星岡 佑美

Coronary artery injury is a rare complication following blunt chest trauma (BCT), and can be fatal. Here we report findings on postmortem selective coronary angiography of right coronary artery rupture after an assault involving blunt trauma to the chest. A woman in her 60s died after her son stomped on her chest. There were no appreciable signs of injury on external examination, and cause of death could not be determined by postmortem computed tomography (PMCT). Internal findings indicated that an external force had been applied to the anterior chest, as evidenced by subcutaneous hemorrhage and pericardial and cardiac contusions. Postmortem coronary angiography revealed irregularity of the intima and of the fat tissue surrounding the proximal part of the right coronary artery associated with a local filling defect. Histopathological examination suggested coronary rupture with dissection of the tunica media and compression of the lumen cavity. The key points in the present case are that no fatal injuries could be determined on external examination, and the heart and coronary artery injuries were not evident on PMCT. Criminality might be overlooked in such cases, as external investigation at the crime scene would be inadequate and could result in a facile diagnosis of cause of death. This is the first report of coronary artery rupture with dissection that was detected by CT coronary angiography, and provides helpful findings for reaching an appropriate decision both forensically and clinically.

Accurate sex estimation based on measurements of dimorphic dimensions in human unknown remains is important as the first step toward making individual identification. The purpose of this study was to assess the sexual dimorphism of the scapula and to quantify the accuracy of sex estimation in a contemporary Japanese forensic sample using scapular measurements based on three-dimensional (3D) computed tomographic (CT) images. A total of 218 cadavers (109 males, 109 females) that underwent postmortem CT and subsequent forensic autopsy were used. Ten scapular measurements were performed on 3D CT reconstructed images that extracted only bone data, and were analyzed using descriptive statistics and discriminant function analyses (DFA). All measurements were dimorphic in terms of sex differences. Univariate DFA provided sex classification accuracy rates of 75.7-91.3%. Stepwise DFA yielded sex prediction accuracy rates of 93.1-94.5%. In conclusion, the scapular measurements using 3D CT images of a contemporary Japanese population may be useful for the estimation of skeletal sex in the field of forensic anthropology. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Traumatic rhabdomyolysis generally occurs after severe blunt trauma and is acute in onset, associated with severe disease, and potentially lethal. Accordingly, diagnosis of traumatic rhabdomyolysis in patients without massive subcutaneous or intramuscular hemorrhage is difficult, especially in the postmortem period, which is limited in terms of the availability of biochemical examination tools and accurate history of illness. To the best of our knowledge, there are no previous reports of death from traumatic rhabdomyolysis among individuals who did not pursue medical consultation. A previously healthy man in his early sixties had been punched and kicked several times in the previous 2 months, but he had not gone to a hospital. He suddenly lost consciousness at his workplace approximately 5 days after the most recent assault, and cardiopulmonary arrest occurred when the emergency service arrived. He died the same day, and a medicolegal autopsy was performed. Although several sites of minor subcutaneous and muscle hemorrhage were observed, the cause of death was unclear upon macroscopic assessment. Immunohistochemical staining revealed acute renal failure caused by rhabdomyolysis. We herein report a rare case of fatal traumatic rhabdomyolysis, seemingly associated with minor and apparently nonlethal muscle injury. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Acute subdural hematoma (ASDH) is mostly caused by head trauma, but intrinsic causes also exist such as aneurysm rupture. We describe here a case involving a man in his 70s who was found lying on the bedroom floor by his family. CT performed at the hospital showed ASDH and a forensic autopsy was requested. Postmortem cerebral angiography showed dilatation of the bifurcation of the middle cerebral artery, which coincided with the dilated part of the Sylvian fissure. Extravasation of contrast medium into the subdural hematoma from this site was suggestive of a ruptured aneurysm. Autopsy revealed a fleshy hematoma (total weight 110 g) in the right subdural space and findings of brain herniation. As indicated on angiography, a ruptured saccular aneurysm was confirmed at the bifurcation of the middle cerebral artery. Obvious injuries to the head or face could not be detected on either external or internal examination, and intrinsic ASDH due to a ruptured middle cerebral artery aneurysm was determined as the cause of death. One of the key points of forensic diagnosis is the strict differentiation between intrinsic and extrinsic onset for conditions leading to death. Although most subdural hematomas (SDH) are caused by extrinsic factors, forensic pathologists should consider the possibility of intrinsic SDH. In addition, postmortem angiography can be useful for identifying vascular lesions in such cases.

The aim of this study was to assess the correlation between stature and cranial measurements in a contemporary Japanese population, using three-dimensional (3D) computed tomographic (CT) images. A total of 228 cadavers (123 males, 105 females) underwent postmortem CT scanning and subsequent forensic autopsy between May 2011 and April 2015. Five cranial measurements were taken from 3D CT reconstructed images that extracted only cranial data. The correlations between stature and each of the cranial measurements were assessed with Pearson product-moment correlation coefficients. Simple and multiple regression analyses showed significant correlations between stature and cranial measurements. In conclusion, cranial measurements obtained from 3D CT images may be useful for forensic estimation of the stature of Japanese individuals, particularly in cases where better predictors, such as long bones, are not available. (C) 2015 Published by Elsevier Ireland Ltd.

