Spontaneous umbilical cord hematoma: an unusual cause of fetal mortality: a report of 3 cases and review of the literature

Spontaneous hematoma of the umbilical cord represents a rare cause of fetal morbidity and mortality and the outcome is poor in half of the cases. There are many risk factors, such as infections, morphologic anomalies, alterations of the vessel walls, prolapses, twisting and traction of the cord, but in many cases the causes remain unknown. We present 3 cases of umbilical cord hematoma which took place at the end of the pregnancy and were followed by perinatal death of the fetus. In the 3 cases, which were autopsied including macroscopical and histopathologic examination of the placenta and the umbilical cord, a cordonal pathology was present; in all cases, there were alterations of the vascular wall, and in the third case inflammatory vasculopathy was found. In all 3 cases, the cause of death was attributed to acute anoxia due to the cordonal hematoma.     

Forensic medical characteristic of the neurovascular apparatus in the case of spinal cord injury

This paper is devoted to the analysis of the results of the author's investigations concerning spinal cord injuries. The voluminous material obtained with the use of up-to-date research methods (histological, histochemical, and biochemical) includes basic data on the mechanisms of regulation of blood circulation under normal conditions and in the case of a mechanical injury. It is shown that pathological morphological changes in the affected areas of the spinal cord as well as activities of transport enzymes in the capillaries and the reactive processes in the monoaminoergic nervous apparatus of he arteries may be used as the objective criteria for the determination of the time of the injury. The results of these studies find application in the practical diagnostic work for the estimation of the time of the spinal cord injury.     

甲醛处理后人脊髓中的利多卡因和布比卡因的同时测定

目的建立经甲醛防腐处理后人脊髓中利多卡因和布比卡因同时定量测定的HPLC分析法,以满足法医学鉴定的需要。方法以空白人脊髓经甲醛防腐处理后添加标准利多卡因和布比卡因,对样品的前处理方法及仪器测试条件、方法的线性范围、检测限、精密度、回收率进行系统考察。结果所建方法中两药物的线性范围为0.5～10.0ug.g-1(利多卡因r=0.9999;Bupivacaine r=0.9998),检测限利多卡因为15ng布比卡因为20ng,日内、日间分析的相对标准偏差均在4.3％以内,加样回收率在97.3％～100.3％之间。结论经甲醛防腐处理后的脊髓可同时进行利多卡因和布比卡因定量测定。所建方法准确、实用,适用于法医学鉴定及相关研究。     

Vertebral artery dissection complicating occipital injection of heparin for treatment of thoracic outlet syndrome

A 38-year-old woman with a 2-year history of chronic neck pain radiating down her right arm underwent radiological and neurological evaluations, which revealed no anatomical cause for her pain. She sought alternative therapies including intramuscular heparin injections. Following a right occipital injection of heparin, cyanocobalamin, and lidocaine, she had a sudden cardiorespiratory arrest and was successfully resuscitated, but did not regain consciousness.Computed tomography of the head and neck and subsequent autopsy revealed a right vertebral artery dissection, but at autopsy, no significant subarachnoid hemorrhage was noted at the base of the brain. This is the first case report where heparin (a potent anticoagulant) used in an occipital injection was documented to cause a vertebral artery dissection. It is also the first reported case where radiographically and histologically documented vertebral artery dissection did not present with overwhelming subarachnoid hemorrhage at the base of the brain. The subtle gross anatomical findings in this case highlight the importance of evaluating the cervical spinal cord in any case of sudden cardiorespiratory arrest following even apparently minor neck injury.     

利多卡因在蛛网膜下腔和静脉注射致死犬体内的死后分布

目的比较利多卡因在蛛网膜下腔和静脉注射致死犬体内的死后分布特点。方法犬12只,其中6只经蛛网膜下腔,另6只经股静脉匀速注入利多卡因(5×15mg/kg)致死,迅速解剖动物,取大脑、侧脑室脑脊液、腰段脊髓腔脑脊液、不同脊髓节段(颈髓、胸髓、腰髓、骶髓),心、肺、肝、脾、肾、胆汁、尿、心血、周围血、注射部位肌肉和注射部位20 cm以外肌肉等脏器组织和体液,用气质联用法定性,气相色谱法定量检测其中利多卡因含量。结果蛛网膜下腔注射致死犬体内利多卡因的含量由高到低顺序依次为腰段脊髓腔脑脊液、骶段脊髓、胸段脊髓、侧脑室脑脊液、腰段脊髓、颈段脊髓、肺、肾、注射部位肌肉、心、大脑、脾、心血、肝、周围血、胆汁、注射部位20 cm以外的肌肉、尿;静脉注射致死犬体内利多卡因的含量由高到低顺序依次为肾、心、肺、脾、大脑、肝、周围血、胆汁、心血、颈段脊髓、胸段脑脊液、注射部位肌肉、腰段脊髓、注射部位20 cm以外的肌肉、侧脑室脑脊液、尿、腰段脊髓腔脑脊液、骶段脊髓。结论蛛网膜下腔注射致死犬背侧脊髓液中利多卡因含量最高,静脉注射致死犬肾脏利多卡因含量最高,此分布特征可为利多卡因麻醉意外法医学鉴定中入体途径的判定提供参考。     

