暴发型脑膜炎与多系统器官功能衰竭2例

暴发型脑膜炎与多系统器官功能衰竭２例官鹏（华西医科大学法医学系；四川成都６１００４１）多系统器官功能衰竭（ＭｕｌｔｉｐｌｅＳｙｓｔｅｍｓＯｒｇａｎＦａｉｌｕｒｅ，ＭＳＯＦ）是近年来医学界研讨的热门课题．有关暴发型脑膜炎球菌败血症引起ＭＳＯＦ死亡的尸解...     

多系统器官功能衰竭

多系统器官功能衰竭官鹏综述多系统器官功能衰竭（Ｍｕｌｔｉｐｌｅｓｙｓｔｅｍｓｏｒｇａｎｆａｉｌｕｒ－ｅ，ＭＳＯＦ）是指疾病或损伤过程中，序贯发生２个或２个以上系统、器官功能衰竭的综合征［１－４］。ＭＳＯＦ是本世纪７０年代才开始形成的概念。１９７３年Ｔ...     

生产事故伤487例分析

创伤是现代社会的一个突出问题，并已成为人口死亡的主要原因之一。生产事故同交通事故一样危害极大，严重威胁人类的生命安全。本文就近年来阳泉地区生产事故伤４８７例进行统计分析，结果提示：（１）生产事故死亡高危人群呈“四多”特征：男性多（男女之比为８０：１）；青壮年多（７４．９％）；农协工、临时工多（８５．０％）；外地人多（６１．６％）。（２）生产事故作业环境有“四高”现象；县乡村办企业发生率高（８５．４％）；煤炭建材部门发生率高（８８．３％），冒顶爆炸等事故发生率高（８６．４％）；并下高空事故发生率高（７２．５％）。（３）时间因素以７－９月份、每月下旬，每天８－１０时和１６－１８时是高发。（４）ＣＯ中毒、缺氧窒息、挤压是生产事故致伤人体的主要方式（８２．１％）。（５）机械性损伤多，损伤复杂。（６）颅脑损伤、ＣＯ中毒、创伤性窒息、失血性休克、多系统器官功能衰竭构成生产事故的五大死因。同时作者建议：加强生产事故伤的流行病学研究；加强生产安全管理；加强创伤初期急救系统建立。     

一氧化碳中毒致周围神经病3例

周围神经病临床上表现为周围运动、感觉、反射和植物神经功能障碍，习惯上称周围神经炎，包括脑神经病和脊神经病两部分，多由感染、外伤、中毒、压迫、缺血和代谢障碍等病因引起［１］。急性重度ＣＯ中毒，有２～３％的患者出现周围神经病，且多为单神经炎，如尺神经、正...     

MODSE模型的生理生化学及组织形态学研究

目的　探讨老年多器官功能障碍综合征 (multipleorgandysfunctionsyndromeintheelderly ,MODSE)的生理生化指标及组织形态学变化特点及其意义。方法　本实验采用盲肠结扎穿孔术 (cecalligationpuncture ,CLP)制作MODSE模型和青年多器官功能障碍综合征 (multipleorgandysfunctionsyndrome ,MODS)模型 ,并设立与以上两种模型相应的假手术对照组和未加任何处理的对照组 ;分别于术后 6,12 ,2 4,48和 72h监测生理生化学指标并同时采用常规HE染色法对各重要器官 (心、脑、肺、肝和肾 )的组织形态学变化进行研究。结果　MODSE组在 6h左右就可以观察到器官功能受到损害 ,2 4h左右达高峰且持续的时间很长 ( 72h还持续存在 ) ,而MODS组则在 2 4h左右才会出现器官功能受损且受损严重程度较MODSE组轻微 ,48h达高峰。结论　MODSE模型的器官功能障碍发生率较高 ,其器官结构与功能的损害发生亦较早而且严重 ,此结果为多器官功能衰竭死亡的法医学鉴定提供一定的实验依据。     

