钝力性心脏外伤实验性研究——隐囊流体压力冲击心前区

本文应用隐囊流体冲击心前区，成功地制造了钝力性心脏外伤，包括心脏震荡、心脏挫伤，心脏裂伤等原发性心脏外伤以及外伤性冠脉血管炎。心肌炎血栓形成，心肌缺血坏死（外伤性心肌梗死）等继发性或迟发性外伤性损伤，指出：心肌膜爆裂（ｍｅｍｂｒａｎｅｂｕｒｓｔ），相应纤维横向膨出畸型变可以作为心脏震荡性外伤的形态学指征：钝力作为原始致伤因素作用于心前区通过压，拉，旋转或剪切力引起心脏各部，包括刺激传导系统，心脏神经组织损伤；心脏挫裂伤等见于左右心壁室中隔，心内膜下并呈播散分布。     

心脏震荡死的法医学鉴定探讨

心脏震荡死(deathfromcardiacconcussion,deathfromcommotiocordis)系指既往无心脏疾患的健康人心前区突然遭受高速、低能量、非贯通性的钝性打击后,突然发生的致死性心跳骤停,其心脏和其他内部器官没有肉眼可见的结构损伤的病理过程[1]。由于国内心脏震荡死亡尸检报道甚少,组织病理学改变缺乏特征性,法医学鉴定有一定的难度,易被误诊、漏诊。现结合笔者在检案中遇到的1例,浅析心脏震荡死的特点及法医学鉴定要点,以供同仁参考,旨在引起对该诊断的重视。1案例某男,15岁,中学生,因涉嫌故意杀人被羁押于某看守所。某晚左胸部心前区被同监室人员…     

钝力冲击后心脏血液动力学及心电图变化的实验性研究

本研究中应用机械式弹性拉力打击器以１００米／秒速度冲击犬胸骨心前区，结果表明：（１）心前区受钝力冲击瞬间左右心室内压力突然升高，继之左右心室内压力过度降低，低于相应冲击前的左右心室舒张压。这两种瞬间变化的压力在钝力性心脏外伤的成伤机制中可起一定作用。（２）伤后１８０分钟内左心室收缩压降低显著，右心室收缩压持续降低１２０分钟。左右心室舒张压分别在伤后９０分钟及６０分钟内升高。因此，左右心室收缩功能在伤后受抑制时间相对较长。（３）冲击后即刻表现出各种心律失常，以室性心动过速最多见，其次为完全性房宣传导阻滞及室性停搏，这些改变持续短时间后可恢复至窦性心律，但观察期间仍时常发生其它种类的异常心律。     

实验性早期心肌挫伤的免疫组织化学研究

应用机械式弹性拉力打击器，以10．0m／s速度冲击犬胸骨心前区，建立免疫组织化学染色对伤后2～5分钟、30～60分钟、3小时及5小时心肌挫伤组织中Mb、CK－BB及CK－MM的变化进行观察。结果表明：（1）心肌挫伤后2～5分钟检出心内膜下肌层已有重度心肌Mb脱失及中度CK－BB、CK－MM脱失，并沉积于心肌纤维间，同时吸收入血。随着伤后时间延长，挫伤区三种物质脱失加重，但间质中沉积量减少乃至消失；（2）波浪变心肌中也可见三种物质的轻度脱失；（3）同一心脏中不同部位心肌的损伤程度不同、证明应用免疫组织化学染色技术可发现心肌挫伤性损害。心前区受到相当程度的钝力冲击后心脏不同部位损害程度不同。     

氯胺酮致小鼠产生类精神分裂症的行为改变

目的对氯胺酮单次或连续给药后小鼠所产生的类似精神分裂症症状进行观察．以评价不同剂量氯胺酮造模的可行性。方法40只雄性昆明种小鼠,随机分为生理盐水对照组、氯胺酮小剂量（25mg／kg）、中剂量（50mg／kg）和大剂量（100mg／kg）组,腹腔注射给药,1次／d,连续7d。观察小鼠的行为学变化。结果单次注射氯胺酮后,大剂量组小鼠有明显的运动亢进、刻板行为及共济失调现象（P〈0．01）;连续注射7d氯胺酮后,中剂量组小鼠出现了运动亢进、刻板行为及共济失调（P〈0．05）,大剂量组小鼠刻板行为及共济失调现象更为显著（P〈0．01）。结论单次或连续注射氯胺酮均可诱导小鼠产生类似精神分裂症的症状,且大剂量时症状更为显著．连续注射后症状更为稳定。     

