Determination of tributyltin in marine sediment: Comité Consultatif pour la Quantité de Matière (CCQM) pilot study P-18 international intercomparison

The capabilities of National Metrology Institutes (NMIs-those which are members of the Comité Consultatif pour la Quantité de Matière (CCQM)of the CIPM) and selected outside "expert" laboratories to quantitate (C(4)H(9))(3)Sn(+) (TBT) in a prepared marine sediment were assessed. This exercise was sanctioned by the 7th CCQM meeting, April 4-6, 2001, as an activity of the Inorganic Analysis Working Group and was jointly piloted by the Institute for National Measurement Standards of the National Research Council of Canada (NRC) and the Laboratory of the Government Chemist (LGC), UK. A total of 11 laboratories submitted results (7 NMIs, and 4 external labs). Two external laboratories utilized a standard calibration approach based on a natural abundance TBT standard, whereas all NMIs relied upon isotope dilution mass spectrometry for quantitation. For this purpose, a species specific (117)Sn-enriched TBT standard was supplied by the LGC. No sample preparation methodology was prescribed by the piloting laboratories and, by consequence, a variety of approaches was adopted by the participants, including mechanical shaking, sonication, accelerated solvent extraction, microwave assisted extraction and heating in combination with Grignard derivatization, ethylation and direct sampling. Detection techniques included ICP-MS (with GC and HPLC sample introduction), GC-MS, GC-AED and GC-FPD. Recovery of TBT from a control standard (NRCC CRM PACS-2 marine sediment) averaged 93.5+/-2.4% ( n=14). Results for the pilot material averaged 0.680+/-0.015 micro mol kg(-1) ( n=14; 80.7+/-1.8 micro g kg(-1)) with a median value of 0.676 micro mol kg(-1). Overall, performance was substantially better than state-of-the-art expectations and the satisfactory agreement amongst participants permitted scheduling of a follow-up Key comparison for TBT (K-28), a Pilot intercomparison for DBT (P-43), and certification of the test sediment for TBT content and its release as a new Certified Reference Material (HIPA-1) with a TBT content of 0.679+/-0.089 micro mol kg(-1) (expanded uncertainty, k=2, as Sn) (80.5+/-10.6 micro g kg(-1)).

Changes in blood viscosity by heparin and argatroban

Anticoagulants are effective for preventing both venous and arterial thrombosis. Although antithrombotic agents have been reported to reduce thrombin formation, to our knowledge, the relation between blood viscosity (BV) and antithrombotic agents has not been examined. We examined the effects on whole BV of various dosages of the antithrombotic agents-heparin sodium and argatroban. Thirty microliters of either drug was added to 3-ml samples of blood obtained from healthy male volunteers. Whole BV was then immediately examined with an oscillation-type viscometer. When either agent was added, BV decreased and coagulation time increased dose dependently. BV was 4.5+/-0.3 mPa.s in untreated blood but decreased in a dose-dependent manner to a minimum of 2.5+/-0.3 mPa.s with heparin sodium and decreased dose dependently in a sigmoid manner with argatroban. Because thrombin generation is inhibited in all antithrombotic therapies, this inhibition might be reflected by changes in BV. Our results suggest that BV in accordance with blood coagulability are indexes of thrombotic tendency and that decreasing BV prevents life-threatening thromboembolic conditions.

[An autopsy case of accidental hanging during home care]

A 73-year-old man who had suffered from old myocardial and cerebral infarction for 4 years had been secured in wheelchair due to left hemiplegia and aphasia and also been received a home care of his wife. One day, his wife tied a cloth belt around his head and secured it to the wheelchair to prevent the flexion of his neck. One hour later, he was found dead by his wife. He also had slipped down in his wheelchair. The autopsy performed 24 hours after death revealed a ligature marks on the front of the neck. Petechial hemorrhages, visceral congestion and fluid blood, compatible with asphyxial death, were also found. Although severe cerebral cortical atrophy, old myocardial infarction, moderate to severe atherosclerosis and decubitus of the back were also found, they were not considered primary cause of death. No other anatomical or toxicological cause of death was present. Therefore, we concluded that the man died of accidental hanging. Recently, the home care of aged or handicapped patient is a social problem in Japan due to the increase in the number of elderly people. The death was caused by the inappropriate restraints used by his wife. This case suggests the importance of proper advice to non-professional caretakers from care professionals.

Composite optical waveguide composed of a tapered film of bromothymol blue evaporated onto a potassium ion-exchanged waveguide and its application as a guided wave absorption-based ammonia-gas sensor

For what is the first time to our knowledge, we have successfully evaporated a tapered film of bromothymol blue (BTB) onto a potassium ion-exchanged (PIE) waveguide to form a composite optical waveguide (COWG) for trace-ammonia detection. The BTB film has a high refractive index (1.69) and a smooth surface and is transparent to a 633-nm laser beam in air. In the COWG structure, the BTB film serves as a single-mode waveguide, and adiabatic transition of the TE(0) mode was realized between the BTB waveguide and the PIE waveguide with both BTB tapers. In the presence of ammonia, the BTB film changes color from yellow to blue, which causes absorption of the 633-nm guided wave. Our experimental results demonstrate that such a guided wave absorption-based ammonia-gas sensor is much more sensitive than one based on evanescent-wave absorption. A detection limit of part in 10(9) of ammonia has been realized for a BTB film-PIE glass COWG.

