Naofumi Yoshioka

Radiographic Survey of Third Molar Development in Relation to Chronological Age Among Japanese Juveniles

The aim of the present study was to establish Japanese reference material on the third molar development of Japanese juveniles for forensic application. Observations were performed on the orthopantomograms of 1282 Japanese patients between the ages of 14.0 and 24.0 years. Demirjian formation stages of the maxillary and mandibular third molars were recorded for chronological evaluation of wisdom teeth and applied for further statistical analysis. Statistically significant differences were noted between the upper and lower jaws and genders. Accordingly, males achieved root developmental grades earlier than females. We assessed the mean ages for all formation grades and predicted the probability that a Japanese juvenile would be older than the relevant ages of 14, 16, and 20 as defined by Japanese Juvenile Law. We determined the likelihood that a Japanese youth is older than the relevant age of 18 as defined by legislation in the United States.

A case of aconitine poisoning with analysis of aconitine alkaloids by GC/SIM

Described here is a fatal case of accidental aconitine poisoning following the ingestion of aconite, Torikabuto, mistaken for an edible grass, Momijigasa. A 61-year-old man developed symptoms of nausea, diarrhea, and discomfort of the body about 2 h after the ingestion and was taken to an emergency room. Resuscitation and antiarrhythmic drugs were ineffective, and ventricular tachycardia and fibrillation developed and lasted for 6 h. He was transferred to a coronary care unit and complete sinus rhythm was obtained on an electrocardiogram 30 h after his admission. The patient fell into a coma and died of brain edema diagnosed by CT on the 6th day. Consent for autopsy was denied by the family but was given for gas chromatography/selected ion monitoring (GC/SIM) to analyze the toxicity of aconitine alkaloids in the blood and the urine. Only a faint amount of jesaconitine was detected, while aconitine, mesaconitine and hypaconitine were not detectable in the blood 24 h after ingestion. On the other hand, aconitine and its related alkaloids such as mesaconitine, jesaconitine, and hypaconitine were clearly detected in the urine.

The examination of mushroom poisonings at Akita University

In the past 10 years from 1991 to 2000, the number of consultations to the Japan Poison Information Center were 947 concerning mushroom poisonings. However, those from the hospital cases were not analyzed toxicologically. We examined toxicologically 20 cases (35 patients) of mushroom poisonings from 1993 to 2001. Investigation of amanita toxin poisoning was requested in 19 cases. We could detect the amanita toxin, amanitin, and phalloidin, in two cases, which resulted in concluding the cause of death. A fatal case by the magic mushroom poisoning was analyzed in the blood, urine, and mushroom, and we detected the hallucinogenic substances from the body fluids and ingested mushrooms. We report the results of our examinations, and point out the usefulness of the examination of the mushroom itself and biological samples toxicologically for forensic practice.

Regional differences in homicide patterns in five areas of Japan

This article describes regional differences in the homicide patterns which occurred in Sapporo City and the surrounding area, and in Akita, Ibaraki, Chiba and Toyama prefectures in Japan. Information collected from each case of homicide included factors such as age, sex of the victim and assailant, causes of death, disposition of the offender, relationship between assailant and victim, reasons for criminal action, et al. The statistical features of homicidal episodes among the five different regions showed considerable variation, as follows. The mean death rates for homicide (number of victims per 100,000 of population) during the period 1986-1995 were 0.44 (Sapporo), 0.8 (Akita), 0.58 (Toyama), 0.7 (Ibaraki) and 0.75 (Chiba), respectively. Close family relationship between the victim and assailant was observed in the homicidal acts which occurred in Sapporo, Akita and Toyama. Assailants relationship to victim was commonly extra-familial in Ibaraki and Chiba-neighboring megalopolis Tokyo, where some events of murder by a foreigner occurred. Homicide by female assailant, murder by mentally abnormal killers and homicide-suicide events were closely associated with family members. And these factors contributed to the considerable number of victims in Sapporo, Akita and Toyama. But, this close family relationship of the victim to the assailant did not correspond with the elevation in the number of deaths, and it was rather inversely related to the higher death rates recognized in Ibaraki and Chiba. This comparative study suggested that rapid urbanization considerably affects regional differences in homicide patterns.

