Biomedical subjects

S Tsunenari

Publications and source records attributed to S Tsunenari.

At least 19 recordsLinked to original sources

PubMed2002

Interrupted aortic arch with ventricular septal defect: an unsuspected fatal congenital anomaly in forensic pathology.

Interrupted aortic arch (IAA) is a relatively rare cardiovascular anomaly worldwide and is very rarely encountered in forensic pathology. A case of clinically unsuspected fatal IAA in a 5-day old neonate is described. A full term female baby was declared dead on arrival at an emergency hospital few hours after having been discharged from a maternity hospital following delivery. There were no noticeable signs and symptoms reported during the short postnatal period. Antenatal medical history was unremarkable and there were no abnormalities noticed at birth. Autopsy revealed an unsuspected IAA arch with ventricular septal defect (VSD) as cause of sudden unexpected death. Although amenable to surgical intervention, IAA may not produce obvious clinical symptoms as was the case for this baby. Such sudden unexpected deaths raise medico-legal questions as to the manner and the precise cause of death. The importance of a full forensic autopsy to clarify such a sudden death was re-emphasized.

Journal Article↗

PubMed2001

Unusual homicide by air gun with pellet embolisation.

A homicidal case by an air gun involving a 73-year-old woman who was found dead in her home is described. At autopsy, two gunshot wounds were observed on the left anterior chest and the right back. There was neither exit wound nor powder burns. The fatal pellet, 0.9 g and 5.5mm diameter, penetrated the left anterior chest and the heart to cause cardiac tamponade (200 ml) before lodging in the left subclavian artery. Death was due to cardiac tamponade. This case has exhibited two rare phenomena: homicide by an air gun and pellet embolisation. This is the first homicide case by use of air gun in Japan and demonstrates that although it may be rare, air guns can be used as potential homicidal weapons. This experience will alert our society and others on the potential hazards of air guns we have tended to regard as toys.

Aged↗

PubMed2001

Clocapramine-related fatality. Postmortem drug levels in multiple psychoactive drug poisoning.

A suicide caused by ingestion of multiple psychoactive drugs is reported. A 42-year-old man with a history of psychosis was found dead in a blood pool in his room. The forensic autopsy revealed two stab wounds on his chest. However, these wounds could not explain the cause of death. Eighty-six tablets were found in his stomach. Four psychoactive drugs; clocapramine (CC), chlorpromazine (CP), promethazine (PM) and clotiazepam (CT) were detected in blood and tissues. The concentrations of CC, CP, PM and CT in the femoral vein (FV) blood were 0.39, 0.61, 1.23 and 0.09 microg/ml, respectively. The cause and manner of death were attributed to suicidal multiple psychoactive drug poisoning. Postmortem drug redistribution showed great site-dependent variations with the lowest level in the FV blood. Remarkable variations were observed in CC, CP and PM, but not in CT compared to other three drugs. The variations were dependent on the volume of distribution (Vd) of the drugs. Our human case has demonstrated drugs with higher Vd values showed higher degree of postmortem redistribution of the drug and vice versa.

Adult↗

PubMed2001

Accidental injury by a grass strimmer: an unusual fatality.

The body of a 61-year-old woman was found in the morning lying near a wire fence at her farm where she was cutting grass using a motor-powered strimmer. Autopsy revealed a laceration of the heart apex, haemopericardium and left haemothorax caused by a U-shaped wire projectile which was found lodged in the left thoracic cavity. The mechanistic analysis of the injuries and manner of death, however, were conclusive after a scene visit following the autopsy. The farm was surrounded by a wire fence to prevent wild pigs from entering in. The wire projectile was cut by unshielded blade of the strimmer and struck her chest. This case represents an unusual accidental fatality and indicates the need for improved user education and safety when using such implements. This case also reemphasizes scene investigation as an important part of medicolegal autopsy for proper determination of mechanisms of injuries and precise manner of death. We hope this report will increase awareness and alert the general public to the dangers of the grass strimmer operated without proper safety precautions.

Journal Article↗

PubMed2001

Toxoplasma encephalitis in HIV: case report.

