49例烧死尸体的观察

<正> 近年来,我们在火场中发现的由于各种原因烧死的尸体共49例(烧伤后经过一定时间治疗而死亡者不包括在内),现报告如下。一般资料49例中因意外和灾害烧死的40例;他人纵火烧死的2例;暴力致伤后,在濒死状态下烧死的2例;自焚5例。     

家兔烧死后气管、肺及心肌的病理形态学观察

目的探讨烧死的病理形态学依据。方法建立家兔烧死动物模型,用光镜、透射及扫描电镜观察10只生前烧死家兔气管、肺及心肌的病变;并与死后焚尸及非烧死的正常组(各5只)对照。结果透射电镜下,气管粘膜上皮完全脱落,成堆红细胞和纤维蛋白成分粘附在平滑肌表面。肺Ⅰ型上皮细胞结构基本完整连续,线粒体嵴有断裂、缺失;Ⅱ型肺泡上皮细胞微绒毛消失,多数细胞线粒体、板层小体、高尔基体未见异常,少数Ⅱ型肺泡上皮细胞质膜破损、染色质浓集、胞质内容丢失。心肌严重变性坏死,细胞膜破坏,线粒体极度肿胀,肌丝溶解并出现收缩带坏死。扫描电镜下,气管粘膜上皮有完整纤毛,但上皮大片脱落,少数区域纤毛上皮稀疏排列,有脱落柱状上皮附着在纤毛上;肺间皮细胞结构基本完整,微绒毛数量不一致;心内膜的内皮细胞大部脱落,暴露内皮下结缔组织,心肌纤维呈扭曲排列。死后焚尸及正常组对照组未见上述变化。结论烧死兔的光镜和电镜下气管、肺及心肌的病理形态学变化,能为生前烧死与死后焚尸的鉴别提供依据。     

54例意外烧死尸体的法医学分析

本文通过对54例意外烧死尸体的法医学检验,结合文献进行分析,以供法医学实践参考。1案例资料1.1基本情况54例意外烧死尸体的相关资料均来自上海市2002年1月至2006年1月间委托尸体解剖的35起火灾案例。案件性质均认定为意外事故,其中单起事故中死亡2人以上的有8起,死亡人数最多的一起为10人。35起火灾意外中32起发生在居民住宅,且20年以上的老式居民住宅占多数(26起),3起发生在工厂仓库中;起火原因大多为电线老化和电器使用不当(33起),此外还有化学物质爆炸或爆燃等(2起);起火时间多为夜间(28起)。1.2性别和年龄本组案例死者中,男性33例,女性…     

152例火场尸体的法医学检验分析

目的 探讨火场尸体的法医学检验特点及其鉴定。方法 对86起火场中152例尸体的相关检验资料进行回顾性研究。结果 152例火场尸体,生前烧死109例,纵火焚尸38例,无明显高温作用的尸体5例。主要死因有“烧死综合征”100例,火场有毒气体中毒8例,机械性损伤32例(含高坠死4例),机械性窒息5例,电击、服毒各1例;不能确定死因5例。自杀5例,他杀40例,意外107例。在生前烧死尸体,87例呼吸道内有炭末沉着,71例皮肤局部烧伤边缘组织有红肿,46例检见水泡,17例有“闭眼反应”征象,大部分尸体血中HbCO浓度超过20％;纵火焚尸少见或不见上述改变。结论 检验火场尸体,根据烧死尸体征象和血中HbCO浓度检测,并结合火场勘验资料综合分析,其死因鉴定和死亡方式推断结论方能准确。     

气管插管致咽喉部损伤特点分析

气管插管是抢救危重的病人常见、有效的方法之一。由于病人处于严重不合作的状态,气管插管造成咽喉损伤,这些损伤与机械性窒息有相似之处,如何区别和解释其损伤,给死者家属或医院一个圆满的回答,这个问题在国内法医文献尚未见报告。本文复习相关文献,结合本组尸解发现,对其法医病理特点进行分析讨论。1资料与方法1.1资料来源96例气管插管尸解资料取自华西基础医学与法医学院1990年～2003年14年间尸解档案,每例病历资料完全,死后均做系统尸解及HE染色的组织学检查,部分案例做毒、药物分析。1.2方法每例气管插管后死亡在24h内,均做颈部分层的…     

