Changes in aortic shape and diameters after death: comparison of early postmortem computed tomography with antemortem computed tomography.

PURPOSE: The purpose of this study is to evaluate the postmortem deformation of the aorta on postmortem computed tomography (CT) by comparison with the antemortem CT in the same patient. MATERIALS AND METHODS: A total of 58 non-traumatic patients without hemorrhagic events who underwent torso CT before and shortly after death were enrolled. Antemortem chest and abdominal CT were obtained in 44 cases and in 57 cases, respectively. The lengths of the major and minor axes of the ascending and descending thoracic aorta and the abdominal aorta were measured on both antemortem and postmortem CT in the same patient. To evaluate the shape of the aorta, the major axis-minor axis ratio (Ma-MiR) was calculated. Mean values of the diameters of the aorta and Ma-MiRs on postmortem CT were compared with those on antemortem CT using the Wilcoxon signed-rank test. We also evaluated the major and minor axes and Ma-MiRs on both antemortem and postmortem CT in two age groups: 65 years and under (n=13) and over 65 years (n=45). RESULTS: At each level tested, the aorta significantly shrank after death (p<0.001) (ascending thoracic aorta, descending thoracic aorta, and abdominal aorta: 38.5 mm × 33.5 mm, 28.0 mm × 25.9 mm, and 24.4 mm × 21.8 mm on antemortem CT, 30.0 mm × 26.2 mm, 24.4 mm × 20.7 mm, and 21.5 mm × 14.5 mm on postmortem CT, respectively). The postmortem Ma-MiRs significantly increased at the descending thoracic aorta and the abdominal aorta (p<0.001). The diameters of the aorta are longer in older cases at all levels on both antemortem and postmortem CT. The reduction rates were larger in younger cases than older cases at all levels. CONCLUSIONS: After death, the aorta shrunk at all levels, and became oval in shape in descending thoracic and abdominal aorta. The contraction was greater in younger cases than older cases. Investigators who interpret postmortem imaging should be aware of the postmortem deformation of the aorta.

The effectiveness of postmortem multidetector computed tomography in the detection of fatal findings related to cause of non-traumatic death in the emergency department.

OBJECTIVES: To investigate the diagnostic performance of postmortem multidetector computed tomography (PMMDCT) for the detection of fatal findings related to causes of non-traumatic death in the emergency department (ED). METHODS: 494 consecutive cases of clinically diagnosed non-traumatic death in ED involving PMMDCT were enrolled. The fatal findings were detected on PMMDCT and classified as definite or possible findings. These findings were confirmed by autopsy in 20 cases. RESULTS: The fatal findings were detected in 188 subjects (38.1%) including 122 with definite (24.7%) and 66 with possible finding (13.4%). Definite findings included 21 cases of intracranial vascular lesions, 84 with intra-thoracic haemorrhage, 13 with retroperitoneal haemorrhage and one with oesophagogastric haemorrhage. In three patients who had initially been diagnosed with non-traumatic death, PMMDCT revealed fatal traumatic findings. Two definite findings (two haemopericardiums) and seven possible findings (two intestinal obstructions, one each of multiple liver tumours central pulmonary artery dilatation, pulmonary congestion, peritoneal haematoma, and brain oedema) were confirmed by autopsy. The causes of death were not determined in cases with possible findings without autopsy. CONCLUSIONS: PMMDCT is a feasible tool for detecting morphological fatal findings in non-traumatic death in ED. It is important to know the ability and limitation of PMMDCT.

The infiltration of 'primed' neutrophils into multiple organs due to physical abuse to the elderly: An immunohistochemical study.

The infiltration of 'primed' polymorphonuclear neutrophils into multiple organs has been reported in cases of traumatic or hemorrhagic shock. Since multiple injuries are usually observed in cases of physical abuse of the elderly, we investigated neutrophil infiltration into the heart, lung, liver and kidney in cases of abused elderly individuals using immunohistochemistry for myeloperoxidase (MPO). In addition, we examined the expression of molecules associated with neutrophil infiltration, including P-selectin as the adhesion molecule and IL-8 as the chemotactic factor. The number of neutrophils in the physically abused elder cases was increased significantly, particularly in the lung and liver, compared with that of control cases of sharp instrument injury, single fatal blunt injury and polytrauma. In addition, P-selection expression in the endothelium and the presence of IL-8-positive cells (mainly macrophages) in the lung and liver of abuse cases were significantly greater than those in control cases. In contrast, the number of MPO-, P-selectin- and IL-8-positive cells in cases of multiple organ failure (MOF) due to various causes was significantly greater than that in abuse cases. It is known that primed neutrophils accumulation may undergo MOF by 'activation' due to secondary insults. Thus, our results suggest that MPO immunostaining can distinguish cases of elderly physical abuse from non-abuse and MOF cases. In addition, our results indicate that MPO is a potential diagnostic marker for elder physical abuse, and that P-selectin and IL-8 may be useful for a more accurate diagnosis. Finally, our results also suggest that elder cases of physical abuse may be in a primed stage of MOF, and are at risk of falling into MOF by various secondary insults including those following abuse.

