The importance of radiographic imaging in determining the direction of shooting in maxillofacial gunshot wounds

Objective: The aim of this study is to investigate the importanceof the initial radiographies of patients whose firstmedical intervention was made outside the country bordersand recovered after treatment in our hospital.Methods: The patients with maxillofacial trauma due togunshot and shrapnel injuries who were treated by Departmentof Otolaryngology in the last year were examinedretrospectively. Twenty two patients were includedto the study, who had injuries in another country and whowere received initial medical treatments there. The maxillofacialcomputed tomographies of patients which wereperformed before the treatment were evaluated accordingto the direction of movement of bone fracture fragments.Results: The youngest patient was 17 years old and theoldest one was 43 years old. All the patients were male. Itwas observed that all of the patients were referred to ourhospital after the first intervention had been made in othermedical centers. There was no reliable information aboutthe event of injury and type of used weapon. According tothe findings of the radiological images, the directions ofshootings were determined by the evaluation of the directionsof bone fragments in 19 (86.4%) patients.Conclusion: The initial radiographic images of dead ormedically treated patients with bone fractures due to gunshotinjuries, in cases with unidentified origins and injurymechanisms, play an important role in the determinationof the direction of shooting. The wounds have been identifiedwhether they are entry or exit wounds when the directionsof fire are determined.Key words: Gunshot, direction of fire, bone fractur

The importance of radiographic imaging in determining the direction of shooting in maxillofacial gunshot wounds

Amaç: Bu çalışmanın amacı ilk tıbbi müdahalesi ülke sınırları dışında yapılarak gönderilen ve hastanemizde tedavi görmüş olgularda atış yönünün tespitinde tedavi öncesi çekilen grafilerin etkinliğinin araştırılmasıdır. Yöntemler: Bir yıl içerisinde kulak burun boğaz servisinde tedavi görmüş ateşli silah ve şarapnel yaralanmasına bağlı maksillofasiyal travması bulunan olguların kayıtları geriye dönük olarak incelendi. Yurtdışında yaralanan ve ilk tıbbi tedavisi dış merkezlerde yapılan 22 olgu çalışma kapsamına alındı. Olgulara ait tedavi öncesi çekilen maksillofasiyal bilgisayarlı tomografilerde tespit edilen kemik kırıklarının hareket yönleri değerlendirildi. Bulgular: Olguların en küçük olanın yaşı 17, en büyük olgu 43 yaşında olduğu saptandı. Tüm olgular erkek cinsiyetinde olduğu belirlendi. Tüm olguların acil müdahaleleri dış merkezlerde yapıldıktan sonra hastanemize sevk edildiği görüldü. Olayın oluş şekli ve ne tür bir silah ile meydana geldiğine ait güvenilir bir bilgi yoktu. Hastaların radyolojik görüntülerinin değerlendirilmesi sonucunda; 19 olguda (%86,4) kırılan kemik parçalarının hareket yönüne göre atış yönünün tespiti yapıldı. Sonuç: Olayın orijini ve mekanizması belli olmayan, özellikle kemik kırığı bulunan ölümlü veya tıbbi müdahale görmüş ateşli silah yaralanması olgularında atış yönünün tespiti açısından çekilen ilk grafiler oldukça önemlidir. Atış yönünün belirlenmesi halinde hangi yaranın giriş, hangisinin çıkış yarasının olduğu da tespit edilmiş olacaktır.Objective: The aim of this study is to investigate the importance of the initial radiographies of patients whose first medical intervention was made outside the country borders and recovered after treatment in our hospital. Methods: The patients with maxillofacial trauma due to gunshot and shrapnel injuries who were treated by Department of Otolaryngology in the last year were examined retrospectively. Twenty two patients were included to the study, who had injuries in another country and who were received initial medical treatments there. The maxillofacial computed tomographies of patients which were performed before the treatment were evaluated according to the direction of movement of bone fracture fragments. Results: The youngest patient was 17 years old and the oldest one was 43 years old. All the patients were male. It was observed that all of the patients were referred to our hospital after the first intervention had been made in other medical centers. There was no reliable information about the event of injury and type of used weapon. According to the findings of the radiological images, the directions of shootings were determined by the evaluation of the directions of bone fragments in 19 (86.4%) patients. Conclusion: The initial radiographic images of dead or medically treated patients with bone fractures due to gunshot injuries, in cases with unidentified origins and injury mechanisms, play an important role in the determination of the direction of shooting. The wounds have been identified whether they are entry or exit wounds when the directions of fire are determined

