The Tokyo Metropolitan Government has a medical examiner system, in which all cadavers classified as "unusual death" in the city of Tokyo should be examined, and if necessary, autopsied to determine the cause of death. Of about 10,000 unusual deaths examined per year, two thirds are usu ally determined to have died of natural causes. The most common cause of sudden natural death is ischemic heart disease, especially acute myocardial infarction. Pathological examination, however, proves acute myocardial ischemia in only one third of autopsies. Subarachnoid hemorrhage and intra cerebral hemorrhage, acute myocarditis and cardiomyopathies and aortic dissection/aneurysm as well as pulmonary thromboembolism are frequent causes of death in medical examiner cases. Both patholog ical and socio-medical problems associated with these diseases are discussed.

Because the images provided by the ICG system are clearer than conventional ICG images, it could facilitate real-time navigation for laparoscopic anatomic liver resection.

The prognosis and recurrence pattern of right-and left-sided colon cancer in Stage II, Stage III, and liver metastasis after curative resection

No abstract

The level of proviral DNA in peripheral blood mononuclear cells from a representative group of asymptomatic HTLV-I carriers in Miyazaki district, an HTLV-I endemic area in Japan, was determined by a single-cycle polymerase chain reaction method (PCR). Of 217 subjects, 26% had a high level of proviral DNA, 43% a medium level, 18% a low level, and 13% an undetectable level. In the high-DNA group, 60% had at least 0.6% abnormal lymphocytes on peripheral blood smears, significantly higher than in those with low DNA levels (19%). This association was present for men of all ages and for women under 55. Men were more than twice as likely to have abnormal lymphocytes as well as high levels of proviral DNA. These differences may reflect different host responses to the virus by sex or by the time or route of infection. This study supports the utility of PCR for molecular screening in epidemiologic studies of the natural history of HTLV-I, and may lead to the identification of those carriers who are at greatest risk of developing HTLV-I-induced malignancy.

To clarify the pathogenesis of the widely known but obscure syndrome of sudden death with hepatic fatty metamorphosis observed in alcohol abusers, we have scrutinized both the clinical and pathological data of 11 subjects who died under such circumstances between 1987 and 1993. Death followed several days of uninterrupted drinking often with little dietary intake. The notable clinical features on arrival at the emergency room were disturbance of consciousness (11/11), hypotension (4/6), hypothermia (3/5), hypoglycaemia (8/11), metabolic acidosis (6/6), renal dysfunction (11/11), and hyperammonaemia (5/5). The common hepatic pathology was the extensive appearance of numerous microvesicular fatty droplets in the hepatocytes together with varying degrees of macrovesicular fatty change; four subjects had an underlying cirrhosis. Death undoubtedly results from a variety of metabolic disturbances triggered by the combination of massive ethanol intake and starvation. The appearance of extensive microvesicular fatty change superimposed on macrovesicular fatty change was considered to be an associated phenomenon.

Coronary artery bypass graft (CABG) surgery has been performed for about 40 years. In 1967, the technique of saphenous vein (SV) bypass grafting was introduced, followed 1 year later by the use of internal thoracic artery (ITA).1) Whereas ITA is the first-choice arterial graft, 2,3) SV still continues to be the most commonly used conduit vessel for CABG 4,5) because of ready availability and suppleness. One of the most serious problems in CABG surgery is that the bypass grafts often go into spasm after implantation into coronary arterial circulation, which has led to premature occlusion and increased perioperative morbidity. 6,7) Among substances that can initiate severe vasoconstriction, 5-hydroxytryptamine (5-HT) has been identified as playing an important role in the pathogenesis of vascular spasm. [8][9][10][11][12][13] Although 5-HT 2A and/or 5-HT 1B/1D receptor subtypes almost exclusively mediate 5-HT-induced vasoconstriction, [8][9][10][11][12][13][14][15][16][17][18] the relative contributions of these receptor subtypes to vasoconstrictions are species-dependent and vascular beddependent. Therefore, the selection of the best pharmacological agent to prevent 5-HT-induced spasm of the bypass grafts used in CABG surgery requires better understanding of the contributions of 5-HT receptor subtypes to vasoconstriction in the clinically used human vessels.From the viewpoint mentioned above, we revealed that 5-HT-induced vasoconstriction is mediated equivalently via 5-HT 2A and 5-HT 1B receptors in the human ITA.18) In the human SV, Borton et al. 14) have reported that both 5-HT 1 and 5-HT 2 receptors are involved in vasoconstriction by using a 5-HT 2 receptor antagonist and a 5-HT 1 receptor agonist. However, the relative contributions of 5-HT receptor subtypes that mediate vasoconstriction caused by 5-HT in the human SV are still unclear.It has been established that, before implantation into the coronary arterial circulation, the segment of SV used as a vein graft is distended by applying high intraluminal pressures with injection of saline or a patient's heparinized blood to check for leaks and to increase the vascular diameter. This fact should be considered in experiments for evaluation of 5-HT receptor subtypes responsible for vascular functions because the distension may influence both contractile and dilatory responses of the SV. 19)The aim of the present study was to elucidate the relative contribution of 5-HT receptor subtypes mediating 5-HTinduced vasoconstriction of the distended human SV obtained from CABG surgery. We examined the effects of sarpogrelate and SB224289, antagonists of 5-HT 2A and 5-HT 1B receptors, respectively, on the 5-HT-induced vasoconstriction and also performed immunolabeling of the 5-HT 2A and 5-HT 1B receptors in the distended SV. MATERIALS AND METHODS Preparation of Blood Vessels and Contractile StudiesSegments of the human SV were harvested from patients (nϭ12) who were undergoing CABG surgery at Miyazaki Prefectural Nobeoka Hospital (Miyazaki, Japan). Once the vein was comp...

C NMR and fast atom bombardment mass spectra studies. Based on the spectroscopic data, this product was assumed to be a modified compound of chlorhexidine (molecular weight, MW; 530). From the proposed structure, CHDI-C was assumed to be a new chlorhexidine degradation intermediate.