Relationship of ischemic heart disease to sudden death

A clinicopathological synthesis is presented of the relationship of ischemic heart disease to sudden cardiac death. The immediate pathophysiological process responsible for sudden cardiac death is a lethal arrhythmia, usually ventricular fibrillation. Although significant coronary atherosclerosis is present in most cases of naturally occurring sudden death, available evidence indicates that several mechanisms can be operative in the pathogenesis of the fatal event. These are (1) acute myocardial infarction in a minority of cases; (2) myocardial ischemia, without infarction, which is initiated either by (a) an exertion-induced increase in myocardial oxygen demand or (b) an acute coronary event often involving plaque degeneration and platelet aggregation; and (3) a primary arrhythmia, usually resulting from altered electrical conduction in the setting of a previous myocardial infarction.     

Crystallization of cerebrospinal fluid in cases of death from ischemic heart disease and ethanol poisoning

Crystallographic analysis of the cerebrospinal fluid (CSF) was carried out in 18 cases of death from coronary disease and 19 cases of death from ethanol poisoning. The crystallograms were evaluated visually and by the stereoscopic picture. Specific features of the CSF crystal colonies growth in subjects dead from the above conditions are determined.     

缝隙连接、连接蛋白与冠心病猝死

缝隙连接(gapjunction,GJ)构成细胞之间的跨膜水相通道,协调细胞间化学及电信息的交流。心脏上缝隙连接的主要功能是为心肌细胞间的电冲动提供低压传导通路,并维持心肌的协调运动。近年来的研究显示,心肌细胞(特别是心室肌工作细胞)上构成缝隙连接的连接蛋白含量、分布及功能的异常与各种心律失常的产生和持续关系密切。这很可能为临床及法医实践中,诊断冠心病猝死心肌早期病变提供一个新的思路。     

Evaluation of alcoholic intoxication depending of the level of brain ethanol-metabolizing enzymes in death from ischemic heart disease

Activities of alcohol dehydrogenases (ADG), aldehyde dehydrogenases (AlDG), and NADH+ dehydrogenases were measured by histochemical methods in neurons and capillaries of the gyrus cinguli and medulla oblongata of subjects dead from coronary disease. Enzymatic activities were found to depend on the stage of alcoholic intoxication. During resorption, characterized by reversible ethanol oxidation, the activities of AlDG and NADH+ dehydrogenases decreased, while during elimination the activities of these enzymes increased. ADG activity in cerebral tissue was increased during the entire period of alcoholic intoxication. The duration of alcoholic intoxication is determined by the amount of consumed ethanol and activity of AlDG. These regularities can be used for forensic medical evaluation of the role of alcoholic intoxication in coronary death.     

Digoxin, magnesium, and potassium levels in a forensic autopsy material of sudden death from ischemic heart disease

In 91 cases where the cause of death was heart disease, digoxin, Mg and K concentrations in serum and ventricular myocardium were measured post mortem. Forty per cent were positive for digoxin in both serum and myocardium. The mean serum level was 5.1 +/- 2.4 nmol/l and the mean myocardial level was 42.6 +/- 27.5 ng/g. Correlation could be established between serum and myocardial concentrations of digoxin. There were statistically significant differences in serum as well as in myocardial digoxin levels in persons on 0.13 mg and 0.25 mg per day, respectively. Myocardial levels of Mg and K were low as generally found in persons with ischemic heart disease. There was no correlation between these levels and myocardial digoxin concentrations. Caution must be exercised in the assessment of digoxin results from cadaver samples because of the postmortem rise of digoxin serum concentrations. Considering this fact, the results still indicate that the prevalence of toxic digoxin concentrations might be more common than previously thought.     

VEGF与缺血性心脏病及其在法医学的应用

血管内皮生长因子(Vascular Endothelial Growth Factor,VEGF)早先被称作血管渗透因子(Vascular Permeability Factor VPF)和血管调理素(Vasculotropin),是一种特异作用于血管内皮细胞的强有力的多功能细胞因子[1].它强烈而特异地促使内皮细胞分裂增殖、增生、转移,增加血管通透性并促进新血管生成.它促进血管内皮细胞的有丝分裂作用是通过存在于内皮细胞表面VEGF的特异性受体所介导的[2～4].在正常情况下,VEGF参与周期性黄体形成,组织器官修复和胚胎发育等[5].在病理情况下,如肿瘤的发生发展,类风湿性关节炎,以及一些缺血缺氧性疾病等,VEGF的表达都会增加并参入到促进新血管的生成过程中,有研究证实心肌缺血缺氧可促使心脏局部受损心肌细胞的VEGF及其血管内皮细胞上的VEGF受体表达增高[6],因此,本综述将对VEGF的研究概况及其与缺血性心脏病的关系以及在法医学中的应用前景进行讨论.     

Evaluation of severity of harm to health caused by trauma aggravating a preceding disease

A severity of damage made to the health condition by an injury aggravating a preceding pathology is under discussion. It was demonstrated that such criteria as the time period of temporary disablement as well as the permanent disablement ensure, with respect for clinical data, an objective assessment of a severity done to the health in the discussed cases.     

Unusual motor ability in gunshot injury of the heart caused by a shotgun

In a case of shotgun-injury of the heart with complete rupture of both ventricles and lesion of the aorta the victim was able to move a few metres in approximately six seconds. Despite other opinions ability to move or act can be maintained in cases of severest injuries of the heart caused by missiles with high energy.     

