双侧颈动脉海绵窦瘘合并脑梗塞评残1例

外伤致单侧颈动脉海绵窦瘘较常见,曾有多个案例报道,[1,2]但外伤致双侧颈动脉海绵窦瘘却极为罕见,尚未见报道。笔者近来遇1例交通事故致双侧颈动脉海绵窦瘘合并外伤性脑梗塞,现报告如下。案例高某,男,38岁。2003年11月01日因交通事故致头部外伤,当即昏迷。头部C T示:2003-11-1及11-2,未见明显脑实质改变;11-3及11-5,左颞部基底节区脑组织密度逐渐变低;2003-12-30,左颞部大片脑软化灶,脑室扩大,中线左偏。数字减影血管造影示左颈内动脉海绵窦瘘,右颈内动脉海绵窦瘘,左颈内动脉闭锁。于12月6日行右侧颈内动脉海绵窦瘘闭塞术。术后见右眼突出…     

双侧颈动脉海绵窦瘘合并脑梗塞评残1例

外伤致单侧颈动脉海绵窦瘘较常见，曾有多个案例报道，但外伤致双侧颈动脉海绵窦瘘却极为罕见，尚未见报道。笔者近来遇1例交通事故致双侧颈动脉海绵窦瘘合并外伤性脑梗塞，现报告如下。     

蛛网膜下腔出血猝死伴口鼻部蕈样泡沫1例

1 案例资料 郑某,女,45岁,农民。1998年5月31日上午9时干完农活后回家吃饭,于10时40分左右被邻居发现死在自家厨房门口,头面部有伤,怀疑他杀,遂向公安机关报案。     

甲亢性心脏病猝死三例

<正>甲亢性心脏病引起碎死的尸检例报告甚少,我们曾检验3例,现报告如下: 例l,女,43岁。某日下午8时许,患者吃过晚饭后发生呕吐、腹泻及发热等症状.次日下午4时左右出现呼吸困难,急请医生治疗,待医生赶到,患者已死亡。由于死亡突然,要求法医检验,追询既往病史,死者2年前曾     

日本立法强化基础设施安全

<正>当地时间7月2日凌晨1时35分,日本电信运营商KDDI的移动通信服务系统发生故障,影响范围涉及日本全国,语音通话和数据通信均中断。日本埼玉市政府提醒市民：受故障影响,使用KDDI公司移动通信服务的用户在拨打紧急求助电话时可能无法接通,呼吁市民在紧急情况下使用家中固定电话和公用电话。据NHK报道,7月3日,KDDI就该公司发生通信故障一事表示,受到此次故障影响的用户总数超过3100万。经过修复,西日本地区于7月3日11时左右恢复正常通信;东日本地区于当日17时30分左右恢复正常通信。     

CO中毒死亡者尸斑颜色分析

<正> 急性CO中毒死亡者,其尸斑颜色为樱红色。笔者在临案中发现,有的CO中毒死亡尸体的尸斑颜色为暗紫色,并有散在多发小水泡形成,现报道如下。1 案例资料 例1 一家3口被人发现死在自家。室内无抢劫、他杀迹象,夫妻2人穿绒衣绒裤死在床上,丈夫俯卧位,妻子仰卧位。2人身旁均有呕吐物;小孩着装死在地上。室内中间有一燃尽的炭盆。尸检见丈夫胸、腹侧的尸斑呈明显暗紫色,尤其是胸部出现很多散在大小不等的紫色水泡,最大如拇指腹     

法律开始说“不”——致我死于家暴的小姨

小姨被家暴致死那一年,我上高三.我跟小姨走得很近,她的死带给我很大的心理阴影,对我最直接的影响是左右了我高考填报专业的选择,为了“拿起法律武器保护自己”,我填报志愿时选择了“法学”专业.     

安定与度冷丁同时应用致呼吸停止医疗纠纷1例

安定与度冷丁属临床常用药物,两者单独小剂量一次应用几乎没有严重的副作用.安定临床上用于镇静,而度冷丁用于镇痛非常普遍,临床医生也很少注意其副作用;但两者均有抑制呼吸副作用,一旦同时使用时会使呼吸停止,让医生措手不及.笔者报道1例阑尾炎急腹症患者在急诊时同时肌注654-2、安定及度冷丁致呼吸停止而死的医疗纠纷.     

