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Murty OP 《The American journal of forensic medicine and pathology》2008,29(3):245-248
Giant cell myocarditis (GCM) is a rare but fatal disease of idiopathic origin. It results in focal necrosis of myocardium. This is a case report of middle aged Malaysian Indian female who died due to cardiac tamponade due to rupture myocardium and tear in the root of aorta. On naked eye examination, it simply resembled as recent as well as old fibrotic areas of myocardial infarction. She was clinically diagnosed as a case of obstructive cardiomyopathy with atrioventricular block, and was on pace maker. There was subendocardial fibrosis and left ventricular transmural infarction in the left ventricle. On histopathology, this was diagnosed as GCM, there were widespread areas of inflammatory cellular infiltration within the myocardium with multinucleated giant cells and granulomas interspersed with lymphocytes. Microscopic field showed up to 10 multinucleated giant cells. In this case, there were focal areas at multiple locations and caused uneven thickness in the left ventricle wall. Idiopathic GCM is very rare and causation of hemopericardium is the unique feature of this case. In this case the direct link of GCM with aortitis and rupture of left ventricle wall resulting in hemopericardium is shown. This case is documented through macroscopic as well as microscopic photographs in H&E, Ziel-Nelson, and GMS staining. 相似文献
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For postmortem diagnosis of viral myocarditis, 12 specimens of heart in autopsy were studied immunohistochemically with anti-fibronectin(FN) antibody. Among 5 cases with definite or suspected myocarditis, intensive FN-positive could be found in all monocytes, macrophages and some neutrophils and there were 3 cases with FN-positive cardiomyocytes. While in 3 violent death cases with leucocytes infiltration in the interstitial tissue of myocardia, no FN-positive cardiomocytes were observed, which was the same as that of 4 case without cardiac pathological changes. Moreover, there were rarely FN-positive leucocytes in the 7 cases without viral myocarditis. The results suggest that the immunohistochemical observation of FN in myocardia might be of value for detecting slight degeneration of cardiomyocytes and determining the inflammatory leucocyte infiltration in myocarditis. 相似文献
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Sudden cardiac death due to giant cell inflammatory processes 总被引:1,自引:0,他引:1
Granulomatous inflammation of the myocardium may occur in a number of systemic disease processes including those with infectious etiologies such as fungal, mycobacterial and parasitic infections, as well as hypersensitivity reactions, and rarely autoimmune disorders. In many of these disorders, giant cells are components of the inflammatory infiltrate. Systemic granulomatous processes of unknown pathogenesis, most notably sarcoidosis, may also be associated with involvement of the myocardium. Occasionally, these disorders are associated with sudden death due to pathologic involvement of the heart. In contrast, giant cell myocarditis, also known as idiopathic myocarditis, a rare, frequently fulminant and fatal disorder of unknown etiology, is isolated to the heart and lacks systemic involvement. This disorder is most commonly diagnosed at autopsy. We present two cases in which sudden death resulted from a giant cell inflammatory process affecting the myocardium. Both individuals lacked antemortem diagnoses and collapsed at their respective places of employment. These cases compare and contrast the clinical and pathologic issues involved in the differential diagnoses of the subgroup of sudden cardiac deaths resulting from giant cell inflammatory processes that affect the myocardium, as well as the value of histologic examination and immunohistochemical studies. 相似文献
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D J deSa 《Forensic science international》1986,30(2-3):113-117