Depression and neglect of a girl child due to baby boy pressure of the society

Bu çalışmada; üç tane kız çocuğu olduğu için, toplum ve akrabaları tarafından duygusal baskı gören ve major depresyon gelişen; bu nedenle bilerek kız çocuklarını ihmal eden bir annenin sunulması planlanmıştır. Olgumuz 28 yaşında, ortaokul mezunu ev hanımıdır. Hayattan zevk alamama, halsizlik, isteksizlik, ağlama ve özkıyım düşünceleri nedeniyle polikliniğe başvuran hasta özellikle özkıyım planları ve motor retardasyonun belirgin olması nedeniyle major depresyon tanısı konularak psikiyatri servisine yatırılmıştır. Öyküsünde son depresyon atağının 2 yıl önce gebeyken kontrol için gittiği kadın doğum uzmanın, çocuğunun cinsiyetinin kız olduğunu söylemesi ile başladığı anlaşılmıştır. Eşinin ailesi erkek çocuk istediklerini, bunu başaramadığı için de kendini suçladığını ve o zamandan sonra çocukları ile ilgilenmemeye başladığını söylemiştir. Hamile olduğu dönem ve daha sonraları çocuklarına karşı ilgisinin azaldığını, hasta olsunlar diye soğuk havalarda daha ince giydirdiğini, gece çocuklarının üstünü kasıtlı olarak örtmediğini, hasta olduklarında ilaçlarını bazen hiç vermediğini ve "Keşke kızlarım ölse de ben de erkek çocuk doğursam" şeklinde ifadeler kullanmıştır. Cinsiyet ayrımcılığı, kız çocuklarına gösterilmesi gereken ilgiyi azaltmaktadır. Olgumuz da bu ayrımcılık nedeniyle çocuklarının zarar görmesini istemiş ve erkek bir çocuk doğurma ümidi nedeniyle çocuklarını ihmal etmiştir.In the present study, a condition of a major depressed mother who had three daughters and evidently neglect her daughters because of the pressure by the society and her relatives is presented. Our case is a 28-years old housewife with secondary school degree. She was admitted to our clinic with the symptoms of anhedonia, fatigue, unwillingness, crying and suicidal thoughts. She was hospitalized to psychiatric service with diagnosis of major depression because of the obvious symptoms of suicidal plans and motor retardation. It was understood that the last depression episode was experienced by her two years ago when she learned her child's sex form the gynecologist during her pregnancy. She stated that her husband's family wanted baby boy and blamed herself because she had failed to do so. Then, she started to neglect her girls after that time. She also stated that her care was reduced during her pregnancy and even she started to dress her children finer at cold weather and did not cover them at cold nights and did not give their medications to make them more and more ill. Also, said "I wish my daughters die and I have a baby boy". Sex discrimination reduces the care that should be shown to girls. Our case wanted to harm her children because of the sex discrimination and ignored her daughters with the hope of having a baby boy

A series of civilian fatalities during the war in Syria

BACKGROUND: A considerable number of deaths due to firearm injuries have occurred during wars all over the world. In this study, it is aimed to evaluate demographic characteristics and injury properties of cases died during civil war in Syria.METHODS: The postmortem examination and autopsy reports of 321 forensic deaths occurred between January and December 2012 were analyzed, retrospectively. Of the 321 forensic deaths,186 cases were injured and died in the civil war in Syria and, therefore, included in the scope of the study. Four cases died by natural causes or traffic accidents were excluded.RESULTS: Cases were most commonly (n=73, 39.2%) aged between 21 and 30 years, and 21.5% (n=40) of cases aged under 20 years. Of females, 68.8% (n=11) were children and young adults under 20 years of age. An overwhelming majority of deaths (n=125, 67.2%) were caused by explosive and shrapnel injuries, followed by (n=49, 26.3%) gunshot injuries related deaths. CONCLUSION: This study indicated that a significant proportion of those who died after being injured in the Syrian war were children, women and elderly people. The nature and localization of the observed injuries indicated open attacks by military forces regardless of targets being civilians and human rights violationsBACKGROUND: A considerable number of deaths due to firearm injuries have occurred during wars all over the world. In this study, it is aimed to evaluate demographic characteristics and injury properties of cases died during civil war in Syria.METHODS: The postmortem examination and autopsy reports of 321 forensic deaths occurred between January and December 2012 were analyzed, retrospectively. Of the 321 forensic deaths,186 cases were injured and died in the civil war in Syria and, therefore, included in the scope of the study. Four cases died by natural causes or traffic accidents were excluded.RESULTS: Cases were most commonly (n=73, 39.2%) aged between 21 and 30 years, and 21.5% (n=40) of cases aged under 20 years. Of females, 68.8% (n=11) were children and young adults under 20 years of age. An overwhelming majority of deaths (n=125, 67.2%) were caused by explosive and shrapnel injuries, followed by (n=49, 26.3%) gunshot injuries related deaths. CONCLUSION: This study indicated that a significant proportion of those who died after being injured in the Syrian war were children, women and elderly people. The nature and localization of the observed injuries indicated open attacks by military forces regardless of targets being civilians and human rights violation