Two cases of right ventricular ischemic injury due to massive pulmonary embolism

In general, massive pulmonary embolism induces severe right ventricular overload, but pathological changes in the right ventricle due to pulmonary embolism is rarely seen. In this report, we describe two autopsy cases of massive pulmonary embolism without pre-existing cardiopulmonary disease. Both cases were accompanied by myocarditis-like changes in the right ventricle and infiltration of a number of polymorphonuclear neutrophils and mononuclear cells into the dilated right ventricular wall. Transmural or subendocardial coagulation necrosis was not apparent. Almost all of the mononuclear cells were immunohistochemically revealed to be CD68-positive macrophages. We speculated that these findings resulted from ischemia due to massive pulmonary embolism.     

Early and late meningeal reaction to trauma after long-term brain death.

We examined histologically the meninges adherent to traumatic lesions of a patient with brain death sustained for 101 days and observed both early and late reactions of wound healing at the same site of the dura mater. Some parts of the dura mater were thick and histological examinations revealed formation of new vessels and fibrosis with strong positive reaction for iron and fat staining. We also observed fresh haemorrhage and some cell infiltration in the dura and fresh haemorrhage in a small piece of necrotic brain tissue adhered to the dura mater, while other areas of the brain tissue were completely necrotic, enabling the sites of head injury to be localised. These observations suggested that the blood flow in the dura mater fluctuates due to a change of microenvironment, which probably causes repeated secondary petechial haemorrhages in the dura and its adherent necrotic brain tissue, even 101 days after brain death.     

Right ventricular damage due to pulmonary embolism: examination of the number of infiltrating macrophages

To investigate the pathological changes in the heart induced by pulmonary embolism, 20 autopsy cases of pulmonary embolism and 10 control cases of acute death from traumatic injury were examined. Adding to the routine hematoxylin-eosin (HE) staining, immunostaining with CD68 pan-macrophage marker was performed on the specimens obtained from both right and left ventricular walls. The number of macrophages was counted semi-quantitatively in 100 random high-power fields (HPF). Although typical pathological findings of myocardial infarction was not observed in any of the cases, 16 of the 20 pulmonary embolism cases showed an increase in the number of macrophages, mainly in the right ventricular wall. Four cases showed massive macrophage infiltration in the entire right ventricular wall. It is speculated that ischemia due to pulmonary embolism may be connected to its pathogenesis.     

日本社会的结构变化与高等教育的课题

20世纪 90年代 ,日本面临着全球化背景下知识社会的新挑战。因此 ,日本的高等教育不但一方面要把注意力集中在其中的一些结构性问题上 ,同时要满足来自于经济和社会变革的需求。日本政府为此提出了一系列高等教育改革措施。东京大学正在落实的改革有三个方面。第一是管理 ,包括学校管理和财政。目前 ,政府倡导要求国立大学具有更大的自主性 ,给校长更大的权力。虽然这似乎是一种普遍的方向 ,但是 ,政府详细的改革计划也带来了各种各样的问题。第二个改革领域是研究。大学采取措施加强与工业界的关系 ,加强国际关系网络。第三 ,教育 ,特别是本科生层次的教育是大学非常重要的任务之一。然而 ,在一个以研究为中心的大学 ,提高教育质量不是一件容易的事。东京大学已经着手采取措施改进本科生教育     

Screening of milk aspiration in 105 infant death cases by immunostaining with anti-human alpha-lactalbumin antibody.

To determine the frequency and degree of milk aspiration in infant death cases, immunohistochemical examinations were performed on lung sections from 41 sudden death cases and 64 in-hospital death cases using anti-human alpha-lactalbumin antibody. Milk aspiration to some degree was detected in more than half of the sudden death cases and in about one-third of the in-hospital death cases. A semi-quantitative examination of the amount of aspirated milk was subsequently performed in the positive cases. The amount of aspirated milk in the sudden death cases was significantly higher than that in the in-hospital death cases. The frequency distribution of the amount of aspirated milk was similar in shape in both groups. In most cases, a very small amount of aspirated milk was detected. The aspirated milk was assumed to be a result of occasional gastroesophageal reflux or cardiopulmonary resuscitation. However, in five cases, much larger amounts of aspirated milk were found. In these cases, milk aspiration may have been an important part of the cause of death. We concluded that slight milk aspiration is not rare in infant death cases, and that in a few cases, the aspiration is lethal. An immunohistochemical screening test is available to perform a postmortem diagnosis in these cases.     

Determination of a newly encountered designer drug "p-methoxyethylamphetamine" and its metabolites in human urine and blood

A newly synthesized designer drug, para-methoxyethylamphetamine (PMEA) was unexpectedly detected in the postmortem specimens of fatality involving drug intoxication in 2005, Japan. For unequivocal identification, the isomeric discrimination of PMEA and its positional-isomers was performed by GC/MS with the trifluoroacetylation. In order to prove the intake of PMEA, the characteristic metabolites of PMEA were also identified by GC/MS analysis of the urine specimen with trifluoroacetylation. As a result, para-methoxyamphetamine, para-hydroxyethylamphetamine (POHEA) and para-hydroxyamphetamine were identified as the major metabolites of PMEA. For the quantitative analyses of PMEA and its three metabolites in body fluids, an automated column-switching LC/MS procedure was developed, and applied to the postmortem blood and urine specimens. In this fatal case, blood concentration of PMEA was estimated to be 12.2 microg/mL and this level seemed extremely high in comparison with lethal blood-levels of its analogues, representing acute-intoxication of the victim. Based on the quantitative results, PMEA was found to be extensively metabolized to POHEA via O-demethylation, partly followed by its conjugation.     

The Constitution of Japan and Constitutional Reform

Although there have been movements to revise the Constitution of Japan, the original text has remained in effect for 70 years. This article examines the rules of constitutional revision, the basis on which the Constitution was drafted, and the ramifications of an unmodified constitution. Japan's Constitution is compared in terms of length and number of revisions with those of other industrialized countries. The article concludes with recommendations for making Japan's Constitution better able to function in a legal capacity.     

Fatal paradoxical air embolism diagnosed by postmortem imaging and autopsy

The recognition and visualization of an arterial gas embolism are difficult. We report a case of sudden death caused by paradoxical air embolism of coronary and cerebral arteries, diagnosed by the pre autopsy computed tomography (CT) scanning. A 54-year-old woman suddenly died after the self-removal of the jugular vein catheter. Postmortem imaging examination using CT scanning showed multiple gas embolisms in the cerebral arteries, pulmonary artery, right atrium and ventricle, left ventricle, aorta, and coronary arteries. These findings suggested that the occurrence of acute ischemia of the brain and heart caused by massive air inflow to the artery. Conventional autopsy revealed a patent foramen ovale of the heart. These results indicated that the patient died of paradoxical air embolization of the coronary and cerebral arteries through a patent foramen ovale because of right-to-left shunting. The use of postmortem imaging as an aid for conventional autopsy has proved to be of advantage in the case of gas embolism.     

Diagnostic value of the placenta in medico-legal practice

In three suspected cases of infanticide, histological examinations of the placentas were effective in clarifying the circumstances. We have estimated the 5th month of pregnancy from pieces of the placenta in one case and diagnosed the causes of perinatal abnormalities in two cases, those being acute chorioamnionitis and possible premature separation of normally implanted placenta.