钝力性心脏外伤38例尸检病理学研究

本文研究表明钝力作为原始致伤因素作用于胸部通过压、拉、剪切、旋转等可引起钝力性心脏外伤包括心脏震荡、心脏挫裂伤、心脏玻裂、心脏断离等原发性心脏外伤和继发性乃至迟发性心脏外伤，诸如外伤性心脏炎、冠脉血管炎、血栓形成、外伤性心肌梗塞、外伤性冠状动脉瘤、外伤性室壁瘤、迟发性外伤性心脏破裂等。致命性的心脏震荡，除急性冠循环障碍和心失常外，还可有心脏传导系统和神经组织损伤，尤其心肌肌膜爆裂（ｓａｒｃｏｌｅｍｍａｂｕｒｓｔ）及相应的原纤维膨出畸形变可以作为心脏震荡性外伤的形态学指证。外伤性心肌梗塞和迟发性外伤性心脏破裂以突然发生在外伤后的一定间隔期为特征，应予特殊注意．     

Cardiac Ventricular Laceration Due to Child Abuse: Abusive Ventricular Laceration

Traumatic cardiac ventricular ruptures in children are rare. Only a single case of left ventricular rupture due to child abuse has been reported. We report a child who sustained a fatal left ventricular apical rupture. It appeared to have resulted from hydrostatic forces resulting from abusive blunt thoracic injury. That he was being abused was previously missed when he was presented to the emergency department with facial pyoderma. It was not noted that he also had lip and oral mucosal injury, sites not affected by staph toxins. As a result, his underlying, abusive and secondarily infected, facial flow type scald burn was not appreciated. Within a week thereafter his fatal injury occurred, accompanied by extensive and obvious associated abusive injuries. Postmortem high‐detail whole body computed tomography scanning aided the autopsy. Although rare, ventricular rupture from abusive blunt thoracic injury can occur.     

Commotio cordis, revisited

Nonpenetrating cardiac injuries due to direct precordial blunt impacts are a commonly encountered phenomenon in medicolegal offices. These injuries vary from contusions to valvular lacerations, or papillary muscle rupture to coronary arterial injury with resulting infarction. A less commonly occurring manifestation of nonpenetrating injury is a concussion of the heart (commotio cordis), often with dramatic physiological consequences but no morphologic cardiac injury. We describe four case reports of this entity. The cases were collected over a 5-year period (1978-1983) from the Wayne County Medical Examiner's Office in Detroit, Michigan.     

Severe Cardiac Rupture by Only One Blow to the Chest in a Young Boy: An Autopsy Case

Cardiac rupture by blunt chest trauma is commonly seen after motor vehicle accidents and falls; however, it is rarely caused by a blow to the chest. We herein report an autopsy case of a high school boy who sustained severe right ventricular rupture by only one knee kick to the chest during a quarrel. He was hospitalized and developed cardiopulmonary arrest. Emergency surgery was performed, but the patient died. The autopsy revealed no external severe trauma or deformation, but the side wall of the right ventricle contained a large V‐shaped laceration. The other thoracic organs had no injuries. This case illustrates that severe cardiac rupture can occur by only one blow to the chest. Blunt cardiac injuries can occur even if no severe injuries are present on the body surface. We should consider the possibility of severe cardiac injuries regardless of the presence of external injuries.     

The theory of cardiac lesions from blunt chest injury

The main theories of myocardial lesions associated with a blunt chest injury proposed starting from the XIXth century till the present time are considered based on the overview of the literature data. It is shown that the theory of selective mechanical activation of ATP-dependent K+ channels is most promising for further investigations into the mechanisms of myocardial dysfunction resulting from blunt chest injuries. The authors emphasize the absence of the universally accepted theory explaining the mechanism behind traumatic cardiac troubles and its fatal outcome despite numerous studies of cardiac lesions in patients with a blunt chest injury. It dictates the necessity of further research, both clinical and experimental, for a deeper insight into the problem.     

The mechanisms of the formation of kidney damages from action by blunt objects]

Analyzes 206 cases with renal injuries inflicted with blunt objects. Describes the type of renal injury in relation to the type of the trauma and direction of the strike with the blunt object with a limited surface of co-strike. Presents mechanisms of the injury formation.     

Evaluation of the severity of harm to health by gastrointestinal injury caused by blunt trauma

A total of 226 forensic medical conclusions in traumas of the gastrointestinal tract with blunt objects, 111 of these with lethal outcomes, are analyzed. The types of injuries, clinical course, medical care, complications, flaws in medical care and their consequences, and pathomorphology of the injury were analyzed. Criteria of harm inflicted to health are determined and a table of qualifying signs is suggested for cases with blunt injuries of the gastrointestinal system, with consideration for the type of injury.     

