医疗事故中的因果关系初探

医疗事故中的因果关系初探刘新社，刘明俊，唐承汉，张秦初Ａｆｅｗｗｏｒｄｓａｂｏｕｔｔｈｅｃａｕｓａｔｉｏｎｏｆｍａｌｐｒａｃｔｉｃｅ￥ＬｉｕＸｉｎｇｓｈｅ（ＦｕｃｕｌｔｙｏｆＦｏｒｅｎｓｉｃＭｅｄｉｃｉｎｅ，ＸｉａｎＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ...     

《道德和法律理论中的难题群》

书名 :ＴｈｅＰｒｏｂｌｅｍａｔｉｃｓｏｆＭｏｒａｌａｎｄＬｅｇａｌＴｈｅｏｒｙ作者 :ＲｉｃｈａｒｄＡ .Ｐｏｓｎｅｒ出版 :ＴｈｅＢｅｌｋｎａｐＰｒｅｓｓｏｆＨａｒｖａｒｄＵｎｉｖｅｒｓｉｔｙＰｒｅｓｓ,1999,32 0 ｐｐ ;Ｃａｍｂｒｉｄｇｅ ,ＭａｓｓａｃｈｕｓｅｔｔｓａｎｄＬｏｎｄｏｎ ,Ｅｎｇｌａｎｄ .评论人 :ＩｒａＬ .Ｓｔｒａｕｂｅｒ,ＤｅｐａｒｔｍｅｎｔｏｆＰｏｌｉｔｉｃａｌＳｃｉｅｎｃｅ ,ＧｒｉｎｎｅｌｌＣｏｌｌｅｇｅ .Ｅｍａｉｌ:Ｓｔｒａｕｂｅｒ@ｇｒｉｎｎｅｌｌ.ｅｄｕ译者 :陈欣新校者 :吴玉章《…     

35例胰腺出血案例死亡原因分析

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SUBSCRIPTION FOR 1996 JOURNAL OF FORENSIC MEDICE

ＳＵＢＳＣＲＩＰＴＩＯＮＦＯＲ１９９６ＪＯＵＲＮＡＬＯＦＦＯＲＥＮＳＩＣＭＥＤＩＣＥ￥Ａｂｓｔｒａｃｔ：ＪｏｕｒｎａｌｏｆＦｏｒｅｎｓｉｃＭｅｄｉｃｉｎｅｉｓｐｕｂｌｉｓｈｅｄｑｕａｒｔｅｒｌｙｂｙｔｈｅＩｎｓｔｉｔｕｔｅｏｆＦｏｒｅｎｓｉｃＳｃｉｅ...     

《践履正义:一种律师伦理的理论》

书名 :ＴｈｅＰｒａｃｔｉｃｅｏｆＪｕｓｔｉｃｅ :ＡＴｈｅｏｒｙｏｆＬａｗｙｅｒｓ’Ｅｔｈｉｃｓ作者 :ＷｉｌｌｉａｍＨ .Ｓｉｍｏｎ出版 :ＨａｒｖａｒｄＵｎｉｖｅｒｓｔｙＰｒｅｓｓ,Ｃａｍｂｒｉｄｇｅ ,ＭＡ ,1998评论人 :Ｔ .Ｍ .Ｈｉｌｂｉｎｋ ,ＮｅｗＹｏｒｋＵｎｉｖｅｒｓｉｔｙＩｎｓｔｉｔｕｔｅｆｏｒＬａｗａｎｄＳｏｃｉｅｔｙ .Ｅｍａｉｌ:ｔｍｈ70 53@ｎｙｕ .ｅｄｕ译者 :赵雪纲校者 :黄　列《践履正义:一种律师伦理的理论》     

中华人民共和国农业植物新品种保护名录(第二批)

