宝鸡市358例法医送检器官的组织病理学分析

目的 分析法医尸体检验后送检器官的病理学特征,总结此类案件的特点.方法 对宝鸡市法医送检358例尸体解剖器官标本进行常规检查并进行组织病理学诊断. 结果 358例中以青壮年男性为主,死亡原因主要为创伤、猝死、中毒.组织学能明确死亡原因250例,无典型组织学病变101例,组织自溶腐败7例.病理诊断以心血管疾病为主,其次为呼吸、神经、消化系统疾病. 结论 法医解剖具有专业特点,与病理解剖不尽相同.组织病理学检验进行死亡原因诊断时,应积极与法医沟通,以充分掌握案情、死亡经过及特定的法医病理学特征.     

美国马里兰州涉及电击枪死亡案例分析

目的 研究美国马里兰州涉及电子武器(电击枪)死亡案件的特点,探讨其法医学鉴定要点.方法 收集2004-2009年美国马里兰州法医局鉴定的涉及电击枪死亡案件13例,案件均经详细的现场调查,尸体进行系统解剖,并进行全面的毒(药)物检测及组织病理学检验.从一般情况、电击枪类型及接触方式、毒物检测结果、死亡方式、死亡原因等方面...     

300例心源性猝死案例的法医学鉴定分析

目的探讨心源性猝死案例的病因、诱发因素及法医病理学特点,以期为心源性猝死案件的法医病理诊断提供参考。方法收集法医病理检案中的心源性猝死案例,对其年龄、性别、死亡时间、死因、诱因及场所等流行病学特点进行回顾分析。结果 300例心源性猝死案例中男性多于女性,18~45岁发病最多;病因包括冠心病(129例),心肌病(78例),心肌炎(36例)等;应激为SCD最常见的诱发因素(157例)。结论 1应激和冠心病是心源性猝死的重要危险因素。2心源性猝死的法医学鉴定除了要进行系统的尸检及病理学检查外,还要对死者的相关资料如:基础疾病、诱因、死亡时间、死亡经过等进行全面系统的分析以明确死因。     

中国特色的法医毒理学

我国法医中毒案件在许多方面具有显著中国的特色。法医了解和认识这些特色,有利于法医毒理病理学的理论研究和法医中毒案件的鉴定。下面仅从几个主要方面简要加以介绍。1我国中毒发生原因和方式的特点在我国,中毒是法医实践中继机械性损伤、机械性窒息之后第3位常见的死因和尸检类型[1]。综合北京、杭州、广州、西安、汕头、湖北省部分地区等公开报告的资料[2-6],在5757例中毒死尸检案例中,自杀中毒最多见,计4151例,占72.10%;其次是意外中毒,1050例,占18.24%;他杀投毒也不少见,505例,占8.77%;此外,原因不明的中毒尸检51例。Litovitz等[8]20…     

法医病理学尸检对死因分析的意义

目的:旨在通过法医病理学尸检来进一步探讨损伤、死因分布规律与疾病之间的关系。方法:对134例存有争议或死因不明的尸体进行系统的病理学检查,进一步明确其死亡原因。结果:134例尸检中,130例能够确定死因,4例未能发现明显死因。而在96例病理性死亡报告中,以心血管疾病居首,其他疾病致死依次为神经系统疾病、呼吸系统疾病、产科疾病消化系统疾病;34例外力致死报告中,24例为机械性损伤,6例机械性窒息,4例其他。结论:系统的病理学尸检,既有利于相关部门处理、调解医疗纠纷;也利于刑事、民事等案件解决、处理的公正性;同时,还可以为提高医院的诊疗水平发挥出其积极的促进作用。     

75例新生儿死亡案例法医学回顾分析

目的回顾分析新生儿的性别、存活时间、妊娠和分娩情况、病理检验和死亡原因等方面的问题,以探讨新生儿死亡的法医病理学特点。方法收集中国医科大学法医司法鉴定中心1996年～2016年的75例新生儿尸检案例,内容包括病史资料、妊娠分娩及新生儿出生情况、尸检记录、病理检验和死亡原因等,对性别、妊娠分娩情况、出生时Apgar评分及存活时间等资料进行统计分析。结果脐带绕颈导致的宫内窒息死亡多发生于出生后2h以内,羊水吸入性窒息及肺透明膜病死亡多发生于出生后24h以内,而羊水吸入性肺炎导致的死亡多发于出生后1d～7d。结论对于新生儿死亡原因鉴定,法医学工作者除了在进行系统解剖及常规毒物检查外,还应当充分考虑新生儿出生时一般状况、 Apgar评分等临床资料以及新生儿的存活时间,以对死亡原因作出准确鉴定。     

