A frozen newborn infant: froth in the air-passage after thawing.

We performed an autopsy on a frozen newborn infant who was found in a freezer at -18 degrees C. After thawing, froth emerged from the nostrils and was present in the trachea. Sometimes froth may be seen in the air-passage in cases of strangulation and drowning. In our case, however, there was neither proof of asphyxia due to strangulation nor drowning. The existence of the froth indicates that the infant was probably in a state of respiratory distress before death. Histologic findings of the lung showed that the infant did not suffer from respiratory disorders such as respiratory distress syndrome. Karyopyknosis and vacuolation of the keratinocytes, shrinkage of the hepatocytes, dilatation of the sinusoid, spaces between heart muscle fibers and deep staining of the nuclei and hemolysis were characteristic in our case. This case shows that froth persists in the internal air-passage for a long time as a result of freezing. Moreover, the froth in the air-passage, along with the findings of the lungs, demonstrates that the newborn infant was born alive.

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).

Epitope mapping of a monoclonal antibody to human glutathione transferase P1-1 the binding of which is inhibited by glutathione.

Although the three-dimensional structure of human glutathione transferase (GST) P1-1 crystallized with a GSH analogue has been reported, its structure in the non-complexed form has not been determined. Four monoclonal antibodies to GST P1-1 were produced to facilitate structural analysis. Of these, one, clone d-1 of IgG2a isotype, dose-dependently inhibited the activity of GST P1-1 but did not affect the activities of either GST A1-1 or M1-1. On immunoblotting, the antibody reacted strongly with GST P1-1 and weakly with rat GST-P and mouse GST-II, indicating cross-reactivity with Pi-class forms but preferential reactivity with GST P1-1. When GST P1-1 and the antibody were incubated in the presence of 60 microM GSH, no inhibition of activity was found, whereas 1-chloro-2,4-dinitrobenzene had no effect at concentrations up to 10 microM. The binding of GST P1-1 to antibody adsorbed to Protein A-Sepharose was also prevented by both 0.1 mM GSH and N-ethylmaleimide treatment. Trypsin digests of GST P1-1 were resolved by HPLC and a peptide that reacted with the antibody was detected by absorption experiments. N-Terminal amino acid sequencing revealed the peptide to be in the C-terminal portion of the enzyme, stretching from amino acid residues 198 to 208. A synthetic peptide of this sequence also absorbed the antibody. These results suggest that both GSH bound to the active site and N-ethylmaleimide bound to the cysteine residue repress antibody binding to the C-terminal region. Thus this antibody may be useful for examining the steric configuration of the C-terminal and other regions of GST P1-1 in the absence of GSH.

On an accident by liquid nitrogen--histological changes of skin in cold.

Two young researchers were found lying beside 3 Dewar flasks for liquid nitrogen in a cold experimental room of a university. They were sent to a hospital but died 1.5 h after cardiopulmonary resuscitation. One of the cadavers had dark red discoloration of the skin on the left arm at autopsy. By the histological investigation of the discolored region karyopyknosis and vacuolation of the keratinocytes were noticeably observed in the epidermis. In addition, hyperemia and edematous changes were seen. Hemoglobin (Hb) was not immunodetected in the skin tissue except intravascular erythrocytes. Therefore, these histological findings of the discolored skin can indicate that the skin damage was produced by cold due to liquid nitrogen before death. The cause of death was asphyxia due to oxygen deficiency. There were few autopsy findings which showed the participation of liquid nitrogen in the accident. But, the histological findings of the discolored region demonstrate that liquid nitrogen was involved in this accident.

Case report: repeated neonaticides in Hokkaido.

Five cases of repeated neonaticides were reported in Hokkaido, the northernmost island of Japan, during the 10 years from 1983 to 1992. Four or more neonates were involved in each case by each mother. All the suspected mothers were not mentally ill. Two of them were single and the rest were married. Each husband was not aware of the pregnancy of his wife, because he was away from home very often. The main motive of murder seemed to be economic and/or to save appearances. Sentences were 1 year penal servitude with a stay of 3 years for one case, but 30-42 months in prison for the other four cases. We rarely find reports of repeated infanticides committed by the same mother in European countries and the United States.

Loxoprofen--another NSAID associated with acute asthmatic death.