硫化氢中毒致死的案例报告

<正> 硫化氢(H_2S)中毒多发生于排污水、掏粪工人中,笔者曾遇到的一例H_2S 中毒致死的案例,现报道如下:朱某,男,22岁;马某,男,41岁;包某,男,26岁,均系民工。某年5月12日8时45分左右,朱和包下排水管道作业,即刻发生中     

“老鼠”怎能“看仓”? ——保安员现状忧思录

保安员违法让人忧今年3月30日下午5时左右,湖南省浏阳市银行保安员喻小欢用菜刀砍伤市农业银行一位54岁男职员和一位48岁女职员,盗得29.6万元人民币和一支“五四”式手枪、14发子弹。在逃亡途中,被我武警击毙于浏阳市青草乡一农户地窖里,死时喻犯还穿着青色保安服。驰名中外的乐山大佛脚下二星级涉     

病毒性心肌炎猝死的法医病理学诊断及猝死机理

通过对典型病毒性心肌炎猝死案例的分析，提出了心肌炎猝死的法医病理学诊断的要点，并对心肌炎猝死的机理进行了讨论。     

心肌炎侵及心传导系统病理学观察

本研究采用已建立的人体心脏传导系统简易取材法,对6例心肌炎的案例进行了传导组织的病理学观察,结果发现6例心肌炎患者CCS均有明显炎症,尤以SAN、AVN病变为主;推测CCS炎症可能为心肌炎患者猝死的主要原因。因此,本文提出对怀疑心性猝死案例应作常规传导系统检查。     

去甲肾上腺素对实验性冠状动脉粥样硬化猝死影响的研究

本研究在高血压冠状动脉粥样硬化动物模型建立的基础上,研究了去甲肾上腺素(Nor-adrenaline,NA)对冠状动脉粥样硬化家兔猝死的影响。滴注 NA(600μg/kg)后,实验组动物发生猝死,死亡率为63%。其发生机理与冠状动脉粥样硬化及心肌缺血有关。初步建立了研究心脏性猝死的家兔肾性高血压动物模型。     

冠心病猝死的法医病理学免疫组织化学研究进展

冠心病猝死(sudden coronary death,SCD)是各种猝死中最常见的原因,免疫组织化学技术(immuno-histochemistry,IHC)是近年来研究冠心病猝死的有效方法。本文根据国内外文献对冠心病猝死的法医病理学免疫组织化学研究进展作如下综述。     

32例无心外原因猝死者传导系统病理学观察

在对32例无心外原因猝死者传导系统(CCS)组织学观察中,发现31例 CCS 有异常和病变,其中11例可致猝死。这些病变包括有急性炎症、出血、脂肪浸润和结内外神经病变,且与猝死有关。     

Is there progress in the autopsy diagnosis of sudden unexpected death in adults?

Sudden death is now currently described as natural unexpected death occurring within 1h of new symptoms. Most studies on the subject focused on cardiac causes of death because most of the cases are related to cardiovascular disease, especially coronary artery disease. The incidence of sudden death varies largely as a function of coronary heart disease prevalence and is underestimated. Although cardiac causes are the leading cause of sudden death, the exact incidence of the other causes is not well established because in some countries, many sudden deaths are not autopsied. Many risk factors of sudden cardiac death are identified: age, gender, heredity factors such as malignant mutations, left ventricular hypertrophy and left ventricle function impairment. The role of the police surgeon in the investigation of sudden death is very important. This investigation requires the interrogation of witnesses and of the family members of the deceased. The interrogation of physicians of the rescue team who attempted resuscitation is also useful. Recent symptoms before death and past medical history must be searched. Other sudden deaths in the family must be noted. The distinction between sudden death at rest and during effort is very important because some lethal arrhythmia are triggered by catecholamines during stressful activity. The type of drugs taken by the deceased may indicate a particular disease linked with sudden death. Sudden death in the young always requires systematic forensic autopsy performed by at least one forensic pathologist. According to recent autopsy studies, coronary artery disease is still the major cause of death in people aged more than 35 years. Cardiomyopathies are more frequently encountered in people aged less than 35 years. The most frequent cardiomyopathy revealed by sudden death is now arrhythmogenic right ventricular cardiomyopathy also known simply as right ventricular cardiomyopathy (RVC). The postmortem diagnosis of cardiomyopathies is very important because the family of the deceased will need counseling and the first-degree relatives may undergo a possible screening to prevent other sudden deaths. In each case of sudden death, one important duty of the forensic pathologist is to inform the family of all autopsy results within 1 month after the autopsy. Most of the recent progress in autopsy diagnosis of sudden unexpected death in the adults comes from molecular biology, especially in case of sudden death without significant morphological anomalies. Searching mutations linked with functional cardiac pathology such as long-QT syndrome, Brugada syndrome or idiopathic ventricular fibrillation is now the best way in order to explain such sudden death. Moreover, new syndromes have been described by cardiologists, such as short-QT syndrome and revealed in some cases by a sudden death. Molecular biology is now needed when limits of morphological diagnosis have been reached.     

