Mahaim纤维致猝死5例

寻找心源性猝死者的病理形态学诊断依据。采用本组建立的心传导系统检查法 ,对 16 5例无心外器官疾病猝死者的心脏 ,作心传导系统的组织学检查。发现 5例存在心传导系统Mahaim纤维 ,全部均为束室束型。本组Ma haim纤维的形态学与房室束 (HB)或左束支 (LBB)相似 ,胞体横径在 10～ 35 μm左右 ,胞浆丰富 ,色淡红染 ;来自HB的纤维胞体呈细条状 ,核居中 ;来源于LBB的则按其始发点不同自上而下逐渐变大 ,纵切细胞未见分叉 ,但部分细胞周围见有一薄层结缔组织包围。分析结果表明 ,Mahaim纤维是可致猝死的房室传导旁路。     

Death wearing a badge--a study of police officers who died in the line of duty in Metro Dade County from 1956 to 1982

A study of police officers who died in the line of duty in Metro Dade County, U.S.A. was performed. All cases in which a law enforcement officer died while on duty or, off duty while performing police action were collected from the files of the Medical Examiner Department from 1956 to 1982. Cases were then analyzed as to age, race, sex, cause and manner of death, scene circumstances, alcohol and drugs detected at autopsy. A total of 37 cases was studied.     

A death due to subinvolution of the uteroplacental arteries

A 19-year-old G1P0 Caucasian woman died 8 days postpartum because of the subinvolution of the uteroplacental arteries. Microscopic examination of the placental implantation site revealed large, dilated spiral arteries containing partially occluding thrombi in the superficial myometrium. The presence of cytotrophoblasts within and surrounding the spiral arteries was confirmed by low molecular weight cytokeratin immunohistochemistry. Infection of the Cesarean section incision site was demonstrated by the growth of Staphylococcus aureus and Streptococcus agalactiae Group B in the wound as well as the intrauterine blood clot. Although subinvolution of the placental site may be a cause of delayed postpartum hemorrhage and significant morbidity, the underlying pathophysiologic mechanism is unknown.     

A death due to perirenal hematoma complicating extracorporeal shockwave lithotripsy

Perirenal hematoma is an occasional complication of extracorporeal shockwave lithotripsy (ESWL) which does not usually require treatment. A 79-year-old woman died 23 h after ESWL. Forensic autopsy was performed to determine whether medical treatment contributed to her death. The cause of death was hemorrhagic shock due to massive hematoma from a ruptured small vein in the perirenal adipose capsule. No injury to other organs was found and the patient had neither coagulation abnormality nor venous disease. Perirenal hematoma can easily be diagnosed with abdominal sonography, if pain or symptoms of anemia develop. Doctors must be aware of the possibilities of severe renal hematomas after ESWL.     

Sudden Death due to Brainstem Leukemic Hemorrhage: A Case Report

Introduction Leukemia is a hematologic neoplasm character- ized by potential infectious and hemorrhagic com- plications. In adult patients with acute leukemia, in- fection is the most common complication. Intracra- nial hemorrhage （ICH） is the second most common complication. However, ICH has been identified as the major cause of morbidity and mortality in pa- tients with leukemia[1-6].     

白血病死亡的法医学鉴定

材料和方法回顾性研究我所2003～2005年间检案实践中4例白血病死亡的法医学鉴定案件。结果4例死者生前均无明显的血液病症状,其中1例死亡前经临床确诊为急性颗粒增多型早幼粒细胞性白血病（M3）,另外3例均无血液病相应的临床资料。尸体解剖主要所见：（1）多器官（尤其是脑）白血病细胞浸润;（2）肝、脾肿大;（3）凝血功能障碍引起的出血倾向,如：皮肤紫癜、创口渗血或迁延不愈等;（4）可排除暴力死亡。结论白血病细胞脑浸润引起的脑内血肿和血液病的并发症弥漫性血管内凝血（DIC）是导致死亡的常见原因;在白血病患者突发死亡的案例中,死者生前往往缺乏典型的血液病症状,或仅有轻微的症状未引起注意;此类案件的法医学鉴定应注意收集临床资料,必须进行系统的尸体解剖检验,在有检验条件的情况下应进行骨髓细胞学病理检验。     

A case of sudden infant death due to a primary cardiac sarcoma

The case reported herein concerns the unexpected death of a 3-month-old female newborn who suddenly collapsed in her mother's arms and was dead on arrival at the hospital. The clinical histories of the baby and her parents were negative for symptoms or signs of illness, even those of cardiovascular origin. Furthermore, no clinical appearance of a pathologic status was noted by pediatricians after the birth until the last emergency recovery. The autopsy excluded external and internal signs of violence but revealed a large primary cardiac tumor arising from the free wall of the left ventricle, which had totally invaded the heart causing mitral valve deformation. Histological examination showed a low-grade sarcoma that completely infiltrated the myocardial tissue. The pathogenesis of this sudden infant death was postulated as being owing to a fatal ventricular fibrillation combined with a tumor-related restrictive cardiomyopathy obstructing left ventricular filling.     

