病毒性心肌炎对心脏传导系统的影响

病毒性心肌炎 (ｖｉｒａｌｍｙｏｃａｒｄｉｔｉｓ ,ＶＭＣ)是一种由病毒感染所致的以心肌炎症病变为主的疾病。致病病毒有很多种 ,其中以肠道病毒 ,包括柯萨奇Ａ及Ｂ组病毒 ,埃柯病毒 ,脊髓灰质炎病毒等为常见 ,尤其以柯萨奇Ｂ组病毒最为多见。ＶＭＣ近年来在国内发病率趋于增高 ,以儿童及青壮年发病为多。由于病毒感染的隐匿性 ,及病原体的多样性使其病症表现出非典型性及多样性 ,但心脏传导系统受损引起的心律失常仍为其主要的临床表现之一。严重的心律失常可引起猝死。有研究［１］表明心肌炎是猝死的主要原因之一 ,而心肌炎绝大部分是…     

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。     

10例死因不明者心脏传导系统观察

心脏传导系统(CCS)疾病可引起猝死已得到公认,但其各种病变的具体意义尚需更多的资料积累。本文观察了10例经过常规检查,未发现明确死因者的CCS,现将其CCS的病理学改变报道如下:1材料与方法2000年~2004年间沈阳市公安局受理的10例尸检,均经过系统的尸体解剖、病理组织学和毒物分析学检查,排除了暴力、中毒和常见疾病致死。按宋一璇、姚青松[1]介绍的方法检查CCS,常规脱水、石蜡包埋,连续切片,间断取片。每例取25~35片,HE染色,少数经Masson三色染色,光镜检查。表1一般资料及心脏常规检查结果编号性别年龄职业心重(g)冠脉狭窄心脏病变死…     

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。     

26例心脏传导系统发育异常猝死的病理学分析

目的研究心脏传导系统发育异常致猝死的病理变化。方法排除外伤、中毒及疾病所致死亡,收集26例不明原因猝死者心脏,采用作者创建的心脏传导系统取材法,常规切片、HE染色和Masson三色染色,光镜观察。结果 26例中见心传导系统有发育不全、结构异常、细胞或组织结构移位和窦房结纤维垫等病变,9例同时具有2~3种类型。16~30岁共21例,占全部样本的80.8%。结论心脏传导系统发育异常可能是不明原因青壮年猝死的重要原因之一。     

结核播散累及心脏传导系统致死1例

结核虽是一种常见病,但心肌结核很少见,且结核累及心脏传导系统更是罕见。作者通过尸检发现1例结核播散累及心脏传导系统致死,并结合复习相关文献,对心肌结核的发病机制、死亡机制和法医学鉴定要点进行分析,供同仁参考。     

电击死心脏病理学研究

本文对三例因电击死亡尸体的心脏（包括传导系统）的病理改变进行了研究。研究中使用了三例非电击死尸体的心脏进行对照，并采用了多种染色方法以增加诊断的可靠性和消除假阳性。结果显示，两例２２０伏电压电击死的心脏除发现血管壁及其中的血细胞有改变外，心肌及传导系统未见文献所述的坏死性改变。而这种坏死改变在另一例因７５伏交流电电击死的心脏中却表现得相当明显。笔者分析了其中的原因，同时认为在进行类似的研究时，采用对照组和多种染色力“法是十分必要的。     

人额部硬脑膜生物力学参数的增龄性变化研究

目的 探讨不同性别人尸体额部硬脑膜的生物力学特性增龄性变化规律,为不同年龄、不同性别头颅有限元模型硬脑膜参数赋值及拉伸失效阈值确定提供参考依据.方法 284例成人硬脑膜按照年龄分为0～10岁组、11～20岁组、21～30岁组、31～40岁组、41～50岁组、51～60岁组、61～70岁组和>70岁组,每例硬脑膜统一于左...     

