Department of Forensics Medicine , Kyoto Prefectural University of Medicine

�T　History

Department history

1894

　Shunichi Shimamura of the Department of Neuropsychiatry started lectures in forensic medicine.

1911

　The Department of Forensic Medicine was established in 1911. Mataichirou Kominami from Kyoto Imperial University became the first lecturer of forensic medicine at Kyoto Prefectural University.

1954

　The lecturer Kominami passed away and the assistant professor Toru Shakutani (thereafter became an honorary professor at Hokkaido University) engaged in the management of the department.

1957

　Shigeo Ogata of Tottori University became the first professor of forensic medicine at Kyoto Prefectural University of Medicine.

1958

　The first legal autopsy was performed on March 12th.

1965

　Professor Shigeo Ogata established the Medical Society of Alcohol Studies.

1974

　An assistant professor at Tokyo University, Kichihei Yamasawa became the second professor of forensic medicine at Kyoto Prefectural University of Medicine.

1981

　Professor Kichihei Yamasawa passed away suddenly.

1982

　Professor Setsuo Komura from Shiga Medical University became the department's third professor.

1997

　Professor Setsuo Komura retired.

1998

　Masahiro Yasuhara of the Tokyo Metropolitan Government Medical Examiners became the department's fourth professor.

2008

　Professor Masahiro Yasuhara retired from office.

2008

　Hiroshi Ikegaya from the National Research Institute of Police Science was assigned as the fifth and present professor.




Current procedures

since April 2008

　Commencement of the determination of the origins of unidentified cadavers.

since July 2008

　Inter-departmental autopsy consultation system.

since August 2008

　Dental inquests during legal autopsies.

since April 2009

　Drug quantification analysis.

since January 2010

　Introduction of CT imaging for autopsies.

February 2010

　Construction of dental database for unidentified cadavers.

April 2011

　A Buddhist sermon was held to mark the three thousandth autopsy. A memorial ceremony marking the hundredth anniversary of the establishment of the Department of Forensic Medicine.

September 2011

　Introduction of CT imaging (Hitachi ECLOS) of cadavers.

January 2012

　Establishment of a legal autopsy database.

March 2013

　UPLC-MS (ChromaLynx XS) is introduced.

August 2017

　Computed Tomography Suplia(5M) (HITACHI) renewal.





�U　A message from Professor Ikegaya

What is Forensic Medicine?

I think the role of forensic medicine is to determine a previously unknown cause of death, mainly through the utilization of medical knowledge, but also using information from other related areas, if necessary. In addition to the determination of the cause of death, it is also the task of forensic medicine to identify unknown corpses and to establish the cause of unexplained injuries among the living. The determination of cause of death shines light on the circumstances that led to the end of an individual's life, and is society's final act of mercy toward the dead. In this way, Japan's Postmortem Examination and Corpse Preservation Act is one way in which our society pays respect to the dead. A further function of the role of forensic medicine is to provide information on mortality trends and developing problems of the society that we are a part of. There is a dictum from Giovanni Morgagni, an eighteenth-century Italian anatomist: "Hic locus est ubi mors gaudet succurrere vitae". This refers to how information from the bodies of the dead may assist society, and it is the motto of the Department of Forensic Medicine at the Kyoto Prefectural University of Medicine. Forensic medicine is sometimes called the "medicine of the courts" because it plays an important role in criminal cases and legal courts. Its practitioners have a key role in determining legal guilt and appropriate, sentences. In addition, as part of the criminal justice system, which not only investigates and penalizes past crimes, but also seeks to prevent them in the future, it can be said that forensic medicine serves as a deterrent to some of the worst forms of crime. Forensic medicine plays a large role in civil cases, too: the cause of death has an impact upon such various matters as the amount of insurance paid to a bereaved family. Moreover, it is important to remember that a concerned society or bereaved family may simply wish to know a person's cause of death.





