死后尸体CT在法医学鉴定中的应用价值初探

目的 对不同类型案件中的死者进行死后尸体CT扫描和常规尸体解剖,探索PMCT在法医学鉴定中的应用价值.方法 对7例因不同原因死亡的个体进行全身PMCT扫描,随后进行系统的尸体解剖,通过比较两种方法检测的结果,分析PMCT与传统尸体解剖在不同类型案件中应用的优点和不足.结果 在7个案例中,尸体上总共检出67处阳性发现.其...     

Distribution of digoxin, digitoxin and their cardioactive metabolites in human heart and kidney tissue. A postmortem study

A method was developed for the specific determination of digoxin and digitoxin, as well as their semisynthetic derivatives and dependent cardioactive metabolites, in autopsy samples of heart and kidney. A collective of six patients on long-term treatment with therapeutic doses of beta-acetyldigoxin had a mean myocardial digoxin content of 46.1 +/- 25.0 ng/g (SD); kidney: 50.3 +/- 30.3 ng/g. Digoxigenin bisdigitoxoside represented the second most important metabolite in heart and kidney; digoxigenin monodigitoxoside and digoxigenin follow, respectively. In a collective of seven patients on maintenance treatment with digitoxin, the mean tissue levels were higher but the metabolic pattern was similar (myocardial digitoxin content: 78.9 +/- 38.4 ng/g, renal content: 104.1 +/- 44.1 ng/g). The amount of digoxin formed by hydroxylation under long-term treatment with digitoxin in heart and kidney were approximately 10 ng/g. A case of digoxin intoxication differed both in the tissue content and in the metabolic distribution.     

大鼠死后心肌细胞DNA含量与死亡时间关系的进一步研究

目的研究机体的细胞核内DNA含量与死亡时间的关系。方法本实验通过计算机图像系统,选择核面积、积分光密度等7种参数,研究了15只大鼠心肌细胞在死后25～49h细胞核DNA含量的变化规律。结果心肌细胞DNA含量测定适合相对较长死亡时间的推断。结论应用计算机图像分析技术测量机体死后心肌细胞DNA含量将有可能成为推断死亡时间精确、客观的新方法。     

大鼠脾细胞DNA含量与早期死亡时间关系的图像分析研究

选择15只大鼠 ,处死后 ,在24h内每隔1h进行脾细胞学涂片、福尔马林液固定、Feulgen染色后 ,用自动图像分析仪测量细胞DNA的积分光密度、平均光密度、异形指数等指标 ,并对数据进行统计学处理。实验结果证明大鼠脾细胞DNA含量在死后24h内 ,随死亡时间的延长而呈较有规律的下降。其中积分光密度、平均光密度、异形指数是用来研究死亡24h内脾DNA降解规律 ,并准确推断死亡时间的较好指标     

新西兰白兔死亡后颅脑CT检查与死亡时间关系的研究

目的采用CT扫描动态观察新西兰白兔死亡后脑组织变化,建立利用CT值、脑组织/颅腔面积比,推断死亡时间(PM I)的研究方法。方法通过耳缘静脉注射空气,建立新西兰白兔死亡模型;于死亡后0~120h,运用CT进行头颅平描;选取颅顶面层测定脑组织CT值、脑组织/颅腔面积比。结果死亡后兔脑组织CT值呈双峰样上升、脑组织/颅腔面积比呈不断下降趋势;建立与死亡时间的回归方程:CT值=47.4780-0.1768T+0.0049T2(T/h,CT值/HU)、面积比=99.7368+0.3098T-0.0118T2/100(T/h)。结论CT扫描检查可准确显示兔脑的死后变化;脑组织消失之前,综合运用CT检查指标可用于准确推断死亡时间。     

蛋白质降解与死亡时间推断的初步研究

目的观察大鼠肝脏肌动蛋白、微管蛋白在死后不同时间的降解情况,为死亡时间的推断寻找客观依据。方法大鼠麻醉致死后置于21℃温度控制系统模拟死后18d的改变,在不同时间点剪取肝脏组织抽提蛋白质,利用westernblot技术检测肌动蛋白、微管蛋白的降解变化并对产物进行半定量分析。结果大鼠肝脏肌动蛋白在死后8d尚可检测,死亡10d后检测不到;在死后2d,α微管蛋白已检测不到,但可检测到β微管蛋白,死亡4d后,β微管蛋白也检测不到。结论肌动蛋白、微管蛋白的死后降解存在差异,其在肝脏组织保存时间的不同可作为死亡时间推断的参数。     

Fatal combined intoxication with new antidepressants. Human cases and an experimental study of postmortem moclobemide redistribution.