17例缢而未死的临床病例浅析

<正> 我院自1974～1988年9月共收治自缢18例,经抢救存活17例、报告如下:临床资料17例缢而未死的主要临床资料见表。此17例的缢吊方式:1～7、9～14、16、17均为悬吊式,第8例为跪式,第15例为两膝屈曲蹲位。绳套种类及位置:1～8,11～17例均为单环前位,索沟位于喉结上方;第9例为单     

四例火场尸体的法医学鉴定

案例资料例1某户草房半夜起火，室内衣物大部烧毁，夫妻、儿子三人“烧死”。检验见夫妻在炕上睡觉的原始位置，部分烧焦、炭化、屈曲，头皮有多处直角形挫裂创，颅骨粉碎凹陷、脑内有血肿，尸体上下有残缺不全的被褥和焚烧残片，气管粘膜基本正常；儿子尸体在地上，头部裹以大衣，有多处直角形挫裂创、颅骨粉碎，枕头、炕沿及地面上有大量血迹。现场门塑料有新鲜切口，手可自由伸入，屋内顶门杜立在门的一侧，被褥残片有油痕，检出豆油。例2某产0时草房着火塌架，七旬夫妇“烧死”在地上。尸检除肢体大部烧焦、内脏脱出、头皮崩裂、四肢长…     

生前、死后烧伤的法医学检验

火场中的尸体大多被燃烧,而判断生前还是死后烧伤,对火场命案性质的认定具有重要作用。笔者对152例火场尸体检验资料进行研究和分析,提出鉴定生前死后烧伤时需要注意的问题,供同行参考。1尸检资料性别年龄152例中男80例,女72例,男女比例为1.1∶1;年龄在8～68岁,其中20～40岁者102例占67.11%。死亡原因152例中生前烧死有109例,颅脑损伤死亡21例,大失血死亡6例,扼、勒颈部致窒息及高坠死亡各4例,有机磷中毒、自缢及电击死亡各1例,死因不明5例。损伤检验109例生前烧死的尸体上检见局部皮肤烧伤边缘组织有红肿征象的71例,其中检见有“闭眼反应”…     

14例癫痫发作致猝死分析

本文对14例在癫痛发作中死亡者的即往史、现病史、发作情况、尸检及病理资料进行分析,现报告如下。l一般资料本级资料取自本地区804例摔死尸检资料。男性10例,女性4例,年龄至～54岁。摔死发生Zh内者7例,6h内者3例,10h内者4例。2尸检及死因分析各例均经系统解剖检查,并作了组织学检验（HE染色）;4例头颅CT扫描有阳性体征,10例脑电图异常;对部分疑为中毒案例做了血液、胃内容的毒物分析,其结果均为阴性。14例中有9例存在不同诱发因素,如感染发热、停用抗癫痛药、饮酒、过度气愤及悲伤或过劳等［‘］。经调查证实,14例均有癫病病…     

山阳县几起森林失火案所引起的思考

今年以来,山阳县人民检察院先后受理公安机关提请批准逮捕的山林失火案6件,共计烧毁山林9238．9亩,烧死林木蓄积13957．45立方米,烧死各种幼树3万余株,造成直接经济损失95万余元。其中最大的一起失火案是杨花荣失火案,烧毁山林1803．80亩,烧死林木蓄积4441．2立方米。烧死幼树10261株,造成直接经济损失24万余元。在一个较短的时间内,     

