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心脏传导系统(CCS)包括窦房结(SAN)、房室结(AVN)、房室束(又称希氏束,HB)、左右束支(LBB,RBB)及其终末纤维网,其功能是把心脏搏动的冲动传导到整个心脏,以协调心脏的节律性收缩.近年来,CCS病变与猝死的关系引起重视,已有研究表明,一些猝死与CCS的病变有关。但在实际应用中,必须将CCS增龄变化同其病变区分开来,以免误将其正常增龄变化视为病变,导致错误的结论.1SAN的年龄变化在光镜水平,Lev[1]首先对53例4个月胎儿至90岁老人的SAN进行了分年龄组观察;Davies[2]对50岁以下和75岁以上两组各50例的SAN… 相似文献
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心脏传导系统(CCS)疾病可引起猝死已得到公认,但其各种病变的具体意义尚需更多的资料积累。本文观察了10例经过常规检查,未发现明确死因者的CCS,现将其CCS的病理学改变报道如下:1材料与方法2000年~2004年间沈阳市公安局受理的10例尸检,均经过系统的尸体解剖、病理组织学和毒物分析学检查,排除了暴力、中毒和常见疾病致死。按宋一璇、姚青松[1]介绍的方法检查CCS,常规脱水、石蜡包埋,连续切片,间断取片。每例取25~35片,HE染色,少数经Masson三色染色,光镜检查。表1一般资料及心脏常规检查结果编号性别年龄职业心重(g)冠脉狭窄心脏病变死… 相似文献
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心肌及传导组织内3种蛋白的变化与SMDS的相关性 总被引:2,自引:0,他引:2
目的 观察心肌及传导组织内肌动蛋白、血浆白蛋白及纤维连接蛋白的染色变化,探讨青壮年猝死综合征(SMDS)死后诊断的新方法。方法 应用免疫组化S-P法,对SMDS及冠心病猝死者心肌及传导系统内肌动蛋白、血浆白蛋白和纤维连接蛋白的进行染色观察。结果 22例SMDS例猝死者心肌及传导系统内的肌动蛋白缺染17例;血浆白蛋白染色阳性18例;纤维连接蛋白染色阳性15例。并发现在SMDS中,8例有CCS严重病变。结论 心肌及传导系统内血浆蛋白、肌动蛋白改变与SMDS密切相关,部分SMDS病例死前存在早期心肌缺血或梗死的改变。 相似文献
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目的总结不明原因猝死案例的流行病学及法医病理检验特点,为探明其死因提供依据和线索。方法回顾分析发生于云南省的81例不明原因猝死案例的年龄、性别、死亡时状态等流行病学特征以及解剖检验和组织学检验结果。结果 81例不明原因猝死中7例为聚集性不明原因猝死,74例为散发性不明原因猝死。聚集性不明原因猝死发生具有时间、空间和家庭聚集性,死亡时清醒状态较多。散发性不明原因猝死以男性较多见,死亡时以睡眠状态居多。聚集性不明原因猝死病理改变以心肌炎为主,同一家庭内死亡案例间病变可互不相同。散发性不明原因猝死常见的心脏病变依次为心肌脂肪浸润、心肌间质水肿、心肌纤维断裂等非特异性病变和心肌间质局灶性炎性细胞浸润。结论聚集性不明原因猝死符合云南不明原因猝死的特征,其病因可能与季节、环境、遗传等多种因素有关。散发性不明原因猝死大多数具有青壮年猝死综合征的特征。 相似文献
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冠心病猝死的病理学研究——附128例尸检分析 总被引:8,自引:1,他引:8
本文报道128例冠心病猝死的法医病理学研究结果。其中冠脉病变4级63例,3级26例,2级29例。3级以上病变者斑块分布多较广泛。各支病变中以左前降支最常见。并发新鲜血栓形成者18例,斑块内出血17例,急性心肌梗死仅2例。36例冠脉斑块有炎性细胞浸润。56例见心肌间质纤维化或小灶疤痕形成。指出虽然我国冠心病发病率较低,但仍是猝死最常见的原因,尤以中壮年男性多见;多数病例无明显诱因而于睡眠中猝死。对冠心病猝死发生的特点、冠脉和心肌病变及病理诊断等进行了分析讨论。 相似文献
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120例心性猝死心传导系统观察分析 总被引:2,自引:1,他引:1
心传导系统(CCS)在心性淬死者中的病理学意义存有争论。有的学者认为有一定意义[1,2],有的学者持否定态度[3,4]。争论的焦点在于:(1)CCS具有生理性变化,难以判定病变标准;(2)形态学上CCS虽检见病变,但无心电图资料,是否具有临床意义及诊断价值。过去的CCS检查法烦琐,难以作较大量的案例分析。为此,笔者收集了120例经系统尸体解剖检查、部分做了毒物分析,并排除心外原因的摔死者的心脏标本,常规检查CCS以探讨其在心性碎死者中的法医学鉴定的意义。材料与方法材料来自1989年1月至1995年12月期间,广州地区的尸检案例… 相似文献
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Cohle SD Suarez-Mier MP Aguilera B 《The American journal of forensic medicine and pathology》2002,23(1):83-89
Sudden unexpected deaths in young persons with noncontributory histories, autopsy results, and drug screen results are a common problem in forensic pathology. As part of the evaluation of such cases, the cardiac conduction system (CCS) should be studied. To determine the type and incidence of lethal CCS lesions, the authors reviewed their files of sudden unexpected cardiac deaths with particular attention to cases with causes of death in the conduction system. Cases of sudden cardiac death in patients aged < or=40 years during a 10-year period (Michigan) and a 4 year-period (Spain) were selected from the files. From this group, cases were identified in which the cause of