20例脂肪栓塞死亡的法医学分析

目的分析脂肪栓塞综合征（fatembolismsyndrome,FES）死亡的一般情况以及法医病理学特点,为此类案件的法医病理学鉴定提供参考。方法选取某大学法医学鉴定中心1999—2012年20例FES死亡案件．对其一般情况及法医病理学特点（包括致伤方式、损伤类型、临床表现、病理学改变等方面）进行总结。结果脂肪栓塞主要见于损伤导致的长骨骨折和全身大面积软组织损伤,主要类型为肺脂肪栓塞,偶见合并脑脂肪栓塞。症状多出现在伤后和术后较短时间内,组织病理学检查可在肺小血管内检见大量脂滴并经特殊染色证实。结论FES死亡案例在损伤类型、脂肪栓塞出现症状时间及组织病理学表现等方面均有一定规律和特点。在鉴定中应注意进行特殊染色（油红0染色）处理,寻找FES的直接证据。     

肥大细胞类胰蛋白酶的免疫组化染色观察

目的　观察过敏性休克死亡者咽喉、肺、小肠组织肥大细胞类胰蛋白酶 (MCT) ,探讨过敏性休克死亡法医鉴定的形态学依据。方法　交通事故致严重颅脑损伤死亡者 10例 (对照组 )、明确诊断为过敏性休克死亡者 15例(实验A组 )和羊水栓塞死亡者 8例 (实验B组 )的尸体 ,分别取其咽喉部、肺及小肠组织 ,石蜡切片 ,HE染色及用免疫组化超敏SP法进行MCT染色。结果　实验A组的咽喉部组织充血、水肿 ,咽喉部粘膜下层MCT增多 (MCT颗粒计数为 48 2 3 ) ;实验B组的咽喉部粘膜下层MCT增多 (MCT颗粒计数为 42 72 )。肺间质尤其是小支气管壁及小血管壁上MCT增多 (MCT颗粒计数分别为 46 98和 43 5 0 ) ,小肠粘膜层MCT增多 (MCT颗粒计数分别为 48 2 3和 42 72 )。对照组的咽喉部、肺和小肠MCT颗粒计数较少 ,分别为 7 79、 12 94和 2 0 2 5。实验A组与对照组相比 ,两组具有显著性差异 (P <0 0 1) ;实验A、B组相比 ,两组无显著性差异 (P >0 0 1)。结论　过敏性休克及羊水栓塞死亡的尸体 ,其咽喉部组织、肺组织及胃肠道组织MCT增多。     

Tissue distribution of paraquat and diquat after oral administration in rats

The differential distribution of paraquat and diquat in liver, kidney, lung, brain and heart has been studied after oral administration of the LD50 or LD50/2 to rats. Paraquat concentrations were highest in all organs at 24 hours; at this time concentrations in kidney and lung were 2 to 3 times higher than at 2 hours. In contrast, with the exception of kidney, tissue diquat concentrations were highest at 2 hours. There was severe lung damage at 24 hours after paraquat; diquat aid not produce severe lung lesions, but caused intestinal distention and diarrhea. These findings suggest that the difference in the toxicity of paraquat and diquat is related to their difference in tissue distribution and excretion.     

家兔肺脂肪栓塞后超微病理学观察

目的 研究脂肪栓塞后肺组织的超微结构变化.方法 通过向实验组家兔血管内注射脂肪诱导肺脂肪栓塞制作肺栓塞动物模型,分别于栓塞即刻(0 h)和栓塞后3、8 h及1、2、7、14d处死动物;对照组家兔注射同等剂量的生理盐水,其余处理方法与实验组相同.经HE和苏丹Ⅲ染色证实造模成功后,用透射电镜观察肺组织的超微结构变化.结果 ...     

Fatal Fat Embolism After Penis Enlargement by Autologous Fat Transfer: A Case Report and Review of the Literature

Fat embolism is an incidental finding in cases of long bone fractures or other trauma, but it is also associated with liposuction and autologous fat transfer, a procedure where fat from liposuction is injected back into the same patient's face, breast, buttocks or penis. We here present a case of sudden death by fat embolism in a healthy young male, caused by a simple penis enlargement procedure, in which fat was injected into the penis shaft. We suggest that the risk of fat embolization might be higher when pretraumatized tissue is subjected to fat injection, like in this case, where a penis elongation was performed before the fat injection.     

