房室结纤维和脂肪增多与房室结动脉狭窄的关系

目的探讨房室结纤维、脂肪含量与房室结动脉狭窄之间的关系,分析房室结内病理性纤维化和病理性脂肪浸润的原因。方法选取119例心源性猝死案例,用Image-pro plus图像分析软件检测组织切片,计算房室结面积,房室结动脉内径、房室结动脉管腔面积(lumen area,LA)、外周横截面积(perimeterarea,PA),纤维组织面积和脂肪组织面积。将所有案例分为动脉狭窄组和正常对照组组,观察房室结动脉PA/LA值及房室结纤维及脂肪含量的改变。结果狭窄组房室结动脉PA/LA值在21～40岁最大,40岁以下两组房室结脂肪含量和总间质含量差异有统计学意义。结论房室结动脉狭窄与房室结间质含量增多有一定关系。     

Histopathological findings of cardiac conduction system of 150 Finns

One hundred and fifty heart specimens were collected from the cases submitted for autopsy in the Department of Forensic Medicine in the University of Turku in March-May 1995 and May-July 1996, respectively. The cardiac conduction system (CCS) of these hearts were examined in order to find out the histopathological changes in the CCS of Finnish persons and their forensic pathological significance. There were 94 males and 56 females. Almost all age groups were included. The results revealed that in most of the persons the fibrous tissue and fatty tissue in the CCS increased with aging. In about half of the persons, there was deposition of calcium in the central fibrous body, pars membranacea, and the top of the musculature in the interventricular septum. In seven cases, the atrioventricular node (AVN), His bundle (HB) or bundle branches (RBB, LBB) were compressed by the calcium deposition. Hemorrhage, inflammation, amyloidosis, tumor, fatty infiltration and developmental malformations were observed in 31 cases. Twenty-eight cases died of myocardial infarct, among them, no involvement of the CCS could be observed. The authors concluded that routine examination of the CCS is helpful for revealing diseases of the CCS and improving the quality of forensic pathological diagnosis.     

青年人CCS脂肪超前变化致猝死

为研究心传导系统（CCS）与猝死的相互关系，对120例心性猝死者CCS作常规检查，光镜下作半定量计算其脂肪含量。结果发现：9例经一般常规尸检未找到任何致死原因的青年人（30岁以下），其房室结（AVN）与房室束（HB）的脂肪组织含量为70％，比同龄人明显增多，致使结、束肌细胞被脂肪分割中断或压迫萎缩。结内外细胞连接不足或缺失是构成心电不稳的病理基础。此外本文尚对其脂肪浸润的病因发病，猝死机理作了探讨。     

Evaluation of a simplified method of the conduction system analysis in 110 forensic cases

A simplified method of the His bundle analysis is evaluated by the study of 110 forensic cases. The atrioventricular node or its part were observed in 96 cases (87.3%), penetrating bundle in 92 cases (83.6%), branching and left bundles branch in 109 cases (99.1%) and right bundle branch in 73 cases (66.4%). The changes such as fibrosis and fatty infiltration show statistically significant differences (P<0.01) between progressive age groups confirming their degenerative and age-related nature. The study included as well nine cases of sudden unexpected death and two cases of sudden infant death syndrome (SIDS), for which the autopsy with histological examination and toxicological analysis resulted negative. For nine of these cases, pathological lesions were found which can even explain the fatal issue. Moreover, in the cases with known cause of death, potentially lethal changes were noticed. This simple, low cost technique could be proposed to forensic pathologists as easy to fit into the routine processing of autopsy material, allowing the detection of major abnormalities with minimal effort. The authors also consider the difficulties related to the interpretation of the pathological findings in the conduction system.     

