实验性轻度病毒性心肌炎的组织病理学观察

为探索轻度病毒性心肌炎的法医病理学诊断方法,以适量 Coxsackie B3病毒感染 Balb/c小鼠造成小鼠轻度病毒性心肌炎,对病鼠的心、肝、脾、肺、肾进行常规病理学检查。结果发现,心肌炎小鼠的各器官出现不同程度的病理改变。实验提示,病毒性心肌炎是一类多器官病变的疾病;对多器官进行病理学观察和综合分析是轻度病毒性心肌炎的组织病理学诊断的有效方法之一。     

大鼠脑挫伤后脑与其他器官组织中TNF-α表达的比较

目的 比较大鼠脑挫伤组织及其他器官组织中肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)表达的差异,期望为法医病理学脑挫伤的诊断以及损伤时间的判断提供理论依据.方法 对45例SD大鼠脑挫伤后脑组织及心、肝、脾、肺、肾等器官组织进行TNF-α免疫组织化学染色,观察脑挫伤对不同器官中TNF-α表...     

小鼠急性八角枫中毒的病理学观察

目的观察急性八角枫中毒小鼠器官组织病理学变化并探讨其中毒机制。方法应用八角枫须根水煎液对小鼠灌胃急性染毒,提取组织器官经HE染色后进行病理学观察。结果实验组主要病理改变为肺泡腔出血、肺间质出血,肝窦扩张、淤血,肝细胞水肿,蛛网膜下腔出血,其他器官呈淤血、出血性改变。结论八角枫毒性作用的主要靶器官或靶组织为肺、肝和血管平滑肌;毒性作用与剂量具有相关性。     

宝鸡市358例法医送检器官的组织病理学分析

目的 分析法医尸体检验后送检器官的病理学特征,总结此类案件的特点.方法 对宝鸡市法医送检358例尸体解剖器官标本进行常规检查并进行组织病理学诊断. 结果 358例中以青壮年男性为主,死亡原因主要为创伤、猝死、中毒.组织学能明确死亡原因250例,无典型组织学病变101例,组织自溶腐败7例.病理诊断以心血管疾病为主,其次为呼吸、神经、消化系统疾病. 结论 法医解剖具有专业特点,与病理解剖不尽相同.组织病理学检验进行死亡原因诊断时,应积极与法医沟通,以充分掌握案情、死亡经过及特定的法医病理学特征.     

61例儿童病毒性肺炎死亡案例回顾性分析

目的回顾性分析儿童病毒性肺炎死亡原因鉴定案例的法医病理学尸体检验及临床资料,探讨儿童病毒性肺炎的发病特点及病理学特征,为儿童因2019新型冠状病毒感染导致病毒性肺炎的病理诊断提供参考。方法收集南方医科大学司法鉴定中心近年来儿童死亡原因鉴定意见为病毒性肺炎死亡的尸体检验资料共61例,对性别、年龄、临床症状及病理学特征等进行比较分析。结果 61例病毒性肺炎死亡儿童中,年龄主要集中在2岁以内(83.61%),发病后2周内死亡占比较大(91.80%)。尸体检验大体改变包括呼吸道黏膜充血、胸腔积液、肺膨隆、肺胸膜浆膜花斑样改变、肺局灶性出血及肺水肿,肠系膜淋巴结肿大占比较高(83.61%),有21.31%的患儿存在胸腺发育不良。组织病理学改变主要包括肺泡和间质水肿、肺出血、肺泡上皮细胞脱落、肺泡内浆液性和(或)纤维素性渗出、病毒包涵体形成、透明膜形成,间质及肺泡内以巨噬细胞和淋巴细胞为主的炎症细胞浸润。病毒感染常累及心脏和胃肠道。结论儿童病毒性肺炎临床表现隐匿,因儿童免疫系统发育不健全、自身免疫力差,极易转化成重症甚至死亡。通过分析法医学尸体解剖及组织病理学特点,可为病毒性肺炎的病理诊断提供参考。     

肺结节病死亡法医学鉴定1例

<正>结节病（Sarcoidosis）在我国法医学实践非常少见，容易导致漏诊及误诊。本单位曾尸检一例“肺中叶综合征”肺切除术后大出血死亡的医疗纠纷案件，法医病理学检查证实死者患有肺、心、脾等多器官结节病，参考国内外文献对结节病的病理诊断标准及法医鉴定注意事项报道如下。     