Parentally imprinted allele typing at a short tandem repeat locus in intron 1a of imprinted gene KCNQ1.

A short tandem repeat (STR) in the intron 1a of paternally imprinted gene, KCNQ1, is evaluated as a new probe for use in parentally imprinting allele (PIA) typing. This typing can determine the inheritance of one allele from father by the methylation difference. Allelic and genotypic frequencies of the STR were determined using samples from 175 unrelated Japanese and 170 unrelated Germans. The polymorphism information contents were 0.652 and 0.634 for the Japanese and the Germans, respectively, indicating usefulness in individual identification. This method was applied to five Japanese families consisting of 19 individuals. Genomic DNA was digested by methylation-sensitive restriction endonucleases, HhaI and HapII, followed by PCR amplification using two-step sandwich primer sets and the products were analyzed on polyacrylamide gel electrophoresis. For all of the families, each child's paternal allele given by PIA typing corresponded to one of the two alleles from father, not the two from mother, that were determined by the STR genotyping. The results demonstrate that this STR probe is feasible for use in PIA typing and that its typing method can contribute to paternity testing.

Applicability of the parentally imprinted allele (PIA) typing of a VNTR upstream the H19 gene to forensic samples of different tissues.

The parentally imprinted allele (PIA) typing that we have recently developed determines parental alleles at a VNTR locus in the differentially methylated region upstream of the human H19 gene. The usefulness of this typing was demonstrated by its application to blood samples in paternity cases. However, its applicability to other tissue DNA remains to be tested. DNA samples from fifteen different postmortem tissues such as cerebrum, skeletal muscle and skin were examined, all of which were obtained from three autopsy cases 2-11h after death. DNA was digested with a methylation-sensitive HhaI enzyme and diluted solutions of the digests were subjected to the first PCR amplification, providing amplification of only the paternal H19 methylated allele. Subsequent VNTR typing was carried out for the amplified products to determine which allele was of paternal origin. No tissue-dependent difference was observed and all the samples examined, though degraded, were successfully used for determining the paternal allele. These results substantiate the usefulness of PIA typing in forensic examinations. Its application to two identity cases, a burned male body and a male body with adipocere formation, was also shown.

Novel paternity testing by distinguishing parental alleles at a VNTR locus in the differentially methylated region upstream of the human H19 gene.

Conventional PCR-based genotyping is useful for forensic testing but cannot be used to determine parental origins of alleles in DNA specimens. Here we describe a novel method of combined conventional genotyping and PIA typing (parentally imprinted allele typing) at a minisatellite region upstream from the H19 locus. The PIA typing uses two sets of primers and DNA digested with methylation-sensitive Hha I enzyme. The first amplification produces only the methylated fragment of paternal H19 allele, and the second detects polymorphism in the minisatellite. Hence, this distinguishes paternal and maternal alleles by difference in the DNA methylation. Furthermore, the polymorphism in this polymorphic locus was examined using 199 unrelated Japanese and 171 unrelated Germans, their polymorphism information content being 0.671 and 0.705, respectively. Feasibility of this typing is demonstrated for six families, and the usefulness is shown by application to paternity testing.

[Medicolegal and compensation scientific approach to automobile accident].

Multiple injuries are frequently observed over the whole body of traffic victims in medico-legal autopsy cases. The assessment of a traffic casualty must include not only the victim but also the vehicle and the circumstances of the accident. Only consideration of all available data permits a better assessment of the mechanism of the crash and causation of injuries. J. M. Thevenet drove the first car carried from France to Japan on February 6, 1898. On October 28th, 1905, the first death by a road traffic accident occurred in Osaka. We performed a retrospective analysis of 279 traffic fatalities examined by medico-legal autopsy in Niigata that occurred over a twenty-two-year period from 1980 to 2001. All persons who had an ICD-10 code were grouped by 153 pedestrians, 43 pedal cyclists, 20 motorcycle riders, 45 car occupants, 11 occupants of pick-up trucks or vans, 4 occupants of heavy transport vehicles and 3 others. The average of ISS (injury scale score) is 40.7 in pedestrians, 26.7 in pedal cyclists, 32.4 in motorcycle riders, 25.1 in car occupants, 16.5 in occupants of pick-up trucks or vans, 24.0 in heavy transport vehicles and 69.0 in others. Rib fractures were observed in 170 cases (60.9%) and the frequency of other injuries was shown in Table 2. Criminal Punishment for drivers involved in 261 traffic accidents amounted to 35 sentences of imprisonment (13.4%), 46 suspension of execution of sentence (17.6%) and 60 sentence of fine (23.0%). Forty prone pedestrians run over by cars showed high ethanol levels in their blood. It was necessary to identify the driver of a vehicle in twelve car accidents and simulation with a computer is very useful. The average of ISS was 34.0 in ten drivers and 22.0 in fourteen fellow passengers. Four sudden natural deaths of drivers at the wheel, eight cases of death immediately after and from one day to five months after road traffic accidents, nine suicides and one intentional accident are excluded from traffic death. Both a medico legal and scientific compensation approach to automobile accident is now necessary.