Extra-oral dental radiography for disaster victims using a flat panel X-ray detector and a hand-held X-ray generator.

BACKGROUND: Forensic odontologists commonly incise the skin for post-mortem dental examinations when it is difficult to open the victim's mouth. However, it is prohibited by law to incise dead bodies without permission in Japan. Therefore, we attempted using extra-oral dental radiography, using a digital X-ray equipment with rechargeable batteries, to overcome this restriction. MATERIALS AND METHODS: A phantom was placed in the prone position on a table, and three plain dental radiographs were used per case: "lateral oblique radiographs" for left and right posterior teeth and a "contact radiograph" for anterior teeth were taken using a flat panel X-ray detector and a hand-held X-ray generator. The resolving power of the images was measured by a resolution test chart, and the scattered X-ray dose was measured using an ionization chamber-type survey meter. RESULTS: The resolving power of the flat panel X-ray detector was 3.0 lp/mm, which was less than that of intra-oral dental methods, but the three extra-oral plain dental radiographs provided the overall dental information from outside of the mouth, and this approach was less time-consuming. In addition, the higher dose of scattered X-rays was laterally distributed, but the dose per case was much less than that of intra-oral dental radiographs. CONCLUSION: Extra-oral plain dental radiography can be used for disaster victim identification by dental methods even when it is difficult to open the mouth. Portable and rechargeable devices, such as a flat panel X-ray detector and a hand-held X-ray generator, are convenient to bring and use anywhere, even at a disaster scene lacking electricity and water.

Significance of levels of IL-6 and IL-8 after trauma: a study of 11 cytokines post-mortem using multiplex immunoassay.

PURPOSE: To identify cytokines useful for diagnosis of traumatic death. METHODS: Post-mortem serum levels of 11 cytokines were assayed for 43 people who died of traumatic injury or from non-traumatic causes. Levels of granulocyte-macrophage colony stimulating factor, gamma interferon, interleukin IL-1beta, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-13, and tumour necrosis factor-alpha were measured using multiplex immunoassay. RESULTS: Levels of granulocyte-macrophage colony stimulating factor (p<0.01), IL-6 (p<0.001), and IL-8 (p<0.01) among the traumatic group were significantly higher than those among the non-traumatic group. Anatomical trauma severity was also estimated using the total abbreviated injury scale and injury severity score, revealing significant positive correlations between the former and IL-6 (rs=0.6523, p<0.01) and IL-8 levels (rs=0.6584, p<0.01). CONCLUSIONS: Levels of IL-6 and IL-8 assist differentiation between traumatic and non-traumatic death, are useful objective indices of trauma severity and can support a diagnosis of traumatic death.

Diatom numbers around the continental shelf break.

Diatom concentrations in seawater were examined monthly at four aquatic areas. Diatom concentrations inside a bay showed a monthly variation, but these were detectable. On the other hand, in the open sea around the continental shelf break, there were few diatoms in any season. When a person drowns in the open sea, the diatom test cannot be expected to function reliably.

Correlation between serum IL-6 levels and death: usefulness in diagnosis of "traumatic shock"?

Interleukin-6 (IL-6) has been considered as an important mediator of inflammation. Clinically it is a well-known marker of the severity of injury following major trauma. In this study, the levels of IL-6 in body serum were applied to a traumatic death index. Of ninety victims 55 were men and 35 women, with a mean age of 53.4+/- 19 (S.D.) years. The cases were classified as traumatic deaths (38 cases), non-traumatic deaths other than natural causes of deaths (36 cases), and deaths due to natural causes (16 cases). All samples were collected within 2 days after death. The mean values of IL-6 levels of the traumatic, non-traumatic and disease groups were 8608.97, 2205.65, and 3266.64 pg/ml, respectively. Some cases in non-traumatic and disease cases were beyond 10 000 pg/ml, however, the mean value of the traumatic group was statistically higher than that of the other two groups. Even though several cases had high levels of IL-6 in spite of instantaneous death, the results showed that IL-6 levels are helpful in the diagnosis of traumatic shock.

Intracerebral haematoma: traumatic or non-traumatic.

A 35-year-old woman, a chronic alcoholic, died from an intracerebral haematoma 10 hr after she fell downstairs. Some subcutaneous bleeding was seen on the head and face, but there were no new skull fractures and surface contusions of the brain. She appeared to have few predisposing conditions for non-traumatic cerebral haemorrhage. In addition, the haematoma was mainly located "lateral" to the basal ganglia, not where hypertensive bleeding most commonly occurs, and subdural and haemorrhage in the corpus callosum was found with subdural/and subarachnoid haemorrhage. We concluded that on falling a shearing strain from a rotating force produced the intracerebral haemorrhage, but without skull fractures and surface contusions of the brain. She had been admitted to a neurosurgical hospital just 11 months before this incident because of an epidural haemorrhage with left temporal bone fracture. Mild thrombocytopenia was found during that hospitalization. In this report, this abnormality was thought to have some relation to the formation of the huge haematoma occurring after the intracerebral bleeding started.

