头部外伤后精神损伤的法医学鉴定(附204例分析)

目的　研究颅脑外伤所致精神障碍的损伤程度评定标准。方法　通过对２０４ 例由司法部门委托进行法医学精神损伤程度鉴定实践,重点对颅脑外伤所致神经症的损伤程度评定标准及其他相关问题进行了讨论。结果　２０４ 例中,男、女比例无差异。年龄组以２１ ～３０ 岁（６３ 例） 、３１～４０ 岁（５３ 例） 居多。表明上述年龄组的社会活动多,受到伤害的可能性大;职业以工人、农民为多,文化程度相对较低。损伤原因以伤害（１０７ 例） 、交通事故（４９ 例） 为多。损伤与精神障碍间隔时间,半年以内１５２ 例,半年至１ 年为２３ 例,表明鉴定时间选择在１ 年内为佳。精神障碍的种类与性质：器质性精神障碍１０８ 例,占５２－８％ ;功能性精神障碍８４ 例,占４１－４％ ,其中外伤后神经症（ 含癔症３５ 例）６６ 例,占３２－３ ％ 。社会功能评定：无社会功能受损７７ 例,轻度受损４１ 例,明显受损８６ 例。神经系统检查：２０４ 例中有一过性神经体征３８ 例,有明显阳性体征６２ 例。损伤与精神障碍的关系：直接因果关系１０４ 例、间接因果关系６１ 例;条件相关３４ 例、无相关５ 例。损伤程度评定结果：重伤８５ 例,轻伤６７ 例,伤病关系评定４７ 例。结论　通过对２０４ 例头部外伤     

孕产妇死亡医疗纠纷案法医病理研究

目的探讨孕产妇死亡医疗纠纷案的特点、主要死因及其防范对策。方法采用回顾性研究的方法,对我室1985年至2003年12月的法医尸体解剖案例资料进行统计,并对其中存在医疗纠纷的孕产妇死亡案例进行分析。结果31例存在医疗纠纷的死亡孕产妇法医尸检案例中:(1)围产期死亡26例(83.9%),妊娠早期人工流产后死亡5例(16.1%);(2)产科出血引起的失血性休克死亡22例(71.0%),羊水栓塞死亡5例(16.1%),其它原因死亡4例(12.9%);(3)乡镇医疗机构17例(54.8%),地县级医院占7例(23.6%),市级医院占4例(12.9%),其他占3例(9.7%);(4)纠纷产生的原因中疑为误治14例(45.2%),误诊的9例(29.0%),抢救不及时的7例(22.6%),其他1例(3.2%)。结论孕产妇死亡医疗纠纷案主要发生在围产期,其次是妊娠早期;产科出血是导致孕产妇死亡的最主要因素之一;乡镇及县级医疗机构易引起纠纷;引起纠纷的主要原因是误诊、误治和抢救不及时。     

11例脑皮质挫伤远区及脑干病变的光镜和扫描电镜观察报告

本文报告11例因脑外伤致死的案例。肉眼观察10例有轻重不等的大脑皮质挫伤；10例有蛛网膜下腔出血；3例有脑干出血；1例有视丘下部出血。光镜及扫描电镜下见大脑皮质挫伤10例；其余挫伤，在距大脑皮质挫伤3cm的脑白质6例，视丘下部8例，丘脑、中脑各6例，桥脑5例，延髓4例，侧脑室壁8例及视神经4例。镜下检查挫伤远较肉眼为多。10例神经细胞有不同程度变性、坏死及缺血性病变。9例大脑及脑干轴索、髓鞘有不同程度断裂、变性、排列紊乱、崩解及坏死，其中7例轴索断端查见收缩球。作者对脑外伤死因及法医学鉴定应注意的问题作了简要的讨论。     

Screening of milk aspiration in 105 infant death cases by immunostaining with anti-human alpha-lactalbumin antibody.

