Exploring the potential for age estimation using facial image sensing technology for postmortem investigation.

In this study, we examine the potential for using face imaging sensing technology in place of a human forensic practitioner to estimate the age of cadavers. We used the age estimation software FieldAnalyst for Signage Ver. 6.0 AW32. To validate the usefulness of its age estimation for living subjects, images of 28 subjects were taken at three angles (+30°, 0°, and -30°) with respect to the horizontal plane, with their eyes open and closed. The highest positive correlation between mean the estimated age and the actual age (y = 1.02x - 0.35, and Spearman's rank correlation coefficient of 0.78, P < 0.001) was obtained when the subjects had their eyes closed and the image was captured at an angle of 0°. The ages of 93% of the subjects were estimated within ±10 years of their actual ages. We then applied this procedure to 61 cadavers with their eyes closed. Facial images were taken at an angle of 0° with respect to the horizontal plane and used to estimate the ages of the cadavers. Although a positive correlation between the actual and mean estimated ages was obtained (y = 1.28x + 0.43, Pearson's correlation coefficient of 0.69, P < 0.001), the mean estimated ages of only 39.3% of the subjects were within ±10 years of their actual ages. It appears that this technology is not accurate enough to use to determine the age of a cadaver. Therefore, medical inspectors with adequate knowledge and experience are still required for postmortem examination.

Autopsy of a patient with alcoholic suffering from cardiopulmonary arrest at the hospital.

A 48-year-old Japanese woman with >10 years history of alcoholic had been falling repeatedly during 1 week before her death. She complained of nausea and did not eat or drink for 2 days. Thereafter, she became drowsy and she was transferred to the hospital. On arrival at the hospital, she had cardiopulmonary arrest and died soon after. Although blood tests showed metabolic ketoacidosis, a hemorrhagic lesion was also found in the brain by computed tomography. To determine the cause of death,. a forensic autopsy was performed on the next day. At autopsy, cerebral contusion, skull fracture, and subdural hemorrhage caused.by the head injury received after falling were found. Histological examination showed fatty changes and Mallory bodies in the liver. There was a marked increase in ketone bodies, especially ß -hydroxybutyrate, in postmortem blood examination. Therefore, the cause of death was diagnosed as alcoholic ketoacidosis. Accurate diagnosis of mild trauma and metabolic disease is difficult by postmortem computed tomography; therefore, autopsy is required for sudden death. In this case, the cause of death and accompanying traumatic lesions that were compatible with her history was clarified by autopsy. Furthermore, because the blood was taken at the time of cardiopulmonary arrest, we.obtained reliable data from the terminal stage of alcoholic ketoacidosis. This case demonstrates the physiological and pathological changes in sudden death of a patient with alcoholic.

Fatal hypernatremia due to drinking a large quantity of shoyu (Japanese soy sauce).

We report a case of fatal salt poisoning in a 55-year-old woman who suffered from depression and drank a large quantity of shoyu (Japanese soy sauce). She presented with the highest ever documented serum sodium level of 187 mmol/L. This was associated with symptoms of cerebral damage which developed within hours after drinking the soy sauce. She died as a result of massive pulmonary edema, despite intensive medical treatment. Viewing the results of clinical and postmortem investigations together, her death could clearly be attributed to drinking a large quantity of soy sauce.

A fatal case of potential chronic overdoses of prescribed and proprietary remedies.

A 33-year-old man was found in a state of cardiopulmonary arrest. He was transported to an emergency hospital but was pronounced dead. He had suffered from depression for about 8 years and had attempted suicide repeatedly. A search by the police found 645 empty Press Through Package (PTP) sheets. They had included neuroleptics, antidepressants, hypnotics, proprietary antitussives containing caffeine, proprietary cold remedies containing caffeine, and other unidentified drugs. An autopsy showed higher rectal temperature (38 degrees C), severe pulmonary edema (left: 681 g, right: 821 g), and a large amount of urine in the bladder (about 760 mL). Toxicological analyses using gas chromatography-mass spectrometry (GC/MS) and high performance liquid chromatography (HPLC) demonstrated that doses of clomipramine hydrochloride (a tricyclic antidepressant), chlorpromazine (a phenothiazine), and caffeine (a methylxanthine derivative) were within the toxic range (0.68, 0.64, and 34.24 [microg/mL], respectively). Histological examination showed centrilobular necrosis of the liver with small fat droplets. We concluded that he had died of pulmonary edema due to combined drug intoxication including proprietary antitussives and cold remedies. Furthermore, there was a strong possibility that he had habitually taken overdoses of those drugs. Herein, the risk of misuse of prescribed and proprietary drugs, especially for people with psychological problems, should be reemphasized.