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。     

Sudden death following exercise testing related to abnormalities of the cardiac conduction system and coronary artery pathology

A case of sudden death following exercise testing in a 33-year-old man is reported. The forensic autopsy showed atherosclerotic stenosis of the left coronary artery, as well as some changes in the cardiac conduction system, including anomalies of the atrioventricular node and moderate fibrosis and fatty infiltration of the branching bundle. This case demonstrates that cardiac arrest during vigorous exercise may be multifactorial and that abnormalities of the cardiac conduction system may have played some role in the fatal issue.     

6例心脏传导系统病变致交通事故的病理学观察

检查100例交通事故死亡者的心脏传导系统（CCS），发现大部分存在着程度不同的病变。其中6例的SAN、AVN、AVB及LBB、PBB起始部见明显的出血、炎症、脂肪浸润、纤维化、神经病变和结动脉狭窄等病变。结合案情与现场勘查，6例交通事故与CCS病变导致心律失常有关。     

病态窦房结综合征解剖报告一例

<正> 病态窦房结综合征近年来国内报告逐渐增多,但尸检报告尚少,在法医学上对猝死的案例具有重要意义。为进一步提高对本病认识,现将作者遇见1例报告于下,供参考。案例报告案情摘要叶××,男,32岁,农民。某年9月17日上午,酒后大醉,在街上抓东西吃,与人发生争吵、拉扯。午后2时许,叶到乡政府报案时,又与人发生拉扯、倒地,爬起来后到田坝担谷子,担第2趟时自觉不舒服,脸色突变即送往医院,经抢救治疗无效于下午5     

NMDAR1在成人心脏中的分布及其法医学意义

目的 检测成人心脏中NMDAR1蛋白,观察其分布情况,并探讨法医学意义。方法以12例高坠死亡成人心脏为标本,提取左、右心室和心传导系统（窦房结、房室结、房室束及左右束支）组织作为实验组;取大脑额部组织作为阳性对照组。所取标本各两份,一份采用westernblot技术检测NMDAR1蛋白,另一份采用免疫组化染色法观察NMDAR1在成人心脏中的分布。结果两组中用westernblot均可检出NMDAR1蛋白表达,其强弱程度：脑组织最强,其次为窦房结和房室结,左右心室肌最弱;用免疫组化方法观察,结果在心脏传导系统可见NMDAR1阳性表达,而在心室肌中未见表达。结论成人心脏中存在NMDAR1,主要分布在心传导系统,NMDAR1可能在心脏电生理和病理生理中起作用。     

心传导系统结动脉结细胞的定量分析

采用显微图像分析技术，定量观察35例人体心脏传导系统结细胞直径、结动脉管径及管壁厚度，探讨其与年龄变化的关系。结果显示：窦房结（SAN）动脉的血管内径较房室结、房室束供血动脉之内径粗大，反映出窦房结在心传导组织中地位显要；SAN动脉管壁菲薄，中层无完整环行平滑肌，组织构筑上提示SAN动脉对血压波动敏感；结细胞直径在40岁前随年龄增长而变大，40岁后则随年龄增长而逐渐缩小，与人体其它脏器生长发育的规律相一致。意味着年龄老化，心传导系统功能减退。     

心肌炎侵及心传导系统病理学观察

本研究采用已建立的人体心脏传导系统简易取材法,对6例心肌炎的案例进行了传导组织的病理学观察,结果发现6例心肌炎患者CCS均有明显炎症,尤以SAN、AVN病变为主;推测CCS炎症可能为心肌炎患者猝死的主要原因。因此,本文提出对怀疑心性猝死案例应作常规传导系统检查。     

Asymmetric septal hypertrophy of the heart. New findings concerning the possible etiology of sudden deaths in five males