A series of three cases of isolated myocarditis, presenting as sudden death in infancy, occurred over a period of 3 months. This prompted a review of the autopsy records of the Children's Hospital of Winnipeg. Over a period of 40 years, 24 cases of isolated myocarditis were traced from 3196 autopsies. Most (21 of 24) cases of isolated myocarditis occurred in infants less than 12 months of age. In 16 of the infants there were either no antecedent clinical signs (sudden deaths), or a short clinical history of less than 24 h duration. Heart weights, however, were greater than the 99th percentile of published normals in three infants and above the 95th percentile in a further 16 infants. Areas of hypertrophied fibres were seen even in infants with a short history. These latter findings suggest that a latent phase of myocarditis may exist. The responsible pathogens were identified very rarely, due to a lack of suspicion of the existence of myocarditis, and it is suggested that samples of myocardium should be submitted for virologic examination in all cases of sudden death in the first year of life. 相似文献
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We report on a 5-year-old girl who suddenly collapsed and died while dancing at a family party. Histological examination of the heart including the cardiac conduction system revealed lymphocytic infiltrations of the sinu-atrial node and perivascular infiltration in the atrio-ventricular region. Additionally, foci of mononuclear infiltrates were observed in the myocardium. Consequently, myocarditis was diagnosed as cause of death. The child also had lymphocytic conjunctivis, parotitis and tracheitis. Evaluation of infections by means of nested polymerase chain reaction revealed parvovirus B19 DNA (PVB19) in tissue samples of the trachea. 相似文献
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病毒性心肌炎和扩张性心肌病中Dystrophin蛋白的表达 总被引:1,自引:1,他引:0
目的探讨病毒性心肌炎和扩张性心肌病的发病机制及相互关系,从而提高心性猝死法医学鉴定的可靠性和准确性。方法对17例对照(包括正常心脏、冠心病、高血压性心脏病等),25例病毒性心肌炎和28例扩张性心肌病的心肌组织进行改良的病理学dystrophin免疫组织化学研究。结果dystrophin蛋白在对照组,病毒性心肌炎组和扩张性心肌病组中阳性表达率分别为100%,88%,57%,三组表达差异有显著性(P<0.05),且在病毒性心肌炎和扩张性心肌病组间表达有显著差异(P<0.05),经Spearman等级相关分析呈显著负相关(r=-0.526)。结论病毒性心肌炎和扩张性心肌病心肌中细胞骨架蛋白均有破坏,且随着由病毒性心肌炎进展为扩张性心肌病,dystrophin蛋白表达逐渐降低,说明在病毒性心肌炎和扩张性心肌病的发病机制中可能与dystrophin的被破坏有关,病毒感染并破坏心肌细胞骨架蛋白并最终导致心肌细胞坏死,心功能受损,从而使病毒性心肌炎进展为扩张性心肌病。 相似文献
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目的分析甲状腺功能亢进性心脏病(以下简称甲亢性心脏病)猝死案例,探讨其死亡的一般情况及法医病理学特点,为此类案件的法医病理学鉴定提供参考。方法收集中国医科大学法医学院2001—2016年6例甲亢性心脏病猝死案例,回顾性分析基本信息(性别与年龄)、临床表现、病史、解剖所见和组织病理学所见、生物化学检测指标、死亡原因。结果 6例案例多具有明确的甲状腺功能亢进病史,并表现出不同程度的心血管病症状;均具有明显的死亡诱因;甲状腺病理学检验符合弥漫性毒性甲状腺肿的表现;心脏质量均增加,心腔扩张,心肌肥大,灶状坏死;死后心包液的生物化学检测可作为甲亢性心脏病猝死的辅助手段。结论对甲亢性心脏病猝死案例进行诊断时应参考临床病史、尸体检验、组织病理学检验、死后毒(药)物检验等结果综合判定,必要时进行死后甲状腺和心功能的生物化学检测。 相似文献
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用 8只小鼠接种柯萨奇 B3病毒( Coxsackie B3 viral CVB3),形成病毒性心肌炎动物模型。用免疫组织化学方法对心肌碱性成纤维生长因子( basic Fibroblast Growth Factor:bFGF)的变化进行了研究。目的是观察 CVB3对心肌的损害。结果发现小鼠感染病毒第 3天病变心肌中即有 bFGF阳性表达,并且随病程的延长其阳性程度随之增加。常规 HE染色通常在感染病毒 5天后才出现明显的镜下改变。本研究提示 bFGF可以为病毒性心肌炎早期轻微病变的判定提供帮助。 相似文献
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Pakis I Akyildiz EU Karayel F Turan AA Senel B Ozbay M Cetin G 《Journal of forensic sciences》2006,51(2):400-402
Echinococcosis is a human infection caused by the larval stage of Echinococcocus granulosus. The most common sites of infection are the liver and the lungs. Cardiac hydatid cysts are very rare, even in regions where hydatic cysts are endemic (the Mediterranean, South America, Africa, and Australia). It has been reported that cardiac involvement is seen in about 0.5-3% of human echinococcosis cases. Three cases of cardiac hydatid disease that caused sudden death and which were histopathologically diagnosed are reported. Cardiac echinococcosis is rare, but due to its insidious presentation and affinity to cause sudden death, it is important that it be identified in the histopathological examination. 相似文献
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Dettmeyer R Kandolf R Baasner A Banaschak S Eis-Hübinger AM Madea B 《Journal of forensic sciences》2003,48(1):183-186