Incomplete decapitation of a motorcyclist from hyperextension by inertia: a case report

This is a rare case involving a motorcyclist. A 57 year old motorcycle rider wearing a full face type helmet, suffered incomplete decapitation. The autopsy findings revealed a wide lacerated wound accompanied by extension marks in the front neck, atlanto-occipital dislocation and complete transection of the brainstem. According to the police traffic report, the man's head was stationary at the moment of impact and the remainder of the body continued in a backward motion. We concluded that the inertia of the torso caused hyperextension of the neck and subsequent incomplete decapitation.

Immunohistochemistry of atrial natriuretic peptide in brain infarction

Atrial natriuretic peptide (ANP) was originally isolated from cardiac atria, and has potent natriuretic, diuretic, and vasorelaxant properties. It has been localized in neurons and astrocytes in the cerebral cortex and the white matter. We hypothesize that glial ANP may contribute to the regulation of cerebral blood flow in brain infarction. In order to elucidate this possible role, the immunohistochemistry of ANP was studied in cases of brain infarction and in other cases of brain trauma for comparison. A statistically significant increase in the number of ANP-immunoreactive glial cells (mainly astrocytes) was observed in the white matter surrounding the brain infarction compared with the intact area. No statistically significant increase in ANP-immunoreactive glial cell number was observed in the cerebral white matter from brain haemorrhage, contusion and control cases. Our results indicate that glial ANP may increase in number in brain infarction, and that it may be involved in the regulation of the cerebral blood flow in the infarcted area.

Rheologic changes in venous blood during prolonged sitting

We examined blood rheologic changes, mainly blood viscosity, during long-term quiet sitting. Samples of blood were obtained from the arm and foot veins of the healthy adult male volunteers before and after 2 h of quiet sitting. Blood viscosity, was immediately determined with an oscillation viscometer, and blood count and blood chemistry were analyzed. We found that the viscosity in blood from a foot vein but not from an arm vein increased significantly after 2 h of sitting. Our results show that 2 h of quiet sitting can increase thrombotic tendency locally in the leg but not systemically and suggests the importance of measuring focal venous blood viscosity.

[Survey on postmortem examination to police surgeons and emergency physicians. Possibility of physicians' assist in mass-disaster]

We conducted a questionnaire survey of police surgeons and emergency physicians, inquiring about their experience of medicolegal investigation of death and their willingness to join a death investigation team in a major disaster. The questionnaire also asked about their knowledge about and interest in the forensic specialist system established by the Japanese Society of Legal Medicine. Police surgeons were generally willing to join an investigation team only if a disaster occurred in or close to their hometown, because they could not afford more than several days away from patient care. Although many of the emergency physicians were willing to join a death investigation team, they had difficulty in doing so without permission or orders from their employer or the authorities concerned. The survey found that the percentage of aged police surgeons was increasing among those surveyed. This fact, in combination with the current emphasis of postgraduate education on specialty training, threatens to cause a substantial lack of physicians available for medicolegal investigation of death. Therefore, it is urgently necessary to establish a system of training resident and emergency physicians in medicolegal investigation of death. In addition to providing postgraduate training in medicolegal investigation of death to prospective trainees who are emergency physicians at major hospitals in potential disaster-stricken areas, the medical school should incorporate forensic medicine in postgraduate training programs so that they can actively perform death investigation on disaster victims dying before or after arrival at their hospitals. Furthermore, the forensic community should make every effort to increase the number of autopsies in each department of forensic medicine and to expand the medical examiner system throughout Japan that is currently in practice only in the Metropolis of Tokyo and Yokohama, Nagoya, Osaka and Kobe Cities in order to incorporate forensic training in the postgraduate clinical training programs that will become compulsory in 2004.

Injury severity in motor vehicle occupants

We performed a retrospective analysis of injury severity and the effect of seat belt use with findings from forensic autopsies of 50 persons who had died in motor vehicle accidents. From autopsy findings and accident reports, the abbreviated injury scale (AIS) and the injury severity score (ISS) were calculated and analyzed epidemiologically. Among unrestrained occupants, drivers usually sustained more severe chest and abdominal injuries. Furthermore, three-point seat belts significantly decreased the severity of drivers' chest and abdominal injuries. Our results may be useful for forensic pathologists and clinicians and for mechanical engineers who investigate new safety devices for vehicle occupants.

[A proposal of essentials for forensic pathological diagnosis of sudden infant death syndrome (SIDS)]

There are many sudden unexpected infant death cases which are easily diagnosed as sudden infant death syndrome (SIDS) both with or without autopsy in Japan. A SIDS diagnosis may provide a cover for accidental or criminal death. SIDS should not be a convenient diagnostic box that shelters the cases of unexpected infant death which lack the necessary antemortem information to make the correct diagnosis. The authors consider that SIDS should be diagnosed according to the direction of the international definition of SIDS, and propose the following essentials for a forensic pathological diagnosis. 1) A thorough autopsy should be performed based on precise autopsy protocol, including not only histological observation, but also, if necessary, toxicological, bacteriological, viral and/or biochemical examinations. 2) The forensic pathologist should be provided with pertinent information regarding antemortem health status, past clinical history, social circumstances, death scene investigation, etc. In order to collect more precise information, the authors recommend using a questionnaire such as the example in this report to record information from the deceased's guardians. 3) Suspicion of accidental death or infanticide should be completely ruled out. SIDS should be diagnosed only after these three essentials have been satisfied. When there is even a slight suspicion of accidental death or infanticide, or when the forensic pathologist can not obtain pertinent information about the deceased, the causes and classification of the death should be diagnosed as unspecified or undetermined. That is, the causes and classification of the death are undetermined as to whether it is a natural or unnatural death. Furthermore, several warning flags indicating a possible SIDS diagnosis were proposed: a case found dead in a supine position, the existence of a foreign body in the respiratory tract or mild infectious findings. The authors also emphasize the physician's responsibility to report a case found dead or dying of unnatural or clinically unexplained causes to the police. This is the crucial first step in getting an accurate diagnosis of SIDS.