This report describes certain interesting postmortem findings in the hearts of five subjects who died suddenly, silently, and unexpectedly, and in whom the only significant abnormality at autopsy was asymmetric septal hypertrophy (ASH) of the heart. Deep clefts, cystic faults, and dilated vascular channels were not only seen within the septal myocardium in all the hearts, but also within the left ventricular free walls of two hearts. The septal myocardium and the left ventricular free walls of two hearts and the A-V node and His bundle of one heart demonstrated mural and luminal thrombi of several dilated vascular channels. In another heart, foci of cardiocytic myofibrillar degeneration were seen, especially close to narrowed small coronary vessels. Fetal dispersion and fibrosis of the A-V node and His bundle were evident in one heart. These abnormalities in the conducting system and the ventricular myocardium suggest that the hearts of subjects with ASH are not only excellent anatomic substrates for lethal arrhythmias, but also are bound to be hemodynamically impaired. We believe that conditions such as hypoxia, increased oxygen demand by the heart or abnormal sympathetic stimulus may easily trigger fatal arrhythmias in such individuals, thereby causing sudden death.     

Histologic findings of the sinus node and the perinodal area in street heroin addicts, victims of sudden unexpected death

Sudden unexpected death is frequent in street heroin addicts. We conducted a histologic study of the sinus node (SN) to offer some evidence about the possible arrhythmogenic cause of death. Postmortem coronary angiography and microscopic examination of the SN and the perinodal area were performed in 50 heroin addicts (group 1) and in 50 nonaddicts (group 2), all men (16-40 years old). In heroin addicts, fatty and/or fibrous tissue replaced SN tissue in 21 cases (42%). Perinodal infiltration was found in 15 cases (30%). Fibromuscular dysplasia in branches of the sinus node artery (SNA) was found in eight cases (16%). Inflammation with focal and/or diffuse concentration of round cells was detected in the SN in 22 cases (44%). Old mural thrombi were also found in 13 cases (26%). The histologic changes in the SN and perinodal area offer an explanation about the possible mechanism of arrhythmia and sudden death in this population.     

Sudden unexpected death in epilepsy: is death by seizures a cardiac disease?

RESULTS: Sudden unexpected death in epilepsy (SUDEP) gains more and more acknowledgment across the various interdisciplinary fields. Accordingly, we performed in a prospective setting a case-control study of all SUDEP cases in a well-defined part of Denmark (Northern Jutland), between January 1998 and September 2000. We attempted to look into the cardiopathologic mechanism behind this phenomenon by assessing the degree of myocardial fibrosis in SUDEP patients versus controls. The histologic evaluation was possible in 65% of the cases (15/23) whose death was attributed to SUDEP and in 71% (15/21) of controls. Forty percent of the SUDEP cases (6/15) presented several foci of fibrotic changes in the deep and subendocardial myocardium in contrast to 1 control (6.6%, P = 0.03). None of the subjects from the SUDEP group showed fibrotic changes in their conduction system as compared with 1 control (6.6%). The quantitative evaluation of fibrosis demonstrated a trend toward more fibrosis in the deep and subendocardial myocardium of the SUDEP cases. Forty percent of cases in the SUDEP group were men (6/15), characteristically young at time of death (mean age 38 years) and with a late epilepsy onset (mean age 21 years). Antemortem, 73% of the SUDEP patients (11/15) had experienced infrequent seizures (self-reported). We conclude that the SUDEP cases displayed significant fibrosis of the myocardium when this was assessed by qualitative means. This fibrosis may be the consequence of myocardial ischemia as a direct result of repetitive epileptic seizures, which, associated with the ictal sympathetic storm, may lead to lethal arrhythmias.     

Congenital atrioventricular block: histological aspects

It is known that maternal immunological factors such as systemic disease are involved in the genesis of cardiac conduction problems in the fetus but the histologic changes in the conduction system are less documented. We report the case of a 33-year-old woman with no significant medical history. Her first pregnancy was induced by Clomifene. At 17 weeks of gestation, the fetus presented sonographic abnormalities characteristic of a complete atrioventricular block. Biological investigations found anti-SSA and -SSB antibodies. Clinical history search for systemic disease was positive for photosensitivity, lasting 10 years, suggesting the diagnosis of systemic lupus erythematosus. The patient was treated with prednisone 20 mg per day but fetal death occurred at 29 weeks of gestation. Histological examination of the fetal heart showed an altered atrioventricular node and bundle of His with fibrosis, calcifications, endocardial fibroelastosis and mononucleated inflammatory cells. The search for these specific lesions can be determinant in establishing the disease pathogenesis; also, it is important to eliminate this diagnosis in an unexplained fetal death.     

