肾上腺结构猝死死的法医学鉴定

通过两例肾上腺结构猝死的案例观察发现：肾上腺和肾上腺以外器官的结核病变均表现为不典型的慢性陈旧性的病理学特征。提示在法医学鉴定中，对患过结核病和“不明死因”猝死尸体剖验时肾上腺的组织病理学检验尤为重要。     

82例肾上腺出血的法医病理学分析

目的 分析肾上腺出血与个体死亡原因、年龄和性别的关系。方法 对82例。肾上腺出血的案例进行统计学分析。结果 （1）肾上腺出血在猝死、感染、外伤和窒息中最多见。（2）肾上腺出血男性多于女性。猝死、外伤和中毒的肾上腺出血多见于青壮年，感染以幼儿多见，窒息主要为胎儿和新生儿。（3）猝死和窒息的肾上腺出血部位主要在髓质，感染以皮质出血为主，外伤在包膜和髓质的出血概率相等。结论 在法医检案过程中，肾上腺出血可以为寻找死因提供线索。     

病毒性心肌炎猝死的法医病理学诊断及猝死机理

通过对典型病毒性心肌炎猝死案例的分析，提出了心肌炎猝死的法医病理学诊断的要点，并对心肌炎猝死的机理进行了讨论。     

心肌炎死亡案例的法医病理学分析

目的探讨心肌炎的猝死机理和法医病理诊断标准。方法对6例心肌炎死亡者进行系统解剖及组织病理学检验;结果6例心肌炎死亡者中,病毒性心肌炎1例,细菌性心肌炎4例,孤立性心肌炎1例。结论急性充血性心衰和心律失常是心肌炎猝死的主要死因。心肌炎猝死的法医病理学诊断:熟悉心肌炎的病理形态特点,结合临床症状及实验室检查,并排除其他死因。     

心脏性猝死的法医学研究进展

猝死是一类特殊的疾病死亡形式,严重威胁着社区人群的生命安全。心脏性猝死(sudden cardiac death,SCD)是最常见的猝死类型,一直以来是法医病理学鉴定和研究的重要内容之一。本文从流行病学、形态学、分子病理学、虚拟解剖学等角度综述了SCD的法医学研究进展,以期为此类猝死的形态学鉴定、死亡原因诊断及其综合防治提供借鉴。     

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。     

冠心病猝死病理学研究的新进展

<正> 冠心病猝死是目前世界上威胁人类生命健康的一大主要问题。由于它发生率高,达心血管疾病猝死的70～80%,因此它不仅是国内外医学科研的一大重点,也是法医病理学研究的一个突出重点课题。本文拟就近年来国外冠心病猝死病理学研究的某些新进展综述如下:     

冠心病猝死的法医病理学免疫组织化学研究进展

冠心病猝死(sudden coronary death,SCD)是各种猝死中最常见的原因,免疫组织化学技术(immuno-histochemistry,IHC)是近年来研究冠心病猝死的有效方法。本文根据国内外文献对冠心病猝死的法医病理学免疫组织化学研究进展作如下综述。     

6例甲状腺功能亢进性心脏病猝死法医学分析

目的分析甲状腺功能亢进性心脏病(以下简称甲亢性心脏病)猝死案例,探讨其死亡的一般情况及法医病理学特点,为此类案件的法医病理学鉴定提供参考。方法收集中国医科大学法医学院2001—2016年6例甲亢性心脏病猝死案例,回顾性分析基本信息(性别与年龄)、临床表现、病史、解剖所见和组织病理学所见、生物化学检测指标、死亡原因。结果 6例案例多具有明确的甲状腺功能亢进病史,并表现出不同程度的心血管病症状;均具有明显的死亡诱因;甲状腺病理学检验符合弥漫性毒性甲状腺肿的表现;心脏质量均增加,心腔扩张,心肌肥大,灶状坏死;死后心包液的生物化学检测可作为甲亢性心脏病猝死的辅助手段。结论对甲亢性心脏病猝死案例进行诊断时应参考临床病史、尸体检验、组织病理学检验、死后毒(药)物检验等结果综合判定,必要时进行死后甲状腺和心功能的生物化学检测。     

