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

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.

Practice and Research of Forensic Medicine Learned from the Dead' is presented by looking back my 29 years' carrier as a forensic pathologist. After joining in Department of Forensic Medicine, Kumamoto University in 1969, I had spent several happy years with studying on postmortem corneal clouding. Soon I began to have doubts on a purpose of forensic autopsy in my department then, which seemed to be only to/under the police. I spent one year at Department of Forensic Medicine, Leeds University in England in 1979-1980 and experienced Forensic Medicine not only for the police but also for the society in general. Visiting several university departments in Europa at that time, I felt confident that Forensic Medicine is one special field of medical sciences and will be worth a subject to devote my life. Clinical Forensic Medicine is one field of forensic medicine. Its importance has been recognized in the society by increasing numbers of felonious crimes and campaigns of human rights throughout the world. In 1996, the 4th International Conference of World Police Medical Officers in Clinical Forensic Medicine was ended in a great success in Kumamoto, Japan. Now evaluation and development of Clinical Forensic Medicine are very essential for both forensic pathologists and clinicians to serve for the society. My own activities of teaching traffic safety and preventing child abuse and neglect were cited as examples of 'Practice of Forensic Medicine Learned from the Dead'. Studies on differentiation of postmortem discoloration and antemortem bleeding by glycophorin A or erythrocyte membranes and an international joint research project with Tanzania on neuropathology of AIDS were examples of 'Research of Forensic Medicine Learned from the Dead'. It is an important mission for a forensic pathologist to work for/with the police to solve crimes by hearing a voice of the dead on an autopsy table. Through friendship with foreign colleagues, however, I have learned much about what should be a forensic pathologist and have been inspired with a phrase, 'The information learned from studying the dead could be used to help the living.' by Dr. T.A. Gonzales of the Chief Medical Examiner's Office of New York. Because social activities of preventing crimes and accidents are very much important matters indeed, every forensic pathologist must devote his/her forensic practice and research to achieve a peaceful end of life for every citizen, I believe.

It is reported that the annual number of suicides in Japan is more than 20,000, which is as twice as the number of death by traffic accidents. Nevertheless, few protective activities have been developed by government or society. This paper introduces the actual states of suicide in the past few years in Japan, expecting to start a movement for reducing suicidal number by government, society and family in Japan. The number of suicide was less than 15,000 in the late 1960s, but it increased to more than 20,000 in 1970s, which has not been reduced up to the present and the highest number 256,000 was recorded in 1986. The Ministry of Welfare reports that the prefectures showing higher rate of suicide have been Akita, Iwate and Niigata, whose suicide rates are 10 points higher than that of the national average. On the other hand, the prefectures such as Nara, Shiga, Shizuoka and Kanagawa have shown lower rate of suicide. In all the prefectures, the number of males is constantly much larger than that of females and, furthermore, the rate of suicide in the male and female aged group (over 65 years old) is much higher than that of the under-64-year-old group. As a background of suicide, psychiatric disorders account for 30-50% of all suicides in the younger and prime generations, but as a motive of suicide the pain of sickness amounts to 60-70% in the aged group. It is suspected by our epidemiological investigations that the pain of sickness is not a true motive for committing suicide. Sickness usually accompanies anxiety, pessimistic view of life, loss of an important part in his/her family and economical uneasiness. The most frequently used method for committing suicide in male and female especially in the aged group is hanging, and next to this are inhalation of car exhaust, drowning oneself and taking poisons. Firearms are quite rarely used in Japan. Aging, mental disorders and genetic factors are considered to be risk factors for suicide attempt. It should be pointed out that betterment of home life, mental independence, death education and forced intervention by psychiatrists are required to reduce the number of suicides.

The relationship between age and the height of the proximal apex of the medullary cavity of humerus was investigated on 13 male bodies (29-62 years) and 12 female bodies (22-80 years) and a provisional criterion for age estimation was obtained. When the apex is (1) at a height of the surgical neck, the estimated age is under 50 years in both sexes, (2) at the epiphyseal line, over 50 years in males, and from 50 to 75 years in females. In a few cases, however, the apex reaches the line even in the very young age group (20-30 years). (3) When a cavity or rough structure is present above the line in addition to phase (2), the estimated age is over 75 years in females, but unknown in males. We also discuss the validity of Koshinaga's criterion (1951).

Simple and rapid detection of HLA-DRB polymorphism has been performed using AMPLICOR HLA-DRB Typing Kit. We tried to apply this kit to various forensic samples. When DNA was extracted from the forensic samples using conventional phenol-chloroform method, addition of 7.5 mM MgCl2 was required to PCR amplification. HLA-DRB types were detected from DNA more than 0.1 ng by PCR amplification. Typing of unrelated 50 Japanese showed 38 different patterns, of which 30 patterns occurred once in the group. A total of 16 serotypes were deduced from the HLA-DRB DNA types. Out of them, high frequency serotypes were DR4 (24%), DR9 (18%) and DR15/16 (14%). This kit was very useful in forensic cases such as rape and in paternity cases. When we tried to detect HLA-DRB types from a single hair shaft of 3 cm in length, we were successful in detection from only one of five persons.

Utility of caffeine analysis for the purpose of forensic hair discrimination was evaluated. Methanol extracts of each 5-cm strand of scalp hair, after its incubation at 37 degrees C for 15 h, was analyzed by gas chromatography-mass spectrometry (GC-MS). For quantitative analysis of caffeine, caffeine-d3 was added as internal standard to the methanol extract. Hair specimens were obtained from three victims and from twenty-two volunteers. The results showed that caffeine levels in hair varied according to each individual; caffeine was detected up to a maximum level of 4.19 ng/5-cm hair. The concentrations of caffeine in hair obtained from four different regions of the scalp in twenty-two volunteers showed a coefficient of variation not greater than 24.7% for each individual. Based on our data, it was concluded that caffeine levels give relatively high reliability for discriminating a victim's hair from others at a criminal or accidental scene, although it should be used in combination with morphological examination and ABO blood group determination.

A transferrin (TF) variant was found in the child in a paternity case by polyacrylamide gel isoelectric focusing (PAGIF). Further analysis of serum TF disclosed that this rare TF variant was inherited from the alleged father. This TF variant was identified as TF DHR5, being identical with a variant TF DSaga, in a direct comparison with several known TF D variants by PAGIF. The isoelectric points (pIs) of holo-type (Fe(II) binding type) of TF DHR5 (= DSaga) and TF C were 5.6 and 5.4, respectively. After sialidase treatment, TF DHR5 (= DSaga) showed a single band migrating at a more basic position than TF C, thus suggesting that the pI difference between the two was due to amino acid substitution.