过敏性休克死亡豚鼠器官中IgE的表达及其法医学意义

目的寻找法医学鉴定过敏性休克死亡的病理形态学诊断指标。方法利用组织芯片技术采用免疫组化SP法检测豚鼠过敏性休克死亡后0,6,12,24h等4个时间点的心、肝、肺、肾、脾、胃、肠、气管及扁桃体组织中的IgE的表达。结果实验组肺及气管组织IgE呈阳性表达,脾组织IgE呈弱阳性表达,以死亡即刻表达最强,且随死亡时间的延长而减弱,各时间点的显色信号强度存在显著性差异(P<0.05);实验组其它器官及对照组9个器官均无表达。结论应用免疫组化方法检测IgE在肺、气管、脾组织中的表达,可作为法医学鉴定过敏性休克死亡的病理形态学诊断指标;肺及气管组织IgE阳性强度随时间的延长而减弱,提示法医学鉴定过敏性休克死亡应尽早尸检。     

溺死尸体组织与溺液中硅藻种类的一致性研究

目的探讨溺死尸体组织器官与溺液中硅藻的种类的一致性。方法采用微波消解-扫描电镜联用法检测34具已知溺死地点尸体的肝、肾、肺以及溺液中的硅藻,并对各样本检出的硅藻种类进行一致性分析。结果肝组织、肾组织、肺组织和溺液中含量最多的硅藻依次为:舟形藻、菱形藻、针杆藻、直链藻、桥弯藻、小环藻;远端组织器官与肺组织,组织器官与溺液之间的硅藻种类一致率在0.44～0.68;远端组织器官(肝、肾)与肺组织中的硅藻种类一致率无统计学差异(P0.05);组织器官(肝、肾和肺)与溺液中的硅藻种类一致率无统计学差异(P0.05);溺死地点明确案例中有19例(19/34)肺组织和溺液可以被聚为一类。结论组织器官硅藻种类与溺液一致并非溺死诊断的必要条件。     

有关百草枯中毒的组织病理学研究——百草枯对实质器官的毒性

<正> 摄入百草枯后,在不同时间死亡的尸体上提取了所有的实质性脏器并作组织病理学方面的检验。检验结果如下: 在一天内死亡的尸体:肺水肿,急性肾小管坏死,肾上腺皮质凝固性坏死和出血,肝小叶中央脂肪变和灶状出血,在许多器官可见有血管内皮脱落和血栓形成。这些发现似乎描述     

法医病理学教学切片的质量控制与评价

<正>法医病理学是一门实践性很强的形态学科,在法医病理学工作中,组织病理学诊断,对确定死因有着重要意义[1]。阅读组织切片是法医病理实验教学的重要内容,而组织切片质量的优劣直接影响到病理诊断的准确性,从而影响到法医病理学实验课的效果。随着法医学教育的发展和在校学生人数的增长,原有教学切片数量、种类和质量已不能满足教学需要。为     

Sickle cell lung disease and sudden death: a retrospective/prospective study of 21 autopsy cases and literature review

Sudden death in the setting of sickle cell lung disease (SCLD), is periodically seen in the practice of medical examiners. The goal of the present study was to identify the most common pathologic findings of SCLD associated with sudden or unexpected death. A retrospective/prospective review of 21 autopsy cases from sickle cell patients between 1990 and 2004 was performed. Review of medical records, autopsy reports, and H&E-stained slides of lung tissue was performed. Oil-Red-O and elastic staining of lung tissue were evaluated. All cases were screened for both acute and chronic forms of SCLD. Patients admitted for sickle cell pain crisis ranged in age from 8 months to 65 years. Fifteen out of 21 cases (71.4%) showed significant pulmonary pathology. The most frequent lung findings included pulmonary edema (47.6%), pulmonary thromboembolism (38.1%), fat emboli (33.3%), pulmonary hypertension, grades I-IV (33.3%), and microvascular occlusive thrombi (28.5%). Our study demonstrates higher-than-expected percentages of acute and chronic sickle cell-related lung injury such as fat embolism (33.3%) and pulmonary hypertension (33.3%), with right ventricular hypertrophy (33.3%). Therefore, we propose a simple and high-yield autopsy algorithm of ancillary procedures that should be applied on all known and suspected autopsy cases of sickle cell disease.     

