Comparison between the effects of normal saline with and without heparin for the prevention and management of arterial catheter occlusion: a triple-blinded randomized trial.

PURPOSE: We aimed to compare the effects of saline with and without heparin on the catheter-occlusion rate and coagulation-related blood test results for the management of arterial catheters among patients admitted to a short-term intensive care unit postoperatively. METHODS: This prospective, triple-blinded, randomized controlled study recruited patients aged 20-90 years scheduled to undergo radial arterial catheter insertion and postoperative intensive care unit admission between February and August 2019. Patients were randomly allocated to two groups (1:1 ratio) depending on the use of heparin: study (normal saline with heparin, 3000 units to 500 ml of normal saline) and control (normal saline without heparin) groups with arterial catheters. The allocated management method was employed immediately after intensive care unit admission. Occlusion assessment (every 12 h), arterial blood gas tests (every 6 h), and blood sample collection (every 24 h) were performed. The occlusion of arterial catheter was assessed using occlusion rate, and blood test results were assessed using a linear mixed model. RESULTS: There were 147 patients in the arterial catheter groups. There were no significant differences in occlusion rates and changes in platelet counts and activated partial thromboplastin time between the groups with arterial (p = 0.98, 0.16, and 0.32, respectively) catheters during the first 6 days after intensive care unit admission. CONCLUSION: Normal saline with and without heparin showed similar efficiency for both the prevention of occlusion and the results of coagulation.

A case of complex suicide due to acute nicotine intoxication caused by cigarette ingestion.

This paper presents an unusual complex suicide case that died of nicotine addiction. The deceased was a 40-year-old male who was found lying dead on the floor in his room. In external findings, many incision wounds on his forearms and skin discoloration with epidermolysis on his cervical region could be seen. In the room, a blood-stained scissors and electric cord hanged on the exercise bike were found. Moreover, nine cigarette residues which were only the filter part and empty bottle of coffee were found on his side. At autopsy, we found that those injuries were not serious enough to lead him to the death. Toxicologically, caffeine, nicotine, cotinine, mirtazapine, and olanzapine could be detected, and the concentrations of nicotine were 3.740, 2.140, 3.100, and 451.100 µg/ml in cardiac blood, peripheral blood, urine, and stomach contents, respectively. These concentrations were evaluated as the fatal levels, and the cause of his death was diagnosed as acute nicotine intoxication.

Postmortem distribution of acephate and its metabolite methamidophos in body fluids and organ tissues of an intoxication case.

We herein report an intoxication case caused by the ingestion of the pesticide Ortoran®, which consists of 50% acephate aqueous solution. A man in his 60 s was found dead in his car with a 100-mL bottle containing approximately 50 mL of Ortoran®. In a gas chromatography - mass spectrometry (GC-MS) screening test, acephate and its metabolite methamidophos were qualitatively detected in his stomach contents. The amounts of acephate and methamidophos (µg/g) in the extract of each body fluid or organ tissue were measured using GC-MS and were as follows: 35.8, 2.84 (heart blood); 44.0, 2.26 (peripheral blood); 2,240, 2.79 (urine); 53.1, 8.91 (brain occipital lobe); 43.7, 2.95 (liver); 102.3, 8.02 (right kidney); and 5450, 22.9 (stomach contents). Based on these results and autopsy findings, the cause of death was concluded to be acute fatal intoxication caused by the pesticide containing acephate and its active metabolite, methamidophos. Concentration ratios between acephate and methamidophos in each body fluid and organ tissue showed higher relative concentrations of brain methamidophos to acephate than those of other organ tissues. A high relative concentration of brain methamidophos may contribute to the intoxication of acephate in humans.

Postmortem distribution of chlorpyrifos-methyl, fenitrothion, and their metabolites in body fluids and organ tissues of an intoxication case.

