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.