42例外伤性流产的法医学分析

外伤性流产在法医鉴定中偶尔遇到,但认定存在一定难度。本文作者收集1995-2005年42例外伤性流产的案例资料进行回顾性分析,旨在探讨外伤性流产的机制、特点及其鉴定中需要注意的问题。案例资料一、临床资料42例伤者均为育龄女性,年龄21～35岁,平均年龄25岁,其中25岁以下伤者26例(占62%)。42例伤者均有较详细的相关病历资料记载。资料显示:均有明确的停经史,均经HCG试验测试呈阳性反应及次数不等的B超检查确诊为妊娠,受伤前B超检查均未见胚胎发育有任何异常,子宫大小及胚胎生长与孕周相符,孕7～21周不等,其中早期妊娠(12周内)为38例占90.5%…     

42例外伤性流产的法医学分析

外伤性流产在法医鉴定中偶尔遇到，但认定存在一定难度。本文作者收集1995—2005年42例外伤性流产的案例资料进行回顾性分析，旨在探讨外伤性流产的机制、特点及其鉴定中需要注意的问题。     

外伤后流产23例法医学鉴定回顾性分析

目的分析外伤后流产案例法医学临床鉴定的特点,探究外伤与流产之间的因果关系。方法收集近年中国医科大学法医学院临床法医学教研室外伤后流产法医学鉴定共23例,总结和分析外伤后流产案例的特点。结果23例外伤后流产法医学鉴定例均为早期流产,体表损伤轻微,伤后短时间内出现阴道流血,并在较短时间内流产。高龄孕妇、农村人口和无业人员所占比例大。结论流产原因较多,对于外伤后流产的法医学鉴定案例,只有排除非外伤性因素后,才能认定为外伤性流产;对于不能排除非外伤性流产因素的案例,可根据具体情况分析损伤为流产的主要原因、次要原因或诱因。     

外伤后流产法医学鉴定96例分析

外伤后流产的案例在法医鉴定工作中屡见不鲜,而外伤与流产之间的关系常常是案件争论的焦点。本文通过对2001~2011年我县96例外伤后流产案例的分析,旨在讨论流产病因,探讨外伤性流产的鉴定及其损伤程度评定等问题。1案件资料1.     

流产的病因及其法医学鉴定中应注意的问题

流产的病因复杂多样,常见的原因有:遗传基因的异常、免疫疾病、内分泌异常、精子异常等。其他如感染、生殖器官疾病、全身性疾病、环境因素、外伤及其精神刺激与手术等也会导致流产。在法医学鉴定中,对于外伤后流产应排除非外伤性流产因素后,才能认定外伤性流产。     

17例颈椎外伤合并颈椎退行性病变的伤病关系分析

目的研究颈椎外伤合并颈椎退行性病变的法医学鉴定案件特点,探讨如何利用临床资料,法医学检查和影像学检查等对损伤和病变参与程度进行认定等问题。方法收集17例颈椎外伤合并颈椎退行性病变的法医学鉴定案例,对其年龄分布、损伤方式、损伤程度、影像学表现等进行分析,综合评定伤病关系。结果 17例案件以中老年为主。所有案例均存在椎间盘突出,损伤以过伸性损伤为主。按照影像学表现,将损伤程度和脊椎退变程度进行分级,综合计算伤病参与程度。结论颈椎外伤合并颈椎退行性病变的法医学鉴定案件应综合运用临床资料、法医学体格检查和影像学检查结果进行评定。     

DNA检验早期胚胎组织破获强奸案1例

在性犯罪案件中,检验3个月以上流产胎儿、绒毛、羊水的案件较多,检验早期胚胎(8周内)的案件较少,现报道检验早期胚胎破获强奸致孕案1例。1案例资料陈某,女,13岁,在某中学校舍内多次被该校男生叶某强奸,于某年5月9日经医院证实怀孕7周并实施人工流产。提取受害人陈某的血样和流产的胚胎组织及嫌疑人叶某的血样进行DNA检验。2检验与结果用Chelex法提取DNA,用identifiler荧光STR复合扩增试剂盒扩增,扩增产物用PE310测序仪进行检测分型,结果显示送检的胚胎与陈某、叶某有亲生关系(表1)。表1流产胚胎与陈某、叶某血的STR位点基因分型检材D…     

外伤性癫痫的法医学鉴定21例分析

为了探讨颅脑损伤后癫痫的法医学鉴定要点,对 21例颅脑损伤后癫痫出现发作者进行了现病史、既往史调查,并结合临床脑电图（ EEG）及 X线片、 CT片、 MRI片等影像学资料。结果发现外伤后癫痫常继发于严重的颅脑损伤,多以晚期发作为主,其发作性质决定于颅脑损伤的部位和程度,头皮 EEG和 24小时动态 EEG证实有异常癫痫样波存在,影像学检查有助于定性分析。结果提示：外伤性癫痫法医学鉴定必须以掌握外伤史及既往史为基础,结合 EEG、 CT、 MRI等检查方可作出正确鉴定。     

