Nihon hoigaku zasshi = The Japanese journal of legal medicine最新文献

Based on my personal experience publishing case reports on blunt injuries, I hereby focus on issues that have recently come to my attention. 1. Abrasions: 1) As to whether they occurred ante-mortem or post-mortem; those reddish in color cannot always have occurred antemortem. When they overlap with reddish (-purple) discoloration, as in hypostasis, post-mortem abrasions look reddish as well. Abrasions larger than the tip of the finger or the palm of the hand are often seen post-mortem and are thought to occur due to the touching of putrefied skin post-mortem. 2) There are cases where the direction in which the epidermis peeled-off is not apparent, when it peels off in many directions or where there is no residual epidermis. 3) The shape and size of an abrasion can indicate the structure of the offending blunt object. When there is an abrasion on the scalp 3 to 4 cm in diameter, with structures 5 mm in diameter at the margins of the abrasion, it can be inferred that the victim fell on a paved gravel road. 2. Bruises: 1) Inferring the nature of a blunt object: (1) Evidence of a fist blow: Co-existence of the following three features indicates a blow by the fist : 1. macular discoloration, 2. within an area of approximately 8 cm by 5 cm, 3. with an abrasion from the thumb nail. (2) Evidence of being grabbed:Try to grab the corpse with your own hand during autopsy to find how the person was grabbed. Bruise-like discoloration can be generated post-mortem on the upper arm, when a body is being drawn out of water, for example. 2) Tram-line bruises: These appear when a victim was struck by a stick. To estimate the diameter of the object, it is useful to measure two parts of the bruising : the width of the pale part between the bruises and the width between the outer margins of the bruises. 3. Intradermal bleeding: There tends to be a grouping of hemorrhagic spots, the interval between which 1 mm or less. It can be generated by both direct and indirect force. Abrasions may be both present or absent. 4. Contused lacerated wounds: First of all, it is necessary to determine the characteristics of the offending blunt object based on the findings of the wound. When the edge of the end of a column works against the skin at an angle, abrasions are mainly generated on the one margin abraded by the edge. When the smooth round surface of a column is applied, abrasions are not likely to occur on or near the margins. To diagnose a wound as being contused, the following findings are considered valuable : the margins of the wound are more irregular than the incision; the margins are contused; the osseous membrane is detached at the bottom of the wound; and abrasions are present at the margins. Abrasions are generated when the surface of the object is rough and when the sharper edge is at an angle. They tend not to occur when the surface of the object is smooth with no angular edge or when the sharper edge works perpendicularly against the skin. 5. Post-mortem mut

Postmortem imaging (PMI) including computed tomography (CT) and magnetic resonance imaging (MRI) has become a familiar procedure in forensic casework. We investigated a short term impact of postmortem CT(PM-CT) in routine forensic autopsy cases at our institute during a period of 9 months (n = 121, fetus--92 year-old, 7 h--years postmortem), comparing to autopsy findings. In identification, PM-CT was useful for matching skeletal/dental characteristics, superimposing, and detection of foreign materials. However, conventional X-ray was often more effective for detection of small metallic foreign bodies. In pathomorphology, PM-CT partly demonstrated important findings for determining the immediate cause of death, which were confirmed by autopsy, but interpretation to the underlying/initiating/preceding causes of death or contributory factor(s) was mostly difficult or impossible. However, accumulated PM-CT data were useful for retrospective evaluation and review of autopsy findings. These experiences indicate that PMI is useful for radiographic screening and documentation, to be included in supplementary procedures, employing knowledge and experiences of forensic autopsy.

The author attended a practical training program at the Los Angeles County Coroner's Office for 2 weeks in June 2008. The systems of investigating the cause of death in the USA are not unified because every state has its own laws and systems, with Los Angeles County having a mixed system of Coroner and Medical Examiner. This report is presented to introduce the training course for medical residents at the Institute of LA. To begin, a tour through the office was provided. All residents then underwent a mask-fit-test in order to prevent infections. A conference to present cases for the day was held each morning, as well as lectures once or twice per week. The whole staff instructed the trainees with care, not only in the Institute but also at the death scene and the court. Additionally, the author also attended the LAC + USC Medical Center Combined Trauma Death Review Committee as an observer. This committee is very important for trauma quality assurance. The report of the coroner's autopsy is handed to the committee and the chairperson, a coroner, assesses the results of the emergency medical treatment. This greatly improves the quality of emergency medicine and reduces the number of preventable deaths.

Actual circumstances of administrative autopsies which proved connections between medical implication and death had not been very clear in the past. Therefore, using the records of administrative autopsies performed from 2003 to 2005 at Tokyo Medical Examiner's Office, this study looked into the cases in which a certain level of connection between medical implication and death was proved or suspected. This study dealt with 877 cases. The largest age group among the male was the one between 65 and 74, and the number of female cases increased as the age increased. The percentage of the studied cases among all the administrative autopsy cases has become larger after 2004. As regarding medical departments for implication, "internal medicine" had the largest number of the cases, and "unknown", "psychiatry", and "emergency" followed in order. 30 percent were being hospitalized during the final medical consultations, and the percentage went up to just over 60 when the deaths during and on the day after the final consultations were added to the figure. Regarding the causes of death, the great majority was natural death, and the other causes were 'unknown', 'fall', and 'asphyxia'. Also, about 80 percent of the natural deaths were caused by circulatory, gastroenteric and respiratory diseases. Contradictions between clinical and forensic diagnoses were found in approximately 10 percent of the cases. In any case, medical examiners are to diagnose the causes of deaths by autopsy, not to evaluate the quality and safety of medical treatment. But if the quality and safety of medical treatment could be improved through the diagnoses of administrative autopsy, the medical examiner system would function practically as a part of administration for health and welfare. However, as it handles not only deaths by medical treatment but also all the other types of unnatural deaths, the system can also deal with other social problems, for which the correct causes of death must be diagnosed initially. It is socially very unhealthy to focus only on death associated with medical implication, as other types of unnatural death could be seen as relatively less important. Therefore, it is considered that the medical examiner system is effective for investigation of a variety of unnatural death as well as cases associated with medical implication.