Unusual neck lesion in a pedestrian caused by a road accident

The authors describe a road accident that occurred in the Trieste region of Italy in 1998, wherein a pedestrian experienced a mortal injury. During the on-site examination, the forensic officer in charge noticed, in addition to dispersed abrasions, bruises, and fractures, an unusual position of the head with a highly unusual motility of the cervical rachis and, above all, an apparent whitish fibrous elastic cord, 7-8 cm long, which came out of the mouth. The cord was found to be a segment of the spinal cord, expelled and driven into the mouth cavity by the impact. This represents an interesting case because of the specific dynamics of the accident and the type of lesion involved. This kind of spinal cord injury, in particular, is infrequent among pedestrians involved in road accidents in comparison with other road casualties.     

Sudden Unexpected Death due to Chiari Type I Malformation in a Road Accident Case

This case concerns a sudden death of a patient with Chiari I malformation. A 17‐year‐old female was seen unconscious then fell off a motorbike during the vehicle acceleration. The girl was confirmed dead on the way to hospital, being previously asymptomatic and with a clean medical record. Autopsy findings showed an extremely extra‐long cerebellar tonsillar herniation in the left side and unexplained multiple small cavities in cerebral hemispheres. Microscopic findings revealed loss and abnormal migration of the Purkinje cells, as well as capillary congestion in the herniated tonsil. The cause and mechanisms of this sudden death are considered as the cardiopulmonary dysfunction and arrest resulted from compression of the medulla and cervical cord, which was induced by both the positional insult and minor head trauma. In addition, this study stresses the importance of cervical cord examination in the case of unexpected sudden death following road accidents.     

Forensic Imaging‐Guided Recovery of Nuclear DNA from the Spinal Cord*,†

Abstract: Our objective is to document the recovery of DNA from the spinal cord or surrounding dura mater in 11 cases of severely burned human remains. Radiographs established that portions of charred tissue contained spine segments. Multidetector computed tomography (MDCT) revealed that each spine specimen contained an intact spinal cord remnant. A full DNA profile was obtained from seven specimens using spinal cord dura mater in six specimens and spinal cord medulla in one specimen. A partial profile was obtained from four specimens (spinal cord dura mater, 2; spinal cord medulla, 2). Bone and muscle surrounding the spinal cord appear to insulate nucleic acid containing tissue from critical thermal degradation. The spinal cord, which is easily identified by MDCT examination of remains and easily recovered at the postmortem examination, can be a source of DNA with extraction yields comparable with other tissue sources. Specimens of dura mater are preferable as processing time is faster than bone.     

The special case of property rights in umbilical cord blood for transplantation

In this Article, Professor Stephen R. Munzer makes a case for limited property rights in umbilical cord blood. Professor Munzer proposes that the unique nature of cord blood distinguishes it from body wastes and qualifies it as a body part in which property rights vest. Employing a theory of property, based in part on the articulation of the principles of utility and efficiency, justice and equality, and "labor-desert," he explores legal and philosophical arguments that justify the acknowledgment of such rights. He also discusses concerns over alleged generous granting of patents in the area of cord blood stem cells in light of these principles. Significant aspects of health policy are explored with particular focus on the potential value of using cord blood to treat various diseases and disorders. Professor Munzer discusses various difficult cases involving the exercise of property rights in umbilical cord blood with respect to the interests and/or motives of newborns, parents, and other parties. He argues that some of the concerns associated with the commercialization and commodification of cord blood are not serious enough to warrant significant barriers to market exchanges of property rights in cord blood. In addition, he concludes that the particular nature and harvesting of cord blood do not make its commodification morally problematic. Finally, Professor Munzer reinforces his treatment of property rights in cord blood by addressing objections that view property as "propriety," as a pragmatic institution, or as social relations.     

