涉及死亡非医疗过失纠纷的类型,死因和发生原因——27年医疗纠纷法医尸检回?

对1992～1998年间206例非医疗过失尸检资料进行回顾性研究,表明涉及死亡的非医疗纠纷中各类疾病死亡占53.88%,难以避免的并发症占39.81%,医疗意外占6.31%.发生原因中对死因怀疑占44.66%,怀疑输液(血)错误占15.05%,怀疑治疗出问题占9.71%,怀疑用药错误或诊治延误各占8.74%,其它13.11%与医护人员态度不好、医院管理有关.     

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…     

公务员对待廉政教育的政治态度的影响因素研究

本文运用理论分析、文献分析、访谈和开放式问卷等方法，搜集潜在的影响因素；基于两轮问卷调查，运用探索性因子分析和验证性因子分析，确定了6类20项影响因素。在对结论进行分析的基础上尝试构建了影响因素模型。该模型显示，内部要素是公务员对待廉政教育的政治态度的根本影响因素，具体开展的廉政教育作为外在刺激是公务员对待廉政教育的政治态度形成的实践基础；身份特征、政治倾向等个人因素在此过程中发挥着内在作用，同时，这种作用还受他人态度和反腐形势等环境因素的影响。     

574例高坠死亡案件分析

目的通过对大量高坠死亡案件的现场分析、尸体的损伤形态学观察并结合案情调查资料,构建高坠案件法医病理学案例库,为研究疑难坠落死亡案件奠定基础。方法收集并回顾分析5省市574例高坠死亡案件资料,包括死者个人信息、现场勘查资料、尸检结果、精神疾病史和毒物检验结果。结果男性的意外死亡率明显高于女性;在0～10岁年龄组未见自杀案例;在60岁以上年龄组,自杀率明显高于意外死亡;大多数的意外案例都发生在工作地点;坠落高度在10m以下的案例中,落地最先接触部位以头部居多,而在10～25m高度,足或下肢多见。结论大多数高坠案例都有明确的结论,但部分案例成伤机制及死亡方式判断呈现明显分歧,应为今后坠落伤研究的重点方向。     

超越恐惧:基于老年死亡态度的视角

老年心理健康是老龄化社会的重要研究课题,而探讨老年心理健康离不开研究老年死亡态度。文章系统梳理了老年死亡态度的结构和特征、影响因素及其与心理健康的关系。分析了恐惧管理理论对老年死亡态度研究的影响。从轻视死亡接受、缺少理论整合、研究方法单一、忽视文化差异、逃避根本难点等五方面对老年死亡态度研究进行了评价。     

我国公民政治参与及其影响因素分析

本研究以2005年在福建省厦门市进行的“厦门居民不同职业状况调查问卷”统计资料为根据，分析当前我国公民政治参与情况，并通过以性别、年龄、文化程度、个人收入等多个因素作为自变量，以公民政治参与因子作因变量，建立多元回归模型，分析我国公民政治参与的影响因素。     

意外刎颈死亡1例

刎颈死亡，系指用刀、并等锐器切割或砍击颈部造成颈部大血管、神经和气管等破裂而死亡。多见于自杀，亦可见于他杀，极罕见于意外。笔者在检案中，曾遇一例因不慎滑倒而致意外刎颈死亡，现报告如下。1案情摘要某日晚10时余，某银行职工郭某（男，26岁）家中传出一女子哭泣声。据该女子称：今晚郭某邀他至家中玩，在客厅聊天过程中，郭某去厨房倒开水，行至厨房的玻璃门前时，突然不慎滑倒，被玻璃碎片割伤颈部后倒地死亡。2尸检所见尸检在当晚进行。死者衣着尚整齐，全身染有多处血迹，一双黄色塑料拖鞋已脱落。头部未见暴力性损伤。两眼角…     

160起重大责任事故死亡的法医学分析

１６０起重大责任事故死亡的法医学分析王山青本文通过１６０起重大责任事故中死亡１６７人的检验解剖资料，分析了重大责任事故的一般情况，重大事故与致伤方式的关系，讨论了重大责任事故的死亡原因，提出了影响尸检质量的因素及预防对策。资料本组选用北京市房山辖区内...     

