99例医药过失纠纷的类型，死因和发生原因－－27年医疗纠纷法医尸检回顾性研

1972～1998年间318例医疗纠纷尸检中,有99例为医疗过失纠纷,其中责任事故23例(23.23%),技术事故76例(76.77%).医疗事故死因以各类休克最多见,有40例,占40.40%(感染中毒性23、急性失血性14、过敏性3);其次为药物中毒,13例,占17.11%(一般药物7、麻醉药6);疾病12例,占15.53%(心血管3、呼吸1、消化5、CNS1、内分泌2)等.导致纠纷发生的基本原因中,处置错误或失当57例(57.58%),漏诊或诊治延误30例(30.30%),用药错误12例(12.12%).     

99例医疗过失纠纷的类型、死因和发生原因-27年医疗纠纷法医尸检回顾性研究之三

1972～1998年间318例医疗纠纷尸检中,有99例为医疗过失纠纷,其中责任事故23例(23.23%),技术事故76例(76.77%).医疗事故死因以各类休克最多见,有40例,占40.40%(感染中毒性23、急性失血性14、过敏性3);其次为药物中毒,13例,占17.11%(一般药物7、麻醉药6);疾病12例,占15.53%(心血管3、呼吸1、消化5、CNS1、内分泌2)等.导致纠纷发生的基本原因中,处置错误或失当57例(57.58%),漏诊或诊治延误30例(30.30%),用药错误12例(12.12%).     

西德有关尸检的规定

<正> 在德意志联邦共和国的每个州都有关于尸检的立法规定,虽然每个州都有,但大致内容相似。以巴伐利亚州为例,每具尸体都得由医生检查,进行死亡、死亡方式和死因鉴定。(法律规定:医生由于粗心或故意将死因诊断错误将罚款和坐牢一年,或单独惩罚其中一项)。当经过医生鉴定后,认为不是自然死亡和怀疑非自然死亡或死因不明     

孕产妇死亡医疗纠纷案法医病理研究

目的探讨孕产妇死亡医疗纠纷案的特点、主要死因及其防范对策。方法采用回顾性研究的方法,对我室1985年至2003年12月的法医尸体解剖案例资料进行统计,并对其中存在医疗纠纷的孕产妇死亡案例进行分析。结果31例存在医疗纠纷的死亡孕产妇法医尸检案例中:(1)围产期死亡26例(83.9%),妊娠早期人工流产后死亡5例(16.1%);(2)产科出血引起的失血性休克死亡22例(71.0%),羊水栓塞死亡5例(16.1%),其它原因死亡4例(12.9%);(3)乡镇医疗机构17例(54.8%),地县级医院占7例(23.6%),市级医院占4例(12.9%),其他占3例(9.7%);(4)纠纷产生的原因中疑为误治14例(45.2%),误诊的9例(29.0%),抢救不及时的7例(22.6%),其他1例(3.2%)。结论孕产妇死亡医疗纠纷案主要发生在围产期,其次是妊娠早期;产科出血是导致孕产妇死亡的最主要因素之一;乡镇及县级医疗机构易引起纠纷;引起纠纷的主要原因是误诊、误治和抢救不及时。     

昆明地区医疗争议死亡事件的流行病学和法医学鉴定研究

目的回顾性分析研究昆明地区涉及医疗争议死亡事件的流行病学特点,探讨医疗争议死亡事件的法医学鉴定问题,为有效预防医疗纠纷、医疗争议死亡事件的法医学鉴定和相关立法提供重要的实践和理论依据。方法收集昆明医学院司法鉴定中心1998年至2003年间受理的昆明地区涉及医疗争议的死亡事件160例(包括医疗纠纷和非法行医死亡案件)的法医病理鉴定资料进行统计学分析研究,应用法医病理学死因分析理论,对医疗争议死亡事件的司法鉴定问题进行探讨。结果昆明地区医疗争议死亡事件呈逐年上升趋势,其中以育龄妇女发生死亡所占比率最高;其次是5岁以下小儿发生死亡;分娩中或分娩后胎儿迅速死亡居第三位;在后两者中男性死亡发生率高于女性。在非法行医死亡案件中,医疗过错参与死因构成的比率为88.89%。结论昆明地区医疗争议死亡事件的临床诊断符合率和医疗过错发生率与国内外相关报道基本一致。法医学鉴定采用"六等九级法"对医疗争议死亡事件中医疗过错对死亡发生的作用及其参与度进行分析和评价,具有较强的可操作性和实用性。     

