Post-travmatik yağ embolisi saptanan adli otopsi olgularında iskelet travmasının değerlendirilmesi
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Tarih
2005
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info:eu-repo/semantics/closedAccess
Özet
Post-travmatik yağ embolizmi kaynaklı ölüm olgularında saptanan travmatik değişimlerin değerlendirilmesi amacıyla 1994-2004 yılları arasında yapılmış adli otopsilerde yağ embolisi saptanan olgular retrospektif olarak değerlendirildi. 56 olguda yağ embolisi ön tanısı ile inceleme yapılmış olup, 26'sında yağ embolisi saptanmıştır. Olguların 22'si erkek ve 4'ü kadın olup, en fazla olgu 70 yaş ve üzeri yaş grubunda (8) saptanmış, 50 yaş ve üzeri olguların toplam sayısı 20 olarak saptanmıştır. 16 olgu ile trafik kazasının en fazla saptanan orijin olup, femur ve tibia kırıkları olguların % 88.46'ısında saptanmıştır. Olguların 15'inde fokal ve 11'inde yaygın olmak üzere olguların 26'sında akciğerde yağ embolisi ve 8 olguda böbrekte yağ embolisi saptanmış iken beyin dokusunda yağ embolisi saptanmamıştır. Olguların 11'inde yağ embolisi primer ölüm sebebi olup, 15 olguda ise ortak sebep olarak ölüme katkıda bulunmuştur. Primer ölüm sebebinin yaygın yağ embolisi olarak saptanan olgulardaki travmatik bulgular değerlendirildiğinde 10 olguda ekstremite kemiklerinde 2 ve daha fazla kırık ile pelvisekstremite kırıkları gibi travma bulgularının daha şiddetli olduğu saptanmıştır. Travmatik olgularda fraktürlerin erkenden stabilizasyonu ve resüsitasyonla birlikte özellikle çok sayıda majör iskelet kemik fraktürleri bulunan olgular ile ileri yaş grubundaki hastalar gibi risk gruplarının bu sendrom açısından daha yakından takibinin önemi ile birlikte bu olguların otopsilerinde yağ embolisi açısından da inceleme yapılmasının önemine vurgu yapılmıştır.
To evaluate the characteristic features of skeletal traumatic changes in the cases of fat embolism-related deaths, all autopsy cases between the years 1994-2004 performed in Forensic Council of Medicine of Turkey in Istanbul were analyzed. Histologic examination of specimens in terms of postmortem fat embolism was found to be carried on 56 cases and of these cases fat embolism was determined in 26 cases. Of 26 cases, 22 were male and 4 were female, most of the case belonging to the age group of 70 and more. Transportation fatalities constituted the majority of the cases in terms of origin and of 26 cases that fat embolism detected in lungs, the fat embolism was widespread in 11 and focal in 15. Femoral and tibial fractures together constituted the majority of skeletal trauma (88.46%) in these cases. The primary cause of death in 11 cases was pulmonary fat embolism and fat embolism was detected to be contributing factor in death of 15 cases. In the cases that pulmonary fat embolism played primary role in death process, it was also detected that skeletal traumatic findings were also complicated (2 or more fractures in limbs and/or fractures both in pelvic region and limbs). Together with early fracture stabilization and resuscitation in traumatized patients, the risk groups such as the patients with multi-fractures and older trauma patients must essentially be followed very closely for the clinical signs of fat embolism. In autopsy of these cases, specimens (mostly lungs) must be histologically examined for fat embolism.
To evaluate the characteristic features of skeletal traumatic changes in the cases of fat embolism-related deaths, all autopsy cases between the years 1994-2004 performed in Forensic Council of Medicine of Turkey in Istanbul were analyzed. Histologic examination of specimens in terms of postmortem fat embolism was found to be carried on 56 cases and of these cases fat embolism was determined in 26 cases. Of 26 cases, 22 were male and 4 were female, most of the case belonging to the age group of 70 and more. Transportation fatalities constituted the majority of the cases in terms of origin and of 26 cases that fat embolism detected in lungs, the fat embolism was widespread in 11 and focal in 15. Femoral and tibial fractures together constituted the majority of skeletal trauma (88.46%) in these cases. The primary cause of death in 11 cases was pulmonary fat embolism and fat embolism was detected to be contributing factor in death of 15 cases. In the cases that pulmonary fat embolism played primary role in death process, it was also detected that skeletal traumatic findings were also complicated (2 or more fractures in limbs and/or fractures both in pelvic region and limbs). Together with early fracture stabilization and resuscitation in traumatized patients, the risk groups such as the patients with multi-fractures and older trauma patients must essentially be followed very closely for the clinical signs of fat embolism. In autopsy of these cases, specimens (mostly lungs) must be histologically examined for fat embolism.
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