To determine the frequency and degree of milk aspiration in infant death cases, immunohistochemical examinations were performed on lung sections from 41 sudden death cases and 64 in-hospital death cases using anti-human alpha-lactalbumin antibody. Milk aspiration to some degree was detected in more than half of the sudden death cases and in about one-third of the in-hospital death cases. A semi-quantitative examination of the amount of aspirated milk was subsequently performed in the positive cases. The amount of aspirated milk in the sudden death cases was significantly higher than that in the in-hospital death cases. The frequency distribution of the amount of aspirated milk was similar in shape in both groups. In most cases, a very small amount of aspirated milk was detected. The aspirated milk was assumed to be a result of occasional gastroesophageal reflux or cardiopulmonary resuscitation. However, in five cases, much larger amounts of aspirated milk were found. In these cases, milk aspiration may have been an important part of the cause of death. We concluded that slight milk aspiration is not rare in infant death cases, and that in a few cases, the aspiration is lethal. An immunohistochemical screening test is available to perform a postmortem diagnosis in these cases.     

An analysis of data curated from 5 years of identifying human remains

An archive of 5 years of cases involving the identification of human remains was curated, collecting information on: The sample type submitted, the number of STR loci yielding interpretable results, the kinship challenge posed, and the outcome for the case. A total of 129 cases of remains ID were investigated using manual DNA extraction and recovery methods with amplification of STR markers using the Power Plex 21 multiplex STR kit from Promega Corp. In 52 cases, blood spots collected by the ME were provided as sample and in 100% of those cases, probabilities of relatedness to the reference samples was ≥99%. In 77 cases, tissue other than blood was provided as a source of DNA. These other samples were grouped categorically into long bones (femur and tibia; 40 cases), skull bones/teeth (11 cases), other bones (16 cases), and tissue (normally adherent to bone) (10 cases). Reference samples provided for cases included alleged parents or child(ren) of the victim (86 cases), alleged full siblings of the victim (38 cases), or alleged second-order relatives (five cases). The overall success rate in confirming the identity of the source of the remains in these cases was 89.2%. Our results demonstrate that a laboratory can be often successful identifying human remains using methods easily implemented in any DNA typing laboratory.     

53例小脑挫伤的形态学观察

目的观察53例原发性小脑挫伤的形态学改变。方法全部小脑标本在表面检查后分别进行矢状、水平切面观察。结果①表面局部散在出血21例,弥漫性出血15例,出血伴局部叶片挫伤28例,切面见8例导水管周围、13例第四脑室壁、6例小脑扁桃体上部与9例蚓小结表面有散在点状出血;②表面未见出血但有局部肿胀17例;局部肿胀致小脑中线移位5例。矢状与水平切面:山顶肿胀向上移位4例,直达胼胝体压部6例;山顶并中央小叶向上向前移位挤压上、下丘致导水管狭窄4例;闭塞10例;中央小叶并蚓小结肿胀向前移位11例,均致导水管闭塞与第四脑室狭窄。中央小叶并小脑扁桃体上部肿胀6例,造成导水管闭塞与第四脑室腔狭窄。小脑扁桃体上部与蚓小结肿胀向脑桥第四脑室移位12例。结论小脑受力可使应力部位肿胀,移位,造成导水管闭塞或第四脑室狭窄,甚至与脑干背侧相互挤压致伤。这是脑干损伤与继发脑肿胀原因之一。     

过敏性反应死亡法医病理学研究

目的探讨过敏性反应死亡的法医病理学特点,从而解决困扰法医学工作者对过敏性反应死后诊断的鉴定要点。方法对华西法医鉴定中心1995―2004年尸检检出的26例药物过敏性死亡案例进行回顾性分析。结果本组26例药物过敏所致死亡案例的死者年龄以31-40岁的例数最多,占了38%;26例因药物过敏所致死亡的案例中,12例为青霉素类药物过敏,为引起过敏最常见的药物;而药物使用途径引起过敏反应死亡的案例中以注射为主,共20例;以个体诊所及基层医院多发生过敏反应死亡的案例;18例在使用药物后出现典型的严重的过敏性反应的临床表现;15例为在用药后半小时内发生死亡;病理解剖可见咽喉粘膜水肿20例,其中咽喉腔阻塞大于75%2例,50￣75%5例,25～50%7例,小于25%6例,显微镜下检查嗜酸性粒细胞浸润咽喉粘膜者21例、肺组织18例;6例血清IgE检测值呈现出显著的升高。结论过敏性反应的死后诊断应结合死者的生前临床病史,死亡时间,生前临床表现,病理解剖发现及血清IgE检测值综合分析。     