The present situation in Japan

In recent years, the number of unnatural deaths-all deaths not resulting from disease or old age, according to the definition of Japanese Society of Legal Medicine- has greatly increased in Japan. Compared to ten years ago, the number has doubled. Partly as a result of our aging society, if present trends continue, the number of solitary deaths will increase for some time. When someone dies alone, their death goes unreported and the cause of death is unclear. In such a situation, it is necessary to perform an autopsy to determine the cause of death. As a result, this social phenomenon has increased, and will continue to increase, the number of autopsies performed in Japan. In addition, if society develops further and becomes more complex, there is a potential for the increase of certain types of crime. In such a situation, it is necessary for forensic medicine to progress, and embrace new research and techniques, and perform innovative research which shines new light on established concepts. That is to say, it is necessary for us to raise both the quality and quantity of forensic medicine. However, in general, forensic medicine departments in Japan lack staff. In fact, Japan has a shortage of doctors practicing forensic medicine. In Japan, the annual number of undiagnosed causes of death is 140,000. Yet legal and administrative autopsies are performed in only 10,000 of these cases. This is because there are only around 150 forensic doctors throughout Japan. There are far fewer forensic physicians and far fewer autopsies conducted in Japan compared to other developed countries. In such a situation, it is feared that forensic medicine might fail to progress and lose its function before long. Actually, some universities do not employ professors of forensic medicine, and have no choice but to cancel courses of study in forensic medicine. If this staff shortage continues, other universities might follow the same fate. It is not recognized by the public that forensic medicine in Japan is confronted with this present crisis. However, as a result of pressure from forensic scientists, the status of forensic medicine is gradually improving. Our relatively early utilization of computed tomography (CT) when examining autopsy cases is one example of new method to identify the cause of death without performing an autopsy. In addition, two laws related to the investigation into causes of death enacted in June 2012 are expected to change the face of forensic medicine in Japan.





Characteristics of our laboratory

Despite forensic medicine originally involving a wide range of disciplines, presently forensic medicine classes cover a single specialized discipline. In contrast, our forensic medicine laboratory at Kyoto Prefectural University of Medicine, not including medical doctors, employs two pharmacists, two medical technicians, a dentist, a biologist and a law professor. Forensic medicine departments including professionals from various fields are extremely rare, and may not be found so easily. We are fortunate enough for our facilities to include such various testing equipment as a CT device and equipment for large-scale drug analysis and DNA analysis, all in satisfactory condition. Moreover, our laboratory has broad and deep connections with other clinical departments of Kyoto Prefectural University of Medicine, and has developed cooperative relationships, especially in relation to research. Therefore, we can conduct research in various fields, and from such research, we may establish causes of death though sophisticated multiple disciplinary approaches. With our specialists in so many areas, unless we worked together as a team, conducting research in these various fields would be problematic. Recently, in the world of clinical medicine, the concept of team medical care is presented more and more as the ideal. However, I feel that there are still many areas in which doctors can improve. When a doctor joins a forensic medicine department and cooperates with other members, they sometimes encounter difficulties due to differences in methods or knowledge between doctors and other medical staff. It is not until staff members cooperate with each other using their specialized skills and knowledge that the benefit of having staff with varied specializations becomes clear. It is hoped that skilled staff and facilities will improve further in the near future.




Future prospects and messages for persons who aspire to work in forensic medicine

Recent social issues include the decline of medicine and a shortage of medical doctors. While forensic medicine is not a clinical department it is facing the same problem. For forensic medicine, from both academic and social standpoints, these are extremely important issues that must be dealt with as soon as possible. Our laboratory primarily needs doctors who are able to preserve and lead our department. Simply put, in order to increase the number of autopsies, it is necessary to increase the number of doctors who can perform autopsies. If the number of autopsies increases, the number of unknown causes of death will decrease, which contributes to a safer society. It is hoped that we will able to increase the number of autopsies gradually, and be able to determine causes of death for all unnatural death cases needing autopsy in Kyoto. I emphasize and repeat that our laboratory is one of the best in Japan for research and issues of forensic medicine. It can be said that we can perform any task in our field, so we want as many new staff members as possible. For example, we are not concerned about a lack of autopsy experience in prospective doctors for our laboratory. We need members who can contribute to the development of forensic medicine using their specialties. If you want to contribute to society through the efficient use of your ability in forensic medicine, studying in our laboratory can make you a future leader in this field. Japan can afford to develop more, and to raise the level of practice of forensic medicine. We would like to work with persons from various fields. We would like you to help develop forensic medicine in Japan. We are looking forward to working with persons who take our statement to heart and are interested in forensic medicine.