Copper-binding protein in acute copper poisoning

This paper presents a suicide case of copper sulfate ingestion. Post-mortem autopsy revealed mucous membrane necrosis of the esophagus and the stomach. Histological examination revealed centrilobular necrosis in the liver and renal insufficiency. The quantitative determination of copper, zinc and cadmium in various tissues showed that the copper concentrations in blood, liver, kidney and lung were 3.5-24-fold higher than those of the normal level, whereas zinc and cadmium concentrations were within normal range. Chromatographical patterns on Sephadex G-75 showed that most of the accumulated copper in the liver and kidney was bound to metallothionein (MT), a low molecular weight protein with high metal binding capacity which plays a role in the detoxification of heavy metals, while no copper bound to MT was found in the lung. These results suggest that the formation of Cu-induced MT in the liver and kidney occurred at the early stage in fatal acute copper poisoning.     

肺动脉栓塞致死23例法医学分析

目的总结分析肺动脉栓塞致死的一般特点,探讨法医病理学鉴定要点及注意事项。方法对2001~2011年在中山大学法医鉴定中心鉴定的23例肺动脉栓塞案例进行回顾性分析。结果肺动脉栓塞致死以男性多见;发病年龄主要集中在31～70岁之间;主要诱因是严重外伤、长期卧床后运动,以下肢静脉系统血栓形成并脱落致肺动脉栓塞最为常见。结论对肺动脉栓塞致死案例法医病理学鉴定要点进行了总结。     

α-纤维蛋白原基因多态性与肺动脉栓塞相关性初探

目的探讨α-纤维蛋白原Thr312Ala基因的多态性分布与肺动脉栓塞的相关性。方法选取尸检已确诊的肺动脉栓塞病例的甲醛固定心肌组织14例和正常健康人群外周血56例,采用改良酚-氯仿法和Chelex100法分别提取心肌组织和外周静脉血基因组DNA,用PCR-RFLP法检测α-纤维蛋白原基因Thr312Ala多态性,并分析其与肺动脉栓塞的关联性。结果α-纤维蛋白原Thr312Ala基因的各基因型在肺动脉栓塞组与对照组比较差异具有显著性意义（P〈0.05）;各等位基因在两组间比较差异具有显著性意义（P〈0.05）;A等位基因与PE呈负相关（RR=0.475,P〈0.05）;G等位基因与PE呈正相关（RR=5.818,P〈0.05）。结论α-纤维蛋白原基因Thr312Ala位点G等位基因与肺动脉栓塞有正关联,肺动脉栓塞死亡者中GA、GG基因型分布频率较高,本文数据可为相关研究提供参考。     

新疆地区66例多类型栓塞死亡法医学尸检分析

总结分析不同类型的栓子(血栓、脂肪、空气、羊水)栓塞致死的一般特点,探讨其法医病理学鉴定要点及注意事项.对2015～2021年在新疆医科大学司法鉴定所鉴定的66例栓塞致死案例进行回顾分析.经过研究分析,导致患者出现栓塞的因素较多,栓塞致死以肺动脉血栓栓塞多见,另外空气栓塞、羊水栓塞和脂肪栓塞也不容忽视,其均能导致呼吸、...     

实验性兔羊水栓塞血浆NO和ET的含量变化

目的观察兔羊水栓塞(AFE)后血浆一氧化氮(NO)、内皮素(ET)含量的动态变化。方法采用怀孕家兔制作羊水栓塞动物模型,将不同性质的自身羊水注入兔血循环,分别在羊水注入前、注入后5min、45min从兔心脏取血,用镉还原法、放射免疫分析(RIA)法分别检测血浆中NO和ET的动态变化。结果注入羊水后ET含量显著增加,NO含量则显著降低,对照组无显著变化。NO与ET含量变化呈显著负相关。结论NO、ET的动态变化在羊水栓塞早期的一过性肺动脉高压及随后发生的DIC等过程中起重要作用。     

Postmortem changes in cytochrome c oxidase activity in various organs of the rat and in human heart