Stressful events as a trigger of sudden death: a study of 43 medico-legal autopsy cases

The reports relating emotional stress to sudden death are largely anecdotal. In addition to experimental and electrophysiological studies, an opportunity for a better understanding of possible stress-related sudden death (SSD) may be provided by medico-legal autopsies. The goal of our autopsy study was to analyze cardiovascular pathologic findings in cases of SSD and if possible identify mechanisms by which the stressful event (SE) could be the cause. Forty three cases were studied (29 males and 14 females). In all cases, the SE and the death were witnessed. The age range was 22 to 90 years in males (mean, 52) and 30 to 92 years in females (mean, 64). Death occurred in all cases without premonitory symptoms. In 20 cases, death occurred during the SE and in the other 23 cases occurred within 2 h of the event. SE included fear, 15 cases; altercation, 21 cases; sexual activity, 3 cases; police questioning or arrest, 4 cases. According to police reports, in 40 cases (90%), the victims had no previous clinical history of cardiovascular disease. At autopsy, the heart weight in males ranged from 255 to 1000 g with a mean of 517 g and in females the range was 250–700 g with a mean of 417 g. In only 3 cases, gross and microscopic examination of the heart was normal. In 2 of the remaining 40 cases the subjects died of subarachnoid hemorrhage. In 38 cases, a cardiac cause of death was found as follows: coronary heart disease, 27 cases; cardiomyopathy, 6 cases; aortic valvular stenosis, 2 cases and right ventricular dysplasia, 3 cases. A coronary artery thrombosis was found in 8 cases of sudden coronary death. Post myocardial infarction fibrosis was present in 25 cases (92%) of sudden coronary death. In conclusion, it appears from our autopsy study that SSD occurs primarily in those individuals with severe heart disease, especially coronary heart disease.     

38例单纯型脑干损伤法医学尸检的回顾性研究

目的报道38例原发性单纯型脑干损伤致死案例法医学尸检所见的脑干损伤、致伤方式和致伤物等特点,并探讨在法医学鉴定中的意义。方法从208例脑干损伤死亡法医学尸检案例中,挑选出38例符合单纯型脑干损伤的案例,分析单纯型脑干损伤发生的案情、损伤的部位和类型等特点。结果38例中男性占绝大多数,农民明显多于其它人员;大多发生于纠纷斗殴中;头部拳击伤18例(47.4%);头皮挫伤19例(50.0%);头皮挫裂创9例(23.7%);未见头皮损伤7例(18.4%);受伤当时昏迷并很快死亡者34例(89.5%);其损伤为局灶性挫伤出血,有32例(84.2%)肉眼未能辨认出,镜检见小灶性出血:其中,桥脑18例(47.4%)、延脑10例(26.3%)、中脑4例(10.5%)、桥脑和延脑均有出血6例(15.8%)。结论原发性单纯型脑干损伤不仅存在,而且能致人死亡;应引起同行的重视。     

19例基因突变分析

目的对19例不符合遗传规律的基因突变现象进行分析，并探讨其对亲子鉴定的影响。方法对使用Profiler Plus＋Cofiler试剂盒鉴定的118例，使用Identifiler^TM试剂盒鉴定的552例亲子鉴定案例中出现的19例1～2个STR不符合遗传规律的家庭，使用DNATyper15^TM试剂盒进行复检。结果原鉴定19个案例中有1个STR基因座不符合遗传规律的17例，有2个STR基因座不符合遗传规律的2例；使用DNATyper15^TM试剂盒进行复检，结果其中3例D8S1179基因座被证实系等位基因丢失，其余16例复检结果仍不符合遗传规律，分析认为系等位基因突变所致。结论在有1～2个基因座不符合遗传规律时，要综合分析，并增加检测基因座的数量，避免基因座的错误分型和亲子关系的误判。     