癫痫的神经病理学研究进展

癫是一种常见的脑疾病,可引起猝死,以往人们侧重于对癫脑电活动的研究,而近年来癫的神经病理学研究已成为临床和法医工作者的一个研究热点。本文依据一系列文献资料分别从癫的发育障碍、瘤性异常增殖、海马硬化、双重病理改变、苔藓纤维发芽等神经病理学变化方面进行综述,进而探讨其法医学意义,希望对癫猝死的法医病理学诊断提供一定的帮助。     

Sudden infant death syndrome: Histological studies on adrenal gland and kidney

Histological observations were made on the adrenal glands and kidneys in ten cases of sudden infant death syndrome (SIDS). The amount of fetal cortex was excessive in the adrenal glands and many glomeruli of fetal form were observed in the kidneys. These findings suggest that the adrenal glands and the kidneys in SIDS cases are more or less immature in development. The immature development in these organs, especially in the adrenal glands, was considered to play a role in the cardiac or respiratory mechanisms in SIDS.     

Ethanol-oxidizing enzymes of the adrenal glands in acute alcoholic intoxication

Complex morphological-and-histological examinations of the adrenal glands were performed on actual forensic-medical samples in acute alcoholic intoxication (AAI), i.e. 107 death cases of men and women, aged 17 to 60, due to mechanical trauma, lethal ethanol intoxication and somatic complications of chronic alcoholism. A differentiated distribution of ethanol-oxidizing enzymes was defined, i.e. of alcohol-dehydrogenase and acetyl-dehydrogenase in the structural-and-functional zones of the adrenal cortex and medullary substance. A differential activity of enzymes was established that correlated with the level of exogenous alcoholemia. Sets of morphological signs related with examinations of the adrenal glands, which enabled a differential diagnosis of death causes in AAI, were specified.     

Thymus and adrenal glands in elder abuse

Endogenous glucocorticoid-induced thymic involution is generally considered to be an important finding for determining child abuse. The present study investigated the weight of the thymus and the adrenal glands in elder abuse cases to identify a potential marker for elder abuse. There was no significant difference in the thymus and the adrenal weight between elder abuse and control cases. However, the elder abuse cases in which the duration of abuse was less than 3 months showed a significant increase in the adrenal weight in comparison to control cases. In such cases, histopathological findings showed a loss of intracellular light granules from the zona fasciculata, which might indicate a loss of cholesterol due to the overproduction of glucocorticoid. These results might imply that the elderly, who were maltreated for less than 3 months, were in the early phase of a long-term stress state during which stress-induced overproduction of glucocorticoid was observed in adrenal glands as indicated by Selye. Our results suggest that an increase in adrenal weight may be a potential marker for elder abuse of relatively short periods, especially less than a few months.     

Histochemical changes in the hypothalamus, hypophysis, and adrenal glands observed in ethanol poisoning

A comprehensive morphological-and-histochemical study of neuroendocrinal internals in cases of ethanol poisonings was undertaken. Actual forensic medical materials were used (62 cadavers) to make morphometry examinations of the hypothesis and adrenal glands. Besides, the distribution of alcohol dehydrogenase and acetaldehyde dehydrogenase was investigated in the mediatory differential brain sections, i.e. cerebellum, locus coeruleus, dorsal raphe nucleus, hypothalamus and adrenal glands. A differential distribution of ethanol-oxidizing enzymes as well as their changes in ethanol lethal poisoning were established; additionally, a variety of morphological signs were defined, which enable the differential diagnosis of a death reason in acute alcoholic intoxication.     

Autopsy and genetic diagnosis of 21-hydroxylase deficiency with bilateral testicular tumors in a case under no medication for over one year