An immunohistochemical study on cathepsin D in human hippocampus

Cathepsin D is a lysosomal enzyme involved in neuronal degeneration. In this study, the immunohistochemistry of cathepsin D was studied in hippocampal CA1 neurons that are vulnerable to ischemia, and parahippocampal glial cells. CA1 neurons from the majority of cases showed cathepsin D immunoreactivity in the cytoplasm, whereas shrunk neurons were unstained in only one case. There was no statistically significant correlation between the postmortem interval between death and autopsy, and cathepsin D immunoreactivity in CA1 neurons. These observations indicate that cathepsin D immunoreactivity is not a sensitive marker for neuronal degeneration or postmortem changes. On the other hand, there was a statistically significant correlation between age and cathepsin D immunoreactivity in the cytoplasm of parahippocampal glial cells. This shows that senescence is correlated with cathepsin D expression in humans as has been reported previously in an animal study.

An autopsy case of sudden death in a patient with idiopathic scoliosis

A 38-year-old woman with idiopathic scoliosis (right convex thoracic scoliosis, 78 degrees; left convex lumbar curvature, 75 degrees) died suddenly. Forensic autopsy and histopathologic examination revealed chronic congestive oedema, numerous cavities and atrophic changes of heart. These changes, including both respiratory changes and biventricular failure caused by hypoplastic cardiac changes, were due to a deformed thoracic cage. This case illustrates that not only abnormalities of respiratory function and cor pulmonare, but also hypoplastic cardiac changes, may cause sudden death in a patient with untreated scoliosis.

A case of strangulation by a vehicle seat belt

A healthy 23-year-old man wearing a three-point seat belt suffered from a roll-over traffic accident. When the man was found, the fastened seat belt had loosened and the diagonal belt was tightened against the neck. Autopsy findings revealed ligature marks on the surface of the neck, hemorrhages in the muscles of the neck, petechial hemorrhages in palpebral conjunctivae and viscera, dark red liquid blood in the heart cavities and visceral congestion. We concluded that the man died of strangulation by the seat belt. In this case, the loose belt allowed the body to move and subsequently the diagonal belt applied external pressure to the neck while the car was rolling over. Although there have been several reports of neck injuries due to diagonal belts, this is the first report of strangulation by a properly used three-point belt in a roll-over vehicle accident.

Immunohistochemical localization of P-selectin in the glomeruli from forensic autopsies

The expression of the adhesion molecule P-selectin is known to be up-regulated in several vital organs including the kidney after trauma in experimental animals. We examined the expression of P-selectin in the kidney by immunohistochemistry in 41 forensic autopsies mainly from trauma cases. P-selectin immunoreactivity was present in the glomerular capillary endothelial tufts and cortical interstitial vascular endothelial cells. The P-selectin immunoreactivity in the glomeruli was not co-localized with CD41 (platelet marker) immunoreactivity. The antemortem interval between the onset of injury and death (AMI) was statistically significantly longer in the cases with more P-selectin-positive capillary endothelial tufts in the glomeruli. Our results show that P-selectin immunoreactivity exists in the glomerular capillary endothelial cells rather than platelets. Our results also indicate that the P-selectin expression increases in the glomerular endothelial cells of the human kidney with the longer duration of the state under injury.

Immunohistochemical localization of heat shock protein 70 in the human medulla oblongata in forensic autopsies

Heat shock protein 70 (hsp70) can be induced under various stresses in experimental animals. We investigated hsp70 immunoreactivity in the human medulla oblongata in forensic autopsies. Hsp70 immunoreactivity was observed in the cytoplasm of some neurons in the hypoglossal nucleus (XII), the dorsal motor nucleus of the vagal nerve (X), the lateral cuneate nucleus (Cun), and the inferior olive (Oli). Neurons with positive hsp70 immunoreactivity were statistically significantly fewer in the Oli than in the XII, X, and Cun. There was no statistically significant correlation between the AMI (the antemortem interval between the onset of injury and death) or PMI (the postmortem interval between death and autopsy), and the percentage of positive cytoplasmic hsp70 immunoreactivity in any of the nuclei studied. Age had a statistically significant negative correlation with the percentage of positive hsp70 immunoreactivity in the Oli. The percentages of positive hsp70 immunoreactivity in the XII and Cun were statistically significantly lower in burn cases than in other cases. Therefore, the induction of hsp70 immunoreactivity in the medulla oblongata may not reflect the duration of stress in the AMI, but may reflect the regional (nuclei) and conditional (burns) differences in autopsy specimens.