In Tanzania, no data are available on the prevalence of brain infection by toxoplasma in HIV-infected patients. A case of a 35-year old man with fulminant toxoplasma encephalitis (TE) is reported for the first time. TE was not suspected clinically in our patient who presented with a one week history of severe headache and treated empirically with antimalarial drugs. TE was diagnosed postmortem histologically by haematoxylin-eosin and immunohistochemical stain with P30 antibody for toxoplasma antigen. The findings in our case support the suggestion that a high index of suspicion for TE should be maintained in HIV-infected patients presenting with focal neurological symptoms. The case highlights the importance of autopsy studies in not only documenting a toxoplasma brain lesion but also in increasing the awareness for its diagnosis in HIV-infected patients in Tanzania and other developing countries.

AIDS-Related Opportunistic Infections↗

PubMed2000

Discrepancy of clinical symptoms and prognosis of a patient--forensic significance of "talk and die" head injury.

Deaths of patients who had talked after sustaining a head injury and were then assumed clinically to be recovering from the head trauma raise medicolegal questions about the precise causes of deaths. A forensic autopsy on a 77-year-old man who had been talking after a road traffic accident and died on the sixth day showed slight subdural hematoma, bifrontal cerebral contusions and diffuse axonal injury. No natural diseases or delayed complications of injury were found. The cause of death was certified as head injury due to a traffic accident. This is a case of "talk and die" head injury. Forensic autopsy is important in patients with "talk and die" to clarify the causal relation to the head trauma in relation to any further forensic dispute.

Journal Article↗

PubMed2000

Pink spots of Hedley-White in the brain. Evaluation of the significance in the forensic autopsy.

Pink spots are sharply demarcated round to oval discolorations with a white center in the deeper areas of the formalin-fixed brain. In 152 forensic autopsies with neuropathological examinations, the authors observed pink spots in three of 16 patients with bacterial infectious diseases. Pink spots could not be found in 136 patients without bacterial infectious diseases. These results verify the concept that pink spots correlate with bacterial infections. The presence of pink spots will be used as an indication of infectious diseases in the forensic autopsy.

Journal Article↗

PubMed2000

Medico-legal implications of acute subdural haematoma in boxing.

A 16-year-old male high school student with a history of fever (38-39 degrees C) for 4 days lost consciousness following the end of a three round boxing match. He was transferred to a neurosurgical unit located 48 km away 1 h 36 min after injury. Clinical assessment at the unit revealed a comatose patient with a left acute subdural haematoma, but because of advanced brain oedema surgical management was deemed futile. At autopsy an acute subdural haematoma and a severe brain oedema were confirmed. Evaluation of physical conditions before the fight should have been more rigorous in our patient. The observations in our case support the published literature that boxing matches should be held only where neurosurgical expertise is readily available.

Journal Article↗

PubMed2000

Traumatic basal subarachnoid hemorrhage due to rupture of the posterior inferior cerebellar artery--case report.

A 20-year-old male presented with traumatic basal subarachnoid hemorrhage after being involved in a fight. Antemortem clinical examinations could not exclude the possibility of rupture of abnormal blood vessels because of the absence of external injuries. Careful postmortem examination of the head and neck regions and histological examination of the intracranial arteries demonstrated traumatic rupture of the left posterior inferior cerebellar artery due to a fist blow to the jaw. This case indicates the need for careful autopsy examination for the differentiation of traumatic and non-traumatic basal subarachnoid hemorrhages.

Adult↗

PubMed2000

Japanese monozygotic twins with familial amyloidotic polyneuropathy (FAP) (ATTR Val30Met).

Twenty-nine-year-old twin brothers having the amyloidogenic transthyretin (ATTR) Val30Met gene developed the clinical symptoms of familial amyloidotic polyneuropathy (FAP) in 1995. The twins had the same educational background and lived in the same district. FAP manifestations were similar in both cases, although electromyographic examinations revealed sensorimotor polyneuropathy in No. 1 and sensory polyneuropathy in No. 2. DNA analysis revealed that they were monozygotic twins. In addition to environmental factors, genetic factors may play an important role in determining the onset of FAP.

Adult↗

PubMed2000

[Aircraft crashes in sky sports. Report of two autopsy cases and review of the accidents during 1981 to 1997 in Japan].

The authors report two forensic autopsy cases of pilots who died in glider and ultra-light plane crashes in Aso, Kumamoto and review sky sports accidents in Japan (1981-1997). In the glider crash, sharp abdominal pain due to gallstones in a 78-year-old pilot was a possible cause of the accident. In the ultra-light plane crash, unskillful control of the plane by a 38-year-old pilot was the cause of the accident. The incidence of sky sports accidents increased from 12 cases in 1981 to 62 cases in 1997. The mortality rate of the victims of the accidents is very high. Investigation of natural diseases in pilots as a cause of accidents and the mechanisms of fatal injuries will help to assess preventive measures against sky sports accidents.

