A case of sudden death after Japanese encephalitis vaccination.

Japanese encephalitis (JE) virus is estimated to result in 3500-50,000 clinical cases every year, with mortality rates of up to 20-50% and a high percentage of neurological sequelae in survivors. Vaccination is the single most important measure in preventing this disease. Inactivated Vero cell culture-derived JE vaccines have not been linked to any fatalities, and few serious adverse events after vaccination have been reported. Here, we report a case of sudden death in which a 10-year-old boy experienced cardiopulmonary arrest 5 min after receiving a Japanese encephalitis vaccination. He had been receiving psychotropic drugs for the treatment of pervasive developmental disorders. Postmortem examinations were nonspecific, and no signs of dermatologic or mucosal lesions or an elevation of the serum tryptase level, which are characteristic of anaphylaxis, were observed. A toxicological examination revealed that the blood concentrations of the orally administered psychotropic drugs were within the therapeutic ranges. The patient was considered to have died of an arrhythmia that was not directly associated with the vaccination.

Iatrogenic rupture of the left gastric artery during percutaneous endoscopic gastrostomy.

Gastric arterial rupture is a rare but serious and potentially fatal complication of percutaneous endoscopic gastrostomy (PEG). We report a case in which insertion of a needle during PEG caused iatrogenic rupture of the left gastric artery.

Sudden death due to undiagnosed intracranial hemangiopericytoma.

A previously healthy 9-year-old Japanese boy with a 4-day history of vomiting and headache died suddenly and unexpectedly. An external examination revealed no abnormalities other than foam around the mouth and nose. An internal examination revealed severe pulmonary edema and hemorrhagic hemangiopericytoma arising from the choroid plexus of the right lateral ventricle. The cause of death was thought to be neurogenic pulmonary edema caused by the rapid growth of a hemangiopericytoma, with intratumoral hemorrhage.

Fatal hyperthermia associated with excited delirium during an arrest.

An autopsy case of fatal hyperthermia in a state of excited delirium is reported. On a hot summer night a 39-year-old man was suspected of being a rapist, and police officers and several men attempted to arrest him. He vigorously resisted, but after a 20-min struggle he was ultimately forced into a prone position on the ground with his arms and legs restrained by police officers. He collapsed shortly after being arrested and was taken to a hospital, but was pronounced dead on arrival. His rectal temperature measured 2.5 h after death was 40 degrees C. At autopsy the body showed a severer degree of postmortem change than after death at a normal body temperature and a similar postmortem interval. Autopsy revealed abrasions and subcutaneous hemorrhages of the head, face, arms, and legs. The heart was dilated and exhibited subendocardial hemorrhages in the left ventricle. The brain and both lungs were congested. Microscopic examination of the lungs revealed intraalveolar edema and hemorrhages. The skeletal muscles showed contraction band necrosis and hyaline degeneration. The liver showed diffuse coarse-droplet fatty infiltration of hepatocytes. Neither addictive drugs nor alcohol were detected from the blood or urine. The suspect was concluded to have died of fatal hyperthermia in a state of excited delirium.

Usefulness of post-mortem ophthalmological endoscopy during forensic autopsy: a case report.

Post-mortem intraocular findings in two autopsy cases with traumatic intracranial haemorrhage were obtained using an ophthalmological endoscope. The endoscopy results clearly revealed the presence of intraocular haemorrhages and papilledema caused by intracranial haemorrhage. Post-mortem ophthalmological endoscopy offers several benefits. First, post-mortem intraocular findings can be directly observed in corpses with post-mortem clouding of the cornea. Secondly, the endoscopy only requires a 0.9 mm incision in the sclera and does not require the removal of the eye from the corpse, a procedure that should be avoided for ethical and cosmetic reasons. Thus, post-mortem opthalmological endoscopy is a useful method for obtaining intraocular findings in autopsies.

Usefulness of postmortem ocular findings in forensic autopsy.

We report three autopsy cases in which the eyeballs were removed and examined macroscopically and microscopically after being cut using the alternate gross examination technique. The first case was a 67-year-old woman who was killed by ligature and manual strangulation. A postmortem opthalmological observation of the left eyeball revealed tiny hemorrhages and congestion in the pars plicae of the ciliary body. These changes were considered to arise by a mechanism similar to that by which facial hemorrhages arise during strangulation. The second case was a 54-year-old man who died from a cerebral contusion received during a traffic accident. A postmortem opthalmological observation of the eyeball using a surgical microscope revealed papilledema and retinal hemorrhages resulting from a rise in intracranial pressure. The third case was a 77-year-old woman who died from cardiac tamponade caused by a stab wound to the heart. A postmortem ophthalmological examination revealed that she had undergone cataract surgery and an intraocular lens implantation. However, her relatives did not know when and where she had received the surgery. An intraocular lens was removed and its material and shape was examined. Based on an examination of the lens, we were able to locate the hospital where she had received the surgery 4 years earlier. This suggests that postmortem opthalmological observations may be useful for forensic pathology and personal identification.

Myocardial damage by resuscitation methods.

Medico-legal autopsy cases were reviewed to detect myocardial changes induced by resuscitation methods. Myofibrillar degeneration (MFD) induced by resuscitation methods was classified into two types according to Luxol fast blue staining: contraction band (CB) and diffuse staining (DS). In the cases in which cardiopulmonary resuscitation had been performed, myocytes showing CB or DS formed small foci and were distributed in the papillary muscles, septum, and inner to middle layers of the myocardium. MFD induced by vasopressors was characterized by solitary distribution of degenerating myocytes that mainly showed DS and sometimes CB. When direct current countershocks had been performed, focal MFD in the subepicardial zone appeared to be a characteristic feature.

Elder abuse and neglect: social problems revealed from 15 autopsy cases.

This study examined the elder abuse cases that occurred in Gifu Prefecture, Japan between 1990 and 2000. We conducted a retrospective study of all the cases in which the victim was 65 years or older and autopsied in the Department of Legal Medicine, Gifu University School of Medicine. Fifteen victims were classified as elder abuse victims: five men and ten women. The victims ranged in age from 66 to 87 years (mean age, 74.5 years). The types of abuse were as follows: physical abuse, 13 cases; emotional abuse, five cases; neglect, four cases; and financial abuse, three cases. In eight cases, the victims were subjected to two or more types of abuse. The cause of death of the victims varied with the type of abuse. In the physical abuse cases, subdural hemorrhage was the most common cause, followed by other violence-related deaths and hypothermia. In the neglect cases, the victims died of either starvation or suffocation after the aspiration of food into the airway. In the domestic abuse cases, one of the victim's sons was the most common perpetrator, and little or no income was considered to be a risk factor for perpetrators. In the neglect cases, dementia and difficulty in performing activities of daily living were considered to be risk factors for victims, in addition to living in social isolation.