Unexplained sudden death and the likelihood of drug abuse

The common history of drug abuse in adults with an undetermined cause of death has led us to hypothesize that chronic drug abuse increases the risk of sudden death. To begin evaluating this hypothesis, we conducted a retrospective case-control study of 61 decedents whose cause of death remained undetermined following autopsy matched one to one to a control group of pedestrians or passengers killed in motor vehicle collisions. In 21 pairs, the case subject had evidence of drug abuse but the control did not, and in 5 cases the reverse was true. Analysis showed that individuals with an undetermined cause of death are 4.2 times more likely to have evidence of drug abuse than are victims of a motor vehicle collision.     

窦房结中央动脉狭窄与心源性猝死

近年来国内外学者相继报道由单纯窦房结中央动脉狭窄引起的猝死。本文就窦房结中央动脉的解剖、组织学特点、病变特点进行综述,探讨窦房结动脉狭窄引起猝死的机制,以期为相关法医病理学死因鉴定提供理论基础。     

Molecular autopsy of sudden unexplained death in the young

Sudden unexplained death (SUD) claims over 4,000 persons between the age of 1 and 22 each year in the United States. Nearly half of all pediatric SUD cases have a normal structural autopsy evaluation and are dismissed without a diagnosis. With the discovery of the genetic basis for potentially fatal arrhythmias associated with the inherited long QT syndrome (LQTS), postmortem molecular diagnosis of this disorder is possible. The authors describe the results of a molecular autopsy performed on a 17-year-old boy found dead in bed. A novel clinical test involving an epinephrine challenge in the decedent's mother implicated a potential defect in the phase 3 potassium current encoded by the gene KVLQT1. Exon-specific amplification by polymerase chain reaction and direct DNA sequencing of KVLQT1 revealed a 5-base pair deletion in the genetic material recovered from the decedent's paraffin-embedded heart tissue. The ability to perform molecular autopsies on archived necropsy material undoubtedly will transform the forensic evaluation of SUD. The combination of catecholamine provocation testing in survivors and a postmortem LQTS gene analysis may unmask families with "concealed" LQTS and establish the cause and manner of death in SUDS.     

Changing trends in the diagnosis of sudden infant death

A study of 114 consecutive cases of unexpected infant death that occurred in South Australia over a 5-year period from January 1994 to December 1998 was undertaken. There were 45 deaths attributed to sudden infant death syndrome (SIDS), 19 to natural causes, 21 to accidents. and 5 to homicides; 24 cases were listed as "undetermined." Although there has been a genuine and continued decline in SIDS numbers in this population, there has also been an increase in the diagnosis of cases of accidental asphyxia due to unsafe sleeping environments and of cases in which the family background and autopsy findings suggested more complex mechanisms. The change in diagnostic profile has followed the introduction of more rigorous clinical history review, death scene examination, and autopsy testing. Thus, although diagnostic outcomes have altered in this population, it is more likely the result of more careful interpretation of the extensive investigations that are now undertaken rather than arbitrary reclassification.     

青壮年猝死综合征研究现状

青壮年猝死综合征(SMDS)一直是国内外医学界尤其是法医学领域研究的热点,近来对SMDS的发病特点及致病机制等都有广泛而深入的研究,但仍有部分关键问题尚未解决。本文通过文献复习并结合法医检案,分别从分子遗传学、免疫组织化学、冠状动脉结构或功能异常、自主神经调节作用等方面介绍SMDS的研究进展。     

300例心源性猝死案例的法医学鉴定分析

目的探讨心源性猝死案例的病因、诱发因素及法医病理学特点,以期为心源性猝死案件的法医病理诊断提供参考。方法收集法医病理检案中的心源性猝死案例,对其年龄、性别、死亡时间、死因、诱因及场所等流行病学特点进行回顾分析。结果 300例心源性猝死案例中男性多于女性,18~45岁发病最多;病因包括冠心病(129例),心肌病(78例),心肌炎(36例)等;应激为SCD最常见的诱发因素(157例)。结论 1应激和冠心病是心源性猝死的重要危险因素。2心源性猝死的法医学鉴定除了要进行系统的尸检及病理学检查外,还要对死者的相关资料如:基础疾病、诱因、死亡时间、死亡经过等进行全面系统的分析以明确死因。     

New criteria for diagnostics of sudden cardiac death in forensic medicine

New data on characteristics of sudden cardiac death are provided. It is characterized by hypohydration of the brain, elevated cerebral impedance, a sharp fall of the index of coronary heart arteries passability, mostly areactive affection of the stem nuclei of the brain.     

