基于眼组织结构的死亡时间推断研究进展

死亡时间(postmortem interval,PMI)推断是法医病理学研究的重点与热点问题。近年来,国内外学者利用眼组织推断PMI取得了一定进展,机体死后眼角膜、房水、虹膜、晶状体、玻璃体液、视网膜等改变均呈现与PMI高度相关的时序性变化规律。本文基于眼组织不同结构死后形态学、生物化学、分子学、遗传物质改变等方面,对PMI推断研究进展进行了综述,对存在的问题及发展趋势进行探讨。     

致死性心律失常的法医学研究进展

据文献报道,有很多心源性猝死是由于致死性心律失常所致。在法医学鉴定工作中,心律失常所引起的猝死往往很突然,尸检及镜下病理学检查又缺乏特征性的改变,使得鉴定其死亡机制成为一大难点。因此,寻找一种客观、准确的心律失常鉴定方法,对于致死性心律失常所致心源性猝死的鉴定尤为重要。本文将就上述问题,从致死性心律失常的定义、分类、产生原因、致死机制、形态学所见及死后生化检测指标等方面进行综述,以期为心源性猝死致死原因的法医病理学分析、鉴定提供帮助。     

宝鸡市358例法医送检器官的组织病理学分析

目的 分析法医尸体检验后送检器官的病理学特征,总结此类案件的特点.方法 对宝鸡市法医送检358例尸体解剖器官标本进行常规检查并进行组织病理学诊断. 结果 358例中以青壮年男性为主,死亡原因主要为创伤、猝死、中毒.组织学能明确死亡原因250例,无典型组织学病变101例,组织自溶腐败7例.病理诊断以心血管疾病为主,其次为呼吸、神经、消化系统疾病. 结论 法医解剖具有专业特点,与病理解剖不尽相同.组织病理学检验进行死亡原因诊断时,应积极与法医沟通,以充分掌握案情、死亡经过及特定的法医病理学特征.     

甲亢性心脏病猝死三例

<正>甲亢性心脏病引起碎死的尸检例报告甚少,我们曾检验3例,现报告如下: 例l,女,43岁。某日下午8时许,患者吃过晚饭后发生呕吐、腹泻及发热等症状.次日下午4时左右出现呼吸困难,急请医生治疗,待医生赶到,患者已死亡。由于死亡突然,要求法医检验,追询既往病史,死者2年前曾     

非高血压主动脉夹层破裂猝死8例法医病理学分析

目的探讨非高血压主动脉夹层猝死的死因、临床症状及法医病理形态学特点,以期为非高血压主动脉夹层猝死的法医病理学诊断及规范尸体检验提供参考。方法对2007-2015年本司法鉴定中心受理鉴定的8例非高血压主动脉夹层猝死的案例进行统计、归纳和分析。结果非高血压主动脉夹层破裂多见于40岁以下男性,病理分型主要为De Bakey I型,临床表现多不典型,无1例临床确诊。经基因检测1例确诊为Marfan综合征,1例存在Smad3基因变异。非高血压主动脉夹层均无高血压病史,排除外伤,均未见高血压病相关病理学改变,镜下大动脉检见弹力纤维减少、平滑肌减少、囊性中膜变性、炎细胞浸润等改变,某些案例还见于中动脉。结论非高血压主动脉夹层发病机制复杂,与遗传学和炎症等多因素密切相关,常常波及全身多血管病变的特点。尸检时除了系统检验大血管的同时,还有必要对全身的中动脉进行检验,建议积极进行基因检测,探究发病机制。     

孤立性心肌炎引起猝死的法医学鉴定(附五例尸检报告)

孤立性心肌炎（isolatedmyocarditis）在心血管系统疾病中并不少见，由于本病可致猝死，故在法医病理学鉴定工作中常可遇到。一般对那些病变典型，有相应临床表现的案例，鉴定并不困难，但对病变程度较轻，又无相应临床表现的猝死案例，在死因诊断时往往出现分歧。作者复习本室30余年来尸检诊断为孤立性心肌炎猝死的案例，并选择部分因急性暴力死亡尸检案例的心脏标本作对照，结合文献，对该病猝死的法医病理学诊断问题进行探讨。材料与方法1．5例孤立性心肌炎猝死者的心脏。分别在其左室、乳头肌、右室取材，石蜡切片，HE染色，镜检。2．1…     