We herein report a fatal intoxication case caused by the ingestion of the insecticides chlorpyrifos-methyl (CPFM) and fenitrothion (MEP). A 70-year-old man was found dead in his house and a cup containing a small amount of agricultural chemicals was on the table near his body. External and internal examinations revealed no injuries. In a gas chromatography-mass spectrometry (GC-MS) screening test, CPFM, MEP, and their metabolites, 3,5,6-trichloro-2-pyridinol (TCPY) and 3-methyl-4-nitrophenol (3MNP), respectively, were qualitatively detected in his stomach contents. The concentrations (µg/g) of CPFM, TCPY, MEP, and 3MNP in the extracts of each body fluid and organ tissue were assessed by GC-MS and were as follows: 27.8, 56.2, 17.2, and 2.82 (heart blood); 6.60, 42.9, 1.80, and 2.59 (peripheral blood); 0.0821, 45.9, 2,09, and 102 (urine); 21.4, 26.6, 76.2, and 3.83 (brain (frontal portion)); 16.1, 101, 9.67, and 1.26 (liver); 7.45, 101, 21.4, and 26.1 (right kidney); and 73,500, 9750, 232,000, and 1880 (stomach contents), respectively. Based on these results and autopsy findings, the cause of death was acute fatal intoxication by CPFM and MEP.

Sudden unexpected neonatal death due to late onset group B streptococcal sepsis--a case report.

We report a case of sudden unexpected death due to late onset neonatal group B streptococcal sepsis. A male neonate weighing 2731g was born at 35week gestational age, and discharged at the age of 4days after the birth. At 6days after the discharge (10days after the birth), because of consciousness loss and hypothermia, the neonate was conveyed to an emergency hospital, eventually followed by his death. Forensic autopsy revealed neither severe trauma nor cardiac anomaly. Both lungs were edematous. Histopathologically, a lot of bacterial clusters were found in the lungs and intracerebral vessels. Cerebrospinal fluid contained a lot of leukocytes. Streptococcus agalactiae was detected in the specimens from the feces and the blood. Collectively, we diagnosed that the cause of the neonate's death was late onset group B streptococcal sepsis. In autopsy cases of neonates, careful macroscopic and microscopic observations and bacteriological/virological examination should be performed.

High concentration of methidathion detected in a fatal case of organophosphate-poisoning.

We report a case of fatal intoxication caused by the ingestion of an organophosphate pesticide, methidathion (DMTP). An 80-year-old male was found dead in his bed. Forensic autopsy revealed no remarkable morphological changes. However, in a toxicological screening test, methidathion was qualitatively detected in extracts of stomach contents. Concentrations of methidathion (µg/g) in body fluids and organ tissues, determined by gas chromatography-mass spectrometry, were as follows; 66.2 in heart blood, 8.33 in peripheral blood, 8.80 in urine, 2000 in the brain (frontal lobe), 4800 in the left lung, 810 in the liver, 150 in the left kidney, and 64,000 in the stomach contents (total 1.9 g). These results strongly suggested that the victim orally ingested methidathion. Additionally, xylene was determined in body fluids and organ tissues. From the toxicological data together with autopsy findings, the cause of his death was diagnosed as acute poisoning by an emulsion of methidathion.

Postmortem distribution of ametryn in the blood and organ tissues of an herbicide-poisoning victim.

We report a case of fatal intoxication caused by the ingestion of the herbicide Gesapax (an emulsion type), which consists of 25% ametryn (ametryne, ametrin, ametrine, and ametrina), and 75% other components (xylene and cyclohexanone). A female in her 70's was found dead in her bed. Forensic autopsy revealed no remarkable injury or morphological changes. In a gas chromatography-mass spectrometry (GC-MS) screening test, ametryn was qualitatively detected in her stomach content. Then, the other components of xylene and cyclohexanone were detected by headspace GC-MS in the stomach content. The amount of ametryn (microg/g) extract from each body fluid or organ tissue was determined by GC-MS as follows: 6.69 (heart blood), 3.50 (peripheral blood), 0.085 (urine), 17.2 (brain frontal lobe), 71.9 (right lung), 23.9 (liver), 19.1 (right kidney), and 74,200 (stomach contents). The other components, xylene and cyclohexanone, were also determined in the body fluids and organ tissues. These data strongly suggest that the female orally ingested the herbicide. From these toxicological data together with autopsy findings, the cause of her death was determined to be an acute herbicide poisoning.

Detection of human parechoviruses from clinical stool samples in Aichi, Japan.

