Mariko Kawaguchi

Retrospective study on suicidal cases by sharp force injuries.

A total of 65 suicidal cases due to sharp force injuries (cut and/or stab wounds) were investigated. Suicide by sharp force injuries accounted for 2.5% of all suicides in our prefecture during 1995-2005. The 65 victims were composed of 49 males and 16 females, and the age range of 50-70 years was most common. A history of psychiatric disease was found in 11 victims, and depression was the most common disease followed by schizophrenia. Of 65 cases, 8 victims had a history of previously attempting suicide. In 41 cases, a suicide note or will was found. Forty-six cases had pleural sharp force injuries. Interestingly, the remaining 19 deaths were due to a single sharp injury. Cutting injuries were predominantly located at the flexor side of the wrist (11 cases, 38%), followed by the neck (10 cases, 34%). On the other hand, stab wounds were most commonly located in the chest (17 cases, 49%). Tentative wounds, which were superficial cut wounds or stab wounds, were present in 37 cases (57%). In 27 of 37, hesitation marks were observed in close proximity. Tentative wounds more frequently appeared in cut injuries than in stab injuries. Of 28 cases with fatal cut or stab wounds localized in the trunk, 11 cases (39%) had clothing damage. In the discrimination between suicide and homicide, forensic pathologists should obtain information on victims and witnesses as well as investigating the scene and postmortem examination of the victim.

Distribution of zolpidem in body fluids and organ tissues in five autopsy cases

We investigated the distribution of zolpidem throughout femoral vein blood, urine, stomach contents, the brain, lung, liver, and kidney in five autopsy cases using gas chromatography-mass spectrometry. Four out of the five cases showed toxic levels of zolpidem. Only one case showed a lethal blood level. The zolpidem concentrations in solid organ tissues were generally several times higher than that in blood. Among four solid organ tissues, the differences in concentration were not drastic; they were similar or within the same order of magnitude except for one case. These results suggested that measurements of zolpidem concentrations in multiple solid organ tissues are useful for estimating whether zolpidem poisoning is related to the cause of death, especially when blood cannot be collected.

Distribution of carbamazepine and its metabolites carbamazepine-10,11-epoxide and iminostilbene in body fluids and organ tissues in five autopsy cases

Carbamazepine (CMZ) and its metabolites, carbamazepine-10,11-epoxide (CMZepo) and 2,2’-iminostilbene (Imi), were simultaneously assayed by gas chromatography-mass spectrometry (GC-MS) in body fluids and organ tissues taken from victims in five autopsy cases. Clomipramine-HCl was added to each specimen as internal standard (IS); target compounds and IS were simultaneously extracted with an Extrelut NT column before analysis by GC-MS. The concentrations of CMZ were generally much higher in organ tissues than in blood and urine, and were higher in the liver than in the lung in three cases. The concentrations of metabolites CMZepo and Imi were lower than those of CMZ in all body fl uid and organ tissue specimens; the Imi concentrations in the brain were higher than CMZepo concentrations in four cases. Imi concentrations in the kidney, however, were lower than those of CMZepo in four cases. In the lung and liver, the concentrations of Imi did not show a consistent trend; those of Imi were higher or lower than those of CMZepo, but both metabolites were not at negligible levels. To our knowledge, this is the fi rst demonstration of the distribution of Imi among human body fluids and tissues.

Sudden unexpected neonatal death due to late onset group B streptococcal sepsis—A case report

We report a case of sudden unexpected death due to late onset neonatal group B streptococcal sepsis. A male neonate weighing 2731g was born at 35week gestational age, and discharged at the age of 4days after the birth. At 6days after the discharge (10days after the birth), because of consciousness loss and hypothermia, the neonate was conveyed to an emergency hospital, eventually followed by his death. Forensic autopsy revealed neither severe trauma nor cardiac anomaly. Both lungs were edematous. Histopathologically, a lot of bacterial clusters were found in the lungs and intracerebral vessels. Cerebrospinal fluid contained a lot of leukocytes. Streptococcus agalactiae was detected in the specimens from the feces and the blood. Collectively, we diagnosed that the cause of the neonates death was late onset group B streptococcal sepsis. In autopsy cases of neonates, careful macroscopic and microscopic observations and bacteriological/virological examination should be performed.

Postmortem distribution of chlorpyrifos-methyl, fenitrothion, and their metabolites in body fluids and organ tissues of an intoxication case

We herein report a fatal intoxication case caused by the ingestion of the insecticides chlorpyrifos-methyl (CPFM) and fenitrothion (MEP). A 70-year-old man was found dead in his house and a cup containing a small amount of agricultural chemicals was on the table near his body. External and internal examinations revealed no injuries. In a gas chromatography-mass spectrometry (GC-MS) screening test, CPFM, MEP, and their metabolites, 3,5,6-trichloro-2-pyridinol (TCPY) and 3-methyl-4-nitrophenol (3MNP), respectively, were qualitatively detected in his stomach contents. The concentrations (µg/g) of CPFM, TCPY, MEP, and 3MNP in the extracts of each body fluid and organ tissue were assessed by GC-MS and were as follows: 27.8, 56.2, 17.2, and 2.82 (heart blood); 6.60, 42.9, 1.80, and 2.59 (peripheral blood); 0.0821, 45.9, 2,09, and 102 (urine); 21.4, 26.6, 76.2, and 3.83 (brain (frontal portion)); 16.1, 101, 9.67, and 1.26 (liver); 7.45, 101, 21.4, and 26.1 (right kidney); and 73,500, 9750, 232,000, and 1880 (stomach contents), respectively. Based on these results and autopsy findings, the cause of death was acute fatal intoxication by CPFM and MEP.

High concentration of methidathion detected in a fatal case of organophosphate-poisoning

We report a case of fatal intoxication caused by the ingestion of an organophosphate pesticide, methidathion (DMTP). An 80-year-old male was found dead in his bed. Forensic autopsy revealed no remarkable morphological changes. However, in a toxicological screening test, methidathion was qualitatively detected in extracts of stomach contents. Concentrations of methidathion (μg/g) in body fluids and organ tissues, determined by gas chromatography-mass spectrometry, were as follows; 66.2 in heart blood, 8.33 in peripheral blood, 8.80 in urine, 2000 in the brain (frontal lobe), 4800 in the left lung, 810 in the liver, 150 in the left kidney, and 64,000 in the stomach contents (total 1.9 g). These results strongly suggested that the victim orally ingested methidathion. Additionally, xylene was determined in body fluids and organ tissues. From the toxicological data together with autopsy findings, the cause of his death was diagnosed as acute poisoning by an emulsion of methidathion.