractures that occurred during front-impact collisions were correlated with the injured patients’ sex, age, and position in the vehicle.

Material/Methods

We retrospectively evaluated 191 patients (136 males, 55 females) who were injured in motor vehicle accidents, specifically in frontal collisions.

Results

This study revealed that most of lower limb and pelvic fractures occurred in males (71.2%; p=.000), 19–36 years old (55.5%; p=.000), small vehicles (86.4%; p=.000), and rear seat passengers (49.2%; p=.000). Fractures most commonly occurred in the left side of the body (46.6%; p=.000) and upper legs (37.7%; p=.000). Severity scores were higher (2.76) in males than females (2.07). No statistically significant was found in severity scores of patients and other personal characteristics and fracture features of patients with lower limb and pelvic fractures who were injured in a vehicle during front-impact collisions (p>0.05).

Conclusions

The results of this study will be useful for the automobile industry, forensics and criminal scientists, and for trauma research studies.

A case of shotgun injury which occurred while an unconventional home security alarm system was being checked

Installation of devices involving shotguns is rarely encountered in forensic medicine practice. In this case report, authors aimed to present an unusual and rare case of shotgun injury due to a home security alarm system and its legal assessment. An electrical technician was invited to a summer house to check a home security alarm system installed by another firm which he worked for previously. It was an unconventional home security alarm system attached to a shotgun. The technician was injured with 18 buckshot pellets (no: 4) while checking the system. The host was convicted of a possible intent to cause a life-threatening injury to the technician. We think that this verdict will set a precedent for similar cases.

Defining the macroscopic and microscopic findings of experimental focal brain ischemia in rats from a forensic scientist's point of view

Approximately 10% of all deaths in the world occur as a result of stroke. Determination of the time schedule of the pathologic events in a stroke patient is invaluable for a forensic specialist. The aim of this study was to define the schedule of the macroscopic and microscopic changes that occurred in a rat model of permanent focal ischemia for providing useful clues for the evaluation of stroke patients. Male Wistar rats weighing 250 to 350 g were used in this study. Permanent focal brain ischemia was applied by the suture occlusion method. The animals were divided into 7 experimental groups (n = 6) with time schedules including 1.5, 3, 6, 12, 24, 72 hours, and the sham. Brains were harvested at the end of the determined time schedule. Lesions in the frontoparietal cortex were evaluated macroscopically first and later hematoxylin eosin stained sections from the infarct core were investigated microscopically. Macroscopically, enlargement of the ipsilateral hemisphere was mild at 6 hour, apparent at 12 and 24 hours, and mild again at 72 hours. Microscopically, ischemic changes were apparent even at 1.5 hour. Red neurons and infiltration of the parenchyma with neutrophil leukocytes were observed at 12 hours. Pannecrosis and massive leukocyte infiltration were observed at 72 hours. Macroscopic and microscopic findings obtained from a rat model may provide clues for determination of the time-dependent changes due to brain ischemia in human subjects. Finally, the benefits of determination of time course of pathologic changes in the brain for forensic scientists were discussed.

Criminal and legal responsibilities in Tourette's syndrome

Tourette's Syndrome (TS) is a neuropsychological disorder characterized by the presence of multiple involuntary motor tics accompanied by one or more vocal tics. Articles about TS and criminal responsibility and the restriction of civil rights are limited. A person with TS was evaluated to consider his criminal responsibility after swearing at a referee during a football game. He was also evaluated as to whether or not he was capable of professionally driving a service bus. Additionally, medico-legal situations regarding military service, obtaining a shotgun license and marriages of patients with TS were considered.

CT study on morphometry of frontal sinus

The aim of this study was to determine the prevalence and morphological characteristics of the frontal sinus in an adult population. This study was conducted retrospectively on paranasal CT scans in the axial and coronal planes of 300 cases (123 male and 177 female). The mean age was 40.74 +/- 13.34 (range 20-83). Measurements of the width, height and anteroposterior length for each sinus and total width were obtained from CT scans. Measurements were compared statistically with relation to side and sex. The cases were divided into subgroups according to age for each sex and each measurement parameter was also compared among the subgroups. All measurements tended to be larger on the left side and were significantly larger in males than females. There was a significant difference in the anteroposterior lengths of right and left sides in both males and females and height for males and width for females. In both sexes, the highest values of measurements were usually observed at the 31-40 age group and there was a tendency to decrease with aging. The larger diameters of the left frontal sinus imply that it may be more possibly violated during surgical interventions. Morphometric features differed significantly in the two sexes at different ages and comparison with previous studies presented great regional variability. The size of the frontal sinus was seen to be related to age and sex. The knowledge provided in the present study is useful for some surgical procedures and widens the anthropometric knowledge of humanity.