Evaluation of eosin-fluorescence in the diagnosis of sudden cardiac death

The diagnostic significance of the eosin-fluorescence method was evaluated and compared with the enzymehistochemical β-hydroxybutyrate-dehydrogenase method (β-HBDH) and the degree of hyperchromasia in 568 samples from 24 β-HBDH-negative and β-HBDH-positive sudden cardiac deaths (SCD) and 23 non-cardiac deaths as controls. The effect of autolysis was investigated separately on isolated human hearts at +4°C and +22°C. All samples were examined without any knowledge of clinical or autopsy data. Normal olive-green fluorescence was observed in only five individuals of the control group and two in the β-HBDH-negative one. The frequency of the yellow-fluorescence and hyperchromasia increased from the control subjects towards the β-HBDH-positive-ones. The difference in frequency distribution of fluorescence between the groups was statistically highly significant (P < 0.001). The change in fluorescence did not correlate with the loss of β-HBDH-reaction or the distribution pattern of hyperchromasia. Postmortem autolysis did not change the fluorescence significantly but the 78% wrong positive subjects in the control group render this method too sensitive and unreliable for medicolegal purposes.     

Evaluation of eosin-fluorescence in the diagnosis of sudden cardiac death

The diagnostic significance of the eosin-fluorescence method was evaluated and compared with the enzymehistochemical beta-hydroxybutyrate-dehydrogenase method (beta-HBDH) and the degree of hyperchromasia in 568 samples from 24 bets-HBDH-negative and beta-HBDH-positive sudden cardiac deaths (SCD) and 23 non-cardiac deaths as controls. The effect of autolysis was investigated separately on isolated human hearts at +4 degrees C and +22 degrees C. All samples were examined without any knowledge of clinical or autopsy data. Normal olive-green fluorescence was observed in only five individuals of the control group and two in the beta-HBDH-negative one. The frequency of the yellow-fluorescence and hyperchromasia increased from the control subjects towards the beta-HBDH-positive-ones. The difference in frequency distribution of fluorescence between the groups was statistically highly significant (P less than 0.001). The change in fluorescence did not correlate with the loss of beta-HBDH-reaction or the distribution pattern of hyperchromasia. Postmortem autolysis did not change the fluorescence significantly but the 78% wrong positive subjects in the control group render this method too sensitive and unreliable for medicolegal purposes.     

191例急死死因分析

本文对191例急死法医病理检案资料进行统计分析，结果表明急死年龄以15～59岁为多，共154例（占80．63％）。死因以心血管系统疾病为多，80例（占41．88％），但5岁以下以呼吸系统疾病为多；在191例急风中，以冠状动脉疾病最多，共55例（占28．80％），其次为小叶性肺炎21例（占10．99％）和急性出血性胰腺炎（12例占6．28％）。死亡诱因多为纠纷／或轻微外伤87例（占45．55％），另有51例（占26.70％）死前有轻微临床症状体征，经医生诊治用药后很快死亡，从而引发医疗纠纷。     

婴幼儿猝死综合征神经病理学的研究进展

婴幼儿猝死综合征(SIDS)是指发生于1岁以内婴儿无明显病因的突然死亡,其死亡原因及鉴别诊断标准迄今仍不明确。本文参考了近年来采用免疫组化方法对SIDS神经系统病理变化的研究文献,提出SIDS致命的病理生理机制是与睡眠相关的呼吸循环失控或衰竭,即SIDS的主要病因存在于中枢神经系统,但不是单一病因。     

Homicide as a cause of the sudden infant death syndrome

The homicidal asphyxiation of a 10 1/2-month-old male infant and the attempted asphyxiation of his 4-month-old sibling, documented by parental confession, is presented as evidence that murder may sometimes be mistaken as sudden infant death syndrome (SIDS). A review of the literature of the relationship between murder and SIDS deaths reveals the suspicions of some physicians but few published cases; this reflects not only the difficulties of making a determination of murder by suffocation, since no injuries may be present, but also a lack of awareness among physicians who must evaluate infant deaths. It is recommended that murder should be considered in the differential diagnosis of sudden, unexpected death in infants and that the autopsy should include full-body x-rays and at least an initial look at the social history of the child.     