Immunohistochemical localization of c-fos in the nuclei of the medulla oblongata in relation to asphyxia

The immediately early gene product c-fos is known to be induced in neurons under noxious stimuli. Therefore, the immunohistochemistry of c-fos expression in human brains might offer information on the localization of stimulated neurons. In this study, the immunohistochemical localization of c-fos was studied in the neurons of the hypoglossal nucleus (XII), the dorsal motor nucleus of the vagal nerve (X), the nucleus solitarius (Sol), the accessory cuneate nucleus (Cun), the spinal trigeminal nucleus (V) and the inferior olive (Oli) of the human medulla oblongata from forensic autopsy cases. The neurons in the X nucleus showed the highest percentage of positive reactions for c-fos, followed in descending order by the Cun, V, Oli, XII and Sol. The c-fos immunoreactivity in the Cun and X was statistically significantly higher than in the Sol, XII and Oli. Although neurons in the Sol are known to be involved in respiration, there was no statistically significant difference in the c-fos immunoreactivity in the neurons in the Sol between asphyxia and non-asphyxia cases. On the other hand, the percentage of neurons positive for the c-fos immunoreactivity was statistically significantly higher in the Oli of asphyxia cases than of non-asphyxia cases. Our results indicate the difference in the immunoreactivity of c-fos among the nuclei of the human medulla oblongata and that the c-fos immunoreactivity in the Oli might assist the diagnosis of asphyxia.

Arsenic accumulation in organs of the fresh water fish Tribolodon hakonensis

The fish Tribolodon hakonensis lives in good health in Lake Usoriko, which has been acidified and naturally contaminated with arsenic by volcanic activities. We have determined the contents of various metals in various fish organs of T. hakonensis, collected at Lake Usoriko. We found that a large amount of arsenic was accumulated in the eye, especially in the choroid-retina part. The arsenic concentrations in the liver and kidneys were about 0.4 microgram/g (wet), whereas the muscle contained less arsenic. The arsenic accumulation in the skin was also observed, especially in the epaxial part. Zinc and arsenic contents in various fish organs correlated well.

The concept of the digital morgue as a 3D database

The concept of the construction of a 3-dimensional database of a body structure, or a digital morgue, and its advantages to the field of forensic medicine was proposed. The digital morgue stores the body structure of each case as a 3D data set of sectioning planes of the whole body obtained from computer tomograms or magnetic resonance imaging figures. Furthermore, the medical virtual reality technique makes it possible to perform a simulated autopsy of the body in the digital morgue (virtual autopsy). Therefore, in the digital morgue, retrospective observation and quantitative analysis of the structural damage of the body are possible using high-dimensional medical imaging and medical virtual reality.

Injuries of motorcyclists and bicyclists examined at autopsy

Few studies of autopsy findings of persons dying of head and neck injuries in cyclists have been published. We performed a retrospective analysis of injury severity and the relation between head and neck injuries and helmet use. Seventy-six bicyclists and motorcyclists were collected from among the forensic autopsy at the Jikei University School of Medicine. From autopsy findings and accident reports, the abbreviated injury scale (AIS) and the injury severity score (ISS) were calculated and analyzed epidemiologically. As a result, helmet use significantly decreased the severity of head and neck injuries but had no effect on overall injury severity or the severity of injuries to other body regions. Furthermore, helmets had little effect on injuries remote from the point of impact, injuries resulting from angular acceleration, or injuries at the junction of the head and neck. These findings may be useful for both forensic pathologists and clinicians evaluating injuries in bicyclists and motorcyclists.

IgG immunohistochemistry for the assessment of brain injuries in forensic autopsies

Immunohistochemical staining of IgG in the sections of injured brain areas was performed in forensic autopsies. IgG immunoreactivity was present mainly in glial cells surrounding hemorrhagic areas, which may be a useful tool to detect and evaluate injured areas of the brain in forensic autopsies.

Estimation of normal heart weight in Japanese subjects: development of a simplified normal heart weight scale

To estimate cardiac workload from total heart weight (HW) in persons who have died suddenly, standards of normal HW must be established. We present standards of normal HW for Japanese subjects and propose a simplified scale for calculating normal HW from body height (BH) and body weight (BW). A total of 830 persons (506 male and 324 female) who had died suddenly of unnatural causes were selected for analysis from among persons examined at forensic autopsy at the Jikei University School of Medicine. The HW, BH and BW of each subject were measured. Body surface area (BSA) in square meters was calculated from BH in centimeters and BW in kilograms with Takahira's equation. We found allometric relations between HW and BSA represented by these equations: HW=BSA(1.441) x 168.200 for males and HW=BSA(1.367) x 161.970 for females. For practical use, we developed a simplified scale with which normal HW can be easily and quickly calculated from BH and BW. Our simple technique can be used to estimate normal HW in routine autopsy practice.

[An autopsy case of sudden death caused by untreated sepsis after complete remission of acute promyelocytic leukemia]

The patient was 63 year-old man. He had been diagnosed as acute promyelocytic leukemia (APL) and treated until 4 month before his death with complete remission. The patient suddenly died 9 days after he complained of occipital headache. Autopsy and histopathologic findings were as follows: the left pleura was thick and calcificated with abscess, compatible with the findings of old tuberculosis complicated with bacterial infection. Furthermore, polynuclear leukocytes and gram-positive micro-organisms were accumulated in the lungs, and pyogenic meningitis, pyonephritis, splenitis were also found. Bacteologically, Streptococcus pneumoniae was detected from cadaver's blood and cerebrospinal fluid. Therefore, we concluded that the patient was died of septic shock caused by systemic infection of Streptococcus pneumoniae. The mortality of septic shock is high and in some patients, causative organisms may not be isolated. In the present case, although the original inflammation was left pleuritis due to Streptococcus pneumoniae, correct clinical diagnosis was not made before death as the patient had lacked any complaints except for occipital headache. This case revealed that the cause of sudden death was sepsis induced by Streptococcus pneumoniae instead of a relapse of APL. This case also illustrated the importance of reviewing the previous history of a patient and doing postmortem bacteologic examination in a case of suspected sepsis.

