宝鸡市358例法医送检器官的组织病理学分析

目的 分析法医尸体检验后送检器官的病理学特征,总结此类案件的特点.方法 对宝鸡市法医送检358例尸体解剖器官标本进行常规检查并进行组织病理学诊断. 结果 358例中以青壮年男性为主,死亡原因主要为创伤、猝死、中毒.组织学能明确死亡原因250例,无典型组织学病变101例,组织自溶腐败7例.病理诊断以心血管疾病为主,其次为呼吸、神经、消化系统疾病. 结论 法医解剖具有专业特点,与病理解剖不尽相同.组织病理学检验进行死亡原因诊断时,应积极与法医沟通,以充分掌握案情、死亡经过及特定的法医病理学特征.     

全面系统的法医学尸体检验及常见失误的防范

法医学尸体检验是法医学检案鉴定工作中的重要环节,是保证鉴定质量的基础和前提。虽然各人所做方法、步骤略有不同,每一案例又各有特殊性,但力求全面系统和规范是其基本要求。狭义的全面系统尸体检验是指尸体解剖时不仅应剖验颅、胸、腹腔这“三大腔”,还应剖验脊髓腔及其它应解剖的部位。如脊髓腔、关节腔、骨骼、眼球、周围神经和软组织等。而广义上的全面系统法医学尸体检验则应包括上述尸解和提取并保存适当、足量、可靠的检材标本这两方面。其常见的失误有:①案情不清,致尸检方案错误;②准备不足,盲目尸检;③仅作局解,片面不全;④尸解不规范,操作不标准;⑤观察不仔细,遗漏损伤或病变;⑥描述不准,记录不明,图照不清;⑦取材不适当,不能反映事实。     

Deaths associated with choking in San Diego county

Death from choking is the fourth most common cause of unintentional-injury mortality, but little data are published on causes or locations of these episodes. These deaths typically are peaked at the extremes of age, with young children and the elderly having the greatest rate of fatal choking. Our objective was to characterize the causes of fatal airway obstruction in adults. The San Diego County Medical Examiner's database was searched for deaths attributed to choking in decedents 18 years and older during the 10-year period from 1994 to 2004. Data were abstracted regarding the underlying medical conditions, items choked on, location of the choking, and treatments involved in the individual cases. We found 133 victims who died from choking, with 14% having using alcohol or other sedatives and 55% having a documented neurological deficit or anatomic difficulty with swallowing. The most common specified food objects that victims choked on were meat products, and 45% occurred at home, followed by 26% at supervised facilities, and 14% at restaurants. Of the 19 choking episodes occurring in restaurants, only one employee was documented to attempt a resuscitative effort. Most victims who choked to death had an underlying neurological deficit, and occurred at home or supervised facilities appear to have an appropriate initial-response intervention.     

医用纱布留置腹腔时间推断的初步研究

目的比较不同时间异物多核巨细胞数、细胞核数、Ⅰ/Ⅲ型胶原纤维及Ⅰ型胶原纤维/嗜银纤维比例的变化,推断异物（医用纱布）遗留腹腔时间。方法采用F344大鼠腹腔留置医用纱布的方法制作异物遗留腹腔2,8,30,120d的动物模型,肉眼观察大网膜包裹异物程度,HE染色观察异物多核巨细胞数、细胞核数变化,天狼猩红偏振光法观察Ⅰ/Ⅲ型胶原纤维比例变化、银染法观察Ⅰ型胶原纤维/嗜银纤维比例变化,并用图像分析系统对上述结果进行分析。结果随纱布留置腹腔时间延长,异物多核巨细胞数、细胞核数及Ⅰ/Ⅲ型胶原纤维比例、Ⅰ型胶原纤维/嗜银纤维比例逐渐上升,差异均具有统计学意义（P〈0.01）。Ⅰ型胶原纤维/嗜银纤维比例与纱布留置腹腔天数之间存在Power函数关系：Days=23.5[Proportion]^1.6,r=0.972。结论异物多核巨细胞数、细胞核数、Ⅰ/Ⅲ型胶原纤维及Ⅰ型胶原纤维/嗜银纤维比例变化规律有助于异物（纱布）遗留腹腔时间推断。     

90例医疗纠纷尸检分析

目的分析、讨论医疗纠纷中法医病理学尸体解剖的重要性。方法收集温州医学院法医学系2001—2008年涉及医疗纠纷尸体解剖案例90例,按照死者年龄、性别、死亡原因及临床诊断和法医病理诊断等要素进行分类整理和分析。结果死者年龄从新生儿至72岁,男女比例为1∶1,医院级别以县级医院较多（30例,33.33%）,临床诊断与法医病理死因诊断符合率为33.33%。结论尸体解剖对涉及死亡的医疗纠纷的正确处理和防范有重要作用。     