中华人民共和国农业部令 第２７号根据《中华人民共和国植物新品种保护条例》规定，《中华人民共和国农业植物新品种保护名录（第二批）》，经２０００年２月１３ 日农业部第一次常务会议通过，现予发布施行。部长陈耀邦 ２０００年３月 ７日属或者种名学名１．普通小麦 Ｔｒｉｔｉｃｕｍ ａｅｓｔｉｖｕｍ　Ｌ·２．大豆 Ｇｌｙｃｉｎｅ ｍａｘ（Ｌ．） Ｍｅｒｒｉｌｌ３．甘蓝型油菜 Ｂｒａｓｓｉｃａ ｎａｐｕｓ　 Ｌ４．花生 Ａｒａｃｈｉｓ ｈｙｐｏｇａｅａ Ｌ．５．普通番茄 Ｌｙｃｏｐｅｒｓｉｃｏｎ ｅｓｃｕｌｅｎｔｕｍ Ｍｉｌｌ…     

委婉语初探——Euphemisms

“ＴｈｏｓｅＭａｃｅｄｏｎｉａｎｓ” ,ｓａｉｄｈｅ ,“ａｒｅａｒｕｄｅａｎｄｃｌｏｗｎｉｓｈｐｅｏ ｐｌｅ ,ｔｈｅｙｃａｌｌａｓｐａｄｅａｓｐａｄｅ” .———Ｐｌｕｔａｒｃｈ ,ＡｐｏｔｈｅｇｍｓｏｆＧｒｅａｔＣｏｍｍａｎｄｅｒｓ,Ｐｈｉｌｉｐ一、委婉语 (Ｅｕｐｈｅｍｉｓｍ)在所有文化中 ,人们对某些概念或事物总想避免直接提到它 ,尽管在他们的语言里有这些词语。委婉说法就是用一个听起来比较婉约的词语来替代不宜直言的人或事物。Ｈ .Ｗ .Ｆｏｗｌｅｒ说 ,委婉语是“ａｍｉｌｄｏｒｖａｇｕｅｏｒｐｅｒｉｐｈｒａｓ…     

宪法变迁理论评析

宪法变迁理论评析韩大元在当代的宪法学理论研究中，各国宪法学家们普遍关注规范与现实的冲突和协调问题。宪法学既是一门规范科学（Ｎｏｒｍｗｉｓｅｎｓｃｈａｆｔ），又是一门现实科学（Ｗｉｒｋｌｉｃｈｋｅｉｔｓ－Ｗｉｓｓｅｎｓｃｈａｆｔ）。规范科学与现实科学...     

法律与医学杂志1995年第2卷主题词索引

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VEGF与缺血性心脏病及其在法医学的应用

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Traumatic subarachnoid haemorrhage: a 10-year case study and review

Fourteen cases of traumatic subarachnoid haemorrhage (TSAH) from the years 1985-1995 are described. Two of these cases, one paediatric and one involving controlled substances, are considered separately. All 14 cases are then discussed together with the current literature with respect to: typical subject, the circumstances and aetiology of injury, time interval between injury and collapse; time of survival, the role of alcohol, the site of arterial rupture, and the methods recommended by other authors for the location of such an injury. We conclude that TSAH is a poorly understood cause of sudden death; fuller research is needed to clarify aetiology.     

慢性乙醇中毒脑β-淀粉样前体蛋白与外伤性蛛网膜下腔出血死亡的关系

目的观察大鼠慢性乙醇中毒下脑组织轻微伤后β-淀粉样前体蛋白(β-amyloid precursor protein,β-APP)的表达,探讨乙醇中毒与外伤性蛛网膜下腔出血(traumatic subarachnoid haemorrhage,TSAH)死亡的相关性。方法雄性SD大鼠60只,随机分为灌水组、灌水打击组、灌酒组、灌酒打击组。灌酒组以食用酒连续灌胃4周,打击组予脑震荡打击,各组大鼠脑组织行HE、免疫组织化学染色,组织病理图像系统量化分析检测结果。结果灌水组脑无异常;灌水打击组全脑神经元轻度水样变性;灌酒组脑表面可见血管纹理,神经纤维排列稍疏松、间隙增大;灌酒打击组脑表面弥漫性淤血,脑干周围多见厚层斑片状TSAH,轴索不规则断裂。灌酒组额叶、海马、小脑、脑干β-APP IOD值高于灌水打击组及灌酒打击组。结论慢性乙醇中毒脑组织的耐受性明显下降,轻微损伤情况下即可引起致死性TSAH和神经病理学变化。     