50例男子性功能鉴定分析

对５０例男子性功能障碍法医学鉴定案例进行了分析,旨在探讨不香阴茎勃起功能障碍的发病特点及其原因。结果表明,在１６例骨盆骨折伴尿道断裂的病人中,有１０例阴茎勃起功能有不同程度的障碍,其主要原因为阴部神经和血管损伤。在６例脊柱骨折伴轻度脊髓损伤的病人中,有３例阴茎勃起功能有不同程度的障碍,其主要原因为脊髓或脊神经损伤。而在１９例睾丸损伤的病人中,除２例双侧睾丸损伤者阴茎勃起功能障碍外,其余１７例单侧睾     

全球新型冠状病毒感染（COVID-19）相关死亡的病理变化及死因分析

新型冠状病毒感染（coronavirus disease 2019,COVID-19）已在全球流行超过3年,造成690多万人死亡。COVID-19具有强传染性和长潜伏期的临床特点,能造成以肺损伤为主的多系统损伤,临床出现急性呼吸窘迫综合征以及全身多器官损伤症状,其病毒SARS-Co V-2仍在不断变异。目前全球对COVID-19相关死亡的病理改变乃至于死因判断标准并未达成共识,调查该疾病的基本病变和病变进展,有助于指导临床治疗以及治疗药物的研制。本文综述了全球2020年2月至2023年6月发表的COVID-19尸体检验报告及相关文献,以有明确的尸体检验案例数量以及对应的重要器官病理学改变为纳入标准,共纳入来自18个国家65篇论文的1 111例尸体检验案例,对病理表现和死因进行归类和统计学分析,归纳和总结了COVID-19的共性病理变化,并提出分析结论 ,认为COVID-19感染能引起全身重要器官发生危及生命的病理改变,在感染群体健康水平各异的基础上,死亡案例的直接死因主要为严重的肺部损伤及其继发的全身多器官功能衰竭。     

腹部闭合性损伤诊断鉴定的思路

依照《人体重伤鉴定标准》第六十七条、六十八条之规定，胃、肠、胆道系统穿孔，破裂；肝、脾、胰等器官破裂；因损伤致使这些器官形成血肿、脓肿，均属重伤范围。因此，及时、准确地诊断鉴定腹腔损伤就成了重要的问题。那么，怎样做到诊断正确，鉴定无误呢？其一般思路如下：一、了解致伤因素，详细查体腹部闭合性损伤的原因多系腹部受到钝性暴力所致：一为直接暴力，如踢伤、压砸伤、撞击伤；二为间接暴力，如水浪的冲击伤、震荡伤；三为惯力损伤，如高处下坠和高速行车中骤停致使腹压突然改变发生破裂伤。损伤的严重程度常取决于两个因素…     

创伤致休克和多器官功能不全综合征中的细胞凋亡研究

研究创伤致休克和多器官功能不全综合征中的细胞凋亡 ,探讨细胞凋亡在创伤性休克和多器官功能不全综合征中的发生机理及其在法医学上的应用。用TUNEL末端标记、流式细胞仪等方法 ,对广泛软组织挫伤死亡尸解15例的肝、肾、心、脑等组织进行凋亡检测。其中因创伤性休克死亡 10例 ;因MODS死亡 5例。TUNEL末端标记法检测 :创伤休克组肝、肾、心、脑的细胞凋亡指数 (AI)明显高于对照组 ;创伤MODS组肝、肾、心、脑的细胞凋亡指数 (AI)明显高于创伤休克组和对照组 ,经统计学处理有显著性差异 (P <0 0 1)。流式细胞仪检测 :创伤休克组肝、肾、心、脑的凋亡峰值分别为 2 0 3 %、 19 1%、 18 6 %、 30 0 % ;创伤MODS组肝、肾、心、脑的凋亡峰值分别为 42 2 %、 45 1%、 39 7%、 6 2 9%。创伤致休克和MODS死亡人体尸解器官中细胞凋亡增多。     

器官病变患者输液中死亡医疗纠纷尸解1例

病人在输液过程中突然死亡比较常见。本文报道1例多器官病变患者输液中死亡医疗纠纷尸解发现，结合医疗行为分析，对输液中死亡发生机理进行探讨。     

Morphological changes in the lungs in chronic drug addiction

Morphological studies of the lungs and immune system organs were made in drug addicts with narcotic intoxication. Depletion of the central and peripheral lymphoid organs was found in most cases. It is shown that morphological changes in the lungs in acute and (or) chronic narcotic drug intoxication, the rate of acute and chronic inflammatory lung diseases reflect development of lung inflammation in the presence of aquired immunological deficiency in terminal chronic drug abuse. The documented features of different pathological processes in the lungs can improve diagnosis of acute and chronic drug intoxication by results of section and histological examinations.     