20例脂肪栓塞死亡的法医学分析

目的分析脂肪栓塞综合征（fatembolismsyndrome,FES）死亡的一般情况以及法医病理学特点,为此类案件的法医病理学鉴定提供参考。方法选取某大学法医学鉴定中心1999—2012年20例FES死亡案件．对其一般情况及法医病理学特点（包括致伤方式、损伤类型、临床表现、病理学改变等方面）进行总结。结果脂肪栓塞主要见于损伤导致的长骨骨折和全身大面积软组织损伤,主要类型为肺脂肪栓塞,偶见合并脑脂肪栓塞。症状多出现在伤后和术后较短时间内,组织病理学检查可在肺小血管内检见大量脂滴并经特殊染色证实。结论FES死亡案例在损伤类型、脂肪栓塞出现症状时间及组织病理学表现等方面均有一定规律和特点。在鉴定中应注意进行特殊染色（油红0染色）处理,寻找FES的直接证据。     

机械性窒息他杀儿童5例法医病理分析

<正>1材料与方法1.1样本来源5例尸检资料均来自于2013~2015年作者所在教研室,基本情况见表1。1.2研究方法1.2.1系统尸检及组织病理学检查依次进行尸表检查、系统尸体解剖,按顺序先解剖胸腹腔及颅腔,在颈部人工缺血后,逐层分离颈部皮肤、肌肉,进行颈部分层解剖,仔细检查舌     

监禁死亡的法医病理学研究

目的　探讨监禁死亡的法医病理学及其流行病学特点。方法　对华西医科大学法医学系 1 987～ 1 998年所作 5 2例监禁死亡案例病理材料进行统计分析。结果　性别 :5 2例均为男性。年龄 :从 1 8岁～ 70岁 ,以 2 1至 4 0年龄段为主 ( 6 1 5 3% )。民族 :汉族人居多 ( 84 6 1 % )。职业 :待业、农民、工人最多 ( 75 % )。婚姻状态 :已婚者占多数 ( 5 9 6 1 % )。监禁原因 :以抢劫、偷盗为主 ( 6 3 4 6 % ) ,首次被监禁为主 ( 94 2 3% )。监禁死亡时间以 3个月常见 ( 36 5 4 % ) ,死亡地点以派出所、看守所及监狱常见 ( 82 6 9% )。死亡方式 :自然死亡以肺结核及支气管炎为主 ( 4 6 1 5 % ) ,自杀以自缢及高坠为主 ( 4 8 1 5 % ) ,少部分为他杀 ,以同监犯人打死为主( 5 76 % )。结论　监禁中死亡与多种因素有关 ,防止该类事件的发生需要各方面的努力。     

死后变化与生前损伤或疾病的鉴别

人体死后受物理、化学以及生物学等各种内外因素的作用,在尸体上发生的各种变化称为死后变化。在法医尸检工作中,一些死后变化常被误认为是生前损伤或病理改变,由此导致法医病理学死因鉴定或死亡损伤方式推断的错误结论。笔者结合法医尸检的实践经验,总结了常见的容易被误认为是生前损伤或疾病的一些死后变化,以供法医同仁们在检案实践中借鉴。     

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。     

Post-mortem forensic neuroimaging: correlation of MSCT and MRI findings with autopsy results

