TY - JOUR T1 - An autopsy report on multiple system atrophy diagnosed immunohistochemically despite severe ischaemic damage: a new approach for investigation of medical practice associated deaths in Japan JF - Journal of Clinical Pathology JO - J Clin Pathol SP - 1029 LP - 1033 DO - 10.1136/jcp.2009.065060 VL - 62 IS - 11 AU - M Nakajima AU - H Kojima AU - Y Takazawa AU - N Yahagi AU - K Harada AU - K Takahashi AU - K Unuma AU - K Yoshida Y1 - 2009/11/01 UR - http://jcp.bmj.com/content/62/11/1029.abstract N2 - A 60-year old man with a 10-year history of multiple system atrophy (MSA) was found in respiratory arrest. After 4 months of respiratory support with two episodes of septic shock, he died. Autopsy disclosed severe atrophy of the mesencephalon, brainstem, medulla oblongata and cerebellum. Gallyas–Braak, α-synuclein and ubiquitin-positive inclusions in the cytoplasm of glial cells were evident, despite the severe ischaemic damage due to respiratory arrest and subsequent respiratory support for 4 months. The cause of respiratory arrest was not identified, but could be explained by the natural history of MSA. The bereaved family, who had suspected malpractice, was satisfied with the explanation based on the investigation performed by eight expert doctors, one expert nurse, two coordinator nurses and two lawyers in the model project promoted by the Japanese government. ER -