心肌病猝死者心肌连接蛋白43的免疫组化染色观察

目的探讨心肌病猝死者心肌连接蛋白43(Cx43)染色变化及其与猝死的关系。方法运用免疫组化和图像分析技术,分2组(A和B组)检测20例心肌病猝死者心室肌的Cx43染色情况;并与14例非心肌病猝死者(C组)的检测结果对照。结果扩张型心肌病(DCM)猝死组(A组,11例)心肌Cx43染色明显减弱,阳性着色斑点大小不等、深浅不一、分布不均,有的呈散在颗粒状;其它类型的心肌病猝死组(B组,9例)亦见类似变化;非心肌病猝死的对照组(C组,14例)未见明显变化。定量检测并经统计分析发现,Cx43蛋白染色阳性的面积,A组与B组和C组的差异有非常显著性意义(P<0.01),B组与C组的差异无显著性意义(P>0.05);而平均光密度各组之间的差异无显著性意义(P>0.05)。结论心肌病猝死者心肌Cx43免疫组化染色明显减弱,尤以扩张型心肌病明显;心肌病猝死者心肌Cx43变化可能与其猝死有一定关系。     

DCM猝死与晚期DCM心肌Cx43表达的比较

目的观察和探讨扩张型心肌病(DCM)猝死与晚期DCM心肌中心肌连接蛋白(connexin,Cx)43表达差异及其意义。方法收集13例DCM猝死者心脏(A组)和5例晚期DCM患者行心脏移植手术切除的心脏(B组),运用免疫组化染色和图像分析技术,检测心肌Cx43阳性表达产物的平均光密度(OD)值和面积(S)值,比较两组间和左右心室间的差异。结果 Cx43阳性表达在A组明显减少,分布不均;在B组表达清晰,主要位于闰盘处。A组与B组心肌Cx43的S值之间的差异有统计学意义(P0.01),而各组左、右心室肌间相比,差异无统计学意义(P0.05);心肌Cx43的OD值,在A组与B组之间,以及各组左、右心室肌间差异均无统计学意义(P0.05)。结论 DCM猝死心肌Cx43表达较晚期DCM心肌明显减少,这种变化可能与DCM患者因心律失常发生猝死有关。     

原发性心肌病猝死心肌mtDNA~(4977)缺失变化

目的探讨原发性心肌病(PCM)猝死者心肌线粒体DNA(m tDNA4977)缺失情况及其与猝死的关系。方法对18例PCM猝死和28例对照组病例心肌组织蜡块,用常规方法提取心肌m tDNA,以PCR、琼脂糖紫外凝胶成像技术确定扩增产物激光密度,初步定量检测m tDNA4977缺失率。结果PCM猝死18例中,检见13例m tDNA4977缺失,占72.44%。对照组28例中,检见3例m tDNA4977缺失,占10.71%;两组病例m tDNA4977缺失率均值分别为0.5795和0.0744,差异有非常显著性意义。结论多数PCM,特别是扩张型心肌病猝死者心肌可检见m tDNA4977缺失;提示其心肌m tDNA4977缺失变化与PCM猝死的发生可能有一定关系。     

Mahaim纤维致猝死5例

寻找心源性猝死者的病理形态学诊断依据。采用本组建立的心传导系统检查法 ,对 16 5例无心外器官疾病猝死者的心脏 ,作心传导系统的组织学检查。发现 5例存在心传导系统Mahaim纤维 ,全部均为束室束型。本组Ma haim纤维的形态学与房室束 (HB)或左束支 (LBB)相似 ,胞体横径在 10～ 35 μm左右 ,胞浆丰富 ,色淡红染 ;来自HB的纤维胞体呈细条状 ,核居中 ;来源于LBB的则按其始发点不同自上而下逐渐变大 ,纵切细胞未见分叉 ,但部分细胞周围见有一薄层结缔组织包围。分析结果表明 ,Mahaim纤维是可致猝死的房室传导旁路。     

急性出血坏死怀肠炎猝死7例尸检分析

对牡丹江等城市 1986～ 1998年因急性出血坏死性肠炎猝死 7例尸检资料进行分析 ,探讨其年龄、性别、临床症状和生前临床诊断与病理解剖结果。结果表明因其病变不典型、不特异、患者的临床症状有所不同 ,所以在临床上容易造成漏诊、误诊、引起医疗纠纷 ,其病理变化因患者临床表现不同可有程度不同的差别。     

Forensic evaluation of sudden death due to tuberculosis

Abstract:  The emergence of drug-resistant tuberculosis (TB) poses a major threat to TB control efforts. We report a case of a 50-year-old man with pulmonary TB. The scene investigation had initially suspected for homicide; however, the result of medico-legal autopsy demonstrated natural cause of death. Statistical data suggest that the rates of national mortality by respiratory TB decreased in the last decades in Hungary; however, an increasing TB mortality was detected in the capital Budapest. Facing a new mortality trend in TB, the forensic scene investigation and determination of manner of death represent new challenges for practitioners.     