家庭暴力致骨折损伤机制分析1例(英文)

本文报道了一名37岁女性遭受丈夫殴打,造成下肢受伤。医院诊断为右髌骨和左胫骨骨折,伤者遂接受了切开复位内固定术。由于丈夫否认对其实施家庭暴力,声称其下肢骨折系交通事故坠落伤。警方遂委托对该女性的损伤进行法医学鉴定。经过审阅X线和CT检查资料,结果为伤者右侧髌骨骨折、左胫骨骨折,以及左眶内侧壁骨折。鉴定意见为髌骨的横向骨折系由肌肉的牵拉暴力引起,左胫骨损伤符合直接和间接外力所致,左眶内侧壁骨折在施暴期间形成的可能性较大。本文阐述了运用影像学技术对家庭暴力案件与交通事故损伤进行鉴别,强调了影像学技术在法医临床鉴定中的应用价值。     

G-map's application of the Good Lives Model to adolescent males who sexually harm: A case study

Abstract

The Good Lives Model (GLM) is a strengths-based approach that conceptualises sexually harmful behaviour as an individual's inappropriate means to meet their core personal and social needs. It promotes managing potential risk through acknowledging the individual's needs, goals and aspirations and working towards meeting these in safe and positive ways. As a specialist organisation working with adolescents who sexually harm, G-map has adapted the GLM for its client group and employs it as a framework for problem formulation and intervention planning. Using a single case-study design, this paper illustrates how the GLM can be used as a framework for therapeutic practice. The case study involves an adolescent male who sexually assaulted an adult female. G-map's experience of the clinical utility and strengths of the Good Lives Model are discussed, alongside an acknowledgement that the dearth of outcome research relating to this model is a limitation.     

An autopsy case of intraoperative death due to pulmonary fat embolism--possibly caused by release of tourniquet after multiple muscle-release and tenotomy of the bilateral lower limbs

Acute interstitial pneumonitis (AIP), also known as Hamman-Rich syndrome, is a distinct type of idiopathic interstitial pneumonia affecting patients of both genders without pre-existing lung diseases. We describe the case of a fulminant form of AIP and discuss the pathophysiological mechanisms of AIP with reference to the histological pattern. A 15-year-previously-healthy male boy presented to the Hospital with a 6-day history of malaise, fever and cough. The clinical prodromes were followed by the acute onset of increasing shortness of breath rapidly progressing in acute respiratory failure. Chest X-ray demonstrated bilateral diffuse airspace opacification; the high resolution CT confirmed the presence of bilateral, symmetric diffuse ground-glass attenuation. The patient was admitted to the intensive care unit, but died after few hours. An autopsy was performed within 24h. The histological examination of lung specimens showed a pattern of diffuse alveolar damage. immunohistochemical, microbiological and toxicological tests were also carried out. The clinical presentation, the histological findings and the exclusion of infective, traumatic, toxic and metabolic causes of acute respiratory distress syndrome (ARDS) allowed us to conclude that the boy was affected by AIP. In conclusion, AIP is a diagnosis of exclusion. It has a mortality rate ranging about 50%, despite mechanical ventilation. In fatal cases of AIP diagnosis can be based on clinical presentation, radiological, histological and microbiological findings and can be further confirmed by immunohistochemical analysis.     

A Case of Toxic Shock due to Clandestine Abortion by Misoprostol self‐administration

Maternal mortality and morbidity are the leading causes of death and illness, respectively, among women of reproductive age in many countries throughout the world. Of all maternal deaths, those related to unsafe abortions are the most widely underestimated, but they are also the most largely preventable. Medical abortion is a safe and reliable method for termination of a pregnancy in early gestation, although it is important to be aware of signs and symptoms of severe infection and toxic shock syndrome after the medical termination of pregnancy; case studies in literature are rarely fatal events. We report the first case of septic shock syndrome following a clandestine pregnancy termination with a misoprostol‐only regimen (12 tablets 200 μg each). Autopsy findings and histopathological examination proved that the woman died from septic shock. This case suggests to improve the forensic investigations in case of unsafe, often clandestine, abortion is suspected.     

