Yasusei Okada

Penetrating cardiac injuries. A pathological analysis of 20 autopsy cases.

A total of 20 autopsy cases involving deaths due to penetrating cardiac injuries were analyzed pathologically: the causes of death of the victims who died before cardiorrhaphy were exsanguination or hemorrhagic shock in nine cases, pericardial tamponade in three, and a combination of the two in another three. Three of the remaining five cases of early postoperative death resulted from hemorrhagic shock, one resulted from pulmonary air embolism, and one resulted from a combination of hemorrhagic shock and coronary platelet embolism. We should pay more attention to air embolism and platelet embolism as causes of death of victims who have had penetrating cardiac injuries, whose exsanguinating hemorrhage and/or pericardial tamponade may be controlled by emergency-room thoracotomy and cardiorrhaphy.

Forensic Usefulness of the Injury Severity Score

This paper, based upon a case report, shows the forensic usefulness of the Injury Severity Score (ISS). The ISS is found to be of great use in deciding to what degree each injury is responsible for the death of a patient with multiple injuries.

Bilateral Jugular Bulb Oximetry

Jugular bulb oxygen saturation (SjO2) monitoring has been proposed as a means of early detection of cerebral ischemia caused by intracranial hypertension. There remain, however, many unsolved problems as to the physiological basis for this monitoring, so that the obtained SjO2 value sometimes is difficult to interpret. One may ask, for instance, which side of the internal jugular vein is to be cannulated or whether the SjO2 values obtained from one side really represent whole-brain oxygenation or at least that of the ipsilateral hemisphere. To answer this question, a considerable amount of knowledge about cerebral blood flow distribution and metabolism and their response to various insults must be obtained. Several studies have investigated bilateral jugular bulb oxygenation. The problem of side-to-side discrepancies is still controversial. Our study was planned to observe bilateral SjO2 in various clinical settings to see whether such discrepancies, if such ever existed, would change our perspective on cerebral oxygenation monitoring.