冠状动脉粥样斑块中C-反应蛋白的免疫组化研究

目的探讨冠状动脉粥样硬化斑块中C-反应蛋白(CRP)对冠心病猝死(SCD)的诊断意义。方法从本教研室2001~2004年尸检案例中挑选68例案例资料和心脏标本,分为3组A组SCD(27例);B组冠心病非猝死者(21例);C组无明显动脉粥样硬化病变的死者(20例);应用免疫组化染色(SABC法)和图像分析技术,检测每例冠状动脉左前降支和右主支粥样硬化斑块内的CRP染色情况,并对所得数据进行统计分析。结果A组有20例CRP免疫组化染色强阳性,6例呈较强阳性,1例为弱阳性;B组中3例呈较弱阳性,11例微弱阳性,7例为阴性;C组均未见阳性反应。结论检测冠状动脉粥样硬化斑块中的CRP对SCD的死后诊断具有一定意义。     

两高指导性案例效力新论

两高指导性案例的效力问题应当分为三个层面加以讨论:第一个层面是效力的有无与强弱的问题;第二个层面是效力的来源问题;第三个层面是两高指导性案例的相互关系问题。以往学界将前两个层面混为一谈,对第三个层面关注甚少。在效力有无的问题上,两高指导性案例都具有强制性的约束力;在效力来源的问题上,两高指导性案例的效力来自两高《规定》,属于一种"准法律拘束力";在效力延伸的问题上,法院指导性案例可以适用于检察院,而检察院指导性案例不应适用于法院,并且,为了避免两高指导性案例发生冲突,应当对检察院指导性案例的适用范围进行明确限定。     

220例损伤导致精神障碍损伤程度的法医学鉴定

研究损伤导致精神障碍损伤程度的评定标准。对 1986年 7月～ 2 0 0 0年 7月受理的精神损伤司法鉴定 2 2 0例资料进行回顾性研究。结果显示 :男女比例无差异 ;以中青年组居多 (占 5 5 % ) ;职业以工人、农民多见 ,损伤原因多为伤害和交通事故 (占 82 % ) ;鉴定时间以 1年内为佳。损伤与精神障碍间有直接因果关系者 110例 ,有间接因果关系者 6 9例 ,两者间条件相关者 35例 ,无相关者 6例。对有相关关系的 2 14例作损伤程度评定 ,重伤 91例 ,轻伤6 8例 ,仅就伤病关系作出评定者 5 5例。损伤导致精神障碍的损伤程度应具体案情具体分析 ;对颅脑外伤所致神经症的损伤程度评定提出可操作性的意见。     

171例脑干颅神经损伤

目的　观察头部受力致脑干颅神经损伤的形态学改变 ,探讨脑干颅神经损伤形成机制及其与头受力部位和方式的关系。方法　 171例脑干标本 ,于双侧第 3～ 12对颅神经的根部水平横切取组织块 ,常规固定、脱水、包埋、切片、HE染色 ,光镜检查。结果　所有标本均见颅神经损伤。有动眼神经损伤 ( 12 0例 ,70 2 % ) ,面听神经损伤( 92例 ,5 3 8% ) ,三叉神经损伤 ( 85例 ,49 7% ) ,外展神经损伤 ( 4 5例 ,2 6 3 % ) ,舌下神经损伤 ( 3 1例 ,18 1% ) ,迷走神经损伤 ( 2 7例 15 8% ) ,舌咽神经损伤 ( 2 4例 ,14 0 % )及滑车神经和副神经损伤 (各 10例 ,5 8% )。损伤可为单侧或双侧 ,累及单条或多条。病理形态学改变有出血 ( 4 2例 ,2 4 6% ) ,水肿 ( 2 6例 ,15 2 % ) ,神经根部组织结构变形 ( 71例 ,41 5 % ) ,根部撕裂 ( 3 2例 ,18 7% )等。结论　脑干颅神经损伤是脑干损伤的并存病变 ;位脑干高位的颅神经损伤比位低位的多 ,粗的神经损伤比细的多而严重 ;动眼、面、听神经损伤的发生率较高。     