A rare case of sudden death due to IgG4-related giant coronary artery aneurysms

Immunoglobulin G4-related disease (IgG4-RD) is a fibro-inflammatory condition that can affect many organs, either simultaneously or metachronously. In recent years, IgG4-related vascular complications of larger arteries such as the aorta and iliac arteries have been increasingly identified. Among vascular complications, coronary artery involvement in the forms of either periarteritis or coronary artery aneurysms (CAAs) has also been reported; however, are very rare in comparison. This case report presents a rare case of a sudden death due to occlusive thrombosis of IgG4-related giant CAAs measuring up to 10 cm in diameter, demonstrates their possible clinical progression, and shows how they can distort normal anatomy which may then pose challenges in the interpretation of postmortem-computed tomography scans. It also briefly discusses the diagnosis of IgG4-RD in arteries, both clinically and in the postmortem setting.     

钝力冲击后心脏组织形态学变化的实验研究

本研究用自制机械式弹性拉力打击器以６．７ｍ／ｓ、８．０ｍ／ｓ、９．１ｍ／ｓ及１０．０ｍ／ｓ速度冲击大胸骨心前区，然后采用多种组织学染色及透射电镜技术对心脏组织形态学变化进行了观察。结果表明：①以６．７ｍ／ｓ及８．０ｍ／ｓ速度冲击后心脏宏观未见有明显改变，微观可见心肌波浪变。电镜下可见肌原纤维肌节收缩，Ｉ带消失或轻度Ｉ带增宽乃至肌原纤维断裂。②以９．１ｍ／ｓ及１０．０ｍ／ｓ速度冲击后宏观可见心脏挫伤，微观心肌挫伤改变明显，实验观察６０ｍｉｎ内心肌血管内皮损伤处已有血小板粘附集聚甚至血栓形成，心肌超微结构损害严重。③同一心脏可有多部位损伤，且损伤程度不均一。本研究进一步表明钝力性心脏外伤中．虽然无宏观损伤所见，其微观，特别是超微结构可有损害。     

A study on the depression levels of children who are brought to the forensic DNA laboratory for paternity testing

This study aims to identify the depression levels of children who were brought to the forensic DNA laboratory for paternity testing. A total of 35 such children were enrolled in the study. Data were gathered using the parent interview form, general information form for children, and the "Child Depression Scale" as it had been tested for validity and reliability in the 6-17 year age group in the country. Data were analyzed using one-way analysis of variance and Scheffe test. The results showed that the age of children who were brought in for paternity testing created a meaningful difference in their depression scores (p < 0.01) while gender did not. In addition, c. 63% of the children in this study did not know why they were in the laboratory, which also caused a meaningful difference in depression scores (p < 0.01).     

A Rare Presentation of Sudden Death due to Pulmonary Thromboembolism Possibly as a Result of Giant Hepatic Hemangioma

Hepatic hemangiomas are usually detected incidentally when investigating for other nonrelated pathologies. When symptomatic, they are usually large and cause symptoms such as abdominal discomfort or other digestive issues. Occasionally, uncommon presentations such as bleeding with coagulopathy (Kasabach–Merritt syndrome) or even fever of unknown origin may occur. As hepatic hemangiomas are benign, they do not result in tumor emboli and pulmonary thromboembolism due to hepatic hemangiomas is extremely rare. This is a case report of a rare case of a female with no known past medical history who presented with sudden death due to pulmonary thromboembolism, possibly as a result of an underlying giant hepatic hemangioma. Incidentally, she also had three other tumors—pancreatic cystic lymphangioma, cerebral capillary telangiectasia, and papillary thyroid carcinoma, and their potential contribution to the cause of death will be discussed.     

原发性心肌病猝死心肌mtDNA~(4977)缺失变化

目的探讨原发性心肌病(PCM)猝死者心肌线粒体DNA(m tDNA4977)缺失情况及其与猝死的关系。方法对18例PCM猝死和28例对照组病例心肌组织蜡块,用常规方法提取心肌m tDNA,以PCR、琼脂糖紫外凝胶成像技术确定扩增产物激光密度,初步定量检测m tDNA4977缺失率。结果PCM猝死18例中,检见13例m tDNA4977缺失,占72.44%。对照组28例中,检见3例m tDNA4977缺失,占10.71%;两组病例m tDNA4977缺失率均值分别为0.5795和0.0744,差异有非常显著性意义。结论多数PCM,特别是扩张型心肌病猝死者心肌可检见m tDNA4977缺失;提示其心肌m tDNA4977缺失变化与PCM猝死的发生可能有一定关系。     