Traumatic Death in Ankylosing Spondylitis

Abstract: Ankylosing spondylitis (AS) is a chronic rheumatic disease that causes spinal rigidity with an increased risk of spinal fractures. We present a case report where a middle‐aged man, in apparent good health, died following a fall from his bike. Postmortem computed tomography (CT) showed several fractures in the cervical and thoracic spine, with displacement into the spinal canal as well as spinal changes consistent with AS. The cause of death was determined to be upper spinal cord injury caused by cervical spinal fractures that were facilitated by spinal rigidity from AS. Further investigation into the medical records revealed that the decedent had previously been treated for AS. This case report illustrates the importance of obtaining a detailed medical history when investigating deaths, including nonfatal conditions, such as AS. Furthermore, it shows the value of CT in the evaluation of the mechanism and manner of death.     

Forensically relevant unexpected delivery after unrecognized or denied pregnancy

The authors report on two cases of supposed unknown pregnancy, in which the newborns were found dead in the lavatory by the emergency physician. Besides the classical questions of newborn's autopsies concerning vitality, viability and cause of death, position was to be stated towards the probability of an unexpected birth. In the first case the mother's statement of not having been aware of her pregnancy was plausible considering the general circumstances such as corpulence, continued bleedings and intact family situation; autopsy proved a (rare) twin stillbirth as a result of fetal hypoxaemia caused by grave placental dysfunction and misinsertion of the umbilical cord. Contrary to this, in the second case, a live birth, a denial of pregnancy was more likely to be assumed due to misinterpretation of typical symptoms of pregnancy in combination with professional and private stress.     

Fatal high cervical spinal cord injury in an automobile accident complicating os odontoideum

We report a case where spinal instability from incomplete fusion of the dens of C2 (os odontoideum) allowed anterior displacement of the skull and first cervical vertebra following right frontal impact against the A pillar in an automobile accident. Resultant crushing and laceration of the spinal cord occurred at the level of C1 and C2. Without either radiographic investigation or detailed examination of the spine, the fatal injury might have been overlooked and death attributed to acute alcoholic poisoning because the blood alcohol level was .613%.     

Asphyxiating laryngeal cyst

Cysts of the larynx are uncommon lesions that on rare occasions may cause sudden death. We report herein the asphyxial death by an obstructing vocal cord cyst in a woman whose body was found in a setting that aroused suspicions of foul play. Features of this case and the autopsy findings are compared with a literature review of laryngeal cysts.     

体感诱发电位检查在法医学鉴定中的应用探讨

目的探讨体感诱发电位(SEP)检查在法医学鉴定中的应用价值。方法将60例神经系统外伤(不包括周围神经损伤)并功能障碍者分为脊髓损伤组(33例)和颅脑损伤组(27例),分别进行神经系统查体及SEP检查,并对其结果进行相关分析。结果脊髓损伤组SEP结果33例均表现为异常,异常率100%,且随着功能障碍程度的加重,SEP异常的程度亦加重,两者呈正相关(R=0.72,P<0.01,n=33)。27例颅脑损伤者,仅有9例异常,异常率为33%,功能障碍程度与SEP异常相关性分析(R=0.36,P>0.05)。结论SEP检查是客观评定脊髓功能较为敏感而准确的辅助检查手段;但对颅脑损伤功能障碍的客观评价价值相对有限。     

Laryngeal teflonoma identified by Fourier-transform infrared microspectroscopy after forensic autopsy: an interesting tool for foreign material identification in forensic cases

Forensic pathologists are sometimes confronted with microscopic foreign bodies mixed in with soft tissues surrounding wounds and which are thus difficult to identify. This identification, however, could be primordial in investigating a crime and in determining the weapon used. A case of a fatal respiratory distress syndrome due to conjoining suicidal drug intoxication and laryngeal obstruction by a voluminous foreign body giant cell granuloma is presented. The classical histological examination showed exogenous particles in the vocal cord tumor with birefringent qualities. Their analysis with Fourier-Transform infrared (FTIR) spectrometry coupled with infrared microscope allows the determination of their chemical nature as polytetrafluoroethylene and to the diagnosis of teflonoma. This case report put the emphasis on the forensic interest of the FTIR imaging.     

Autonomic dysreflexia and sudden death in people with traumatic spinal cord injury

Autonomic dysreflexia (AD) is an uncommon but potentially life-threatening clinical syndrome consisting of acute episodes of excessive, uncontrolled sympathetic output that may occur in quadriplegics and in paraplegics whose spinal cord lesions are above the level of T6. These uncontrolled bouts of sympathetic output can cause transient and pronounced elevations of blood pressure that on occasion can lead to serious sequela such as the precipitation of a hypertensive intracerebral hemorrhage. The episodes of AD are often triggered by some type of noxious stimulus such as a distended urinary bladder or a fecal impaction. We present the case of a 62-year-old man with a history of quadriplegia resulting from a diving accident 40 years ago that was complicated clinically by episodes of autonomic dysreflexia. While hospitalized, he experienced an episode of autonomic dysreflexia with severe hypertension, which was soon followed by neurologic deterioration and death. Antemortem imaging revealed a large hypertensive-type intracerebral hemorrhage originating in his right caudate nucleus. Although his death at first appeared to be a natural death due to a spontaneous hypertensive-type intracerebral hemorrhage, his clinically documented autonomic dysreflexia convincingly linked the remote spinal cord injury and the fatal intracerebral hemorrhage, engendering an accidental manner of death.     

