Takahisa Okuda

Prefabrication of tissue engineered bone grafts: an experimental study.

The purpose of this study was to determine whether angiogenesis could successfully be induced into bone tissue that was engineered by cultured adipose-derived stem cells with porous beta-tricalcium phosphate and whether its biologic properties could be maintained by flap prefabrication technique.Adipose-derived stem cells with porous beta-tricalcium phosphate were implanted into the superficial inferior epigastric artery flap of the Fisher rats. After prefabrication for 8 weeks, the prefabricated flaps were elevated and the pedicles were clamped for 4 hours. The samples were harvested after 2 weeks for analyses.Angiogenesis was significantly increased in the prefabricated groups (P < 0.05). There was no significant difference between the prefabricated and nonprefabricated groups in terms of the osteogenic capacity (P > 0.5).The promising results obtained with prefabrication in tissue engineered bone grafts encourage the clinical application of this technology. Thus, prefabrication may be a useful technique in any engineered bone tissue transfer.

Sudden death as a late sequel of Kawasaki disease: postmortem CT demonstration of coronary artery aneurysm.

Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that primarily affects the coronary artery (CA) and presents during childhood. The characteristic coronary arterial lesion of KD is an aneurysm. Ischemic heart disease derived from a CA aneurysm is experienced approximately two decades after the onset of acute KD. In recent years, the primary issue of concern has been asymptomatic adults with a CA aneurysm caused by undiagnosed KD. We present a case of sudden death as a late KD sequel in a young adult. A postmortem CT scan revealed a coarse calcification of a left anterior descending CA aneurysm, which was confirmed at the time of autopsy. A postmortem CT scan is useful in cases of sudden death where the detection of a calcified CA aneurysm would suggest to the forensic pathologist that the deceased suffered from a late sequel of KD. The use of screening postmortem CT scans for young people may detect cases of unsuspected CA aneurysms, raising the possibility of untreated KD.

A case of fatal cervical discoligamentous hyperextension injury without fracture: Correlation of postmortem imaging and autopsy findings☆

We present a case of fatal cervical discoligamentous hyperextension injury without fracture. Postmortem computed tomography (PMCT) and postmortem magnetic resonance imaging (PMMRI) disclosed cervical instability and spinal cord injury in the absence of fracture, which was confirmed by autopsy. Cervical discoligamentous injury without fracture may be unnoticeable on PMCT because signs of cervical misalignment change depending on the posture of the neck at the time of postmortem imaging. Because of its greater sensitivity for soft tissue injury, PMMRI is especially useful for detecting pathological changes in cases of death due to cervical discoligamentous injury. In this paper, findings on postmortem imaging for this injury are described in detail and correlated with findings on autopsy.

Bathtub drowning: An 11-year retrospective study in the state of Maryland

A bathtub drowning is one of the leading causes of death in a bathtub. The purpose of this study was to evaluate how reliable the drowning-related signs could be for identifying a bathtub drowning in the cases of death in the bathtub. Performing a retrospective review of 92 deaths in the bathtub in Maryland, 71.7 percent were the presence of bathtub drowning and 28.3 percent were the absence of bathtub drowning. Three leading contributory causes of death were cardiovascular disease, drug/alcohol-related death, and seizure disorder in both groups. There was a statistically significant difference between the groups in relation to a history of recovery from the water (95.5% and 38.4%, p<0.001), foam in the air way (33.3% and 15.4%, p<0.05), watery fluid in the sphenoid sinuses (81.8% and 11.5%, p<0.05), hyperinflated lungs (36.4% and 3.8%, p<0.01), and watery fluid in the stomach contents (40.9% and 3.8%, p<0.01). More than triple overlapped drowning-related signs could be beneficial for the diagnosis of a bathtub drowning. A comprehensive investigation incorporating a thorough scene investigation, gathering of the victims medical and psychosocial history, and a meticulous full autopsy is necessary to elucidate both the cause and manner of death in these cases of death in the bathtub.

Immediate non-traumatic postmortem computed tomographic demonstration of myocardial intravascular gas of the left ventricle: effects from cardiopulmonary resuscitation

SummaryAn 87-year-old man was found in a state of cardiopulmonary arrest. Despite cardiopulmonary resuscitation (CPR) for over 1 hour by emergency technicians and physicians, the patient died. Immediate postmortem computed tomography showed cardiovascular gas in the right atrium, right ventricle, and left ventricle. Cardiovascular gas in the left ventricle was located in the myocardium and appeared as linear or branch-shaped suggesting the presence of myocardial intravascular gas. This is the first report describing the appearance and significance of myocardial intravascular gas of the left ventricle as a CPR-related change.