�V　Laboratory

Postmortem Imaging

Since January 18, 2010, we have used CT scans for postmortem imaging to perform accurate diagnosis of the cause of death through checking for pathological lesions before autopsy. For various reasons, it is not possible for CT scanners meant for use with patients in hospitals to be used for postmortem examinations. In our laboratory, to assist in establishing the cause of death, we perform postmortem CT scans utilizing a recently introduced CT device used exclusively with cadavers. However, the diagnosis of internal pathological lesions in dead tissue through CT scans is not yet well established. We do not easily diagnose the cause of death solely through the use of CT imaging. If the cause of death cannot be revealed through such a CT imaging, we determine the cause of death through an autopsy. Because our university is a prefectural institution, as a medical service for citizens, we perform autopsies to assist the police in solving crimes and to maintain public safety in Kyoto Prefecture.





Forensic autopsy practice

Our laboratory carries out legal and administrative autopsies for Kyoto Prefecture and conducts forensic medicine classes for Kyoto University. Along with the increase in crime, the number of legal autopsies conducted in Kyoto is increasing year by year. Because our university is a prefectural institution, as a medical service for citizens, we perform autopsies to assist the police in solving crimes and to maintain public safety in Kyoto Prefecture. Starting in April 2008, for the first time in Japan, we established a formal, specialized medical investigation system through which other university departments conduct analysis where necessary, and the police meet the financial burden. Not only other forensic medicine departments, but also clinical medicine departments are working with us.





Autopsy requests

We perform not only autopsies but also such various analyses as the detection of drugs and toxins, the differentiation of blood and bloodstains from other bodily fluids, and DNA analysis. However, we do not accept autopsy requests from members of the public. All cases are carried out only through contact with the police. There are approximately 3,000 cases of unnatural death each year in Kyoto Prefecture. After postmortem inspection, about 200 cases in which the cause of death cannot be determined or is thought to be crime-related become autopsy cases. If a dead body is found and criminality is suspected an autopsy is usually conducted. All autopsy costs are met by the government. Besides autopsies, pathological examinations and drug and toxin analyses are also conducted in order to determine the cause of death with the greatest possible accuracy. Furthermore, despite these examinations, it is believed that it is not possible to determine the cause of death in 15% of autopsy cases. On behalf of Kyoto Prefecture, we can now also conduct autopsies where no criminal activity is suspected. These examinations are administrative autopsies, and their rate of implementation is limited relative to autopsies in criminal cases. However, sometimes they reveal the cause of death, which may influence insurance claims. When a family member's cause of death is uncertain, please inform the police. In addition to examination of cadavers, analysis of urine, blood and hair samples from the living for the presence, type and amount of drugs and toxins is conducted on request from the police. Detailed results from legal autopsies cannot be revealed to the bereaved family without permission of the police. Only the police may inform the family of the deceased of details from autopsies.






�X　Research

Studies in Medical Law and Ethics

Recent achievements are in the areas of the Brain Death and Organ Transplantation Act, clinical research regulations, the Basic Medicine Act and alternative dispute resolution in medically-related cases. In addition, we perform activities that aim to have practical research applications for our associated university hospital, such as the creation of a Hospital Ethics Committee and improvement of medical safety.





Studies in Forensic Toxicology

One part of determining the cause of death in autopsy cases is establishing the presence, type and quantity of alcohol, drugs and toxins. We determine the presence of drugs or toxins in such specimens as blood obtained during legal autopsies and investigations by the police. Toxicological analysis plays an important role in the determination of the cause of death though the identification of drug types, the drug quantities and the distribution of drugs in the body. Moreover, we are actively conducting essential research into drug addiction and drug abuse utilizing data collected from autopsy cases.





Medical and biological studies on alcohol consumption and the formation of alcohol dependence

Testing on animals and extrapolating the results to humans, we perform neuropharmacological and neurochemical analysis on alcohol tolerance formation, which is clearly a central cause of alcoholic dependence and various drinking behaviors.





Studies on the brain's susceptibility and resistance to reperfusion injury after ischemia

Reperfusion injury after ischemia causes critical complications in the brain. On the other hand, some reports say that the brain demonstrates its resistance to ischemia. We are conducting research on this brain site-specific resistance to ischemia from a neurochemical aspect.