Immunohistochemistry of neuron-specific enolase in neurons of the medulla oblongata from human autopsies

Neuron-specific enolase (NSE) is a glycolytic enzyme specifically expressed in neurons. NSE has been used as a marker for neuronal damage in brain injury. We studied the immunohistochemical localization of this enzyme in the medulla oblongata obtained from human forensic autopsy specimens. Neurons in the dorsal motor nucleus of vagal nerve expressed statistically significantly less NSE immunoreactivity in the cytoplasm than in the hypoglossal nucleus (XII), solitary nucleus, spinal trigeminal nucleus, and lateral cuneate nucleus. Cases of carbon monoxide intoxication by burning showed a higher incidence of NSE immunoreactivity in the cell nucleus of the XII than other cases, while there was no statistically significant correlation between NSE immunoreactivity in the cell nucleus and the Nissl amount. This indicates that the accumulation of NSE immunoreactivity in the cell nucleus might be a vital reaction rather than a postmortem artifact.

[Hemorrhagic shock death caused by not so severe injury during the medication of anticoagulants]

A 73-year-old man receiving anticoagulants (warfarin potassium) orally with a history of prosthetic heart valve replacement was struck by a truck. When admitting to the hospital, he complained of lumbago with laboratory findings of anemia and prolongation of prothrombin times. Twenty-two hours after the accident, he died suddenly in the hospital and forensic autopsy was performed 9 hours after his death. Autopsy findings revealed marked subcutaneous and intramuscular hematoma in the lumbar and gluteal region and anemic change of viscera. Furthermore, 854 ng/ml of warfarin which was well accordance with the therapeutic levels was detected in the serum obtained from cadaver by using gas chromatography-mass spectrometry. Therefore, we concluded that the man had died of hemorrhagic shock caused by the force acting to the lumbar region accompanied by the influence of anticoagulant action of warfarin. To our knowledge, this is the first report to detect the warfarin from cadaver's serum. In dealing with the unnatural death of the patient receiving the anticoagulants, it is valuable to survey the medications and detect the presence of anticoagulants in cadaver.

A case of fatal benzalkonium chloride poisoning

Five elderly persons with senile dementia accidentally ingested Hoesmin, a 10% aqueous solution of benzalkonium chloride (BAC). The condition of one patient, an 84-year-old woman whose lips and oral cavity became erythematous, gradually deteriorated. Although gastric lavage was performed, the patient died 3 h after ingestion of Hoesmin. Autopsy revealed corrosive changes of the mucosal surfaces of the tongue, pharynx, larynx, esophagus and stomach which may have come in contact with BAC. In addition, BAC was detected in the serum. We conclude that the patient died of BAC poisoning. Fatal BAC poisoning is rare and autopsy findings in only a few cases of BAC poisoning have been reported. Our findings emphasize the risk of oral ingestion of BAC.

Staining for histologic diagnosis of aluminum osteopathy--application of confocal laser scanning microscopy to observation for offminum in bones from aluminum-treated, subtotally nephrectomized rats

To histologically detect excess aluminum (Al) taken up by bones in a rat model of renal failure prepared by 5/6-nephrectomy, non-decalcified bone tissue sections from specimens of the tibia, femur, rib and ilium were stained with a newly developed lumogallion reagent and examined for aluminum by confocal laser scanning microscopy. The assay revealed that Al contents in the tibia and femur of Al-treated rats tended to be a few-fold higher, compared to controls. With the lumogallion stain technique, Al in bones could be detected and identified at Al concentrations of > or = 9.0 micrograms/g in bone tissues. The reaction of the metal with lumogallion is specific and proved to be positive even at concentrations of excess Al so low as to be undetectable by conventional methods. The present observation disclosed that, unlike the generally accepted view, the Al was accumulated not in the calcification front but was distributed diffusely or as aggregates at high concentration in osteoid tissues. Z mode scans of the slides permitted steric delineation of the state of Al accumulation in bone tissues. The method described herein is considered a useful means for clinical diagnosis of aluminum osteopathy.

Autopsy case of duodenal obstruction from impacted mushroom

We report an autopsy case of duodenal bulb obstruction caused by a shiitake mushroom. A 74-year-old woman with depression was admitted to the hospital after suffering nausea and abdominal fullness for 3 days. Because the physical findings and laboratory data on admission revealed marked dehydration, lactated Ringer's solution was administered. Twelve hours later, the patient suddenly died. Autopsy showed an enlarged stomach filled with 850 ml of partially digested food. In the anal side of the pylorus, a 9-cm-diameter shiitake mushroom had become impacted, causing complete obstruction. We conclude that the patient suffered from duodenal bulb obstruction caused by the impacted mushroom and subsequently died of ileus. This case illustrates a rare cause of duodenal obstruction and emphasizes that ingested food can cause obstructive ileus and death.