眼部损伤程度法医学鉴定60例分析

目的探讨眼外伤的特点及其损伤程度法医学鉴定要点。方法对60例眼外伤的法医学鉴定案例进行回顾性分析,对所有案例按照性别、年龄、职业、致伤物及损伤类型进行分类研究。结果眼外伤中农民、工人占61.7%,钝性损伤达85.0%,且大多属单纯挫伤,占63.3%。结论眼外伤大多属钝性外力所致,眼底病变是影响视力的重要原因,对外力与视力受损关系的评价要充分考虑致伤物种类、打击部位及伤前眼病史等诸多因素的影响。     

Death Due to Coronary Artery Insufficiency Following Blunt Trauma to the Chest

There have been numerous reports of sudden cardiac death following blunt trauma to the chest, but there is lack of such references in forensic literature. It is the court of law which makes decision about trauma precipitating natural events. The forensic pathologist is scientifically trained in the medical field and would be in a better position to give clear picture about the victim's general status at the time of death, exact nature and severity of the illness he is suffering from if any. He can also assess the nature and severity of injuries sustained, and thus, his opinion as to the possible role played by the traumatic event in bringing about the death is valuable. This paper will discuss the mechanism of cardiac injury or possible cardiac injury and sudden death of an apparently healthy 36‐year‐old male following blunt chest trauma sustained during alleged assault by his neighbor.     

480例活体损伤的法医学鉴定分析

目的分析活体损伤的特征,探讨其损伤类型与损伤程度的关系,以及法医学鉴定的有关问题。方法随机抽取1998-2001年间活体损伤的鉴定资料,对伤者的损伤及其法医学鉴定进行回顾性分析。结果男性伤者居多;多发伤高于任何单一部位损伤;致伤方式以钝器致伤为主;重伤以颅内血肿和腹腔脏器破裂最多,轻伤以四肢骨折居首。结论损伤程度与损伤部位及类型有一定的关系。     

Specific Characteristics of Injuries Inflicted by Claw Hammer

Claw hammers have the specific characteristic of having two distinct ends: one a flat head of variable form, the other bifurcated. So the use of this tool as a blunt instrument will cause varying injuries. The authors present two clinical cases of assault with a claw hammer. Examinations revealed two types of wound. A first injury composed of integumentary lacerations and underlying bone injuries in terms of “shape” suggested the use of a blunt instrument. A second injury made up of damage showing two parallel wounds or two wounds located one in the extension of the other suggested the use of an object with a bifurcated end. The combination of both types of injury should alert examiners to the possibility of the use of a claw hammer in causing the injuries in order to help direct investigators in their investigations and in the search for the weapon used.     

Feasibility of Contactless 3D Optical Measurement for the Analysis of Bone and Soft Tissue Lesions: New Technologies and Perspectives in Forensic Sciences

Abstract:  In forensic pathology and anthropology, a correct analysis of lesions on soft tissues and bones is of the utmost importance, in order to verify the cause and manner of death. Photographs, videos, and photogrammetry may be an optimal manner of immortalizing a lesion, both on cadavers and skeletal remains; however, none of these can supply a detailed three-dimensional (3D) modeling of the lesion. Up to now, only the use of casts has given us the possibility of studying deep lesions such as saw marks with an accurate and complete 3D reconstruction of bone structure. The present study aims at verifying the applicability of 3D optical contactless measurement for the accurate recording of soft tissue and bone lesions, in order to develop a unique and precise method of registering and analyzing lesions, both in forensic pathology and anthropology. Three cases were analyzed: the first, a car accident with blunt force skin injuries; the second, a murder with blunt force injury to the head applied with a metal rod; the third, a series of sharp force knife and saw lesions on bone. Results confirm that 3D optical digitizing technology is a crucial tool in the immortalization of wound morphology in the medico-legal context even on "difficult" substrates such as cut marks and saw marks on bone.     

Fatal child abuse-maltreatment syndrome. A retrospective study in Ontario,Canada, 1990-1995

Child death due to repeated episodes of physical assault or neglect has been termed the child abuse-maltreatment syndrome (CAMS). We characterized the injuries in a series of fatally abused or maltreated child to delineate objective diagnostic criteria for the CAMS for use by clinicians and pathologists. All deaths (age <17 years) investigated by the Office of the Chief Coroner for Ontario, Canada during the time period 1990-1995 were reviewed. Cases of CAMS were defined as death due to lethal recent injury or malnutrition in the presence of significant old (healing or healed) injuries indicative of repeated episode of inflicted trauma. The nature and frequency of the various injuries was determined. The frequency of the shaken baby syndrome, and the types and frequency of ano-genital injuries were also studied. Twenty-one cases of fatal CAMS were found in the study period. Most cases had significant recent head injury with intra-cranial hemorrhage (71%). Other significant recent injuries commonly observed included blunt injuries of the skin and soft tissues (67%), blunt abdominal trauma with visceral injuries (14%), and fractures (18%). Eight cases (38%) fulfilled accepted criteria for the shaken baby syndrome. Many children with fatal head injuries had evidence of older head trauma (38% of all cases). A significant minority of cases had evidence of malnutrition due to neglect (10%) or ongoing ano-genital injuries (10%). Most cases of child homicides due to repeated episodes of abuse or maltreatment involve head trauma including shaken baby syndrome. Fractures of long bone and ribs, the classical markers of child abuse, were relatively infrequent compared with head injury. A proportion of cases had ano-genital injuries due to repeated sexual abuse or punitive maltreatment. All clinicians and pathologists must recognize the wide spectrum of injuries in child abuse to ultimate protect the victim or other children in an at-risk situation.     

