Toxicological analysis with mass chromatography-spectrometry has spread widely and quickly with the progress in ionizing methods.
This review describes new developments in mass chromatography-spectrometry research for forensic toxicology. Time-of-flight (TOF) mass spectrometry (MS) coupled with liquid chromatography (LC) has been developed for screening and for determining benzodiazepines with an exact mass database. All benzodiazepines have similar chemical structures and molecular weights, and, thus, show similar mass spectra and protonated molecule ions. Discrimination of mass spectrometry at low resolving power with LC-MS is usually difficult.
Benzodiazepines are widely used in medical practice in Japan, and data acquired from LC/TOF-MS measurements of 130 drugs, including benzodiazepines, were used to create an exact mass database. This database comprises molecular formulae, calculated exact masses, retention times and calibrations. In the analysis of samples from patients who had taken many drugs, selectivity was improved when the LC/TOF-MS exact mass database was used.
Comprehensive screening with LC/quadrupole TOF is the most effective method in forensic toxicology for analyzing the samples from cases of multidrug overdose. New developmental mass chromatography-spectrometry equipment is required because of the more precise and exact analyses in forensic toxicology.

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We report on 10 premature infants with acute hemolytic anemia and Heinz bodies treated from 1999 to 2007 and discuss their clinical characteristics. All patients were very low birth weight infants (mean gestational age, 27 weeks; range, 24～30 weeks; mean birth weight, 889g; range, 598～1,412g), and hemolytic anemia developed after cardiopulmonary adaptation had been achieved. Heinz body appeared an average of 20 days after birth (range, 11～25 days), and hemolysis persisted for an average of 9 days (range, 4～16 days) and spontaneously resolved. Hemolytic anemia and jaundice developed suddenly, during which time Heinz bodies were observed on hematologic examination. The affected infants showed refractory apnea just before the onset of hemolytic anemia.
The exact cause of these hemolytic episodes remains unclear. However, the immature antioxidant function of the red blood cell membrane against oxygen radicals was a suspected cause, because most of the infants required ventiratory managements with high concentration of supplemental oxygen.

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The basic knowledge of treating clinicopathological features is essential for analysis. In this note, we describe procedures for the analysis of clinicopathological features, with a focus on statistics.

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Pyogenic spondylitis most often presents with fever and low back pain, and delayed treatment increases the risk of nerve paralysis and vertebral destruction. We report the conditions and treatment plans of 58 patients with pyogenic spondylitis who were admitted to and treated in our department from 1989 through 2005. The patients were 42 men and 16 women with a mean age of 57 years. Most patients had been referred by other departments. The mean time to diagnosis was 48 days, and the mean hospital stay was 106 days. Pyogenic spondylitis most often involved the lumbar spine (36 of 58 patients, 62%). Motor paralysis was frequently observed in patients with cervical or thoracic disease (7 patients [70%] and 6 patients [50%], respectively) but rarely in patients with lumbar disease (1 patient, 3%). About half of the patients underwent surgical procedures, including computed tomography guided puncture, endoscopic puncture, and anterior spinal fusion. Causative organisms were identified with blood culture in 53% of cases and with specimen culture in 68% of cases. Thirteen patients had antecedent infections, and 60% of patients had underlying diseases, such as diabetes mellitus and cancer. It is important for pyogenic spondylitis to be diagnosed and treated early. We feel the need to enlighten orthopedic surgeons and all other physicians about the concept of pyogenic spondylitis.

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