Adli Tıp Muğla Şube Müdürlüğü’nde Otopsi Yapılan Yangın Ortamından Çıkarılan Olgularının Değerlendirilmesi
Abstract
Amaç: Bu çalışmada Muğla ilinde otopsisi yapılan yangın ortamından çıkarılan olgularda ölüm nedeninin belirlenmesi açısından makroskobik, mikroskobik ve toksikolojik bulguların değerlendirilmesi yanı sıra vitalite bulgularına vurgu yapılması amaçlanmıştır.
Yöntem: 2013-2021 yılları arasındaki 9 yıllık periyotta yapılan tüm adli otopsiler içindeki yangın ortamından çıkarılan olgular retrospektif incelenmiştir.
Bulgular: Adli Tıp Muğla Şube Müdürlüğünde 2013-2021 yılları arasında yapılan toplam 3981 otopsinin 61’i (%1,5) yangın ortamından çıkarılan olgulardır. Yangın ortamı, olguların %83,6’sında (n:51) kapalı alan, 10 olguda (%16,4) açık alandır. Olguların %20’sinde karbonmonoksit saptanmamıştır. Olguların 31’inde (%50,8) vücut bütünlüğünün tam olduğu, 30’unda (%49,2) vücut bütünlüğünde eksiklik olduğu, vücut bütünlüğünde eksiklik olan olgularda kısmen/tamamen kömürleşme derecesinde yanma olduğu saptanmıştır. Olgularda mikroskopik olarak organlarda konjesyon ve ısı etkisine bağlı değişiklikler gibi nonspesifik bulgular dışında, %25-50 arasında değişen oranlarda histopatolojik bulgular saptanmıştır. Antemortem ya da postmortem yanık ayrımı açısından; olguların 39’unda %10’dan fazla COHb saptandığı, COHb düzeyi %10’dan az/saptanmayan 22 olgunun 9’unda koagülasyon nekrozu, mononükleer inflamatuar hücreler, subkutan yağ dokusu altında kanama, akciğerlerde dokusunda karbon partikülleri ve pigment yüklü histiositler gibi histopatolojik olarak destekleyici bulgular olduğu saptanmıştır. Geri kalan 13 olgunun, ikisinde orijin cinayet olup otopsilerinde makroskobik ve mikroskobik olarak vitalite bulgusu saptanmamıştır. Dört olguda yanmadan önce kendilerinde mevcut bazı hastalıkların ölüm sürecini hızlandırması; iki olguda eksojen alınmış olan yüksek doz etanol ve bazı ilaçların varlığı, iki olgunun yaşlı/çocuk olması; iki olgunun orman yangını sırasında açık havada yoğun alevlere maruz kalması, 3 olguda hastanede tedavi süreci ve uygun örnekte inceleme yapılamaması; iki olgunun trafik kazasında yanan araç içinde aynı zamanda künt travma bulgularının olması nedeniyle kişilerin COHb içeren havayı soluma fırsatının olmadığı ya da çok yüzeyel bir solunum yapabildiği, olay yeri inceleme bulguları ve adli tahkikatları çerçevesinde bu kişilerin yangın ortamında canlı bulunduğu değerlendirilmiştir.
Sonuç: Yangın ortamından çıkarılan olgularda mutlaka otopsi yapılmalı, ileri derecede yanmış olsalar da mutlaka histopatolojik ve toksikolojik incelemeler yapılmalı, yanma olayının kişi canlı iken mi yoksa öldükten sonra mı olduğunun ayrımı açısından vitalite bulguları dikkatli değerlendirilmeli ve yorumlanmalıdır. Ölenin kanında belirli bir düzeyin üzerinde karbonmonoksit tespiti, kişinin yangın yangın ortamında canlı bulunulduğunun değerli bir göstergesi olmakla birlikte kanda karboksihemoglobin tespit edilmemiş olması kişinin öldükten sonra yandığı anlamına gelmemektedir.
