急性安妥中毒尸检1例

安妥 (Ａｎｔｕ)属硫脲类杀鼠剂 ,其分子式为Ｃ11Ｈ10 Ｎ2 Ｓ ,化学名α -萘硫脲或甲萘硫脲 (α -Ｎａｐｈｔｈｙｌ -ｔｈｉｏｕｒｅａ) ,1942年由ＣｕｒｔＰ .Ｒｉｃｈｔｅｒｔ合成本品 ,1945年用于防治褐家鼠。 1973年ＷＨＯ专家委员会主张禁用安妥 ,国内尚未见安妥中毒的尸检报道。同济医科大学法医病理学教研室曾检验一例如下 :某男 ,2 2岁 ,自服大量安妥后出现呕吐 ,呕吐大量黄色胃内容物。次日上午 10时被发现后送医院急救 ,患者烦躁不安、检查不合作、口唇及鼻腔周围有黄色血性物 ,颈软、瞳孔对光反射存在。肺呼吸音增强、心音快。病…     

Sellar fracture followed by sudden death: an autopsy case

The authors describe a case of sellar fracture followed by sudden death. The victim was involved in a wrangle. The autopsy revealed facial damage and sellar fracture and no evidence of cerebral damage, except for a mild subarachnoid hemorrhage in the left parietotemporal regions and undersurface of both frontal lobes. Sellar fracture is a rare and severe entity, associated with serious complications, which is frequently diagnosed postmortem. In any case, death is rarely a direct consequence of the sellar fracture itself and is usually considered to be the result of associated cerebral trauma. This case prompted us to screen the literature on sellar fracture to gain a better understanding of the mechanism of death.     

急性安妥中毒尸检1例

安妥(Antu)属硫脲类杀鼠剂,其分子式为C11H10N2S,化学名α-萘硫脲或甲萘硫脲(α-Naphthyl-thiourea),1942年由Curt P.Richtert合成本品,1945年用于防治褐家鼠.1973年WHO专家委员会主张禁用安妥,国内尚未见安妥中毒的尸检报道.同济医科大学法医病理学教研室曾检验一例如下: 某男,22岁,自服大量安妥后出现呕吐,呕吐大量黄色胃内容物.次日上午10时被发现后送医院急救,患者烦躁不安、检查不合作、口唇及鼻腔周围有黄色血性物,颈软、瞳孔对光反射存在.肺呼吸音增强、心音快.病理反射阴性.裤上有大便.入院2小时后患者烦躁、神志不清,面色苍白、口唇紫绀、大小便失禁、吐黄色血性物,血压140/90mmHg,心律齐,呼吸急促,未闻及干湿性罗音.经洗胃、给氧、对症及抗感染等治疗,7.5小时后患者满肺湿性罗音,两眼瞳孔对光反射消失.12小时后血压降至90/70mmHg,约12.5小时血压已量不出,呈潮式呼吸,脉搏细弱,心跳弱而速,最终因呼吸心跳停止而死亡. 尸检见死者瞳孔直径0.5cm,口唇青紫,气管及支气管内多量白色泡沫状液体,两肺共重1450克,饱满,胸膜下少数点状出血,肺切面有多量泡沫状液体流出,轻度灶性肺气肿,镜下肺重度淤血水肿、部分肺泡腔内出血明显,有大量的肺透明膜形成(图1、图2),合并急性支气管肺炎.灶性肺气肿.胃内有约450克酱褐色液体,混有灰黑色粉末状物质及食物残渣,无特殊臭味,胃粘膜轻度充血,无明显腐蚀出血.十二指肠粘膜充血.脑淤血水肿.肝、肾水肿.心肌横纹尚清晰,心肌间质较增宽.肠壁粘膜下层水肿显著.膀胱内充满尿液,位于耻骨联合上12cm.胰无明显病变.病理诊断:肺重度淤血水肿、急性支气管肺炎;肝、肾、肠壁水肿;脑淤血水肿;膀胱内尿潴留.胃及胃内容物检出安妥成分.鉴定认为死者系口服安妥引起急性中毒,因重症肺水肿并发急性支气管肺炎而死亡. 讨论(1,2):安妥是中性化合物,市售商品为蓝灰色粉末,纯品为白色结晶,无臭,味苦,不溶于水,难溶于乙醇及醚,易溶于碱及有机溶剂(特别是丙酮),其溶液具有蓝色荧光.特别对家鼠有明显的选择性高效毒杀作用.对人毒性较低,故中毒案例极少,作为投毒他杀者罕见.安妥可经胃肠道、呼吸道吸收,吸收后主要分布在肺、肝、肾和神经系统,大部分由肾排出.安妥除对胃肠道粘膜有刺激作用外,主要由于损害毛细血管,促进毛细血管扩张和渗透性增加,引起肺水肿、胸膜炎、胸腔积液及肺出血,最终因呼吸困难、窒息而死亡;也可引起肝、肾脂肪变性及坏死.本例即因重度肺水肿而死亡.Round等1985年报道,用安妥腹腔内注射引起大鼠急性肺损伤,肺血管的反应性随急性安妥损伤增加而增强.反复安妥损伤可引起不可逆性肺动脉高压,从而导致右心室肥厚.也可引起肝肾变性坏死;此外它破坏胰腺β细胞,影响糖代谢,引起糖尿.安妥中毒致死的动物,常见重度肺水肿和多量胸水形成.狗或鼠还可有血糖显著升高,肝糖原含量降低,也可表现体温降低及血液浓缩等现象.因安妥对人中毒致死的报告不多,故其致死量各家意见不一,有报告成人口服致死量为4～10克,敏感者0.5克也可致死.小儿对安妥较第三较易引起中毒.大白鼠一次口服急性中毒LD50为6.25mg/kg,小白鼠为35mg/kg.     