Loxoprofen sodium (sodium 2[4-(2-oxocyclopentylmethyl) phenyl] dehydrate; CAS #68767-14-6) is a nonsteroidal, inflammatory drug marketed only in Japan. A case report describes its association with an acute asthmatic death with features resembling those evoked by similar drugs. The analytic methodology is reported. The blood levels of loxoprofen were in the therapeutic range. The tissue concentrations are reported.

Studies on asphyxia: morphological research for the aid of diagnosis of asphyxia using light and electron microscopy and immunohistochemical methods.

The lattice-form structure and/or tubular myelin can be found in the debris-like structure which is the pinkish substance in the alveolar space in the Hematoxylin & Eosin stained sections. These findings were obtained by using rats in the air containing oxygen of 5% or mixing and/or contaminating each of methane, carbon dioxide, carbon monoxide and freon gases. The immunohistochemical detection using the monoclonal mouse antibody against human pulmonary surfactant (PS) apoprotein is of highly useful. The positive reaction products observed in the alveolar space indicate the localization of the tubular myelin. The data suggest that the PS appears when the inhaled air contains oxygen in low concentration. The immunohistochemical method using the antibody against human PS apoprotein is worth applying for the diagnosis of oxygen deficiency including the respiratory distress syndrome (RDS) of the new born. We conclude that the appearance of the positive reaction products suggests that, at least, the air did not come in contact with the surface of alveoli, which leads us to the diagnosis of death was from oxygen deficiency, even if we are at the stage when the mode of death is undetermined.

Organ specificity of the antigens reacting with the 48-1 and S-1 antibodies in chimpanzees infected with hepatitis C virus.

48-1 and S-1 antibodies produced by lymphoblastoid cells transformed with Epstein-Barr virus were reported to be associated with infection by not only the hepatitis non-A, non-B (NANB) virus but also hepatitis delta virus. Appearance of the antigens reacting with these antibodies in the liver of chimpanzees was recently found to be a host response to alpha-interferon induced by infections of both viruses. To investigate organ specificity of these antigens, various organs obtained from chimpanzees with hepatitis C (NANB) were examined. In addition to the liver, the adrenals and spleen were found to be positive by immunofluorescence. The positive reactions of these three organs were also confirmed by radioimmunoassay. By electron microscopy, microtubular aggregates similar to those observed in the liver were detected in the adrenals, but not in the spleen. The results suggested that these antigens existed in the liver, adrenal, and probably spleen of chimpanzees infected with hepatitis C.

Further studies of 48-1 antigen in serial liver biopsies from chimpanzees infected with hepatitis delta virus.

The 48-1 antibody, initially reported to react specifically with non-A, non-B infected liver tissue, has been found to react also with liver specimens from chimpanzees infected with hepatitis delta virus (HDV). To clarify further the relation between HDV and appearance of the antigen reacting with the 48-1 antibody (48-1 Ag), immunoperoxidase studies were carried out on serial liver specimens from chimpanzees infected with HDV. Immunohistochemical and serological findings suggested that the appearance of 48-1 Ag paralleled that of HDV. Double immunoperoxidase staining revealed HDAg in the nucleus and 48-1 Ag in the cytoplasm of the same hepatocytes as well as in different hepatocytes separately. The course of appearance of microtubular aggregates paralleled that of 48-1 Ag. The present results suggested that expression of 48-1 Ag was related to infection with HDV, probably because expression of this antigen is induced from the host genome.

Enterically transmitted non-A, non-B hepatitis in cynomolgus monkeys: morphology and probable mechanism of hepatocellular necrosis.

Two cynomolgus monkeys were inoculated with a stool extract originally derived from patients suffering from enterically transmitted non-A, non-B hepatitis. Subsequently, the primates developed self-limiting acute hepatitis and their liver tissues were obtained sequentially by needle biopsy or at sacrifice. Histologically, the liver tissues exhibited necroinflammation which appeared in parallel, both in time and magnitude, with elevation in serum aminotransferases. Necroinflammation was characterized by focal dropout of hepatocytes with accumulation of lymphocytes and macrophages. These lymphocytes were positive for a cytotoxic/suppressor immunophenotype. The hepatocytes surrounding these focal necroses showed depletion of glycogen granules and decrease in glucose-6-phosphatase and succinic dehydrogenase activities. Ultrastructurally, damaged hepatocytes around the focal necroses revealed marked dilatation of both rough and smooth endoplasmic reticula, swelling and disruption of the mitochondria and leakage of nuclear materials into the cytoplasm. Frequently, direct contact between the damaged hepatocytes and lymphocytes was noted. Virus-like particles measuring about 27 nm in diameter were observed singly or in small groups within the cytoplasm of damaged hepatocytes. Primary hepatocyte culture of a cynomolgus monkey, inoculated with a transmissible stool extract did not show any cytopathic change, although similar virus-like particles were recognized ultrastructurally in the cultured hepatocytes. Morphological analysis of in vitro and in vivo transmission studies in cynomolgus monkeys strongly supported the hypothesis of immune-mediated hepatocytolysis rather than a direct cytopathic effect of this hepatitis virus.