Keywords
Ethical Statement
Makale içindeki bilgilerin herhangi bir kısım daha önce herhangi bir şekilde yayınlanmamıştır (kongre, sempozyum, medya haberi vb) veya değerlendirilmek üzere başkaca bir akademik dergiye gönderilmemiştir. Helsinki Bildirgesi kriterleri göz önünde bulundurulmuştur.
References
- International Association of Fire and Rescue Services Center for Fire Statistics of CTIF 2022 https://www.ctif.org/sites/default/files/2022-08/CTIF_Report27_ESG.pdf
- Prahlow J, Byard RW. Burns and fire-related deaths. In: Prahlow J, Byard RW, editors. Atlas of Forensic Pathology. New York: Springer Publishers; 2012. pp. 753-84. https://doi.org/10.1007/978-1-61779-058-4_19
- Büyük Y, Koçak U. Fire-related fatalities in Istanbul, Turkey: analysis of 320 forensic autopsy cases. J Forensic Leg Med 2009;16(8):449–54. https://doi.org/10.1016/j.jflm.2009.05.005
- Melez, İE, Arslan MN, Melez DO, Gürler AS, Büyük Y. Manner of death determination in fire fatalities: 5-year autopsy data of Istanbul City. Am J Forensic Med Pathol 2017;38(1):59–68. https://doi.org/10.1097/PAF.0000000000000292
- Aydoğdu HI, Ketenci HÇ, Askay M, Boz H, Kırcı GS, Özer E. Evaluation of the fire-related deaths: Autopsy study. Ulus Travma Acil Cerrahi Derg. 2021;27(5):539–546. English. https://doi.org/10.14744/tjtes.2020.64911
- T.C. Muğla Büyükşehir Belediyesi Emir ve Yasakları Yönetmelik İkinci Bölüm Madde: 7 Temizlik ile ilgili Emir ve Yasaklar No: 19 https://www.mugla.bel.tr/uploads/mecliskarartr/144%20NOLU%20KARAR%20ZABITAEM%C4%B0R-YASAKLAR%20(1).pdf
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- Llano AL, Raffin TA. Management of carbon monoxide poisoning. Chest. 1990;97(1):165–69. https://doi. org/10.1378/chest.97.1.165
- Conway KS, Schmidt CJ, Brown TT. Medical examiner review of the characteristics of fire-related homicides. Acad Forensic Pathol. 2020;10(2):87–93. https://doi.org/10.1177/1925362120964377
- Downs JCU. Carbon monoxide exposure: autopsy findings. In: Payne-James J, Byard RW, editors. Encyclopedia of Forensic and Legal Medicine, 2nd ed. US. Elsevier; 2016. pp.444-60. https://doi.org/10.1016/B978-0-12-8000342.00058-6
- Greenberg DA. Ethanol and sedatives. Neurol Clin. 1993;11(3):523–34. https://doi.org/10.1016/S0733-8619(18)30136-1
- 2918 Sayılı Karayolları Trafik Kanunu’nun 48/5 maddesi h t t p s : / / w w w . m e v z u a t . g o v . t r / m e v z u a t ? MevzuatNo=2918&MevzuatTur=1&MevzuatTertip=5
- Jonsson A, Runefors M, Särdqvist S, Nilson F. Fire-related mortality in Sweden: Temporal Trends 1952 to 2013. Fire Technol. 2016;52:1697–707. https://doi.org/10.1007/s10694-015-0551-5
- İstanbul Büyükşehir Belediyesi İtfaiye Daire Başkanlığı İstatistikler 2020 http://itfaiye.ibb.gov. tr/img/_131638942020_.pdf
- Esen Melez İ, Arslan MN, Melez DO, Gürler AS, Büyük Y. Manner of death determination in fire fatalities: 5-Year autopsy data of Istanbul City. Am J Forensic Med Pathol. 2017;38(1):59–68. https://doi.org/10.1097/PAF.0000000000000292
- Bohnert M, Rost T, Pollak S. The degree of destruction of human bodies in relation to the duration of the fire. Forensic Sci Int. 1998;95(1):11–21. https://doi.org/10.1016/S0379-0738(98)00076-0
- Saukko P, Knight B. Burns and scalds. In: Knight’s Forensic Pathology, 4th ed. New York: CRC Press; 2016. pp. 311–24. https://doi.org/10.1201/b13266
- Anderson RA, Watson AA, Harland WA. Fire deaths in the Glasgow Area 1; general considerations and pathology. Med Sci Law 1981;21(3):175–83. https://doi.org/10.1177/002580248102100305
Evaluation of Cases Found at the Fire Environment for which Autopsies were Performed at the Muğla Branch of Forensic Medicine
Abstract
Ojective: In this study, it was aimed to evaluate the macroscopic, microscopic and toxicological findings, as well as to emphasize the vitality findings, in order to determine the cause of death in cases removed from the fire scene for autopsy in Muğla province.
