An unusual case of suicide by stabbing with a falling weighted dagger.

An unusual suicide by self-stabbing is presented. A 42-year-old man committed suicide with a dagger weighted with 2.72 kg in total and allowed to fall freely. The blade of the dagger fell from a height of 10 cm above the chest, penetrated the second left intercostal skin and pierced the upper lobe of the left lung. However, the weapon did not penetrate the chest skin from a stationary position in our trial at the autopsy. This finding confirms the results of experiments with stab wound dynamics which demonstrated that the impact velocity of the weapon as well as the sharpness of the tip is important for skin penetration.

Cholesterol hydroperoxides in erythrocyte membranes of alcoholic patients.

Evidence for the presence of 5alpha-hydroperoxycholest-6-en-3beta-ol (cholesterol 5alpha-hydroperoxide, Ch 5alpha-OOH) and 7alpha- and 7beta-hydroperoxycholest-5-en-3beta-ols (cholesterol 7-hydroperoxides: Ch 7alpha-OOH and Ch 7beta-OOH, respectively) in human erythrocyte membrane was found. Blood samples were collected from alcoholic patients and healthy volunteers (controls), and their cholesterol hydroperoxides were analyzed by high-performance liquid chromatography postcolumn chemiluminescence and roughly identified by liquid chromatography-mass spectrometry. Ch 7alpha-OOH and Ch 7beta-OOH were present in each sample, being significantly higher in alcoholic samples than in control samples. Ch 5alpha-OOH was present in some alcoholic samples, but not in the control ones. The accumulation of cholesterol hydroperoxides suggests enhanced lipid peroxidation by active oxygen species and/or a reduced elimination system for lipid peroxide in alcoholic patients.

[An autopsy case of pulmonary thromboembolism associated with chlorine gas poisoning].

We report a rare case of sudden death of a patient with acute pulmonary thromboembolism associated with chlorine gas poisoning. A 21-year-old man in a water-filtration plant accidentally inhaled highly concentrated chlorine gas. He was immediately brought to a hospital after exposure. On admission, the patient had clouding of consciousness, dyspnea, and deep cyanosis. Arterial blood gas values indicated severe hypoxemia; PaO2 was 35.9 mmHg and PaCO2 was 42.4 mmHg. The clinical course was uneventful and he was satisfactorily recovering. However, ten days after admission he became sick and markedly cyanotic. He lost consciousness and then he went into cardiopulmonary arrest. Despite efforts at resuscitation, he died. An autopsy revealed bilateral pulmonary thromboembolism, although he apparently did not have any risk factor for embolism. The toxicity of chlorine gas may be related to the pulmonary thromboembolism, but the mechanisms leading to his death are unclear.

Evaluation of the psycho-oncological effectiveness of the bedside wellness system.

This article describes how a virtual forest walk system (a bedside Wellness system) is expected to help cancer patients to relax and become more positive emotionally. It is also expected that the beautiful scenery (with wind, scents, and sounds) will refresh patients and that the evoked changes in the natural world will relax them. We have demonstrated the possible uses of virtual reality (VR) technology in the care of patients' mental health; however, we still have to improve the VR technology itself and investigate how to utilize it most effectively. It is essential that VR technology may be able to construct virtual, but realistic, environments that patients can enjoy without being caused additional stress or fatigue. This type of medical VR system may be effective in improving the quality of life of not only cancer patients, but also of the elderly.

Abnormality of very long-chain fatty acids of erythrocyte membrane in alcoholic patients.

Profiles of very long-chain fatty acids were studied in the erythrocyte membrane of five alcoholic patients. We identified three fatty acids as cis-16-pentacosenoic acid (C25:1), cis-17-hexacosenoic acid (C26:1), and hexacosenoic acid (C26:1), and hexacosanoic acid (C26:0) by gas chromatography-mass spectrometry. The ratios of C26:1/C22:0, C26:0/C22:0, C24:1/C22:0, and C24:0/C22:0 were increased. These findings suggest that active oxygen species or free radicals generated by chronic alcohol consumption in alcohol patients interrupt the peroxisomal beta-oxidation of fatty acids, because very long-chain fatty acids are mainly metabolized by the peroxisomal beta-oxidation system. This is the first study showing accumulation of very long-chain fatty acids in the erythrocyte membrane of alcoholic patients.

Elevated plasma nitrate in patients with crush syndrome caused by the Kobe earthquake.

We investigated the nitric oxide profile in the plasma of ten healthy controls and 29 patients hurt by the Kobe Earthquake. The levels of nitrite (NO2-) and nitrate (NO3-) were measured simultaneously by high-performance liquid chromatography (HPLC) with UV detection using the Griess reaction after the reduction of nitrate to nitrite. Arginine consumed in food or diet-derived nitrite had no effect on the plasma nitrite and nitrate contents of the healthy volunteers. Plasma nitrate was elevated in the crush syndrome patients; whereas neither nitrite nor nitrate was increased in patients with normal renal function. This finding suggests increased nitric oxide synthesis, decreased excretion of nitric oxide in the crush syndrome or both.

