夜间不明原因猝死综合征和阻塞性睡眠呼吸暂停低通气综合征关系的研究进展

夜间不明原因猝死综合征一直是法医学研究的难点,近年来分子遗传学的发展促进了其病因学研究,但仍有大部分案例病因不明。睡眠呼吸暂停综合征是一种常见的睡眠障碍性疾病,其中以阻塞性睡眠呼吸暂停低通气综合征最为常见。近年来,国内外研究表明阻塞性睡眠呼吸暂停低通气综合征与心血管疾病的发生密切相关,可以导致心律失常甚至引起猝死。本文主要综述了夜间不明原因猝死综合征与阻塞性睡眠呼吸暂停低通气综合征之间的关系,从而为不明原因猝死的发病机制提供新的思路。     

心肌炎猝死案例的法医病理学研究

从法医尸检案例中取心肌炎猝死17例进行分析及病理学观察，对心肌炎的分关、心肌炎导致猝死机制进行探讨，认为诱发急性心力衰竭是心肌炎猝死的主要原因。     

6例白喉分析

白喉是由白喉杆菌引起的急性传染病,我国在50年代较为多见,现基本消灭,本病已极少见。白喉一年四季均可发病,但以秋冬和初春寒冷季节为多见。潜伏期多为2～4日(1～7日),其临床特征是白喉杆菌外毒素使咽、喉气管等多处粘膜坏死形成假膜和引起全身中毒症状,如发热、乏力、头痛等,严重者可引起中毒性心肌炎或窒息而导致猝死。 1 一般资料 1.1 资料:1994年10月～12月,我市德城看守所先后发现白喉患者5例,均为男性;社会发     

冠状动脉畸形引起猝死1例

猝死是指貌似健康的人，因潜在的疾病或重要器官急性功能障碍导致的意外突然死亡。心血管疾病是引起猝死最常见的疾病，其中以冠心病和高血压性心脏病最多见，冠状动脉畸形引起猝死的案例报道较少见。笔者检验了一起因冠状动脉开口畸形引起猝死的案例，报道如下。     

肝包虫破裂罕见并发症致死2例

<正>包虫病是人类感染棘球蚴绦虫的幼虫所致的疾病，主要侵犯肝和肺两个器官^[1]。棘球蚴主要有细粒棘球蚴和泡状棘球蚴绦虫两种，临床上前者较为多见，包虫破裂往往引起皮肤瘙痒、红斑、荨麻疹，甚至过敏性休克等并发症^[2]，而肝细粒棘球蚴病肝内囊肿破裂引起肺动脉包虫栓塞导致猝死极为罕见。另外，包虫破裂后囊液外溢致腹腔并发急性弥漫性腹膜炎致感染性休克而死亡案例也不多见，现报道2例。     

一例急性肾衰竭合并脑梗死的抢救及护理体会

急性肾衰竭合并脑梗死患者病情危重,常易发生呼吸、循环衰竭而导致生命危险,及时、有效地抢救和护理是提高病人存活率的重要条件.     

脑膜瘤伴囊肿形成致脑疝死亡一例

一般来说，颅内原发性肿瘤生长较缓慢，在逐渐生长而体积增大时，可较早出现颅内压增高及其定位症状，但有时症状不明显，未引起怀疑，可突然发生猝死。其中以各型胶质细胞瘤、室管膜瘤、小脑髓母细胞瘤等较多导致猝死，而脑膜瘤则因生长缓慢，较少导致猝死。笔者在参与一起医疗意外的尸检中碰见较罕见的脑膜瘤伴囊肿形成致脑疝而发生猝死1例，现报告如下。女，34岁，因左侧卵巢瘤要求入院手术，术前体检：BP：13.3／7.9KpaP：56次／min，心肺、肝、脾无特殊，神经系统检查正常。遂于某日上午9时在持续硬膜外麻醉下，行左侧卵巢癌切除，手…     

