Two cases of right ventricular ischemic injury due to massive pulmonary embolism

In general, massive pulmonary embolism induces severe right ventricular overload, but pathological changes in the right ventricle due to pulmonary embolism is rarely seen. In this report, we describe two autopsy cases of massive pulmonary embolism without pre-existing cardiopulmonary disease. Both cases were accompanied by myocarditis-like changes in the right ventricle and infiltration of a number of polymorphonuclear neutrophils and mononuclear cells into the dilated right ventricular wall. Transmural or subendocardial coagulation necrosis was not apparent. Almost all of the mononuclear cells were immunohistochemically revealed to be CD68-positive macrophages. We speculated that these findings resulted from ischemia due to massive pulmonary embolism.     

闭合性脑损伤后血清和海马的蛋白质表达

目的 研究大鼠脑损伤后血清和海马中蛋白质表达的差异.方法 用雄性SD大鼠制造脑损伤模型,应用弱阳离子交换(WCX2)芯片和铜离子结合(IMAC-Cu)芯片结合表面增强激光解析电离飞行时间质谱技术,分析大鼠闭合性脑损伤后不同时间血清和海马中蛋白质表达谱的变化.结果 WCX2芯片在血清和海马样本中分别捕获436个和364个...     

大鼠闭合性脑损伤后血清髓鞘碱性蛋白研究

用ＥＬＩＳＡ双抗体夹心方法研究了大鼠闭合性弥漫性脑损伤后,血清髓鞘碱性蛋白（ＭＢＰ）含量的时序变化。正常大鼠血清中ＭＢＰ为６．１６３３±１．５３０１ｎｇ／ｍｌ（Ｘ±Ｓ）。伤后立即死亡组大鼠的血清ＭＢＰ为１１．３８１８±２．６５７４ｎｇ／ｍｌ,伤后１５ｍｉｎ,为１０．８３１９±２．３１３５ｎｇ／ｍｌ,此血清高ＭＢＰ水平一直持续到伤后３天。伤后第４天和第５天,血清ＭＢＰ基本恢复到正常水平。立即死亡组、伤后１５ｍｉｎ组和伤后３天之内各组的ＭＢＰ水平与正常组和伤后第４天和第５天的比较,Ｐ＜０．０１。认为可进一步探讨将血清ＭＢＰ含量的检测,作为脑震荡性脑损伤的辅助生化诊断指标之一     

Spontaneous fatal perforation of aorta and vena cava by Mobin-Uddin umbrella

A 60-year-old Caucasian woman died suddenly and unexpectedly after 4 days of dyspnea, lower back pain, and numbness of the legs. Autopsy revealed that death was due to perforation of both the aorta and the vena cava by the spikes of a Mobin-Uddin umbrella (an inferior vena cava filter designed to prevent recurrent pulmonary embolism) which was implanted 8 years prior to the patient's death. To prevent this type of lethal complication, it is suggested that the sharp spikes of the Mobin-Uddin umbrella be modified into curved, hook-like ends.     

广泛软组织挫伤后器官形态学的研究

目的探索法医病理学诊断广泛软组织挫伤、挤压综合征致死案例的形态学改变。方法采用大鼠广泛软组织挫伤模型和人体挤压综合征致死标本,对器官进行HE染色、肾肌红蛋白HSP免疫组化染色及电镜观察。 结果肾肌红蛋白的阳性率分别为60％、75％、95％;心肌、脑组织阳性染色率为90％;广泛软组织挫伤短期内死亡的大鼠肾电镜观察,可见多种组织细胞病理改变致使毛细血管腔狭窄、闭塞等。结论建立了较理想的大鼠广泛软组织挫伤形成的挤压综合征动物模型;为此类研究积累了具有一定实用价值的病理形态学资料。     

Analysis of pituitary lesions in fatal closed head injury

We analyzed forensic autopsy findings of 66 consecutive patients with fatal closed head injury who survived up to 48 days after trauma to ascertain the causal factors and the time course of development of posttraumatic pituitary lesions. Pituitary lesions were identified in 27 patients. In patients with pituitary lesions, posterior lobe hemorrhage was observed in 21 patients, followed by anterior lobe hemorrhage in 10 patients and anterior lobe infarct in 7 patients. Comparisons between patients with and without pituitary lesions showed that falls and subdural hematoma were significantly frequent in patients with pituitary lesions. Immunohistochemistry of neurophysin showed increased immunoreactivity in the hypothalamus of patients with pituitary lesions and brain edema, providing morphologic evidence of pituitary dysfunction. Hemorrhage in the anterior or posterior lobe was identifiable in patients with short survival periods, whereas infarct in the anterior lobe appeared in patients surviving at least 14 hours. These data further our understanding of the mechanisms of pituitary dysfunctions and help in the estimation of the survival period after head trauma.     

