Under the revised Medical Service Law, in-depth investigations of unpredictable deaths in health facilities must be undertaken. To illustrate our suggested procedure for investigating the sudden death of inpatients, and to emphasize the importance of postmortem examinations, we discuss an unusual forensic autopsy case. An 82-year-old Japanese woman with a 17-year history of type 2 diabetes and angina pectoris suddenly died after the injection of a water-soluble, nonionic contrast medium called iso-hexol (Omnipaque). The forensic autopsy and postmortem blood examination revealed an elevated serum level of tryptase (242 μg/L), a normal serum levelof IgE (64 IU/mL) and 5076 μg/mL of iso-hexol, but no morphological evidence suggesting injury or disease. Therefore, the cause of death was confirmed as a fatal anaphylactoid reaction caused by the injected contrast medium. Although severely adverse reactions from nonionic contrast media are rare, patients should be observed carefully after administration of such compounds. This case also illustrates the importance of determining the correct cause of sudden death by performing an autopsy and subsequent analytical examinations. The possibility of anaphylactic/anaphylactoid reaction should be considered in all cases of sudden unexpected deaths in hospitals or clinics.

Anaphylactoid reactions

Sudden Death

10.4172/2329-9126.1000239

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Citations (1)

Author response for "Impaired eye movements in Parkinson's disease and their relationship to top–down and bottom–up neural processing"

Nobuhiro Takahashi Mimpei Kawamura Yasutaka Kobayashi Masahito Hitosugi

10.1002/brb3.3404/v3/response1

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Aortic Injuries and Rib Fractures Among Unrestrained Drivers in Frontal Collisions

American Journal of Forensic Medicine & Pathology (2010)

Masahito Hitosugi Toshiaki Nagai Shogo Tokudome Yasuki Motozawa

Hitosugi, Masahito MD, PhD; Nagai, Toshiaki PhD; Tokudome, Shogo MD, PhD; Motozawa, Yasuki BS Author Information

10.1097/paf.0b013e3181dfc99f

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Degree of injury severity of the traffic accident autopsy cases.

Nihon Kyukyu Igakukai Zasshi Journal of Japanese Association for Acute Medicine (1998)

Masahito Hitosugi Akihiro Takatsu Akio Shigeta Osamu Kitamura Kenji Fukui

交通事故剖検例171例(男126例,女45例,平均年齢45.3±21.5歳)に対してAIS-85, ISSを用いて重症度評価を行った。対象例の約50%が現場死群,21%が受傷後6時間以内の短期生存群であった。死因別では,胸腹腔内臓器損傷が約半数を占め,頭蓋内損傷がこれに続いた。全対象例のISS平均値は43.9±19.8であり,生存時間とISSの関係では長期生存群ほどISSは低値であった。現場死群を除いた受療群のISS値は32.8±13.0であり,死因別では胸腹腔内臓器損傷が34.9±14.8と最も高く,以下頭蓋内損傷33.7±6.6,二次性感染症30.1±11.6であった。受療群を対象とした検討では,65歳以上の高齢者群でISS値は27.1±10.1と有意に低値を示した。そして事故様式別では,ISS,頭部AIS値ともに自転車群で最も高く,車両群にて有意に低値であった。また,四肢AISは歩行者群で最も高値を示した。医療行為とISSの関係は開腹手術施行群で50.4±12.1と最も高く,開胸手術,開頭手術,保存的療法群ではおおむね30~33の範囲であった。外来処置のみの医療が3例みられ,その原因として塞栓症等が含まれた。交通事故による多発外傷死の剖検による重症度判定は,救急医学の領域での重症度判定にも参考になると思われる。

Traffic accident

10.3893/jjaam.9.173

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Cerebral oxygenation monitoring during resuscitation by emergency medical technicians: a prospective multicenter observational study

Acute Medicine & Surgery (2020)