正常人心脏传导系统神经组织的免疫组化研究

作者应用抗Ｓ１００抗体，对１０例正常心脏传导系统的神经进行了免疫组化研究。结果显示：Ｓ１００阳性的神经组织在心脏传导系统内广泛分布，其含量以窦房结最多，房室结次之，希氏束和束支最少。该研究获得了正常人心脏传导系统神经组织分布的概貌，为进一步研究心脏传导系统神经组织病变与猝死的关系打下了基础。     

HPLC法检测人外周血5-~mC含量及其与年龄相关性研究

目的探讨人外周血中5-mC含量随年龄变化的规律。方法94例健康个体(4~87岁,男性50例,女性44例)按年龄分为6组<20岁、20~30岁、30~40岁、40~50岁、50~60岁及>60岁组,用HPLC法对外周血中5种脱氧核苷进行定量分析。结果50~60岁组(平均年龄54.7岁)和>60岁组(平均年龄71.7岁)间的5-mC含量差异无显著性,但与其它4组有明显差异(P<0.0001);<20岁、20~30岁、30~40岁和40~50岁4组间无显著性差异。男性5-mC含量的均值(3.5%±0.005%)稍低于女性(3.32%±0.006%),但差异无统计学意义。结论5-mC的含量随着年龄的增长呈下降趋势,但其下降程度很小。     

Applicability of Greulich and Pyle skeletal age standards to Indian children

A total 375 Indian children of age 1 day to 19 years were studied (male 194 and female 181). For determining the bone age (skeletal age), wrist and hand radiographs were taken. The skeletal age was determined by blinded review of radiograph using Greulich and Pyle atlas (2nd edition, 1959). If we consider all age group (1-19 years), the Indian boys were retarded in skeletal age by 0.7 years and females by 0.33 years. Male and female children skeletally lag behind the American standard (GP Atlas) in all age groups except 12-13 years age group in which girls are accelerated by 0.22 years. Chronological age and skeletal age difference of more than 1 year is seen between age group 7 years and 12 years in males. Females after second year showed a retardation, which ranged from 0.2 to 0.8 years, up to the age of 19 years. The present study concludes that, Greulich and Pyle atlas is not applicable to the Indian children of both sexes especially in middle and late childhood.     

房室传导系统发育异常猝死的病理学研究

本文报告了三名男性青年人房室结和／或房室束、束支发育异常，在情绪激动和／或用力情况下突然无声息倒地死亡。经病理组织学研究，发现有胎儿型房室结、心传导系统附加束存在和房室结畸形等发育异常改变。本文对其病理组织学特征、猝死机理和诱因进行了讨论。     

Evaluation of age estimation technique: testing traits of the acetabulum to estimate age at death in adult males

This study evaluates the accuracy and precision of a skeletal age estimation method, using the acetabulum of 100 male ossa coxae from the Grant Collection (GRO) at the University of Toronto, Canada. Age at death was obtained using Bayesian inference and a computational application (IDADE2) that requires a reference population, close in geographic and temporal distribution to the target case, to calibrate age ranges from scores generated by the technique. The inaccuracy of this method is 8 years. The direction of bias indicates the acetabulum technique tends to underestimate age. The categories 46-65 and 76-90 years exhibit the smallest inaccuracy (0.2), suggesting that this method may be appropriate for individuals over 40 years. Eighty-three percent of age estimates were ±12 years of known age; 79% were ±10 years of known age; and 62% were ±5 years of known age. Identifying a suitable reference population is the most significant limitation of this technique for forensic applications.