过敏性休克死亡法医学诊断的研究现状

过敏性休克死亡在临床医学及法医学鉴定中较为常见,但过敏性猝死的死后诊断一直是法医病理学鉴定的一大难点。近年来,国内外学者研究了过敏性死亡血清IgE、组胺、肥大细胞类胰蛋白酶和P物质的含量以及其在肺脏和胃肠等组织中的免疫表达,试图为过敏性猝死的法医学鉴定提供客观、准确的形态学依据和诊断指标。本文就过敏性休克死亡法医学诊断的研究进展和存在的问题加以综述。     

心肌炎死亡案例的法医病理学分析

目的探讨心肌炎的猝死机理和法医病理诊断标准。方法对6例心肌炎死亡者进行系统解剖及组织病理学检验;结果6例心肌炎死亡者中,病毒性心肌炎1例,细菌性心肌炎4例,孤立性心肌炎1例。结论急性充血性心衰和心律失常是心肌炎猝死的主要死因。心肌炎猝死的法医病理学诊断:熟悉心肌炎的病理形态特点,结合临床症状及实验室检查,并排除其他死因。     

喉气管支气管炎猝死法医学检验文献回顾

喉气管支气管炎是一种罕见的上呼吸道感染,病变主要涉及上呼吸道声门下至支气管部位,发病多见于学龄前儿童。患者常见的,瞄床表现为喘呜,犬吠样咳嗽甚至呼吸窘迫。严重的喉气管支气管炎可导致急性呼吸道阻塞引起呼吸功能衰竭死亡。喉气管支气管炎所导致猝死在法医学实践中较为罕见。本文回顾了喉气管支气管炎相关的文献报道并结合2例典型喉气管支气管炎急性发作导致猝死的案例进行综述,主要探讨喉气管支气管炎患者临床表现、尸体检验以及法医病理学检查特征。     

成人心脏性猝死的心脏大体病理学测量数据报告

目的 分析不同原因心脏性猝死(sudden cardiac death,SCD)的大体病理学数据,为不明原因的猝死鉴定提供证据支持。方法 收集南京医科大学司法鉴定所2010—2020年行法医病理鉴定的167例成人SCD案件,汇总SCD案例的大体病理学检验数据,统计分析不同死因的特征。结果 男、女性SCD案例比例3.4∶1。冠状动脉粥样硬化性心脏病是引起SCD的首要原因,主要分布于40岁以上的人群。心肌炎导致的猝死主要分布于年轻群体,平均死亡年龄为(34.00±9.55)岁。分析不同原因SCD的心脏病理学参数差异发现,主动脉瘤或动脉夹层猝死者的主动脉瓣瓣环周径多呈明显扩张(P<0.05)。男性主动脉瘤或动脉夹层和合并死因组的心脏质量增大,合并死因组的肺动脉瓣和三尖瓣瓣环均扩张(P<0.05)。结论 不同原因SCD存在多个大体病理学测量指标差异,在心脏性猝死的原因推断中具有参考价值。     

Sudden Unexpected Death Due to Graves' Disease During Physical Altercation

We report a case of a 30‐year‐old woman who suddenly collapsed after having a physical altercation with her husband. Despite immediate resuscitation, she died on arrival at the hospital. The victim's parents requested an autopsy because they believed that their daughter was killed by her husband. Postmortem examination revealed that the victim had a diffusely enlarged thyroid gland and cardiomegaly with left ventricular hypertrophy. There was no evidence of significant trauma on the body. Further postmortem thyroid function tests and review of her medical history indicated that her death was due to Graves' disease. To the best of our knowledge, this is the first case reported of sudden death due to cardiac arrhythmia from Graves' disease induced by physical and emotional stress associated with the criminal activity of another person. The autopsy findings are described. In addition, the literature is reviewed and the significance of postmortem evaluation of thyroid hormones in the cases of sudden death is discussed.     