医疗纠纷中死亡争议案件尸检价值的评估

目的探讨尸体检验对死亡争议事件的医疗鉴定、赔偿处理上的价值,以妥善处理医疗纠纷中医患双方的矛盾.方法对温州市4个市、区、县2002-2004年的182例死亡争议事件进行回顾性分析,就尸检率,临床、尸检诊断,尸检对医疗鉴定及争议事件处理上的作用,及其在不同级别医院的具体情况等进行了统计处理.结果182例其中尸检46例,尸检率25.27%.二级以上医疗机构死亡争议事件112例,尸检率19.64%.临床死因诊断与尸检死因诊断不符合率37%,以循环系统、呼吸系统为多.46例尸检中,医疗鉴定32例（69.5%）,经济赔偿29例（63%）.未尸检136例,医疗鉴定20例（14.7%）,经济赔偿121例（88.9%）,两者差异显著,有统计学意义（P＜0.05）.结论尸体检验对死亡争议案件的医疗鉴定与处理具有重要意义,尤其在死因鉴定方面具有不可替代性.     

52例心脏性死亡相关医疗损害的法医学分析

目的综合分析涉及医疗损害的心脏性死亡法医学鉴定案例,探讨其死亡原因、医疗过错及参与程度评定的共性与特点。方法收集2015年1月—2018年4月杭州明皓司法鉴定所萧山分所受理的涉及心脏性死亡的医疗损害案例52例,对案件一般情况、医疗机构、住院情况、死亡原因、医疗过错行为及过错参与程度评定进行回顾性分析。结果 52例中,男女性比例为2.25∶1,年龄以50~60岁居多。高血压性心脏病及冠心病所引起的心脏性死亡占首位(67.3%),其次为病毒性心肌炎和心肌病(13.5%)。涉及手术的有24例,术后至死亡时长为1 h~118 d,中位数为7 d。医疗损害涉及医疗机构63所,多数医院存在不同程度的医疗过错行为,参与程度多为20%~30%。结论法医学鉴定有助于确定死亡原因,为医疗损害案件评定提供了科学的依据,有助于医疗部门进一步提高诊疗水平。     

涉及死亡医疗纠纷的发生:27年医疗纠纷法医尸检回顾性研究之一

为了探讨医疗纠纷法医尸检的特点,回顾性研究了1972～1998年27年间318例医疗纠纷尸检资料.在这第一篇报告中,介绍与死亡有关医疗纠纷发生上的一些特点:医疗纠纷尸检的案例数从1972～1983年的23例上升到1984～1998年的295例;死者中男女性别无显著差别;年龄分布有两个高峰,10岁以下有104例(32.71%),20～40岁组161例(50.63%);发生在市(县)级中等大小医院的纠纷最多见,有195例,占61.32%,近年私人诊所的医疗纠纷明显增多;医疗纠纷尸检最常涉及外科(71例,22.33%)和产科(58例,18.24%);也简略讨论了206例非医疗过失纠纷和99例医疗过失纠纷发生的原因.     

73例儿科医疗损害的法医病理学鉴定

目的通过对73例儿科医疗损害的法医病理学鉴定案例进行分析,探讨法医病理学在解决儿科医疗损害等问题上的重要性。方法收集南京医科大学司法鉴定所2002年1月—2016年8月受理的、死亡年龄在28 d~10岁的儿科医疗损害病理检验案例73例,对死亡原因及与涉案医疗机构的关系进行回顾性分析。结果 73例中,男女性比例1.70∶1,年龄在28 d~1岁的居多,为26例(35.62%),其次是1~3岁,为21例(28.77%)。通过尸体检验确定死亡原因的71例中,死亡原因以疾病为主,其中呼吸系统疾病占首位,为33例(46.48%),其次是心血管系统疾病,为12例(16.90%)。医疗损害涉及医疗机构共75所,三级医疗机构32所(42.67%),其次为二级以下(不包括二级)医疗机构23所(30.67%)。临床诊断与法医病理学诊断相符及基本相符的有38例(52.05%),未明确或者误诊的35例(47.95%)。结论法医学尸体解剖及病理学鉴定有助于确定死亡原因,不仅为儿科医疗损害提供了科学的依据,并且丰富和发展了临床医学知识,可在一定程度上提高诊疗水平。     