温度对硬膜外麻醉致死犬体内布比卡因死后再分布的影响

目的建立布比卡因在硬膜外麻醉犬体内死后再分布动物模型,观察温度对其死后再分布规律的影响。方法雄性杂种犬18只,盐酸布比卡因（5mg/kg）硬膜外麻醉致死,随机分3组,分别置于室温（20～23℃）、4℃和-20℃,于死后0、2、4、8、24、48、72、96、120h同一尸体提取心血、周围血、肝和大脑,GC-NPD、GC-MS法检测其中布比卡因含量,比较其各组含量变化。结果室温时心血、周围血和大脑的死后再分布现象较明显且复杂．4℃时死后再分布现象较室温下弱且缓慢。-20℃时4种检材中布比卡因的再分布现象进一步减弱。结论布比卡因在硬膜外麻醉致死犬体内可发生死后再分布．低温保存可延缓或阻止其发生。     

狠治“官奢”正当时

近从媒体一连读到几则有关官员奢侈消费的新闻,例如：一说深圳市目前在职局级干部和处级干部可以享受包括足疗、按摩在内的疗养待遇,局级干部标准是4000元／人·年,处级干部标准是2100元／人·年。记者大致推算,此项“待遇”,一年花费的资金超过650万元。（据2、28《扬子晚报》A12）一说最近安徽淮南市给市里的所有副处级以上干部办理了一张澳瑞特健身中心健身贵宾卡。     

三例心脏挫伤死亡的报告

本文对三例胸腹部暴力引起的心肌挫伤导致死亡的案例,进行了分析和讨论。一例系拳击胸部引起左心室肌多处挫裂伤,形状呈长条状或灶状;镜下见心肌间质内有明显炎细胞浸润,故称“外伤性心肌炎”并提出与“损伤后反应性心肌炎”,“急性间质性心肌炎”和急死时心外膜下出血相鉴别;其余二例系暴力引起心肌出血。作者还对上述病变心脏的法医学检验提出了自己的看法。     

要制止中小学变相乱收费

中小学校乱收费几经治理,取得了一定的成绩,但一些地方乱收费仍时有发生,特别是一些中小学校的变相乱收费更需要引起有关部门的重视.这些变相乱收费花样翻新:一是变“集资”为“借资”.中小学校“集资”成为明令禁止的项目后,一些学校便以向学生“借资”为名,在新生入学时向学生收取高额费用,少则数百元,多则上千元,直到学生毕业时才无息偿还,有的甚至毕业时也不还给学生.名义上是学生自愿     

“呼死你”为何逍遥法外

业务员在网上公布了联系方式,却收到源源不断的骚扰电话;网购时给卖家一个差评,却被千番百次的“一声响”打爆手机;甚至啥都没干,就接到无数的莫名来电,然后收到短信说给几百元就可停止……他们都遭遇到了“呼死你”.     

Sympatho-adrenal activity in acute cold stress. The mechanism of sudden death following water immersion]

In addition to currently known mechanisms of sudden death following water immersion, predominantly vagal cardio-depressive reflexes are discussed. The pronounced circulatory centralization in diving animals as well as following exposure to cold water indicates additional sympathetic activity. In cold water baths of 15 degrees C, our own measurements indicate an increase in plasma catecholamine levels by more than 300%. This may lead to cardiac arrhythmias by the following mechanism: Cold water essentially induces sinus bradycardia. Brady- and tachyarrhythmias may supervene as secondary complications. Sinusbradycardia may be enhanced by sympathetic hypertonus. Furthermore, ectopic dysrhythmias are liable to be induced by the strictly sympathetic innervation of the ventricle. Myocardial ischemia following a rise in peripheral blood pressure constitutes another arrhythmogenic factor. Some of these reactions are enhanced by alcohol intoxication.     