The role of eustachian valve and patent foramen ovale in sudden death

Sudden unexpected cardiac death is the leading cause of death in industrialized countries. Patent foramen ovale and eustachian valve are two of cardiac diseases and they may be associated with clinical disorders as embolism, stroke, plathypnea-orthodeoxia syndrome, carcinoid heart disease, atrial flutter and endocarditis. The literature for the roles of patent foramen ovale and eustachian valve in the causes of sudden deaths are reviewed.

Identification of unknown bodies by using CT images of frontal sinus

The aim of the study was to define a simple system for the identification of unknown bodies by using CT images of frontal sinus and to discuss whether it was worth to add measurements to the system or not. The system was including simple features as F (presence or absence of frontal sinus), S (intersinus and intrasinus septum) and S (scalloping), and named as FSS system. Measurements selected for the study were width, height, anteroposterior length, total width of two sinuses, the distance between the highest points of the two sinuses and the distance of each sinus to its maximum lateral limit. The study was conducted retrospectively on the paranasal CT scans of 100 cases (38 male and 62 female) who had no apparent sinonasal pathology. All the features and measurements were coded according to the system defined by the authors for each case and coded formulas were compared. At least 93% of the formulas could be eliminated for a case by using FSS system. The rate of success was increased to 98% by adding measurements. Contrary to objective criteria of FSS system, measurements were prone to bias. Therefore, in practice success rate would be expected to be lower than calculated. In the study population, instead of making 100 measurements, eliminating the most of the cases with FSS system and later discriminating the rest by pattern matching was seen logical.

Femoral and tibial fractures in a child with myelomeningocele

Femoral and tibial fractures can occur from accidents, child abuse or pathological causes. It is often very difficult to distinguish the cause among those cases. Radiological diagnosis may be needed for clinicians and medical examiners in order to assist determining the reason of fractures. In this report, we submit a case with femoral and tibial fractures associated with myelomeningocele. This patient was diagnosed as child abuse by clinicians. On review it was decided that her fractures were not because of non-accidental injury. The values of bone mineral density of the upper limb were low and illness caused her fractures.

Unusual torture methods and mass murders applied by a terror organization

This study aims at describing autopsy findings of 19 victims killed by various torture methods applied by a terror organization after they had been kidnapped by this organization, as well as the unusual and unique binding style applied during these killings. The present study also aims at describing the unusual killing method of binding for literature and discussing international descriptions of torture.

Deaths due to terrorist bombings in Istanbul (Turkey)

Our study was based on a retrospective analysis of terrorist bombing related deaths in Istanbul (Turkey) between 1976 and 2000. A total of 45,714 autopsy case reports from the Morgue Department of Council of Forensic Medicine were reviewed for this study. There were 120 (0.26%) deaths due to terrorist bombing. Terrorist bombing related deaths were significantly higher during the years of increasing terrorism events in Turkey. Ninety-eight (81.7%) of cases were male and 22 (18.3%) of cases were female. The most frequent age groups of victims and terrorists was between 21 and 30 years of age (n=60; 50% of the total cases). In 49 events only one death occurred. The highest mortality was 24 in a single event. In this study, we have renewed of characteristics traumatic lesion to ascertain the cause of deaths and other autopsy findings in victims and terrorists. We also emphasize that scene investigation and medico-legal autopsy are the most important procedures provide appropriate information about deaths due to terrorist bombings.