Accidents, Aviation↗

PubMed1999

Fatalities by inhalation of volcanic gas at Mt. Aso crater in Kumamoto, Japan.

Volcanic gas is one of the hazards which tourists rarely meet in mountains. We present six fatalities due to volcanic gas inhalation on Mt. Aso, an active volcano in Kumamoto, Japan, over a period of nine years (1989-1997). One accident occurred at the lip of the crater and the other five within a distance of 250 m from the lip of the crater. Four of the six fatalities had a history of bronchial asthma. A forensic autopsy was performed for a fatality with a history of hypertensive heart disease; pulmonary emphysema was disclosed for this victim. These findings supported the idea that individuals with chronic lung diseases were at higher risk of death by volcanic gas inhalation. Safety precautions are effected through regular surveillance of the area and monitoring of volcanic gas levels. The criterion for sulfur dioxide levels has been changed to a more rigorous one (from >5.0 ppm to >0.2 ppm) according to our advice based on the autopsy. Further forensic analyses will help to design additional preventive measures so as to reduce mortality resulting from inhalation of toxic volcanic gas.

Journal Article↗

PubMed1999

Accidental decapitation: an unusual injury to a passenger in a vehicle.

A case of decapitation of a vehicle passenger in an accident on a highway is reported. Evaluation of roadside evidence and the deceased's injuries revealed that the victim was partially ejected from a broken passenger-side window as the vehicle spun out of control, decapitation being due to the impact of his head against a barrier stanchion on the shoulder of the road. An unfastened seat-belt, high-speed driving and the construction of the road barrier were contributory factors.

Accidents, Traffic↗

PubMed1999

Neuropathology of human immunodeficiency virus 1 infection. Significance of studying in forensic autopsy cases at Dar es Salaam, Tanzania.

OBJECTIVE: In sub-Saharan Africa, only a few studies of neurologic complications of human immunodeficiency virus 1 (HIV-1) infection have been done. The authors studied neuropathology of HIV-1 infection in Tanzania. DESIGN: Forensic autopsy study at Dar es Salaam, Tanzania. SETTING: A joint research project between Dar es Salaam, Tanzania, and Kumamoto, Japan. PATIENTS: Thirty patients with risk factors for HIV-1 infection. MAIN OUTCOME MEASURES: Human immunodeficiency virus 1 infection was evaluated by HIV-1 antibody test on postmortem serum samples. The brains of HIV-1-infected persons were studied histopathologically. RESULTS: Infection with HIV-1 was identified on postmortem serum samples in 10 of 30 forensic autopsy cases. Neuropathologic changes of the brain were observed in 8 of the 10 HIV-1-infected persons; these changes consisted of lymphocytic meningitis, bacterial meningoencephalitis, cryptococcal meningoencephalitis, tuberculous meningitis with brain abscesses, and intracerebral hemorrhage. CONCLUSIONS: Because none of the persons studied was suspected to have had brain diseases before autopsy, the results suggest that brain diseases of HIV-1-infected patients are likely to go unrecognized in Tanzania. In addition, the high incidence of neuropathologic findings in HIV-1-infected persons indicates that HIV-1-related brain diseases are common in Tanzania, as they are in developed countries. Further forensic autopsy study will determine the range and prevalence of brain complications and have immediate impact on the management of HIV-1-infected patients in Tanzania and other developing countries.

AIDS Dementia Complex↗

PubMed1998

Death as a result of heat stroke in a vehicle: an adult case in winter confirmed with reconstruction and animal experiments.

A 54-year-old man was found dead in the driver's seat of his vehicle on a winter's day. Investigations of the vehicle revealed that the engine was running, and the car heater was left on with the maximum temperature and velocity. The body was found excessively sweating. Rectal temperature of the body was 43 degrees C at 10 h post mortem. In autopsy, several superficial skin burns were observed on the face, the shoulders and the legs. The lungs were heavily congested and hemorrhagic. The liver showed typical alcohol-induced micronodular cirrhosis. The alcohol concentrations were 0.17% in the blood of both the left and the right heart, 0.17% in the femoral-vein blood, 0.21% in the bladder urine and 0.34% in the gastric contents. A reconstruction experiment demonstrated that the temperature inside the vehicle rose rapidly and reached 50-58 degrees C in 3 h. Animal experiments showed that the temperature threshold for rats to succumb to heat was between 40 and 45 degrees C. This case shows that heat stroke in a vehicle can occur in adults with chronic diseases or alcoholism, such as in this particular case, even in the winter.