Sex estimation of decomposed or skeletal remains is clearly important in forensic contexts. Recently, contemporary population-specific data has been obtained using multidetector computed tomography (MDCT) scanning. The main purpose of this study was to investigate skeletal pelvic dimorphism in a contemporary Japanese forensic sample and to quantify the accuracy of sex estimation using various pelvic measurements obtained from three-dimensional (3D) CT images. This study used a total of 208 cadavers (104 males, 104 females) of which postmortem CT scanning and subsequent forensic autopsy were conducted between December 2011 and August 2014. Eleven measurements of each pelvis were obtained from 3D CT reconstructed images that extracted only bone data. The measurements were analyzed using descriptive statistics and discriminant function analyses. All except one measurement were dimorphic in terms of sex differences. Univariate discriminant function analyses using these measurements provided sex classification accuracy rates of 62.0-98.1%. The subpubic angle was found to contribute most significantly to accurate sex estimation. Multivariate discriminant functions yielded sex prediction accuracy rates of 63.9-98.1%. In conclusion, the pelvic measurements obtained from 3D CT images of a contemporary Japanese population successfully demonstrated sexual dimorphism and may be useful for the estimation of skeletal sex in the field of forensic anthropology. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

The aim of this study was to assess the mechanical properties and thickness of adult frontal and parietal bones. The heads of 114 Japanese cadavers (78 male cadavers and 36 female cadavers) of known age and sex were used. A total of 912 cranial samples, 8 from each skull, were collected. Samples were imaged using multidetector computed tomography to measure sample thickness. The fracture load of each sample was measured using a bending test with calculation of flexural strength. Statistical analyses demonstrated no significant bilateral difference in either the mechanical properties or thickness of frontal or parietal bones. The mechanical properties and thicknesses of frontal bones were significantly greater than those of parietal bones regardless of sex. Therefore, the skull may have a great ability to resist frontal impacts compared with parietal impacts. In female samples, parietal bones were found to have a more uniform structure when compared with male samples. Male parietal bones were found to be thicker at medial sites than at lateral sites. This study also revealed parietal bones at lateral sites in female samples were thicker than in male samples. No strong association was observed between age and flexural strength of frontal or parietal bones. However, the fracture load was negatively correlated with age most likely due to the reduction of thickness. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

This study assessed the sex-discrimination potential of the sternum in a Japanese population using three-dimensional (3D) computed tomographic (CT) images. A total of 200 cadavers (100 males, 100 females) who underwent postmortem CT and subsequent forensic autopsy between December 2011 and June 2014 were used. Five measurements of each sternum were performed on 3D CT reconstructed images that extracted only bone data, and two sternal dimensions and three indices were calculated. Univariate discriminant function analyses using these linear measurements and calculated sternal dimensions and indices yielded sex classification accuracy rates of 62.5-84.0%, and 63.0-90.5%, respectively. The results of this study indicate that sternal measurements may be useful for the forensic assessment of sex in Japanese individuals, particularly in cases where better predictors, such as the pelvis or skull, are unavailable. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

The purpose of this study was to assess correlations between measurements of the second cervical vertebra (C2) and stature using multidetector computed tomography (MDCT) images, and to develop regression equations for estimating stature in a Japanese population. Measurements were performed on 216 Japanese subjects (116 males and 100 females) who underwent postmortem CT between May 2011 and November 2013. Sagittal images through the center of the C2 were used for assessment. The length from the top of the dens to the anteroinferior point of the vertebral body (DA), the length from the anteroinferior point of the vertebral body to the posterior point of the spinous process (AS), and the length from the top of the dens to the posterior point of the spinous process (DS) were measured. The correlation between stature and each parameter (DA, AS, and DS) was assessed using Pearson product-moment correlation coefficients and regression analysis was performed for stature estimation. All measurements of the C2 were positively correlated with stature regardless of sex. The highest correlation was observed for the DA in all. cases, and the lowest correlation was observed for AS in all cases. However, the standard errors of estimate were large. Thus, our study concludes that the size of the C2 as measured with MDCT images may be useful for stature estimation only when better predictors, such as long bones, are unavailable. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

This study assessed the correlation between stature and scapular measurements in a Japanese population, using three-dimensional (3D) computed tomographic (CT) images, and derived regression equations for predicting stature. A total of 194 cadavers (100 males 94 females) underwent postmortem CT (PMCT) and subsequent forensic autopsy in our department between May 2011 and April 2014. Left and right longitudinal scapular lengths (LLSL and RLSL, respectively) and left and right transverse scapular lengths (LTSL and RTSL, respectively) were measured on 3D CT reconstructed images that extracted only scapular data. The correlation between stature and each of the scapular measurements were analyzed using Pearson product-moment correlation coefficients. The four variables correlated significantly with stature, regardless of sex. The LLSL measurement had the lowest standard error of estimation value among all subjects (4.22 cm) and among all females (4.37 cm), whereas the RLSL measurement had the lowest standard error of estimation value among all males (3.75 cm). The results of this study indicate that scapular measurements may be useful for the forensic estimation of the stature of Japanese individuals, particularly in cases where better predictors, such as long bone lengths, are unavailable.