389例不同年份的中毒尸检资料对比分析

本文报告近16年来(1983～1998)本教研室检验的中毒尸检158例,并与本教研室1983年以前26年(1957～1982)的中毒尸检231例进行对比分析.发现中毒毒物的种类在近16年虽然仍以有机磷农药为主,但敌敌畏中毒在90年代后则明显减少,相反新型有机磷农药及其它新型农药则逐渐增加;杀鼠剂、醇类、麻醉品及毒品呈明显增多趋势,而金属盐类毒物则减少较明显.90年代后,杀鼠剂投毒及医源性或非法行医所致药物中毒案例显著增多.     

214例中毒尸检的分析

中毒死亡案在法医学尸检工作中较为常见。本文通过对214例中毒尸检资料的统计分析，着力从毒物种类、中毒途径、死亡性质、年龄结构及农村中常见农药中毒尸体征象等问题进行分析，现总结如下。材料和方法本文收集的资料源于本地区1987年以来受理的中毒死亡法医学检验档案，经筛选资料齐全的计214例；经调查证实及医院抢救或尸检后进行毒物化验其毒物种类明确的案例。1．性别男性78例，女性136例，男女比例为1：1·74。2．年龄见表1。3．毒物种类和中毒死亡性质214例中毒尸检涉及两类毒物，一类系农药中毒，另一类系抗疟药物中毒，农药中毒之…     

604例中毒死亡案件资料分析

本文报告近20年间(1982年～2001年)湖北省孝感市公安局检验的中毒死亡尸体604例,并以10年分为两个对照组进行对比分析。发现中毒毒物的种类、中毒方式在不同的年份有较大的变化,前10年(1982年～1991年)以有机磷农药为主,其中敌敌畏占有相当比例(93%),后10年(1992年～2001年)新型农药和新型有机磷农药中毒者仍有一定的比例(23%),较前10年相比明显下降,杀鼠药、醇类、麻醉药品及毒品显著上升,而金属、盐类毒物则较少见。1材料和方法本文收集孝感市8县、市604例尸体检验资料,逐年查阅原始尸检记录和毒化检验结果,整理后进行回顾性分析。604例中…     

13例毒鼠强隐匿式自杀中毒死亡分析

隐匿式中毒自杀是指死者生前出于特殊目的,如嫁祸别人,而隐蔽地应用毒物自杀的一种死亡方式[1,2]。隐匿式中毒自杀多发生在纠纷发生过程中或不久,易引起对死因的争议。本文收集13例毒鼠强隐匿式中毒自杀资料,通过回顾性研究,提出毒鼠强隐匿式中毒自杀的特点及相关法医学鉴定注意事项。1案例资料13例毒鼠强中毒均为华中科技大学同济医学院法医学系1997-2003年的尸检资料,每份资料包括法医病理学尸检鉴定书、尸体解剖记录、毒物化验资料等,部分案例还包括案情调查和抢救病历,见表1。案例性别年龄案情争议原因病理检查及化验结果1男42伍某因家…     

汽车内 CO中毒死亡的法医学鉴定

在法医学实践中, CO中毒颇为常见,且多见于自杀或意外。在大多数情况下尸体检验时可以发现 CO中毒的迹象,尸检后毒物分析确证为 CO中毒。还有一些情况下现场不提示 CO中毒,而尸检时毒物分析发现为 CO中毒。我们报道 4例因汽车废气中的 CO中毒而死亡的案例 ,并结合文献加以分析。     

农村中毒死亡案件596例分析

本文着重从年龄、毒物种类、死亡性质、中毒途径等方面对596例农村中毒死亡案件进行了统计分析,报道如下,以供同仁参考。 1 资料统计 本文资料来源于本市自1983年～1996年间受理的中毒死亡案件,每例均有完整的尸检和毒物分析报告。     

浅述由中毒性案件引致的医疗纠纷

中毒性案件是法医学鉴定的一个重要内容。目前中毒法医学鉴定的任务主要是解决是否中毒、中毒时间、毒物种类及毒物量、案件性质等。然而随着人们的医疗意识的增强．近年来由中毒后产生的医疗纠纷案件时有报道．尤其集中在患者的死亡是由中毒直接导致．还是由医疗行为的不当引起。这为中毒的法医学鉴定提出了新的课题。由于中毒性案件的鉴定有时本身就存在相当大的难度．病史采集的不确定性及中毒者不配合治疗又可使这类案件更加复杂，     

中枢神经系统肿瘤法医学尸检13例分析

涉及中枢神经系统肿瘤死亡的尸检案例在法医学实践中并不多见.作者通过对13例尸检案例进行回顾性分析,以探讨中枢神经系统肿瘤的病理类型、死亡机制及法医学鉴定要点等问题.     