Journal Article↗

PubMed1998

[Practice and research of forensic medicine learned from the dead].

Practice and Research of Forensic Medicine Learned from the Dead' is presented by looking back my 29 years' carrier as a forensic pathologist. After joining in Department of Forensic Medicine, Kumamoto University in 1969, I had spent several happy years with studying on postmortem corneal clouding. Soon I began to have doubts on a purpose of forensic autopsy in my department then, which seemed to be only to/under the police. I spent one year at Department of Forensic Medicine, Leeds University in England in 1979-1980 and experienced Forensic Medicine not only for the police but also for the society in general. Visiting several university departments in Europa at that time, I felt confident that Forensic Medicine is one special field of medical sciences and will be worth a subject to devote my life. Clinical Forensic Medicine is one field of forensic medicine. Its importance has been recognized in the society by increasing numbers of felonious crimes and campaigns of human rights throughout the world. In 1996, the 4th International Conference of World Police Medical Officers in Clinical Forensic Medicine was ended in a great success in Kumamoto, Japan. Now evaluation and development of Clinical Forensic Medicine are very essential for both forensic pathologists and clinicians to serve for the society. My own activities of teaching traffic safety and preventing child abuse and neglect were cited as examples of 'Practice of Forensic Medicine Learned from the Dead'. Studies on differentiation of postmortem discoloration and antemortem bleeding by glycophorin A or erythrocyte membranes and an international joint research project with Tanzania on neuropathology of AIDS were examples of 'Research of Forensic Medicine Learned from the Dead'. It is an important mission for a forensic pathologist to work for/with the police to solve crimes by hearing a voice of the dead on an autopsy table. Through friendship with foreign colleagues, however, I have learned much about what should be a forensic pathologist and have been inspired with a phrase, 'The information learned from studying the dead could be used to help the living.' by Dr. T.A. Gonzales of the Chief Medical Examiner's Office of New York. Because social activities of preventing crimes and accidents are very much important matters indeed, every forensic pathologist must devote his/her forensic practice and research to achieve a peaceful end of life for every citizen, I believe.

Accidents, Traffic↗

PubMed1998

Binswanger's disease. A rare cause of dementia in elderly persons.

A 80-year-old in-patient with abnormal behaviors was strangulated in a hospital bed by another in-patient while he could not escape from the violence because of being restrained to the bed with safety belts. Neuropathological examination of the victim's brain showed characteristic pathological changes of Binswanger's disease (BD), a rare cause of dementia inducing abnormal behaviors. The authors methodically documented BD of the victim and at least justified the restraint as a preventive measure of his abnormal behaviors. Although the etiology of BD is unknown, immunostaining for glial fibrillary acidic protein of the white matter lesions showed neither hyperplasia nor hypertrophy of astrocytes. This result suggested that astrocytes may play an important role in the pathogenesis of BD.

Aged↗

PubMed1998

[Forensic medicine in Dar-es-Salaam, United Republic of Tanzania].

The authors had opportunities to visit and see the present state of forensic medicine in Dar-es-Salaam, a capital city of United Republic of Tanzania. In this city, Department of Histopathology and Morbid Anatomy in Muhimbili University College of Health Sciences is in charge of education and practice of forensic medicine. All bodies of unusual death, about 3,000 cases per year, are brought to the university mortuary and examined by pathologists. An order of forensic autopsy from the Tanzanian police is submitted to the department with details of the case, i.e. circumstances of death, witnesses, weapons, etc. In each case, a pathologist signs out a death certificate and issues an autopsy report which is standardized throughout the country. Embalming after autopsy is essential in a tropical country. Tanzania in particular, to prevent both putrefaction of the body and dispersion of pathogens during its transportation. Preventive measures against biohazards from human immunodeficiency virus-infected bodies are considered in the autopsy room and laboratory. Although Tanzania is one of the developing countries in the world, the forensic medicine in the capital city is rendering great services in the promotion of public health.

Acquired Immunodeficiency Syndrome↗