心脏传导系统的增龄性变化

心脏传导系统（CCS）包括窦房结（SAN）、房室结（AVN）、房室束（又称希氏束，HB）、左右束支（LBB，RBB）及其终末纤维网，其功能是把心脏搏动的冲动传导到整个心脏，以协调心脏的节律性收缩．近年来，CCS病变与猝死的关系引起重视，已有研究表明，一些猝死与CCS的病变有关。但在实际应用中，必须将CCS增龄变化同其病变区分开来，以免误将其正常增龄变化视为病变，导致错误的结论．1SAN的年龄变化在光镜水平，Lev[1]首先对53例4个月胎儿至90岁老人的SAN进行了分年龄组观察；Davies[2]对50岁以下和75岁以上两组各50例的SAN…     

Fetal death due to nonlethal maternal carbon monoxide poisoning

Fetal death due to acute carbon monoxide poisoning is rarely reported in the medical literature. Of the eight cases found in literature review, only one documented the fetal carboxyhemoglobin concentration. This paper reports a fetal death due to accidental nonlethal maternal carbon monoxide intoxication in which both maternal and fetal carboxyhemoglobin concentrations were obtained. The corrected carboxyhemoglobin concentration was 61% at the time of death in utero, while the maternal carboxyhemoglobin was measured at 7% after one hour of supplemental oxygen. The authors review the mechanisms of fetal death and emphasize the different carbon monoxide kinetics in the fetal circulation.     

Parallels between clinical and morphological characteristics in fetal and newborn asphyxia from the standpoint of forensic medicine

This paper deals with morphological methods for diagnostics of pre-, intra-, and postnatal asphyxia in newborn infants. Parallels between clinical and morphological characteristics in fatal cases resulting from this condition are described. The analysis of the voluminous literature has demonstrated the imperative necessity to broaden the scope of diagnostic morphological and pathomorphological methods for the study of newborn baby corpses in order to elucidate the causes of death or clarify whether a baby was born alive or stillborn.     

Is there recent progress in the estimation of the postmortem interval by means of thanatochemistry?

Numerous methods have been proposed in the last 60 years for the determination of the time since death by chemical means. Many of them were reviewed by Schleyer in his monograph on the determination of the time since death by means of thanatochemistry about 40 years ago and none of these early methods has gained any practical value since they do not meet the demands in practice (being precise, reliable, giving an immediate result). While the earlier studies were mainly carried out on blood and cerebrospinal fluid (CSF) since the late 60s most investigations have been performed on vitreous humor (VH). This is mainly due to the fact that vitreous humor is topographically isolated and well protected, and thus, autolytic changes proceed slower compared to blood and CSF. The most studied parameter in VH is potassium and even nowadays reports on the postmortem rise of vitreous potassium are published, proposing new analytical methods or statistical evaluations. Chemical parameters studied for the determination of the time since death have to be differentiated according to the underlying process (catabolism, metabolic processes, pure autolysis and diffusion, putrefactive changes). In the present paper, recent studies on thanatochemistry are discussed regarding the underlying process, the analytical methods (for instance H magnetic resonance spectroscopy (1H MR spectroscopy), immunohistochemistry), the studied fluid compartment, the statistical evaluation and the precision of death time estimation. The value of chemical methods for the determination of the time since death is up to now very limited. This is supported by the fact that field studies on the reliability and precision of death time estimation by chemical means are still scarce in the literature.     

Morphometric approaches to diagnosing the time of death

A new method has been used to evaluate the time of death. The relationship between the degree of autolysis of cadaveric viscera and time of death has been studied by histomorphometrical methods. The study was carried out on histological preparations of the lungs, heart, liver, spleen, and kidneys from 20 corpses of humans dead from craniocerebral injuries. Based on the results, tables were created for evaluating the time of death even at remote periods after death, when the results of other methods are unreliable.     

胎盘血肿致死胎的法医学鉴定

孕妇外伤能引起胎盘血肿,但较为少见,特别是胎盘血肿与疾病共存时,各自对胎儿死亡的参与程度,与损伤程度鉴定有直接的关系.在法医学鉴定中如何全面地收集鉴定资料,如何选择最佳方法进行材料汇总,如何对它们之间的伤病关系进行客观的分析、论证,准确、及时地出具鉴定结论,是法医学鉴定中的难点.本文结合胎盘的结构和功能,综述了常见引起胎盘血肿的原因,血肿部位和时间与损伤的关系,胎盘疾病和损伤的参与度分析,以及胎儿的死亡原因、死亡机理,为胎盘血肿致死胎的法医学鉴定提供参考.     

Fetal death following maternal trauma: two case reports and a survey of the literature.