62例围产儿死亡的法医学分析

围产儿死亡率是衡量一个国家和地区的医疗卫生、妇幼保健水平的重要指标之一[1] 。为探讨围产儿死亡的一些特点 ,提高我国医疗卫生、妇幼保健水平及法医学鉴定水平 ,本文作者对同济医科大学法医学教研室 4 3年来 6 2例围产儿死亡的案例进行了法医学分析 ,供临床和法医工作者参考。1　材料和方法资料来源于同济医科大学法医病理学教研室1957～ 1999年 4 3年间法医病理尸检档案中围产儿死亡案例。案例选择的标准 :(1)死亡发生在胎龄满2 8周至出生后 7ｄ内 ;(2 )每例均经本教研室系统解剖或经外单位尸检后提取主要脏器组织送做法医病理学检查 ;…     

20例中毒合并损伤尸检资料分析

在法医学尸体检验中,中毒死亡或损伤致死的案例经常遇到,但中毒合并损伤死亡的案例文献报道较少.本文对20例中毒合并损伤死亡的尸检资料加以分析,从判断死亡原因、确定案件性质等方面进行归纳,力图找出其中的规律和特点.1 资料分析1.1一般资料中毒合并损伤死亡的案例中,男14例,女6例,男女比为7:3.年龄最大者为67岁,最小的19岁,20～60岁16例.其中农民18例,教师和售货员各1例.1.2中毒、损伤与死亡原因的关系本组案例全部经过系统解剖、毒物检验,除3例检见致命性损伤外,其余17例损伤均匀非致命伤.3例有致命伤的案例中,2例检出非剧毒毒物,为损伤致死,1例检出剧毒毒物,为中毒致死;17例非致命伤的案例均检出剧毒物质,均为中毒致死.     

Poisoning deaths in Central China (Hubei): A 10-year retrospective study of forensic autopsy cases

A retrospective study of autopsy cases was conducted at the Department of Forensic Medicine, Tongji Medical College (DFM-TMC), in Hubei, China to describe the characteristics of poisoning deaths from 1999 to 2008. A total of 212 poisoning deaths were investigated by DFM-TMC during the 10-year period. The poisoning deaths ranged from 17 cases in 1999 to 27 cases in 2008. Of the 212 cases, 82 deaths (38.7%) were from pesticides, 36 deaths (17.0%) from carbon monoxide, 34 deaths (16.0%) from drugs, 22 deaths (10.4%) from alcohol, 17 deaths (8.0%) from other chemicals, 15 deaths (7.1%) from poisonous plants and animals, and six deaths (2.8%) from heavy metals. Of the 82 pesticide poisoning deaths, 43 (52.4%) cases were caused by rodenticides, mainly tetramine (N = 39). The majority of poisoning deaths were accidents (63.7%), followed by suicides (25.9%) and homicides (3.8%). The manner of death could not be determined in 14 cases (6.6%).     

Seven cases of fatal aconite poisoning: forensic experience in China

This paper presents seven fatal cases of aconite poisoning encountered in the Tongji Center for Medicolegal Expertise in Hubei (TCMEH), China, from 1999 to 2008 retrospectively. In six of the cases, deaths occurred after drinking homemade medicated liquor containing aconite, and in one case death was due to ingestion of traditional Chinese medication containing aconite. Forensic autopsy and pathological examinations ruled out the presence of physical trauma or life-threatening diseases. Diagnosis of aconite poisoning was made after postmortem toxicological analysis. Animal experiment was performed in one case demonstrating that the medicated liquor could cause death rapidly. We present the autopsy and histopathological findings, toxicological analysis, and results of animal experiment done on samples from those seven cases. As an important herbal Chinese medicine, Aconitum species deserve special attention, especially because it contains poisonous alkaloids.     