death was a lethal change in the CCS. The portions of the heart containing the CCS were excised, and at least one hematoxylin and eosin slide and at least one trichrome or elastic trichrome slide per block were studied. In the two centers, 381 cases of sudden cardiac death were identified. The most common causes of sudden cardiac death were arteriosclerotic narrowing of the coronary arteries, cardiomyopathy, and myocarditis. In 82 cases, there was no identifiable cause of death even after complete gross and microscopic autopsy was performed, a medical history was obtained, and a drug screen was performed. In 11 cases, the CCS contained lesions that were considered lethal: narrowing of the atrioventricular node artery by fibromuscular hyperplasia (7 cases) and atrioventricular node tumors (4 cases). The 11 cases accounted for 2.9% of the 381 cases of sudden cardiac death and 11.8% of the indeterminable cases. It was concluded that examination of the CCS in deaths in which the gross and microscopic autopsy, history, and drug screen fail to provide a cause of death can yield a cause of death in a significant percentage of cases. If heart block was not documented during life and no explanatory lesions were found during routine cardiac examination, examination of the CCS can yield valuable information. 相似文献
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青壮年猝死综合征心传导系统及心肌HHF35免疫组化研究 总被引:6,自引:0,他引:6
为了探讨青壮年猝死综合征(SMDS)的死亡原因与心性猝死之间的关系,作者对SMDS、冠心病、非心血管疾病死亡(正常对照)三组共23例心脏标本进行H.E和HHF35免疫组化观察.结果:9例SMDS中,8例心传导系统及心肌细胞出现小灶性HHF35阴性缺染区,而H.E染色未发现明显梗死灶;冠心病组7例均出现不同程度的心肌细胞缺染,呈广泛大面积分布;对照组心肌细胞、心传导系统及血管壁里均匀一致的阳性染色.表明部分SMDS死前已有早期心肌缺血或梗死等病变,其死亡原因应为急性心功能不全而致猝死. 相似文献
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886例人心传导系统形态变异研究 总被引:3,自引:0,他引:3
探讨划分心传导系统 (CCS)变异与发育异常的界限。用本组建立的CCS检查法[1] ,连续切片 ,HE或Masson三色染色 ,光镜检查 ,对非心源性死亡组 (737例 )和心源性猝死组 (14 9例 )进行形态学及死因对比分析。结果显示 :(1)人CCS具有大小、位置和形态的先天性变异 ;(2 ) 4例心源性猝死者的房室结、房室束发育异常。房室束分叉部向室间隔膜部内移位、偏向于室间隔左侧、向左下侧移位 ,以及不足 1/2房室结移位至中心纤维体内、普通心肌移位至房室束或左束支内等应属变异 ;成年人胎儿型房室结及房室结全部移位至中心纤维体内或房室束完全分成 3束以上 ,房室束分叉部移位至三尖瓣根部应视为发育异常 相似文献
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《法医学杂志》2017,(2):171-174
Sudden cardiac death (SCD), most commonly seen in coronary heart disease, is a kind of sudden death caused by series of cardiac parameters, which usually combines with myocardial infarction. However, some SCDs (including early myocardial infarction) happen suddenly and cause death in a very short time. In these circumstances, typical morphological changes are lack in macroscopic or microscopic fields, which make such SCDs become the emphasis and difficulty in the present research. SCD caused by myocardial infarction and abnormalities of cardiac conduction system (CCS) is related to atherosclerosis of coronary artery closely. This paper reviews cardiac dysfunction caused by myocardial infarction and diseases of CCS from morphology and molecular biology, and explores potential relationship between them. This paper aims to provide clues to the mechanism of myocardial infarction related sudden death and possible assistance for forensic diagnosis of SCD. © 2017 by the Editorial Department of Journal of Forensic Medicine. 相似文献