The autopsy findings of an adult patient with 21-hydroxylase deficiency are presented. Genetic analysis of the 21-hydroxylase gene (CYP21A2) was performed for accurate diagnosis of congenital adrenal hyperplasia (CAH), and bilateral testicular tumors were characterized. We report a 29-year-old Japanese man who was diagnosed with CAH (21-hydroxylase deficiency) in infancy and had continued steroid therapy until the age of 28. However, for more than one year, he had not been treated for CAH and was found dead. In the medico-legal autopsy findings, both adrenal glands were enlarged, and hypertrophy of adrenal cortices and bilateral testicular tumors positive for melan-A were observed. Genomic DNA was prepared from cervical lymph nodes collected during autopsy, and CYP21A2 was PCR amplified and sequenced directly using newly designed primers. From the morphological findings, the bilateral testicular tumors were considered to be adrenogenital syndrome (TTAGS). Through the whole sequence of CYP21A2, the intron 2 splice mutation (656)A to (656)G was found. TTAGS were thought to be adrenal rests enlarged by ACTH stimulus. From the autopsy findings and the result of genetic analysis, he was diagnosed with the salt-wasting form of 21-hydroxylase deficiency and his cause of death was presumed to be heart failure based on abnormal electrolytes.     

Diabetes mellitus and hypopituitarism

A 38-year-old diabetic woman developed hyponatraemia and fatal non-ketotic coma after elective cholecystectomy. At the autopsy, it was revealed that the immediate cause of death was cerebral oedema with secondary pontine haemorrhage. The cerebral oedema was associated with severe hyponatraemia and atrophy of the endocrine organs, including the adrenal glands. Biochemical analysis of serum taken immediately before death indicated that the primary defect was pituitary insufficiency, a recognised but rare complication of diabetes.     

Pregnancy,Cesarean, and Pheochromocytoma: A Case Report and Literature Review

A 43‐year‐old full‐term pregnant woman (gravida 2, para 1, medical history of gestational diabetes mellitus) developed a sudden and malignant hypertension with hemoptysis, sweat, and tachycardia during a scheduled C‐section. A dead newborn was delivered and was successfully resuscitated. The mother died after resistant cardiac arrest. Autopsy and pathological analyses revealed an acute pulmonary edema and a necrotic and hemorrhagic voluminous tumor of the left adrenal gland, which was a pheochromocytoma. Pheochromocytoma is a rare tumor of the adrenal glands which secretes catecholamines. In pregnant women, its symptoms can mimic gestational hypertension, preeclampsia or eclampsia, and gestational diabetes mellitus. The gestational diabetes mellitus was presumed to be a symptom of the pheochromocytoma, and cardiopulmonary failure the result from the necrosis of the tumor provoked by gravid uterus compression. From a medico‐legal point of view, the tumor could not have been suspected during the pregnancy.     

Sudden infant death due to asplenia syndrome

An apparently healthy 80-day-old boy died suddenly for no apparent reason. The autopsy revealed that the patient had had congenital asplenia, extensive cardiovascular anomalies, and other organ malformations, including trisegmented lungs, hypoplasia of the corpus callosum and cranial bones, a symmetrical liver, accessory hepatic tissue in the adrenal glands, malrotation of the intestine, and hypoplasia of the greater omentum.     

Postmortem detection of hemp intoxication

The diagnostic tools applicable to the forensic medical expertise of cadavers in cannabinoid intoxication (CI) were evaluated. Histochemistry with incubation of stable blue "B" (SBB) were used for the detection of cannabinoids in the bronchi and lungs. Hyperemia and capillarostasis in the mucous tunics of the mouth and stomach as well as hyperemia and edema in the lungs and brain were histochemically detected in CI. The histochemical activity of aldehyde dehydrogenase (AlDG) was most essentially decreasing in the adrenal glands and brain of younger persons. The SBB reaction in the bronchial and alveolar epithelia was positive in 85% of cases. A high proof value of the CI diagnostics was pointed out in cadaver expertise.     

A rare cause of 2 unclear fatalities: undiagnosed acute and chronic amebiasis

Two cases are reported of unexpected and unclarified death caused by an infection with Entamoeba histolytica. The first case concerned a German whose disease was not diagnosed during the asymptomatic phase (2 years' duration) or in the acute phase during the last 3 weeks before death. This is typical of the disease. In the final phase, he developed a hepatic abscess. Death occurred as a consequence of bilateral apoplexia in the adrenal glands. In the second case a Turk fell ill with gastralgia and diarrhea. Developing hepatic insufficiency with comsumptive coagulopathy, he died after 6 days. Intoxication and/or intolerance of fructose were assumed as tentative diagnoses. These two cases show clearly that even outside an endemic area, one has to reckon with the possibility of amebiasis.