Three cases are presented in which death was caused by suicidal intoxication with moclobemide in combination with a selective serotonin reuptake inhibitor. Both antidepressant drug types are considered to be relatively safe with regard to lethal overdose. However, the combination may cause the serotonin syndrome, a condition with a high mortality rate. In one of the cases, there was clinical information consistent with the serotonin syndrome, in the two other cases, there was no information of the clinical course. Postmortem redistribution of the selective monoamine oxidase inhibitor moclobemide was investigated in a rat model. Postmortem concentrations in blood from the vena cava and the heart were found to be in good accordance with antemortem concentrations. Postmortem concentrations in vitreous humour and various tissues were also measured. The apparent volume of distribution was calculated to be 0.95 +/- 0.10 l/kg, which is in the same range as that reported in man.     

TUNEL法检测大鼠死后心肌细胞核DNA断裂与死亡时间关系研究

目的用原位脱氧糖核苷酸末端转移酶介导的缺口末端标记法(TUNEL)观察大鼠死后心肌细胞DNA断裂与死亡时间(postmortem interval,PMI)的关系。方法建立SD大鼠死亡模型,在25.1℃,分别于死后6、12、24、36、48、60h提取大鼠心肌组织进行TUNEL检测,显微成像系统采集图像,经计算机图像系统分析及统计学处理。结果死后6~60h,心肌细胞核荧光染色依次由绿色、黄绿色亮度增强、亮黄色到荧光亮度减弱;形态由扁圆形或柱状,大小较均匀,到体积增大、呈毛虫状、多数核碎裂到形态不规整,大部分核形成碎片;心肌组织细胞核的IG,死后6h至36h依次增高,36h达到高峰,随后下降;心肌细胞核DNA的AG死后24h最高。结论死后各时间点,心肌细胞核的荧光颜色和亮度以及细胞核的大小和形态有一定的变化规律。     

Forensic entomology exemplified by a homicide. A combined stain and postmortem time analysis]

The combined analysis of both ant and blow fly evidence recovered from a corpse, and from the boot of a suspect, suggested that an assumed scenario in a high profile murder case was likely to be true. The ants (Lasius fuliginous) were used as classical crime scene stains that linked the suspect to the scene. Blow fly maggots (Calliphora spec.) helped to determine the post mortem interval (PMI) with the calculated PMI overlapping with the assumed time of the killing. In the trial, the results of the medico-legal analysis of the insects was understood to be crucial scientific evidence, and the suspect was sentenced to 8 years in prison.     

小鼠心肌细胞核DNA变化与死亡时间的关系

目的监测小鼠死后细胞核DNA降解的情况,探讨死后细胞核DNA降解的一般规律。方法应用单细胞凝胶电泳(SCGE)技术结合荧光显微镜和专业的计算机图像分析技术,测定111只小鼠在死后72h内不同时间点小鼠心肌组织细胞头半径、尾长度、头DNA含量比例、尾DNA含量比例、尾矩、Olive矩、头面积、尾面积八项参数的变化值。结果在个体死亡72h内,测定的八项参数指标均显示细胞核DNA降解速率和程度与死亡时间具有高度的相关性,并获得了更能体现DNA降解趋势的二项式回归方程和多元回归方程,均具有高度的统计学意义。结论应用72h内心肌组织DNA变化与死亡时间之间呈线性关系的各组回归方程,可为法医学推断死后经过时间提供一种新的、客观的、精确的方法和参考依据。     

Virtopsy,a new imaging horizon in forensic pathology: virtual autopsy by postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)--a feasibility study

Using postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI), 40 forensic cases were examined and findings were verified by subsequent autopsy. Results were classified as follows: (I) cause of death, (II) relevant traumatological and pathological findings, (III) vital reactions, (IV) reconstruction of injuries, (V) visualization. In these 40 forensic cases, 47 partly combined causes of death were diagnosed at autopsy, 26 (55%) causes of death were found independently using only radiological image data. Radiology was superior to autopsy in revealing certain cases of cranial, skeletal, or tissue trauma. Some forensic vital reactions were diagnosed equally well or better using MSCT/MRI. Radiological imaging techniques are particularly beneficial for reconstruction and visualization of forensic cases, including the opportunity to use the data for expert witness reports, teaching, quality control, and telemedical consultation. These preliminary results, based on the concept of "virtopsy," are promising enough to introduce and evaluate these radiological techniques in forensic medicine.     

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.     

牙髓细胞DNA含量与死后经过时间的相关性

目的探讨死后不同环境温度下离体牙的牙髓细胞平均DNA含量变化与死后时间(PM I)的相关性。方法采用细胞图像分析系统(PIPS-2020),测定离体即刻至15d牙齿在低温环境(10~15℃)和高温(30~35℃)环境下牙髓细胞DNA含量变化值,并对其数据进行统计学分析。结果在不同的环境温度下,牙髓细胞DNA降解的速度有所不同,温度的升高有加速牙髓细胞DNA降解的趋势,且DNA降解存在一个平台期。低温组牙髓细胞平均DNA含量与PM I之间的相关系数r=0.953,相关指数R2=0.917;高温组的相关系数r=0.991,相关指数R2=0.971。结论牙髓细胞平均DNA含量与PM I之间具有高度相关性,测定牙髓细胞的DNA变化情况对推断3d(高温环境)或6d(低温环境)后的PM I有参考价值。     

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.     