Pericardial lipoma: an autopsy case and review of the literature

Postmortem examination performed on a 70-year-old man revealed a thinly encapsulated, ovoid, large mass in the right hemithorax. The tumor was attached with its pedicle to the atrioventral pericardium and adjoined the diaphragm with compression of the right lower lobe of the lung. There was no adhesion between the tumor and the surrounding organs. Light microscopy showed a lipoma consisting of mature adipose tissue, and no malignancy was found.     

Sudden death due to congenital pericardial defect: an autopsy case

Pericardial defects are rare in childhood and outcome is usually benign. Patients may be asymptomatic, but chest pain, emboli, arrhythmia, and sudden death have been described in the literature. We report the case of a 12-year-old boy who suddenly died after mild exercise. A left-sided pericardial defect with a diameter of 8 cm was detected on medico-legal autopsy.     

An uncommon delayed sequela after pressure on the neck: an autopsy case report

Delayed sequelae after pressure on the neck are rare. Awareness of such sequelae as well as a high degree of suspicion is essential for early detection and proper clinical management. Injuries to the common carotid artery and pseudo aneurysm formation leading to fatal hemorrhage are still rare occurrences after attempts of manual strangulation. When such cases are presented to the forensic pathologist, he has to establish the link between the cause and effect, excluding other possible causes for such complications. In addition, he may have to give opinions in possible medical negligence charges.     

Hemopericardium following cerebral hemorrhage. Report of an autopsy case.

The simultaneous occurrence of cerebral hemorrhage and hemopericardium due to the rupture of a dissecting aneurysm has not been previously reported. We describe an autopsy case of a 45-year-old man with hypertension who died suddenly following both of these conditions. He had been treated for hypertension; the finding of arteriolar nephrosclerosis supported the existence of the disease. Because rupture of the aorta invariably causes a marked fall in blood pressure, the occurrence of cerebral hemorrhage following hemopericardium is highly unlikely. Thus, we presume that rupture of the aorta occurred after the cerebral hemorrhage.     

An autopsy case of malignant hyperthermia

A report is made of a 44-year-old female who died of malignant hyperthermia during general anesthesia for an operation of left subtrochanteric femoral fracture. Symptoms began with increases in heart rate and blood pressure after the introduction of anesthesia with halothane and were accelerated by the administration of succinylcholine, followed by muscle rigidity and high temperature. The typical wine red urine was observed. The oral temperature of 42 degrees C was recorded within 1 h after succinylcholine. The rectal temperature was 30 degrees C 22 h after death. Severe pulmonary edema and tubular necrosis of the kidney were found by postmortem examination. No latent myopathy was observed. The creatine phosphokinase levels in plasma obtained after the onset of malignant hyperthermia and at the time of autopsy were abnormally high and were 5632 and 34,854 mU/ml, respectively. Plasma myoglobin levels were 130,000 and 2.8 X 10(6) ng/ml, respectively.     