Comparison of Age Estimated from Degree of Racemization of Aspartic Acid, Glutamic Acid and Alanine in the Femur

Aspartic acid (Asp) is generally used for estimation of age by measuring the degree of racemization. For other amino acids, however, there are few reports regarding the usefulness of the degree of racemization for the estimation of age. Accordingly, in this study using the femur (obtained from 21 cadavers) as the specimen, we measured the degree of racemization of glutamic acid (Glu) and alanine (Ala) along with Asp in the total amino acid (TAA) fraction as well as in acid-insoluble collagen-rich (IC) and acid-soluble peptide (SP) sub-fractions. We compared the degrees of racemization of each amino acid and the accuracy of the ages estimated from them. The degree of racemization and the reaction rate of racemization were ranked in the order of Asp > Glu > Ala in the TAA and IC fractions, but Asp > Ala > Glu in the SP fraction. It is noteworthy that the degrees of racemization differed between the three amino acids depending on the fraction tested. The correlation coefficient (r) between the degree of racemization and the chronological age was higher in the SP than in the TAA or IC fraction. Among three amino acids, Asp showed the highest correlation coefficient as predicted. The present study confirmed that Asp from the SP fraction is the best indicator for age estimation using racemization rates.

Two adult cases of congenital atresia of the left coronary ostium—comparison of a sudden death case with a long-term survival case

We present two extremely rare autopsy cases with atresia of the left coronary ostium. Case 1 was a 34-year-old man who died of sudden cardiac causes with localized acute subendocardial infarction and Case 2 was an 82-year-old woman who died from non-cardiac causes. In both cases, a string-like small left main trunk that was located in its normal position was found; however, the orifice of the left coronary artery was absent in both cases. The collateral artery (CA), whose caliber was smaller than that of the proximal left descending artery (LAD), arose from the right coronary sinus and was anastomosed with the distal LAD. However, it was only in Case 1 that the CA showed an acute angle of take-off from the aorta, subsequently coursing between the root of the aorta and the pulmonary trunk, with possible mechanical compression by these two arteries. These two cases suggest that atresia of the left coronary ostium is developmentally and anatomically different from single coronary artery or left coronary artery arising from the opposite sinus of valsalva. Atresia of the left coronary ostium is considered to be an important differential diagnosis as a cause of sudden death, not only in the pediatric population but also in adults. The caliber and/or other anatomical features of the CA may predominantly dictate the clinical course of patients with atresia of the left coronary ostium.

Determination of fluoride in human whole blood and urine by gas chromatography-mass spectrometry

We developed a simple and sensitive method for determination of fluoride in human whole blood and urine using gas chromatography-mass spectrometry (GC-MS). Fluoride was alkylated with pentafluorobenzyl bromide in a mixture of acetone and phosphate buffer (pH 6.8). The derivative obtained was analyzed by GC-MS in the positive-ion electron-impact mode. The lower limit of detection for the compound was 0.5 mg/l for both matrices. The calibration curve for fluoride was linear over the concentration range of 1–100 mg/l. The precision and accuracy of the method were evaluated, and relative standard deviation was within 10%. Using this method, levels of fluoride in whole blood and urine were determined in a case of poisoning caused by hydrofluoric acid exposure.

A case of fatal intoxication with ammonium sulfate and a toxicological study using rabbits.

Agricultural fertilizers such as ammonium sulfate are widely used in house gardens as well as in agriculture, but few case reports or toxicological studies of ingested fertilizers have been reported. This paper investigates a fatal case of ammonium sulfate poisoning and demonstrates its clinical and biochemical findings in rabbits. An 85-year-old woman was found dead lying on the ground outside her house in the middle of March, but the autopsy could not determine the cause of her death. Examination at the police laboratory of the solution in the beer can found next to her showed that it was very likely ammonium sulfate. Our measurement showed a significant increase of ammonium and sulfate ions in serum and gastric contents. The cause of her death was determined as poisoning by ammonium sulfate. The total dose of 1500 mg/kg of ammonium sulfate was administered to three rabbits, all of which showed similar symptoms such as mydriasis, irregular respiratory rhythms, local and general convulsions, until they fell into respiratory failure with cardiac arrest. EEG showed slow, suppressive waves and high-amplitude slowing wave pattern, which is generally observed clinically in hyperammonemia in man and animal. There was a remarkable increase in the concentration of ammonium ion and inorganic sulfate ion in serum, and blood gas analysis showed severe metabolic acidosis. These results, mainly findings by EEG, have shown that a rapid increase in ammonium ions in blood can cause damaging the central nervous system without microscopic change. When the cause of death can not be determined, measurement of ammonium ion, inorganic ion and electrolytes in blood as well as in stomach contents at forensic autopsy is necessary.