Multislice-computed tomography (MSCT) and magnetic resonance imaging (MRI) are increasingly used for forensic purposes. Based on broad experience in clinical neuroimaging, post-mortem MSCT and MRI were performed in 57 forensic cases with the goal to evaluate the radiological methods concerning their usability for forensic head and brain examination. An experienced clinical radiologist evaluated the imaging data. The results were compared to the autopsy findings that served as the gold standard with regard to common forensic neurotrauma findings such as skull fractures, soft tissue lesions of the scalp, various forms of intracranial hemorrhage or signs of increased brain pressure. The sensitivity of the imaging methods ranged from 100% (e.g., heat-induced alterations, intracranial gas) to zero (e.g., mediobasal impression marks as a sign of increased brain pressure, plaques jaunes). The agreement between MRI and CT was 69%. The radiological methods prevalently failed in the detection of lesions smaller than 3mm of size, whereas they were generally satisfactory concerning the evaluation of intracranial hemorrhage. Due to its advanced 2D and 3D post-processing possibilities, CT in particular possessed certain advantages in comparison with autopsy with regard to forensic reconstruction. MRI showed forensically relevant findings not seen during autopsy in several cases. The partly limited sensitivity of imaging that was observed in this retrospective study was based on several factors: besides general technical limitations it became apparent that clinical radiologists require a sound basic forensic background in order to detect specific signs. Focused teaching sessions will be essential to improve the outcome in future examinations. On the other hand, the autopsy protocols should be further standardized to allow an exact comparison of imaging and autopsy data. In consideration of these facts, MRI and CT have the power to play an important role in future forensic neuropathological examination.     

法医病理检案工作中的人为现象

目的 研究法医病理检案工作中常见的人为现象及其造成法医学鉴定结论错误的原因。方法 收集13例法医病理复核鉴定案例,并对其进行回顾性分析。结果 胸外心脏按压所致肋骨骨折,胸、腹腔出血及肺动脉栓塞栓子破碎,误认为生前外伤或死因不明5例;胰腺死后变化(自溶和被膜下及间质出血),误认为急性出血坏死性胰腺炎4例;死后动物咬伤误认为生前损伤2例;腐败尸斑误认为皮下出血1例;死后颈部解剖不当造成颈部肌肉出血,影响死因分析1例。结论 法医病理检案工作中的人为现象,常导致法医学鉴定的结论错误。     

210例司法精神病学鉴定案例分析

作者对210例司法精神病学鉴定案例进行分析。该组刑事案例以凶杀居首位,被鉴定人以患精神分裂症为多。鉴定结论评为无责任能力者占41.6％。案件中受害者以精神发育迟缓、正处于发病期的精神分裂症或情感性精神病的女性患者(78.4％)被奸污为多。经随访司法部门的最后处理结果和我们的鉴定结论意见较为一致。     

死后尸体CT在法医学鉴定中的应用价值初探

目的 对不同类型案件中的死者进行死后尸体CT扫描和常规尸体解剖,探索PMCT在法医学鉴定中的应用价值.方法 对7例因不同原因死亡的个体进行全身PMCT扫描,随后进行系统的尸体解剖,通过比较两种方法检测的结果,分析PMCT与传统尸体解剖在不同类型案件中应用的优点和不足.结果 在7个案例中,尸体上总共检出67处阳性发现.其...     

Medical malpractice as reflected by the forensic evaluation of 4450 autopsies

A multicentre retrospective analysis of 4450 autopsies carried out due to suspicion of medical malpractice in 17 German institutes of forensic medicine from 1990 to 2000 was performed for the German Federal Ministry of Health. During the time period analysed an increase of cases could be mentioned. The main results of the study are: in the cooperating institutes the total number of autopsies due to suspected medical malpractice ranged from 1.4 to 20%. In more than 40% of the cases preliminary proceedings were started because the manner of death was certified as non-natural or not clarified. Hospital doctors were more affected by medical malpractice claims than doctors in private practice. However, the number of confirmed cases of medical malpractice was higher for doctors in private practice than for hospital doctors. Although surgery is still at the top of the disciplines involved in medical malpractice claims the number of confirmed surgical cases was below the average. Mistakes in care were confirmed to be above the average. Medico-legal autopsies are still a very sufficient method to evaluate cases of medical malpractice: 2863 cases could already be clarified by autopsy. Up to now there is no systematic registration of medical malpractice charges in Germany. A systematic registration should be initiated to build up and/or improve error reporting systems and, thus, to improve patient safety. Compared to other sources of medical malpractice claims (arbitration committees of the medical chambers, reference material of health and insurance companies, files of civil courts) the data of the present multicentre study are in so far unique as only lethal cases were evaluated and a complete autopsy report was available as basis of an expert opinion in alleged medical malpractice cases.     

