Shirushi Takahashi

Sudden death of a young woman due to aortic dissection caused by Turner's syndrome

A 24‐year‐old woman was found dead in her bed. There had been an episode of fainting with cervicodynia 1 day before death but no significant past medical history, except for menstrual irregularities. Post‐mortem examination revealed that death was due to hemopericardium caused by rupture of the ascending aorta by thoracic aortic dissection (Stanford type A). Microscopically, weakness of the aorta was due to cystic medial necrosis. On external examination, short stature, a short neck and multiple pigmented nevi were observed, while internal examination revealed coarctation of the aorta and funicular ovaries. Examination of the X chromatin showed a decrease in numbers of Barr bodies in the tissues, and a 45,X/46,XX mosaicism was suspected. It is concluded that the cause of death was aortic dissection due to Turners syndrome.

Usefulness of catheter guide wires for identifying sites of vascular injuries.

We report 2 cases in which catheter guide wires were useful for detection of vascular injury site. Case 1: A woman was died of hemorrhagic shock after being slashed at the extremities, but the vessels were so collapsed that it was not easy to find the injured site. After a wound track on the left forearm was cut open and a guide wire was inserted, the injury site was detected expeditiously at the left radial artery. Case 2: A woman was stabbed and died of hemorrhagic shock. An autopsy revealed 2 stab wounds in the back, one of which made a cut in the left lung. The wound track was cut open, and the injured vessel was revealed. It was too small in diameter to macroscopically determine whether the injured branch arose from, and so a guide wire was introduced from the injured site, and the injured vessel was easily determined to be a branch of the left pulmonary artery. Guide wires have many features, such as elasticity, flexibility, and hydrophilicity, which are considered to be applicable to forensic uses. The guide wire technique is easy, less invasive, highly vasoselective, and reproducible in identifying vascular injury sites.

Gas dispersal potential of infant bedding of sudden death cases. (I): CO2 accumulation around the face of infant mannequin model

We assessed CO(2) gas dispersal potential of bedding that had actually been used by 26 infants diagnosed with sudden unexpected infant death using a baby mannequin model. The age of victims ranged from 1 to 12 months. In some cases, the parents alleged that the infant faces were not covered with bedding when they were found. The parents memories, however, may not have been accurate; therefore, we examined the potential for gas dispersal based on the supposition that the bedding had covered their faces. The mannequin was connected with a respirator set on the tidal volume and respiratory rates matched with the babys age. Before measuring, CO(2) flow was regulated in 5%+/-0.1% of end-tidal PCO(2). After the model was placed on each bedding condition, measurements were performed at least five times under each respiratory condition. Four cases showed a plateau of FiCO(2) <4.8%, 15 were 4.8-12%, and the other seven were 12% or more, when they reached a plateau. Of course, our model does not take large tissue stores of CO(2) into account. However, our model could show the potential gas dispersal ability of bedding. Especially, the latter seven bedding could have high rebreathing potential if they covered the infants faces and the probability of environmental asphyxia should be considered.

An infantile case of asphyxia with coincidental myocarditis.

A six-month-old infant was found dead in a small dustbin in an upside-down position. The police investigation showed that there was no criminal environment including negligence. Analysis at the scene suggested death caused by asphyxia (wedging death). Microscopically, however, diffuse lymphocyte infiltration was observed in the interstitial spaces of the myocardium. Common symptoms of infantile myocarditis are generally non-specific, and the predominant neurological problem is a decrease in activity. The records of rectal temperature suggested that the decedent was dead without a high fever. In the present case, there was no obvious relationship between myocarditis and movement of the infant. We conclude that myocarditis was coincidental to the cause of death by asphyxia.

Sudden collapse after minor head injury in an elderly man; association with cardiocerebral decompensation and fat embolism syndrome

An 86-year-old man suffering from right hemiparesis and dementia fell from a stretcher and sustained laceration and bruising to his right eyebrow. He was brought to an emergency room, and his wounds were treated. Shortly after discharge, his respiratory and mental status dramatically declined. Despite supportive care, he died about three hours after re-admission. Autopsy revealed a minor laceration to the eyebrow with minor intracranial injuries, mild cardiomegaly (370 g) with right atrial dilatation, pericardial effusion (170 ml) and marked pulmonary edema. Microscopically, fatty droplets were observed in the lung capillaries, the glomeruli and the intracerebral vessels. Although the extent of the original injuries seemed insufficient to cause systemic fat embolism syndrome (FES), the patients decreased cardiac reserves and stress associated with this event likely contributed to his death consistent with the physiochemical model of FES pathogenesis.