特发性心肌病与猝死（附二例尸检报告）

特发性心肌病是一种原因不明,以心肌病变为主的心脏疾病。在法医尸检工作中,心肌病猝死案并不十分罕见。国内最近报道过10例心肌病猝死。我们见到2例,现报告如下:     

从理论到实践:法医病理学心脏性猝死研究新动态

<正>猝死(sudden death)在本质上是指潜在的疾病或重要器官急性功能障碍所导致的急速而出乎意料的自然性死亡[1];心脏性猝死(sudden cardiac death,SCD)特指由于心脏病所引发的猝死,居猝死的各类病因分布之首,其发病率呈逐年递增的趋势,严重威胁着人类的健康[1]。由于此类突发死亡可能牵涉到暴力因素,或被怀疑为暴力死,或真正的暴力死被误报为猝死,故涉及SCD案件的确切死因鉴定     

浅谈脑血管畸形致猝死的法医学鉴定

引起猝死的第一大原因是心血管系统的疾病,其次是脑血管畸形.脑血管畸形破裂引起蛛网膜下腔出血(SAH)是导致猝死的主要机制.     

Sudden death due to atlantoaxial subluxation in marfan syndrome

Marfan syndrome is 1 of the commonest inherited connective tissue disorders. Sudden death may occur and is usually attributed to cardiovascular manifestations of the syndrome. Atlantoaxial hypermobility, increased odontoid height, and rotatory subluxation are well described in this syndrome, but this paper details what seems to be the first reported case of sudden and unexpected death due to spontaneous atlantoaxial subluxation in Marfan syndrome.     

Sudden Death from Cardiopulmonary Arrest on Arrival of a Patient with Pulmonary Tuberculosis: A Case Diagnosed by Postmortem CT and Autopsy

Sudden death due to massive hemoptysis during management of tuberculosis occurs in a considerable number of patients. However, when massive airway hemorrhage occurs in a patient in whom tuberculosis has not been confirmed and a blood is not apparent externally on the face/body, it is difficult to immediately identify the cause of death as airway obstruction by tuberculous bleeding in the airway. We encountered an 83‐year‐old Japanese woman with her medical history included treatment of tuberculosis in her 20s who was in cardiopulmonary arrest on arrival (CPAOA), and the cause of sudden death could not initially be identified. Postmortem CT (PMCT) and autopsy revealed that the cause of sudden death was airway obstruction/asphyxia by tuberculous massive airway hemorrhage. Identification of the cause of death facilitated a subsequent active contact investigation and led to prevention of secondary tuberculosis infection.     

Sudden death from saccular laryngeal cyst

Laryngeal cysts are benign, uncommon lesions of the larynx that have been reported on rare occasions to cause sudden death in infants and adults by acute airways obstruction. In this report, we document the sudden death of a 36-year-old woman from a previously undiagnosed, asymptomatic laryngeal saccular cyst that presented with acute, and consequent fatal, airway obstruction. Difficulty during intubation, both in theater and in emergency settings, is a frequent presenting problem. This can have significant medicolegal implications in determining possible negligence. The diagnosis, classification, and management of such cysts, and their importance to both the forensic pathologist and clinicians are discussed.     

Sudden Death Caused by Anomalous Origin of the Coronary Artery During Exercise

Anomalous origin of the coronary artery (AOCA) is a rare, but important cause of sudden cardiac death among young athletes. Nine autopsy cases (8 male, 1 female; mean age, 17.9 years; age range, 11–31 years) of sudden death during or just after exercise caused by AOCA were reviewed. The exercises performed at the time of death were running (4 cases), soccer (2 cases), and baseball, swimming and kendo (Japanese swordsmanship) (1 case each). In 6 cases, the left coronary artery arose from the right sinus of Valsalva, and in 3, the right coronary artery from the left sinus. The coronary arteries passed between the pulmonary artery and the aorta with an acute angle takeoff from the orifice. Three cases had cardiovascular manifestations prior to death. In cases with cardiovascular manifestations, novel imaging methods should be considered to prevent sudden death.     