Postmortem diagnosis of sepsis

Human sepsis is a spectrum of pathophysiological changes in the host system resulting from a generalized activation and systemic expression of the host's inflammatory pathways in response to infection. Since autopsy findings and routine histology in cases of suspected fatal sepsis are most often unspecific and unconvincing, a number of studies has recently dealt with different methods and markers to better define criteria for the postmortem diagnosis of sepsis. Research carried out on specimens obtained postmortem from sepsis-associated fatalities is an important tool to improve our understanding of inflammatory organ changes and the associated underlying pathophysiological mechanisms. One pitfall the investigator has to be aware of is how to select appropriate case material that constitutes the basis for the setting-up of reference values that derive from such studies. Since no scientific studies have investigated the value of cardiac blood samples in the present context, autopsy blood samples for the determination of biochemical sepsis markers have to derive from the femoral vein. In both sepsis cases as well as controls, the time of death has to be well defined.     

论建立与完善食品安全二级检验体系--由苏丹红事件引发的法律思考

近期,食品安全问题突出,一系列个案拷问着我国食品安全监管和立法部门,从中暴露了食品安全立法和监管的缺陷.借鉴日本和欧盟等国家与地区的法律实践经验,改革现存法律法规与监管机构,设立独立的食品安全管理机构,建立以政府机构和科研单位为主、社区检验机构为辅的二级检验体系.     

Fatal intoxication due to tramadol alone: case report and review of the literature

Poisoning may also lead to both coma and multiple organ failure, also in youngsters without a known major medical history. As not all toxic agents are routinely screened when a poisoning is suspected, it is useful to consider less frequently encountered poisons in certain cases. We describe the occurrence of asystole and multiple organ failure which occurred in a young man after a suspected tramadol overdose. The tramadol concentration on admission in the ICU was indeed 8 microg/ml (mg/l), far above the therapeutic range. Subsequently, the patient developed severe acute liver failure, finally leading to death. Post-mortem toxicology did not reveal any other poison responsible for this unfavourable course as only very high serum and tissue tramadol and desmethyltramadol concentrations were found. Only a few fatal poisonings attributable to tramadol alone, as observed in our case, have been reported. An overview of these cases is presented.     

检察机关与侦查、审判机关配合制约机制的现状分析及完善

在我国刑事诉讼制度中,检察机关与侦查机关之间主要围绕侦查分工和追诉目标形成相应的配合制约机制;检察机关与审判机关之间则围绕查清犯罪事实和管辖程序展开配合、围绕裁判和审理程序展开制约。检察机关主要通过通知立案、通知撤案、不捕、不诉、追捕、追诉、纠正违法等方式对侦查机关进行制约,侦查机关则通过对不捕、不诉决定的复议、复核等方式对检察机关进行制约;检察机关主要通过抗诉和纠正违法对审判机关进行制约,审判机关则通过无罪判决、改变指控等对检察机关进行制约。在司法实践中,检察机关还通过侦诉协作、附条件逮捕、建议撤案和地方政法委协调等方式与侦查机关和审判机关进行配合。总体而言,在检察机关与侦查、审判机关之间的配合制约体系中还存在制约范围不全面、制约手段有限、制约结构不稳定、配合机制缺乏约束力、配合范围不明确、考核评价机制不协调等问题。对此,应当分别加以解决和完善。     

Posttraumatic acute cholecystitis. Relationship to the initial trauma

Posttraumatic acute cholecystitis is an often unrecognized and potentially fatal complication seen among patients hospitalized for trauma, and differs in etiology from cholecystitis which develops de novo. The cause, although not yet clearly defined, is believed to be related to bile stasis, ischemia, bacterial infection, sepsis, the activation of factor XII, and the Shwarzman reaction. A case is described in which a 53-year-old man with pelvic fractures developed acute acalculous cholecystitis and died of multiple organ failure 3 weeks following cholecystectomy. The histopathological findings are also reported; these are most likely attributed to the Shwarzman reaction or the activation of the factor XII pathways. There has been a tendency to regard posttraumatic acute acalculous cholecystitis as induced by trauma, and calculous as mere coincidence. We believe, however, that it is not calculous but histopathological findings that determine whether acute cholecystitis following trauma was more than coincidence or just mere coincidence. Although progress in clinical care has improved the chances of survival of severely traumatized patients, posttraumatic acute cholecystitis has been increasing in frequency. We cannot be careful enough in judging the relationship of this fatal complication to the initial trauma.     