大鼠急性CO中毒的超微病理学研究

大鼠吸入 CO(1500～4500PPM,2小时)急性中毒后,观察其心、肝、脾、肺、肾、脑的病理改变。光镜下可见心肌细胞浊肿,水性变,肌浆凝聚,间质水肿;肝细胞浊肿,轻度脂肪变;肺淤血、水肿;肾曲管上皮细胞浊肿,神经细胞急性肿胀,尼氏小体减少或消失。电镜下,心肌原纤维过度收缩,肌节交短,质膜部分破坏,肌原纤维断裂、坏死;线粒体肿胀,肌浆网扩张;神经细胞内粗面内质网呈囊状扩张;神经细胞固缩;星形细胞突起水肿。     

Adenoid Cystic Carcinoma of the Trachea Resulting in Fatal Asphyxia

Primary malignant tumors of the trachea are uncommon. The authors report a case of a 72‐year‐old female who died from asphyxia due to an undiagnosed obstructing adenoid cystic carcinoma of the trachea. The decedent became unresponsive while eating cereal and was pronounced upon arrival at the local hospital. The autopsy revealed a near occlusive tumor mass just superior to the bifurcation of the distal trachea. There was no evidence of aspiration. The death was the result of asphyxia due to obstruction of the trachea by an adenoid cystic carcinoma. This case demonstrates that an obstructive tumor mass may remain undiagnosed until an obstructive episode results in a sudden death.     

病毒性心肌炎和扩张性心肌病中Dystrophin蛋白的表达

目的探讨病毒性心肌炎和扩张性心肌病的发病机制及相互关系,从而提高心性猝死法医学鉴定的可靠性和准确性。方法对17例对照(包括正常心脏、冠心病、高血压性心脏病等),25例病毒性心肌炎和28例扩张性心肌病的心肌组织进行改良的病理学dystrophin免疫组织化学研究。结果dystrophin蛋白在对照组,病毒性心肌炎组和扩张性心肌病组中阳性表达率分别为100%,88%,57%,三组表达差异有显著性(P<0.05),且在病毒性心肌炎和扩张性心肌病组间表达有显著差异(P<0.05),经Spearman等级相关分析呈显著负相关(r=-0.526)。结论病毒性心肌炎和扩张性心肌病心肌中细胞骨架蛋白均有破坏,且随着由病毒性心肌炎进展为扩张性心肌病,dystrophin蛋白表达逐渐降低,说明在病毒性心肌炎和扩张性心肌病的发病机制中可能与dystrophin的被破坏有关,病毒感染并破坏心肌细胞骨架蛋白并最终导致心肌细胞坏死,心功能受损,从而使病毒性心肌炎进展为扩张性心肌病。     

The course of respiration in death caused by obstructive asphyxia

Experiments were carried out on 30 dogs to investigate the course of respiration during obstructive asphyxia. They were asphyxiated by occlusion of the exposed trachea. Intrathoracic pressure, blood pressure in the femoral artery, electrocardiogram and electroencephalogram readings were registered. In most cases, the respiration course during the dyspnea stage by occlusion of the trachea generally had an inspiratory character. In a few animals, when the trachea was occluded in the expiratory phase, there were a few positive expiratory respirations with moderate inspiratory movement and thereafter the respirations were inspiratory during the dyspnea stage. The terminal respirations, which occurred 1-2 min before the circulatory breakdown, were generally inspiratory, but in a few dogs they were expiratory.     

Radiographic demonstration of esophageal and tracheal fistulas at autopsy using a contrasting medium that vulcanizes at room temperature

Esophageal and tracheal fistulas, which occur in 0.05% of medicolegal autopsies, were demonstrated in three cases by a postmortem radiographic technique using silicone rubber/lead oxide as a contrasting medium that vulcanizes at room temperature. In one 83-year-old male, a tracheoesophageal fistula was detected, which had developed after surgical repair of an esophageal rupture caused by a flexible fiberoptic endoscope. In a second case, carcinoma of the esophagus in a 78-year-old male had eroded the trachea and arcus of the aorta creating a fatal tracheoesophagoaortic fistula. In a third case, 55-year-old female developed a tracheobrachicephalic artery fistula as a result of an infiltrating cystic adenocarcinoma of the trachea, resulting in a fatal hemorrhage into the trachea. The results of this study indicate that diagnostic radiologic methods using a vulcanized contrasting medium are useful in supplementing normal dissection in autopsy cases with suspected fistulas of the esophagus or trachea.     