Studies on age-related changes in eating behavior

We are conducting research on age-related changes in eating behavior by investigating interactions between such substances such as hypothalamus leptin, ghrelin, NPY, uncoupling protein and neurological activity of serotonin in the raphe nuclei.





Neurochemical research investigating the effectivness of alternative medicine acupuncture therapy

We are investigating the therapeutic effect of acupuncture, particularly through the use of scientific models in toxicology, in order to investigate stress-related pathology.





Studies regarding legal issues of complementary and alternative medicine

Complementary and alternative medicine means non-Western medicines: for example, aromatherapy and chiropractic treatment. They are gaining recognition as supporting tools of contemporary medicine. However, complementary and alternative medicine have some limitations. For instance, some patients are harmed by procedures performed by unlicensed practitioners. Bringing action in court is not uncommon and therefore there are strong possibilities that various legal problems may emerge in the future.





Methods for identifying the geographic and ethnic origin of the deceased.

In collaboration with the National Research Institute of Police Science and Forensic Medicine and Chiba University, we have developed methods for identifying the geographic and ethnic origin of the increasing number of unidentified autopsy cases. In addition to human DNA, our method may utilize viral and mycotic genomes such as JC virus, BK virus, EB virus and Candida albicans as markers. In addition, regarding infections that become issues when dealing with a dead body and tissue samples, we determine the risk of infection and investigate rapid diagnostic methods.





Development of blood type and infection examination method using DNA chips

In partnership with the National Research Institute of Police Science, we are developing DNA chips that are utilized for ABO blood type determination during criminal investigations.





Regarding Article 21 of the Medical Practitioners Act and informed consent

Under Article 21 of the Medical Practitioners Act doctors are required to report unnatural deaths. However, it is not clear whether deaths resulting from medical treatment are unnatural deaths under Article 21 of the Medical Practitioners Act , and in regard to this there is a divergence of opinion between clinical associations and the Society of Legal Medicine. We have revealed that informed consent and notification of unnatural deaths resulting from medical treatment are closely related. In addition, we are at the same time investigating medical law and ethics and the relationship between Article 21 and informed consent.





Investigations into the relationship between unnatural death and environmental factors

Through data regarding legal autopsies we have investigated and are continuing to investigate the relationship between crime and various environmental factors such as weather and temperature.






�Y　Research/Ethical review

Correlation between concentration of polyamines in blood and cause of death

We are investigating the correlation between polyamines in the blood and cause of death in legal or administrative autopsy cases that were performed by the Department of Forensic Medicine at the Kyoto Prefectural University of Medicine between April 2008 and October 2009. Through the utilization of clinical data we hope to detect cancer and inflammatory disease. Personal information is protected. The results of our studies are announced officially at conferences and in research papers.





Correlation of cytochrome C oxidase activity and age

We are investigating age-specific test results of cytochrome c oxidase of legal from administrative autopsy cases that were performed by the Department of Forensic Medicine, Kyoto Prefectural University of Medicine between April 2008 and April 2009. It has been reported that cytochrome c oxidase decreases its various functions with age. Therefore we are investigating the possibility of estimating age of cadavers through the measurement of cytochrome C oxidase activity of mitochondria. These studies only utilize examination data that is commonly collected during postmortem examinations. Personal information and identities are protected. The results of our study are officially announced at conferences or in research papers.





The estimation of time of death through the analysis of postmortem creatinine concentrations in the blood

We are investigating the possibility of estimating postmortem time from concentrations of creatinine in the blood of legal or administrative autopsy cases that were performed by the Department of Forensic Medicine at the Kyoto Prefectural University of Medicine between April 2008 and March 2010. We are investigating the possibility of estimating time of death from creatinine concentrations in blood used during the diagnosis of the cause of death. This study uses only examination data from routine tests. Personal information and identities are protected. The results of our study are announced officially at conferences and in research papers.






�Z　Inquiries

Address


Department of Forensics Medicine, Kyoto Prefectural University of Medicine

Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto.

602-8566

JAPAN

TEL/FAX　075-251-5343

E-mail　hoi@koto.kpu-m.ac.jp




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