Immunohistochemical study of neuron-specific enolase in human brains from forensic autopsies

Immunohistochemistry using anti-human neuron-specific enolase (NSE) mouse monoclonal antibody was performed in human brains from autopsy cases, which enabled us to assess the neuronal damage besides hematoxylin and eosin or Klüver-Barrera stain. Neurons in cerebral neocortex which showed necrotic changes such as prominent cytoplasmic vacuolization or cellular shrinkage with nuclear pyknosis showed a tendency to be less stained by anti-NSE antibody. Anti-NSE immunostaining was statistically significantly less in the neocortex from CO intoxication than from other causes of death, although morphological necrotic changes were less observed in CO intoxication. Hippocampal CA1 neurons clearly lost NSE immunoreactivity with the progression of necrotic changes. Neurons in CA2 were statistically significantly better stained by anti-NSE antibody than in CA1, 3, and 4. Cerebellar Purkinje cells were poorly stained by anti-NSE antibody, whereas neurons in cerebellar dentate nucleus and inferior olive in medulla oblongata were better stained. Anti-NSE immunostaining was lost in the injured areas of the cerebral neocortex while neurons in the intact areas were better stained in brain injury. These results indicate that anti-NSE immunostaining of neurons could reflect vital reaction and could be useful in evaluating neuronal damage in the hippocampal CA1 region or brain injury.

Sudden death of a patient with Crohn's disease

We describe a case of sudden death caused by a rare complication of Crohn's disease. A 29-year-old man with Crohn's disease who had not taken medications regularly complained of nausea, vomiting, and abdominal pain for 2 days, and then died suddenly. Autopsy revealed protruding intestinal loops filled with gas, internal fistulas between fused loops of the terminal ileum, and complete obstruction of the fistulous tract. The histologic findings of transmural inflammation consisting of lymphocytic infiltration, accumulation of partially hyalinized collagen, and fibrosis in the skip areas from the ileum to the cecum were compatible with Crohn's disease. Furthermore, marked emaciation, atrophic change of the heart muscle, and diffuse fatty change of the liver were found. Although the patient died of obstructive ileus caused by a stricture produced by progression of Crohn's disease, he was severely affected by malnutrition which may have been fatal. This case not only illustrates that Crohn's disease can cause obstructive ileus and sudden death, but also makes the forensic pathologist realize the importance of suspecting the presence of an active inflammatory bowel disease in a patient with internal fistulas or malnutrition.

Sensitive detection of trace aluminium in biological tissues by confocal laser scanning microscopy after staining with lumogallion

This paper describes a method for the sensitive detection of aluminium in biological tissues by real time confocal laser scanning microscopy after staining with lumogallion. The method enabled detection of aluminium > or = 9 micrograms g-1 in bone and is more sensitive than the conventional histochemical methods with aluminium and solochrome azurine, etc. Lumogallion reacts specifically with aluminium to form a fluorescent complex so that the proposed method is useful for detection and identification of aluminium in tissues.

Simulator for virtual surgery using deformable organ models and force feedback system

This paper describes a real-time surgery planning system using virtual reality techniques. This system allows us to simulate incision of skin and organs which respond as elastic objects with surgical tools in virtual space. Inner structures such as blood vessels and lesions can be seen and manipulated in the simulation. In addition to these functions we attempted to add a feedback function that responds to the operator's hands. We developed a force feedback device to manipulate the elastic organ model based on pressure from the operator's fingers.

3D and 4D atlas system of living human body structure

A reference system for accessing anatomical information from a complete 3D structure of the whole body "living human", including 4D cardiac dynamics, was reconstructed with 3D and 4D data sets obtained from normal volunteers. With this system, we were able to produce a human atlas in which sectional images can be accessed from any part of the human body interactively by real-time image generation.

[A case of dural sinus thrombosis during the medication of medroxyprogesterone acetate]

It is reported that medroxyprogesterone acetate (MPA) causes venous thrombosis as one of the side effects. A 49-year-old woman suffering from metastatic lung carcinoma from breast carcinoma was administered MPA 1200 mg/day for about four months. Thereafter she complained of dizziness about two weeks but the general practitioners could detect no abnormality on physical examinations and on brain CT X-ray findings. Six days later, she died suddenly at her home. Forensic autopsy findings revealed the marked superior sagital sinus thrombosis and the malignant lymphadenomatosis caused by metastatic lung carcinoma. As the patient had not disease or trauma causing dural sinus thrombosis except for the administration of MPA, we concluded that superior sagital sinus thrombosis was due to the medication of MPA. This case illustrates that forensic pathologist should consider the major side effect of some drugs like our case.

[Analysis of sudden death caused by intestinal obstruction]

Five autopsy cases of sudden death caused by intestinal obstruction are reported. The causes of death of the cases were duodenal obstruction of impacted food stuff, ileocaecal obstruction caused by Crohn's disease, incarceration of inguinal hernia, intestinal obstruction caused by heterotopic pancreas and paralytic ileus. In three cases, the patient was in cardiopulmonary arrest on arrival at hospital, and in the remaining cases the patient died within 12 hours from the beginning of treatment; therefore, a correct clinical diagnosis was not made before the death in all cases. All the patients had from one to three days history of nausea and abdominal pain, major complications of intestinal obstruction. Among all cases, the duration from the onset to death was the shortest in the case of a patient complicated with schizophrenia. It is characteristic that the patients of all cases died suddenly and resuscitation was not successful. Regarding the laboratory data of a hospitalized patient, marked hemoconcentration and an increased level of BUN/Cr ratio and blood sugar were shown. The patient who died from duodenal obstruction caused by impacted food-stuff had suffered from depression for six years, and the patient who died from paralytic ileus had suffered from schizophrenia for about 23 years. In both cases, it is characteristic that the complaints of the patient were poorer than what would be expected. Furthermore, these patients had been taking medication of psychotic, anti-depressant and anti-parkinsonism drugs; therefore the combination of these drugs was thought to be reflected in the bowel movement.

