Nihon hōigaku zasshi = The Japanese journal of legal medicine
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Nihon Hoigaku Zasshi · Sep 2004
Review[Induction mechanism of shock: applying the etiology in judgment of the cause of death in forensic practice].
In the field of forensic medicine, shock has been identified as a cause of death owing to various kinds of exogenous insults. The etiology and pathogenesis of shock cannot be explained well by the usual gross appearance in medicolegal autopsies, because it is now generally established that the shock is a functional reaction of the vascular system to bodily injury, and that several organs are secondarily impaired during shock. Thus it seemed to forensic pathologists that these morphological changes in several organs after shock did not reveal any significant differences among the causes of death. ⋯ In every organ, a significant appearance of PMNs was observed in the hemorrhagic shock compared to the other causes of death. Especially, the appearance of PMNs in the heart was clear than that of the other organs in the hemorrhagic shock cases. Therefore, detecting the appearance of PMNs as a marker of shock induction is a very useful and significant method forjudging the cause of death in forensic practice.
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Nihon Hoigaku Zasshi · Sep 2004
Review[Pathophysiochemistry of acute death: an approach to evidence-based assessment in forensic pathology].
The essential social and academic task of legal medicine is to devote itself to a multidisciplinary approach to problems at the interface of medicine and law. It includes forensic medical activity, in which one of the social concerns is to investigate the fatal mechanisms, survival time and physical activity, especially in traumatic and unexpected sudden death, by means of forensic pathological procedures. To meet the social requirements through reliable interpretation of those issues, systematic practical investigations are necessary, establishing the evidence-based assessment in forensic pathology. ⋯ In the present paper, reviewing the literature, our data in routine casework are summarized. Routine forensic casework at our institute includes biochemistry on automated analyzer systems, immunohistochemistry using commercial kits and molecular biology by means of RT-PCR: 1) blood and urine biochemistry in general, 2) oxymetry, 3) serum and pericardial myocardial markers (creatine kinase MB, troponin I and T), 4) serum pulmonary surfactants (SP-A and -D), 5) other serum markers including C-reactive protein, neopterin, catecholamines, cortisol, erythropoietin and S-100 protein, 6) pericardial natriuretic peptides, 7) urinary myoglobin, 8) immunohistochemistry of a pulmonary surfactant (SP-A) in the lungs, ubiquitin, S-100 protein and ssDNA in the brain, and 9) RT-PCR for a pulmonary surfactant (SP-A) in the lungs, ischemia- and hypoxia-related factors (hypoxia-inducible factor 1A, vascular endothelial growth factor and erythropoietin) in the brain, heart and kidneys. Further accumulation of practical data may be essentially important to establish evidence for medico-legal assessment in individual cases and to renew forensic pathology in response to potential social requirements.