Sudden infant death syndrome in Japan.

Two autopsied cases are presented, one involving a 5-month-old infant, and a 6-month-old infant both of whom died suddenly and unexpectedly. The incidence of sudden infant death syndrome in Japan is 1.2 per 1,000 babies live births. Among all cases autopsied in the departments of legal or forensic medicine in 78 universities or colleges of Japan, the incidence was 15 (0.5%) per 3,329 in 1984 and 20 (0.6%) per 3,150 in 1985.

Tetraploidy in a 15-month-old girl.

We present a 15-month-old girl with tetraploidy and compare the manifestations with those of 3 previously reported liveborn infants with the same type of polyploidy. Common anomalies noted included micro-turricephaly, a prominent but narrow forehead, microphalmia or anophthalmia, limb anomaly, sacral meningomyelocele, and mental retardation.

A single fatal penetrating chest wound caused by a dagger-shaped fragment of broken door glass.

A 19-year-old woman ran against a glass door, and, breaking it, was struck in the left anterior chest by a single dagger-like fragment of broken door glass. This fragment deeply penetrated her chest and wounded the anterior wall of the left ventricle of her heart. She rapidly died from loss of blood. The majority of single fatal penetrating chest wounds seen at postmortem examinations are caused by firearms and bladed weapons. While penetrating chest wounds occasionally result from fragments of glass, most severe and fatal wounds from glass result from one's falling into or through plate glass and sustaining wounds of the head, face, abdomen, or extremities. A single fatal wound from a dagger-shaped piece of glass is distinctly uncommon. To prevent such an accident from occurring, safety glass must be used in front doors of public institutions.

Medicolegal aspects of infanticide in Hokkaido District, Japan.

Since 1978, a total of 55 infanticides were investigated by our department (16.9% of the total number of medicolegal autopsies). This article describes the infanticides in the Hokkaido district of northern Japan. The characteristic finding for the cause of death was drowning in the toilet. This mode of killing seems to be chosen because of the style of toilet in the district, which includes a collecting tank for feces and urine under the commode.

Chromosome heteromorphisms and paternity testing.

Most of the blood group systems have now been applied to paternity investigations. In a complicated case, an alleged father not excluded with blood group testing, could be excluded with only chromosome heteromorphisms. Chromosome heteromorphisms are inherited from parents to offspring as simple Mendelian laws. The authors' paternity testing is presented with the help of chromosome heteromorphism analysis.

The Sydney line and the simian line: the incidence in Down's syndrome patients with mental retardation and Japanese controls.

The frequencies of the Sydney line and the simian line on the palms of 694 normal Japanese subjects (500 males and 194 females), 180 with Down's syndrome (113 males and 67 females) and 107 with mental retardation (62 males and 45 females) were studied and the following conclusions were obtained: the frequency of the Sydney line tends to be lower in normal Japanese controls than in Australian and North American controls, and the simian line tends to be higher in normal Japanese controls than in Australian and North American controls. Of these two palmar creases, the simian line is more useful in identification of Down's syndrome patients than is the Sydney line in the Japanese population.

A new approach in the evaluation of chromosome variants in man, III. Pairs with established Q or C variable sites.

A new approach is proposed for the evaluation of chromosome variants, which uses a scanning microdensitometer in the determination of the area of a variant. Results are assigned into five classes based on the difference from an average in terms of standard deviation. In the first two papers of the present series, results obtained in C variants of 1,9, and 16 and LBA variants in 12 pairs lacking an established variable site (e.g., nos. 2, 5, 6, etc.) were described. In the present communication, results obtained in pairs with a known Q-variable site are described. When a variable region outside of +/- 1 SD of the average is defined as a variant, 9, 11, 7, 10, and 10 variants are detected in pairs 13, 14, 15, 21, and 22, respectively, from 12 individuals by means of LBA preparations, in addition to Q variants, which can be detected by the standard QFQ technique.