Emergency medical support system for extravehicular activity training held at weightless environment test building (WETS) of the Japan Aerospace Exploration Agency (JAXA) : future prospects and a look back over the past decade.

The Japan Aerospace Exploration Agency (JAXA) provides extravehicular activity (EVA) training to astronauts in a weightless environment test building (WETS) located in Tsukuba City. For EVA training, Tsukuba Medial Center Hospital (TMCH) has established an emergency medical support system, serving as operations coordinator. Taking the perspective of emergency physicians, this paper provides an overview of the medical support system and examines its activities over the past decade as well as future issues.

Postmortem computed tomography for detecting causes of sudden death in infants and children: retrospective review of cases.

Purpose: The aim of this study was to investigate the usefulness of postmortem computed tomography (PMCT) in detecting causes of sudden death in infants and children.

Materials And Methods: Our subjects were 15 nontraumatically deceased patients (nine boys and six girls, ranging in age from 20 days after birth to 12 years old, mean age 1.6 years), who had been in a state of cardiopulmonary arrest on arrival at our hospital.

Comparison between computed tomography (CT) and autopsy findings in cases of abdominal injury and disease.

We report 10 autopsy cases involving fatal pathological changes in abdominal organs, for which findings of computed tomography (CT) on admission or after death were compared with autopsy findings. Two of the cases were death due to natural causes and eight were death due to traffic accidents. From the findings at autopsy, the causes of death were considered to be rupture of an aortic aneurysm in one case, gastrointestinal bleeding due to gastric cancer in one case, retroperitoneal bleeding in two cases, laceration of the liver in three cases, and traumatic rupture of the small intestine in three cases.

Postmortem computed tomographic (PMCT) and postmortem magnetic resonance imaging (PMMRI) demonstration of fatal massive retroperitoneal hemorrhage caused by abdominal aortic aneurysm (AAA) rupture.

We report a case of fatal massive retroperitoneal hemorrhage caused by the rupture of an abdominal aortic aneurysm (AAA) in which postmortem computed tomography (PMCT) and postmortem magnetic resonance imaging (PMMRI) provided clear delineation. In this case, the autopsy imaging system using PMCT and PMMRI was useful as a screening method to determine the cause of death as AAA rupture and became a guide for the subsequent autopsy.

Postmortem magnetic resonance imaging (PMMRI) demonstration of reversible injury phase myocardium in a case of sudden death from acute coronary plaque change.

We report a case of sudden death from acute coronary plaque change in which postmortem magnetic resonance imaging (PMMRI) detected reversible injury phase myocardium. Postmortem computed tomography (PMCT) of the chest showed diffuse ground-glass attenuation (GGA) in both lungs, suggesting pulmonary edema due to cardiac pump failure. T2-weighted imaging (T2WI) of PMMRI delineated the left anterior descending coronary artery (LAD) territory as showing high signal intensity relative to the remaining myocardium.

Cardiovascular gas on non-traumatic postmortem computed tomography (PMCT): the influence of cardiopulmonary resuscitation.

Purpose: The purpose of this study was to investigate the causes of cardiovascular gas (CVG) detected on non-traumatic postmortem computed tomography (PMCT).

Materials And Methods: PMCT was performed on 247 subjects within two hours of non-traumatic death, including 228 patients who had undergone cardiopulmonary resuscitation (CPR) and 19 patients who had not. We evaluated the incidence and distribution of CVG in four areas of the heart, namely, 1) the upper course of the right atrium (UC-RA), 2) the right atrium, 3) the right ventricle, and 4) the left heart (left atrium, left ventricle, and aorta).

Postmortem computed tomographic (PMCT) findings of pericardial effusion due to acute aortic dissection.

Purpose: To describe the appearance of pericardial effusion in deceased acute aortic dissection patients using postmortem computed tomography (PMCT).

Materials And Methods: PMCT examinations were performed within 2 hours of death in 30 patients with pericardial effusion due to aortic dissection who arrived at our hospital in a state of cardiopulmonary arrest.

Results: Pericardial effusion in 18 of 30 patients (60%) showed double concentric rings on PMCT with striking differences in density, a low-density outer ring along the pericardium and a high-density inner ring on the epicardial surface (hyperdense armored heart).

Postmortem computed tomographic (PMCT) demonstration of the relation between gastrointestinal (GI) distension and hepatic portal venous gas (HPVG).

Purpose: The purpose of this study was to investigate the relation between gastrointestinal (GI) distension and hepatic portal venous gas (HPVG) on postmortem computed tomography (PMCT).

Materials And Methods: Our subjects were 190 PMCT obtained within two hours of non-traumatic death [175 patients underwent cardiopulmonary resuscitation (CPR) and 15 patients did not undergo CPR]. We evaluated the incidence and location of GI distension (0 = no distension, 1 = stomach and duodenum, 2 = more distal than 1) and HPVG (0 = no gas, 1 = left lobe, 2 = 1 + right anterior lobe, 3 = 2 + right posterior lobe).

Non-traumatic postmortem computed tomographic (PMCT) findings of the lung.

Purpose: We attempted to obtain postmortem computed tomographic (PMCT) images of the lung in cases of non-traumatic death and describe the results to distinguish usual postmortem findings from those of specific thoracic causes of death.

Materials And Methods: Our subjects were a total of 150 consecutive non-traumatic cases with cardiopulmonary arrest on arrival who were examined by CT within 2h after certification of death between January 1993 and December 2001. PMCT images of the lung and the frequency of imaging findings (dependent density, ground glass attenuation (GGA), consolidation, pleural effusion, and endotracheal (or endobronchial) air defect) were retrospectively reviewed.

Hepatic portal venous gas and hyper-dense aortic wall as postmortem computed tomography finding.

Postmortem computed tomography (PMCT) is useful for diagnosis of cause of death not only by emergency physicians but also medical examiners or police surgeons conducting postmortem studies. However, postmortem biological conditions are quite different from those in the living body. Hepatic portal venous gas (HPVG) and a hyperdense aortic wall (HDAW) are often found by PMCT, although no significant autopsy findings are evident in the liver or aorta.

Dilatation of the heart on postmortem computed tomography (PMCT): comparison with live CT.

Purpose: To delineate cardiac structures on postmortem computed tomography (PMCT) and quantitatively to prove dilatation of the heart after death.

Materials And Methods: Our subjects were 50 PMCT of non-traumatic deaths and 50 CT of living persons (live CT). We measured maximal and minimal diameters of the superior vena cava (SVC) at three levels (upper, middle, and lower), the inferior vena cava (IVC), pulmonary artery (PA), pulmonary vein (PV), right atrium (RA), and left atrium (LA).

Postmortem intravascular high-density fluid level (hypostasis): CT findings.

Purpose: To evaluate postmortem CT (PMCT) finding of hypostasis.

Methods: PMCT examinations were performed within 2 hours of death in 126 patients who arrived at our institution in nontraumatic cardiopulmonary arrest.

Results: PMCT showed hypostasis as high-density fluid level in the lumen of the heart or great vessels in 66 of 126 patients (52%).

Hyperattenuating aortic wall on postmortem computed tomography (PMCT).

Purpose: To quantitatively evaluate the finding of hyperattenuating aortic wall on postmortem computed tomography (PMCT) and investigate its causes.

Materials And Methods: Our subjects were 50 PMCT of non-traumatic deaths and 50 CT of living persons (live CT). The ascending aorta at the level of the carina was visually assessed regarding the presence or absence of hyperattanuating aortic wall and hematocrit effect on PMCT and live CT.