Kunio Hamanaka Manabu Shimoto Masahito Hitosugi Satoru Beppu Mariko Terashima

To assess the feasibility and predictive ability of regional cerebral oxygen saturation monitoring during cardiopulmonary resuscitation by emergency medical technicians.This prospective observational study included 33 cardiac arrest patients who received cardiopulmonary resuscitation in a prehospital setting. Patients were connected to a near-infrared spectrometer through two disposable probes immediately after entering the ambulance. The monitor, which showed regional cerebral oxygen saturation readings, was obscured by covering it with a sheet of paper. Regional cerebral oxygen saturation was measured continuously until hospital arrival. Outcome variables included the prehospital return of spontaneous circulation, survival to hospital admission, and survival at 90 days.For patients who survived >90 days after hospital admission (n = 2), the mean regional cerebral oxygen saturation values upon ambulance and hospital arrival were 24% and 60%, respectively; for patients who did not survive (n = 31), the mean regional cerebral oxygen saturation values were 15% and 17%, respectively. Regional cerebral oxygen saturation values increased to a greater extent between ambulance arrival and hospital arrival in patients who survived >90 days (median, 36%; interquartile range, 32-40%) than in those who did not survive (0; 0-6%; P = 0.07). Additionally, regional cerebral oxygen saturation values were not related to the prehospital return of spontaneous circulation or survival to hospital admission.Regional cerebral oxygen saturation could be monitored during resuscitation by emergency medical technicians, and it can be used during physiological monitor-guided cardiopulmonary resuscitation.

Interquartile range

Oxygen Saturation

10.1002/ams2.528

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Severity of child pedestrian injuries due to bonnet‐type‐vehicle collision

Pediatrics International (2013)

Masahito Hitosugi Hitoshi Kawato Sayaka Gomei Koji Mizuno Shogo Tokudome

The aim of this study was to clarify the pattern of child pedestrian injury, injury severity, and its relation to collision velocity in bonnet-type-vehicle collision.In-depth data were retrospectively collected from the Institute for Traffic Accident Research and Data Analysis on pedestrians younger than 13 years old with any bodily injuries from collisions with bonnet-type vehicles between 1993 and 2004.Forty-seven patients from 43 collisions with a mean age of 6.9 ± 2.5 years were included in the study. Injury severity was not significantly different between patients who were hit by the front of the vehicle and those who were hit by the side of the vehicle. In front collisions, impact with the vehicle was associated with significantly higher Abbreviated Injury Scale (AIS) scores than those for impact with the road, especially for the lower extremities (mean: 1.2 vs 0.2, P < 0.001). Injury severity of the lower extremities and collision velocity were examined. The estimated collision velocity of the vehicle was not significantly different between patients with lower extremity AIS scores of 0 or 1 and those of 2 or 3.Some pediatric pedestrians suffer from collisions with bonnet-type vehicles without lower extremity fractures owing to the characteristics of child pedestrians. Providing injury prevention programs for children in communities and schools, developing active safety devices in the vehicle, and modifying the vehicle body to a pediatric pedestrian-friendly structure may increase pedestrian protection.

10.1111/ped.12140

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Mechanisms of Negative Fetal Outcome in Frontal Vehicle Collisions Involving Unbelted Pregnant Drivers

Healthcare (2020)

Arisa Takeda Yasuki Motozawa Marin Takaso Mami Nakamura Shinobu Hattori

To determine the cause of negative fetal outcomes and the causative mechanism in a frontal collision, we analyzed the kinematics and mechanisms of injuries using an unbelted pregnant dummy, the Maternal Anthropometric Measurement Apparatus dummy, version 2B. Sled tests were performed to recreate frontal impact situations with impact speeds of 13, 26, and 40 km/h. Overall kinematics of the dummy were examined through high-speed video imaging. Quantitative dummy responses—such as time courses of the abdominal pressure, chest deflection, neck injury criteria (Nij), and displacement of the pelvis during impact—were also measured. The maximum abdominal pressure of 103.3 kPa was obtained at an impact speed of 13 km/h. The maximum chest deflection of 38.5 mm and Nij of 0.36 were obtained at an impact speed of 26 km/h. The highest maximum chest deflection of >40.9 mm, Nij of 0.61, and forward pelvis displacement of 478 mm were obtained at an impact speed of 40 km/h. Although the kinematics and mechanism of injuries of the dummy were different for different collision speeds, we found that unbelted pregnant drivers suffer severe or fatal injuries to the fetus even in low-speed collisions.

10.3390/healthcare9010025

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Effect of seatbelt fastening position on placental abruption of pregnant occupant in frontal collision

Baioenjiniaringu Koenkai koen ronbunshu/Baioenjiniaringu Kouenkai kouen rombunshuu/Ippan Shadan Hojin Nihon Kikai Gakkai Baioenjiniaringu Koenkai (2019)

Jun Iwase Yasuki Motozawa Masahito Hitosugi Tetsuo MAKI Toshiaki SAKURAI

Placental abruption

Position (finance)

10.1299/jsmebio.2019.32.1d25

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