Pericardial tear as a consequence of cardiopulmonary resuscitation (CPR) involving chest compression: A report of two postmortem cases of acute type A aortic dissection with hemopericardium

We present two cases of a pericardial tear as a consequence of cardiopulmonary resuscitation involving chest compressions in fatal acute type A aortic dissection (AoD) with hemopericardium. For each case, postmortem computed tomography revealed a hematoma in the false lumen of the ascending aorta with a slight hemopericardium and a large left hemothorax, as well as focal pericardial dimpling and discontinuity around the left ventricle. At autopsy, we confirmed a convex lens-shape gaping pericardial tear at the left posterolateral site of the pericardium and a massive volume of bloody fluid in the left thoracic cavity. It has been hypothesized that the pericardium ruptured due to chest compressions during resuscitation in these cases of acute type A AoD with hemopericardium and that intrapericardial blood leakage through the pericardial tear resulted in a hemothorax.

Possibility of visualization of gastrothorax based on unenhanced postmortem computed tomography/PMCT

We present a fatal case of a gastrothorax due to an acute gastric volvulus resulting from a Bochdalek hernia. A 5-year-old boy without previous medical history was brought to our institution in a state of cardiopulmonary arrest and was subsequently pronounced dead. Postmortem computed tomography (PMCT) of the torso showed abdominal organs involving the lower section of the esophagus up to the entire stomach, the left side of the transverse colon, the entire spleen, and the tail of the pancreas herniated into the left thoracic cavity. The stomach was markedly expanded and a mesentero-axial (rotation along the short axis) volvulus was observed, displacing mediastinal structures to the right side and depressing the diaphragmatic contour. A PMCT of the thorax at the lung window setting revealed displacement of bilateral lungs. The bilateral lungs were severely atelectatic and congested. The PMCT findings mentioned above were consistent with the autopsy findings. PMCT can provide useful information for the diagnosis in cases we initially cannot predict any significant changes, for example, organ displacement.

Metabolic pharmacokinetics of early chronic alcohol consumption mediated by liver alcohol dehydrogenases 1 and 3 in mice: Adaptation of alcohol dehydrogenases

Alcohol dehydrogenases (ADHs) 1 and 3 are responsible for systemic alcohol metabolism. The current study investigated the contribution of liver ADH1 and ADH3 to the metabolic pharmacokinetics of chronic alcohol consumption (CAC).

A systematic review and pooled analysis of CPR-associated cardiovascular and thoracic injuries

We read with great interest the recent article entitled “a systemtic review and pooled analysis of CPR-associated cardiovascular nd thoracic injuries” by Dr. Miller and colleagues1 and would like o congratulate the authors on their impressive work. We would make some comments in regard to the analysis of PR-associated pericardial injuries. According to the article, the uthors collected nine cases of pericardial injuries, accompanying ith two references by Rabl et al.2 and Smekal et al.3 Rabl et al. howed two cases of pericardial injuries, considering a complicaion associated with sternal fracture. Smekal et al. reported seven ases of pericardial bleeding. They said in the discussion part that njuries to the aorta and ruptures of the pericardial wall were in all ases considered by the pathologist to be the primary cause of death nd not due to chest compression. Certainly, the cases of pericardial leeding in this literature were not a complication of resuscitation nd the authors would cite by error in the article. Resuscitative injuries related to chest compression can occur requently in the chest. Rib/sternal fractures and pneumothorax re common complications; however, pericardial injuries due to hest compression are rare occurrences with only a handful of cases eported in the literature.2–5 Pericardial injuries during resuscitaion are basically divided into two categories: pericardial injuries n the presence of rib/sternal fracture and pericardial injuries in he absence of rib/sternal fracture. In most cases, resuscitationnduced rib/sternal fractures penetrate the pericardial sac,2 as cited n the article. A case of pericardial injuries due to chest compresions in the absence of rib/sternal fractures is extremely rare and nly two articles have been published in the literature. Kan et al.4 eported that a patient suffering from hemopericardium due to ostinfarction left ventricular rupture was salvaged since cardiac amponade was released by resuscitation-induced pericardial tear. e have recently reported two postmortem cases of acute type A ortic dissection with hemopericardium involving resuscitationnduced pericardial tear in the absence of rib/sternal fracture.5 ne of the possible causes was considered that a direct impact f dislocated heart distends the pericardial wall, resulting in periardial tears; however, we were wondering there would be much ore literatures in regard to the pericardial tears after chest comression, if pericardial tears occur through a certain mechanism. e focused attention on the common finding among three cases

190C: NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY AS A USEFUL TOOL FOR INGREDIENT ANALYSIS OF ARTIFICIAL MATERIALS

Introduction: There are a variety of commercially available artificial materials such as hyaluronic acid for dermal filler or even for breast augmentation. However, off-label materials which consist of unknown gradients have been also spread in some countries, which sometimes results in serious problems including erythema, induration and chronic inflammation. In order to identify such materials precisely, we performed chemical analysis of foreign materials postoperatively using nuclear magnetic resonance (NMR) spectroscopy.