法医学高危尸检的风险识别与防护

高危尸检(High Risk Autopsy)是指对患有或者可能患有严重传染性疾病的尸体进行解剖检验,该传染性疾病可能传染给尸体解剖检验的法医及其他高危人群,从而导致严重疾病或引起死亡。本文对高危尸检中的感染风险、风险识别方面进行论述,在个人防护、解剖室防护、虚拟影像方面提出安全预防措施。     

新冠肺炎尸检:法医工作者面临的挑战与对策

新型冠状病毒肺炎(简称"新冠肺炎")病例于2019年12月出现,疫情在短时间内蔓延,已导致数千名患者死亡。目前我们对新冠肺炎的致病、转归、致死的病理学机制了解甚少,尽早开展新冠肺炎死亡病例的尸体检验尤为重要,这给法医工作者带来了挑战。新冠肺炎尸检应在可以维持负压的独立解剖室进行,检验人员应严格按照三级防护标准穿戴防护用具,注重环境、器械、耗材的消毒以及废液废弃物处理。解剖及检验过程应规范、谨慎,尽量减少切割操作,并避免体液流出或组织飞溅导致病毒传播。本文将就法医工作者面临新冠肺炎尸检的挑战与对策做一述评。     

急性雷公藤中毒尸检1例

雷公藤(Tripterygium Wilfordii Hook.f.)属卫矛科藤本灌木,别名红药、黄藤根、断肠草、菜虫药等.民间常用雷公杀菜虫,功效颇佳.自1958年徐英含等[1]报道雷公藤中毒病例后,国内陆续有较多临床中毒病例报道,但尸检报告甚少[2,3,4].现将用雷公藤投毒一例报告如下.     

瑞氏综合征尸检2例

瑞氏综合征尸检２例涂彬，孔祥麟（上海医科大学法医学系；上海２０００３２）瑞氏综合征（ＲｅｙｅＳｙｎｄｒｏｍ。），又称急性脑病合并内脏脂肪变性综合征、呕吐病或肝脏脂质沉着症等．１９６３年由澳大利亚医生Ｒｅｙｅ首次报道［１］。国内自１９７２年曾有陆续报道...     

290例急死尸检病理分析

本文对290例急死尸检材料进行综合性分析。结果表明,急死尸检率有逐年上升的趋势。急死病因以心血管系疾病、呼吸系疾病及消化系疾病较多,且各年代亦有所变化,本文还对心脏性急死、急性出血坏死性胰腺炎急死、肿瘤急死、睡眠中急死进行了讨论。     

急性万年青中毒尸检1例

急性万年青中毒尸检１例刘世新，李玲，黄光照（同济医科大学系法医病理学教研室，武汉４３００３０）吴德城曾报首一例用万年青叶煎水眼治疗感冒而中毒死亡，但尚款见尸检报告。本文报告一例服用万年青根茎自杀引起心室纤颤致死，以供参考。１案例汤某，男性，２９岁。１...     

浅谈贯彻落实尸检制度的几点认识

《医疗事故处理条例》（以下简称《条例》）已颁布实施4年余．对改善医院及医务人员执业环境、妥善处理医疗事故起到了很大的作用。但《条例》就如何落实尸检。还只是原则性的规定。而医院和临床医务人员在实际工作中仍缺乏具体可操作的程序引导。笔者结合近年的医政工作实践和处理医疗诉讼案件的体会，就我院如何落实尸检、完成举证责任谈几点粗浅体会。     

浅谈贯彻落实尸检制度的几点认识

《医疗事故处理条例》(以下简称《条例》)已颁布实施4年余,对改善医院及医务人员执业环境、妥善处理医疗事故起到了很大的作用。但《条例》就如何     

法医尸检中应注意的几种现象

尸体是法医学研究的重要对象。尸体检验是法医鉴定工作的一个重要组成部分，通常尸体检验可以明确死因和致死方式，推断死亡时间和致伤物体，为刑事、民事诉讼和非正常死亡案件的审理提供医学证据。我国伟大的法医学家宋慈在《洗冤集录》序言中述：“狱事莫重于大辟，大辟莫重于初情，初情莫重于检验。”充分阐明了慎重全面检验的重要性。所以，尸体检验要求全面、仔细，稍有疏忽就可能酿成不可弥补的损失。但目前有些尸体检验工作不仔细、不规范，致鉴定结论不能令人信服。造成当事人上访，要求复检和重新鉴定，给审理工作带来不少麻烦和非…     

法医病理学尸检对死因分析的意义

目的:旨在通过法医病理学尸检来进一步探讨损伤、死因分布规律与疾病之间的关系。方法:对134例存有争议或死因不明的尸体进行系统的病理学检查,进一步明确其死亡原因。结果:134例尸检中,130例能够确定死因,4例未能发现明显死因。而在96例病理性死亡报告中,以心血管疾病居首,其他疾病致死依次为神经系统疾病、呼吸系统疾病、产科疾病消化系统疾病;34例外力致死报告中,24例为机械性损伤,6例机械性窒息,4例其他。结论:系统的病理学尸检,既有利于相关部门处理、调解医疗纠纷;也利于刑事、民事等案件解决、处理的公正性;同时,还可以为提高医院的诊疗水平发挥出其积极的促进作用。     

Adult Hirschsprung's disease diagnosed during forensic autopsy

We report a case of fatal Hirschsprung's disease (HD) discovered at autopsy. A 20-year-old man collapsed at home. Emergency medical personnel found him in cardiac arrest and all resuscitative efforts failed. He had a past history of chronic constipation since infancy. Forensic autopsy revealed a megacolon full of gas and stools. Microscopic examination showed absence of ganglion cells in a short segment of the rectum and enterocolitis in the left and transverse colon. HD is rarely described in adults. In many cases, patients complained of constipation since infancy but the affection remained misdiagnosed. The relative good tolerance of the disease is usually due to a short aganglionic bowel segment. Enterocolitis is a frequent and severe complication of HD in children but is rarely described in adults. This case suggests the importance of HD diagnosis in childhood in order to avoid fatal complications with forensic consequences.     

