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Öğe Ankara'da otopsi yapılmış fatal alkol entoksikasyonları (2001-2004)(2007) Eke, Murat; Büyük, Yalçın; Dinç, A. Hakan; Çitici, IşılAdli Tıp Kurumu Ankara Grup Başkanlığı Morg İhtisas Dairesi'nde 2001-2004 yıllarını kapsayan 4 yıllık süre içinde yapılmış olan adli otopsi olgularının retrospektif analizinde toplam 40 alkol entoksikasyonu kaynaklı ölüm olgusu saptanmıştır. Alkol entoksikasyonu olgularının 18'inde saptanan alkol etil alkol iken 22'sinde metil alkol saptanmıştır. Olguların sadece üçü kadın olup, en fazla olgu 14 olguyla 41-50 yaş grubunda saptanmıştır. 22 olgunun ölü olarak bulunduğu, 7 olgunun hastaneye ölü olarak getirildiği ve 11 olgunun hastanede kısa bir süre içinde tanı konulamadan öldüğü belirlenmiştir. Metanol kaynaklı ölüm olgularında metanol kaynağı değerlendirildiğinde 3 olguda kaynağın ispirto, 10 olguda kolonya, 1 olguda ispirto ve kolonya olduğu bildirilmiş iken 8 olguda kaynakla ilgili bilgiye ulaşılamamıştır. Alkol düzeyleri değerlendirildiğinde, en düşük ve en yüksek düzeylerin etil alkol olgularında 279-516 mg/dl iken, metil alkol olgularında 74-485 mg/dl olduğu saptanmıştır. Olguların tamamına yakınında makroskobik ve mikroskobik olarak kronik alkolizmi düşündüren karaciğerdeki patolojik değişimler ve yaygın hiperemi dışında belirgin patolojik değişiklik saptanmamıştır.Öğe Effect of Partial, Distal Epicondylectomy on Reduction of Ulnar Nerve Strain: A Cadaver Study(W B Saunders Co-Elsevier Inc, 2013) Çırpar, Meriç; Türker, Mehmet; Yalçınozan, Mehmet; Eke, Murat; Şahin, FeyziPurpose To compare the decrease in ulnar nerve strains using a modification of medial epicondylectomy by removing the distal half of the medial epicondyle with in situ decompression and partial medial epicondylectomy. Methods Using 20 elbows of 10 fresh human cadavers, we measured the strain on the ulnar nerve using a microstrain gauge before and after in situ decompression. Then, we repeated the measurements after partial medial epicondylectomy on left elbows, and after distal medial epicondylectomy on right elbows. We compared the mean strain values with 2-way analysis of variance. Results The decrease in mean ulnar nerve strain with in situ decompression from 5.4% to 5.2% on the right side and 5.4% to 5.0% on the left was not statistically significant. The decrease to 2.9% on the left elbows after partial and to 1.9% on the right elbows after distal medial epicondylectomy was statistically significant. In addition, the remaining ulnar nerve strain after distal medial epicondylectomy was significantly less compared with that after partial medial epicondylectomy. We observed nerve subluxation only with partial medial epicondylectomy. Conclusions In situ decompression alone does not change ulnar nerve strains. The significant change in ulnar nerve strain with partial or distal medial epicondylectomy underlines the role of medial epicondyle on stretching of the ulnar nerve. Excision of the distal half of the medial epicondyle sets the contact point of the nerve with the bone proximally and decreases the strain on ulnar nerve more effectively than partial epicondylectomy. However, its efficacy and complications need to be studied clinically. Clinical relevance The results of the present cadaveric study suggest that excision of the distal half of the medial epicondyle in cubital tunnel syndrome may decrease ulnar nerve strain effectively. The clinical effect of decrease in nerve strain and the indications for the procedure need to be investigated. (J Hand Surg 2013;38A:666-671. Copyright (C) 2013 by the American Society for Surgery of the Hand. All rights reserved.)