越智 拓

Methamphetamine induces several cardiac dysfunctions, which leads to arrhythmia, cardiac failure and sudden cardiac death. Although these cardiac alterations elicited by methamphetamine were thought to be due to an indirect action of methamphetamine, namely, an excessive catecholamine release from synaptic terminals, while it seems likely that methamphetamine directly modulates the functioning of cardiomyocytes independent of neurotransmitters. However, the direct effects of methamphetamine on cardiomyocytes are still not clear. We show that methamphetamine directly accelerates the beating rate and alters Ca2+ oscillation pattern in cultured neonatal rat cardiomyocytes. Adrenergic receptor antagonists did not block the methamphetamine-induced alterations in cardiomyocytes. Treatment with a ryanodine receptor type 2 inhibitor and a sarcoplasmic reticulum Ca2+-ATPase inhibitor did not affect these responses, either. In contrast, the L-type Ca2+ channel inhibitor nifedipine eradicated these responses. Furthermore, methamphetamine elevated the internal free Ca2+ concentration in HEK-293T cells stably transfected with the L-type Ca2+ channel alpha 1C subunit. In neonatal rat cardiomyocytes, methamphetamine accelerates beating rate and alters Ca2+ oscillation pattern by increasing Ca2+ entry via the L-type Ca2+ channels independent of any neurotransmitters. (C) 2009 Elsevier Inc. All rights reserved.

GC-FID is the method of choice for alcohol screening and quantitative analysis in modern forensic medical practice. Although specific enough for routine use, some results could be misleading. In the current article we present a case of sexual asphyxia with drug and volatile substance abuse. Toxicological analysis revealed the presence of methamphetamine at a concentration of 1.3 mu g/mL in blood. An ethanol-like peak was detected during our routine GC-FID test for alcohol (methylethylketone IS). Subsequent GC-MS analysis identified the peak as ethyl chloride. Levels of 0.05 mg/mL in blood and 0.01 mg/mL in urine were measured. Two facts proved misleading in our case. First: very small difference of 0.027 between the ethyl chloride and ethanol peaks in relative retention times at the GC-FID chromatograms. Second: missing evidence for the use of ethyl chloride at the scene-neither cans of the substance were found, nor such information was available otherwise. Conclusion: there is a substantial risk for mistaking ethyl chloride for ethanol, when ethyl chloride abuse is unanticipated. In the case of slightest uncertainty a GC-MS analysis should be employed to reliably determine the actual substance. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

To enhance the quality and safety of medical care, the Ministry of Health, Labor and Welfare (MHLW) launched a model project in September 2005 for investigation and analysis of medical practice associated deaths in an attempt to move the existing system in a different direction. The project, initiated in Tokyo, Osaka, Nagoya, and Kobe, has now been implemented in nine prefectures. In the hope that the model project will lead to the nationwide development of medical safety investigating committees, the MHLW has submitted a provisional third plan. Based on our practical experience of the model project in Osaka, we present and discuss practical problems and legal issues involving surgeons' criminal punishment. © 2009 Elsevier Ireland Ltd. All rights reserved.

A 59-year-old man was carried to the hospital by three men. The deceased was unconscious at admission and his face was severely swollen with many subcutaneous hemorrhages and extensive edema. His death was confirmed 17 min after resuscitation. A judicial autopsy was performed the next day. Findings showed that the victim's face and head were reddish and swollen, and that subscalp bleeding was ubiquitous, but no skull fracture, epi- and subdural hematoma or subarachnoidal bleeding was observed. The brain itself was severely edematous but no bleeding was found. Although small hemorrhages were seen in the limbs and back, there were no marked wounds except to the head. To determine the cause of death, we performed a microscopic histochemical examination. Conventional H.E. staining disclosed eosinophilic change, concentration of nuclei, edema, gliosis, and oozing at the corpus callosum. To identify further details of the cause of death, we used Bodian staining, Kluver-Barrera staining, anti-beta amyloid immunostaining, and anti-neurofilament immunostaining. We found sinusoidal swelling of axons and waving axons, which are typical findings of Diffuse Axonal Injury (DAI), but no positive staining of beta amyloid. Focal lesions of the corpus callosum and of the dorsolateral quadrant of the rostral brain stem, and diffuse damage to axons are considered to constitute the DAI triad. We therefore diagnosed the cause of death as DAI. Our experience shows that it is important to use several staining methods for diagnosis of a variety of neuronal degenerative disorders. Several days later, we were informed by the police that several men had hit and kicked the victim in an attempt to lynch him. To compare with this case, we also report two other cases in which DAI was observed. © 2009 Elsevier Ireland Ltd. All rights reserved.