Undetermined Manner of Death: An Autopsy Series

A manner of death may be ruled undetermined by the forensic pathologist when there is insufficient information about the circumstances surrounding the death to make a ruling. The aim of our study was to retrospectively analyze a series of autopsy cases that were classified as undetermined manner of death after complete investigations. In all, 48 cases were examined. In 23 cases (48%), the cause of death was determined. The most frequent cause of death was toxic death (n = 11). More than one manner of death was deemed conceivable for most cases (n = 39). The most frequent and the most probable manner of death was accident (n = 37). Homicide was not excluded in about 23% of the cases. Our study showed that the manner of death may remain undetermined despite an established cause of death, and even when two or more conceivable causes of death are considered. Our study pointed out that undetermined manner of death covers a wide range of situations and that homicide may be underestimated.     

Uncertainty of determining cause of death in a medicolegal material without autopsy. An autopsy study

In constrast to other studies, this investigation was made on cases of medicolegal deaths that would not normally be autopsied. 223 females and 322 males, whose deaths were found to be natural before as well as after autopsy, were studied. The cause of death was estimated by external medicolegal examination, and after autopsy.In 79 females and 109 males, i.e. 35% and 34% respectively, estimated cause of death was found to be different after the autopsy. This was mostly because ischaemic heart disease as a cause of death was overestimated at the external medicolegal examination. No constant relationship between differing causes of death and age group could be demonstrated. Underdiagnoses and overdiagnoses tended to outweigh each other. Pneumonia, pulmonary embolism, cor pulmonale and aortic stenosis were clearly underestimated before autopsy. In addition, a variety of diseases that were not even mentioned at the medicolegal examination was found (subarachnoid haemorrhage, uraemia, perforated and bleeding gastric ulcers, tuberculosis).The same unreliability in the estimated cause of death therefore exists among cases not normally autopsied as found in retrospective studies of cases where autopsy is performed under all circumstances at the request of the police.False information will thus be given to the mortality statistics among the approximately 5000 cases of medicolegal deaths not autopsied in Denmark per year, most of these being natural deaths. Besides, contagious and inherited diseases could be overlooked, relatives given false information and the value of scientific studies in causes of death diminished.The conclusion is that autopsy is still essential to ensure continuous control and correction of causes of death.     

Fatal subarachnoid hemorrhage complicating actinomycotic meningitis

Actinomycosis is caused by Gram-positive Actinomyces species that are part of the normal oral flora with low virulence. We describe a rare case of sudden death of a 48-year-old man with actinomycotic basilar meningitis that was complicated by fatal subarachnoid hemorrhage. Autopsy revealed meningitis at the basilar region of the brain, and histological examination revealed characteristic bacterial aggregates with extensive leukocyte infiltration and severe vasculitis of arteries of this region. Rupture of an artery by severe arteritis was thought to be the cause of the subarachnoid hemorrhage. The probable primary source of infection was found in the left lung. To the best of our knowledge, the complication of subarachnoid hemorrhage has not been reported previously in actinomycotic meningitis.     

机动车驾驶人酒后驾车管理对策研究

酒后驾车对社会财产和人身安全造成了巨大威胁,是交通事故中机动车驾驶人过错造成人员死亡突出因素之一。通过依法管理,技术控制,经济制约,教罚结合,多方参与,堵疏互补等多种管理对策,兼顾以人为本和可操作性,可以减少酒后驾车,保障道路交通安全。     

原发性蛛网膜下腔出血的讨论——附7例尸检报告

本文报告7例法医病理解剖材料,其中脑血管动静脉畸形引起的5例,动脉瘤与巨细胞性动脉炎引起的各1例。因死亡都是发生在头部外伤之后,故引起申诉。肉眼检查时,7例中有6例未查明病因,诊断系依靠病理组织学检查。本文结合文献复习,重点讨论了检验鉴定的方法和注意事项。文中4个重新鉴定的案例,原结论均未发现本病的病因,甚至有的误认是损伤性蛛网膜下腔出血,此点应引以为戒。     