Öğe Homeless deaths in Istanbul, Turkey(2008) Büyük, Yalçın; Üzün, İbrahim; Eke, Murat; Çetin, GürselWe retrospectively analyzed the autopsy records of the Council of Forensic Medicine during the 5-year period between the years 2000 and 2004 to contribute to the efforts targeted at lowering death rate in the milieu of homelessness by documenting the current status of this group particularly in terms of mode of death. Two hundred and nine of the 229 cases (91.27%) were males and remaining 20 were females. The preponderance of male cases in our autopsy population was also detected in homeless population. Most of the cases were in the age group of 40-49 years (64 cases, 27.95%). One hundred and ninety two corpses (83.85%) were found outdoors and only 37 of the cases (16.15%) indoors. Natural events constituted the cause of death in 138 of the cases (60.26%) and in remainder 91 cases the cause of death was related to an unnatural event (39.74%). In approximately 1/3 of the cases of natural death cases, autopsy revealed the evidence of pulmonary tuberculosis but only in 32 of these cases the tuberculosis was the primary cause of death. The presence of alcohol was found to be significantly associated with the manner of death. Blood alcohol level over 50 mg/100 ml was determined only in 9.42% of natural death cases, whereas it was positive in 61.53% of unnatural death cases. We concluded that immediate precautions targeted at lowering death rate in this population must include health care for preventable natural diseases. © 2008 Elsevier Ltd and FFLM.Öğe Limitations in the approach health caregivers can take in end-of-life care decisions(Wiley, 2015) Bülbül, Selda; Surucu, M.; Karavaizoğlu, Çağla; Eke, MuratBackground In the terminal stages of neuro-metabolic diseases, parents can begin to experience a sense of loss even before the child dies, and might accept death prematurely. Cases A 2.5-year-old female patient with Sandoff Disease (diagnosed at 9 months of age), and a 17-month-old male Krabbe patient (diagnosed at 5 months of age) were admitted to the hospital with hypernatraemic dehydration and bronchopneumonia, respectively, within 10 days of each other. Both patients developed respiratory arrest short after admission and were supported with mechanical ventilation. Both families gave written consent to end life support, but their wishes could not be accepted according to Turkish law. Conclusions Specialists are expected to communicate well with families and give continuous care while respecting the opinions of patients' families on the timing of the withdrawal of life support. However, ethical and legal regulations on the conduct of health care professionals in these circumstances are unclear in Turkey and should be developed rapidly.Öğe Post-mortem alcohol analysis in synovial fluid: an alternative method for estimation of blood alcohol level in medico-legal autopsies?(Taylor & Francis Ltd, 2009) Büyük, Yalçın; Eke, Murat; Cağdır, A. Sadi; Karaaslan, Hicran K.To evaluate the effectiveness of synovial fluid alcohol concentration in prediction of blood alcohol concentration, synovial fluid and blood was studied of 50 autopsy cases and the alcohol levels determined by using Head Space Gas Chromatography method. To exclude the effect of decomposition on alcohol levels, corpses with postmortem intervals less than 24 hours and not showing signs of decomposition were selected. Of 50 cases, alcohol was detected in 15 cases both in blood and in synovial fluid. In 35 cases alcohol analysis was negative both in blood and synovial fluid. No false positive results were seen in terms of synovial fluid. In two of the 15 cases, the alcohol determined was methyl alcohol and in others the alcohol was ethyl alcohol. In these 15 cases, only in one case was SAC level lower than the BAC level, and in 14 cases; SAC levels were higher than those of BAC. BAC (Blood Alcohol Concentration)/SAC (Synovial Fluid Alcohol Concentration) ratios were determined, and in 13 ethanol cases the mean ratio was determined to be 0.95 (0.90 +/- 0.07). The regression analysis showed a fairly linear relationship between the BAC and SAC, with a correlation coefficient of 0.984 (y=0.86x + 10.4). The present study demonstrates that the synovial fluid is a valuable body fluid that can be used in prediction of blood alcohol concentration in forensic autopsy cases in which blood can not be properly obtained.
