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

The method for estimating age-at-death of human skeletal remains based on the morphological changes of maxillary sutures is widely accepted in Japan. This method is based on the work of Kamijo (1949), which describes the age-related alternations in the morphology of maxillary sutures in Japanese population. However, from the modern anthropological viewpoint, Kamijo's report has some serious flaws in the definition of the morphology of the sutures as well as in the quality and quantity of the samples. Despite these problems, no verification has been conducted for the validity of estimating age-at-death based on his data. Recently, Mann et al. (1991) published a new method for estimating skeletal age based on the progressive obliteration of maxillary sutures. However, there has been no report that verified the effectiveness of their method in Japanese. In the present study, we re-examined the age-related alternations in the morphologies of maxillary sutures in Japanese and assessed the effectiveness of the method of Mann et al. (1991) by using 375 (274 males and 101 females) Japanese skeletons of known sex and age. In all maxillary sutures, the morphological transitions from "no obliteration" to "partial obliteration" with age could be confirmed. However the transition from "partial obliteration" to "complete obliteration" with age could be seen only in the incisive suture and the posterior median palatine suture. Moreover the percentage of each morphology of suture to a total within each decade shows almost no change over fifth decade. By using the method of Mann et al., we could correctly estimate the age-at-death of only 36.9% for males and 25.7% for females of the Japanese samples, however, we seldom overestimated the age-at-death of these samples compared with their actual age. This finding suggests that this method is applicable to estimate the minimum age-at-death in Japanese population.

The deceased was a 75-year-old male, found dead in his home. He had a history of occupational asbestos exposure for 13 years. At autopsy, there was diffuse fibrosis of the lung, with diffuse pleural thickening. Large amounts of asbestos bodies were detected in the lung tissue. The findings of transmission electron microscopy with energy-dispersive X-ray microanalysis (TEM-EDX) also showed asbestos fibers deposited in the lung tissue. From the macroscopic and histological findings of the lung, the number of asbestos bodies in the lung tissue and the TEM-EDX findings, we concluded that the cause of his death was chronic respiratory failure due to asbestosis. We recognize the importance of a detailed occupational history, which provides useful information for determining the cause of death.

We report a medico-legal autopsy of a 4-year-old girl without any history of allergies, who died following anaphylactic shock due to local anesthesia with lidocaine during dental treatment. The shock symptoms were overlooked due to a rubber-dam-sheet covering her face. The autopsy revealed laryngeal edema, secretory fluid filling the trachea, severe pulmonary congestion and edema. An immunohistochemical investigation showed numerous mast cells releasing histamine in lungs, and the fluids in the pulmonary alveoli and veins also showed positive staining. In addition, the plasma concentration of histamine in the heart blood showed a high value. From these findings, the cause of death was determined to be respiratory failure due to anaphylactic shock induced by lidocaine. In this case, her death was considered to be due to medical malpractice; adequate life support had not been performed, because anaphylactic shock was overlooked until the rubber-dam-sheet removed. In addition, due to two previous autopsy case reports that described infantile fatalities involved with the misusage of a rubber-dam-sheet for the patients under local anesthesia, we therefore recommend immediate improvements in rubber-dam-sheets and/or better applications of them in pediatric dentistry.

The Rh system clinically is one of the important blood groups. The major Rh antigens are RhD, RhC/c, and RhE/e, which are carried by two integral membrane polypeptides consisted of 416 amino acids. These polypeptides are encoded by two closely related genes, RHD and RHCE. Both RH genes are composed of ten exons. It is thought that multiple recombinations, nucleotide substitutions, large nucleotide gaps (due to Alu sequence), and high level of the homology between the RHD and RHCE genes are the important factors in the formation and evolution of these genes. The RHD gene is deleted in most white individuals who lack the RhD antigen, while 12% of Japanese individuals have an RHD gene. Molecular analyses have elucidated the background of various Rh-related variants; D--, partial D, weak D, and Rhnull. The Rhnull phenotype is divided into the most common type by the Rhnull regulator gene and second type by the amorph gene that arose by homozygosity of a silent allele at the RH locus. The RhAG glycoprotein has been regarded as a most critical Rhnull gene of the reglurator type and a critical co-expressing factor of the Rh polypetides on red blood cells. Studies on the autoantibodies against red blood cells in aoutoimmune hemolytic anemia have suggested that the public epitopes of autoantigens exist on the Rh polypeptides.

An autopsy case performed by the author in 1986 had been gradually revealed to be a murder using aconite poisons. The puffer fish toxin was certified afterwards to be co-administered together with aconite alkaloids in this case. In order to investigate this murder case, animal experiments were done using mice to clarify the metabolism of aconitine and tetrodotoxin, and to examine the influences of tetrodotoxin on aconite poisoning. We also examined biological effects under the chronic intoxication of aconitine, and the elimination and degradation of aconitine in dead body. For this purpose we have developed technical methods using GC/MS and LC/MS for the quantification of these toxins in biological materials.

We reviewed the records of 118 medicolegal autopsy cases, in which psychotropic drugs were detected in blood, in the Tokyo Medical Examiner's Office in 1997, to explore how the drug levels were considered in determining the cause of death. Names and doses of the drugs were clear in 70 of 118 cases, and in most cases of the 70 cases, multiple drugs (up to 13 drugs) were prescribed to a person. It was also evident that 75 of the 118 cases had demonstrated psychosis for several months to 38 years prior to death. No information concerning prescriptions or history of psychosis could be obtained in the other cases. The causes of death in these 118 cases were as follows: deaths from specific diseases, 30 cases (25.4%); deaths from extrinsic factors excluding drug intoxication, 22 cases (18.6%); suicide related to drug intoxication, 31 cases (26.3%); deaths from extrinsic factors related to drug intoxication suggestive of suicide, but not confirmed, 19 cases (16.1%); non-suicide, including probable drug intoxication, 13 cases (11.0%); and deaths from malignant syndrome, 3 cases (2.5%). There were cases diagnosed as death from specific diseases based on morphological findings, though drug concentrations in blood were at a toxic or even lethal level. In some cases, drug intoxication was suspected, but drug levels in their blood were at a therapeutic level and there were no identifiable morphological changes directly associated with deaths, resulting in a cause of death other than drug intoxication being indicated. Thus, drug levels detected in the cadaver's blood are not always useful for determining the cause of death. This might be due to poor information on interactions between drugs (including alcohol), pathological changes or genetic variability of drug metabolism and excretion, and so on. Thus, further studies of these aspects are needed in order to make information on drugs detected in the cadaver more useful for determination of cause of death.

In forensic science and medicine the ABO system has been a major focus, since the record of this blood system is a very prevalent one and A, B and O(H) antigens on erythrocytes are also associated with other cells and tissues throughout the body and are known to be considerably stable to the such violent conditions as heating or drying. However the determination of the ABO grouping from the body often encounters the difficulty due to haemolytic erythrocytes, and putrefaction, mummification or skeletonization of the body during post-mortem interval. In this presentation I review the merit and demerits of the ABO blood-grouping methods utilized in my division at the forensic autopsies according to the haemagglutination, absorption-elution and histochemical techniques and ABO genotyping method. It is important for ABO grouping to know the distribution of the ABO antigen in the body. I would like to emphasize that the species identification prior to ABO grouping is an important procedure because forensic materials such as from saliva, urine and seminal fluid might be contaminated with the fluid from animals, and DNA extracted from vertebrate species might be amplified with the primer for ABO genotyping and the amplified PCR products might be hybridized to those from human.