Study of the brainstem, particularly the arcuate nucleus, in sudden infant death syndrome (SIDS) and sudden intrauterine unexplained death (SIUD)

Complete examination of the brainstem involves transverse serial 5-microm sections made throughout the entire brainstem. The number of serial sections varies from 360 in sudden intrauterine unexplained death (SIUD) to 600 in term fetuses to over 1400 sections in sudden infant death syndrome (SIDS) victims. The procedure is not applicable in all histopathological laboratories, owing to the need for additional technical personnel. The simplified procedure allows a remarkable reduction of the number of sections. The brainstem is divided into 3 blocks. The first, cranial block, extends from the border between the medulla oblongata and pons up to the upper pole of the olivary nucleus. The second, intermediate block, corresponding to the submedian area of the inferior olivary nucleus, has as reference point the obex and extends 2 to 3 mm above and below the obex itself. The third, caudal block, includes the lower pole of the inferior olivary nucleus and the lower adjacent area of the medulla oblongata. Examinations of the brainstems from 106 SIDS victims, 30 controls, and 51 stillborns underlined a remarkable variability, particularly of the arcuate nucleus. The simplified examination of the brainstem makes it possible to evaluate the structures, examining 3 specific levels, defined by morphologic reference points.     

Age-dependent morphologic findings of the thyroid in sudden infant death

Age (eight days to 12 months) and degree of colloid depletion or colloid content of the follicles (normal, partially depleted, depleted) were correlated on the basis of 176 thyroid investigations in cases of sudden infant death syndrome (SIDS). In the 176 SIDS cases, a resting thyroid gland with normal colloid content could only be found in 14%, whereas partially depleted follicles were found in 35% and depleted follicles in 51%. 60% of all cases showed a large degree of epithelial desquamation up to collapse of all follicles. A marked capillary hyperemia was found in 48%. 80% of the cases showed a normal colloid content in the first month of life, and colloidfree follicles should not be detected in any case. An increased incidence of thyroid activation was obtained in the total number of cases only from the second month of life. The histomorphological appearance of the thyroid gland thus corresponds to that of healthy infants only in the first month of life. The question as to why there is an evidently raised thyroid activity in the subsequent months of life in SIDS cases is discussed.     

Mallory-Weiss syndrome as the cause of sudden, unexpected death

The Mallory-Weiss-syndrome is an upper gastrointestinal haemorrhage due to longitudinal mucosal lacerations in the oesophagogastric junction. The mucosal lacerations occur as a sequel of vomiting or any other increase in intraabdominal pressure and account for up to 15% of all upper gastrointestinal bleedings. If death is due to a bleeding Mallory-Weiss-tear, however, massive blood stains on the corpse and around it frequently give rise to the suspicion of an unnatural cause of death. For this reason, autopsy is usually indispensable to elucidate the circumstances in which death occurred. The authors carried out a retrospective analysis of 5958 autopsies performed between 1997 and 2001 at the Institute of Legal Medicine, University of Hamburg, in order to identify all cases of Mallory-Weiss-syndrome as cause of sudden, unexpected death. The results (9 cases, amounting to 0.15% of all autopsies) suggest that Mallory-Weiss-syndrome is probably much more common as a cause of sudden death than previously described. Regarding epidemiological aspects, men clearly predominate; the average age was 48 years. It should also be stressed that in 8 of the 9 cases there was a previous history of chronic alcohol abuse.     

连接蛋白43与心性猝死的相关性研究进展

部分心性猝死者死后尸检时心脏没有发现明显病理学异常征象,过去均将其归属原因不明的猝死范畴。近年来研究显示,心肌连接蛋白43（connexin43,Cx43）表达对于心性猝死的诊断具有十分重要的意义。本文就Cx43结构、功能以及在心血管疾病发生发展中的作用与法医学意义作一综述。