Dental identification using digital images via computer network.

Dental identification is a useful scientific method. In Japan, however, there are only a few forensic odontologists; moreover, until now, forensic dental services have only been offered by general dentists. These dentists may not be able to offer such forensic services during office time. For a quick comparison, the authors tried sending digital photos, taken with a 2-million-pixel digital camera, to dental offices via the Internet. If a dental office has Internet access, it is possible for dental charting to be sent directly to the autopsy room. Of course, digital images only provide the first outline. However, when antemortem dental records of the person in question are available at autopsy, a quick comparison can be made.

A fatal case of infantile scurvy.

We report a case of infant death due to scurvy, which is very rare in Japan. We initially had little knowledge of the disease and suspected that the bleeding in the body was caused by domestic violence. The case did not fall under the category of the battered child syndrome but the death was caused by ignorance with respect to child care. In addition the parents usually locked the child alone in a room during the day and this is probably a case of neglect.

Paraquat myopathy: report on two suicide cases.

We describe two suicide cases in which old paraquat was ingested. In conjunction with lung involvement a pronounced degeneration was observed in skeletal muscle of one who died on the 14th day after the ingestion. The following sarcoplasmic or endoplasmic reticulum Ca2+ ATPase (SERCA) monoclonal antibodies were used for skeletal muscle fiber typing by an immunohistochemical method: NCL-SERCA1, reactive with type 2 fiber (fast-twitch), and NCL-SERCA2, reactive with type 1 fiber (slow-twitch). The examination revealed that the remarkably degenerated fibers belonged to type 1 muscle fibers. This case showed an abrupt increase of plasma CK levels (1796 mU/ml) on the fifth day after the ingestion. The authors presume that the damage to the skeletal muscle had occurred in this period. The degeneration of the muscle seemed to be attributable to the long retention of paraquat in the tissue because these findings were not observed in the other case who died on the fifth day. Paraquat-induced myopathy may develop in prolonged paraquat poisoning. The examination of CK levels in plasma will be useful for diagnosis of damage of skeletal muscle.

Inhaled air trapping effect of Japanese bedding as a risk of sudden unexpected death in infancy.

We assessed some Japanese bedding on the assumption of the effects of air trapping using an infant mannequin. The change of CO2 concentration in the airway of a mannequin head placed on bedding was continuously monitored using a CO2 analyzer during simulated breathing. To compare the level of CO2 dispersal among different items of bedding, CO2 half time (t1/2) values were used. The t1/2 values were calculated by measuring the time required for the expired percent CO2 to reach 1/2 the initial percent end-tidal PCO2. We also measured softness and resistance to airflow (R) of the same items. As for the bedding, 4 types of futon and several types of bottom sheets/towels were combined. The t1/2 value in supine position was 9.8 seconds. When the model was placed prone on futon, the t1/2 values increased to 14.1 seconds (hard mattress type)--17.2 seconds (soft cotton-like futon). With respect to present Japanese baby futon (hard mattress type), there may be a relatively low potential for rebreathing to occur, compared with soft futon. In every case, the t1/2 value was prolonged by the use of a towel spread on the futon. CO2 dispersal may depend not only on the softness of the futon, but also on the combination of bottom sheet/towel and mattress. There was no relationship between R values and t1/2 values. The potential of rebreathing increased in face down position among all bedding, and supine position was the best CO2 dispersal position.

Child death related to insulin omission by mother.

A 4-year-old child was found dead in her house. She had been suffering from insulin-dependent diabetes mellitus (IDDM) for 3 years. She had been admitted to hospital three times, and attended the hospital once a month. Her glycaemic control remained poor. Autopsy findings revealed a remarkably fatty liver and lack of beta cells in the pancreatic islets of Langerhans. The laboratory reported ketoacidosis, ketonuria, glycosuria, and high levels of vitreous glucose and ketones. Her father had been absent for the 3 days before her death, and the mother should have fed her. Her mother was found drunk on the floor. No detailed history was available because of the mother's death, but the probability of the mother's omission of the insulin injection was suggested. Poor control of IDDM might have also been closely connected to general neglect by the mother. This case was considered child abuse.

Spontaneous bilateral dissections of the intracranial vertebral arteries: a case report.

A 41-year-old woman died of subarachnoid hemorrhage. She had had severe headaches for 10 days, but no abnormalities were detected on the brain computer tomography (CT) taken about a half day prior to her death. At autopsy, bilateral dissecting aneurysms were found in the intracranial vertebral arteries. Headaches related to dissection are considered to be due to distension of the artery, and the dissection may have occurred 10 days before her death. In considering the brain CT and autopsy findings, subaracnoid hemorrhage may have occurred within several hours of death. Although multivessel dissections suggest the possibility of underlying angiopathy, the present case had no clear finding of angiopathy in any of the brain vessels. When one sees subarachnoid hemorrhage in the basal area of the brain and finds "black" or "bluish black" discoloration(s) in the circle of Willis, one should suspect a dissecting aneurysm(s).