Eosinophilic myocarditis from a forensic histopathological perspective

Eosinophilic myocarditis (EM) is a rare and potentially fatal form of myocarditis characterized by infiltration of the myocardium with eosinophil leukocytes, often accompanied by eosinophilia. Although the exact underlying cause remains unknown, it has been shown to be associated with hypersensitivity reactions, immune-mediated disorders, infections, or cancer. Due to the differences in symptomatology, it is often diagnosed by postmortem histopathological examination. We aimed to retrospectively examine the histopathological findings of rare cases of EM and to detect accompanying cardiac and other organ pathologies. The histopathological findings of the cases that underwent autopsies between 2012 and 2020 and were diagnosed with EM were assessed. Demographic features, symptoms, causes of death, macroscopical findings at autopsy, toxicologic and microbiological analysis results, accompanying cardiac pathologies, and histopathological findings in other organs were evaluated. Myocarditis was detected on histopathologic examination in 558 (1.1%) of 49,612 forensic autopsies. There were 12 (2.3%) EM cases. There were nine males and four females. The mean age was 42.3 (3–83) years. Heart weights ranged from 82 to 564 g. The most common finding on macroscopic examination was the mottled discoloration and scarring in the myocardium. Microscopic examination revealed perivascular and interstitial infiltration of eosinophils in all of the cases accompanied by myocyte necrosis in four of them. EM was reported as the cause of death in four cases. EM remains a challenging heart disease with its obscure etiopathogenesis and varying clinical presentation and a rare entity diagnosed by postmortem histopathological examination in sudden and unexpected deaths.     

A retrospective analysis of cardiovascular deaths: A 5-year autopsy study of 1045 cases in Antalya,Turkey

This study aims to identify the macroscopic and microscopic changes that occur in the heart in different causes of cardiovascular death and sudden cardiac death in autopsy cases and evaluate the difficulties that a forensic practitioner may encounter during autopsies. All forensic autopsy cases in the Morgue Department of the Council of Forensic Medicine, Antalya Group Administration between January 1, 2015, and December 31, 2019, were examined, retrospectively. The cases were chosen according to inclusion and exclusion criteria, and their autopsy reports were examined in detail. It was determined that 1045 cases met the study criteria, 735 of which were also met the sudden cardiac death criteria. The top three common causes of death were ischemic heart disease (n = 719, 68.8%), left ventricular hypertrophy (n = 105, 10%), and aortic dissection (n = 58, 5.5%). The frequency of myocardial interstitial fibrosis was significantly higher in deaths due to left ventricular hypertrophy than in deaths due to ischemic heart disease and other causes (χ²(2) = 33.365, p < 0.001). Despite detailed autopsy and histopathological examinations, some heart diseases that cause sudden death may still not be detected.     

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.     

早期心肌梗死死后诊断的法医病理学研究进展

心源性猝死在成人猝死的死因中占首位,心肌梗死是冠心病猝死的主要机制之一,由于早期心肌梗死发生突然,且可在短时间内死亡,肉眼和镜下都缺乏典型的形态学改变,一直都是法医实践中研究的热点,本文回顾多年来心肌梗死的研究成果在法医学中的应用及局限,展望新的临床指标在法医工作中的可行性,期望提高死后心肌梗死诊断的准确率。     

Sudden Death as a Complication of Choriocarcinoma

We report the case of a young man with a history of sudden death. On autopsy, a large retroperitoneal mass was found along with secondaries in the liver and lungs. No testicular abnormality was detected on palpation. Based on histopathological examination, it was diagnosed to be a case of choriocarcinoma. Unfortunately, it was not definitively determined whether the retroperitoneal mass represents the primary tumor or secondary involvement with testes being the primary source. It is important that forensic pathologists are aware of this disease as a potential cause of sudden death. The main focus of the paper is the approach of a forensic pathologist to a case of a sudden death when an unexpected and undiagnosed tumor is found in the retroperitoneum and not much information is available about the clinical history of the deceased.     

Is there progress in the autopsy diagnosis of sudden unexpected death in adults?