When a fetus dies after its mother has suffered trauma, questions often arise about whether the fetal death was linked to the maternal injury. Many state statutes make it a criminal act to cause the death of a fetus by injuring the mother. The authors present two cases in which fetal death resulted from maternal trauma. In addition, we review the pertinent literature on this subject and offer guidelines that may help forensic pathologists evaluate these difficult and often emotionally charged cases.     

Fetal death from abruptio placentae associated with incorrect use of a seatbelt

A female driver, 24 weeks pregnant, was wearing a three-point seatbelt in the manner usual for nonpregnant women, when her automobile collided head-on with another vehicle. A cardiotocographic examination after the accident revealed the fetus to be alive. Five days after the accident, however, a cardiotocographic examination showed fetal death. At that time, a transverse ecchymotic band on the lower abdominal wall that had not been observed at the first examination was noticed. Eight days after the accident, the mother delivered a macerated female fetus. At autopsy, the baby showed no abnormality, but there was a hematoma on the placental surface toward the uterus. These results suggest that the fetus died of abruptio placentae associated with incorrect placement of the lap belt.     

Suicide by gabapentin overdose

Gabapentin is an antiepileptic drug that is prescribed for both FDA-approved and multiple off-label conditions, and has a relatively safe side-effect profile. Rare cases of overdose-related adverse effects have been reported in the literature. Described herein are the circumstances and autopsy findings of a 62-year-old woman with a history of depression, whose death was caused by intentional ingestion of excess gabapentin. The postmortem peripheral blood gabapentin concentration as determined by high-performance liquid chromatography/tandem mass spectroscopy was 88 μg/mL. Previously reported cases of individuals surviving gabapentin overdoses are discussed and compared with this case. Based on a review of the available literature, this appears to be the first published report of a death due solely to gabapentin toxicity.     

Acute cardiovascular fatalities following cannabis use.

We report six cases of possible acute cardiovascular death in young adults, where very recent cannabis ingestion was documented by the presence of tetrahydrocannabinol (THC) in postmortem blood samples. A broad toxicological blood analysis could not reveal other drugs. Similar cases have been reported in the literature, but the toxicological analysis has been absent or limited to urine samples, which represent a much broader time window for cannabis intake. This paper presents six case reports, where cannabis alone was detected in blood. Further, an overview over previously published cases, clinical trials and possible patho-physiological mechanisms are presented.     

Acute and subacute fetal CO-poisoning

The main principles of placental CO exchange in cases of CO intoxications of pregnant women are shown. Fetal COHb lags behind maternal COHb by several hours depending on the exposure pattern. During CO elimination the fetal COHb levels again lag behind the mother's. A case of a lethal CO intoxication of a pregnant woman, mens IX, with exposure time of 10-12 h and COHb of 75% for the mother and 46% for the fetus allows to make conclusions about process of intoxication and about different times of death for mother and fetus. In highly acute lethal intoxications of the mother COHb in fetal blood is low or negative. A vital danger of the fetus is not probable when mother survived a short CO exposure.     

Strangulation of pregnant woman leads to one first-degree murder indictment for the death of the mother: a medicolegal reconsideration of maternal/fetal/homicide.

A Hispanic woman, 7 1/4, to 7 1/2 lunar months pregnant, was strangled to death by her common-law husband. After receiving information from an informant, a reporter uncovered the remains of the woman and fetus in a grave in a river bank near Eloy, Arizona. The remains were submitted by local law enforcement officials to the forensic pathologist for medicolegal examination. After this analysis, they were turned over to the consulting forensic anthropologist for positive identification of the mother and for fetal age determination to assess possible viability. During the 1970s and 1980s, viability for a fetus of this age was thought possible, although not probable. Prosecution of the common-law husband on the charge of first-degree murder of his wife was successful, whereas a comparable charge for the fetus was not sought. Many issues are raised, including gestational age estimation in relation to fetal viability. Fetal age is reassessed by means of measurements from diaphyseal lengths. These measurements allowed for comparability of fetal age estimations between published studies, with discussion of changing dates of fetal viability made possible through technologic advances. Because fetal viability changes with these advances, it is necessary to establish and update the guidelines for medicolegal practice.     

An estimation of the post-mortem interval in human skeletal remains: a radionuclide and trace element approach

Estimation of the post-mortem interval remains a contentious issue, with forensic pathologists often relying upon the recognition of morphological changes.A radionuclide approach has often been suggested in the literature, although limitations have prevented its application, most notably those of diagenesis. Within this pilot study, we show for the first time that there is a correlation between certain radionuclide content and time since death.A larger study is proposed to confirm these findings and possibly provide a calibration against which bones uncovered can be dated.     