Cardiac pathological study of sudden death due to myocarditis: analysis of 17 cases

17 cases of sudden death due to myocarditis were presented. The problem of the classification and mechanism of sudden death is discussed. It is concluded that heart function failure is the main reason for the sudden death of myocarditis.     

Sudden death due to right ventricular cardiomyopathy

A 21-year-old man died suddenly at a small party. He had had no clinical signs of cardiac disease except for a slightly abnormal electrocardiogram (occasional premature ventricular contractions) since he was 15 years of age. Autopsy examination revealed cardiomegaly (469 g), with right atrial and ventricular dilatation. The right ventricular myocardium was massively replaced with adipose tissue, and there was one isolated fatty lesion in the right side of the ventricular septum. There were no congenital malformations such as a septal defect or valvular deformity. Histologically, muscular fibers remaining in the right ventricular wall showed neither degenerative nor inflammatory changes. An isolated lesion of the ventricular septum consisted of almost complete replacement of the muscle bundles with adipose tissue. Such a pathologic condition has recently been termed right ventricular cardiomyopathy. Postmortem examination is necessary to make a definite diagnosis of the disease, because in most adult cases of the disease, sudden death occurs before there have been any critical signs.     

心肌炎猝死案例的法医病理学研究

从法医尸检案例中取心肌炎猝死17例进行分析及病理学观察，对心肌炎的分关、心肌炎导致猝死机制进行探讨，认为诱发急性心力衰竭是心肌炎猝死的主要原因。     

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．     

Diagnosis of sudden death in infants due to acute dehydration

When infants die suddenly of acute dehydration, clinical signs and autopsy findings may be equivocal or absent, and microbiologic cultures often are not helpful. Vitreous humor electrolyte and urea nitrogen concentrations were measured in 53 infants dying of gastrointestinal infections, sudden infant death syndrome (SIDS), other infectious diseases, and miscellaneous causes to determine whether these parameters would assist in the recognition and confirmation of deaths resulting from dehydration. Significant differences were found when comparing the mean sodium and urea nitrogen levels of infants dying of gastrointestinal infections with those succumbing to SIDS or other causes. We recommend that these determinations be routinely performed whenever the gross autopsy findings are insufficient to explain the death.     

Insight into stress-induced cardiomyopathy and sudden cardiac death due to stress. A forensic cardio-pathologist point of view

Emotional, physiological and physical stress is associated with increased rates of cerebrovascular events and sudden deaths. The pathophysiology of stress-induced cardiomyopathy is not well understood. Proposed mechanisms for catecholamine-mediated stunning in stress cardiomyopathy include epicardial vasospasm, microvascular dysfunction, hyperdynamic contractility with midventricular or outflow tract obstruction, and direct effects of catecholamines on cardiomyocytes. Studies show evidence of significant heritable influences on individual responses to adrenergic stimulation. Data from such studies may be of help for a more accurate comprehension of clinical and morphological alterations of the heart. Irrespective of the cause, patients with the classic stress-induced cardiomyopathy morphology deserve special attention because this extensive distribution of wall motion abnormalities has implications for potential associated complications. Cardiac response may be significantly coupled to genetic differences at candidate loci that encode components of catecholamine biosynthesis, storage, and metabolic pathway. Given the role of the sympathetic nervous system in responses to acute stress, it is reasonable to explore whether genetically determined alterations in catecholamine system functions contribute to acute and chronic cardiovascular disorders such as stress-induced cardiomyopathy.     

冠状动脉肌桥与心源性猝死

冠状动脉肌桥也称冠脉肌桥或心肌桥,是一种先天性冠状动脉分布走行的发育畸形,为冠状动脉某一段或其分支的某一段走行于心外膜下的心肌层内。这种先天性冠状动脉分布走行的发育畸形可以引起猝死,在尸体解剖中也较为常见。本文对冠脉肌桥的形态学特点、临床影像学与心电图改变、猝死机制以及法医学鉴定中需要注意的问题等方面进行了阐述。     