Medicolegal evaluation of vascular injuries of limbs in Turkey

This study evaluated 372 cases of post-traumatic extremity vessel lesions, for which the Forensic Medicine Council, Istanbul, Turkey prepared medicolegal evaluation reports between 1998 and 2000. The study group (n = 372) comprised of 346 men (93.0%) and 26 women (6.9%), and their ages ranged between 6 and 73 years (30.18 +/- 6.13). There were 378 artery (74.5%), and 131 vein injuries (25.5%) out of a total of 509 limb vascular injuries. The most frequently injured arteries and veins were the femoral artery (n = 73), and the deep femoral vein (n = 41), respectively. The causes of injuries were as follows: cutting and stabbing complements, in 160 cases (43.0%); gunshots in 136 cases (36.6%); traffic accidents in 52 cases (14%); work accidents in 23 cases (6.2%); and blunt trauma in one case (0.3%). These injuries were accompanied by local nerve lesions (27.1%), local bone lesions (37.1%), and injuries to other organs (11.0%). The medicolegal assessments by the Forensic Medicine Council showed that there were risk of death in 371 cases. Additionally, there was 'organ dysfunction' in 37 (9.9%) and 'organ loss' in 53 (14.2%) cases. The results of this study suggested that the main causes of severe vascular injuries (i.e. those accompanied by bone and nerve lesions) had serious consequences such as amputation, permanent disorders or loss of function and were caused by gunshot and traffic accidents.

The Correlation Between Skull Fractures and Intracranial Lesions Due To Traffic Accidents

In this study, it was aimed to investigate the relationship between skull fractures and intracranial lesions following head injury. For this purpose, 500 cases, which were referred to the Third Committee of Council of Forensic Medicine in Istanbul due to traffic accidents by the courts of laws between 1998 and 2000, were examined retrospectively. They were categorized in 3 groups based on findings of their cranium x-rays and brain tomographies. 1- The cases who have fractures in skull bones with brain lesions 2- The cases who have fractures in skull bones with no brain lesions 3- The cases who have brain lesions with no skull fractures. They were examined in detail according to age, sex, localization of skull fractures and brain lesions, and if surgery was applied or not. Of the cases, 152 (30.4%) had only linear fractures, 69 (13.8%) had depressed fractures, 92 (18.4%) had linear fractures plus intracranial lesions, 49 (9.8%) had depressed fractures plus intracranial lesions and 138 (27.6%) had only intracranial lesions. The rate of intracranial lesion among the cases with the skull fracture was 38.9% (141/362), while the rate of skull fracture among the cases with the intracranial lesion was 50.3% (141/279) (P < 0.001). Male to female ratios were 2.4/1 for linear fractures, 5.2/1 for depressed fractures, and 3.5/1 for intracranial lesions. Linear fractures were more frequent among females whereas depressed fractures were often among males (chi2: 9.68, df: 4, p: 0.046). The mean age was 26.3. The rate of depressed fractures was higher the age groups of 0-30 years. (chi2: 16.28, df: 4, p: 0.003). Depressed fractures in the regions of frontal and parietal and, linear fracture in the regions of temporal and occipital were found at higher rates (P < 0.001). In conclusion, we reviewed skull fractures and/or intracranial lesions due to traffic accidents, and found depressed fractures to be more common among males whereas linear fractures to be more common among females and young males. In the male, the skull architecture is thicker and stronger than females and young males. We can state that presence of skull fractures lowers the incidence of intracranial lesions by lowering the intracranial pressure.

Pleural effusion in bodies recovered from water

Both in saltwater and freshwater drowning cases, a common autopsy sign is pleural effusion. However, the factors that determine the amount of pleural effusion have not been well established. An attempt was therefore made to correlate the amount of pleural fluid in bodies recovered from water with several parameters registered on the judicial files as well as autopsy findings from the years 1994-1998. The number of cases with pleural fluid increase was found to be very high in saltwater drowning (P<0.001). But, when the freshwater and saltwater drowning cases with pleural fluid increase were compared according to pleural fluid amount, no significant difference was detected (521+/-340 and 768+/-536 ml, respectively). Although there was a positive correlation between the decomposition degree and the fluid in the pleural cavity, a relative decrease was detected in the amount of effusion contrary to the expectations in cases of extreme decomposition. Pleural fluid amount provides significant data about the type of water and the cause of death in early postmortem interval. And there is a link between the time spent in water and the amount of pleural effusion. With the advance of the postmortem interval, decomposition level and the duration of immersion should be taken into account in differential diagnosis.