Fatty degeneration in renal tubule epithelium in accidental hypothermia victims

The diagnosis "death due to hypothermia" is mainly based on circumstances and gross autopsy findings like frost erythema and gastric erosions. Up to now, there are no reliable histologic criteria available to confirm the diagnosis "death due to hypothermia." However, fatty changes of organs have been reported already in the literature as a histological finding contributing to the diagnosis "death due to hypothermia." To evaluate these reports, cases with well-documented hypothermia (study-group; n=83), cases with other causes of death (control-group; n=25) and additionally also seven cases with a past medical history of diabetes mellitus were investigated. Renal tissue autopsy samples were taken from both the left and the right kidney and investigated for signs of fatty degeneration within the renal tubule epithelium. The results were compared with regard to macroscopic signs of hypothermia (Wischnewski-ulcers, erythema), as reported in the autopsy protocols. The results lead to the conclusion, that fatty degeneration is a very reliable histologic diagnostic criterium in cases of hypothermia, comparable to the significance of Wischnewski-ulcers.     

Postmortem microscopic changes observed at the human head hair proximal end

Only two types of human hair roots (proximal ends) derived from decomposing scalps are reported in the literature. The most common representation of the putrid root includes a postmortem dark root band in published photomicrographs. In this study, 22 cases were reviewed in which there was reliable time of death documentation from medical investigator reports. A review of these cases finds that the most common putrid hair proximal end change does not contain the postmortem root band. Four primary types of hair proximal end postmortem change were identified. This study finds no correlation of time of death with scalp hair proximal end decomposition. In addition two examples are presented that suggest that hair roots do not decompose after fresh removal from the scalp and exposure to the outside elements.     

Duration of the fire and degree of charring of a burned cadaver]

A 37-year-old woman was found dead severely charred in the bedroom of her house. The autopsy revealed as cause of death a strangulation of the neck. On the basis of the decomposition of the body the experts were asked for a statement on the duration of burning. There seems to be only little medicolegal experience on the duration of burning to a defined state of decomposition. Based on observations during cremations published in the literature and experimental burnings a burning time of approximately 20 minutes (after temperatures of more than 700 degrees C had been reached) is supposed to be sufficient to produce the present state of the body.     

The potential to determine a postmortem submersion interval based on algal/diatom diversity on decomposing mammalian carcasses in brackish ponds in Delaware

Recently botanical evidence has been studied to determine if it is useful in forensic investigations. This study was performed to examine stillborn piglet decomposition in a brackish water environment and to semi-quantitatively document stages of decomposition, degree day accumulation per stage as well as the algal/diatom diversity useful in determining a postmortem submersion interval (PMSI). Piglets and ceramic tiles were submerged in brackish ponds and sampled on a regular basis to document algal diversity and succession between substrates and stages of decomposition. Significantly greater weight was lost from piglet carcasses during the early floating and advanced floating decay stages. Seasonal effects were observed in degree-day accumulations. Diatom diversity was significantly greater on piglet carcasses compared to tile substrates. Algal diversity decreased over time on the piglet carcasses as well as the stage of decomposition. A significant relationship and strong correlation between algal diversity found on the piglet substrate with time was observed. Our results indicate that more research is needed to examine the potential to use diatoms in not only determining manner of death but also the duration of time (PMSI) a victim may have been immersed in an aquatic environment.     

The belated autopsy and identification of an eighteenth century naval hero--the saga of John Paul Jones

John Paul Jones, the "Father of the American Navy," is known for the battletime assertion that he had "not yet begun to fight." His central role in a triumph of scientific forensic identification more than a century after his death is less known. John Paul Jones died in 1792 and was buried in Paris, France. The location of his grave was lost over time and a search for his corpse began in 1899. Remains matching his physical characteristics and circumstance of burial were discovered in 1905 and returned to the United States for a hero's burial. Some questioned the identification at the time and the major source of identifying information has since been shown to contain false information. The published forensic literature fails to address existing critiques of the identification. We provide a substantive analysis and conclude that the available evidence supports the identification of the unknown remains as those of John Paul Jones.     

Histologic findings in the lung in sudden infant death

The lungs of 79 children who had died between the ages of 1 week and 2 years old were histologically examined. 59 of these children could be categorized as cases of Sudden Infant Death because of the history and postmortem findings. In the remaining 20 cases a definite cause of death could be established. This is the same collective on which the histological investigations of the lymphatic tissue has been carried out. Morphological changes which are typical for a virus pneumonia were found in a substantially higher frequency in the cases of Sudden Infant Death than in the control cases. The validity of these findings and their possible significance for the cause of death are discussed.