[Methamphetamine-like substance detected only in stomach contents from autopsied cadavers]

In this paper we show that a methamphetamine-like substance was detected in the stomach contents of deceased patients who had never taken methamphetamine (MA). MA was assayed by using gas chromatography/mass spectrometry. Blood, urine and stomach content samples were collected from 65 patients not suspected of taking MA. In seven victims, MA-like substance was detected in the stomach contents. Concentration of MA-like substance ranged from 0.03 to 0.38 microgram/ml. Though MA and amphetamine, a metabolite of MA, were detected in forensic samples of patients who had used MA, amphetamine could not be identified in the stomach contents of these seven cases. There was no correlation between MA concentration and interval of time from death to autopsy. The mechanism of the production of MA-like substance is not clear. This phenomenon should be paid attention to in the course of forensic drug analysis because of the possibility of misjudgement.

[Sudden unexpected natural death from a viewpoint of forensic pathology]

Sudden unexpected natural death (SUND) has several characteristics, such as unknown clinical history, very short course to death, evidence of trauma, interference of postmortem changes and social implications of diagnosis. From these points, SUND involves important challenges in forensic pathology. Presented here are the highlights of our SUND studies which allow scientific speculation into the antemortem pathophysiological course to death and a subsequent accurate diagnosis of the cause of death in SUND cases. 1. Forensic problems of SUND of unknown etiology 1) Do sudden infant death syndrome (SIDS) studies continue endlessly? In Japan there are many cases of sudden unexpected infant death (SUID) which were regarded as SIDS, often without postmortem examination. Pure SIDS should be a diagnosis of exclusion under thorough postmortem examination. Additionally, many SIDS studies have focused on pathogenesis of pure SIDS based on the analysis of so-called SIDS cases described above. In this sense, SIDS studies may continue forever. To clarify whether SIDS is an onion type, that is a heterogeneous disease entity, or bamboo shoot type, a single disease entity with a single cause, it is more vital to accurately search autopsy findings to exclude the cause of death, rather than to study pathogenesis of SIDS. Thereafter, pure SIDS will be carved in relief and we could study the pathogenesis, if it remains in the future. Present in 40% of our SUID cases examined was the existence of viral infection as a cause of death. 2) Pokkuri disease It has long been believed that the main branches of coronary arteries in Pokkuri-disease cases are macroscopically hypoplastic and cause sudden cardiac death. However, our two-dimensional morphometric analysis of the main branches, such as wall thickness, degree of stenosis, lumen area, area within internal elastic lamina, showed no significant differences between Pokkuri-disease cases and age and sex-matched control cases. 2. Information for grasping antemortem pathophysiological state in SUND cases 1) Standardization of the degree of cardiac hypertrophy based on heart weight. In the course of our preliminary examination, we found that heart weight correlates significantly with body length and weight. Therefore, we tried to standardize the range of normotrophy, hypertrophy and hypoplasia/atrophy of the heart based on the correlation between heart weight and body type index calculated by body length and weight (Broca's index). 2) Evaluation of the clinical laboratory data in cadaveric blood. We examined 32 clinical laboratory parameters in cadaveric blood samples obtained from 192 autopsy cases. Behaviour of the laboratory parameters in cadaveric blood in relation to postmortem interval was divided into four types: increased, decreased, no particular tendency and remaining between upper and lower normal value. Parameters included in the last type, which is a useful tool for speculation of antemortem pathophysiology were T-Bil, TTT, ZTT, BUN, Cre, UA, alpha 1- and beta 2-microglobin, T-Chol, GHA1c, TP, A/G, Hb and Hct. A case was demonstrated in which values of clinical laboratory parameters in agonar stage were the same as in cadaveric blood obtained at autopsy. This indicates that caution is necessary in evaluating clinical laboratory data in agonar patients in the emergency room. 3) Diagnostic evaluation of immunohistochemical myoglobin staining in the kidney In order to evaluate the diagnostic value of myoglobin (Mb) staining in the kidney in medicolegal autopsy cases, Mb staining was carried out on the kidney sections of 141 victims, including 59 natural and 82 unnatural deaths. At the same time, Serum and Urine GFR parameters were measured and systemic histological changes were observed on some sections of each kidney. The incidence of Mb positive cases was 74.6% in unnatural, and 25.4% in natural death, indicating the importance of nontraumatic rhabdomyolysis in natural death cases.

The quantitative analysis of inhalational anaesthetics in forensic samples by gas chromatography/mass spectrometry/selected ion monitoring

The quantitative analysis of volatile anaesthetics for biomedical applications by means of gas chromatograph/mass spectrometry/selected ion monitoring (GC/MS/SIM) was studied. Xenon gas was selected as an internal standard for the assay by adding to a closed system, because of its stability and inactivity. In the assay of inhalational anaesthetics, isoflurane and nitrous oxide (laughing gas), in forensic samples (serum and cerebrospinal fluid), the calibration of the anaesthetic was linear from 0.12 to 12 nmol/mL in isoflurane and from 30 to 300 nmol/mL in nitrous oxide. Our results suggest that this new method is suitable for the quantitative analysis of inhalational anaesthetics in the biomedical field.