Reporting a sudden death due to accidental gasoline inhalation

The investigation of uncertain fatalities requires accurate determination of the cause of death, with assessment of all factors that may have contributed to it. Gasoline is a complex and highly variable mixture of aliphatic and aromatic hydrocarbons that can lead to cardiac arrhythmias due to sensitization of the myocardium to catecholamines or acts as a simple asphyxiant if the vapors displace sufficient oxygen from the breathing atmosphere. This work describes a sudden occupational fatality involving gasoline. The importance of this petroleum distillate detection and its quantitative toxicological significance is discussed using a validated analytical method. A 51 year-old Caucasian healthy man without significant medical history was supervising the repairs of the telephone lines in a manhole near to a gas station. He died suddenly after inhaling gasoline vapors from an accidental leak. Extensive blistering and peeling of skin were observed on the skin of the face, neck, anterior chest, upper and lower extremities, and back. The internal examination showed a strong odor of gasoline, specially detected in the respiratory tract. The toxicological screening and quantitation of gasoline was performed by means of gas chromatography with flame ionization detector and confirmation was performed using gas chromatography-mass spectrometry. Disposition of gasoline in different tissues was as follows: heart blood, 35.7 mg/L; urine, not detected; vitreous humor, 1.9 mg/L; liver, 194.7 mg/kg; lung, 147.6 mg/kg; and gastric content, 116,6 mg/L (2.7 mg total). Based upon the toxicological data along with the autopsy findings, the cause of death was determined to be gasoline poisoning and the manner of death was accidental. We would like to alert on the importance of testing for gasoline, and in general for volatile hydrocarbons, in work-related sudden deaths involving inhalation of hydrocarbon vapors and/or exhaust fumes.     

Comparison of heart mass in seizure patients dying of sudden unexplained death in epilepsy to sudden death due to some other cause

Proposed mechanisms by which sudden unexplained death syndrome in epilepsy (SUDEP) occurs include cardiac dysrhythmias. We hypothesized that individuals dying of SUDEP would have enlarged hearts compared with normal, increasing the risk of sudden cardiac death should the autonomic nervous system initiate a dysrhythmia. We performed a retrospective case-control study in a medical examiner population, comparing the mean heart mass in a group of individuals who died of SUDEP to a group of individuals with epilepsy who died suddenly due to some unrelated cause (non-SUDEP). We found no significant difference in the mean heart mass between the 2 groups when analyzing the unadjusted data. Upon stratifying the cases by age, however, we found a significant reduction in the frequency of SUDEP in individuals 40 or more years of age with an increased heart mass compared with those younger. This reduced frequency disappeared when cases where the cause of death was indeterminate between SUDEP and heart disease were reclassified from non-SUDEP to SUDEP. With increasing age, the likelihood of finding a cause of death that competes with the possibility of SUDEP increases, making SUDEP appear to be a phenomenon of the young. The inclusion of seizure deaths evaluated in a medical examiner office in studies of SUDEP would provide the benefit of a more certain diagnosis in each given case. Moreover, the inclusion of cases from the medical examiner population would stem attrition in a clinical study due to loss to follow-up.     

病毒性心肌炎猝死心肌MMP-9和TGF-β1表达与心肌纤维化的关系

目的研究病毒性心肌炎心肌MMP-9、TGF-β1表达与心肌纤维化的关系,探讨其在病毒性心肌炎猝死鉴定中的作用。方法筛选30例病毒性心肌炎作为实验组（18例为明确性心肌炎组,12例为界限性心肌炎组）,另选10例非病毒性心肌炎作为对照组。Masson染色观察病毒性心肌炎心肌胶原增生的情况;免疫组化法检测MMP-9、TGF-β1的蛋白表达和组织定位,并用图像分析系统及统计学方法进行定量分析。结果病毒性心肌炎组心肌胶原纤维较对照组明显增多;MMP-9、TGF-β1的表达水平明显增高,MMP-9、TGF-β1的表达与心肌胶原纤维增生呈正相关。结论MMP-9、TGF-β1可能在病毒性心肌炎心肌纤维化过程中起重要作用,可以作为病毒性心肌炎猝死的辅助诊断的指标。     

Sudden unexpected death due to familial hypertrophic obstructive cardiomyopathy

Hypertrophic cardiomyopathy is a familial condition with a very distinct risk of sudden death in males in certain families. The disease appears to be not uncommon in Sri Lanka. A sudden death in a 26-year-old healthy man is reported: At autopsy the heart was 500 g due mainly to left ventricular hypertrophy, and showed histological changes consistent with cardiomyopathy. Symptomless family members of the deceased were subsequently referred to a cardiologist. Cardiomyopathy was diagnosed in one of them.     

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.     

青壮年猝死综合征心肌细胞内Cx43的表达

目的观察连接蛋白43（Cx43）在青壮年猝死综合征（SMDS）者心肌细胞的表达,并探讨其法医学意义。方法筛选法医尸检案例45例,其中SMDS组、冠心病猝死组及对照组各15例。采用免疫组织化学和图像分析技术对不同组别Cx43蛋白在心肌细胞内的表达进行阳性单位（PU）定量检测,分析Cx43蛋白在各组表达的差异。所得数据进行统计学分析。结果 SMDS组心肌Cx43染色明显减弱,阳性着色条带分布不均、深浅不一,有的呈散在颗粒状;冠心病猝死组亦见类似变化;对照组未见明显变化。经统计分析发现,3组心肌细胞内Cx43表达的PU值存在显著性差异（P〈0.05）。结论 SMDS死前存在心肌缺血及心电紊乱,应属心性猝死范畴。