Daunorubicin-induced chronic cardiomyopathy — An experimental model system for study of sudden death. A preliminary report

Experimental cardiomyopathy in terms of heart hypertrophy and noninflammatory myocardial lesions was induced in rabbit by i.v. administration of anthracycline antibiotic daunorubicin during 2 to 12 weeks. The animals showed a high rate of unexpected mortality in comparison with controls. This mortality was evaluated from the point of view of the unexpected death as a forensic pathologic term.     

Sleeping arrangements of sudden infant death syndrome victims in the District of Columbia--a preliminary report.

The recent decline in the incidence of the SIDS in the District of Columbia has permitted identification of what appears to be two separate groups of cases within the generic SIDS population. While deaths of bed-sharing victims remained relatively constant throughout the study period, a greater than fourfold decrease was seen in non-bed-sharing SIDS fatalities. The implications and preliminary nature of these findings are discussed in an attempt to stimulate further inquiry into the possible safety hazard of the practice of bed-sharing in the SIDS age group and its potential influence on the incidence of the SIDS.     

A pathological study of sudden coronary death in China: report of 89 autopsy cases.

This paper reports the results of a forensic pathological study of 89 autopsy cases of Sudden Coronary Death (SCD). Of 89 cases, 63 (52 male, 11 female) were narrowed by 76-100% in cross-sectional area (XSA) of the coronary artery (CA) and 26 (22 male, 4 female), by 51-75%. Atherosclerotic plaques in the CA were serious and extensive, especially in the left anterior descending and often involved several branches of CA at the same time. Recent thrombosis was found in 18 cases, haemorrhage in plaques in 17 cases. Only 2 cases had visible acute myocardial infarction. Inflammatory cell infiltration was found in coronary plaques in 36 cases. Myocardial fibrosis or small scar formation was detected in 51 cases. It is suggested that although the incidence of coronary heart disease (CHD) is low in China, SCD is the commonest mode of Sudden Unexpected Death. The majority of SCD (52%) were middle aged males (30-49 years old). Most of the cases died suddenly during sleep without any clear precipitating factors. The characteristics of occurrence and pathological changes in the CA and myocardium and the pathological diagnosis of SCD are also analysed and discussed.     

Supravalvular aortic stenosis, Williams syndrome and sudden death. A case report

Supravalvular aortic stenosis (SVAS) is an uncommon but well characterized congenital narrowing of the ascending aorta above the level of the coronary arteries. It can be a familial disorder, can occur sporadically, or associated with Williams syndrome (WS) which is a neurodevelopmental disorder affecting connective tissue and the central nervous system. Sudden death is a well-known complication of non-syndromic SVAS but few cases have been reported associated with WS. We present a case of sudden death in a woman with the diagnosis of SVAS and WS since the age of 3 years who refused surgical correction and died at the age of 27 years. At autopsy, the aorta and pulmonary trunk were narrowed and the walls showed peculiar microscopical characteristics. In the cardiac conduction system the His bundle was small and intramyocardial. The incidence, pathology, pathogenesis and prognosis of both conditions (SVAS and WS) are reviewed.     

Simultaneous sudden infant death syndrome: a case report.

The first reported case of simultaneous sudden infant death syndrome (SSIDS) in Allegheny County, Pennsylvania, occurred on February 27, 1998. Two-month-old black fraternal twin girls were both found dead in their crib at the same time. After an in-depth death scene investigation, police investigation, toxicologic analysis, and complete autopsies, a specific cause of death could not be identified. The deaths of the two girls were therefore ruled simultaneous sudden infant death syndrome.     

东莞地区外来工青壮年猝死综合征的流行病学研究

目的研究东莞地区青壮年猝死综合征(SMDS)的流行病学特征。方法对东莞市公安局1990～2001年的法医学检案中遴选的284例SMDS案例资料进行回顾性研究。结果分析SMDS猝死者的籍贯、年龄、性别、死亡季节的分布及死亡经过、尸检所见的特征。结论此项研究为下一步进行SMDS的流行病学研究积累了初步资料。     

Aortoesophageal fistula and sudden death. A report of two cases and review of the literature

Two cases of aortoesophageal fistula are presented. The etiology, symptoms, and diagnosis of aortoesophageal fistula are reviewed. Signs and symptoms of gastrointestinal hemorrhage followed by sudden collapse hours to days later should prompt consideration of an aortoesophageal fistula. Accidental ingestion of foreign bodies, particularly by children, is a frequent etiology.     

Schizophrenia and sudden death: a medical examiner case study.

This study reviews the causes of sudden death of 66 schizophrenic patients who presented to the Office of the Chief Medical Examiner (OCME) for the State of Maryland over a 3-year period from 1994 through 1996. We identified an increased incidence of suicide compared with the general population of OCME cases. This observation is consistent with reports by other investigators. The majority of the deaths were the result of natural diseases, mostly atherosclerotic cardiovascular disease. Accidents, suicides, and 1 homicide were also present in this group.     

19例原发性心肌病猝死案例的病理学研究

本文对19例原发性心肌病猝死的尸检案例的发病年龄、职业特点及病理学改变进行了分析和讨论，其中扩张性心肌病11例,肥厚性心肌病8例．     

Case report of sudden death after a blow to the back of the neck.