法律监督机关的宪法内涵

现行宪法关于"法律监督机关"(第134条)与"检察权"(第136条)之规定呈现出机关定位与权力定性的非对应性,此迥异于"一府一委两院"之其他国家机关,凸显了检察院的独特宪法地位,其蕴含的是法律监督机关的多重宪制功能。法律监督机关之宪法定位规约了检察权行使方式和检察制度的变革路径,检察权行使方式和检察制度的变革丰富了法律监督的内涵进而强化了法律监督机关的宪法定位。检察机关正是在这一良性互动中走上独具中国特色的实行法律监督之路。新时代法律监督机关应在其宪制功能与规范内涵指引下,全面维护国家法制统一,提升对行政权监督的质效,在法律监督新格局中切实捍卫社会的公平正义,进而推动中国特色社会主义检察制度行稳致远。     

Detection of species of graft in xenotransplants using arbitrary primed polymerase chain reaction.

Because of a shortage in the availability of human organs, xenografts have been attempted in humans with cardiac, renal, and hepatic failure, despite limited success. Use of xenografts, however, is regulated under law in various countries. In xenotransplant cases related to violation of transplantation law, determination of species of the source of tissue and organ(s) becomes highly essential. Random amplified polymorphic DNA (RAPD) protocols using six sets of arbitrary short-sequenced primers have been standardized for verifying claims of porcine cardiac and renal grafts in human transplantation cases. Six arbitrary primers used were found to generate unique amplicon patterns at 36 degrees C annealing temperature. Among the selected primers, a single primer set having the sequence 5'- GGTGCGGGAA -3' is found to be the most informative in discerning porcine tissue contamination in humans. The patterns obtained were consistent for a particular genome. The grafted organs in the studied case were analyzed to be of porcine origin.     

Ethical criteria for procuring and distributing organs for transplantation

This article provides an ethical analysis and assessment of various actual and proposed policies of organ procurement and distribution in light of moral principles already embedded in U.S. institutions, laws, policies, and practices. Evaluating different methods of acquisition of human body parts--donation (express and presumed), sales, abandonment, and expropriation--the author argues for laws and policies, including required request, to maintain and facilitate express donation of organs by individuals and their families. Such laws and policies need adequate time for a determination of their effectiveness before society moves to other major alternatives, such as a market. In organ allocation and distribution, which have close moral connections with organ procurement, the author defends the judgment of the federal Task Force on Organ Transplantation that the community should have dispositional authority over donated organs, that professionals should be viewed as trustees and stewards of donated organs, and that the public should be heavily involved in the formation of policies of allocation and distribution. Concentrating on policies being developed in the United Network for Organ Sharing, the author examines the point system for cadaveric kidneys, the access of foreign nationals to organs donated in the U.S., and the multiple listings of patients seeking transplants. He concludes by identifying two major problems of equitable access to donated organs that will have to be addressed by social institutions other than UNOS: access to the waiting list for donated organs and the role of ability to pay in extrarenal transplants.     

实验性轻度病毒性心肌炎的组织病理学观察

为探索轻度病毒性心肌炎的法医病理学诊断方法,以适量 Coxsackie B3病毒感染 Balb/c小鼠造成小鼠轻度病毒性心肌炎,对病鼠的心、肝、脾、肺、肾进行常规病理学检查。结果发现,心肌炎小鼠的各器官出现不同程度的病理改变。实验提示,病毒性心肌炎是一类多器官病变的疾病;对多器官进行病理学观察和综合分析是轻度病毒性心肌炎的组织病理学诊断的有效方法之一。