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Publications (14)20.98 Total impact

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    ABSTRACT: Alcohol consumption before bathing is listed as a risk factor for sudden death in a bathtub, which occurs relatively frequently in Japan. This study aimed to clarify the epidemiology of alcohol-related deaths in bathtubs. Among all autopsy cases that were performed at the Tokyo Medical Examiner's Office between 2009 and 2010 (N = 5635), 357 cases of death in a bathtub were evaluated. Data regarding age, sex, blood ethanol level, manner and. cause .of death, alcohol consumption, and alcohol-related gastrointestinal diseases were extracted. The cases were divided into three groups according to their blood ethanol levels (no blood ethanol, low ethanol, and high ethanol), and their data were compared. A large majority of the cases in all groups involved persons who were 50-89 years old. The mean age of the high ethanol group (61.7 years) was significantly lower than.that of the control group (71.1 years; P < 0.01). In addition, the proportion of men was significantly higher in the low and high ethanol groups (70.1% and 75.5%, respectively), compared to that in the control group (55.9%; P < 0.05). Daily alcohol consumption was significantly more common in the low and high ethanol groups (49.5% and 87.8%, respectively), compared to that in the control group (23.2%; P < 0.01). Furthermore, alcohol-related gastrointestinal diseases were more common in the low and high ethanol groups (26.8% and 63.3%, respectively), compared to that in the control group (4.3%; P < 0.01). Preventive strategies for reducing alcohol-related deaths in bathtubs should target male habitual drinkers (middle-aged to seniors), especially patients who have been diagnosed with alcohol-related diseases.
    No preview · Article · Apr 2015 · Nihon Arukōru Yakubutsu Igakkai zasshi = Japanese journal of alcohol studies & drug dependence
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    ABSTRACT: Background Sudden bath-related deaths occur frequently in Japan, particularly among elderly people. However, the precise mechanism of bath-related death remains uncertain, and effective prevention strategies have not been established. Methods Cases of bath-related deaths (n = 3289) were selected from all cases handled by the Tokyo Medical Examiner’s Office from 2009 to 2011 (N = 41 336). The ages and occurrence dates were examined, and major autopsy findings, including toxicological analysis, were evaluated for the autopsied cases (n = 550). Results Most cases occurred in individuals older than 60 years of age during winter. Analysis of autopsy findings revealed water inhalation signs in many cases (n = 435, 79.1%). Circulatory system diseases constituted more than half of the pathological findings regarding factors that may have contributed significantly to death (n = 300, 54.5%), and cardiac lesions were the most common pathological finding (n = 250, 45.5%). However, approximately one-third of the cases exhibited no remarkable pathological findings (n = 198, 36.0%). A quarter of all cases involved blood ethanol levels that exceeded 0.5 mg/mL (n = 140). Conclusions The results suggested that drowning plays an important role in the final process of bath-related death. Circulatory system diseases may be the primary underlying pathology; however, there were variations in the medical histories and pathologies of cases of bath-related death. From a preventive perspective, family members should pay attention to elderly people with circulatory system diseases during bathing, particularly in winter. Additionally, the notion that ill or inebriated individuals should not take baths should be reinforced.