Cytochrome c oxidase (COX), a mitochondrial enzyme, is inactivated by cyanide or carbon monoxide (CO) intoxication. To test whether cytochrome c has potential as an indicator of these toxins in cadavers, we measured COX activity in the main organs of the rat, and in the human heart, at various times after death. Each tissue sample or organ was homogenized and the COX activity in the mitochondrial fraction was measured using ferrous cytochrome c as the substrate. COX activity was significantly higher in rat brain, heart and kidney than in lung and liver from 0 to 4 days after death. The loss of COX activity was significantly slower in the brain and heart than in the lung, liver and kidney. Most importantly, COX activity correlated with the time-since-death for each of the rat organs we tested (r2=0.70-0.95), but for the human heart (r2=0.47). It may be possible that COX activity is likely to be a useful indicator of the time-since-death, and is worth pursuing as an indicator of the tissue cyanide and CO content.     

盐酸曲马多在大鼠体内的分布特点

目的观察盐酸曲马多在大鼠体内的分布及其特点。方法大鼠以3倍和6倍LD50228mg/kg剂量盐酸曲马多灌胃染毒致死,取材,薄层色谱法检测其心、肺、肝、脾、肾、大脑和血内盐酸曲马多的浓度。结果3倍LD50剂量组大鼠肾、肺、血、肝、大脑、脾和心组织盐酸曲马多的浓度分别为112±15、59±17、53±31、32±19.7、22±11.5、20±20、16.7±8.3μg/g或μg/ml;6倍LD50剂量组大鼠血、肺、肝、心、肾、大脑和脾中盐酸曲马多的浓度分别为107.6±7.2、26.3±20、11.7±6.6、11.2±7.2、10.3±3.6、6.38±0.2、6.1±0.3μg/g或μg/ml。结论3倍LD50剂量组大鼠,肾、肺、血内盐酸曲马多浓度最高;6倍LD50剂量组大鼠血、肺、肝中盐酸曲马多的浓度最高。盐酸曲马多中毒时,血、肝、肺和肾可以作为法医毒物分析的检材。     

GC/MS法测定人体血液和肾、肝组织中的丙泊酚

目的 采用气相色谱/质谱法检测人体血液和肾、肝组织中的丙泊酚.方法 心血和肾、肝组织中的丙泊酚经环己烷提取,采用气相色谱/质谱法,丙泊酚选择m/z 163、178,内标百里香酚选择m/z 150、135进行测定;并考察方法专属性、线性范围、定量线与检出限、回收率与精密度.结果 丙泊酚的保留时间为8.17min,与内标百里香酚分离良好;其在心血和肾、肝组织中的检测浓度线性关系良好,r值均大于0.992,最低检测质量浓度分别为0.05 μg/mL、0.10μg/g及0.05 μg/g,方法回收率90％ ～ 110％,日内、日间RSD均小于7％.结论 本文方法简便、灵敏、快速,其准确度、精密度和回收率均可满足生物检材中丙泊酚浓度的测定,可在相关研究及实践中选用.     

脂肪栓塞中苏丹Ⅲ染色的定量分析

目的探讨苏丹Ⅲ染色如何定量应用于脂肪栓塞的法医学鉴定。方法应用苏丹Ⅲ对11例肺脂肪栓塞猝死的案例和11例其他原因致死的案例进行染色,并结合统计学方法对脂肪栓塞的阳性面积百分率及脂肪栓子数进行定量分析。结果脂肪栓塞致死者肺内苏丹Ⅲ染色阳性面积百分率为（5±1．7）％、脂肪栓子数为（9±2．4）％,均远大于其他原因致死的案例（P〈0．01）。结论苏丹Ⅲ染色法定量分析在脂肪栓塞中的法医学鉴定上结果可靠。     

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.     

