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

Öz

Amaç: Bu çalışmada, sistematik toksikolojik inceleme için karışık iç organ örnekleme yöntemi yerine izole karaciğer örneklemesinin kullanılabilirliğinin araştırılması amaçlanmıştır. Yöntemler: 135 otopsi olgusunda standart örnekleme ile birlikte izole karaciğer örneklemesi yapılmış ve örneklerin eşzamanlı analizi sağlanmak suretiyle her iki örneklem grubuna ait toksikolojik inceleme sonuçları istatistiksel olarak değerlendirilmiştir. Bulgular: Herhangi bir ilaç ve/veya toksik madde saptanmış olan örnekler pozitif, saptanmamış olan örnekler negatif olarak yeniden kodlanmak suretiyle Kappa istatistiğiyle incelendiğinde; izole karaciğer örneği bulguları ile kan/çürüme sıvısı ve idrar/mesane yıkama sıvısı bulguları birbirleriyle orta derece uyumlu ve istatistiksel olarak anlamlı; izole karaciğer örneği bulguları ile karışık iç organ örneği ve içeriği ile birlikte alınan mide örneği bulguları birbirleriyle yüksek derece uyumlu ve istatistiksel olarak anlamlı bulunmuştur. Sonuç: Toksik madde maruziyetine bağlı ölüm olgularında, maruz kalınan toksik maddenin bilinmesi durumunda etken maddenin metabolizma sürecine ait bilgiler, analiz için hangi numunelerin alınması gerektiği konusunda hekime ve toksikoloğa yol göstermekte ise de, çoğu olguda bu tür bilgiden yoksun olunmaktadır. Sistematik toksikolojik analizde izole karaciğer örneğinin herhangi bir ilaç ya da toksik madde tespiti açısından karışık iç organ örneklerine kıyasla başarı yüzdesinin daha yüksek olduğu belirlenmiştir.

Anahtar Kelimeler

• adli toksikoloji
• intoksikasyon
• sistematik toksikolojik analiz
• karaciğer

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

Öz

Objective: In this study we aimed to test the applicability and diagnostic value of isolated liver sampling for systematic toxicological analysis as an alternative to mixed sampling. Methods: Total 135 forensic autopsy cases were selected and in addition to routine sampling of internal organs, isolated liver samples were taken simultaneously. Toxicological analysis was also performed simultaneously in both groups and results were statistically evaluated. Results: When the results were recorded as positive and negative and concordance success was evaluated by the use of Kappa statistics; toxicological results of isolated liver sampling group were found to be moderately concordant and statistically significant with the findings of other body fluids; highly concordant and statistically significant with those of stomach content and mixed organ sampling group. Conclusion: In toxic substance-related fatalities, if the putative toxic substance is known, the decision of the forensic pathologist and/or toxicologist for selection of internal organs for sampling is based upon the nature of metabolic process of substance. As a conclusion, the success rate of isolated liver sampling in detection of any drug or toxic substance in systematic toxicological analysis is higher than that of mixed sampling.

Anahtar Kelimeler

• forensic toxicology
• intoxication
• systematic toxicological analysis
• liver

Kaynakça

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