单亲亲子鉴定及其法律问题思考——附275例单亲鉴定分析

目的探讨单亲鉴定及其有关的法律及社会问题. 方法对1998年1月至2002年12月275例单亲鉴定进行回顾分析,对案例的数量、来源、鉴定事由、鉴定结论等作统计分析. 结果单亲鉴定近3年明显增多,占亲子鉴定总数的三成.案例来源以自诉为主,占95.27%.鉴定事由中,怀疑妻子有婚外性关系为主 ,占88.36%.275例单亲鉴定中,排除亲生关系39例,占14.18%.结果表明,非婚生子女只占少数. 结论自诉单亲鉴定存在法律盲区,但在维护家庭稳定具有一定作用.受理单亲鉴定宜取慎重态度,有关的社会及法律问题需要解决.     

Forensic Pathological Examination on 73 Medical Malpractice Cases of PediatricsCSCD

Objective: To analyse 73 medical malpractice cases of pediatrics for discussing the importance of forensic pathology in solving the issues such as medical malpractice of pediatrics. Methods: From January 2002 to August 2016, 73 medical malpractice cases of pediatrics with age of death between 28 days old and 10 years old were collected from Institute of Judical Expertise of Nanjing Medical University. The relationship between causes of death and related medical institutions was retrospectively analysed. Results: In 73 cases, the male to female ratio was 1.70:1, and ages of 28 days old to 1 year old were common (26 cases, 35.62%), followed by ages between 1 year old and 3 years old (21 cases, 28.77%). In 71 cases which had been determined the cause of death by postmortem examination, the main cause of death was disease, especially respiratory diseases (33 cases, 46.48%), followed by cardiovascular diseases (12 cases, 16.90%). In 75 medical institutes which involved with these medical malpractices, most were tertiary medical institutes (32, 42.67%), followed by the sub-secondary (excluding the secondary)medical institutions (23, 30.67%). The clinical diagnosis of 38 cases (52.05%) completely or mostly corresponded with the pathological findings. There were 35 cases (47.95%) undefined or misdiagnosed cases. Conclusion: Autopsy and forensic pathological examination contribute to determine causes of death, which not only provide scientific evidence for medical malpractice of pediatrics, but also enrich and develop clinical medical knowledge, and thus improve diagnosis and treatment level in a certain extent. © 2018 by the Editorial Department of Journal of Forensic Medicine.     

Toxicologic analysis in cases of possible sudden infant death syndrome: a worthwhile exercise?

The diagnosis of sudden infant death syndrome (SIDS) is one of exclusion. At the Department of Forensic Medicine, Westmead Hospital, toxicologic analysis is performed as part of the postmortem examination of all apparent SIDS deaths. The results for the 5-year period January 1, 1994, to December 31, 1999, were audited to determine whether such routine testing was worthwhile. During this time there were 117 cases with a history consistent with SIDS. Drugs were detected in 19 (16%) of these cases. In 1 case, death was attributed to the finding of methadone. The presence of methadone was regarded as a possible contributing factor to death in a further 2 cases. The presence of possible methadone toxicity had not been expected from the history given before the examination in these 3 cases. In 114 cases there was a suitable sample for alcohol testing; in no case was alcohol detected. In 13 cases the postmortem examination revealed an anatomic cause of death (including 3 cases consistent with whiplash/shaken baby/impact head injury), which excluded a diagnosis of SIDS. In conclusion, routine toxicologic testing in all possible cases of SIDS death supplements the postmortem examination in excluding cases of non-SIDS.     

Tricyclic Antidepressants Found in Pilots Fatally Injured in Civil Aviation Accidents

Prevalence of tricyclic antidepressants (TCAs) has not been explored in pilots. The National Transportation Safety Board (NTSB) aviation accident and the Federal Aviation Administration's Civil Aerospace Medical Institute (CAMI) toxicology and medical certification databases were searched for pilots fatally injured in aviation accidents. During 1990–2012, CAMI received bio‐samples of pilots from 7037 aviation accidents. Of these, 2644 cases were positive for drugs. TCAs were present in 31. TCA blood concentrations ranged from therapeutic to toxic levels. The NTSB determined that the use of drugs and ethanol as the probable cause or contributing factor in 35% (11 of 31) of the accidents. None of the 31 pilots reported the use of TCAs during their aviation medical examination. The prevalence of TCAs in aviators was less than 0.5% (31 of 7037 cases). There is a need for aviators to fully disclose the use of medications at the time of their medical examination.     