Survey of dental diseases in forensic autopsy cases.

Forensic odontology plays an important role in the age estimation of a corpse. However, some cases exhibit a large margin of error when using conventional morphological methods. The final purpose of this study was to survey dental diseases to find the factors that result in errors in age estimation. First, we surveyed dental status related to dental caries in forensic autopsy cases to examine their characteristics. We investigated 335 forensic autopsy cases with accurate age and gender information available from autopsy and police reports. We assessed the number of teeth with caries, including the number of present teeth, missing teeth, sound teeth, treated teeth, untreated teeth, and the total number of carious teeth (DMF teeth: decayed, missing, and filled teeth).Then, each mean number of teeth from autopsy cases was compared with that from the results of a control survey of dental disease performed by Akita Prefecture. The autopsy cases, mainly in their 50s, showed a significantly higher incidence of DMF teeth, missing teeth, and untreated teeth. They also showed lower incidence of treated teeth. The more severe carious status in the autopsy cases suggested that they did not regularly visit dental clinics while they were alive. We will continue to analyze their past physical disease histories, the causes of death, and their antemortem lifestyles to find the factors that lead to incorrect age estimation.

Selective obstruction of lateral striate capsular arteries due to a small cardiogenic embolus as a cause of acute cerebral infarction limited to unilateral putamen

Autopsy reports of an acute striate capsular infarction are few (1) and therefore pathologic studies of acute infarction limited to the putamen are scarce. One of the reasons for this may be the relatively good prognosis of such patients (2). In the middle of winter, a 70-year-old women who had been living alone and had a history of hypertension and diabetes mellitus, was found dead at home by her visiting children. Autopsy showed fracture of the bilateral femurs with marked hemorrhage in the circumferential muscle, and the direct cause of death was judged to be traumatic shock because of these fractures. The fractures were thought to have been caused by a fall. A pale infarct involving most of the left-sided lower half of the putamen measuring 2 cm vertically and 1 cm transversely was observed in a coronal section of the brain (Fig. 1A). The caudate nucleus, internal capsule, and the insula were not involved. There were six branches of lateral striate capsular artery (LSAs) branching from the main and the distal M1 portion of the left middle cerebral artery (MCA), and macroscopic examination of the transverse sections of the trunk of the MCA under a magnifying lens showed that a round-shaped thrombus was present in the lumen. Microscopically, the infarct of the putamen showed ischemic neuronal changes, sparse perivascular and parenchymal infiltration of polymorphonuclear leukocytes, as well as partial destruction of axons. There were no ischemic neuronal changes in other parts of the brain. A fibrinized thrombus containing a small amount of fine collagen fibers was found in the left MCA. No atheromatous elements were found within the thrombus, and reactive change of the intima had not yet begun in the area. In addition, no ulceration with mural thrombi was found in the proximal aorta and bilateral carotid arteries. Referring to these autopsy findings, we considered that the thrombus in the MCA originated from the heart. Focal atherosclerosis of the left MCA was evident, and severe stenosis was found in the specimen just distal to the artery that was obstructed by the thrombus (Fig. 1B). The LSAs supply the putamen, body and the superior aspect of the head of the caudate nucleus, the lateral segment of the globus pallidus, the substantia innominata, and the lateral half of the anterior commisure (3). With regard to the distribution of the infarction in the present case, limited posterior branches of the LSAs were involved, while other anterior branches were not. Our case confirmed that the thromboembolism within the MCA trunk could cause an acute cerebral infarction that is limited to the putamen in some instances. On the other hand, this embolus was relatively small and did not completely obstruct the MCA itself, Figure 1 (a) Gross appearance of the cerebrum which contained the basal ganglia. Acute infarction is evident limited to the left lower half of the putamen. (b) Microscopic appearance of the trunk of middle cerebral artery. Round-shaped thrombi can be seen in the left-sided artery. Right-sided artery is the specimen just distal to the artery of the left one and shows stenosis of the lumen (arrow) due to severe atherosclerosis.