Material and Methods: Cases recovered from the fire scene in all forensic autopsies performed in the 9-year period between 2013 and 2021 were examined retrospectively.
Results: 61 (1.5%) of the total 3981 autopsies performed at the Forensic Medicine Muğla Branch Directorate between 2013 and 2021 were cases found in the fire environment. The fire environment was a closed area in 83.6% of the cases (n: 51) and an open area in 10 cases (16.4%). Carbon monoxide was not detected in 20% of the cases. It was determined that 31 (50.8%) of the cases had complete body integrity, 30 (49.2%) had a lack of body integrity, and in cases with lack of body integrity, there was partial/complete burn to the extent of charcoal. Apart from nonspecific findings such as microscopic changes in organs due to congestion and heat effect, histopathological findings were detected in rates varying between 25-50%. In terms of differentiating antemortem or postmortem burns; More than 10% COHb was detected in 39 of the cases, and histopathological findings such as coagulation necrosis, mononuclear inflammatory cells, bleeding under the subcutaneous fat tissue, carbon particles in the lung tissue and pigment-laden histiocytes were detected in 9 of the 22 cases with COHb level less than 10%/not detected. It was found that there were supportive findings. Apart from nonspecific findings such as microscopic changes in organs due to congestion and heat effect, histopathological findings were detected in rates varying between 25-50%. In terms of differentiating antemortem or postmortem burns; More than 10% COHb was detected in 39 of the cases. In 9 of the 22 cases where the COHb rate was less than 10% or not detected, histopathologically supportive findings such as coagulation necrosis, mononuclear inflammatory cells, bleeding under the subcutaneous fat tissue, carbon particles in the lung tissue and pigment-laden histiocytes were detected. In two of the remaining 13 cases, the origin was homicide and no signs of vitality were detected macroscopically or microscopically in their autopsies. In four cases, some of the diseases they had before they were burned accelerated the death process; The presence of high doses of exogenous ethanol and some drugs in two cases, the fact that two cases were elderly/children; Two cases were exposed to intense flames outdoors during a forest fire, three cases were treated in hospital and the appropriate sample could not be examined; It was evaluated that in two cases, due to the presence of blunt trauma findings in the vehicle that burned in a traffic accident, the people did not have the opportunity to breathe air containing COHb or could only breathe very superficially, and within the framework of the crime scene investigation findings and forensic investigations, these people were found alive in the fire environment.
Conclusion: Autopsy should be performed in cases removed from the fire environment, histopathological and toxicological examinations should be performed even if they are severely burned, and vitality findings should be carefully evaluated to distinguish whether the burning occurred while the person was alive or after death. Although the detection of carbon monoxide above a certain level in the blood of the deceased is a valuable indicator that the person was alive in the fire environment, the absence of carboxyhemoglobin in the blood does not mean that the person was burned after death.