Simulation of parameters of alcohol-oxidizing enzyme systems and pathomorphological characteristics in situations of acute ethanol poisoning and ischemic heart disease

Morphometric characteristics and forensic chemical information used in diagnostics of acute ethanol intoxication and coronary heart disease in conjunction with macro- and microscopic pathomorphological signs of the changes in the heart, liver, and kidneys provide data that may suggest the presence of pathology but do not permit to reliably identify it. In this context, evaluation of activities of alcohol-oxidizing enzyme systems acquires clinical significance. The analysis of correlations between quantitative parameters supplemented by the construction of binary models allows to objectively interpret the conclusions about the cause of death in each concrete case of acute ethanol poisoning and coronary heart disease.     

A case of sudden death from primary intracranial germinoma complicated by microvascular disease of the heart

A coroner's autopsy conducted on an 11.5-year-old girl, with a history of hypopituitarism, manifesting as growth hormone deficiency associated with short stature, demonstrated the presence of an undiagnosed hypothalamic intracranial germinoma, showing hypophyseal and mesencephalic invasion, together with histological evidence of microvascular (small coronary artery) disease of the heart. The substantive, or primary, cause of her sudden death was clearly the intracranial germinoma, which was acutely haemorrhagic and necrotic. However, it is postulated that there might be an, as yet, undescribed association between this malignancy and the pathogenesis of the coronary microvascular disease; the latter being deemed, in this instance, to be a contributory cause of death.     

成趟足迹提取方法导致误差的探讨

目的研究提取成趟足迹的低误差方法。方法比较相同条件下一次性拍照、分段连续拍照和扫描仪提取所产生的误差的大小。结果扫描仪提取法的误差最小。结论扫描仪提取足迹的方法易于掌握,适合基层技术员推广使用。     

一起医疗事故争议引发行政复议的分析与思考

医疗事故技术鉴定结论是处理医疗事故纠纷的重要依据,根据国务院《医疗事故处理条例》规定,对鉴定结论有异议,可要求重新鉴定和申请再次鉴定,但这两种情况存在较大的法律意义差别,同时在实践中也存在一些问题。本文从一起医疗事故鉴定引发的行政复议案出发,剖析了我国现行医疗事故鉴定制度存在的一些亟待解决的问题,并就鉴定评审制度及法律责任提出了相应的法律适用建议。     

Pathology of the heart conducting system in the thanatogenesis of sudden death from alcoholic cardiomyopathy and coronary heart disease

The present literature review is focused on the contribution of various pathological changes in the heart conducting system to the tanatogenesis of sudden death from alcoholic cardiomyopathy and coronary heart disease viewed from the perspective of a forensic medical expert. The currently available data on the disorders in the heart conducting system in the subjects with these diseases are presented. Various aspects of pathology of the heart conducting system are considered in the modern and historical contexts. The prospects for the further investigations into the tanatogenic mechanisms of sudden death by reason of alcoholic cardiomyopathy and coronary heart disease are outlined.     

Incidence of familial hypercholesterolaemia in premature deaths due to coronary heart disease

Cholesterol estimations were performed on blood collected postmortem from a group of subjects coming to autopsy and showing that they had had a high risk for hypercholesterolaemia, and from an unselected group of subjects dying in hospital. Subjects from the first group had apparently been healthy, aged less than 45 years, had had no known risk factors for hyperlipidaemia, and showed extensive coronary artery atheroma (stenosis greater than 50% by diameter). Eleven cases from 485 consecutive autopsies fulfilled these criteria; three showed considerable hypercholesterolaemia (11.2, 11.8, and 21.6 mmol/L). Family studies confirmed the diagnosis of familial hypercholesterolaemia in one case; the other two remain unproven. Cholesterol measurement by cholesterol oxidase and quinoneimine dye production is subject to interference by haemolysis; provided that serum haemoglobin is less than 200 mg/dl, the cholesterol underestimate is less than 5%. The decline in serum cholesterol in the group of unselected subjects was 1.7 (0.3-4.9) mmol/L, 50.4 (28-84) h postmortem. Results are means and ranges for seven subjects. Measurement of cholesterol in serum obtained postmortem (provided that the sample is not grossly haemolysed) is a valid approximation of antemortem levels: this measurement should be made when autopsy reveals evidence of premature coronary heart disease. If hypercholesterolaemia is discovered, the diagnosis of familial hypercholesterolaemia, a common genetic disorder inherited in an autosomal dominant fashion, should be considered and appropriate family studies instituted.     

Characteristic of the damage caused to the clothes from woven fabric by a tiger's bite

The tiger's teeth have been identified that may be of diagnostic value for the purpose of trace evidence analysis. The morphological features of the damage caused to the clothes from woven fabric by the tiger's bite are described. The knowledge of these features facilitates differential diagnostics between such damage and that inflicted by other blunt and sharp objects.     

电击伤后大鼠心肌TIMP-1表达的实验研究

目的探讨心脏电击伤后心肌金属蛋白酶组织抑制物（TIMP-1）随时间变化的规律及其法医学意义。方法220V低压电电击复制大鼠电击伤模型，采用免疫组化方法和图像分析技术，观测电击伤后不同时间点心肌TIMP-1免疫组化反应的表达情况及其面积积分光密度，并对所测数据进行统计学分析。结果电击伤后心肌TIMP-1阳性细胞在伤后0．5h内开始增加，24～72h达到高峰，随后逐渐减少，至12d时恢复到正常水平。结论电击伤后心脏TIMP-1阳性表达细胞数呈现一定的时序性变化，可望将其用作推断电击伤后经过时间的指标之一。