    Full-text · Article · Dec 2014 · Journal of Epidemiology
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    ABSTRACT: Caffeine is widely available in beverages and over-the-counter products; however, in large doses, it can lead to lethal arrhythmia. This study aims to clarify the characteristics of caffeine intoxication-related deaths in Tokyo, Japan. Among the 4754 forensic autopsy cases between 2008 and 2013 in which a toxicological investigation was performed, cases in which the blood concentration of caffeine exceeded toxic levels (15 μg/ml) were selected (N = 22). We examined subjects' ages, medical histories, direct/underlying causes of death, and manner of death. We also assessed concurrent drug substance detection and identified the origin of the caffeine. More than 60% of the subjects were between the ages of 20 and 49 years (n = 14, 63.6%). Sixteen cases (72.7%) showed a history of psychiatric diseases such as depression and sleep disorders. The underlying cause of death for all cases except two was caffeine intoxication, and manner of death was classified as undetermined (n = 11), accidental (n = 7), suicide (n = 2), or others (n = 2). Toxicological analysis revealed the presence of ingredients common to analgesics/cold remedies in 12 cases (54.5%). The origin of the caffeine was identified in 11 cases (50.0%); the proportion of identification was significantly lower among the cases in which analgesic/cold remedy ingredients were not detected (20.0%). Caffeine intoxication-related deaths mainly occurred in young and middle-aged persons with common psychiatric diseases. Psychiatrists should take note of caffeine dependence while diagnosing common psychiatric symptoms. In half of the cases, the origin of the caffeine was unidentified; nevertheless, dietary sources or over-the-counter drugs containing caffeine were suspected. As it becomes easier to obtain caffeinated products, continuous monitoring of the number of deaths from caffeine intoxication, in addition to detailed investigations of the caffeine's origin, will be necessary.
    No preview · Article · Oct 2014 · Nihon Arukōru Yakubutsu Igakkai zasshi = Japanese journal of alcohol studies & drug dependence
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    ABSTRACT: Background There has been increasing interest in the formal review of child deaths in Japan. In this study we examined the causes and scene information regarding child deaths from injury in Tokyo, the capital of Japan, as preparation for implementation of a full-scale review of child deaths. Methods Documents on deaths from injury (excluding homicides) investigated by the Tokyo Medical Examiner’s Office during the period from 2006 through 2010 were reviewed. Deaths of children younger than 18 years (N = 217) were selected as the study sample. We examined the cause of and information on the death and were particularly interested in whether a case had preventable factors. Results Overall, 67% of the cases were deaths from unintentional injury. The main cause of death among children younger than 1 year was asphyxia, and the proportions of deaths from traffic accidents were higher in older age groups. Thirty percent of deaths from injury were due to suicide, and all cases of suicide were among children older than 10 years. Although analysis of preventable factors was difficult in some cases, owing to limited information on the death scene, 87% of deaths from unintentional injury, excluding those involving traffic accidents, had preventable factors. Conclusions Most unintentional child deaths from injury appear to be preventable. Development of a system to collect detailed information on the scene at the time of death will help decrease child deaths in Japan.
    Full-text · Article · Apr 2014 · Journal of Epidemiology
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    Hideto Suzuki · Takanobu Tanifuji · Nobuyuki Abe · Tatsushige Fukunaga
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    ABSTRACT: Background: Annually, about 400 cases of sudden unexpected death are attributed to cancer in Tokyo, Japan. These individuals may have been undiagnosed, or their medical conditions may not have been carefully evaluated before death. We examined medical consultations, cancer diagnoses, and economic status of all cancer deaths investigated by medical examiners in 2009. Methods: Among cases handled by the Tokyo Medical Examiner's Office in 2009 (N = 12 493), records for all cases of cancer death (n = 400) were reviewed to determine the extent of medical care provided, diagnosis before death, and economic status of the decedent. Results: Most of the decedents (n = 232; 58%) had received a diagnosis of terminal/advanced cancer during a medical consultation. Most did not receive such medical consultations at home, despite their very weak physical condition. However, nearly one quarter of decedents (24%; 95/400) had not received a cancer diagnosis before death. The proportions of decedents who had been indigent, received no medical consulting, and had colon cancer were significantly higher among undiagnosed cases than among diagnosed cases. Indigent persons were the largest subgroup (n = 19; 43%) among those who had never received a medical consultation (n = 44). In addition, the proportion of those who had discontinued or received no medical consultation was higher among indigent persons than among non-indigent persons. Conclusions: The quality of medical services for cancer patients could be improved by educating general practitioners about terminal care, expanding efforts to monitor and diagnose cancer, especially among indigent patients, and increasing participation rates for colorectal cancer screening.