Postmortem metabolic indices of antemortem adrenergic stimulation

Tissue lactate concentration has been reported to be a useful postmortem indicator of antemortem awareness of mortal danger. The purpose of this study was to determine further whether selected tissue metabolites could be used as postmortem markers of antemortem adrenergic stress. Sprague-Dawley albino rats were anesthetized with pentobarbital and then injected with 2.0 mg kg-1 i.p. epinephrine hydrochloride to induce experimentally a severe sympathetic response that may be associated with the awareness of mortal danger; 20 min after the injection of epinephrine, when the metabolic response was at its peak, the animals were killed by exsanguination. Samples of the following tissues were removed immediately prior to death (0 h) and 48 h postmortem: soleus, plantaris, kidney medulla, kidney cortex, liver, and heart. These samples were analyzed for glycogen, lactate, ATP, creatine phosphate, pH, and total protein concentration. Significant differences in lactate concentration were observed in all tissues except soleus at 0 h in the epinephrine-injected animals. Specific tissues also had significant reductions in glycogen, ATP, and creatine phosphate concentrations at 0 h. At 48 h postmortem, however, only the liver and soleus lactate concentrations were significantly different from the 48-h control samples. It is unlikely that these small differences found in some tissues at 48 h postmortem would be detected in an uncontrolled accident situation. We concluded from these findings that these selected tissue metabolites are not useful as long-term postmortem indicators of antemortem adrenergically induced hypermetabolism.     

外周神经损伤与男子性功能障碍

支配生殖器官的外周神经包括植物神经和躯体神经,前者又分为交感神经和副交感神经,后者分为运动神经和感觉神经。男子性功能障碍可表现为性欲异常、勃起障碍、射精异常、高潮障碍和异常勃起。不同神经损伤导致性功能障碍的临床表现形式也不同,同一症状可由不同神经损伤所致。应当正确理解外周神经损伤与男子性功能障碍之间的关系。     

Diverse morphological lesions and serious arrhythmias with hemodynamic insults occur in the early myocardial contusion due to blunt impact in dogs

To investigate the morphology and hemodynamics of the early myocardial contusion, an animal model of cardiac contusion was established by impact to the precordial region at sternum at velocity of 10.0m/s with a mechanical elastic-cord propelled impactor in 19 dogs. The electrocardiogram and both the left and right intra-ventricular pressures were recorded continuously throughout the experiment. Histological and immunohistochemical examinations of myoglobin, creatine kinase-MB and fibrinogen were conducted. At the moment of impact, abrupt over-pressures within the left and right ventricles occurred with concomitant serious arrhythmias followed by variety of cardiac conduction disorders and depressed left and right ventricular systolic pressures during the observation times. Histologically, lesions of myocardial contusions were identified at subepicardial, myocardial or subendocardial layer as interstitial hemorrhage, disruption or coagulative necrosis as well as contraction band necrosis of the muscle fibers, which might be categorized into the hemorrhagic, necrotized and mixed forms. The three forms of lesions were found to exist independently, or co-existed in a heart. However, severity of the lesions varied greatly with different parts even within a heart. Intravascular thromboses were occasionally discovered post-impact. Immunohistochemically, loss of myoglobin and creatine kinase-MB from cardiac cells, and accumulation of fibrinogen at the cell membranes were detected 5min post-impact. The intracellular accumulation of fibrinogen increased with extension of post-impact intervals. Our results indicate that diverse morphological lesions concomitant with hemodynamic compromise and serious, even fatal arrhythmias occur in the early myocardial contusion, and intravascular thromboses are occasionally produced, suggesting that traumatic myocardial ischemic lesion may be induced due to blunt impact to the precordial region.     

Autonomic dysreflexia and sudden death in people with traumatic spinal cord injury

Autonomic dysreflexia (AD) is an uncommon but potentially life-threatening clinical syndrome consisting of acute episodes of excessive, uncontrolled sympathetic output that may occur in quadriplegics and in paraplegics whose spinal cord lesions are above the level of T6. These uncontrolled bouts of sympathetic output can cause transient and pronounced elevations of blood pressure that on occasion can lead to serious sequela such as the precipitation of a hypertensive intracerebral hemorrhage. The episodes of AD are often triggered by some type of noxious stimulus such as a distended urinary bladder or a fecal impaction. We present the case of a 62-year-old man with a history of quadriplegia resulting from a diving accident 40 years ago that was complicated clinically by episodes of autonomic dysreflexia. While hospitalized, he experienced an episode of autonomic dysreflexia with severe hypertension, which was soon followed by neurologic deterioration and death. Antemortem imaging revealed a large hypertensive-type intracerebral hemorrhage originating in his right caudate nucleus. Although his death at first appeared to be a natural death due to a spontaneous hypertensive-type intracerebral hemorrhage, his clinically documented autonomic dysreflexia convincingly linked the remote spinal cord injury and the fatal intracerebral hemorrhage, engendering an accidental manner of death.     

