Masahito Hitosugi

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.

A case of fatal benzalkonium chloride poisoning

Abstract 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.

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.

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 mans 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.

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 Takahiras 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.

Prediction of injuries to the heart and thoracic aorta in unrestrained drivers.

The purpose of the study was to investigate factors predicting injuries to the heart and/or thoracic aorta (H/TA) of unrestrained drivers in frontal motor vehicle collisions. We retrospectively analyzed findings of forensic autopsies of 37 unrestrained drivers of automobiles without airbags involved in frontal collisions. Mechanisms of injury, injury severity, presence of major injuries, and the number of fractured ribs were examined in each case. Victims were subdivided for comparison into those with (19 cases) and without (18 cases) H/TA injuries. The injury severity score and the abbreviated injury scale of the chest were significantly higher in persons with H/TA injuries (65.3+/-15.7 and 5.4+/-0.9) than in persons without (31.6+/-22.0 and 1.8+/-1.9). Because univariate analysis showed that the presence of multiple fractured ribs was an important predictor of H/TA injuries, we examined the relation between H/TA injuries and the number of fractured ribs. Copass nonparametric smooth binary regression model showed that H/TA injuries were more likely in persons with eight or more fractured ribs. The presence of eight or more fractured ribs predicts H/TA injuries in unrestrained drivers.

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.

Autopsy case of duodenal obstruction from impacted mushroom.

Abstract: 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 Ringers 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.

Trends in early and late deaths due to motor vehicle accidents in Japan

To clarify trends and urban-rural differences in the early death rate (deaths within 24 h divided by the deaths within 1 year after motor vehicle accident x100 [%]) due to motor vehicle accidents (MVAs) in Japan. Mortality data were collected from the annual statistics of traffic accident research and vital statistics in Japan from 1980 through 1998 and analyzed. Early death rates were nearly constant (73.9-78.0%) from 1980 through 1998. Early death rates were lower in younger and elderly groups. As regards to geographic variations, early death rates and 1-year death rates per 100,000 vehicles were significantly higher in rural areas (population density <1000/km(2)) than in urban areas. To investigate MVA deaths, both early and late deaths should be examined. Decreasing the early death rate, a new index for MVA death, which reflects the reduction of injury severity is important for preventing MVA deaths.