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G. Haring E. Kralj J. Bala?ic B. Ermenc 《Forensic Science International Supplement Series》2009,1(1):72-75
Introduction (Aim)
Sudden unexplained death (SUD) is a common problem in forensic pathology. In many of these cases, the autopsy findings, toxicological examinations and patient history are inconclusive. Many studies suggest that in such cases, the cardiac conduction system (CCS) should be histologically examined. We decided to determine the diagnostic value of histological examination of the CCS.Methods
We reviewed autopsy files from the period 2005–2007 and selected those cases in which the CCS had been sampled. These were divided into two groups, the first comprising cases with an obvious cardiac pathology (e.g. severe coronary disease, myocardial infarction, significant myocardial hypertrophy/dilatation, valvular disease, etc.) and the second comprising cases without obvious cardiac pathology (i.e. fatal injuries, intoxications and deaths unexplainable by routine procedures). The CCS was sampled according to a detailed protocol and examined under a light microscope. On the basis of the findings of histological examination of CCS, we formed subgroups of the aforementioned main groups.Results
We analyzed 118 cases, of which 83 were males and 35 females. In 57% of cases, autopsy revealed gross pathological abnormalities of the heart. In 10 (15%) of them, examination of the CCS showed significant pathological changes (narrowing of the nodal artery and its branches, moderate to severe interstitial fibrosis, calcifications in the central fibrous body impinging upon CCS). In some, especially those with no acute findings, CCS disease can be considered to have been the cause of fatal arrhythmias. In 43% of cases, autopsy revealed no gross abnormalities of the heart, while histological examination of the CCS disclosed significant pathological changes in 4 (8%). Among them, CCS disease was regarded as the cause of death in one case and as a possible cause in another case.Conclusion
As with other similar studies, our study showed that examination of the CCS can provide valuable information on the cause of death. We therefore consider that examination of the CCS should be performed in all SUD cases, especially those in which the cause of death cannot be established by routine procedures. Although we had only 1 confirmed cause of death linked to CCS disease and one possible, we had 14 cases with significant pathological CCS changes. This leads us to the conclusion that post-mortem examination of the CCS is of diagnostic value. 相似文献16.
作者应用PGP9.5与抗S100抗体和高压消毒蒸锅抗原复活技术对4例婴幼儿猝死综合征(SIDS)和3例非心源性死亡对照婴儿心传导系统的神经组织总量进行免疫组化研究。结果:在正常婴儿心传导系统,PGP9.5与S100阳性的神经纤维里不均匀分布,以窦房结最多,房室结次之,希氏束最少;4例SIDS心传导系统的神经组织分布同对照组无明显差异。 相似文献