Fatal drug poisonings: medico-legal reports and mortality statistics

The entire fatal drug poisoning panorama in Finland is considered in terms of three catergories: accidental, self-inflicted and undetermined (whether accidental or with intent to harm) deaths. The study material consisted of all 500 deaths in 1997 that medical examiners, after examination(s) at the Forensic Toxicology Division (FTD) of the Department of Forensic Medicine, University of Helsinki, officially certified as resulting from drug poisoning. These deaths were matched with data on the same deaths registered at Statistics Finland (SF), the national mortality statistics office. The SF register included 72 additional instances of deaths resulting from drug poisoning. In all but two of these cases, the cause-of-death determination was based on a medico-legal inquest with autopsy and forensic toxicological examination(s) and was certified, in most of the cases, as due to the alcohol component in multiple-toxicant combinations. Reclassifying these deaths at SF to the category of drug component is in accordance with current International Classification of Diseases (ICD-10) regulation of coding "to the medicinal agent when combined with alcohol"; the principle and practice, which is recommended to be amended to equalize the status of alcohol and drug when explicitly stated by a forensic examiner as the principal toxicant in combined poisonings. With regard to manner-of-death, the agreement rates between medico-legally proven deaths from drug poisoning and those registered at SF were 79.8% for accidents, 98.5% for suicides and 0% (nil) for undetermined deaths, at the level of three-character external cause codes (E-code). All deaths originally certified as undetermined were re-assigned, most frequently to the category of accidental death. Since within an advanced and sophisticated medico-legal system, a medical examiner's evidence-based statement, even when the conclusion reached is undetermined (as to intent), should be taken as a compelling argument, the practice of reclassification cannot be considered advisable because assembled information is lost. Concerning the assigned drug-specific groups, the agreement according to the manner-of-death between certifications and registrations was fairly good. From among the accidents, however, opioid poisonings were re-assigned in 11 (29.7%) cases, mostly to the drug abuse/dependence categories, i.e. they were considered as natural deaths by the statistics office. The drug-specific observations were possible only by using the codes from the Anatomical Therapeutic Chemical (ATC) classification of drugs. This is why the incorporation of ATC codes into the ICD system, whenever reasonable, is recommended.     

Asphyxial deaths: a retrospective study and review of the literature

An increasing death rate as a result of violence constitutes a large group in medicolegal autopsies. Specially, deaths due to asphyxia are one of the most important causes in violence deaths.During the 21-year period from January 1984 to October 2004, there were 134 asphyxial deaths autopsied by the Department of Forensic Medicine, Trakya University, Edirne, Turkey. Asphyxial deaths comprise 15.7% of all forensic autopsies; 20.8% of the cases are aged between 30 and 39 years, and the average age was 41.9 years. Males constitute 79.8% of all the cases.The most frequent method of asphyxiation death is hanging (56 cases, 41.8%), followed by drowning (30.5%) and carbon monoxide poisoning (8.2%). More violent methods, such as ligature or manual strangulations, constitute 2.9% and 2.3% of all asphyxial deaths, respectively. Although it was varying according to the methods of asphyxiation, suicide was found to be the manner of death in the majority of the cases.     

The forensic deaths caused by pesticide poisoning between the years 2006 and 2009 in Izmir, Turkey

Pesticide poisoning is still a significant health problem in Turkey. We conducted a retrospective study of autopsy cases at Izmir Branch of the Council of Forensic Medicine to describe the characteristics of deaths caused by pesticide poisoning between 2006 and 2009. The distributions of the cases according to gender and age were as follows: men 74.1% (n = 40, mean [±SD] age, 44.7 ± 14.1), women 25.9% (n = 14, mean [±SD] age, 39.2 ± 18.9). The majority of pesticide-poisoning deaths were suicides (n = 43, 80%) followed by accidents (n = 4, 8%) and homicide (n = 1, 2%). The manner of death could not be determined in six cases (11%). Suicides mostly occurred at home (n = 26, 63%) (p < 0.05). Methomyl was the most frequent pesticide (n = 9, 17%) among the all cases. This study reported that most of the pesticides found in poisoning cases were highly hazardous types. Combined efforts of medical professionals and law makers are needed for enacting strict laws against highly hazardous pesticides.     