Nonfracture-associated fatal fat embolism in a case of child abuse

Fatal fat embolism is usually thought of as a sequel to long-bone fracture, although cases secondary to soft tissue injury and atraumatic conditions have been infrequently reported. In this case of a two-year-old child-abuse victim who sustained multiple blunt traumatic injuries without skeletal fractures, pulmonary and systemic (brain and kidney) fat emboli were identified. At autopsy, all thoracic and abdominal viscera were intact; cranial contents exhibited only diffuse symmetrical petechial hemorrhages of the white matter. Because of the severe and widespread nature of soft tissue hemorrhage, and the absence of a grossly discernible cause of death, fat embolism was suspected. Using a combination of frozen section with oil red O staining and formalin-fixed osmium stained tissues, the immediate cause of death was determined to be diffuse fat embolism. Review of the literature reveals a pathophysiologic basis for fat embolism in the absence of fracture, both as a consequence of an acute increase in local pressure at the site of trauma and an alteration of the emulsification of blood lipids during shock. In light of these findings, we present this case to remind the forensic science community to consider fat embolism as the cause of death in cases of blunt-force injury without fracture.     

Retrograde venous cerebral air embolism from disconnected central venous catheter: an experimental model

There are few reported cases of death attributed to retrograde cerebral air embolism from central venous catheter. The pathophysiological mechanism and the necessary conditions are not fully understood, also because of missing experimental data. We performed experimental simulation while working on a possible case of retrograde cerebral air embolism. A hermetic system consisting of two containers connected to each other and to an electric pump by means of rubber hoses was built. In this system, a fluid (water and blood) could continuously flow under conditions similar to those of the common jugular vein. The part of the system representing the jugular vein could be freely positioned at angles between 0 and 90°. A central venous catheter was inserted into this part. After disconnection, the behavior of the air bubbles entering the hose through the tip of the catheter was evaluated at different positions. At angles between 0 and 45°, the air bubbles followed the fluid flow. At angles >45°, the air bubbles showed the tendency to flow upstream; this phenomenon was more evident the more vertically the hose was located. We were able to demonstrate that a retrograde air embolism can be caused by a disconnected catheter and is even more likely if the neck is in a vertical position.     

浮游生物16S rDNA检测在大鼠溺死鉴定中的价值

目的建立浮游生物16S rDNA PCR检脸法应用于溺死的鉴定。方法将15只SD大鼠随机分为溺死组、死后抛尸组和正常对照组,死后分别取脑、肝、肾和肺等脏器,提取DNA.用特异性引物扩增浮游生物16S rDNA第三和第四可变区特异片段。结果溺死组5例,肺全部检出(100%)浮游生物16S rDNA;肝、肾分别检出4例(80%);脑检出3例(75%)。死后抛尸组仅1例在肺中检出浮游生物(20%)。正常对照组均未检出。苗论浮游生物16S rDNA PCR检验法可用于溺死的鉴定。     

Occult Adrenocortical Carcinoma and Unexpected Early Childhood Death

A four‐year‐old previously well boy collapsed unexpectedly and was taken immediately to hospital, where he developed seizures and cardiogenic shock with lethal, rapidly progressing multi‐organ failure. At autopsy, the height was >90th percentile and there were indications of early virilization. Internally, a friable tumor of the left adrenal gland was identified that had invaded the left renal vein and inferior vena cava. Histology revealed typical features of an adrenocortical carcinoma with aggregated trabeculae of cells containing abundant eosinophilic cytoplasm and large pleomorphic nuclei. There was strong positive cytoplasmic staining for inhibin; mitochondria were shown on electron microscopy to contain prominent electron‐dense granules. Death was due to massive pulmonary tumor embolism. Although adrenocortical carcinomas are very rare and are more commonly found in adults, the current case demonstrates that they may also occur in childhood and be responsible for unexpected death by the very unusual mechanism of tumor embolism.     

Fat embolism syndrome associated with atraumatic compartment syndrome of the bilateral upper extremities: An unreported etiology

Fat embolism syndrome (FES) is a potentially life-threatening condition that develops when fat embolism leads to clinical symptoms and multisystem dysfunction. The classic triad of respiratory distress, neurologic symptoms, and petechial rash are non-specific, and the lack of specific laboratory tests makes the diagnosis of FES difficult. Although FES is most common after long bone fractures, multiple conditions some of which are atraumatic have been associated with the development of FES. We report a case of FES that occurred in the setting of a non-traumatic compartment syndrome of the upper extremities. The pathologic and clinical findings, pathophysiology, diagnostic challenges, and pathologic methods to properly diagnose FES are discussed with a review of the relevant literature. This case highlights the importance of the autopsy in making a diagnosis of FES in cases where death could otherwise be incorrectly attributed to multi-organ system failure, shock, or sepsis.