A 13-year-old girl experienced a fall during gym class that caused immediate unresponsiveness and death. The lone witness reported that the decedent lost her balance as she approached a hurdle and fell, striking her head on a crossbar of the hurdle near the ground. Autopsy revealed no external injury. Internal injury that could be demonstrated anatomically was confined to a contusion within the right semicapitis muscle at the base of the skull. In the absence of an anatomic cause of death, possible explanations of the death include a cardiac dysrhythmia, a vasovagal stimulus, and diffuse axonal injury caused by a concussive force to the junction of the medulla and spinal cord. Animal studies have shown that severe concussion can cause death via profound autonomic dysfunction without leaving anatomic evidence of injury, and that the essential component of concussion is an element of rotational injury to the brain. The authors believe that the blow to the neck caused this death by the transmission of a concussive force through the reticular activating system. The prompt work of police in distinguishing the lone witness from several people in the area who thought they knew what had happened was essential for diagnosis. On reaching our conclusions, the authors notified first the family, then the superintendent of the school system, and finally the news media. The authors told each party in turn that they would be contacting the others.     

心脏性猝死的机制研究进展

世界范围内心脏病性猝死发病率正呈逐年升高趋势并已成为第一大死亡原因,因此国内外学者在这方进行了广泛而深入的研究。本文综述了心脏病性猝死的病理学、神经体液、电生理特别是其分子生物学发病机制的研究成果。     

316例急死的法医学分析

对重庆地区316例急死进行分析。结果表明:男性多于女性,中青年及小于10岁的婴幼儿居多,第三季度增多,呼吸系统疾病居首位,其次为循环系统疾病,死亡场所是医院占多数。     

医疗纠纷中135例猝死分析

目的为探讨引起医疗纠纷案例中猝死发生的特点，特别是其年龄、性别、科室、疾病的分布和发生纠纷的原因，为有关单位调处医疗纠纷和制定有关法规提供科学依据。方法自本教研室1955～1996年42a间受理的法医病理学尸检资料中挑选各种医疗纠纷案例；制定统一表格，将其中猝死者逐一登记，并进行统计分析。结果42a中涉及医疗纠纷的淬死135例。其中男87例、女48例。年龄自新生儿～67岁。以新生儿和婴儿居多（67例），男明显多于女；其次为25～34岁的青壮年组（21例），女多于男。近12a发生的猝死（94例）是过去30a（41例）的2．3倍。猝死疾病以呼吸系统最常见（46％），次为心血管系统疾病（25％）；但54例成人猝死者心血管系统疾病占首位（26例），次为泌尿生殖系统疾病（12例）。发生的科室多见于产科和儿科（74例）。结论认为近10年来医疗纠纷中猝死案例明显增多；医疗纠纷中非医疗事故远多于医疗事故；法医病理尸检对正确、合理地调处医疗纠纷，并对探讨猝死的发生机制，反馈、丰富和发展相关临床学科的内容，以及提高诊治水平均具有重要意义。     

An experimental study of death in a reverse suspension.

To investigate the course of respiration and circulation in a head-down position, 14 rabbits were set in reverse suspension. The respiratory rate increased a little, but the amplitude of the respiratory movements did not change in the beginning of the experiment. The amplitude of respiratory movements then began to reduce gradually, and toward the end of the experiment, it reduced suddenly. PaO2 increased in the beginning of the experiment and then began to decrease in accordance with the reduction of the amplitude of the respiratory movements. The blood pressure decreased with relation to the decrease of PaO2 resulting from the reduction of the amplitude of the respiratory movements. All rabbits died in 17 to 44 hours (average, 26 hours). The results suggested that the cause of death in a head-down position is due to postural asphyxia resulting from hindered respiratory movements, and that it is possible to survive for at least half a day in a head-down position.     

118例心源性猝死分析

心源性猝死(sudden cardiac death,SCD)在成人猝死的死因中占首位,本文对1998-2005年陕西地区发生的118例SCD案例进行统计分析,结果显示男性是女性的5.9倍,其中冠心病占55.1%,心肌炎占17.8%,心肌病占9.3%,先天性心脏病、瓣膜病、主动脉夹层瘤破裂各占2.5%,其他疾病占4.5%。说明SCD多发于男性,冠心病仍是SCD的主要基础疾病,心肌炎是青少年SCD的主要原因,心肌病是青壮年SCD的危险因素,无结构异常的心脏病也同样严重威胁生命健康。     

Isolated rat cardiac myocytes as an experimental tool in the study of anoxic cell injury. Effect of reoxygenation — A preliminary report

Rat cardiac myocytes were isolated by heart perfusion in the presence of collagenase and incubated in the absence or presence of oxygen. As a result of anoxia, there was a gradual increase in plasma membrane permeability, noted as a decrease in trypan blue exclusion frequency, leakage of cytosolic lactate dehydrogenase and intracellular accumulation of the isotope compound ⁹⁹Tc^m-gluconate. The changes in plasma membrane permeability properties were preceded by a marked decrease in cellular ATP level and an increased proportion of contracted myocytes. The ability of the myocytes to resynthesize ATP and to recover from the anoxic injury upon reoxygenation decreased gradually with the length of initial anaerobic incubation during the first 25 min and disappeared after 30 min of anoxia, indicating that the anoxic injury to the isolated rat cardiac myocytes becomes irreversible after 25 – 30 min of anoxia. It is suggested that a decreased energy level is of primary importance for the initiation of cell injury in anoxia and that it is followed by cell contracture and subsequently by a disturbed plasma membrane function, cell swelling and death. This experimental model system of isolated viable rat cardiac myocytes is suitable for problems dealing with reversibility of myocytic injury.