外伤致鼓膜穿孔318例分析

外伤性骨膜穿孔在法医临床学鉴定中经常遇见,如何与疾病性骨膜穿孔及如何确定损伤程度,是法医学需要解决的重要问题之一。为此,本文作者对相关的案例进行收集、分析,并探讨相关问题。材料及方法对我所1997—2003年符合系列条件的案件进行统计分析:1.诊断外伤性鼓膜穿孔,有耳部明确的外伤史,伤后不久即在医院检查,排除非外伤性鼓膜穿孔。2.鉴定档案资料齐全。鉴定均依据相关急诊病历及二级以上医院专科原始检查记录,并有脑干听觉诱发电位等客观听力测试报告佐证。符合条件共318例。结果一、一般情况类别例数耳聋耳鸣耳痛鼓腮试验阳性裂隙状13…     

158例"周围神经损伤"法医学鉴定分析

目的 研究"周围神经损伤"法医学鉴定案件的特点,探讨如何运用临床资料、法医检查和神经电生理检测结果等对周围神经损伤者进行法医学鉴定.方法收集临床诊断为"周围神经损伤"的158例法医学鉴定案件,对其个体特征、损伤情况、鉴定结果、夸大与伪装情况等进行统计分析.结果 在158例"周围神经损伤"案件中以男性、青壮年及无业人员多...     

外伤性视神经损伤的法医学鉴定

目的 探讨外伤性视神经损伤的特点及其法医学鉴定的要点。方法 对40例视神经损伤的法医学鉴定案例进行回顾性研究,所有案例均进行眼科常规检查及眼电生理(VEP)检查,视力接近正常或正常者进行视野检查。结果视神经损伤在眼外伤中占13.84％,多并发于颅脑损伤(65％),交通肇事致伤67.50％。伤者多表现为明显的视功能障碍(67.50％)。LED-VEP检查表现为潜伏期延长和/或波幅降低,严重者为切迹波甚至无波;视盘色淡或苍白,90.00％瞳孔对光反射异常。结论 外伤后,LED-VEP异常、眼底视盘改变、瞳孔对光反射,以及视野异常是判定视神经损伤的主要指标。     

外伤性鼓膜穿孔面积测定方法及41例分析

目的探索外伤性鼓膜穿孔面积大小的测量方法并分析41例病例。方法用图像分析软件Photoshop分析耳内窥镜获得的外伤穿孔鼓膜照片,计算穿孔与鼓膜面积比例并分析外伤性鼓膜穿孔的法医临床学特性。结果外伤性鼓膜穿孔通常为小穿孔,边缘血污部分外翻,形状不规则,左侧居多。结论耳内窥镜可以清晰记录外伤性鼓膜穿孔,图像处理软件可以定量分析鼓膜穿孔大小。     

外伤与肺部感染5例尸检分析

外伤与肺部感染５例尸检分析刘新社，张迪（１．西安医科大学法医系；西安７１００６１２．黑龙江省绥化地区中级人民法院；绥化１５２０００）ＲＥＬＡＴＩＯＮＳＨＩＰＢＥＴＷＥＥＮＴＲＡＵＭＡＡＮＤＬＵＮＧＩＮＦＥＣＴＩＯＮ：ＡＮＡＬＹＳＩＳＯＦ５ＣＡＳＥＳ￥...     

外伤与流产关系的法医学鉴定

外伤后流产的案例在法医鉴定工作中屡见不鲜,而外伤与流产之间的关系及外伤的参与度问题常常是案件争论的焦点。一方面流产受较多因素影响,尤其是早孕期发生率高,另一方面案情具有复杂性和待推定的特点如外力未直接作用于腹部,外伤轻微通常不至于引起流产、流产儿出现畸形,案情不确定或资料不完整等情况给外伤后流产鉴定带来一定难度。通过对证实已孕、外力作用方式作用机制、伤后症状体征出现的时间特点、孕妇自身流产史及病理基础、流产物病理检查相互佐证分析流产与外伤的关系,得出合理结论。     

Gas at postmortem computed tomography - An evaluation of 73 non-putrefied trauma and non-trauma cases

