青壮年猝死综合征心肌细胞内Cx43的表达

目的观察连接蛋白43（Cx43）在青壮年猝死综合征（SMDS）者心肌细胞的表达,并探讨其法医学意义。方法筛选法医尸检案例45例,其中SMDS组、冠心病猝死组及对照组各15例。采用免疫组织化学和图像分析技术对不同组别Cx43蛋白在心肌细胞内的表达进行阳性单位（PU）定量检测,分析Cx43蛋白在各组表达的差异。所得数据进行统计学分析。结果 SMDS组心肌Cx43染色明显减弱,阳性着色条带分布不均、深浅不一,有的呈散在颗粒状;冠心病猝死组亦见类似变化;对照组未见明显变化。经统计分析发现,3组心肌细胞内Cx43表达的PU值存在显著性差异（P〈0.05）。结论 SMDS死前存在心肌缺血及心电紊乱,应属心性猝死范畴。     

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。     

青壮年猝死综合征心肌肌红蛋白缺失的免疫组化研究

作者应用免疫组比技术（ＡＢＣ）对青壮年淬死综合征及对照组病例的心肌肌红：蛋白缺失情况进行了研究，并经扫描显微镜光度计测量分析，结果发现青壮年猝死综合征组心肌肉肌红蛋白均有不同程度的缺失，多数病例呈多发、散在、节段性分布，而对照组无明显缺失。认为这种多发、散在、节段性的肌红蛋白缺失与其仅有不同程度的心肌缺血而未出现大片心肌梗死有关，而这种不同程度的心肌缺血很可能为冠状动脉痉挛所致。     

婴幼儿猝死综合征心传导系统的免疫组化研究

作者应用ＰＧＰ９．５与抗Ｓ１００抗体和高压消毒蒸锅抗原复活技术对４例婴幼儿猝死综合征（ＳＩＤＳ）和３例非心源性死亡对照婴儿心传导系统的神经组织总量进行免疫组化研究。结果：在正常婴儿心传导系统，ＰＧＰ９．５与Ｓ１００阳性的神经纤维里不均匀分布，以窦房结最多，房室结次之，希氏束最少；４例ＳＩＤＳ心传导系统的神经组织分布同对照组无明显差异。     

瑞氏综合征猝死1例

1 案 例 1.1 简要案情 某男婴,4个月余,某日上午09:00许出现腹泻、发烧,送至医院检查,诊断为胀气和贫血.当天12:30离开医院后,至某诊所行灌肠治疗,当天18:01治疗结束.回家1h后男婴出现呼吸困难,立即送医院救治.送至医院时患儿意识丧失,呼之不应,呈深昏迷状态,压眶无反应,双侧瞳孔直径约4 mm,对光反...     

小心脏综合征猝死法医学鉴定3例

<正>1案例1.1案例11.1.1简要案情某女,23岁,某日上午8:00行走至一超市门口突然晕倒,脸色苍白,出现口唇发绀、呼吸困难、口吐白沫等症状,经送医院抢救无效于当日上午10:00死亡。1.1.2尸体检验尸长153 cm,全身肤色浅淡,营养、发育正常,体表及解剖未见损伤及机械性窒息征象。心脏质量192.0 g,横径8.5 cm,左心室壁厚1.1 cm,右心室壁厚0.3 cm,心脏各瓣膜未见异常,冠状动脉左前降支检见     

云南猝死综合征的流行特征及其研究进展

云南猝死综合征(Yunnan sudden death syndrome,YSDS)是一种每年6~9月份发生在云南省中部和西北部海拔1815~2225m的山区、半山区,以突然发病并死亡为特征且病因不明的疾病。该病以青壮年为主,女性多于男性,傈僳族、彝族和苗族发病率较高,具有家庭聚集性,临床表现多样,病理学特点缺乏特异性,发病原因与卫生、经济条件、硒铬微量元素缺乏、柯萨奇B组病毒感染、食用蘑菇及当地特殊地质条件相关。本文综述了YSDS的流行病学特征、临床表现、病理性特点、病因研究及假说,以期对YSDS进一步研究提供线索。     

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。     

青壮年猝死综合征的研究现状

青壮年猝死综合征（SMDS）是法医学研究的难点之一，其猝死机制尚未阐明。本文从SMDS的流行病学、心脏组织免疫学、心脏电生理、基因学等方面的研究进行综述，以期望为进一步研究获得启示。     

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。     

婴儿猝死综合征的研究现状及其法医学检验

婴儿猝死综合征(dudden infant death s yndrome,SIDS)一直是法医学和儿科学领域的研究热点。相对于北美、欧洲、澳洲以及日本等地对SIDS广泛深入的研究,来自中国的报道相对较少。本文通过总结文献,介绍SIDS的发展历史、研究现状和新的发展趋势,并结合2004年各国学者在美国圣地亚哥公布的SIDS分型,讨论实际检案中需注意的问题以及推进其调查研究的可行性。     

Pathology of sudden infant death syndrome

This study is based on 15 cases examined by the author. The majority of the infants were found in a prone position. Thymus was enlarged in all cases. Its enlargement of the lower portion overlying the basal portion of the heart formed an unyielding, tense membrane. In prone position, the heavy ventricles fell forward, producing angulation and kinking against this membrane and inhibited the filling of the heart or irritated the heart, producing arrhythmia and cardiac arrest.     