硬膜外神经阻滞麻醉死亡原因分析(附1例尸检报告)

本文通过一例硬膜外神经阻滞麻醉下阑尾切除术后患者死亡的临床及尸检资料的分析，对死因认定及相关医疗纠纷的防范进行了讨论。指出规范的尸体检验对明确死因、解决医患纠纷具有重要作用，尸检前的解剖设计是做好尸检、找到死因不容忽视环节，规范、科学的死因分析是进行诊疗评价、责任划分、防范医疗纠纷的科学依据。     

从法医病理角度探讨老年人肺动脉栓塞

目的：从法医病理角度探讨老年人肺动脉栓塞临床特点，为临床准确诊断肺动脉栓塞疾病提供可靠依据，降低误诊、漏诊几率。方法：对7例老年肺动脉栓塞死亡患者临床资料进行回顾性分析，内容包括患者临床表现、临床检查结果等，之后对其进行尸检。记录尸检病理结果，对肺动脉栓塞临床特征进行总结。结果：老年人肺动脉栓塞患者临床表现为突发性胸膜痛、心悸、冷汗、胸闷、咯血、突发劳力性呼吸困难甚至晕厥等，最终因肺部出现急性循环衰竭导致死亡。尸检结果为将老年肺动脉栓塞患者心脏及肺动脉切开后均可见血栓形成，且数量较多或体积较大，血栓可呈现出红色或混合性质。结论：老年人具有肺动脉栓塞多种危险因素，因此肺动脉栓塞疾病发生率较高，易形血栓成胁健康及生命安全，应引起临床医务工作者及法医工作者高度重视。     

Dementing diseases among elderly persons who suffered fatal accidents: a forensic autopsy study

The demographics and forensic autopsy findings of 125 elderly persons were analyzed to identify the risk factors of fatal accidents among elderly and to develop preventive measures to minimize such events. Cliniconeuropathologic dementing diseases were diagnosed in 13 of the 69 accidental death but only 1 of the 56 nonaccidental death cases, indicating that dementing diseases are associated with accidental deaths of elderly in forensic autopsy populations and suggesting that interventions for preventing fatal accidents should focus on elderly persons with dementia. Blood alcohol was only detected in persons without dementia, indicating that dementing diseases and drunkenness are not coexisting factors for fatal accidents among elderly. Living alone might increase the risk of mortalities associated with accidental injuries because of the absence of a caregiver at the scene and delayed medical help. The majority of fatal accidents occurred outdoors, emphasizing the need for interventions to reduce environmental hazards such as those related to traffic, open water, and cold weather. Increased public awareness of accident risks and preventive interventions will reduce accidental deaths among community-dwelling elderly people.     

Nursing home deaths which fall under the jurisdiction of the coroner: an 11-year retrospective study

Twenty percent of deaths in the United States occur in nursing homes, yet less than 1% come to autopsy. The current study analyzed causes and manners of death in all nursing homes between 1993 and 2003, investigated by the coroner of Allegheny County, PA, which has the second highest elderly population in the United States. Two hundred eight decedents were identified, aged 19 to 91 years, 58% women and 42% men, 88% Caucasian and 22% African-American. Fifty-eight percent were accidental and 38.5% were natural manners of death, with 2 homicides, 2 suicides, and 3 undetermined cases. The manner of death was significantly different between Caucasians and African-Americans, with 92.6% of accidental deaths occurring in Caucasians and 6.6% in African-Americans (P < 0.1). Most common natural deaths were arteriosclerotic cardiovascular disease, nonarteriosclerotic cardiovascular disease, pneumonia, pulmonary thromboembolism, chronic obstructive pulmonary disease (COPD), seizure disorder, and atraumatic intracranial hemorrhage. Blunt force trauma was the single most commonly identified traumatic accidental death. Accidental deaths were more common in Caucasians than African-Americans. Homicides and suicides were rare events (<2%). Blunt force trauma is a major autopsy finding in accidental nursing home deaths, and a root-cause analysis may be helpful in developing policies and procedures to decrease the incidence of blunt force trauma.     