Between April 1999 and March 2008, a total of 4,976 stool specimens collected from patients with suspected viral infection through infectious agent surveillance in Aichi, Japan, were tested for the presence of human parechoviruses (HPeVs). We detected HPeVs in 110 samples by either cell culture, reverse transcriptase PCR (RT-PCR), or both. Serotyping either by neutralization test or by nucleotide sequence determination and phylogenetic analysis of the VP1 region and 5' untranslated region (5'UTR) regions revealed that 63 were HPeV type 1 (HPeV-1), followed by 44 HPeV-3 strains, 2 HPeV-4 strains, and 1 HPeV-6 strain. The high nucleotide and amino acid sequence identities of the Japanese HPeV-3 isolates in 2006 to the strains previously reported from Canada and Netherlands confirmed the worldwide prevalence of HPeV-3 infection. Ninety-seven percent of the HPeV-positive patients were younger than 3 years, and 86.2% younger than 12 months. The clinical diagnoses of HPeV-positive patients were gastroenteritis, respiratory illness, febrile illness, exanthema, "hand, foot, and mouth disease," aseptic meningitis, and herpangina. Among 49 HPeV-positive patients with gastroenteritis, 35 were positive with HPeV-1 and 12 with HPeV-3, and out of 25 with respiratory illness, 11 were positive with HPeV-1 and 14 with HPeV-3. HPeV-3 seemed to be an important etiological agent of respiratory infection of children. While HPeV-1 was detected predominantly during fall and winter, the majority of the HPeV-3 cases were detected during summer and fall. A different pattern of clinical manifestations as well as seasonality suggested that there are different mechanisms of pathogenesis between HPeV-1 and HPeV-3 infections.

A fatal intoxication from ingestion of 2-methyl-4-chlorophenoxyacetic acid (MCPA).

We report a fatal intoxication case by the ingestion of an herbicide, 2-methyl-4-chlorophenoxyacetic acid (MCPA). A 23-year-old male was found dead in his car. The forensic autopsy revealed no remarkable morphological changes. However, in a toxicological screening test, MCPA was qualitatively detected from the extracts of stomach contents. Then MCPA in the extract of each body fluid and organ tissue was determined by gas chromatography-mass spectrometry with trimethylsilyl-derivatization as follows (microg/g): 888.3 in the heart blood, 578.1 in the peripheral blood, 52.2 in the urine, 770.9 in the brain, 1362 in the right lung, 1135 in the liver, 755.5 in the right kidney, and 10,200 in the stomach contents. These data strongly suggested that the male orally ingested MCPA. Moreover, p-chloro-o-cresol (4-chloro-2-methylphenol) was also determined in the body fluids and organ tissues, suggesting a metabolite of MCPA. From these toxicological data, together with autopsy findings, the cause of his death was diagnosed as acute MCPA poisoning.

Retrospective study on suicidal cases by sharp force injuries.

A total of 65 suicidal cases due to sharp force injuries (cut and/or stab wounds) were investigated. Suicide by sharp force injuries accounted for 2.5% of all suicides in our prefecture during 1995-2005. The 65 victims were composed of 49 males and 16 females, and the age range of 50-70 years was most common. A history of psychiatric disease was found in 11 victims, and depression was the most common disease followed by schizophrenia. Of 65 cases, 8 victims had a history of previously attempting suicide. In 41 cases, a suicide note or will was found. Forty-six cases had pleural sharp force injuries. Interestingly, the remaining 19 deaths were due to a single sharp injury. Cutting injuries were predominantly located at the flexor side of the wrist (11 cases, 38%), followed by the neck (10 cases, 34%). On the other hand, stab wounds were most commonly located in the chest (17 cases, 49%). Tentative wounds, which were superficial cut wounds or stab wounds, were present in 37 cases (57%). In 27 of 37, hesitation marks were observed in close proximity. Tentative wounds more frequently appeared in cut injuries than in stab injuries. Of 28 cases with fatal cut or stab wounds localized in the trunk, 11 cases (39%) had clothing damage. In the discrimination between suicide and homicide, forensic pathologists should obtain information on victims and witnesses as well as investigating the scene and postmortem examination of the victim.