Keywords
References
- International Association of Fire and Rescue Services Center for Fire Statistics of CTIF 2022 https://www.ctif.org/sites/default/files/2022-08/CTIF_Report27_ESG.pdf
- Prahlow J, Byard RW. Burns and fire-related deaths. In: Prahlow J, Byard RW, editors. Atlas of Forensic Pathology. New York: Springer Publishers; 2012. pp. 753-84. https://doi.org/10.1007/978-1-61779-058-4_19
- Büyük Y, Koçak U. Fire-related fatalities in Istanbul, Turkey: analysis of 320 forensic autopsy cases. J Forensic Leg Med 2009;16(8):449–54. https://doi.org/10.1016/j.jflm.2009.05.005
- Melez, İE, Arslan MN, Melez DO, Gürler AS, Büyük Y. Manner of death determination in fire fatalities: 5-year autopsy data of Istanbul City. Am J Forensic Med Pathol 2017;38(1):59–68. https://doi.org/10.1097/PAF.0000000000000292
- Aydoğdu HI, Ketenci HÇ, Askay M, Boz H, Kırcı GS, Özer E. Evaluation of the fire-related deaths: Autopsy study. Ulus Travma Acil Cerrahi Derg. 2021;27(5):539–546. English. https://doi.org/10.14744/tjtes.2020.64911
- T.C. Muğla Büyükşehir Belediyesi Emir ve Yasakları Yönetmelik İkinci Bölüm Madde: 7 Temizlik ile ilgili Emir ve Yasaklar No: 19 https://www.mugla.bel.tr/uploads/mecliskarartr/144%20NOLU%20KARAR%20ZABITAEM%C4%B0R-YASAKLAR%20(1).pdf
- Türk Ceza Kanunu’nda tanımlanan yaralama suçlarının adli tıp açısından değerlendirilmesi rehberi, Haziran 2019. https://www.atk.gov.tr/tckyaralama24-06-19.pdf
- Llano AL, Raffin TA. Management of carbon monoxide poisoning. Chest. 1990;97(1):165–69. https://doi. org/10.1378/chest.97.1.165
- Conway KS, Schmidt CJ, Brown TT. Medical examiner review of the characteristics of fire-related homicides. Acad Forensic Pathol. 2020;10(2):87–93. https://doi.org/10.1177/1925362120964377
- Downs JCU. Carbon monoxide exposure: autopsy findings. In: Payne-James J, Byard RW, editors. Encyclopedia of Forensic and Legal Medicine, 2nd ed. US. Elsevier; 2016. pp.444-60. https://doi.org/10.1016/B978-0-12-8000342.00058-6
- Greenberg DA. Ethanol and sedatives. Neurol Clin. 1993;11(3):523–34. https://doi.org/10.1016/S0733-8619(18)30136-1
- 2918 Sayılı Karayolları Trafik Kanunu’nun 48/5 maddesi h t t p s : / / w w w . m e v z u a t . g o v . t r / m e v z u a t ? MevzuatNo=2918&MevzuatTur=1&MevzuatTertip=5
- Jonsson A, Runefors M, Särdqvist S, Nilson F. Fire-related mortality in Sweden: Temporal Trends 1952 to 2013. Fire Technol. 2016;52:1697–707. https://doi.org/10.1007/s10694-015-0551-5
- İstanbul Büyükşehir Belediyesi İtfaiye Daire Başkanlığı İstatistikler 2020 http://itfaiye.ibb.gov. tr/img/_131638942020_.pdf
- Esen Melez İ, Arslan MN, Melez DO, Gürler AS, Büyük Y. Manner of death determination in fire fatalities: 5-Year autopsy data of Istanbul City. Am J Forensic Med Pathol. 2017;38(1):59–68. https://doi.org/10.1097/PAF.0000000000000292
- Bohnert M, Rost T, Pollak S. The degree of destruction of human bodies in relation to the duration of the fire. Forensic Sci Int. 1998;95(1):11–21. https://doi.org/10.1016/S0379-0738(98)00076-0
- Saukko P, Knight B. Burns and scalds. In: Knight’s Forensic Pathology, 4th ed. New York: CRC Press; 2016. pp. 311–24. https://doi.org/10.1201/b13266
- Anderson RA, Watson AA, Harland WA. Fire deaths in the Glasgow Area 1; general considerations and pathology. Med Sci Law 1981;21(3):175–83. https://doi.org/10.1177/002580248102100305
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Forensic Medicine |
| Journal Section | Research Article |
| Authors | |
| Publication Date | April 29, 2024 |
| Submission Date | January 8, 2024 |
| Acceptance Date | March 17, 2024 |
| Published in Issue | Year 2024 Volume: 38 Issue: 1 |