膝关节侧副韧带损伤MRI影像诊断的比较研究

目的研究膝关节侧副韧带损伤的MRI诊断与法医学鉴定意义。方法对经手术或临床证实的11例共13条损伤的侧副韧带与12例正常膝关节进行回顾性MRI对比研究。结果正常胫、腓侧副韧带在T1WI和T2WI上均呈扁平条状低信号结构,平均长度分别为6.8cm和5.7cm;13条侧副韧带损伤,单纯胫侧副韧带损伤6条,单纯腓侧副韧带损伤3条,两侧侧副韧带同时损伤2例4条;其中I级侧副韧带损伤5条,II级侧副韧带损伤5条;III级侧副韧带损伤3条;7例(63.6%)出现并发症,其中前交叉韧带损伤3条,后交叉韧带损伤4条,半月板损伤2个。结论MRI能清晰显示膝关节侧副韧带解剖结构,能准确诊断侧副韧带损伤并进行分级,还能发现多种并发症,对法医学鉴定有重要意义。     

Fatal hunting injuries in North Rhine-Westphalia

The investigation covers 14 fatal hunting accidents which occurred in North Rhine-Westphalia in the last 23 years, among them 13 firearm fatalities. All the accidents happened during the statutory hunting season reaching a peak in the main small game season. 86% of the persons causing the accidents and 73% of the victims were over 41 years and experienced hunters. 36% of the accidents were caused by the victims themselves. The fatal gunshot injuries were inflicted by rifle bullets in 7 cases (54%) and shotgun pellets in six cases (46%). No accidents were due to shotgun slugs or handgun ammunition. The main factors responsible for the fatalities were: covering the victim while swinging on the game (31%), failure to discharge the firearm while descending from the raised hide or transporting the weapon in vehicles (31%), mistaking the victim for game (15%), failure to discharge the weapon during a hunting break or while pressing down obstacles or careless handling of the weapon (23%). In no case was the accident caused by a defective weapon or ammunition. In conclusion aspects of preventing fatal hunting accidents are discussed.     

An approach to dissecting the congenitally malformed heart in the forensic autopsy: the value of sequential segmental analysis.

The demonstration of congenital heart disease at autopsy necessitates the careful preservation and examination of the heart, the vessels, and their connections. Techniques preserving these connections and using a reproducible and systematic approach are preferred. The Rokitansky method of organ block dissection, in combination with a system of heart examination termed sequential segmental analysis, provides such an approach. This study is based on the examination of heart specimens accessioned into the Frank E. Sherman, M.D., and Cora C. Lenox, M.D., Heart Museum (containing approximately 2400 specimens) of the Pathology Department, Children's Hospital of Pittsburgh. Specimens received in consultation during a 25-year period from hospitals and coroners'/medical examiners' offices were examined, and the corresponding reports were reviewed. Of 46 total heart specimens examined (1975-1999), 29 (63%) were dissected properly or left intact for dissection at Children's Hospital of Pittsburgh, and 17 (37%) were incorrectly dissected for the demonstration of congenital heart disease. Of these 17 cases, 11 (24%) displayed dissection errors, which did not hinder a complete diagnosis, 3 cases (6.5%) had errors that enabled only an incomplete diagnosis, and in 3 cases (6.5%), no diagnosis of congenital heart disease could be made. Dissection mistakes and means of avoiding them are discussed. Review of medical and family history, external and internal examination, and a reproducible and sequential method of examining the heart and its connections enables documentation of even the most complex cardiovascular anomalies.     