高效液相色谱法检测人脊髓中的利多卡因

建立高效液相色谱法对人脊髓中利多卡因进行分析的方法 ,以扩大药 (毒 )物检测范围及检测手段 ,适应法医学鉴定及对特殊检材检验的需要。用利多卡因标准品及空白脊髓标准添加实验 ,对色谱条件、样品处理方法、回收率及方法的线性和精密度进行了系统考察。所建方法线性范围是2 0～20 0μg/ml(r=0 9999) ,最低检测限为0 2μg/ml(S/N≥3),加样回收率为82 4 %～92 7% ,该法选择性好、不受干扰。所建方法灵敏、准确、简捷 ,可用于法医学鉴定。     

Fatal birth trauma due to an undiagnosed abdominal teratoma: case report and review of the literature

The fetus is subjected to mechanical forces during labor and delivery, which may result in traumatic injuries. Such injuries include intracranial hemorrhage, spinal cord lesions, cephalhematoma, cranial or peripheral nerve palsies, intraabdominal organ rupture, or bony fractures. Risk for perinatal trauma and mortality is increased in primigravidas, multiple gestations, abnormal presentations, maternal-fetal disproportion, oligohydramnios, forceps or vacuum extractions, and internal version maneuvers. Very-low-birth-weight neonates (<1500 g) are at high risk due to ease of deformity of the cranium. Infants with certain congenital anomalies or pathologic processes that distort normal anatomy are also at increased risk, especially when a prenatal diagnosis is lacking. The authors present a case of a term gestation neonate who sustained a cervical spine dislocation fracture of C5-7, with subtotal transection of the spinal cord and resultant paralysis. The fetus was in vertex presentation, and a manual vaginal delivery was attempted. When the infant lodged in the birth canal following a difficult delivery of the head and arms, its enlarged abdomen was palpated, and the delivery was converted to an emergent cesarean section. The infant lived for 3 days and then expired due to neurologic complications of trauma sustained during the attempted vaginal delivery. Autopsy revealed a previously undiagnosed intraabdominal immature teratoma. The pathology of teratomas, the most common neonatal tumor and occasionally implicated in cases of birth trauma, will be addressed, followed by a review of the literature concerning birth trauma.     

Accidental electrocution during autoeroticism: a shocking case

A case of atypical autoerotic death is described. An 18-year-old white man clad in two brassieres was found dead in his bedroom by his brother. Two wet green terry cloths were under the brassiere cups, connected to the house current via two metal washers and a bifid electrical cord. Literature depicting nude women was found near the victim. Autopsy revealed second-degree and third-degree burns of the mammary regions. Death was attributed to accidental self-electrocution. The authors will discuss typical and atypical forms of autoerotic death.     

大鼠脊髓挫伤后BDNF表达的实验性研究

目的探讨大鼠脊髓挫伤后脑源性神经营养因子(BDNF)在脊髓内的表达变化规律。方法建立大鼠脊髓挫伤模型,以正常脊髓组织为对照,采用RT-PCR和免疫组化SABC法对伤后即刻、1h、3h、6h、12h、1d、3d、5d、7d大鼠脊髓组织中的BDNF和BDNF mRNA进行检测,并对所得数据进行统计学分析。结果正常大鼠脊髓组织细胞内有低水平的BDNF mRNA表达和少量BDNF阳性染色细胞,BDNF mRNA和BDNF的积分光密度(IOD)值分别为45.83±3.545、20286.225±2094.955,BDNF阳性细胞数为16.50±3.391;伤后6~12h,BDNF mRNA和BDNF呈升高趋势,5d达高峰,二者的IOD值及阳性细胞数分别为795.83±112.55、54272.143±2704.239和158.17±12.287。伤后7d,BDNF mRNA和BDNF的IOD值及阳性细胞数分别为655.17±80.871、42249.928±809.391和100.17±5.529。各组之间比较,其差异具有统计学意义(P<0.05)。BDNF免疫阳性细胞在损伤早期主要是脊髓神经元和少量星形胶质细胞,后期则以小胶质细胞为主。结论大鼠脊髓挫伤后,脊髓组织细胞中的BDNF及其mRNA增多,并随伤后时间呈现一定规律性变化。