冠心病猝死的病理学研究——附128例尸检分析

本文报道128例冠心病猝死的法医病理学研究结果。其中冠脉病变4级63例,3级26例,2级29例。3级以上病变者斑块分布多较广泛。各支病变中以左前降支最常见。并发新鲜血栓形成者18例,斑块内出血17例,急性心肌梗死仅2例。36例冠脉斑块有炎性细胞浸润。56例见心肌间质纤维化或小灶疤痕形成。指出虽然我国冠心病发病率较低,但仍是猝死最常见的原因,尤以中壮年男性多见;多数病例无明显诱因而于睡眠中猝死。对冠心病猝死发生的特点、冠脉和心肌病变及病理诊断等进行了分析讨论。     

Sudden death due to undiagnosed Wilms' tumor in an adult

Sudden unexpected deaths due to natural causes constitute a large number of cases encountered by the forensic pathologist. In a majority of such cases, heart disease is responsible for sudden death. Rare disease entities resulting in sudden death are occasionally encountered and may not fit the classic epidemiological profile. We present a case of sudden death due to a previously undiagnosed Wilms' tumor (WT) in an adult. The pathology of WT is discussed, as is the topic of sudden death due to previously unrecognized malignancy.     

过敏性和冠心病猝死者心肌组织中肥大细胞类胰蛋白酶、脑利钠肽的表达

目的探讨肥大细胞类胰蛋白酶、脑利钠肽(brain natriuretic peptide,BNP)在过敏性猝死和冠心病猝死鉴别诊断中的意义。方法选取山西医科大学法医病理学教研室2010—2015年尸检案例心肌标本共30例,分为颅脑损伤致死组、过敏性猝死组、冠心病猝死组,每组各10例。采用免疫荧光染色和Western印迹法分析各组心肌组织肥大细胞类胰蛋白酶和BNP的表达。结果过敏性猝死组、冠心病猝死组心肌组织内肥大细胞类胰蛋白酶免疫荧光染色均出现阳性染色;三组间两两比较,表达差异均具有统计学意义(P0.05)。冠心病猝死组心肌组织内BNP的表达量高于过敏性猝死组、颅脑损伤致死组(P0.05),过敏性猝死组与颅脑损伤致死组之间差异无统计学意义(P0.05)。结论联合检测心肌组织内肥大细胞类胰蛋白酶、BNP有望为过敏性猝死和冠心病猝死的法医学鉴别诊断提供帮助。     

A comparison of respiratory symptoms and inflammation in sudden infant death syndrome and in accidental or inflicted infant death

Upper respiratory infection and pulmonary inflammation are common in sudden infant death syndrome, but their role in the cause of death remains controversial. Controlled studies comparing clinical upper respiratory infection and inflammation in sudden infant death syndrome with sudden infant deaths caused by accidents and inflicted injuries (controls) are unavailable. Our aim was to compare respiratory inflammation and upper respiratory infection within 48 hours of death and postmortem culture results in these two groups. A retrospective analysis of upper respiratory infection and pathologic variables in the trachea and lung of 155 infants dying of sudden infant death syndrome and 33 control infants was undertaken. Upper respiratory infection was present in 39% of sudden infant death syndrome cases and 40% of control cases. Upper respiratory infection was more likely to have occurred in association with more severe lymphocytic interstitial pneumonitis when sudden infant death syndrome cases and control cases were combined ( P=.04). Proximal and distal tracheal lymphocytic infiltration was more severe in control cases than in sudden infant death syndrome cases ( P=.01 and.01, respectively). Lymphocytic infiltrations of the bronchi, bronchioles, and pulmonary interstitium were similar between groups. Bronchial associated lymphoid tissue was more prominent in control cases ( P=.04). Cultures were positive in 80% of sudden infant death syndrome cases, 78% of which were polymicrobial. Among control cases, 89% were positive, with 94% being polymicrobial. This study confirms that microscopic inflammatory infiltrates in sudden infant death syndrome are not lethal.