Detection of measles virus mRNA from autopsied human tissues.

By reverse transcription-PCR, measles virus (MV) mRNA was detected in the brain, kidney, spleen, liver, and lung tissues obtained from 23 (45.1%) of 51 autopsy subjects, with the detection rates of each tissue ranging from 8 to 20%. Sequence analysis revealed frequent mutations in the corresponding viral protein. These results suggest that MV mutants commonly persist in apparently healthy individuals.

Increased very long-chain fatty acids in erythrocyte membranes of patients with aceruloplasminemia.

Aceruloplasminemia is a newly recognized autosomal recessive disorder of iron metabolism that causes neurodegeneration of the retina and basal ganglia as well as diabetes mellitus. Our previous studies suggested that increased susceptibility to plasma lipid peroxidation secondary to iron accumulation may contribute to the pathogenesis in this disease. We now have identified increases in the very long-chain fatty acids cis-17-hexacosenoic (C26:1) and hexacosanoic (C26:0) acid in the erythrocyte membranes of three family members affected with aceruloplasminemia. All of them had elevated C26:1/C22:0 and C26:0/C22:0 ratios. These findings suggest that free radicals generated in persons with aceruloplasminemia may interrupt the peroxisomal beta-oxidation of fatty acids.

Chemiluminescent determination of cholesterol hydroperoxides in human erythrocyte membrane.

A method for separating, detecting, and quantifying cholesterol hydroperoxide (Ch-OOH) based on extraction, purification by solid-phase extraction cartridge, high-performance liquid chromatography with chemiluminescent detection (HPLC-CL), and liquid chromatography-mass spectrometry has been developed for human erythrocyte membrane. We prepared standard compounds of the cholesterol 5alpha-, 7alpha-, and 7beta-hydroperoxides (Ch 5alpha-OOH, Ch 7alpha-OOH, and Ch 7beta-OOH). An octyl silica column with methanol/water/acetonitrile 89:9:2 (by vol) as eluent was used to determine Ch-OOH. HPLC-CL that incorporated cytochrome c and luminol as the post-column luminescent reagent was used. We also investigated the optimal assay conditions and how to prevent formation of artifact Ch-OOH. Analysis of erythrocyte membranes from seven healthy volunteers identified Ch 7alpha-OOH and Ch 7beta-OOH, but not Ch 5alpha-OOH, as commonly occurring components. The respective mean concentrations of Ch 7alpha-OOH and Ch 7beta-OOH were 2.5+/-1.6 and 5.4+/-3.5 pmol/mL blood.

Change in nitric oxide in humans due to application of a pneumatic tourniquet.

The nitric oxide profile produced by application of a pneumatic tourniquet was investigated in the plasma of 15 patients. Nitrite (NO2-) and nitrate (NO3-) plasma concentrations were measured simultaneously by high-performance liquid chromatography (HPLC). UV detection using the Griess reaction was done after the reduction of nitrate to nitrite. The plasma nitrate concentration 5 min after reperfusion was significantly higher than the concentrations before ischemia, immediately before reperfusion, and the next day. In contrast, there was no significant difference in the plasma nitrite concentrations before ischemia, immediately before reperfusion, 5 min after reperfusion, and the next day. These findings suggest that the generation of NO is important in ischemic reperfusion injury.

Bedside wellness--development of a virtual forest rehabilitation system.

The present study aims at the development of a new concept system that will contribute toward improving the quality of life for bedridden patients and the elderly. The results of a basic study showed the possibility of a virtual reality system reducing stress and pain, provided VR sickness does not occur. A Bedside Wellness System which lets a person experience a virtual forest walk and provides a facility of rehabilitation was proposed based on the basic study and developed. An experiment to assess the developed system using healthy subjects was executed. The data suggested the positive effects of the system; however, some points to be improved were also extracted. After a few improvements, the system will be available for clinical use.

Epicoprostanol found in adipocere from five human autopsies.

Adipocere formation is well known as a later postmortem change. We collected adipocere from five male victims which had been submerged under the sea or fresh water for 1 mon to 4 yr. Fresh subcutaneous fat of a male victim who died from a cerebral contusion was used as the control. The samples were homogenized, and the lipids were extracted with chloroform and methanol followed by injection into a gas chromatograph and a gas chromatograph-mass spectrometer. We detected hydroxy fatty acids (10-hydroxyoctadecanoic acid and 10-hydroxyhexadecanoic acid) as well as 10-ketooctadecanoic acid in adipocere, but not in the control. In addition, we found for the first time a cholesterol-related peak with a molecular ion of 388 in adipocere and identified it as epicoprostanol, suggesting not only oxidation but also reduction had occurred during the formation of adipocere. In addition, we showed the time-course of epicoprostanol accumulation. The relationship between the time of adipocere formation and the characteristic lipid composition is discussed.

[An autopsy case of sudden death due to Chagas' disease].

An autopsy case of sudden death of a 41-year-old male Brazilian with Chagas' disease in reported. In his life time, right handle branch block and ventricular premature contractions were marked in electrocardiogram. Autopsy revealed striking dilatation of both cardiac ventricles. Histopathologically, extensive myocardial fibrosis due to chronic interstitial myocarditis was observed. On myocardial tissue preparation performed Giemsa's stain, leishmania foci of Trypanosoma crusi were detected around the myocardial fibrosis.