大鼠颅骨材料力学和骨质参数的增龄性变化

目的 通过检测大鼠颅骨材料力学和骨质参数,探讨二者关系及其与年龄的相关性.方法 48只健康雄性SD大鼠按年龄分为2、4、6、8、17、26、52和104周龄组,每组6只.利用KDⅡ-0.2型微机控制电子万能试验机压缩右侧颅盖骨检测其材料力学参数(极限载荷、压缩强度、压缩模量),之后分离颅骨骨片进行Micro-CT系统扫...     

心脏传导系统的一种新型染色法

本文建立了一种研究心脏传导系统和心血管形态学的特殊染色技术（改良的Ｍａｓｓｏｎ’ｓ三色法十Ｖｅｒｈｏｅｆｆ’ｓ弹力染色法），能在同一玻片上将起搏细胞、工作心肌、胶原纤维及弹力纤维区分开来，且操作简捷，色彩对比鲜明。     

Diagnostic value of post-mortem examination of the cardiac conduction system

Introduction (Aim)

Sudden unexplained death (SUD) is a common problem in forensic pathology. In many of these cases, the autopsy findings, toxicological examinations and patient history are inconclusive. Many studies suggest that in such cases, the cardiac conduction system (CCS) should be histologically examined. We decided to determine the diagnostic value of histological examination of the CCS.

Methods

We reviewed autopsy files from the period 2005–2007 and selected those cases in which the CCS had been sampled. These were divided into two groups, the first comprising cases with an obvious cardiac pathology (e.g. severe coronary disease, myocardial infarction, significant myocardial hypertrophy/dilatation, valvular disease, etc.) and the second comprising cases without obvious cardiac pathology (i.e. fatal injuries, intoxications and deaths unexplainable by routine procedures). The CCS was sampled according to a detailed protocol and examined under a light microscope. On the basis of the findings of histological examination of CCS, we formed subgroups of the aforementioned main groups.

Results

We analyzed 118 cases, of which 83 were males and 35 females. In 57% of cases, autopsy revealed gross pathological abnormalities of the heart. In 10 (15%) of them, examination of the CCS showed significant pathological changes (narrowing of the nodal artery and its branches, moderate to severe interstitial fibrosis, calcifications in the central fibrous body impinging upon CCS). In some, especially those with no acute findings, CCS disease can be considered to have been the cause of fatal arrhythmias. In 43% of cases, autopsy revealed no gross abnormalities of the heart, while histological examination of the CCS disclosed significant pathological changes in 4 (8%). Among them, CCS disease was regarded as the cause of death in one case and as a possible cause in another case.

Conclusion

As with other similar studies, our study showed that examination of the CCS can provide valuable information on the cause of death. We therefore consider that examination of the CCS should be performed in all SUD cases, especially those in which the cause of death cannot be established by routine procedures. Although we had only 1 confirmed cause of death linked to CCS disease and one possible, we had 14 cases with significant pathological CCS changes. This leads us to the conclusion that post-mortem examination of the CCS is of diagnostic value.     

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。     

肢体挤压伤大鼠早期心电图及血清cTnI的变化

目的观察挤压伤大鼠早期心电图的改变,并检测血清心肌肌钙蛋白I(cTnI)的变化。方法复制挤压伤大鼠动物模型,标准Ⅱ导联记录心电图变化,化学发光法检测血清cTnI水平。结果挤压伤后心电图ST段明显抬高,并持续24h,伤后6h血清cTnI则显著升高,并持续24h以上。结论肢体挤压伤早期存在心肌细胞的损伤。     

急性心肌梗死心传导系统的免疫组化实验观察

观察急性心肌梗死时心传导系统的形态学改变。取急性心肌梗死死亡者的心传导系统标本6例,运用抗纤维连接蛋白抗体、肌红蛋白抗体、血管内皮生长因子抗体进行免疫组化染色。结果发现,纤维连接蛋白染色有3例呈现强阳性,2例出现阳性,1例出现弱阳性;血管内皮生长因子染色均呈弱阳性;肌红蛋白染色呈脱失改变。提示纤维连接蛋白检测量敏感性强,稳定性好,易于观察,可作为在心肌梗死时了解心传导系统受损害的指标之一。     

