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。     

心脏传导系统的研究进展

心传导系统（CardiacConductingSystem，简称CCS）是由窦房结（Sino－atrialnede．SAN）、房室结（Atri。entricularnede，AVN）、房室束（Hisbundle，BB）、左右束支（RightandLeftbun－dlebranches，RBBand．l，BB）及其末梢等部分构成。其功能是产生并传导冲动，维持心脏收缩的正常节律，使心房肌和心室肌的收缩互相协调“’。80多年来，对CCS基础研究及其临床应用已取得一定进展，但由于其检查方法工作量巨大，难以普遍使用，故应用CCS病理形态学的知识来解决死因问题的报道不多。作者通过复习文献，对CCS取材方法，及其…     

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。     

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。     

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。     

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…     

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。     

6例肥厚性心肌病猝死者心传导系统病变

1958年，DonaldTears首次描述了肥厚性心肌病（HypertrophicCardiomyopathy，HCM）。其后40年来，虽有许多有关HCM的临床、超声心动电图和病理学的研究屡见报道，但对其。已脏传导系统的研究尚少，我们遇到6例HCM摔死者，现对其尸检材料的研究报告如下。材料与方法6例选自近4年来法医破案P检材料。全部尸检在死后低温保存36小时内进行。尸体解剖检查除心脏外未见有其它病变。切取心脏在心室组织4块（左前壁、外侧壁、室间隔上1／3部和中部各1块）；窦房结（SAN）、房室结（AVN）、房室束（HB）和左右束支（LBB、RBB）共6块（SA…     

886例人心传导系统形态变异研究

探讨划分心传导系统 (CCS)变异与发育异常的界限。用本组建立的CCS检查法[1] ,连续切片 ,HE或Masson三色染色 ,光镜检查 ,对非心源性死亡组 (737例 )和心源性猝死组 (14 9例 )进行形态学及死因对比分析。结果显示 :(1)人CCS具有大小、位置和形态的先天性变异 ;(2 ) 4例心源性猝死者的房室结、房室束发育异常。房室束分叉部向室间隔膜部内移位、偏向于室间隔左侧、向左下侧移位 ,以及不足 1/2房室结移位至中心纤维体内、普通心肌移位至房室束或左束支内等应属变异 ;成年人胎儿型房室结及房室结全部移位至中心纤维体内或房室束完全分成 3束以上 ,房室束分叉部移位至三尖瓣根部应视为发育异常     

120例心性猝死心传导系统观察分析

心传导系统（CCS）在心性淬死者中的病理学意义存有争论。有的学者认为有一定意义[1，2]，有的学者持否定态度[3，4]。争论的焦点在于：（1）CCS具有生理性变化，难以判定病变标准；（2）形态学上CCS虽检见病变，但无心电图资料，是否具有临床意义及诊断价值。过去的CCS检查法烦琐，难以作较大量的案例分析。为此，笔者收集了120例经系统尸体解剖检查、部分做了毒物分析，并排除心外原因的摔死者的心脏标本，常规检查CCS以探讨其在心性碎死者中的法医学鉴定的意义。材料与方法材料来自1989年1月至1995年12月期间，广州地区的尸检案例…     

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。     

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.     

Sudden cardiac death in a young woman: tumor of the atrioventricular (AV) node or citalopram intoxication?

Atrioventricular (AV) node tumor is a very rare lesion of the cardiac conduction system. Clinically, it is associated with complete AV block and sudden cardiac death, often in apparently healthy young people.We report a case of a 24-year-old woman who developed ventricular fibrillation during sexual intercourse and died before admittance to the hospital. The woman had a medical history of depression and was treated with citalopram.At first, no macroscopic or microscopic pathologic changes were found. Toxicologic analysis showed a toxic level of citalopram in the blood. Further microscopic examination of the cardiac conduction system disclosed a tumor of the AV node. Immunohistochemical staining confirmed endodermal origin in accordance with the latest hypothesis of the pathogenesis of this tumor.It was concluded that this young woman died of cardiac arrhythmia due to the AV tumor and not from citalopram intoxication, as first suspected. This case emphasizes the importance of a microscopic examination of the cardiac conduction system in cases of sudden unexpected death, even in cases with a plausible cause and manner of death at first glance.     