A comparison of pulmonary intra-alveolar hemorrhage in cases of sudden infant death due to SIDS in a safe sleep environment or to suffocation

The differentiation of SIDS from accidental or inflicted suffocation may be impossible without corroborating findings from the death scene or autopsy or in the absence of a confession from a perpetrator. Pulmonary intra-alveolar hemorrhage (PH) has been proposed as a potential clue to suffocation, but none of the previous studies on this topic have limited SIDS cases to those who were in a safe sleep environment, in which all were found supine and alone on a firm surface with their heads uncovered. Our aims are to: (1) compare PH in SIDS cases found in a safe sleep environment to a control group comprised of infants whose deaths were attributed to accidental or inflicted suffocation and (2) assess the effect of age, CPR, and postmortem interval (PMI), with regard to the severity of PH in this subset of safe-sleeping SIDS cases. We conducted a retrospective study of all postneonatal cases accessioned by the Office of the Medical Examiner in San Diego County, California who died of SIDS or suffocation between 1999 and 2004. A total of 74 cases of sudden infant death caused by SIDS (34 cases as defined above, comprising 8% of the total SIDS cases), accidental suffocation (37), and inflicted suffocation (3) from the San Diego SIDS/SUDC Research Project database were compared using a semiquantitative measure of pulmonary intra-alveolar hemorrhage. The most severe (grade 3 or 4) PH occurred in 35% of deaths attributed to suffocation, but in only 9% of the SIDS cases. Age, duration of CPR attempts and PMI had no effect on the severity of PH in SIDS. Our results indicate that the severity of PH cannot be used independently to differentiate SIDS from suffocation deaths. Each case must be evaluated on its own merits after thorough review of the medical history, circumstances of death, and postmortem findings.     

Patterned imprint mark due to the folded shoulder stock: A possible finding in contact shots from submachine guns

The muzzle imprint (barrel mark) is a pressure abrasion typically associated with contact shots. Apart from the contours of the actual muzzle profile, other constructional parts such as the front sight and/or the recoil spring guide of semiautomatic pistols may be imprinted next to the bullet entrance wound. In some types of submachine guns the shoulder stock can be folded forward so that its end partly encircles the muzzle. If such a weapon was in contact with the skin at the instant of discharge, a corresponding contusion mark is to be expected. The imprint configuration may point to the type of weapon and to the way in which the gun had been held when firing the shot. The paper presents the injury pattern in a 36-year-old man who committed suicide with a Scorpion SA Vz 61 submachine gun cal. 7.65 mm Browning from former Czechoslovakia.     

Severe Hypokalemia due to Combination Use of Dexamethasone and Calcium Gluconate for Diabetics with Infection: A Case Report

The combination use of dexamethasone and calcium gluconate can be applied to hypersensitiv-ity. Severe hypokalemia is a usual complication of dexamethasone and calcium gluconate therapy, whichoccurs frequently with therapeutic use. Fatal cases, accidental and intentional, occur frequently in forensicpractice. The current case report presented a 43-year-old man with diabetes mellitus with infection, towhom dexamethasone and calcium gluconate were administered in the private clinic. With the develop-ment of such clinical symptoms of severe hypokalemia as quadriplegia, he was confirmed to have severehypokalemia through a biochemical test before dying of arrhythmia. And also it presented pathophysio-logic mechanism underlying severe hypokalemia as well as suggestions for clinical practice regardingcombination use of dexamethasone and calcium gluconate.     

Acute Respiratory Obstruction due to Accidental Inhalation of Perlite: A Novel Mechanism for Upper Airway Occlusion with Cast Formation

A 56-year-old man died following a fall resulting in complete submersion into a deep pit containing insulation material, expanded perlite. The most striking finding at autopsy was of impacted, moist pale yellow perlite that extended from the epiglottis into the main bronchi resulting in complete obstruction of the larger and smaller airways with cast formation. Perlite inhalation differs from inhalation of inert materials such as sand and wheat due to its hygroscopic properties and ability to expand forming an occlusive cast. Subsequent analyses of perlite from the worksite and within the airways indicated that hydration of perlite and adsorption of organic molecules into the perlite glass flakes had formed an interlocking, three-dimensional structure that was likely responsible for triggering a coagulation–flocculation process causing strong cohesion between the aggregates of glass flakes. This unique mechanism was likely responsible for the formation of the plug of perlite that obstructed the upper airway.