A Rare Case of Sudden Death Due to Hypotension during Cesarean Section in a Woman Suffering from Pheochromocytoma and Neurofibromatosis

Sudden death following acute hypotension due to an undiagnosed pheochromocytoma (PHEO) is a rare event. Moreover, histopathology of the myocardium in such cases is rarely reported. We present a case of a woman who died during delivery. A 37‐year‐old parturient, who was 38 weeks pregnant, suffering from neurofibromatosis underwent a cesarean section following peridural anesthesia. Acute hypotension, acute intra‐operative pulmonary edema and supraventricular paroxysmal tachyarrhythmia occurred during delivery, followed by death. The autopsy revealed the presence of a PHEO, confirmed immunohistochemically with chromogranin‐A (CgA), CD20 antibody (L26), anti‐Keratocan antibody (KER‐1) and neuron‐specific enolase (NSE), and a PHEO‐induced cardiomyopathy. The physiopathology of both stress‐induced cardiomyopathy and PHEO‐induced cardiomyopathy, as well as the role of anesthesia in provoking the death, are discussed. The association of an undiagnosed PHEO with neurofibromatosis as the cause of sudden death in pregnancy is an obstetric urgency that raises forensic pathology issues.     

Commotio Cordis – A Report of Two Similar Cases

Commotio cordis is a rare and fatal mechano‐electric arrhythmogenic syndrome, occurring mainly during sports activities. The present study describes two similar cases of sudden death caused by commotio cordis associated with homicide. The two decedents were both 15‐year‐old male teenagers. Both collapsed within several minutes after being punched in the precordial region, as observed by witnesses at the scenes. Although electrocardiograms were not recorded at the scenes or the hospitals, the sudden onset of cardiovascular, respiratory, and neural symptoms were consistent with sudden cardiac death caused by commotio cordis. Autopsy and forensic morphology both revealed no cardiac or pericardiac structural damage, evident lesions of other internal organs, or underlying diseases, along with negative toxicological analysis, conforming to criteria for diagnosis of commotio cordis. The diagnosis of commotio cordis by forensic pathologists is important in deliberating a verdict of homicide, especially involuntary homicide. In rare instances, a death caused by commotio cordis may have a homicide manner of death.     

Site, number and depth of wounds of the scalp in falls and blows--a contribution to the validity of the so-called hat brim rule

The sites, numbers and lengths of wounds of the skin of the scalp and head caused by blunt injuries (falls from standing position, falls downstairs, blows) in an autopsy series. Analysis of the localization, length and number of wounds located at the head in 305 autopsy cases of falls from a standing position (203 cases), falls downstairs (51 cases) and blows with relatively long materials (51 cases). For the distinction between falls and blows, among several other aspects the so-called rule of the hat-brim-line is described: in cases of falls from a standing position down to a flat bottom, contusions can be expected in or near a line which represents the greatest horizontal circumference of the skull, whereas in cases of blows the contusions lay above this area. Although such a tendency was found in our material, a rule could not be confirmed: only approximately 55% of the wound due to blows were above this line, and in cases of falls from a standing position ca. 1/3 of the wounds were above this area. Only in the (dorso-frontal and parietal) region "top of the head" contusions due to falls from a standing position were quite uncommon. The mean length and length distribution of wounds in the hat-brim-zone was not different between the 3 causes of injuries; in positions above this, wounds due to blows were longer compared to those by falls. In falls from a standing position, only exceptionally more than 1 wound was found, whereas in cases of homicide several or many wounds were common. Single wounds due to blows were only found in cases, in which the victims were knocked down but not killed by blunt forces, and death was caused by other methods (e.g. strangulation or stabbing).