32例无心外原因猝死者传导系统病理学观察

在对32例无心外原因猝死者传导系统(CCS)组织学观察中,发现31例 CCS 有异常和病变,其中11例可致猝死。这些病变包括有急性炎症、出血、脂肪浸润和结内外神经病变,且与猝死有关。     

178例心源性猝死法医组织病理学诊断分析

目的探讨心源性猝死(SCD)的病理特点与鉴别要点。方法对四川华西法医学鉴定中心2000—2005年尸检出的178例SCD死亡案例进行回顾性分析,主要对其病因、年龄、诱因及病理改变进行分析。结果本组资料显示冠心病、心传导系统病变、心肌炎、心肌病等在SCD中占有较大比例。冠心病猝死是中老年人SCD的最主要原因,青壮年人SCD的病因以非冠心病为主。如传导系统病变、心肌炎、心肌病。在儿童的SCD中先天性心脏病、传导系统病变及心肌炎占主导地位。结论不同的病因,其病理特点不同,其病理变化是法医学鉴定的主要依据。     

An Unexpected Finding in SUDEP Involving a Child: Focal Myocardial Infarct Adjacent to Bundle of His

Sudden unexpected death in epilepsy (SUDEP) is a nontraumatic, nondrowning death of an individual with epilepsy in which an autopsy with appropriate ancillary studies does not identify a cause of death. The mechanism of death in SUDEP is unknown, but is thought to involve cardiac and/or respiratory mechanisms. Research in SUDEP is hindered by a lack of consensus regarding required components of a death investigation before a cause of death may be certified as SUDEP. Histopathologic examination of the cardiac conduction system is not routinely performed in SUDEP death investigations. We present a case of SUDEP where histopathologic examination of the cardiac conduction system revealed a focal myocardial infarct of the summit of the ventricular septum abutting the bundle of His, which potentially provides insight into the mechanism of SUDEP for this particular case, and suggests that routine examination of the cardiac conduction system in SUDEP may be beneficial.     

Sudden death related to small coronary artery disease

Two cases of sudden death of young people in apparently good health are reported. The only pathologic change found was a fibromuscular dysplasia of the artery supplying the conduction system of the heart with an important narrowing of the lumen and strong thickening of the arterial wall. The first case was of a 12-year-old girl who died suddenly while skiing; the second was of a 32-year-old man who died while talking to his wife. No other pathologic changes were found at autopsy, and the results of toxicologic analysis were negative. There was no individual or family history of cardiac diseases. These cases illustrate the importance of an analysis of the conduction system, including examination of the intramural coronary arteries supplying the conduction system.     

Impact of Myocardial Infarction and Abnormalities of Cardiac Conduction System on Sudden Cardiac DeathCSCD

Sudden cardiac death (SCD), most commonly seen in coronary heart disease, is a kind of sudden death caused by series of cardiac parameters, which usually combines with myocardial infarction. However, some SCDs (including early myocardial infarction) happen suddenly and cause death in a very short time. In these circumstances, typical morphological changes are lack in macroscopic or microscopic fields, which make such SCDs become the emphasis and difficulty in the present research. SCD caused by myocardial infarction and abnormalities of cardiac conduction system (CCS) is related to atherosclerosis of coronary artery closely. This paper reviews cardiac dysfunction caused by myocardial infarction and diseases of CCS from morphology and molecular biology, and explores potential relationship between them. This paper aims to provide clues to the mechanism of myocardial infarction related sudden death and possible assistance for forensic diagnosis of SCD. © 2017 by the Editorial Department of Journal of Forensic Medicine.     

Morphological signs of impaired excitation conduction in the myocardium

The article describes morphological changes in cardiac muscular fibers and cardiomyocytes secondary to disorders in conduction of excitation in the myocardium. These changes may indicate cardiac arrest as a result of reflex impacts including cases of damage which is not lethal.