传染病病人或疑似传染病病人尸体解剖查验规定

第一条为了及时查明传染病病因,提高传染病诊疗水平,有效控制传染病流行,防止疫情扩散,根据《中华人民共和国传染病防治法》第四十六条(以下简称《传染病防治法)》,制定本规定。第二条本规定适用于病因不明的传染病病人或者疑似传染病病人尸体的解剖查验工作。第三条传染病病人或者疑似传染病病人尸体解剖查验工作应当在卫生行政部门指定的具有传染病病人尸体解剖查验资质的机构(以下简称查验机构)内进行。设区的市级以上卫生行政部门应当根据本辖区传染病防治工作实际需要,指定具有独立病理解剖能力的医疗机构或者具有病理教研室或者法医教…     

新型冠状病毒肺炎死亡尸体系统解剖大体观察报告

正新型冠状病毒肺炎(corona virus disease 2019,COVID-19)自2019年12月起,已造成中国7万余人确诊感染,2 000多人死亡[1],对人民生命健康、国家经济造成了严重威胁和影响。由于一直缺乏系统尸体解剖提供的完整病理学资料[2],对疾病的发病机制、器官     

14例胸腺淋巴组织增生与急死关系的分析

<正> 胸腺淋巴组织增生是不是一个独立的疾病?能否引起急死?目前尚存在分歧。现就浙江医科大学病理学教研室和法医学教研室历年来解剖的14例具有胸腺淋巴组织增生改变的急死尸体解剖材料作一分析。材料和方法本文收集的14例伴胸腺淋巴组织增生改变的急死尸体解剖占同期(1949～1990年)3400例尸体解剖的     

美国州法律有关尸体解剖的规定

在美国尸体解剖可以简单地分为出于法律目的的法定解剖和出于医学需要的医学解剖。前者由法律直接授权,后者须经死者的遗偶或直系亲属同意,但各州法律对此规定并不尽一致。一、同意做医学尸体解剖一般说来,医学尸体解剖(也称非官方尸体解剖)必须得到适当形式的批准。为此,有的州制定了专门的法律,规定了谁有权作出同意表示和拥有同意权的顺序,对此没有专门制定规定的州则适用普通法原则。基本做法是,活着的配偶或直系亲属有合法的尸体保护权及同意或拒绝同意进行尸体解剖的权力。按照美国法律,有权或有义务处理尸体的人,在人死亡的同时,即拥有收回死尸的权力。各州的法律虽然都规定了死者的父母、夫妻、成     

传染病疫情下法医学尸体解剖检验室建设展望

人群对新型冠状病毒肺炎普遍易感,在国内已造成数万人感染。由于现有的尸体解剖检验室不具备传染病患者或疑似传染病患者尸体解剖检验条件,公安机关法医人员在处理感染状态不清、疫情接触时不明的未知名尸体案事件时,面临着严峻的感染风险。为满足传染病患者或疑似传染病患者尸体解剖工作需要,确保法医人员身体健康安全,了解传染病患者的病理生理改变,完善法医学解剖检验室的建设十分必要。     

新冠肺炎等传染病与法医学鉴定评述

新冠肺炎致死或引发的其他法律纠纷可能涉及法医学病理解剖或者法医临床学鉴定。在日常法医学解剖中时有遇到因传染性疾病死亡患者的尸体,法医鉴定机构及鉴定人应当有风险识别意识,充分认识到在解剖、检查这类尸体时的被传染风险。法医鉴定人需要采取充分有效的防护措施。由于新冠肺炎属于新型传染性疾病,相关研究成果、信息资料更新快,鉴定中的信息参考要慎重选择。同时本文对因传染性疾病死亡患者的尸体解剖中常见的职业伦理、知情同意、保险理赔和环境保护等问题进行讨论。     

一种法医解剖缝合辅助器的介绍

正尸体解剖是法医学检验的重要环节,对正确判断死亡原因、死亡方式、死亡时间、致伤物具有非常重要的意义。同时在解剖过程中对法医的保护也非常重要,应尽量避免解剖器械的误伤、传染性疾病的感染。为增强自我防护、克服解剖工作中的困扰,本研究改造出一种实用小工具——法医解剖缝合辅助器,其构造简单、方便实用,值得推广。1传统的尸体解剖、缝合技术在尸体解剖、缝合过程中,应特别注意:(1)用传统方法打开腹腔、盆腔的过程[1]为:使用     