过敏性反应死亡法医病理学研究

目的探讨过敏性反应死亡的法医病理学特点,从而解决困扰法医学工作者对过敏性反应死后诊断的鉴定要点。方法对华西法医鉴定中心1995―2004年尸检检出的26例药物过敏性死亡案例进行回顾性分析。结果本组26例药物过敏所致死亡案例的死者年龄以31-40岁的例数最多,占了38%;26例因药物过敏所致死亡的案例中,12例为青霉素类药物过敏,为引起过敏最常见的药物;而药物使用途径引起过敏反应死亡的案例中以注射为主,共20例;以个体诊所及基层医院多发生过敏反应死亡的案例;18例在使用药物后出现典型的严重的过敏性反应的临床表现;15例为在用药后半小时内发生死亡;病理解剖可见咽喉粘膜水肿20例,其中咽喉腔阻塞大于75%2例,50￣75%5例,25～50%7例,小于25%6例,显微镜下检查嗜酸性粒细胞浸润咽喉粘膜者21例、肺组织18例;6例血清IgE检测值呈现出显著的升高。结论过敏性反应的死后诊断应结合死者的生前临床病史,死亡时间,生前临床表现,病理解剖发现及血清IgE检测值综合分析。     

Natural death in the forensic setting: a study and approach to the autopsy

Although unexpected natural deaths comprise a large proportion of the cases seen in the forensic setting, the investigation of these cases remains a unique challenge. Some cases are straightforward; however, others require special examination and dissections, as well as the use of special dissections and ancillary studies. For the forensic investigator to accurately assign a cause and manner of death, one must be aware of the differential diagnoses, common scenarios, and typical victim. The authors reviewed all forensic cases referred to the Forensic Section of the Medical University of South Carolina over a 15-year period from January 1989-December 2003. The number of natural deaths occurring in adults (age 18 years and older) was 6932, compared with the overall number of 13,227 cases. The natural deaths were then analyzed as to autopsy findings, cause of death, cardiac versus noncardiac, age, race, and gender. Current techniques, special dissections, and ancillary studies that can assist in the classification of these deaths in the forensic setting are reviewed.     

The use of rapid diagnostic test of procalcitonin serum levels for the postmortem diagnosis of sepsis

Because serum Procalcitonin is reported to be a valid postmortem marker of sepsis, this prospective study was carried out to determine whether the semi-quantitative PCT-Q((R))-Test (B.R.A.H.M.S., Germany) is a reliable indicator of postmortem Procalcitonin (PCT) serum levels, thus enabling a quick "tableside" diagnosis of sepsis. Postmortem PCT-levels of 70 forensic and 78 clinical-pathological autopsy cases (n=148) were examined using the B.R.A.H.M.S-PCT-Q-Test during autopsy. 27 cases were categorized as the cases of sepsis according to the ACCP/SCCM Consensus Conference criteria. 121 cases were assigned to the non-sepsis group. Among the 148 cases, 18 samples could not be analyzed by the reason of strong hemolysis. Using a cut-off point of 2 ng/ml, 20 cases of sepsis were identified (true positive) whereas 3 cases of sepsis were not detected (false negative). In the non-sepsis group (107 cases) 6 cases showed a positive testing (false positive). When applied within 48 h postmortem, the PCT-Q-Test showed a sensitivity of 86.96% and a specificity of 94.39% (at cut-off 2 ng/ml). Likelihood ratios and positive predictive values proved to be lower in the forensic autopsy group (PPV: 59.3% in forensic case vs. 85.1% in clinicopathological cases; NPV: 98.73% in forensic cases vs. 95.2% in clinicopathological cases). The PPVs using a cut-off point of 10 ng/ml were 100% in both groups independent of sepsis prevalences. The results show, that a high NPV for prevalences ranging from 3% to 30% can be reached using a 2 ng/ml cut-off point, whereas a cut-off of 10 ng/ml ensures a high PPV for the respective prevalences in the absence of exclusion criteria. The study provides strong evidence that the introduction of rapid diagnostic test (RDTs) of postmortem PCT serum levels may be useful in achieving rapid distinction between sepsis and non-sepsis-related causes of death, especially in conjunction with the medical case history and further autopsy results. In addition, the use of RDTs enables clinicians to conduct an evidence-based validation of clinical diagnosis, thus facilitating future clinical decision-making.