Sudden death is now currently described as natural unexpected death occurring within 1h of new symptoms. Most studies on the subject focused on cardiac causes of death because most of the cases are related to cardiovascular disease, especially coronary artery disease. The incidence of sudden death varies largely as a function of coronary heart disease prevalence and is underestimated. Although cardiac causes are the leading cause of sudden death, the exact incidence of the other causes is not well established because in some countries, many sudden deaths are not autopsied. Many risk factors of sudden cardiac death are identified: age, gender, heredity factors such as malignant mutations, left ventricular hypertrophy and left ventricle function impairment. The role of the police surgeon in the investigation of sudden death is very important. This investigation requires the interrogation of witnesses and of the family members of the deceased. The interrogation of physicians of the rescue team who attempted resuscitation is also useful. Recent symptoms before death and past medical history must be searched. Other sudden deaths in the family must be noted. The distinction between sudden death at rest and during effort is very important because some lethal arrhythmia are triggered by catecholamines during stressful activity. The type of drugs taken by the deceased may indicate a particular disease linked with sudden death. Sudden death in the young always requires systematic forensic autopsy performed by at least one forensic pathologist. According to recent autopsy studies, coronary artery disease is still the major cause of death in people aged more than 35 years. Cardiomyopathies are more frequently encountered in people aged less than 35 years. The most frequent cardiomyopathy revealed by sudden death is now arrhythmogenic right ventricular cardiomyopathy also known simply as right ventricular cardiomyopathy (RVC). The postmortem diagnosis of cardiomyopathies is very important because the family of the deceased will need counseling and the first-degree relatives may undergo a possible screening to prevent other sudden deaths. In each case of sudden death, one important duty of the forensic pathologist is to inform the family of all autopsy results within 1 month after the autopsy. Most of the recent progress in autopsy diagnosis of sudden unexpected death in the adults comes from molecular biology, especially in case of sudden death without significant morphological anomalies. Searching mutations linked with functional cardiac pathology such as long-QT syndrome, Brugada syndrome or idiopathic ventricular fibrillation is now the best way in order to explain such sudden death. Moreover, new syndromes have been described by cardiologists, such as short-QT syndrome and revealed in some cases by a sudden death. Molecular biology is now needed when limits of morphological diagnosis have been reached.     

Investigation of cardiac troponins in postmortem subjects: comparing antemortem and postmortem levels

The limitations of autopsy in the diagnosis of death due to ischemic heart disease are well known. In the living, a simple reliable biochemical assay for cardiac troponins is used in the diagnosis of acute myocardial ischemia. Several studies have investigated the use of biochemical assays for cardiac troponins in postmortem subjects as a means to distinguish between a cardiac and anoncardiac cause of death. All of these studies, however, rely upon assigning subjects to "cardiac" or "noncardiac" death on the basis of a postmortem examination. As postmortem examination does not always accurately distinguish between these two groups, this approach is intrinsically flawed.Our study compares antemortem and postmortem cardiac troponin levels in five subjects. The antemortem samples were retrieved from the hospital biochemistry laboratory after each subject's death. The postmortem samples for each subject were taken from different sites and at different times during the early postmortem period.Erratic results bearing little or no relation to the antemortem cardiac troponin level were obtained for all subjects. Four of the five subjects had raised antemortem troponin levels, although only one had a cardiac cause of death.From this, we conclude that postmortem blood is not a suitable substrate for standard biochemical assays of cardiac troponins, which are designed for use on serum taken from living patients. In addition, the results of our study support the view that elevated cardiac troponins are a marker of serious morbidity and are not specific for cardiac injury as the primary cause of morbidity or mortality.     

心脏钠通道SCN5A基因突变与致心律失常性疾病

致心律失常性疾病患者死后尸检时心脏没有发现病理学异常的证据,过去都将其归为原因不明的猝死,近年研究显示,很多致心律失常性疾病与心脏钠通道基因(SCN5A)突变相关。本文对钠通道SCN5A基因的基本结构、SCN5A基因突变与几种相关的致心律失常性疾病的相关性等进行了综述,旨在为原因不明猝死的研究提供新思路。     

Sudden unexpected death due to a previously undiagnosed plasma cell dyscrasia

The plasma cell dyscrasias are a diverse group of disorders characterized by the production of a clonal paraprotein. Sudden death is a recognized complication of the plasma cell dyscrasias, most commonly in individuals with cardiac involvement by amyloidosis. However, the current forensic literature has no reported cases in which sudden death resulted from complications of a plasma cell dyscrasia that was first diagnosed by postmortem histologic examination. We present the case of a woman whose sudden and unexpected death resulted from a seizure. Postmortem examination revealed no evidence of trauma or a grossly identifiable natural disease process that would have accounted for her death. However, microscopic and immunohistologic studies revealed a previously undiagnosed plasma cell dyscrasia, the clonality of which was determined by immunohistochemical studies for immunoglobulin light chains, that was not associated with amyloid deposition. This case elucidates a previously unrecognized cause of sudden unexpected death and illustrates the importance of microscopic studies in selected cases examined in medical examiner/coroner offices.