A report is given on an 8-year-old boy who suddenly and unexpected died. Autopsy findings point to acute heart failure. Microscopic examination of the heart showed increased interstitial and perivasal fibrosis and myocarditis with macrophage infiltration. Polymerase chain reaction (PCR) analysis for parvovirus B19 was positive in heart samples and in the spleen. Immunostaining for parvoviral surface antigens was negative. Although the virus does not appear to have infected the cardiomyocytes, we speculate that myocarditis arose from immunological cross-reaction to epitopes shared between the virus and the myocardium. 相似文献
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N Kirkham S J Peacock D H Melcher D Machin 《The American journal of forensic medicine and pathology》1989,10(4):299-302
The circumferences of the four intact cardiac valves were measured during 397 coroner's autopsies using an obturator cone to assess the value of this measurement in the postmortem diagnosis of cardiac disease. Valve sizes of cases with cardiac and noncardiac causes of death were compared using logistic regression to assess the effects of confounding variables including sex, age, height, build and the presence of chronic obstructive airways disease. Mitral valve enlargement was found to be significantly associated with cardiac death, as were build, age, and sex. Measurement of the mitral valve at autopsy can help distinguish cardiac from noncardiac causes of death. 相似文献
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OBJECTIVE: To make a distinction between myocarditis and the reaction to some pathological state of myocardium. METHODS: Myocardium of 26 cases with sudden cardiac death were stained and LM light microscopies with immunohistochemical method 10 cases with normal myocardium were contrasted. RESULTS: A great deal of stained positive monocyte of immunohistochemistry emerged in the parasetions of myocarditis patients with various farms and stacking(> 15). CONCLUSION: The stain of immunohistochemistry can be used as one of the indications for diagnosing non-typical myocarditis. 相似文献
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K Lalu P J Karhunen P Rautiainen 《The American journal of forensic medicine and pathology》1992,13(3):196-198
A 6-month-old girl died suddenly without any previous symptoms of heart failure. Autopsy examination showed cardiomegaly (97 g) with a severely fibrotized myocardium. The left coronary artery was originating from the pulmonary artery. Histologically, the myocardium showed myocardial infarcts of different ages, as well as grossly thickened arterial branches due to increased flow in left-right shunt. We suggest that rare anomalies of the coronary arteries should be considered in the autopsies of suspected sudden infant death syndrome cases. 相似文献
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Postmortem ophthalmologic examination by endoscopy 总被引:1,自引:0,他引:1
Abnormal intraocular findings detected during forensic autopsies have generally been ignored. In this study, we assessed the usefulness of postmortem ophthalmologic examination in 46 cases using an endoscope system with a tip diameter of 0.9 mm. This procedure was performed using a portable system, and only 1 assistant was needed. Furthermore, the procedure required only about 5 minutes for both eyes. Abnormal intraocular findings were seen in 22 (47.8%) of 46 cases. Fundus hemorrhages were observed in 4, and papilledema was observed in 3 of 5 cases of death due to head trauma; besides, it was possible to estimate the interval between head trauma and death based on intraocular findings. Seven of 16 cases of death from asphyxia presented abnormal intraocular findings, including retinal splinter hemorrhages. Fundus hemorrhages were observed in 2 of 3 cases of death by drowning, which, to our knowledge, had never been reported to date.Thus, this procedure proved easy to perform, and it may be useful to detect significant abnormal intraocular findings related to the presumed cause of death during autopsies. 相似文献
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目的探讨病毒性心肌炎(viral myocarditis,VMC)和扩张型心肌病(dilated cardiomyopathy,DCM)的发病机制及相互关系,从而提高心源性猝死法医学鉴定的可靠性和准确性。方法对VMC组22例、DCM组20例和对照组16例的心肌组织中柯萨奇-腺病毒受体(coxsackie-adenovirus receptor,CAR)的表达进行改良的免疫组织化学研究。结果 VMC组和DCM组心肌组织细胞膜呈现深棕黄色阳性颗粒,有较高水平的CAR表达,与对照组比较,差异有统计学意义(P<0.05),对照组染色阴性。结论 VMC和DCM组心肌中CAR的高表达,提示VMC和DCM的发病机制可能与病毒感染有关,病毒感染并破坏心肌细胞导致心肌细胞坏死,心功能受损,使VMC进展为DCM。 相似文献