心脏传导系统取材方法多媒体计算机辅助教学的应用研究

本研究综合应用多媒体计算机,ＷＩＮＤＯＷＳ３．１视窗下多媒体创作工具等技术,结合法医学实际,根据心传导系统取材方法的研究成果,研制适用于法医学的心传导系统取材方法计算机辅助教学系统,探索新的教学手段和技术方法。并经实际使用得到较满意的效果,满足了法医学工作的需要。本文还就提高法医学计算机应用水平的问题进行讨论。     

Sudden death resulting from lesions of the cardiac conduction system

Sudden unexpected deaths in young persons with noncontributory histories, autopsy results, and drug screen results are a common problem in forensic pathology. As part of the evaluation of such cases, the cardiac conduction system (CCS) should be studied. To determine the type and incidence of lethal CCS lesions, the authors reviewed their files of sudden unexpected cardiac deaths with particular attention to cases with causes of death in the conduction system. Cases of sudden cardiac death in patients aged < or=40 years during a 10-year period (Michigan) and a 4 year-period (Spain) were selected from the files. From this group, cases were identified in which the cause of death was a lethal change in the CCS. The portions of the heart containing the CCS were excised, and at least one hematoxylin and eosin slide and at least one trichrome or elastic trichrome slide per block were studied. In the two centers, 381 cases of sudden cardiac death were identified. The most common causes of sudden cardiac death were arteriosclerotic narrowing of the coronary arteries, cardiomyopathy, and myocarditis. In 82 cases, there was no identifiable cause of death even after complete gross and microscopic autopsy was performed, a medical history was obtained, and a drug screen was performed. In 11 cases, the CCS contained lesions that were considered lethal: narrowing of the atrioventricular node artery by fibromuscular hyperplasia (7 cases) and atrioventricular node tumors (4 cases). The 11 cases accounted for 2.9% of the 381 cases of sudden cardiac death and 11.8% of the indeterminable cases. It was concluded that examination of the CCS in deaths in which the gross and microscopic autopsy, history, and drug screen fail to provide a cause of death can yield a cause of death in a significant percentage of cases. If heart block was not documented during life and no explanatory lesions were found during routine cardiac examination, examination of the CCS can yield valuable information.     

窦房结间质增生与年龄及右冠状动脉病变程度的关系

目的研究年龄及右冠状动脉粥样硬化病变程度对窦房结间质增生的影响。方法选择右冠状动脉有粥样硬化病变的心脏标本,登记年龄,复查并登记右冠状动脉病变,窦房结取材,常规制片,HE染色及Massom三色染色,用图像分析系统分析窦房结间质增生程度及右冠状动脉粥样硬化斑块病变的阻塞程度。结果右冠状动脉粥样硬化病变程度及年龄对窦房结间质增生的影响都有统计学意义(P0.001);右冠状动脉粥样硬化病变程度对窦房结间质增生的影响强度约为年龄的2.16倍。结论年龄及右冠状动脉粥样硬化病变程度均与窦房结间质增生有线性关系,右冠状动脉粥样硬化病变程度导致窦房结间质增生较年龄因素更为明显。     

Examination of the cardiac conduction system: forensic application in cases of sudden cardiac death

Forensic pathologists may occasionally encounter cases of apparent sudden cardiac death without gross cardiac abnormality. In some of these cases, evaluation of the cardiac conduction system may reveal pathologic lesions which may act as the substrates for ventricular tachyarrhythmias and sudden death. Sample case studies are used to illustrate the suggested criteria and techniques for examination, and commonly-encountered pathologic lesions and normal variants are discussed.