特殊火场尸体检验体会1例

在法医命案现场勘验中,火场尸体案件并不鲜见。犯罪嫌疑人为了达到毁灭罪证、逃避打击的目的,可能会选择纵火焚烧现场,处于现场中的人体亦     

特殊火场尸体检验体会1例

在法医命案现场勘验中,火场尸体案件并不鲜见。犯罪嫌疑人为了达到毁灭罪证、逃避打击的目的，可能会选择纵火焚烧现场。处于现场中的人体亦常常被烧毁。典型的焚尸命案相对容易甄别,而一些比较特殊的案例，检验和甄别的难度较大,尸检过程中容易出现疏漏或者误判。本文就实际检案工作中遇到的一起案例进行报告。     

Amount of postmortem bleeding: an experimental autopsy study

An experimental autopsy study was performed on 64 cases (55 male, 9 female; average age 51.5 +/- 16.2 years) of sudden natural (38 cases) and asphyxic deaths (26 cases). The study objective was the amount of postmortem bleeding from postmortem cutting of the thoracic aorta, related to the time since death. The amount of postmortem bleeding ranged from 100 to 1300 cm, 440.6 +/- 268.1 cm on average. The time since death up to the autopsy time ranged from 4 to 72 hours, 19.4 +/- 12.9 in average. A statistically significant correlation between the amount of postmortem bleeding and postmortem time interval was stated: Pearson correlation test value r = -0.461 (P = 0.000): the shorter the time interval, the larger the amount of bleeding. The formula of linear regression was estimated according to this correlation: amount of postmortem bleeding (cm) = -9.571 x time since death (h) + 626.659. This proves that the amount of postmortem bleeding (eg, from aortic blunt rupture) could be about 620 cm.     

Rupture of a giant splenic artery aneurysm. Report of an autopsy case.

We describe an autopsy case of a 61-year-old woman with von Recklinghausen's disease, who died suddenly following intraperitoneal hemorrhage due to the rupture of a giant splenic artery aneurysm. The aneurysm measured 16 x 13 x 5.5 cm--much larger than those in most previous reports. The pancreatic body, which was pressed by the aneurysm, was widely atrophic. In general, splenic artery aneurysms are more frequent in pregnant women or patients with portal hypertension. The pathogenesis of this aneurysm is presumed to be arterial dysplasia, focal arterial inflammation, or portal hypertension, unlike other aneurysms due to arteriosclerosis or syphilis. Since the patient had not been pregnant and had not had liver cirrhosis or arteriosclerosis, the pathogenic factor could not be determined in this case. The relationship between the genesis of the aneurysm and von Recklinghausen's disease was not clear either.     

Virtual autopsy and forensic identification-practical application: a report of one case

The body of an unidentified elderly woman was found trapped in a floodgate. Prior to autopsy, full-body multislice computed tomography (MSCT) was performed for study of bone lesions and cause of death. Age was estimated by analysis of the sternal end of the fourth rib and of the pubic symphyseal medial articular surfaces. The results were then compared with the autopsy findings. MSCT was superior to autopsy in diagnosis of traumatic bone lesions and also revealed dental anomalies and signs of drowning. Age estimation gave a similar result for both methods. This case report illustrates the potential value of MSCT for medico-legal investigations of death: diagnosis of injuries, possibility of determining the cause of death, and anthropological study in order to estimate age or to visualize features likely to enable identification of a corpse.     