Unusual blunt force wound patterns due to a hexagonal steel bar

Pathologists routinely examine victims with blunt force traumatic injuries. Many of these victims exhibit injury patterns that can help identify the weapon used in the assault. Proper documentation that accurately portrays the injury pattern and allows for comparison with recovered weapons is therefore essential. Our office investigated a homicide with unusual blunt force injuries. This article presents the procedure that we followed to identify the weapon.     

A review of blunt force injury homicides of children aged 0 to 5 years in bexar county, Texas, from 1988 to 2009

ABSTRACT: It is essential that clinical physicians, medical personnel, medical examiners, and law enforcement agencies understand the types of injuries seen and demographics of children affected by intentional blunt force as this understanding can be crucial to the death and/or criminal investigations. An understanding of the injuries can also assist in drawing conclusions regarding how those injuries could have been sustained. This study discusses the types and patterns of injuries seen in blunt force homicides in children younger than 6 years. The study found that male infants are more often intentionally injured than are female infants and that fatal head injuries most frequently occur in the first year of life, whereas most fatal thoracoabdominal injuries occur in the first 3 years of life. In children with head injuries, subdural hemorrhage was the most common finding, followed by subarachnoid hemorrhage. In 2.5% of deaths due to head injury, concurrent neck injury was seen, a percentage far lower than previous literature would suggest if shaking was the primary mechanism of injury. Twelve legal confessions were also reviewed, none of which disclosed a pure mechanism of shaking the infant.     

Stab injuries of the skull and brain

A few cases of skull and brain stab wounds are described and the clinicodiagnostic problems discussed. The injuries often remain unrecognized because the external wound often appears harmless, there are no neurological symptoms, or the clinical picture is interpreted as drunkenness, blunt injury or as another disease. The importance of a precise physical examination of the whole patient's head is pointed out. The refined methods used in modern radiodiagnostics of the skull are the most helpful in correctly recognizing these injuries; there are reports of patients with severe injuries who recovered when the correct diagnosis had been established.     

钝力性心脏外伤实验性研究——隐囊流体压力冲击心前区

本文应用隐囊流体冲击心前区，成功地制造了钝力性心脏外伤，包括心脏震荡、心脏挫伤，心脏裂伤等原发性心脏外伤以及外伤性冠脉血管炎。心肌炎血栓形成，心肌缺血坏死（外伤性心肌梗死）等继发性或迟发性外伤性损伤，指出：心肌膜爆裂（ｍｅｍｂｒａｎｅｂｕｒｓｔ），相应纤维横向膨出畸型变可以作为心脏震荡性外伤的形态学指征：钝力作为原始致伤因素作用于心前区通过压，拉，旋转或剪切力引起心脏各部，包括刺激传导系统，心脏神经组织损伤；心脏挫裂伤等见于左右心壁室中隔，心内膜下并呈播散分布。     

钝力冲击后心脏组织形态学变化的实验研究

本研究用自制机械式弹性拉力打击器以６．７ｍ／ｓ、８．０ｍ／ｓ、９．１ｍ／ｓ及１０．０ｍ／ｓ速度冲击大胸骨心前区，然后采用多种组织学染色及透射电镜技术对心脏组织形态学变化进行了观察。结果表明：①以６．７ｍ／ｓ及８．０ｍ／ｓ速度冲击后心脏宏观未见有明显改变，微观可见心肌波浪变。电镜下可见肌原纤维肌节收缩，Ｉ带消失或轻度Ｉ带增宽乃至肌原纤维断裂。②以９．１ｍ／ｓ及１０．０ｍ／ｓ速度冲击后宏观可见心脏挫伤，微观心肌挫伤改变明显，实验观察６０ｍｉｎ内心肌血管内皮损伤处已有血小板粘附集聚甚至血栓形成，心肌超微结构损害严重。③同一心脏可有多部位损伤，且损伤程度不均一。本研究进一步表明钝力性心脏外伤中．虽然无宏观损伤所见，其微观，特别是超微结构可有损害。     

Identification of blunt objects according to the injuries caused by them

The article presents principles of forensic-medical identification of blunt objects by injuries inflicted with them. It is shown that each injury has its own complexes of identifying signs. It is necessary to consider mechanisms of action of blunt objects inflicting contact, noncontact and other injuries. Mathematical methods should be employed to estimate probability of identification of traumatic blunt object.     

有限元方法在法医学颅脑损伤分析中的应用

有限元方法(finite element method,FEM)是一种与现代计算机技术相联系的计算应力分析方法,已逐渐被应用于生物力学领域仿真人体结构力学功能研究,尤其是在颅脑损伤研究中最为广泛和深入。本文综述了现有头部有限元模型的特点、材料属性的赋值以及颅脑损伤有限元模型在钝力击打、高坠、交通事故等鉴定中的应用情况,探讨FEM建模在法医学颅脑损伤预测中的优劣势及其应用价值。