Sudden death associated with food and exercise

Exercised-induced anaphylaxis occurs in conjunction with significant physical exertion. Anaphylaxis occurring when an individual exercise within a few hours of ingesting a particular food is an unusual variant. Cardiovascular symptoms can be the sole manifestation of exercise-induced food allergies, in which case death may mimic sudden cardiac death during physical exertion due to other pathologic causes. We report the sudden and unexpected death of an individual following the ingestion of hazelnuts and almonds, to which the individual was not previously known to be allergic. The decedent collapsed during vigorous dancing. The death was not associated with cutaneous or laryngeal manifestations of anaphylaxis. Awareness of the variable manifestations of food-precipitated anaphylaxis is necessary to correctly establish the diagnosis. An elevated serum tryptase level may be indicative of an allergic reaction, and allergen-specific IgE levels may be used to confirm the particular antigen.     

Molecular genetics of sudden cardiac death

Sudden cardiac death (SCD) is one of the most common causes of death. An important number of sudden deaths, especially in the young, are due to genetic heart disorders, both with structural and arrhythmogenic abnormalities. In recent years, significant advances have been made in understanding the genetic basis of SCD. Identification of the genetic causes of sudden death is important because close relatives are also at potential risk of having a fatal cardiac condition. A comprehensive post-mortem investigation is vital to determine the cause and manner of death and provides the opportunity to assess the potential risk to the family after appropriate genetic counselling. In this paper, we present an update of the different genetic causes of sudden death, emphasizing their importance for the forensic pathologist due to his relevant role in the diagnosis and prevention of SCD.     

Sudden Death Due to Recent Hemorrhage From an Intrathoracic Chronic Expanding Hematoma

Chronic expanding hematoma (CEH) is a rare disease that can develop in any region of the body, but it most frequently develops in the thorax. When intrathoracic CEH is left untreated, gradually expanding hematoma can be life‐threatening, leading to respiratory failure or hemoptysis. We encountered an 89‐year‐old man with cardiopulmonary arrest on arrival. He had been healthy, and it was unclear whether CEH had previously been detected. A very large mass was observed on chest computed tomography (CT), but the cause of death could not be determined. In the autopsy, this mass was identified as CEH and no malignant findings were noted. A fresh hemorrhage had occurred in the hematoma and perforated the bronchial lumen, which caused airway obstruction/asphyxia and resulted in sudden death. CEH should be suspected when a very large tumorous lesion occupying the entire hemithorax is observed on chest imaging, and it is important to recognize that sudden death can occur in the natural course of CEH.     

过敏性休克死亡法医学诊断的研究现状

过敏性休克死亡在临床医学及法医学鉴定中较为常见,但过敏性猝死的死后诊断一直是法医病理学鉴定的一大难点。近年来,国内外学者研究了过敏性死亡血清IgE、组胺、肥大细胞类胰蛋白酶和P物质的含量以及其在肺脏和胃肠等组织中的免疫表达,试图为过敏性猝死的法医学鉴定提供客观、准确的形态学依据和诊断指标。本文就过敏性休克死亡法医学诊断的研究进展和存在的问题加以综述。     

Sudden death and anomalous origin of the coronary arteries from the aorta. A case report and review

Based on a case report of sudden death in a young boy, this paper reviews the available information concerning the various combinations of anomalous origins of coronary arteries and associated sudden death. Left coronary arteries arising from the right sinus of Valsalva and passing between the aorta and pulmonary arteries are often associated with sudden death and myocardial ischemia in young people. Although right coronary arteries originating from the left sinus of Valsalva and passing between the aorta and pulmonary artery are less frequently associated with symptoms, this condition may be associated with sudden death. The incidence of symptoms associated with other anomalous origins is also discussed.