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Nishi-Tokyo-shi, Japan

Fukunaga T.,Tokyo Medical Examiners Office
Nihon rinsho. Japanese journal of clinical medicine | Year: 2012

Tokyo Medical Examiner's Office has approximately 13,000 inquest cases and 3,000 autopsies per year. Usually the winter season has much number of inquest cases owing to the elder' s death. In summer of 2007 and 2010, however, a number of inquest and autopsy cases increased rapidly and conspicuously. The cause was the increase of heat stroke death caused by intense heat. We often appealed "the prevention of the heat stroke" for the ministries and agencies from the standpoint of medical examiners. In the present paper, the situation of heat stroke deaths in Tokyo metropolitan area and the findings and diagnosis of heat stroke death were introduced. Source


Ro A.,Tokyo Womens Medical University | Kageyama N.,Tokyo Medical Examiners Office
Journal of Neurosurgery | Year: 2013

Object. Subarachnoid hemorrhage (SAH) due to ruptured intracranial vertebral artery (VA) dissection is a lifethreatening disease. Angiographic and symptomatic prognostic factors for rupture and rerupture have been investigated, but the pathological characteristics have not been fully investigated. The authors aimed to investigate these features by performing a pathomorphometic study of ruptured intracranial VA dissections. Methods. This study included 50 administrative autopsy cases of fatal SAH due to ruptured intracranial VA dissection among 517 fatal nontraumatic cases of SAH occurring between March 2003 and May 2011. Pathomorphometry was performed using serial 5-mm histological cross-sections with elastica van Gieson staining from each 0.2-mm segment around the ruptured intracranial VA. The longitudinal lengths of 4 types of vascular lesions-adventitial ruptures, dilated lesions where the internal elastic lamina (IEL) was ruptured with adventitial extension, intimal tears where the IEL was ruptured, and medial defects-were calculated based on the numbers of the slides in which these lesions were continuously detected (minimum 2 adjoining slides). The distance from the vertebrobasilar junction to the center of adventitial rupture was also calculated in 37 cases. Results. All cases showed one adventitial rupture with a mean length of about 1.9 ± 1.1 mm. The center of the adventitial rupture was located 5.0-26.8 mm (mean 14.6 ± 5.5 mm) from the intracranial VA bifurcation. Adventitial ruptures existed in the centers of dilated lesions, where the adventitia was highly extended. Other vascular lesions were serially observed surrounding the adventitial rupture. The mean lengths of dilated lesions, intimal tears, and medial defects were 9.4 ± 4.8 mm, 13.2 ± 6.3 mm, and 15.6 ± 7.2 mm, respectively. The lengths between proximal lesions and distal lesions from the center of the adventitial rupture for both medial defects and intimal tears were significantly longer at proximal lesions than at distal ones (chi-square test, p 0.01). Conclusions. Every ruptured intracranial VA dissection has a single point of adventitial rupture where the adventitia was maximally extended, so dilation appears to be a valuable predictive factor for hemorrhagic intracranial VA dissections. The adventitial ruptures were as small as 2 mm in length, and clinically detectable dilated lesions were about 9 mm in length. However, vascular vulnerability caused by IEL ruptures and medial defects existed more widely across a length of VA of 1.3-1.5 cm. Comparatively broader protection of the intracranial VA than the clinically detected area of dissection might be desirable to prevent rebleeding. Broader protection of proximal lesions than distal lesions might be effective from the viewpoint of site distribution of vascular lesions and blood flow alteration to the pseudolumen caused by the dissecting hematoma. Medial defects are the most widely seen lesions among the 4 types of vascular lesions studied. Medial degenerative disease, known as segmental arterial mediolysis, is suspected in the pathogenesis of intracranial VA dissections. © AANS, 2013. Source


Ro A.,Tokyo Womens Medical University | Kageyama N.,Tokyo Medical Examiners Office
Legal Medicine | Year: 2014

We aimed to establish an objective indicator for differential diagnosis between traumatic rupture of the intracranial vertebral artery (TRIVA) and nontraumatic rupture from intracranial vertebral artery dissection (NIVAD). We investigated 19 intracranial vertebral artery (IVA) samples, including three from TRIVA, seven from NIVAD and nine non-IVA rupture cases using 0.2-mm serial histological sections through the IVA. The internal elastic lamina (IEL)-adventitia ratio for each slide was calculated as the ratio of the traced length of the adventitia to the length of the IEL as measured by digital photomicrography. NIVAD cases showed a significant peak in the IEL-adventitia ratio around the area of rupture, whereas TRIVA and non-rupture cases showed no specific increase or decrease in IEL-adventitia ratios throughout the IVAs. All NIVAD cases had a significantly higher average IEL-adventitia ratio across 10 slides at the site of the rupture lesion than at the site furthest from the rupture. In contrast, two out of three TRIVA cases showed no significant difference between the two points. The other TRIVA case showed a significantly lower IEL-adventitia ratio at the point nearest the rupture compared with that at the point farthest from the rupture. Other histological characteristics considered specific to either TRIVA or NIVAD were observed. Our results indicate that measuring and comparing IEL-adventitia ratios at ruptured and non-ruptured sites of the IVA could be a useful practical indicator for differential diagnosis between TRIVAs and NIVADs. © 2014 Elsevier Ireland Ltd. Source


Inoue K.,Aichi University | Fukunaga T.,Tokyo Medical Examiners Office | Okazaki Y.,Tokyo Metropolitan Matsuzawa Hospital
Journal of Forensic Sciences | Year: 2012

There were more than 30,000 suicides in 1998 in Japan, and since then, the numbers have remained high. In 2009, the number of suicides per a day was c.90. This phenomenon constitutes a major social problem. One of the major reasons for the rapid increase in the number of suicides appears to be the worsening economic problems. It is therefore necessary to research the relationship between economic issues and suicide. In this study, we examined the relationship between the value of the Nikkei Stock Average and suicide rates in Japan. The value of the Nikkei Stock Average may be related to suicide among men. On the basis of the results, relevant researchers and organizations should understand the factors that relate to suicide to better carry out specific suicide prevention measures. © 2012 American Academy of Forensic Sciences. Source


Hikiji W.,Tokyo Medical Examiners Office | Fukunaga T.,Tokyo Medical Examiners Office
Journal of Forensic and Legal Medicine | Year: 2014

Numerous studies on physician suicide in various countries have been reported but no data from Japan on the issue can be found to date. In this study, physician suicides in the special wards of Tokyo Metropolitan area in 1996-2010 were investigated retrospectively. A total of 87 cases were enrolled. The results suggested that physician suicide has been linked to pre-existing psychiatric illnesses and occupational problems, and that psychiatrists have a relatively higher suicide risk compared to those majoring in other specialities of medicine. A distinctive feature was that 19 cases had used either drugs or devices which were accessible due to their profession some time during the process of committing suicide. Another notable feature was that 4 out of 5 anaesthesiologists enrolled in the study had chosen poisoning for their suicide method, with the drugs frequently used in their speciality. The findings advocate strongly for efficient suicide prevention measures for physicians including an early detection and treatment of psychiatric illnesses, as well as an urgent need for a more effective pharmacy management in applicable institutions together with the implementation of self discipline on each physician. This is the first broad academic study on physician suicide in Japan. © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved. Source

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