大鼠急性八角莲中毒的组织病理学变化

目的观察大鼠急性八角莲中毒后主要器官的病理形态学改变,探讨急性八角莲中毒的作用机制及其对靶器官、靶组织的损伤影响。方法随机将40只SD大鼠,分为3个实验组(0.5、1.0和2.0倍LD50剂量的八角莲水煎剂灌胃)和1个对照组(1.0倍LD50剂量的生理盐水灌胃)。大鼠在八角莲急性染毒后14d处死,解剖取脑、心、肝、肺、肾,样品经组织病理学处理后,光镜和电镜下观察大鼠主要器官病理形态学改变。实验数据采用χ2检验进行统计学分析。结果光镜观察结果:神经元胞质疏松,大部分尼氏小体消失;心肌细胞肿胀,润盘及横纹结构消失;肝细胞水肿、气球样变;肾近曲小管上皮细胞肿胀,管腔内见蛋白质样红色淡染物质。电镜观察结果:神经元细胞膜及核膜结构破坏,胞质明显水肿,细胞器大多已破坏、消失。急性染毒后4组大鼠死亡率随着剂量的增加而增高(P0.05)。结论急性八角莲中毒可引起多器官病理形态学改变,其毒性作用与剂量呈正相关性,且主要靶组织、靶器官为脑(神经元)、心、肝和肾。     

Reasons, circumstances and results of repeat forensic medicine autopsy

There are only scant literature data on reasons and circumstances of medico-legal second autopsies. The present study includes 12 second autopsies from the period 1992-1997; the first post-mortem examination took place either in the home country (institutes of pathology) or abroad. 7 of the 12 cases of death investigated happened in Germany (exclusively in hospitals) and 5 of them abroad (Netherlands, Romania, Portugal, Libya). Repeat autopsies were ordered by criminal courts (n = 9), private persons (n = 2) and social insurances (n = 1). The main indication was possible medical malpractice (n = 6); acts of violence (n = 3), insurance questions (n = 2) and accidents (n = 1) followed. The time lapse between death and second autopsy was 2-35 days. It was striking, that German institutes of pathology had partially performed autopsies despite the certification of a non-natural death. Clinical autopsies were stopped twice, when evidence of a possible non-natural death occurred. It could be fundamentally stated, that first autopsies in German institutes of pathology had been carefully performed and sufficiently documented. In these cases the second autopsy presented no or only little additional information, as far as the broader taking of (toxicological) samples is not considered. The final medico-legal expertise was then mainly based on the findings of the clinical first autopsy. However, the concurrence of the forensic expert (instead of the clinical pathologist) is undoubtedly essential for the evaluation of these issues involving frequently questions of malpractice. By contrast, the quality of postmortems performed abroad varies widely. 4 of the 5 first autopsies done abroad were regarded as completely or partly insufficient with superficial or almost absent preparation of organs or contradictions in the medical reports, respectively. A repeat autopsy is absolutely necessary in such cases. On the whole, the initial question could be answered in all second autopsies at least in part. This emphasizes the high value of second autopsies and expertises, especially in non-natural cases of death (10 of 12 deaths were finally judged as non-natural).     

Organ weight in 684 adult autopsies: new tables for a Caucasoid population

The weights of normal organs were retrospectively culled for the years 1987-1991 from 684 forensic autopsy cases. All the subjects were Caucasoid adults who died of external causes and showed no pathological changes. The weights of the following organs were available: the heart, the right and the left lung, the liver, the spleen, the pancreas, the right and the left kidney and the thyroid gland. The external parameters used for statistical correlation were the age, the height, the body weight and the body mass index (BMI) of the deceased. The weight of all the organs was shown to correlate with at least one external parameter, with the exception of thyroids in females. Organ weights decreased with age except for the heart and the thyroid, and increased in relation to body height and/or BMI. Except for the heart, the organ weight showed a better statistical correlation with the body height than the BMI. These updated tables of organ weight were compared with the data collected in previous studies. Such tables have to be regularly updated by pathologists in order to keep organ weight as a good criterion to be used in post-mortem diagnosis.     

Quantitative analysis of pulmonary pathophysiology using postmortem computed tomography with regard to the cause of death

Radiological lung transparency depends on the air contents involved in respiratory function. The present study quantitatively investigated postmortem lung air distribution in forensic autopsy cases (n=135) using computed tomography (CT) to analyze cardiopulmonary pathophysiology in the death process, involving emphysema, congestion and edema. Combined analyses of the CT morphology and attenuation value (Hounsfield unit, HU) of the bilateral lungs, with reference to histopathology, could categorize CT findings (10-90 percentile mode/mean HU values) with regard to the causes of death as follows: (I) hyperaeration (mode/mean HU below -760/-560: emphysema) for obstructive pulmonary disease, starvation and hypothermia (cold exposure); (II) mostly normal aeration with partial ground glass opacification (mode/mean HU, -850 to -360/-700 to -380: partial congestion and edema), consisting of subtype II-a with peri-bronchial/-vascular opacity for mechanical asphyxia, drowning and fire fatality, and subtype II-b with decreased vascularity for gunshot head injury, cerebrovascular disease and hemopericardium; (III) hypoaeration to airless with predominant hypostatic ground glass opacification (mode/mean HU, -870 to 0/-720 to -200: mottled hypostatic congestion and edema) for blunt head/neck injury, intoxication, hyperthermia (heat stroke) and congestive heart failure; (IV) hypoaeration to airless with predominant hypostatic consolidation (mode/mean HU, -790 to 0/-520 to -70: intense hypostatic congestion with edema) for acute ischemic heart disease; and (V) airless to consolidated (mode/mean HU over -420/-370: segmental or multiple patchy consolidations with edema) for pneumonia. Mode HU represents the major alveolar status, while the mean HU reflects the whole lung air contents. CT data analysis is useful for quantitative evaluation of pulmonary pathology as a supplementary procedure.     