Diagnosis of lethal poisoning with some substances used by toxicomaniacs

The authors analyze 62 expert conclusions on deaths from acute and chronic poisoning with various toxic substances used by toxicomaniacs. Forensic medical examination of corpses and forensic chemical analysis identified drugs, toluene, freon, organophosphorus compounds, and other toxins.     

Fatal poisoning with alcohol and drugs in the Greater Amman County

A study of fatal poisoning due to alcohol and drugs was carried out, to examine the mortality resulting from alcohol and drugs in the Greater Amman County, Jordan. A retrospective review of all autopsy records and certified deaths issued by the Department of Forensic Medicine at Jordan University Hospital in the greater Amman county was undertaken. During the 18 years (1978-1996) 6109 postmortem cases were performed in our department. A total of 60 cases were identified and analyzed according to age, race, sex, manner of death of the victims along with blood alcohol concentration, the drug detected at autopsies, the scene circumstances, and the geographic location of the accident and death.     

Fatal dextropropoxyphene poisonings in Jutland, Denmark

For many years dextropropoxyphene (dxp) has been the medicament most frequently occurring in drug poisoning cases examined at the Institute of Forensic Medicine, University of Aarhus. This study includes 85 cases of acute fatal poisoning examined in the period 1985-1987 in which dxp alone (40 cases) or in combination with alcohol (29 cases) and/or other drugs (16 cases) contributed significantly to death. Two-thirds of the deceased were men and one-third women. The average age was 37 years for both sexes. More than half of the deceased were drug and/or alcohol misusers. Eighteen were drug addicts. Half of the deaths resulted from accidents, while 40% were suicides. Accidental deaths prevailed among younger men. In a majority of the cases the drug had been taken orally. In these cases the median total blood concentration of dxp and the metabolite nordextropropoxyphene (ndxp) was 17 mg/kg in the suicide cases and 7.1 mg/kg in the accident cases. The corresponding figures for dxp without metabolite were 9.4 mg/kg and 2.2 mg/kg, respectively. The median value of the quotient dxp/ndxp was 1.9 in the suicide cases and 0.5 in the accident cases. The quotient, together with the concentrations of the drug, may therefore indicate the manner of death in many cases.     

Deaths among drug addicts in Denmark in 1968-1986

In the period 1968-1986 a total of 1618 fatalities among drug addicts were investigated at the three University Institutes of Forensic Medicine in Denmark. The annual number rose from 5 in 1968 to 163 in 1980, thereafter there has been a gradual fall to 121 in 1986. About 80% were males. The average age has risen from 22/23 years in the early 1970s to 31 years in 1986, and the percentage of addicts with a duration of abuse more than 10 years has increased gradually; both facts indicate a decrease in the recruitment among the quite young. In the whole period morphine was abused, supplemented by various medicines. Amphetamine was abused in the first years and again in 1986. The percentages of addicts with an abuse of alcohol and of addicts dying after a period of abstinence lasting more than 1 year, respectively, have increased. No essential changes were observed regarding distribution of residence or of the cause and manner of death. In the poisoning cases the predominant drug of poisoning was morphine/heroin, in all the years constituting approx. 30-50%. The second most frequent drugs of poisoning in the first half of the period was barbiturate, in the last half dextropropoxyphene and methadone. Only very few cases dying of cocaine poisoning were present and deaths due to so-called designer drugs have not been observed.     

中毒死亡案件的法医学分析

目的分析中毒性死亡案件和与中毒死亡有关的医疗纠纷案件的法医学特点,探讨此类案件的防护重点和鉴定要点。方法对四川大学法医学院1985～2004年106例中毒死亡尸体剖验病理材料进行回顾性统计分析。结果性别:男性61例,女性45例,男女比例1.36:1;年龄:以21～40岁年龄组(60.38%)为主;死亡方式:意外死亡最多见(52.83%),其次为自杀(33.02%)和他杀(14.15%);死亡原因:CO中毒、有机磷类中毒、毒鼠强及药物中毒多见(72.64%);医疗纠纷:发生医疗不当12例(11.32%),7例为医源性中毒性医疗纠纷,5例为中毒后在医院抢救中发生的医疗纠纷,主要发生于乡镇医院和县级医院(83.33%)。结论加强毒物的管理、提高安全意识、加强法制教育、增加生产安全等是减少中毒性死亡的重要手段。提高城乡医疗水平,加强中毒急诊抢救临床技能是防止中毒性医疗纠纷的关键。