Therapy-related café coronary deaths: two case reports of rare asphyxial deaths in patients under supervised care

Café coronary deaths, as initially characterized, denote fatal occlusion of the upper airway by food substances. Such fatalities typically occur in individuals who either are clinically inebriated or have clinically significant neuromuscular dysfunction. Both conditions impair mastication and deglutition. The authors review the accidental deaths of two neurologically compromised patients under supervised care. Both subjects underwent complete medicolegal autopsy. In one case, ingestion of a prescribed emollient laxative precipitated death; in the other, death was attributable to aspiration of a contrast medium during a diagnostic radiographic procedure. These therapy-related deaths, which are regarded as a variation of the traditionally described café coronary fatalities summarized in the discussion, represent adverse events occurring during medical care. The adverse outcomes reviewed here are potentially avoidable and require special attentiveness by the clinicians directed to the particular condition of each patient. Such true aspiration-related deaths are confirmed on autopsy examination and are to be differentiated from the findings of agonal aspiration of gastric contents commonly encountered by the autopsy pathologist investigating deaths due to a great variety of natural and traumatic causes.     

Deaths during recreational activity

This study of recreational deaths in the "land of sun and fun" has pointed out several useful factors. Firstly, accidental deaths are more common than naturals. Secondly, the most common accidental death is drowning while swimming. The latter is not usually at public facilities, but rather at unsupervised uninstitutionalized surroundings. Finally, a younger population is involved with a frequent number of them with alcohol detected and/or drugs.     

Evaluation of Computed Tomography as a Screening Test for Death Inquest

Abstract: The Japanese method of inquest, which depends mostly on external examinations, may misdiagnose a considerable number of accidental deaths and suicides as death by disease. We conducted computed tomography (CT) scans of 80 cases for which police concluded death by disease or natural causes based on police investigations into the circumstances and results from external examinations. The cause of death was clearly determined by CT scan in 17 of 80 cases. Ten cases underwent autopsy after the police suspected criminality based on results of the CT examinations. The results suggest CT scan may be a tool for preventing a number of overlooked crimes and accidents in Japan. However, it cannot be a perfect tool for discerning between death by disease and other causes of death without cooperation from the investigative agencies and subsequent forensic examinations such as autopsy and toxicological tests.     

A 25-year retrospective review of deaths due to pediatric neglect

Neglect, defined as the failure of a caregiver to adequately provide safety, food, clothing, shelter, education, protection, medical/dental care, and supervision for a child in his/her care, is a relatively uncommon but important cause of child mortality. A retrospective review of pediatric deaths (age 18 years or less) referred to the Medical University of South Carolina Forensic Pathology Office for autopsy over the past 25 years revealed 16 deaths due to some type of pediatric neglect. Cases were analyzed as to age, sex, race, cause and manner of death, autopsy findings, ancillary studies, past medical history, social/family history, and caregiver. Six cases of malnutrition/starvation and/or dehydration were identified, composing the most common cause of death in the neglect cases identified and the majority of the homicides due to neglect. Other deaths in which neglect contributed significantly included toxic ingestions (2 cases), hyper-/hypothermia (2 cases), unusual drowning/aspiration (4 cases), electrocution (1 case), and delayed/absent medical therapy (2 cases, including one of the previously mentioned ingestions). Of these additional cases, 7 were certified as accidental manner, 2 as natural, and 1 as a homicide. Cases which fell into a "gray zone" in which the appropriateness of invoking neglect was a matter of opinion or societal convention were excluded from the review; examples included conventional accidental drowning, choking on food or aspiration of foreign body, overlying/wedging during sleep, accidental hanging, and motor-vehicle traffic accidents (pedestrians, unrestrained passengers). The findings of this review reinforce the fact that malnutrition/starvation and dehydration compose the most common form of lethal pediatric neglect while highlighting less common forms of neglect and the difficulty of determining manner of death in cases in which neglect plays a more questionable role than in seemingly clear-cut malnutrition/starvation and dehydration cases. We demonstrate the typical victim and scenario that investigators will encounter in cases of fatal pediatric neglect, often a child under the age of 1 year who has been deprived of food and/or drink for some time, or an older, more independently mobile child who has not been adequately supervised. These children may or may not have a demonstrable prior history of maltreatment or (nonfatal) neglect, and review of medical records is an important part of the investigation. We additionally discuss key gross autopsy findings, appropriate specimen collection, helpful ancillary studies, microscopic findings of significance, potential mimickers of neglect, and other special considerations in cases of pediatric neglect.     