    Full-text · Article · Jan 2014 · Journal of Epidemiology
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    ABSTRACT: Background: Recently, the number of homeless persons in Japan has steadily decreased. However, it is not certain whether unexpected death of the homeless have actually decreased in proportion to decrease in total number of cases. Methods: The documentation of medicolegal deaths among homeless persons handled in the Tokyo Medical Examiner's Office during 1999-2010 were reviewed, and we compared the number and manner/cause of death between cases occurring before 2004 and those occurring after 2004. In addition, we compared manner/cause of death between homeless and non-homeless persons. Results: The number of medicolegal deaths of homeless persons remained almost the same during the study period in spite of a marked decrease in the total number of homeless persons after 2004. Age distribution shifted to older after 2004, and a higher proportion of the deceased had longer postmortem periods after 2004. Comparison between the manners/causes of death of the cases occurring before 2004 and those occurring after 2004 showed little difference. Disease constituted about 70% of all cases, and causes of death from disease were more various than those of non-homeless persons. Certain specific patterns included a higher proportion of death from circulatory disease in elderly homeless persons and a higher proportion of death from alcohol-related digestive disease and tuberculosis among younger homeless persons. Regarding accidental death, hypothermia was a leading cause of death irrespective of age group. Conclusion: Aging and isolation among homeless persons might contribute to an unchanged number of medicolegal death of them. In addition to measures to address frequent causes of death in each age group, better intervention for isolated homeless persons might be a key factor to prevent unexpected deaths of homeless persons in the future.
    No preview · Article · Nov 2012 · Legal Medicine
  • Hideto Suzuki · Takanobu Tanifuji · Nobuyuki Abe · Tatsushige Fukunaga
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    ABSTRACT: Purpose: Medical examiners and forensic pathologists often encounter emaciated bodies in postmortem examinations. However, the main disease that caused death is often not clear and measures to prevent the unexpected death of malnourished persons have not been established. In this study, we examined the underlying causes of death among a large number of forensic autopsy cases that showed emaciation to clarify the features of sudden, unexpected death in malnourished persons. Methods: Documents of autopsy cases without putrefaction handled during 2007-2010 by the Tokyo Medical Examiner's Office were reviewed (n=7227). The body mass index (BMI) was calculated for each case. The causes of death for cases with severe malnutrition (BMI<16; n=885) were closely examined. Results: About 70% of all deaths in malnourished cases (BMI<16) was due to disease, and the causative diseases are more varied than in those with less severe malnutrition and those without malnutrition (BMI⩾16). A higher proportion of malnutrition as the cause of death was observed in younger persons for both sexes, and a higher proportion of having a history of psychiatric diseases was observed in younger deceased women. In addition, a higher proportion of alcohol-related digestive diseases was observed especially in younger men, some of whom had a history of alcohol dependence. On the other hand, the proportion of organic diseases, such as neoplasms and gastroduodenal ulcer, was higher in older deceased persons, especially among men. Around 70% of all respiratory diseases comprised pneumonia in both sexes. Among non-disease-related causes of death, poisoning was the most frequent cause in women under 55years old (35.3%), with the majority having had a history of psychiatric disease. Conclusions: Because autopsy cases of malnourished persons show various causes of death, physicians have to pay more attention in making death diagnosis in such cases. From a preventative point of view, early detection of organic diseases, a better approach toward managing psychiatric diseases, and implementation of vaccination for pneumonia will contribute to reduction of future unexpected deaths among malnourished persons.
    No preview · Article · Sep 2012 · Legal Medicine
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    ABSTRACT: Japanese methods of death inquests are still in developmental stages and many problems have been uncovered since an inspection error was reported in 2007. In this study, we investigated the latest results of medicolegal deaths in the Tokyo Metropolis, which is composed of areas with and without the medical examiner system, and compared the results of inquests performed by official medical examiners with those by medical practitioners to re-evaluate the effectiveness of the medical examiner system for the Japanese death inquiry system.