虚拟现实技术在法医病理学中的应用

对虚拟现实技术的概况及其在法医病理中的运用、发展前景进行了综述。文献资料表明:随着手术导航系统、虚拟尸检、显微影像技术等虚拟现实技术的产生发展,这必将对法医病理学的教学、实验、科研及其实际运用产生深远的影响,并将极大推动本学科的发展。但由于软硬条件、成本、费用等的限制,这一技术要真正进入实践运用还需要进一步改进、完善。     

Natural,Unexpected Deaths: Reliability of a Presumptive Diagnosis*

Abstract: We retrospectively analyzed 100 deaths because of suspicions and concerns expressed by the family. We compared the preautopsy cause of death, as determined by a thorough review of the clinical data and circumstances, to the autopsy‐derived cause of death. In the majority (91/100), the preautopsy and postautopsy proximate causes of death were in agreement. In 9%, the autopsy provided information that resulted in a proximate cause of death different than anticipated. In four instances, the manner of death also was incorrect and was determined to be an accident rather than the originally presumed natural. No homicide or suicide would have been misclassified. In another nine instances, where the premortem and postmortem proximate causes of death were in agreement, the autopsy provided a specific mechanism of death. With a quality initial medicolegal death investigation, a subset of sudden deaths in adults may be reliably certified without an autopsy.     

Adult Hirschsprung's disease diagnosed during forensic autopsy

We report a case of fatal Hirschsprung's disease (HD) discovered at autopsy. A 20-year-old man collapsed at home. Emergency medical personnel found him in cardiac arrest and all resuscitative efforts failed. He had a past history of chronic constipation since infancy. Forensic autopsy revealed a megacolon full of gas and stools. Microscopic examination showed absence of ganglion cells in a short segment of the rectum and enterocolitis in the left and transverse colon. HD is rarely described in adults. In many cases, patients complained of constipation since infancy but the affection remained misdiagnosed. The relative good tolerance of the disease is usually due to a short aganglionic bowel segment. Enterocolitis is a frequent and severe complication of HD in children but is rarely described in adults. This case suggests the importance of HD diagnosis in childhood in order to avoid fatal complications with forensic consequences.     

Death caused by a signal rocket--not an isolated case*

Fatalities related to sporting events are predominantly caused by blunt force injuries especially due to the emotional involvement of crowd, but occasionally other types of trauma are reported as well. A case of very rare trauma caused by shooting with a hand-held parachute signal rocket during a football match is presented. A 17-year-old football fan sustained fatal injuries, a combination of mechanical trauma caused by rocket penetration, as well as extensive thermal burning of the thoracic viscera. Analysis of the event was based on autopsy findings and evidence produced by medicolegal and ballistic experts. Improper use of a hand-held signal rocket, designed for marine distress signals, may cause serious injuries either mechanically, due to explosion, or as a result of thermal discharge. In the reported case, pattern of injuries is discussed, and medical finding corroborated to other available evidence. The presented case is a reminder that the forensic pathologist should be informed accordingly on the type and features of weapon suspected to produce injury, to be able to understand traumatic changes, and look for potential presence of foreign bodies at postmortem examination.     

Subarachnoid Hemorrhage and Carbon Monoxide Exposure: Accidental Association or Fatal Link?

This case study reports a fatal subarachnoid hemorrhage (SAH) with concomitant accidental carbon monoxide (CO) exposure in 32‐year‐old man. Autopsy results indicated an antemortem aspiration of smoke, and a massive SAH was identified as the cause of death. Intriguingly, the carboxyhemoglobin level was 30%, suggesting that CO could have played a specific role. Intracranial hemorrhages following CO exposure in brain areas and tissues such as the basal ganglia, globus pallidus, or white matter are rare, but well characterized, whereas SAH related to CO exposure has not been previously described. In this case report, the possible role of CO, either as a primary cause or as a facilitating factor, in the pathogenesis of SAH is discussed. In particular, we propose the hypothesis that the excessive vasodilating effects produced by CO on the cerebral endothelium results in consequential loss of microvascular integrity.     

美国马里兰州涉及电击枪死亡案例分析

目的 研究美国马里兰州涉及电子武器(电击枪)死亡案件的特点,探讨其法医学鉴定要点.方法 收集2004-2009年美国马里兰州法医局鉴定的涉及电击枪死亡案件13例,案件均经详细的现场调查,尸体进行系统解剖,并进行全面的毒(药)物检测及组织病理学检验.从一般情况、电击枪类型及接触方式、毒物检测结果、死亡方式、死亡原因等方面...