Suicide by inhalation of carbon monoxide in a residential fire

Fire deaths are usually accidental, but atypical cases of homicide or suicide have been described. In suicide by fire, the only method reported by several authors consists of self-immolation. We present here the unusual case of an adult female who committed suicide by waiting in the living room after setting fire to her bedroom. The autopsy revealed smoke inhalation and the toxicological analysis revealed carboxyhemoglobin levels of 67%. Very few cases of suicide by fire not of the self-immolation type have been reported, and all have been anecdotal. A review of the literature is presented and a new term, "suicide by inhalation of carbon monoxide in a fire," is proposed for such cases.     

Childhood Fatalities in New Mexico: Medical Examiner‐Investigated Cases, 2000–2010

To better understand risk factors and populations at risk of childhood fatalities, a review of all records of childhood deaths (≤19 years) between 2000 and 2010 from New Mexico's statewide medical examiner was conducted. Annually, 313–383 childhood deaths were investigated (3820 total). Males and American Indians were overrepresented (62% and 20.4% of deaths, respectively). The most common manner of death was natural (44.8%), followed by accidental (31.4%), homicide (8.8%), suicide (8.8%), and undetermined (4.1%). Infants under 1 year of age accounted for 41.4% of deaths. Motor vehicle crashes were responsible for the majority of accidental deaths (69%), followed by unintentional overdoses (6.9%), and drowning (5.3%). Gunshot wounds, either intentional or unintentional, caused 10.7% of childhood deaths. Complete medico‐legal investigation of childhood fatalities is needed to provide public health agencies with adequate data to evaluate and prevent childhood deaths.     

A single fatal penetrating chest wound from shattered wind-blown glass

The great majority of penetrating wounds of the thorax result from firearms and bladed weapons. Penetrating wounds of the heart and of the great vessels still have a high immediate mortality. While penetrating chest wounds occasionally result from fragments of glass; most severe and fatal wounds from glass result from one's falling into or through architectural (plate) glass, sustaining wounds of abdomen or extremities, or both. A single, fatal penetrating chest wound resulting from a wind-blown fragment of glass is distinctly uncommon. The unique case of this type reported herein is that of a 12-year-old youth who was struck in his home in the left anterior chest by a single, sharp, slender fragment of glass blown from a window which shattered in a thunderstorm. This resulted in a rapidly fatal penetrating wound involving thoracic viscera. The forensic pathologist must thoroughly investigate and document such accidental deaths, modifying his/her autopsy procedure as necessary for these purposes and to avoid accidental injury at the autopsy table.     

Digoxin-like immunoreactive substance in postmortem blood of infants and children

A digoxin-like immunoreactive substance (DLIS) has been reported in the serum of infants not receiving digoxin. This study was undertaken to determine if DLIS is present in the postmortem blood and tissues of infants or children and whether the endogenous substance could interfere with forensic toxicological analysis in suspected overdose. Ninety blood specimens taken from the heart at autopsy of children or infants were screened for DLIS using commercial radioimmunoassay kits. The average age at death in these cases was 8.6 months, the median age was 2 months. DLIS equivalent to 0.25 to 2.0 ng/mL digoxin was found in one third of the cases. The incidence of positive findings was 5/6 stillborns, 10/45 Sudden Infant Death Syndrome (SIDS), 10/15 deaths as a result of infection, 4/7 homicides, 1/8 deaths caused by congenital defects, and 0/9 accidental deaths. The body distribution of DLIS was investigated and highest levels were found in the liver. Findings of DLIS in blood were correlated with renal failure, (elevated vitreous urea nitrogen), electrolyte imbalance, and liver trauma. Apparent concentrations were in the equivalent therapeutic range of digoxin and would not be confused with accidental or intentional overdose with digoxin.