Bülent ŞAM, Ahmet Selçuk GÜRLER, İlhami KÖMÜR, Bünyamin BAŞPINAR, Rifat Özgür ÖZDEMİREL, Yeter EROL, Gülter AKYOL, Mehmet Cengil ASLAN, Ufuk İLTİNGİ, Yalçın BÜYÜK

ADLİ OTOPSİLERDE İZOLE KARACİĞER ÖRNEKLEMESİ İLE KARIŞIK İÇ ORGAN ÖRNEKLEMESİNİN TOKSİKOLOJİK İNCELEME SONUÇLARININ KARŞILAŞTIRMALI ANALİZİ

Amaç:Bu çalışmada, sistematik tok- sikolojik inceleme için karışıkiç organ örnekleme yöntemiyerine izole karaciğer örnek- lemesinin kullanılabilirliğininaraştırılması amaçlanmıştır. Yöntemler: 135 otopsi olgusunda standartörnekleme ile birlikte izole ka- raciğer örneklemesi yapılmışve örneklerin eşzamanlı analizisağlanmak suretiyle her iki ör- neklem grubuna ait toksikolojikinceleme sonuçları istatistikselolarak değerlendirilmiştir. Bulgular:Herhangi bir ilaç ve/veya tok- sik madde saptanmış olan ör- nekler pozitif, saptanmamışolan örnekler negatif olarakyeniden kodlanmak suretiyleKappa istatistiğiyle incelendi- ğinde; izole karaciğer örneğibulguları ile kan/çürüme sıvısıve idrar/mesane yıkama sıvı- sı bulguları birbirleriyle ortaderece uyumlu ve istatistikselolarak anlamlı; izole karaciğerörneği bulguları ile karışık içorgan örneği ve içeriği ile bir- likte alınan mide örneği bulgu- ları birbirleriyle yüksek dereceuyumlu ve istatistiksel olarakanlamlı bulunmuştur.Sonuç: Toksik madde maruziyetinebağlı ölüm olgularında, maruzkalınan toksik maddenin bilin- mesi durumunda etken mad- denin metabolizma sürecineait bilgiler, analiz için hanginumunelerin alınması gerek- tiği konusunda hekime ve tok- sikoloğa yol göstermekte isede, çoğu olguda bu tür bilgidenyoksun olunmaktadır. Sistema- tik toksikolojik analizde izolekaraciğer örneğinin herhan- gi bir ilaç ya da toksik maddetespiti açısından karışık iç or- gan örneklerine kıyasla başarıyüzdesinin daha yüksek olduğubelirlenmiştir.

COMPERATIVE ANALYSIS FOR TOXICOLOGICAL EXAMINATION OF ISOLATED LIVER SAMPLING AND MIXED VISCERAL ORGAN SAMPLING IN MEDICO-LEGAL AUTOPSIES

Objective: In this study we aimed to test theapplicability and diagnostic valueof isolated liver sampling for sys- tematic toxicological analysis asan alternative to mixed sampling. Methods: Total 135 forensic autopsy caseswere selected and in addition toroutine sampling of internal or- gans, isolated liver samples weretaken simultaneously. Toxicologi- cal analysis was also performedsimultaneously in both groups andresults were statistically evalu- ated. Results: When the results were recordedas positive and negative and con- cordance success was evaluatedby the use of Kappa statistics; toxi- cological results of isolated liversampling group were found to bemoderately concordant and statis- tically significant with the findingsof other body fluids; highly con- cordant and statistically significantwith those of stomach content andmixed organ sampling group. Conclusion: In toxic substance-related fatali- ties, if the putative toxic substanceis known, the decision of the foren- sic pathologist and/or toxicologistfor selection of internal organs forsampling is based upon the natureof metabolic process of substance.As a conclusion, the success rateof isolated liver sampling in detec- tion of any drug or toxic substancein systematic toxicological analysisis higher than that of mixed sam- pling.