肝动脉栓塞化疗致脊髓损伤引起医疗纠纷法医学鉴定1例

许某，男，41岁。因“右上腹隐痛、纳差、乏力2月余”，于某年3月13日入住甲医院肝胆外科，19日行CT检查，确诊为右肝原发性肝癌，拟定“右半肝切除”的手术方案。3月26日在气管内麻醉下剖腹探查：有少许清亮腹水，全肝呈中度肝硬化改变，右肝膈面侧后腹膜与肝肿瘤粘连，分离粘连，离断肝圆韧带、肝镰状韧带、右肝冠状韧带及三角韧带。在分离膈下肝裸区处曾     

肝动脉栓塞化疗致脊髓损伤引起医疗纠纷法医学鉴定1例

自从《医疗事故处理条例》实施以来 ,无论是医疗纠纷的行政处理、行政机关参与下的调解还是到人民法院进行诉讼 ,来自社会、律师和法官对医疗事故技术鉴定结论的种种质疑就没有停止过 ,尤其是最高人民法院颁布《人民法院参照〈医疗事故处理条例〉处理医疗侵权损害赔偿案件的通知》以来 ,这个问题更是成为事件处理各方争议的焦点。本期我们组织了一部分有关医疗事故技术鉴定的文章 ,设立“医疗事故鉴定专题” ,对该问题进行专门讨论。我们希望在今后一段时间内仍将讨论这一问题。     

PDGFR-β在大鼠闭合性脑损伤中的表达

目的 观察液压冲击脑损伤后血小板衍生生长因子受体(PDGFR-β)的表达变化。方法 复制大鼠闭合性脑损伤模型,应用免疫组化和图像分析技术观察并分析大鼠脑损伤后不同时间PDGFR-β的表达情况。结果 脑损伤后1h即见PDGFR-β的表达上调,于4d达到高峰,14d时接近但仍高于对照组。结论 液压冲击脑损伤后PDGFR-β表达上调及其变化,与脑损伤后经过时间有关。     

Perforation of the superior vena cava during ECMO catheterization in two neonates with congenital diaphragmatic hernia: a cause of accidental death

Congenital diaphragmatic hernia (CDH) is a defect seen in approximately 1 in 3500 live births. A complication of CDH is the herniation of abdominal contents into the chest cavity through the defect, which may prevent normal intrauterine development of the lungs. The resultant pulmonary hypoplasia and pulmonary hypertension causes respiratory distress in the newborn, usually requiring some form of intervention before the defect is surgically corrected (Embryology for Surgeons. Baltimore, MD: Williams & Wilkins; 1994:491-539). Extracorporeal membrane oxygenation, which involves cannulation of the superior vena cava (SVC), is often used to manage these infants. However, the mediastinal shift that often occurs with CDH can cause an abnormal acute angulation of the SVC, which during cannulation can result in trauma and possible perforation of the SVC. We present 2 autopsy cases where the infants accidentally died as a result of extracorporeal membrane oxygenation cannulation.     

Immunohistochemical distribution of C-reactive protein in the hepatic tissue in forensic autopsy

