Technical and interpretive pitfalls of postmortem CT: Five examples of errors revealed by autopsy

Image acquisition of dead bodies, particularly using postmortem computed tomography (PMCT), has become common in forensic investigations worldwide. Meanwhile, in countries such as Japan which have an extremely low rate of autopsy, PMCT is being increasingly used in the clinical field to certify the cause of death (COD) without performing an autopsy or toxicological tests, even in cases of unnatural death. Additionally, these PMCT images are predominantly interpreted by clinical personnel such as emergency physicians or clinicians who are not trained in PMCT interpretation and who work for the police, that is, the so-called police doctors. Many potential pitfalls associated with the use of PMCT have been previously described in textbooks and published papers, including the pitfalls of not performing a complete forensic pathology investigation, and the use of physicians without appropriate PMCT training to interpret PMCT and direct death investigation and certification. We describe five examples in which apparent misdiagnosis of COD based on PMCT misinterpretation was revealed by autopsy. Here are the five examples of errors: (1) Postmortem changes were misinterpreted as COD, (2) resuscitation effects were misinterpreted as COD, (3) COD was determined after an incomplete examination, (4) fatal findings caused by external origin were wrongly interpreted as ‘of internal origin’ based on PMCT, and (5) non-fatal findings on PMCT were wrongly interpreted as fatal. Interpretation of PMCT by appropriately trained physicians and an accompanying complete forensic investigation, including autopsy when indicated, is necessary to prevent significant errors in COD determination and related potential adverse medicolegal consequences.     

Decomposing the Relationship Between Contiguity and Militarized Conflict

It is well known that the majority of militarized conflicts and wars have been fought by neighbors. Yet, much remains to be learned about the relationship between shared borders and militarized conflict. This article decomposes the effects of territorial contiguity into  ex ante  "observable" and "behavioral" effects. It provides powerful empirical evidence for the claim that although neighbors are more likely to experience conflict because of  ex ante  differences in observable variables such as economic interdependence, alliance membership, joint democracy, and the balance of military capabilities, most conflicts between neighbors occur because of differences in how neighbors and nonneighbors respond to the observable variables.     

`Civil society' in Japanese politics: Implications for contemporary political research

Abstract. This article presents a definitional and historical summary of 'civil society' as a western concept, and then traces how it was used in Japanese political theory and practice. 'Civil society' discourse became a familiar term amongst post–war Japanese historians and social scientists in the period 1945–1970, and thus preceded the recent international proliferation of 'civil society' literature in the 'west' from the 1970s onwards. 'Civil society' discourse was politicised in practice in Japan in the 1950s and 1960s, principally in opposition movements wanting to encourage political participation by ordinary citizens. While some 'civil society' discourse in Japan was based on an idealisation of 'western' ideas and practice, it is also the case that the individualism and democratisation implied in 'civil society' discourse has been very differently understood in 'western' countries and very unevenly instituted in their political practice. A simple East–West frame makes significant similarities between Japanese ideas and practice and 'western' concepts and politics disappear, and additionally causes significant differences within the 'west' regarding individualism and democratisation to become invisible.     

Risk factors of sudden death in the Japanese hot bath in the senior population

A series of experiments were carried out to clarify the cause of death and the risk factors related to sudden death in the Japanese senior population while bathing in a Japanese style "hot bath." The biodynamic changes while bathing were carefully monitored under actual bathing situations occurring in both the winter and summer seasons. We observed double product (DP), total peripheral blood vessel resistance (TPR), cardiac output (CO), and blood vessel compliance (COMP) by measuring blood pressure, heart rate, pulse wave, and electrocardiogram (ECG). The finding of a high level of DP in the elderly suggests that more myocardial oxygen consumption is needed than for young adults, particularly in subjects with arrhythmia. Although the values for TPR and CO changed somewhat during bathing, the changes were considered normal and to be expected. However, more significant and substantial changes were observed during the winter experiment than during the summer experiment, no doubt owing to lower temperature of the bathing room. The value of COMP did not vary significantly between winter and summer subjects. Twelve subjects in the elderly developed ECG changes while bathing such as supraventricular extrasystole or ventricular tachycardia. No clinical significance was found in the biochemical analyses of the blood obtained before and after bathing. In conclusion, some subjects in the elderly showed risky changes in the above parameters and ECG, factors which may partially explain some of the causes of the many reported cases of lapse of consciousness and unexpected sudden death in the elderly while bathing especially in the winter season. Cold climate, hot water immersion, and hydrostatic pressure may affect their physiological compensation along with existing of coronary stenosis or weakness of respiratory function as a normal consequence of advanced age.     

Japan and the new world order

We present and consider five alternative scenarios of development — past, present and future — for Southeast Asia. Longitudinal data on foreign direct investment, trade, and currency valuation provide our basis for understanding the relations among the countries in this region as well as their relations with major external powers, especially the United States, Japan, and China. Our analysis suggests regional diversity rather than uniformity, with considerable flux and heterogeneity in the external economic ties of the countries resident in this area. Moreover, we argue that it would be overly simplistic to view changes in these ties only in bilateral terms of US or Japanese gains or losses. Instead, the Southeast Asian themselves, the other newly‐industrializing countries, and the constituent parts of Greater China are all increasingly making their presence felt.     

Pathological demonstration of rapid involvement into the subcutaneous tissue in a case of fatal hydrofluoric acid burns

We report an autopsy case of a man who suffered accidental chemical burns following exposure to 60% hydrofluoric acid. The extent of the burns covered about 30% of his body surface, and cardiopulmonary arrest occurred about 30min after the exposure. At autopsy, the skin of the affected area showed greenish gray or black coloring with thin circumferential erythema, and this discoloration extended as far as the periosteum of the skull. However, such discoloration was not found on the mucosa of the airway or the gastrointestinal tract. Microscopically, severe liquefactive necrosis was already evident on the skin. Elastic fibers within the dermis were completely lost, and the entire wall of large vessels within the subcutaneous layer was already severely affected. Blood analysis in the emergency room showed hypocalcemia, and the levels of fluoride ions in the postmortem blood and urine showed extremely high values. However, fewer fluoride ions were detected from the lung tissue. The present case suggests that the hydrofluoric acid had immediately penetrated down into the deep layer of the skin, thereby involving the large vessels present within the subcutaneous layer. These pathological findings of the skin seen in the present case explain the mechanism behind the rapid dissemination of fluoride ions which entered the bloodstream from damaged arteries, resulting in the development of acute toxicity.     

Fatal Spontaneous Retropharyngeal Hematoma with Airway Obstruction in the Setting of Treatment with Dipyridamole

We report a fatal case of airway obstruction caused by spontaneous retropharyngeal hematoma (RH) in the setting of treatment with dipyridamole. A 90-year-old woman presented with cervical swelling, neck and chest ecchymoses, and complaints of dyspnea. She suffered cardiopulmonary arrest in the ambulance, and her death was confirmed after transportation to the hospital. The major finding of postmortem computed tomography (PMCT) prior to autopsy was widening of the prevertebral soft tissue. The results of the autopsy indicated that the cause of death was mechanical asphyxia, secondary to pharyngeal and laryngeal compression caused by the RH. There were no evident injuries, medical interventions, or particular diseases, suggesting the spontaneous cause of the RH. To the best of our knowledge, this is the first report of a fatal case secondary to spontaneous RH that was revealed through PMCT imaging.