Iatrogenic deaths following treatment for hypertrophic obstructive cardiomyopathy: case reports and an approach to the autopsy and death certification

Hypertrophic cardiomyopathy (HCM) is a disease process which results in a large, heavy heart, with hypertrophy of the interventricular septum (IVS) and left ventricle. HCM accounts for a significant number of cases of sudden cardiac death each year, most infamously in young athletes. The prevalence of the disease has increased over the past several years due to advances in clinical diagnosis and molecular genetic studies. Over this same period, new forms of treatment also have emerged. One such treatment is alcohol septal ablation (ASA). ASA is a procedure performed by a cardiologist, via cardiac catheterization, by injecting pure ethanol into selected arteries which supply the IVS, resulting in a targeted myocardial infarction. This infarct then retracts and forms a scar, decreasing the outflow obstruction and improving the patient's clinical symptoms.The authors report 2 cases of death following ASA treatment of HCM. The first, a 56-year-old male, had his ASA procedure 10 days prior to death. The second decedent, a 76-year-old female, had her procedure only 30 hours before death. These case reports are followed by a discussion about HCM, including pathology, treatments, and treatment-related pathology, before closing with a discussion about death certification in the cases presented and therapy-related deaths in general.     

Endotracheal tube ignition by electrocautery during tracheostomy: case report with autopsy findings

This case of upper airway tract fire resulting from the use of electrocautery during elective tracheostomy has significance for surgeons, anesthetists, and forensic pathologists alike. The major autopsy findings are described and illustrated. Suggestions that may help to prevent or minimize the risk of fire in this context are reviewed.     

Motor vehicle-assisted ligature strangulation causing complete decapitation: an autopsy report

The victim, a 63-year-old prosperous businessman from Labasa, of the Northern Island (Vanua Levu) of Fiji Islands, was found completely decapitated in the early hours of morning in 2004. Initial police investigation did not reveal any history of any medical or family calamity. Further inquiry by the police revealed that on the previous day the deceased had visited all his friends and relatives, and his behavior was not out of the ordinary. The police suspected it to be a case of homicide. On visit to the scene, a completely decapitated body was found in a van on a downhill road. Tire marks were found on the road. A nylon rope was used for ligature strangulation. At autopsy, the decapitation wound of the head and the torso articulated well. The face was congested, and there was tongue bite. Wound margins were clear-cut, with well-demarcated abrasion and multiple imprints of the nylon rope on the neck. The upper one third of the larynx was attached to the head. No other injuries were found on the body. From the findings, it was obvious that asphyxiation was involved in the death before decapitation.     

意外被沙活埋窒息死亡尸检1例

意外被沙活埋窒息死亡在法医实践中罕见 ,现报告 1例 :案　例某男 ,7岁。下午放学后在沙堆上与同学挖地道玩后失踪 ,2天后被人从沙堆中挖出。经公安局调查 :该生下午放学后与同学在沙堆边挖了一条高 1.3米、长约 2米的沙坑道 ,后因天趋黑 ,同学回家 ,该生继续玩未归 ,父母次日报案其子失踪。尸检发现 :尸体呈惊挛状 ,呈痛苦面容 ,头发中布满大量沙子 ,双眼上下睑紧闭 ,双眼球结膜点状出血 ,双鼻孔充满沙子 ,双外耳门处可见沙子 ,舌稍露于齿 ,唇内与牙龈之间可见沙子 ,双指甲内可见沙子 ,口唇及四肢甲床绀。头皮未见出血 ,颅骨未见骨折 ,硬脑…     

意外被沙活埋窒息死亡尸检1例

意外被沙活埋窒息死亡在法医实践中罕见,现报告1例: 案例 某男,7岁.下午放学后在沙堆上与同学挖地道玩后失踪,2天后被人从沙堆中挖出.经公安局调查:该生下午放学后与同学在沙堆边挖了一条高1.3米、长约2米的沙坑道,后因天趋黑 ,同学回家,该生继续玩未归,父母次日报案其子失踪.     

Coronary arteritis diagnosed at autopsy: three case reports and review of the literature

Coronary arteritis is rare but can be fatal either by itself or in conjunction with other diseases. The authors report cases of three men in whom coronary arteritis was an interesting finding that may have caused or contributed to death. One 45-year-old man collapsed at work, another 56-year-old man was found dead in his parked car, and one 80-year-old man had a recent cerebrovascular accident. All three men had coronary arteritis, arteriosclerotic cardiovascular disease, some form of myocardial disease, and fatty liver change. Two had different lung diseases. The findings suggest that coronary arteritis may be an independent cause of death, part of a systemic disease, or, as these three cases illustrate, part of a constellation of cardiac and cardiovascular pathologies with a possible relation to other medical conditions. Coronary arteritis is an important finding in forensic pathology and merits consideration in a case of unexplained death.