Determination of serum creatinine by isotope dilution method using discharge-assisted thermospray liquid chromatography/mass spectrometry

A discharge-assisted thermospray (plasmaspray) liquid chromatography/mass spectrometric method for the determination of serum creatinine is described. The method incorporates stable isotope dilution using (D3)creatinine as an internal standard. Separation is performed in reversed-phase high-performance liquid chromatography using 0.01 M aqueous ammonium acetate as a flow solvent. Effluents are directly introduced to the mass spectrometer and [MH]+ ions are monitored during LC/MS using the selected ion monitoring method. Satisfactory agreement between the analytical result and the certified value of the serum sample of standard reference material and relative standard deviation ranging from 0.6% to 1.2% was obtained.

Supercritical fluid chromatographic determination of cholesterol and cholesteryl esters in serum on ODS-silica gel column

Cholesterol and cholesteryl esters in human serum were determined by supercritical fluid chromatography on an inert ODS-silica gel column using supercritical carbon dioxide as a mobile phase without a modifier. Chromatograms were obtained by monitoring the eluent simultaneously with an FID and UV detector at the wavelength of 190 nm. The retention behavior of cholesterol and cholesteryl esters was investigated in terms of the density of CO2 mobile phase. The separation mode was found to be reversed phase, as in liquid chromatography. The amounts of cholesterol and cholesteryl esters extracted from human serum reference material (NIST SRM 909) were determined individually using cholesteryl laurate as an internal standard to give good agreement of total cholesterol with the value certified by NIST.

Determination of serum cholesterol by stable isotope dilution method using discharge-assisted thermospray liquid chromatography/mass spectrometry

A discharge-assisted thermospray (plasmaspray) liquid chromatography/mass spectrometric method for the determination of total serum cholesterol is described. The method incorporates stable isotope dilution using (3,4-13C)cholesterol as an internal standard. Liquid chromatographic separation is performed using methanol as a flow solvent and effluents are directly introduced to the mass spectrometer. [MH-H2O]+ ions are monitored during liquid chromatography/mass spectrometry using the selected ion monitoring method. Satisfactory agreement between the analytical result and the certified value of the National Institute of Standards and Technology (formerly National Bureau of Standards) standard reference material serum is obtained with a relative standard deviation of 0.6%.

Unusual mechanism of lethal cervical spinal cord injury in a case of atlanto-axial diastasis

A case of traumatic cervical spinal cord injury due to congenital craniocervical abnormalities is described. The autopsy revealed evidence of hyperextension of the neck due to frontal impact, congenital occipitalization of the atlas accompanied by basilar invagination of the odontoid process and atlanto-axial diastasis. The subsequent narrowing of the spinal canal led to a predisposition for this unusual mechanism of spinal cord injury.

Stable isotope dilution method for the determination of serum glucose using discharge-assisted thermospray liquid chromatography/mass spectrometry

A discharge-assisted thermospray liquid chromatography/mass spectrometric method for the determination of serum glucose was studied. Isotope dilution technique was used with uniformly labelled (13C6) glucose as an internal standard. Successful liquid chromatography/mass spectrometry was achieved by post-column addition of aqueous ammonium acetate to the mobile phase. Quantification was performed by measuring the peak intensity ratios of the unlabelled and labelled [M + NH4]+ ions. Analytical results using the National Institute of Standards and Technology standard reference material serum showed satisfactory agreement with the certified value, and a relative standard deviation of about 1% was obtained.

[Scanning electron microscopic study of rat lungs in experimental chronic paraquat poisoning]

It is well known that Paraquat (1,1'-dimethyl-4,4'-bipyridylium dichloride), used widely as a herbicide, causes a primary toxic effect in the lungs of humans and laboratory animals. This paper describes the pulmonary changes of chronic paraquat poisoning in rats, comparing scanning electron microscopic findings. Twenty-four rats were given repeated injections of 10/kg body weight paraquat intraperitoneally for 6 consecutive months, and six control rats were given 0.9% NaCl solution. The animals exposed to paraquat showed thickening of alveolar septum, inflammatory cell infiltration, interstitial fibrosis, and marked proliferation of alveolar macrophages. Among them four rats (21%) showed the typical findings of diffuse pulmonary fibrosis. Lesions were more severe at the subpleural region of the lung. The desquamation of alveolar epithelial cells and subsequent exposure of the basement membranes were observed in places. Although alveolar epithelial cells both in the type I and the type II were prolific, the type II cells showed partial loss of microvilli and projections. These findings may indicate the lowering of the type II cell function and subsequent decrease of surfactant excretion which causes respiratory insufficiency. Furthermore, alveolar macrophages showed a tendency to increase in number with progressive development of fibrosis. This tendency may support the hypothesis by Schoenberger et al., in which alveolar macrophages release both fibronectin and a growth factor for fibroblast after paraquat exposure.

Species identification of blood stains using a biotin-labeled DNA probe

In an attempt to identify blood stains of human origin, DNA was extracted from human and animal dried blood stains and examined using recombinant DNA techniques. As a DNA probe, biotin-labeled or radioisotopically labeled human repetitive sequence 2.3 Kb Hind III fragment (pH 12) in pBR 322 was used. The probe clearly hybridized with human DNA, but not with DNA extracted from frog, fish, mouse, rat, rabbit, chicken, cat, dog, and sheep. DNA from a Japanese monkeies and from a chimpanzee also hybridized with comparable efficiency. The minimum amount of the blood for the species identification was estimated to 0.4 microliter of fresh blood, 2.1 microliters of 2 weeks old blood stain and 3.8 microliters of 3 months old blood stains, indicating that only one drop of human blood is sufficient for species identification. There was no difference of "signal" between isotopic and non-isotopic procedures for DNA analysis. The advantages of the non-isotopic method for species identification of blood stains in forensic science is briefly discussed.