阴性解剖中的心脏性猝死

综述了近年来有关心脏性猝死的分子生物学和电生理学的研究进展,着重讨论了心震荡、先天性长QT间期综合征和Brugada综合征,可能诱发致死性心律失常,发生心脏性猝死。这些功能性病症死亡常可导致病理解剖时无明显客观器质性病理改变。提示法医和病理工作者在遇到阴性解剖猝死时,应注意了解猝死的诱因、继往病史和家族病史,注意排除可能存在的这些病症。     

The value of the hospital autopsy. A study of causes and modes of death estimated before and after autopsy

Among 312 consecutive deaths in a Danish Central Hospital autopsy was performed in the pathology department on 266 cases, i.e. 85%. Retrospectively, the underlying causes of death were estimated from the clinical information alone by an experienced clinician and subsequently compared with the autopsy report. The definite cause of death was determined jointly by the clinician and the pathologist. The clinician's diagnosis was thereby confirmed as incorrect in 18% of the cases if small differences in site and type of malignant tumours were not considered. This is less than in many other investigations, but it is stressed that this could partly be because formal errors in completing the death certificate were avoided. The main causes of death were ischaemic heart disease and neoplasia. Clinical diagnosis of malignant diseases was never found to be erroneous. There was a slight tendency to clinically overestimate ischaemic heart disease, but in general the different errors outweighed each other, so that the total number of different causes of death before and after autopsy was nearly the same. The original death certificate was investigated in 12 accidental cases. Hereby it was found that the mode of death was originally stated erroneously as natural in 7 cases, i.e. 4.5%. It is concluded that hospital autopsy is still needed for the control and correction of causes of death, and it is stressed that clinicians as well as pathologists should be more aware of cases with a trauma in the history to avoid errors in the mode of death. Such errors can imply legal as well as insurance problems.     

Aims,methods and achievements in European data protection1

The protection of personal data represents one of recent most emerging legal issues. On one hand, the privacy and the discretion of individuals are challenged by various new means of data collection and communication. On the other hand, the growth and development of the information economy is heavily dependent on the level of freedom of business units in gathering, processing and distribution of various kinds of information. In this short notice, we will try to summarize the experience with the data protection laws with respect to their basic teleology.     

多层螺旋CT在交通事故尸检中的应用价值

目的在交通事故死亡者尸检中应用多层螺旋CT进行检查,探讨其应用价值。方法随机数字法选取10名因交通事故死亡者的尸体进行常规CT和多层螺旋CT尸检,进行三维重建图像分析,与尸体解剖尸检结果加以对比分析。结果多层螺旋CT诊断与尸体解剖检查一致性高,较常规CT诊断准确。结论在交通事故死亡者尸检中,应用多层螺旋CT诊断,方法简便易行,与常规尸检结果具有较高的诊断一致性,应用价值极高。     

计算机辅助法医教学系统

本研究综合应用多媒体计算机技术，结合法医学实际，研制出法医学尸体解剖教学的计算机软件．结果表明符合形象教学的要求．具有较强的交互能力，能按学习不同层次选择有关步骤和内容．     

香港个人资料隐私保护之经验——兼论我国个人资料保护法之制定

个人信息作为信息的一种,具有与信息相同的特征。个人资料属于现代隐私的外延,指的是可以识别出个人的所有资料。我国香港特别行政区已于1996年12月实施了《个人资料(私隐)条例》。在实施的十年间,法院与香港个人资料私隐专员公署分别做出了一些司法原则和执行决定,很值得我国在制定《个人资料保护法》时加以参考与借鉴。     

Pericardial lipoma: an autopsy case and review of the literature

Postmortem examination performed on a 70-year-old man revealed a thinly encapsulated, ovoid, large mass in the right hemithorax. The tumor was attached with its pedicle to the atrioventral pericardium and adjoined the diaphragm with compression of the right lower lobe of the lung. There was no adhesion between the tumor and the surrounding organs. Light microscopy showed a lipoma consisting of mature adipose tissue, and no malignancy was found.     

涉及死亡医疗纠纷的发生:27年医疗纠纷法医尸检回顾性研究之一

为了探讨医疗纠纷法医尸检的特点,回顾性研究了1972～1998年27年间318例医疗纠纷尸检资料.在这第一篇报告中,介绍与死亡有关医疗纠纷发生上的一些特点:医疗纠纷尸检的案例数从1972～1983年的23例上升到1984～1998年的295例;死者中男女性别无显著差别;年龄分布有两个高峰,10岁以下有104例(32.71%),20～40岁组161例(50.63%);发生在市(县)级中等大小医院的纠纷最多见,有195例,占61.32%,近年私人诊所的医疗纠纷明显增多;医疗纠纷尸检最常涉及外科(71例,22.33%)和产科(58例,18.24%);也简略讨论了206例非医疗过失纠纷和99例医疗过失纠纷发生的原因.