Previously, we examined the expression of C-reactive protein (CRP) in hepatic tissues in fatal injuries (injury deaths) immunohistochemically, and classified the CRP distribution into three patterns: diffuse (D-) pattern, diffuse with strong positivity in the hepatic lobules; periportal (PP-) pattern, characterized by positive cells in the periportal region of some lobules; focal (F-) pattern, showing small islands of positive cells in some lobules. There was a relationship between the CRP distribution and the survival time. In this study, we further analyzed the deaths including those due to other than fatal injuries (non-injury deaths), and a study of a total of 314 deaths from various causes was performed. Generally, non-injury deaths showed findings similar to those in injury deaths. PP- and/or F-patterns were observed in 43.7% of cases having a short survival time (<6 h), but found in only 3% of those surviving longer (>6 h), showing that such findings are suggestive of a short survival time. D-pattern was found more frequently in non-acute deaths (60.4%), than in acute deaths (10.9%). In acute deaths, D-pattern was found in some cases showing extensive tissue injuries, such as burns and polytrauma, and inflammative predisposition. Immunohistochemical findings also showed some correlation with the serum CRP level. Our data suggest that hepatic CRP immunohistochemistry may be a useful tool for elucidating the dying process.     

Intimal tears of the right atrium of the heart due to blunt force injuries to the abdomen. Its mechanism and implications

We present six cases involving intimal tears of the right atrium of the heart. A proposed mechanism for this injury is discussed, along with implications of the lesion in fatally abused children and traumatized older patients who survive until hospitalization.     

大鼠脑外伤后脑组织MMP-9的表达与损伤时间相关性

目的观察大鼠脑外伤后脑组织MMP-9的表达规律,探讨其在损伤时间推断中的应用价值。方法健康SD大鼠75只,随机分为损伤组、假损伤组和正常对照组。损伤组采用自由落体方法建立脑损伤模型;致脑损伤后分10个时间点,采用HE染色观察损伤区的变化,采用免疫组化方法检测各时间点阳性细胞的种类和比值,并与假损伤组和对照组进行统计分析比较。结果免疫组化染色显示损伤组伤后1h可见中性粒细胞阳性着色,6h后可见神经细胞阳性染色并逐渐增强,伤后5d阳性细胞数达到峰值,而后开始减弱,14d基本消失。假损伤组和正常对照组未见阳性表达。将实验组中2h～7d阳性细胞比值与其它各时间点相比,差异有统计学意义(P<0.05);实验组各时间点与假损伤组和对照组相比,差异均有统计学意义(P<0.05)。统计分析结果见表1。结论损伤后MMP-9阳性表达的规律性,有望成为脑损伤时间判定的参考指标。     

挤压家兔后肢导致急性肝损伤和抗氧化能力降低

目的本实验观察挤压家兔后肢导致肝氧化损伤,探讨氧化应激在挤压家兔后肢导致肝损伤中的作用。方法用标准重物间断压迫家兔后肢复制模型。采用生化方法检测ALT和AST活性;分析天平称重方法检测肝脏湿干重比值(W/D);比色法测定肝组织超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)活性和总抗氧化能力(T-AOC)以及丙二醛(MDA)含量变化;并观察肝组织病理学改变。结果血清ALT和AST活性明显增高(P<0.01),肝细胞明显肿胀,肝窦轻度淤血,而肝脏湿干重比值(W/D)轻度增加(P<0.05);肝脏氧化损伤明显加重,MDA含量增高,而肝脏抗氧化能力下降,SOD、CAT、GSH-Px活性和T-AOC分别比对照组降低了17%、29%、24%和21%(P均<0.01)。结论挤压家兔后肢引起急性肝损伤及肝脏的抗氧化能力下降;肝脏局部抗氧化能力下降可能是肝损伤的重要因素。     

大鼠电流损伤多器官c-Fos表达研究

目的探讨c-fos蛋白能否用于生前电击与死后电击的鉴别。方法建立大鼠生前与死后电流损伤模型。生前电击组大鼠于电击后即刻和1,2,4,8h处死;死后电击组大鼠于死后即刻和15、30min及1h电击大鼠,检测所有实验大鼠心、肝、脾、肺、肾、骨骼肌、皮肤、脑等器官c-fos蛋白的表达情况,其结果经图像分析处理。结果生前电击各组大鼠心、肝、肺、肾、骨骼肌、脑c-fos蛋白呈强阳性表达,脾脏与皮肤呈阴性表达;而于死后电击各组大鼠中,仅死后即刻电击组大鼠心、肝、肺、肾、骨骼肌、脑c-fos蛋白呈很微弱的阳性表达,其余各组各器官均为阴性表达。结论检测各器官c-fos蛋白的表达情况,可以鉴别生前电击与死后电击。