Postmortem computed tomography (PMCT) has become an important complement in investigating forensic cases allowing an accurate detection of gas accumulations. The present study investigated the presence and distribution of gas in a large number of non-putrefied cases of traumatic and non-traumatic deaths. Furthermore the possibility of pneumobilia secondary to blunt abdominal trauma was studied. Retrospectively, 73 cases, underwent a whole-body PMCT prior to autopsy. These were divided into four groups: penetrating trauma (20 gunshot cases, 13 stabbing cases), blunt abdominal trauma (20 cases) and a control group of 20 non-trauma cases. Exclusion criteria were visible signs of decomposition. Each group was screened for gas accumulations in the vascular system, internal organs, soft tissues and body cavities. Gas accumulations were present in 98% of the trauma cases, compared to 80% of the control group. The most affected structures and/or organs in the trauma group were soft tissues, vessels and the liver. In most cases of the trauma group gas was associated with open injuries and lacerations of vessels. Furthermore, in the gunshot group gas was frequently seen in the intracranial cavity. Pneumobilia occurred in one case of the blunt trauma group; in that control group gas was also seen, but less frequently. Gas accumulation showed a strong association with traumatic events, but even the majority of non-trauma cases showed gas accumulations. Despite the exclusion of cases with visible decomposition signs, a putrefactive origin of gas was assumed in some cases. Gas accumulations are a frequent finding in PMCT with a higher incidence in (open) trauma cases. Even though a differentiation between putrefactive and traumatic gas accumulations is still difficult, knowledge of the circumstance surrounding the case may help identify the origin of gas.     

10例青光眼法医临床学鉴定分析

目的探讨青光眼的形成机制、鉴别诊断、鉴定方法等相关问题。方法对10例青光眼的临床法医学鉴定例资料进行回顾性研究。结果10例青光眼中,5例为外伤性青光眼,1例可能为混合型,4例属病理性青光眼;鉴定时间在伤后3-12个月,其中轻微伤2例,轻伤6例,重伤2例。结论外伤性继发性青光眼的认定首先需有明确的眼部外伤史,其次是有能导致青光眼的损伤,而后监测眼压确诊青光眼;与病理性青光眼主要鉴别点为前房深浅、前房角、杯/盘比(C/D)、眼底血管改变等;损伤程度应在明确诊断及进行相关治疗后,主要依据视力及视野损害情况确定。     

外伤性脑梗死25例法医临床学分析

目的探讨外伤性脑梗死法医临床学鉴定的要点。方法对25例外伤性脑梗死的案例进行回顾性分析,包括一般情况、梗死部位、临床表现等。结果 25例被鉴定人中以儿童和老年人多见,并均有明确的颅脑外伤。脑梗死部位好发于大脑基底节-内囊区或额、颞、顶叶皮层区。结论外伤性脑梗死的损害后果与脑梗死发生部位具有直接关系,应引起法医临床学鉴定人的重视。     

Comparison between computed tomography (CT) and autopsy findings in cases of abdominal injury and disease

We report 10 autopsy cases involving fatal pathological changes in abdominal organs, for which findings of computed tomography (CT) on admission or after death were compared with autopsy findings. Two of the cases were death due to natural causes and eight were death due to traffic accidents. From the findings at autopsy, the causes of death were considered to be rupture of an aortic aneurysm in one case, gastrointestinal bleeding due to gastric cancer in one case, retroperitoneal bleeding in two cases, laceration of the liver in three cases, and traumatic rupture of the small intestine in three cases. CT findings revealed ascites or retroperitoneal bleeding in eight cases. However, in the cases of small-intestinal rupture, CT findings on admission revealed no free air. Therefore, ascites on CT should be regarded as a useful indicator of blunt abdominal trauma. Hepatic portal venous gas, known to be a post-mortem change, was significantly evident on post-mortem CT in cases of traumatic liver or intestinal injury, and was also seen in cases where the period between the accident and CT examination was long.     

The role of trauma in postmortem blood alcohol determination

In postmortem cases, a blood sample is frequently obtained by transthoracic (TT) puncture. The purpose of this study was to determine if, in traumatic death, blood samples collected by TT provided a valid sample for blood alcohol analysis. A retrospective study (1980–1986) was conducted to evaluate possible contamination of blood by GI alcohol in traumatic death cases. Out of 6000 cases reviewed, 19 cses with BACs >500 mg/dl were found and 8 of these cases involved traumatic death with GI laceration and/or transection. The results of this study support the hypothesis that blood samples from the 8 cases had been contaminated, resulting in a falsely elevated BAC. A transthoracic study (1987–1989) was conducted under controlled conditions, where blood alcohol content of TT blood samples was compared with samples collected from the intact heart chamber. Seven out of 28 cases of traumatic injury revealed trauma to the GI tract. The results showed that when GI traumatic injury occurs and unabsorbed ethanol is present in the stomach, contamination of TT blood samples occurs and artificially elevated BACs are obtained. It is recommended that, in cases of traumatic injury, heart blood samples from the intact heart chamber, as well as samples of additional biological fluids, be collected to rule out the possibility of contamination and to ensure that the BAC used for forensic interpretation is accurate.