Melatonin concentrations in the sudden infant death syndrome

To examine a possible relationship between pineal function and the sudden infant death syndrome (SIDS), samples of whole blood, ventricular cerebrospinal fluid (CSF) and/or vitreous humor (VH) were obtained at autopsy from 68 infants (45 male, 23 female) whose deaths were attributed to either SIDS (n = 32, 0.5-5.0 months of age; mean +/- S.E.M., 2.6 +/- 0.2 months) or other causes (non-SIDS, n = 36, 0.3-8.0 months of age 4.3 +/- 0.3 months). The melatonin concentrations were measured by radioimmunoassay. A significant correlation was observed for melatonin levels in different body fluids from the same individual. After adjusting for age differences, CSF melatonin levels were significantly lower among the SIDS infants (91 +/- 29 pmol/l; n = 32) than among those dying of other causes (180 +/- 27; n = 35, P less than 0.05). A similar, but non-significant trend was also noted in blood (97 +/- 23, n = 30 vs. 144 +/- 22 pmol/l, n = 33) and vitreous humor (68 +/- 21, n = 10 vs. 81 +/- 17 pmol/l, n = 15). These differences do not appear to be explainable in terms of the interval between death and autopsy, gender, premortem infection or therapeutic measures instituted prior to death. Diminished melatonin production may be characteristic of SIDS and could represent an impairment in the maturation of physiologic circadian organization.     

Cardiac lesions in sudden infant death syndrome

Sequential morphological changes as found in the hearts of 250 sudden infant death syndrome (SIDS) infants are described. Detailed examination of macroscopic and microscopic lesions reveal that all SIDS infants had identifiable lesions at the time of their death. The lesions can best be described as selective focal anoxic muscle fibre necrosis at chronologically different developmental stages. The extent of these lesions vary markedly from case to case, from a minimal muscle fibre eosinophilia through contraction band formation, myocytolysis, stromal condensation to scar formation. The morphological variations in the lesions amongst individual cases can be interpreted as relating to the time interval of the development of the lesions. The intramural and coronary arteries in some cases are also affected showing intimal hyperplasia. Although these sequential morphological aberrations are not specific and typical to SIDS infants only, they were present in all SIDS infants in this series.     

The fallacy of the simultaneous sudden infant death syndrome in twins

The likelihood of twin infants dying suddenly and simultaneously of SIDS, a natural disorder, defies credibility. However, injuries associated with environmental hazards provide possible mechanisms of sudden death. A search for hazards in the homes of 13 pairs of healthy twins who died together of no apparent cause formed the basis of this study. Ten of the 13 sets were certified by medical examiners as simultaneous twin SIDS. The findings in this study suggest that all 13 sets died from injuries, either unintentional or otherwise, and that these deaths could have been prevented.     

Cardiac rhabdomyoma presenting as sudden infant death syndrome

A case of cardiac rhabdomyoma presenting as sudden infant death in a four-and-one-half month-old infant is reported. The child was the product of an essentially uncomplicated pregnancy and enjoyed good health before his unexpected, sudden death. Autopsy examination revealed the presence of multiple cardiac lesions which histologically were diagnosed as rhabdomyomas. Death was attributed to fatal cardiac arrhythmia caused by the tumor. To the authors' knowledge this represents the first reported case in the forensic science literature of death as a result of cardiac rhabdomyoma presenting as sudden infant death syndrome (SIDS).     

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.     

Nonnatural death masquerading as SIDS (sudden infant death syndrome)

This article relates our experiences with accidental and homicidal deaths in reported sudden infant death syndrome (SIDS) cases. Our intent is to alert personnel in medical and health-related professions as well as death investigators (coroners, law enforcement officials, etc.) that a thorough scene investigation and history need to be obtained when a child's death has been reported, since this may modify the type of autopsy to be performed. It should not be assumed that all children less than 1 year of age who die suddenly die from SIDS.     

Desquamative interstitial pneumonia in an infant. Mimicry of sudden infant death syndrome

A 15-week-old infant girl, without a prior history of overt illness, was found dead while sleeping between her two parents. The gross examination at autopsy showed only congested lungs, and the initial diagnosis was sudden infant death (SID). On microscopic examination, a desquamative interstitial pneumonia (DIP) was observed. The widespread, patchy intraalveolar histiocytic desquamation was associated with lymphocytic infiltration of bronchiolar and aveolar walls, which together provided convincing evidence that an interstitial pneumonitis was the cause of death. A viral etiology seems most likely in view of the accompanying chronic inflammation of bronchial submucosal glands.