PDF

___

1. Soysal Z, Eke SM, Cagdır AS. Sampling tissues for toxicological analysis. In Fo- rensic autopsy Vol 1. (1st ed). Istanbul: Istanbul University Cerrahpasa Medical Faculty Press 1999:361-83. 2. Drummer OH, Gerostamoulos J. Post- mortem drug analysis: analytical and toxicological aspects. Ther Drug Monit 2002;24:199-209. 3. Ziminski KR, Wemyss CT, Bidanset JH, Manning TJ, Lukash L. Compara- tive study of postmortem barbiturates, methadone and morphine in vitreous humor, blood and tissue. J Forensic Sci 1984;29(3):903-9. 4. Dickson SJ, Cleary WT, Missen AW, Querée EA, Shaw SM. The relative effi- ciency of drug extraction procedures for enzyme digested livers. J Anal Toxicol 1980;4:74-7. 5. Adikwu E, Deo O, Geoffrey OBP, En- imeya DA. Lead organ and tissue toxicity: roles of mitigating agents (Part 1). British Journal of Pharmacology and Toxicology 2013;4(6):232-40. 6. Dix J, Calaluce R. Guide to forensic pathology: drugs and alcohol. Columbia 1998:65-72. 7. Mozayani A, Noziglia C. The Forensic Laboratory Handbook-Procedures And Practice. New Jersey: Humana Press, Totowa, 2006:249-64. 8. Karch SB. Postmortem Toxicology of Abused Drugs: Specimen Selection, Col- lection, Preservation and Security. Berke- ley (California): CRC Press, 2008:15-9. 9. Levine BS, Smith ML, Froede RC. Post- mortem forensic toxicology. Clin Lab Med 1990;10: 571-89. 10. DiMaio VJ, DiMaio D. Forensic Pathol- ogy. 2nd ed. Boca Rotan (Florida): CRC Press, 2001:1-19;507-44. 11. Beyaztas FY, Kılıccıoglu B. The Fo- rensic medical evaluation of poisoning cases in Cumhuriyet University Hospital between years 1992-2002. J For Med 2003;17(34):9-13. 12. Cınar T. Retrospective analysis of 62 intoxication cases in Eskisehir Branch Di- rectorate, Council of Forensic Medicine. [Dissertation]. Department of Forensic Medicine, Medical Faculty, Osmangazi University, Eskisehir, 1996. 13. Knight B, Saukko P. Poisoning And The Pathologist. In: Knight B, ed. Knights Forensic Pathology. 3nd ed. NY: Oxford University Press Inc, 2004:541-50. 14. Azmak D. Postmortem toxicological analysis. Turkiye Klinikleri J Surg Med Sci 2006;2(46):49-52. 15. Eren M, Saltik-Temizel IN, Kocak N. Drug related hepatotoxicity. Turk J Pedi- atr 2004;47(3):222-7. 16. Levine B. Principles of Forensic Toxicology. USA: AACC Press, 1999:1- 13,153-60. 17. Karch SB. Pathology, Toxicogenetics And Criminalistics Of Drug Abuse: Over- view Of Pathology Of Drug Abuse: Scene Of Death And The Autopsy. Berkeley (Cal- ifornia): CRC Press, 2008:71-80. 18. Wyman J, Bultman S. Postmor- tem distribution of heroin metabolites in femoral blood, liver, cerebrospinal fluid and vitreous humor. J Anal Toxicol 2004;28(4):260-3. 19. Ludwig J. Handbook Of Autopsy Practice: Medicolegal Autopsies And Autopsy Toxicology. USA: Humana Press 2002:7-19. 20. Guy NR. Essentials of Autopsy Prac- tice: Postmortem Toxicological Redistri- bution. London: Springer-Verlag Press, 2008:1-22. 21. Pounder DJ, Fuke C, Cox DE, Smıth D, Kuroda N. Postmortem diffusion of drugs from gastric residue: an experi- mental study. Am J Forensic Med Pathol 1996;17(1):1-7. 22. Turkish Republic, Ministry of Jus- tice, Council of Forensic Medicine Law and Implementing Regulations. Istan- bul: Council of Forensic Medicine Press, 2007:140. 23. Flanagan RJ, Connally G, Evans JM. Analytical toxicology: Guidelines for sam- ple collection postmortem. Toxicol Rev 2005;24(1):63-71. 24. Guyton AC, Hall JE. Textbook of Medi- cal Physiology. 9th ed. (Ed. In Turkish: Cavusoglu H.) Istanbul: Yuce Yayınlari, 1996:883-8.