An analysis of the usefulness of specific stages in the pathologic investigation of sudden infant death

Retrospective analysis of autopsy findings in 60 infants who had been found unexpectedly dead in their cribs or beds in South Australia from 1994 to 1998 was undertaken to determine the diagnostic usefulness of individual stages in the postmortem investigation. Positive findings occurred in 2 of 43 scene examinations (3%), 2 of 60 external examinations (3%), 2 of 11 radiologic examinations (18%), 8 of 60 internal examinations (13%), 7 of 60 histologic examinations (12%), and 3 of 58 microbiologic examinations (5%). No positive findings were detected on toxicologic screening. Not every case underwent each diagnostic step. This gave alternative diagnoses to sudden infant death syndrome (SIDS) in 15 cases (25%). This study demonstrates an increase in the percentage of cases of unexpected infant death due to causes other than SIDS; it also shows the diagnostic yield of individual stages in the postmortem evaluation of such cases. Negative findings were important in giving validity to the diagnosis in the 45 cases that were ultimately designated as SIDS.     

医疗纠纷司法鉴定40例分析

目的分析医疗纠纷产生的主要原因和医疗过失行为的主要表现形式,并探讨医疗纠纷司法鉴定中应注意的主要问题。方法对2006—2008年本所鉴定的40例医疗纠纷案件进行回顾性分析。结果在40例医疗纠纷案件中,来自市级、县级、乡镇医院及个体诊所的分别为11例（27.5%）、24例（60.0%）、2例（5.0%）和3例（7.5%）;来自内科、外科、妇产科、儿科和门/急诊的分别16例（40.0%）、10例（25.0%）、9例（22.5%）、2例（5.0%）和3例（7.5%）;来自县级以上医院的医疗纠纷被认定存在医疗过失行为的比例低于乡镇医院及个体诊所。结论市、县级医院医疗纠纷较乡镇医院及个体诊所多见,但被认定有医疗过失的要少于乡镇医院及个体诊所。     

90例医疗纠纷尸检分析

目的分析、讨论医疗纠纷中法医病理学尸体解剖的重要性。方法收集温州医学院法医学系2001—2008年涉及医疗纠纷尸体解剖案例90例,按照死者年龄、性别、死亡原因及临床诊断和法医病理诊断等要素进行分类整理和分析。结果死者年龄从新生儿至72岁,男女比例为1∶1,医院级别以县级医院较多（30例,33.33%）,临床诊断与法医病理死因诊断符合率为33.33%。结论尸体解剖对涉及死亡的医疗纠纷的正确处理和防范有重要作用。     

The epidemiological study on registered cases of sudden infant death syndrome (SIDS) in Tokyo: examination of the effect of autopsy on diagnosis of SIDS and the mortality statistics in Japan

In the United States and most of European countries, a diagnosis of sudden infant death syndrome (SIDS) may be given only after an autopsy has been performed. Under the new definition of SIDS in Japan, an autopsy is now mandatory for the diagnosis of SIDS. However, according to the official records on autopsies, the proportion of autopsy for sudden infant death in Japan is still low (less than 30%). If a physician suspects SIDS from a review of the patient's medical history and medical findings, he can write 'suspected SIDS' as the cause of death on the death certificate without performing an autopsy. Such a clinical diagnosis is entered in the Vital Statistics section by the Japanese Ministry of Health and Welfare. In this report, a comparative epidemiological survey of registered cases of SIDS--after autopsy and with no autopsy--was carried out by examining the data from the death certificates registered by the Japanese Ministry of Health and Welfare (vital statistics in Tokyo from January 1979 to December 1996). There were 369 cases of SIDS registered in Tokyo. We found 247 diagnosed after autopsy (66.9%) and 122 with no autopsy (33.1%). The following epidemiological variables were used: address of the deceased (a specific area in Tokyo), sex, year of death, time of death, month of death, age at death, occupation of householders, and place of death. There were epidemiological differences at the 0.05 significance level between registered cases diagnosed after autopsy and those diagnosed without autopsies, as follows: year (P=0.016) and place of death (P=0.037). In addition, there were slight epidemiological differences at the 0.10 significance level between registered cases diagnosed after autopsy and with no autopsy, as follows: month of death (P=0.076) and age at death (P=0.082). This suggests that the quality of diagnosis of SIDS is not completely guaranteed. With respect to the area of residence, the incidence of SIDS is high in those areas where autopsy is performed frequently. In Tokyo, the medical examiner system is enforced only in the urban area and there is a possibility that SIDS is being underdiagnosed in the rural area of the Metropolitan Tokyo. It is likely that the diagnosis of SIDS without autopsy will influence the quality of SIDS diagnoses. The administrative inadequacy in the autopsy system in Japan should be corrected to improve the accuracy of SIDS diagnosis.