A comparison of carboxyhemoglobin saturation values in postmortem heart blood and peripheral blood specimens

The following is a study conducted to determine whether there was any significant difference in carboxyhemoglobin (COHb) saturation levels between the heart blood and blood collected from a peripheral site. The average heart blood to peripheral blood COHb saturation level ratio in the 42 cases studied was 1.09. Sixty-two percent (26 of 42) of the cases had a heart blood to peripheral blood ratio between 0.9 and 1.1; 74% (31 of 42) had a ratio between 0.8 and 1.2. Eighty-three percent (35 of 42) had a ratio between 0.7 and 1.3. There were four cases where the heart blood to peripheral blood ratio was either below 0.6 or greater than 1.4. The differences between the two sites were not statistically significant.     

小鼠骨骼肌细胞核DNA降解与死亡时间的关系

目的　监测小鼠死后骨骼肌核内DNA降解的情况 ,探讨死后细胞核DNA降解的一般规律。方法　建立小鼠死亡模型 ,在死后 72h内 ,以 12h的间隔取骨骼肌样本进行单细胞凝胶电泳 ,在荧光显微镜下测量彗星图像 ,并作统计学分析。结果　机体死后 ,骨骼肌细胞在电泳图像上出现了明显的彗星形拖尾 ,L/W比值随死亡时间而逐渐增大 ,二者呈一定的线性关系。结论　单细胞凝胶电泳技术可以应用于早期死亡时间推断。     

家兔角膜上皮和内皮细胞DNA含量与PMI关系的图像分析

目的 探讨家兔角膜上皮和内皮细胞DNA含量与PMI的关系。方法 应用计算机图像分析技术,测定105只家兔死后72h内不同时间点家兔角膜上皮和内皮细胞核DNA含量(IOD)的变化值并做统计学分析。结果 家兔死后72h内其角膜上皮细胞和内皮细胞核DNA降解速率与PMI具有显著的相关性,并由此归纳出体现DNA降解趋势的二项式回归方程。结论 应用计算机图像分析技术,测量机体死后角膜内外皮细胞DNA含量变化,将会成为推断PMI精确、客观的新方法。     

Neoplastic disease in a medicolegal autopsy material. A retrospective study in northern Sweden

Only a small fraction of sudden unexpected deaths are caused by neoplastic disease and thus subject ot medicolegal autopsy. The medicolegal autopsy forms an opportunity to study not only medically diagnosed and treated neoplasms, but also the natural evolution of untreated disease. In a series of 7,020 consecutive medicolegal autopsies in northern Sweden, we found 171 cases with malignant and/or intracranial neoplasms. In 41 cases, sudden death was caused by previously unknown tumors. The most common mechanisms of death in this group were disseminated cancer, intracranial tumors, pulmonary thromboembolism, hemoptysis, and aspiration of blood, and the most common locations were the bronchi and the lung. In some of these cases, the mechanism was sometimes dramatic, raising a question of violent death or intoxication. In 30 cases, sudden unexpected death was caused by previously known tumors, and also in this group disseminated cancer was the most common cause of death, and the most common locations were the bronchi and the lung. In 22 cases, tumors were found suicidal cases; in 14 of these, the tumor was considered to be a major causative factor to the suicide, while in eight cases the tumor was considered to be an incidental finding. The expected number of cancers in the 1,060 suicides investigated in this series was 27, according to the official cancer prevalence data. Thus, a possible over-representation of suicides among persons with cancer seems doubtful and needs further exploration.     

人体死后肝细胞DNA含量与死亡时间关系的研究

目的研究人体死后肝脏细胞DNA含量变化与死亡时间的关系及影响因素。方法选取46例已知死亡时间的人体肝脏,根据离体肝脏所处的环境温度分为12—19％（A组）和20—27％（B组）两组,每组23例。在死后24～72h内每隔4h穿刺取肝组织1次,制成细胞悬液,经RNA酶消化,PI染色后,用流式细胞仪测定被检测细胞中含不完整DNA的细胞数所占百分比,所得数据经Exp032V1．2软件计算N值。结果死后24～72h肝细胞N平均值,A组从10．91％增至49．72％,B组从16．22％增至69．63％。两组N平均值随死亡时间的延长均逐渐增高,与死亡时间有相关性,A组r值为：0．598,B组r值为0．77357。并且建立了不同环境温度对应的回归方程。结论在不同环境温度下,死后24～72h内人体肝脏细胞DNA降解均随死亡时间的延长和环境温度的升高而逐渐加快,相关数据可望为死亡时间推断提供一定参考依据。