Very long-chain fatty acid pattern in crush syndrome patients in the Kobe earthquake.

Profiles of very long-chain fatty acid were studied in the erythrocyte membrane of healthy controls and four patients with crush syndrome caused by the Great-Hanshin Earthquake. The identities of cis-17-hexacosenoic acid (C26:1) and hexacosanoic acid (C26:0) were verified by gas chromatography-mass spectrometry (GC-MS). The ratios C26:1/C22:0, C26:0/C22:0, C24:1/C22:0, and C20:1/C22:0 also were elevated. These findings suggest that active oxygen species and/or free radicals generated by ischemia-reperfusion in the crush syndrome result in beta-oxidation disorders in peroxisomes.

A new competitive enzyme-linked immunosorbent assay demonstrates adequate immune levels to rabies virus in compulsorily vaccinated Japanese domestic dogs.

A competitive enzyme-linked immunosorbent assay (c-ELISA) was developed as an alternative to the viral neutralization (VN) test for rapid and simple detection of antibodies to rabies virus. The competitor antibody in the c-ELISA was a biotinylated monoclonal antibody to the nucleoprotein of rabies virus. Initial comparisons showed a high correlation between titers obtained with the VN test and the c-ELISA (n = 88, r = 0.90), indicating that the c-ELISA could be used as a reliable substitute for the VN test. To evaluate the immune status of Japanese dogs to rabies virus, a total of 1,019 serum samples were collected from domestic dogs in 1994 and tested for antibodies with the c-ELISA. Overall, 84.8% of the dogs had antibodies against rabies virus, indicating that the vaccination strategy for preventing rabies outbreaks in domestic dogs is probably sufficient in Japan. Dogs receiving final vaccinations a year or more previously were 48.3 and 90.3% positive for antibodies when vaccinated once only or two or more times, respectively. This suggests that almost all dogs vaccinated twice or more remain seropositive for over 1 year in Japan.

Oxysterols found in opacified cornea of fish.

We describe a new concept implicating oxidized cholesterol derivatives and very long-chain fatty acids as possible factors in the development of corneal opacification after death. Corneal tissues, removed from both fresh and stale fish eyes, were examined for cholesterol derivatives and fatty acids after methanolysis of lipids. Cholesta-3,5-dien-7-one, cholest-4-en-3-one, hexacosenoic acid, and hexacosenoic acid were identified via gas chromatography/mass spectrometry in opacified corneas, but not in significant amounts in fresh ones. The present study confirmed the presence of lipid hydrolysis and a peroxidation process in the opacified cornea.

Effect of the cytochrome P-450IIE1 genotype on ethanol elimination rate in alcoholics and control subjects.

We studied an influence of genetic polymorphisms in the cytochrome P-450IIE1 (CYP2E1) gene on ethanol elimination rate in alcoholic patients and healthy subjects. The CYP2E1 genotype was determined by polymerase chain reaction-restriction fragment length polymorphism method for 124 alcoholics and 54 healthy subjects. There was no significant difference in the gene frequency of CYP2E1 between alcoholics and healthy control subjects. Blood ethanol concentrations in the 65 alcoholics on admission ranged from 0.32 to 4.22 mg/ml. In the patients with the c1/c2 genotype, the elimination rate was significantly correlated with blood ethanol concentration. In each of the three genotypes of CYP2E1, the patients were divided into three groups based on ethanol concentrations. The average of the ethanol elimination rate in the patients with c1/c2 having blood ethanol levels of > or = 2.5 mg/ml was significantly higher than the rates in the two other groups of c1/c2. When blood ethanol levels were > or = 2.5 mg/ml, the elimination rate in the patients with c1/c2 was significantly higher than that in those with c1/c1. Regardless of the CYP2E1 genotype, the elimination rate in the alcoholics was higher than that in the control subjects when blood ethanol levels were < 1.0 mg/ml. These results suggest the possibility that the c2 allele of CYP2E1 Influences the rate of ethanol elimination at high ethanol levels. The rate of ethanol elimination was independent of liver disorder judged by serum total bilirubin values.

Identification of cholesta-3,5-dien-7-one by gas chromatography-mass spectrometry in the erythrocyte membrane of alcoholic patients.

Lipids and oxidized lipids were analyzed by gas chromatography-mass spectrometry in the erythrocyte membranes of alcoholic and control subjects. Cholesta-3,5-dien-7-one and cholesta-trienes were detected in alcoholic samples examined, but not in significant amounts in controls. Levels of polyunsaturated fatty acids (arachidonic acid, 20:4; docosahexaenoic acid, 22:6; and docosatetraenoic acid, 22:4) in alcoholic samples declined significantly, whereas cholesta-3,5-dien-7-one levels increased. A high level of total bilirubin was observed in most patients. A possible mechanism of the accumulation of cholesta-3,5-dien-7-one in the erythrocyte membrane of alcoholics is discussed.