电警棍反复电击引起动物行为、内脏器官活动与病理变化的初步观察

本文报道了用725型电警棍反复电击3只清醒犬所引起的行为反应、重要内脏器官活动变化。结合尸体解剖与组织学检查发现,持续高压脉冲电击可导致机体应激系统机能高度亢奋,但随电击的持续进行而转为逐渐低下,以致衰竭。从而出现各器官、系统不同程度的生理功能障碍和形态结构改变,甚至危及生命。为正确使用电警棍提供了一定的实验依据。     

过敏性反应死亡法医病理学研究

目的探讨过敏性反应死亡的法医病理学特点,从而解决困扰法医学工作者对过敏性反应死后诊断的鉴定要点。方法对华西法医鉴定中心1995―2004年尸检检出的26例药物过敏性死亡案例进行回顾性分析。结果本组26例药物过敏所致死亡案例的死者年龄以31-40岁的例数最多,占了38%;26例因药物过敏所致死亡的案例中,12例为青霉素类药物过敏,为引起过敏最常见的药物;而药物使用途径引起过敏反应死亡的案例中以注射为主,共20例;以个体诊所及基层医院多发生过敏反应死亡的案例;18例在使用药物后出现典型的严重的过敏性反应的临床表现;15例为在用药后半小时内发生死亡;病理解剖可见咽喉粘膜水肿20例,其中咽喉腔阻塞大于75%2例,50￣75%5例,25～50%7例,小于25%6例,显微镜下检查嗜酸性粒细胞浸润咽喉粘膜者21例、肺组织18例;6例血清IgE检测值呈现出显著的升高。结论过敏性反应的死后诊断应结合死者的生前临床病史,死亡时间,生前临床表现,病理解剖发现及血清IgE检测值综合分析。     

Methamphetamine in hair and interpretation of forensic findings in a fatal case

Hair analysis for drugs has been developing and is considered a significant tool for distinguishing between recent and long-term drug abuse in forensic and clinical toxicology. Chronic consumption of drugs can gradually induce certain harmful effects on the human organism and can exacerbate some pre-existing diseases. Analysis for drugs in blood or urine in isolation does not provide sufficient information about the history of drug-use by a person and their results cannot be correlated directly with the toxic effects displayed. The chronic abuse of methamphetamine is known to be associated with cardiovascular diseases. During or after autopsy certain types of morphologic alterations are found in the hearts of stimulant addicts. The rapid increase in blood pressure after an intravenous methamphetamine dose can be risky for addicts with arteriosclerosis. However, the anamnestic data about a deceased person may not always be available to explain the pathological findings and to classify the cause of death correctly. The aim of this study was to demonstrate the value of hair analysis for drugs in the context of explaining pathological cardiovascular alterations observed during the autopsy in a case where methamphetamine consumption was involved. In this case, only methamphetamine and metabolites were detected with traces of ephedrine. Ephedrine is the precursor chemical in the illicit synthesis of methamphetamine (known in the Czech Republic as "Pervitin"). The femoral blood level of methamphetamine was 1500 ng/ml. It was documented by a witness that the 31-year-old man died within 1h after an intravenous injection of the drug. The cause of death was established as cerebral edema due to cerebellar bleeding shortly after an intravenous dose of methamphetamine. Findings of methamphetamine in the first three 2-cm hair segments (numbered from the roots) were nearly equal (132+/-9 ng/mg). In the fourth 2-cm segment, it was approximately one-half of previous values. In the remaining, distal 7-cm hair segment sample, the value of methamphetamine was higher and comparable to the third segment. These results provide clear evidence that the man had been a chronic methamphetamine abuser for more than 8 months. This information can help to explain the pathology, the consequence of which could be the bleeding into the cerebellum after the last single methamphetamine dose.