127例蛛网膜下腔出血案例的法医学研究

目的探讨蛛网膜下腔出血(SAH)对保险公司的直接请求权,从而缓解了患者在请求赔偿方面的特点及法医学鉴定要点。方法通过对华西医科大学法医鉴定中心1983-2001年尸检检出的127例各种原因所致的SAH案例进行回顾性分析。结果各类SAH案例,男性明显多于女性,男女性别比为3:1,高峰年龄为21~40岁。按SAH常见特征可分为外伤性、脑血管畸形、动脉瘤、脑血管粥样硬化、中毒、伴发于心脏疾患、其他等八类。其中,外伤性与脑血管畸形最为多见。外伤性SAH与脑血管畸形出血可见于任何年龄,多见于11~50岁,脑血管粥样硬化出血仅见于50岁以上者,动脉瘤破裂出血者并不多见,见于11~50岁。以SAH为死亡原因者,32例,占25%,多见于脑血管畸形与动脉瘤破裂,出血部位多见于脑底及小脑天幕以下。大多数SAH,出血部位多见于大脑表面,较为局限,出血量较少,非死亡的主要原因。结论多数SAH并非导致死亡的主要原因,SAH死亡者,其死亡性质多属自然死亡。     

利多卡因在蛛网膜下腔和静脉注射致死犬体内的死后分布

目的比较利多卡因在蛛网膜下腔和静脉注射致死犬体内的死后分布特点。方法犬12只,其中6只经蛛网膜下腔,另6只经股静脉匀速注入利多卡因(5×15mg/kg)致死,迅速解剖动物,取大脑、侧脑室脑脊液、腰段脊髓腔脑脊液、不同脊髓节段(颈髓、胸髓、腰髓、骶髓),心、肺、肝、脾、肾、胆汁、尿、心血、周围血、注射部位肌肉和注射部位20 cm以外肌肉等脏器组织和体液,用气质联用法定性,气相色谱法定量检测其中利多卡因含量。结果蛛网膜下腔注射致死犬体内利多卡因的含量由高到低顺序依次为腰段脊髓腔脑脊液、骶段脊髓、胸段脊髓、侧脑室脑脊液、腰段脊髓、颈段脊髓、肺、肾、注射部位肌肉、心、大脑、脾、心血、肝、周围血、胆汁、注射部位20 cm以外的肌肉、尿;静脉注射致死犬体内利多卡因的含量由高到低顺序依次为肾、心、肺、脾、大脑、肝、周围血、胆汁、心血、颈段脊髓、胸段脑脊液、注射部位肌肉、腰段脊髓、注射部位20 cm以外的肌肉、侧脑室脑脊液、尿、腰段脊髓腔脑脊液、骶段脊髓。结论蛛网膜下腔注射致死犬背侧脊髓液中利多卡因含量最高,静脉注射致死犬肾脏利多卡因含量最高,此分布特征可为利多卡因麻醉意外法医学鉴定中入体途径的判定提供参考。     

Brain arteriovenous malformation and its implication in forensic pathology

Despite the fact that brain arteriovenous malformations (BAVMs) are a possible cause of sudden and unexplained death, very few papers have discussed their importance in the forensic context. BAVMs consist of tangled masses of tortuous arteries and veins devoid of intervening capillaries that frequently extend from brain parenchyma into the subarachnoid space. Apart from BAVMs, three major groups of vascular malformations of the brain are known: cavernous hemangioma, venous angioma, and capillary telangiectasia. BAVMs and cavernous hemangioma often cause hemorrhages, while venous angioma and capillary telangiectasia are typically asymptomatic. Presented here is the case of a 14-year-old girl who died from a ruptured BAVM. The present case is a reminder that the forensic pathologist should be able to recognize BAVMs and to differentiate it from other types of vascular malformations. Although rare, it is a cause of sudden death not to be overlooked, especially in children.