新冠疾病疫情期间死因不明尸体解剖处置流程和规范

公安法医在疫情期间随时会接触到未知名或疫情史不明确的尸体,尤其是死因不明的尸体需要进行尸体解剖,不可避免地要全程面对新冠病毒感染的高风险,笔者依据《中华人民共和国传染病防治法》等相关法律法规、新型冠状病毒及肺炎的特点、疫情防控工作指引和公安部《关于规范新型冠状病毒肺炎疫情防控期间现场勘查处置工作的指导意见》,结合本地公安法医鉴定工作实际,通过死因不明的尸体解剖工作流程上,对前期准备、人员防护、解剖操作、后期消毒及物资配备等方面进行探索,提出在新冠疾病疫情期间公安法医尸体解剖处置及防护建议,供一线法医和司法鉴定人员参考。     

法医学高危尸检的风险识别与防护

高危尸检(High Risk Autopsy)是指对患有或者可能患有严重传染性疾病的尸体进行解剖检验,该传染性疾病可能传染给尸体解剖检验的法医及其他高危人群,从而导致严重疾病或引起死亡。本文对高危尸检中的感染风险、风险识别方面进行论述,在个人防护、解剖室防护、虚拟影像方面提出安全预防措施。     

对艾滋病患者尸体解剖的体会

对艾滋病患者尸体解剖的体会张继宗作者在德国慕尼黑大学研究所工作的一年中，曾参加了大约十几具艾滋病非正常死亡者的尸体解剖。艾滋病死者的尸体解剖与常规尸体解剖的解剖过程是相同的，其不同的方面主要是个人防护。根据自己对艾滋病患者的尸体解剖实践及向德国学者的...     

虚拟解剖在新型冠状病毒肺炎法医病理学研究中的应用展望

传染病死者的尸体解剖对于公共卫生事件的管理具有重要意义。由于多种原因限制,新型冠状病毒肺炎(corona virus disease 2019,COVID-19)疫情发生以来,对2019新型冠状病毒感染死者进行法医学尸体解剖的数量较少,使法医学在传染病防治中的作用未能及时发挥。虚拟解剖(virtual autopsy,virtopsy)对传染病死者尸体的检验具有独特的优势,积累虚拟解剖影像学资料对COVID-19的病理机制研究及临床诊治具有重要意义。本文介绍了COVID-19的病理学和影像学改变的对应关系以及虚拟解剖在传染病尸体检验中的应用,旨在为法医工作者在COVID-19疫情中开展虚拟解剖检验提供参考。     

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.     

Brain amino acid abnormalities in kidney disease and diabetes mellitus

The present postmortem study examines whether specific amino acid abnormalities associated with renal diseases or diabetes mellitus in animal experiments and on clinical examination may also be found in human brain samples obtained at clinical autopsies. The material includes 12 deceased with renal insufficiency, 23 deceased with diabetes mellitus and 26 control cases with lethal cardiovascular diseases (without a history of hepatic, renal or metabolic disturbances). The autopsy and clinical records were retrospectively analyzed for age, sex, postmortem delay, cause of death, substantial preexisting diseases and histological findings. The analysis of free amino acid concentrations in human brain specimens was performed applying a Beckman amino acid analyzer. The results were evaluated using the U-test according to Mann, Willcox and Whitney. A P-value less than 0.05 was considered to be significantly different. Differences of amino acid concentrations attributable to sex, age and postmortem delay were not significant. The comparison of postmortem amino acid concentrations in the brains of patients with diabetes mellitus and controls did not reveal relevant changes. However, the patients with renal diseases, as compared to controls, showed a significant cerebral increase of urea, phenylethanolamine and gamma-aminobutyric acid. Thus, the postmortem amino acid analysis may contribute to the understanding of pathophysiological mechanisms of uremic encephalopathy and may supplement the conventional postmortem morphological diagnosis in kidney diseases by indication of functional impairment.     

Perianal and vulvar Crohn's disease presenting as suspected abuse

Misdiagnosis of sexual abuse may arise in cases of vulvar and/or perianal diseases such as lichen sclerosus et atrophicus, Behcet's syndrome, bullous diseases, contact dermatitis, or neoplastic lesions. We present the case of a 7-year-old girl who was referred by her general paediatrician to the local hospital for perianal fissures and swelling of the labia majora. A report to the judicial authorities was made, for suspected sexual abuse, and the patient was transferred to the department of paediatric surgery. Here, histopathologic examination of vulvar and rectal biopsies revealed multiple non-caseating and non-confluent epithelioid-gigantocellular granulomas, consistent with a diagnosis of Crohn's disease, with cutaneous involvement of the genitalia. In cases of suspected sexual abuse, examination of children should be performed by a specialist in legal medicine in collaboration with a gynaecologist or paediatric surgeon. If the patient is hospitalised and the question of protection does not arise, physicians should exclude dermatological diseases before reporting to the judicial authorities.     