    No preview · Article · Nov 2011 · Legal Medicine
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    A Ro · N Kageyama · T Tanifuji · M Sakuma
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    ABSTRACT: This study aimed to evaluate untreated, previous pulmonary thromboembolism (PE) in patients with acute fatal PE. We studied 64 patients diagnosed as having died from acute PE by medico-legal autopsy. Previous PE was histologically confirmed on the basis of organized thrombi (OT). The distributions of OT were analyzed in five different sizes of pulmonary artery branches in each of 18 pulmonary segmental arteries (90 in total). The frequency of OT in each patient was evaluated by determining the percentage of examined sections containing OT. OT were confirmed in 59 of 64 (92%) patients. The mean frequency of OT per patient was 27% of the 90 branches. Among the segmental arteries, the right posterior basal lobe showed the highest frequency of OT; among the five artery branches examined, the subsegmental branch showed the highest frequency of OT. OT were not detected in arterioles. Patients with recent trauma or surgery and inpatients showed significantly lower frequencies of OT than those without these risk factors. The 26 patients with prolonged pre-existing symptoms lasting more than a day showed a higher frequency of OT than the 12 patients who suffered for less than a day and the 26 without pre-existing symptoms. Most patients with acute fatal PE have a subclinical history of recurrent PE. The frequency of their untreated PE is suspected to correlate with specific risk factors for venous thromboembolism and their clinical course.
    Preview · Article · Feb 2011 · Journal of Thrombosis and Haemostasis
  • Ayako Ro · Norimasa Kageyama · Takanobu Tanifuji · Tatsushige Fukunaga
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    ABSTRACT: Pulmonary thromboembolism (PTE) has recently been the focus of research, with special attention to its clinical and medicolegal aspects. Deep vein thrombosis (DVT) is an important embolic source of PTE. We review the epidemiology, autopsy findings, pathophysiology, and clinical issues related to PTE and DVT in Japan based on our autopsy cases at the Tokyo Medical Examiner's Office.
    No preview · Article · Apr 2008 · Legal Medicine
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    Norimasa Kageyama · Ayako Ro · Takanobu Tanifuji · Tatsushige Fukunaga
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    ABSTRACT: In this report, we review the anatomical features of the crural veins and the importance of the soleal vein and its drainage veins for thrombi formation and propagation. The result of our investigation of 120 legs of 60 autopsy cases with fatal pulmonary thromboembolism showed that the soleal vein was the most frequent site of deep vein thrombosis, both for fresh and for organized thrombi. Furthermore, the detection rate of thrombi, both fresh and organized, showed that the most common site was in the soleal vein and then decreased progressively according to the drainage route of the soleal vein. Anatomical characteristics and physiological mechanisms play a major role in the occurrence and propagation of venous thrombi. Thus, an understanding of these features is essential for effective prophylaxis of venous thromboembolism.
    Full-text · Article · Jan 2008 · Annals of Vascular Diseases
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    ABSTRACT: As the pathological features of acute massive pulmonary thromboembolism (PTE) remain unclear, early diagnosis is difficult. We examined 14 autopsy cases of sudden death by massive PTE. Eight cases were male and six female, with a mean age of 57+/-18 years. While none of the cases were diagnosed with PTE during their lifetime, 12 cases had predicting factors for thrombosis. Deep vein thrombosis was found at autopsy in 11 cases. Cross sections of each segmental pulmonary artery were dissected for histological examination. The distribution of fresh thrombi and organized thrombi in the pulmonary arteries was investigated. Results revealed that 13 cases contained both fresh and organized thrombi. More detailed examination indicated that as the organized thrombi were spread in all lobes, the distribution of thrombi extended from the proximal to peripheral arteries. Our findings indicated that most cases of fatal PTE had a subclinical recurrent history. Thus, proper diagnosis and treatment of prior emboli may be vital for the prophylaxis of sudden death by PTE.
    No preview · Article · Apr 2003 · Legal Medicine
  • A. Ro · Y. Hisashi · N. Kageyama · T. Tanifuji · K. Hayashi · T. Fukunaga

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  • A. Ro · N. Kageyama · T. Tanifuji · T. Fukunaga

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