Expression and function of C5a receptor in a fatal anaphylaxis after honey bee sting

The mechanisms leading to death from anaphylaxis after insect sting involve antigen cross-linkage of antibody molecules that activate immunoglobulin receptors on inflammatory cells. The aim of our study was to investigate the pathomorphology and the expression of C5aR in fatal anaphylaxis in a patient after a fatal insect sting. A 38-year-old women was stung by a honeybee. C5R1 expression was detected in many dilated capillaries in the lungs. Pulmonary epithelial cells did not bind the monoclonal antibody for C5R1; however, intensive cytoplasmic staining was detected in endothelial cells. The findings of this case provide evidence for an active role of complement in fatal anaphylaxis elicited by bee venom. C5aR detection could be useful in the identification of sudden death cases because of unwitnessed fatal insect sting cases. Authors can recommend this immunohistochemical analysis on all sudden unexpected deaths outdoors where a possible bee sting might occur.     

Asphyxia by tracheobronchial thrombus

Asphyxia secondary to airway obstruction has numerous underlying causes, both acute and chronic. Causes of chronic airway obstruction, such as neoplasms and tracheal scarring, are often clinically apparent well prior to asphyxia. Causes of acute airway obstruction may not be as obvious to clinicians or investigators. These include infections, anaphylactic reactions, status asthmaticus, inhalational injuries, and aspirations, which may result in acute obstruction and sudden death.We report the deaths of 2 individuals, a 43-year-old female and a 78-year-old female, both with adenocarcinoma. The 43-year-old was hospitalized with a stage III, poorly differentiated infiltrating ductal carcinoma of the breast metastatic to the lymph nodes. She was intubated to treat poor respiratory function and acidosis. A bronchoalveolar lavage was consistent with alveolar hemorrhage; no organisms were identified. Blood and "clot" were in her endotracheal tube, so the endotracheal tube was replaced. She became comatose and life support was withdrawn. At autopsy, a large red-gray thrombus obstructed the trachea and extended into the right bronchus. Microscopically, the entire clot was composed of fibrin, red blood cells, and some mucus. Findings of acute respiratory distress syndrome with hyaline membranes were identified. The cause of death was listed as acute respiratory distress syndrome with tracheobronchial thrombus. Experiencing a decline in mental status, the 78-year-old had metastatic adenocarcinoma of unknown primary. She developed sudden respiratory distress and an airway obstruction was discovered. After failure to relieve the obstruction, she decompensated and died. At autopsy, a large, red-gray thrombus obstructed the distal trachea and both bronchi. Microscopically, the thrombus was composed of fibrin, platelets, and red blood cells. The cause of death was asphyxia secondary to airway obstruction by thrombus. We present these 2 unusual cases of asphyxia and review of the literature focusing on asphyxia and the etiology of airway thrombi.     

Postmortem examination of transepithelial ion currents in rabbit colon and trachea in relation to temperature of storage and its importance for interlethal reactions

Electrical phenomena resulting from transepithelial ion transport have been a subject of clinical, physiological, pharmacologic and toxicologic studies. These examinations concern mainly electric phenomena in live organisms. The changes of transepithelial ion pathways which take place postmortem have not been yet established. The aim of the study was an attempt to trace variability of electrophysiological parameters related to transepithelial ion transport in specimens of rabbit trachea and colon depending on temperature at which specimens were stored after death. It was observed that postmortem electric phenomena in epithelium of airways and alimentary tract of rabbit occur well-ordered but with slower course in trachea samples and in tissues which were preserved at low temperature after death.