Is routine histopathologic examination beneficial in all medicolegal autopsies?

Postmortem examinations are performed for a number of reasons. Medical autopsies are performed at the request of and with the consent of the next of kin of a decedent and are often requested to determine the extent of a disease process or to evaluate therapy. In contrast, medicolegal autopsies are performed by a forensic pathologist primarily to determine cause and manner of death but also to document trauma, diagnose potentially infectious diseases and report them to the appropriate agencies, provide information to families about potentially inheritable diseases, provide information to family members and investigative agencies, and testify in court. As medicolegal and hospital autopsies differ in their purpose, so do they differ in procedure. Medicolegal autopsies often include histologic analysis, but not always, as with medical autopsies. We designed a prospective study to address the question of whether or not routine histologic examination is useful in medicolegal cases, defining a routine case as one where histology would not normally be performed and where the cause and manner of death were readily apparent during the gross autopsy. We reviewed brain, heart, liver, kidney, and lung sections on 189 routine forensic cases and compared the results to the gross anatomic findings. Of the 189 cases, in only 1 case did microscopic examination affect the cause of death and in no case did microscopic examination affect the manner of death. Thus, we feel that routine microscopic examination (performing histologic examination in all cases regardless of cause and manner of death) in forensic autopsy is unnecessary. Microscopic examination should be used, as needed, in certain circumstances but is not necessary as a matter of routine.     

罪犯保外就医法医学文证审查278例

总结2006～2008年福建省长乐市检察技术部门所受理的278例＂罪犯保外就医＂文证审查案例,发现：看守所系统的不符合率明显高于监狱系统;在分系统疾病调查中,循环系统、神经系统以及各类传染病的不符合率明显较高。分析原因,可能为：保外就医审批渠道多,缺乏统一规范;鉴定标准陈旧,不符合当前形势;鉴定人适用标准不够严格;缺少鉴定人资质审查机制;鉴定程序不规范,管理混乱。建议从完善鉴定标准、强化审批管理、加强检察监督等方面规范、提高保外就医病残鉴定工作。     

Fatalities Due to Failure of Continuous Subcutaneous Insulin Infusion Devices: A Report of Six Cases

Diabetes mellitus type 1 and type 2 are diseases characterized by impaired regulation of blood glucose due to decreased insulin production and insulin resistance, respectively. Management of diabetes mellitus often requires injection of exogenous insulin. Continuous subcutaneous insulin infusion (CSII or insulin pump) is a diabetes treatment modality utilizing a device to aid in regulation of glycemic control. Malfunctions in device components can have rare fatal consequences. Described in this report are six fatalities due to one such malfunction, the failure of plastic cannulas of CSII devices to penetrate the skin and deliver insulin, resulting in fatal diabetic ketoacidosis (DKA). The cases derive from four different death investigation systems. For each case, scene and autopsy findings are presented, as well as selected toxicology and histology findings. These cases illustrate the importance of careful examination of CSII devices in death investigations and introduce a discussion on discrepant manner of death classifications.     

Neuropathological examination in forensic context

Different diseases of and trauma to the central nervous system (CNS), as well as their consequences are common causes of death and therefore it is important to examine the CNS appropriately in forensic autopsy, bearing in mind that the site of the disease is often as crucial as its nature. The CNS is a complex organ and its examination requires special methods and knowledge and often consultation with a neuropathologist. The prerequisite for the proper examination is correct handling and processing of the CNS. Because of its soft consistency fixation of the CNS in toto before detailed macroscopic analysis is recommended but guidance for an expedited limited examination is also given. The key features to which attention should be paid during the removal and later macroscopic examination of the CNS are described. Processing CNS for microscopy also requires special techniques and in addition to the routine stains both special histological and selected immunohistochemical stainings are often needed to reach the correct diagnosis.     

A method for group identification of hair infected with Microsporum

A method for identifying the group appurtenance of biological objects from subjects suffering from various diseases is developed. The method can be used in examination of putrefactive objects (blood, secretions, hair, etc.) and in cases when the group appurtenance cannot be identified by other methods.