骨折鉴定中MSCT及图像后处理的诊断与应用

目的探讨多层螺旋CT(MSCT)及其图像后处理功能在骨折法医鉴定中的诊断与应用价值。方法对366例法医鉴定者行薄层扫描并进行表面遮盖成像(SSD),透明化X线模拟投影(see-through)和多平面重建(MPR)处理。对所得图像进行诊断和分型。结果准确诊断并对134例鼻骨、98例眼眶和21例颅骨骨折进行分型。正确显示36例肋骨骨折、4例肩胛骨骨折、24例脊柱骨折和27例四肢骨及关节骨折。利用透明化X线模拟投影等技术鉴别陈旧性骨折18例。结论MSCT及图像后处理在骨折法医鉴定中具有重要实用价值,可为伤害等级鉴定提供有力的法医学依据。     

Understanding Elder Sexual Abuse and the Criminal Justice System's Response: Comparisons to Elder Physical Abuse

A great deal of research has considered the dynamics of sexual assault and the way that sexual assault cases are processed and handled in the criminal justice system. Most of this research has focused on sexual assault cases involving younger victims. Very little criminological research has considered the dynamics of elder sexual abuse. To fill this void, the current study uses a sample of 127 elder sexual abuse cases and 314 elder physical abuse cases to shed some light on the dynamics of elder sexual abuse and the way the justice system processes these cases. Attention is also given to the way that the processing of elder sexual abuse cases can be distinguished from the processing of elder physical abuse cases. Results show that a wide range of elder sexual abuse cases are committed and these cases are processed differently than elder physical abuse cases. Implications are provided.     

现代人面颅角度测量的种族差异性

目的探索面颅角度指标在种族鉴定方面的差异性。方法选取现代人头骨57例,其中中国黄种人头骨30例（女性9例,男性21例）,包括吉林1例,河北5例,山东4例,青海4例,安徽4例,江西3例,云南3例,贵州3例,广西3例。欧洲自种人头骨27例,性别不详,取自欧洲Zellemdorf、Vresovice、Kysperka3地。按体质人类学测量方法,通过参考相关文献和对颅骨形态特点的观察,设计面颅左侧眶角、右侧眶角、鼻颌角3个角度指标进行测量。对测量数据进行描述性统计分析和两独立样本之间的t检验。结果3个角度指标在种族差异性方面,眶角的种族差异性具有显著统计学意义（P〈0．01）,而鼻颌角之间的种族差异性无统计学意义（P〉0．05）。结论有些角度指标显示出明显的种族差异性,今后需要加强此方面的研究。     

人民法院案件分配制度运行状况之调查与思考——以制度革新为视角

案件分配制度是法院案件流程管理中关乎司法公正的一个重要环节,也是法院改革的一项内容,但国内学者极少关注这一问题。通过对某市两级法院案件分配制度运行状况的调研,可以发现我国法院传统的案件分配制度存在诸多弊端。相较于域外之案件分配制度,我国法院应构建以随机分案为主、指定分案为辅的新规则。     

外伤后阴茎勃起功能障碍的夜间阴茎勃起功能监测

目的 夜间阴茎勃起功能监测(NPT)技术在阴茎勃起功能障碍程度鉴定中的法医学意义。方法 用RIGISCAN PLIJS SYSTEM,对13例外伤后主诉阴茎勃起障碍的被鉴定人进行监测。结果 NPT检查的13例被鉴定人,阴茎勃起功能正常者3例,轻度减退者5例,中度减退者2例,完全丧失者3例。其中在IIEF、自我勃起功能评价为严重功能障碍的5例中,NPT检查正常者1例,轻度减退者1例,中度减退者1例,完全丧失者2例。结论　NPT技术能够有效的确定阴茎勃起功能障碍的程度,为法医学损伤程度鉴定或伤残程度评定提供依据。