家兔肺脂肪栓塞后超微病理学观察

目的 研究脂肪栓塞后肺组织的超微结构变化.方法 通过向实验组家兔血管内注射脂肪诱导肺脂肪栓塞制作肺栓塞动物模型,分别于栓塞即刻(0 h)和栓塞后3、8 h及1、2、7、14d处死动物;对照组家兔注射同等剂量的生理盐水,其余处理方法与实验组相同.经HE和苏丹Ⅲ染色证实造模成功后,用透射电镜观察肺组织的超微结构变化.结果 ...     

Massive systemic fat embolism detected by postmortem imaging and biopsy*

Postmortem computed tomography (pmCT) and pmCT angiography (pmCTA) provide a minimally invasive method to determine the cause of death. Postmortem image-guided biopsy allows for precise sampling of histological specimens. This case study describes the findings of lethal systemic fat embolism (FE) on whole-body unenhanced pmCT, pmCTA, and image-guided biopsy, with autopsy and histopathologic correlation. Unenhanced pmCT revealed a distinct fat level on top of sedimented layers of corpuscular blood particles and serum in the arterial system and pulmonary trunk. Subsequent pmCTA showed reproducible results, and image-guided biopsy confirmed fatal FE. pm CT/pmCTA combined with image-guided biopsy established the cause of death as right heart failure as a result of systemic fatal FE prior to autopsy. All imaging findings were consistent with traditional autopsy and histological specimens. This unique case demonstrates new imaging findings in massive, fatal FE and highlights that postmortem imaging, supplemented by image-guided biopsy, may detect the cause of death prior to traditional autopsy.     

Nonfracture-associated fatal fat embolism in a case of child abuse

Fatal fat embolism is usually thought of as a sequel to long-bone fracture, although cases secondary to soft tissue injury and atraumatic conditions have been infrequently reported. In this case of a two-year-old child-abuse victim who sustained multiple blunt traumatic injuries without skeletal fractures, pulmonary and systemic (brain and kidney) fat emboli were identified. At autopsy, all thoracic and abdominal viscera were intact; cranial contents exhibited only diffuse symmetrical petechial hemorrhages of the white matter. Because of the severe and widespread nature of soft tissue hemorrhage, and the absence of a grossly discernible cause of death, fat embolism was suspected. Using a combination of frozen section with oil red O staining and formalin-fixed osmium stained tissues, the immediate cause of death was determined to be diffuse fat embolism. Review of the literature reveals a pathophysiologic basis for fat embolism in the absence of fracture, both as a consequence of an acute increase in local pressure at the site of trauma and an alteration of the emulsification of blood lipids during shock. In light of these findings, we present this case to remind the forensic science community to consider fat embolism as the cause of death in cases of blunt-force injury without fracture.     

Immunoenzyme demonstration of isoantigens A, B and H in kidney tissue changed by putrefaction

In contrast to blood serology, which usually fails in specimens more than a few days old, immunohistochemistry (PAP technique) provided reliable information on the blood group (ABO) and, in most cases, also the secretor character of 23 kidney specimens stored for months at room temperature. Better results were obtained with monoclonal antibodies than with human sera. In the late stages of decomposition, blood group diagnosis is based on the more decomposition-resistant antigens of the collecting tubular epithelium (in secretors) and the endothelia of the arteriolae medullares rectae and not on the identification of erythrocytic antigens. In addition, a decomposition-resistant epithelial antigen in the distal convoluted tubules (Tc II) is unmasked by autolysis or heterolysis. "Blood group" antigens were frequently detected in bacteria and fungi. These antigens, however, were clearly distinguishable from blood group characters of the tissue. A transient, weak, false-positive reaction with monoclonal anti-B appeared in decomposed Tc II epithelia.     

The possible influence of micro-organisms and putrefaction in the production of GHB in post-mortem biological fluid

In recent years, the post-mortem production of the drug of abuse gamma-hydroxybutyric acid (GHB) in biological fluids (e.g. blood and urine) has caused various interpretative problems for toxicologists. Previously, other researchers have shown certain microbial species (Pseudomonas spp. and Clostridium aminobutyricum) possess the necessary enzymes to convert GABA to GHB. A preliminary investigation involving putrefied post-mortem blood indicated there was no observed relationship between "endogenous" GHB concentrations and concentrations of common putrefactive markers (tryptamine and phenyl-2-ethylamine). Microbiological analysis identified the presence of various micro-organisms: Clostridia spp., Escherichia coli, Proteus vulgaris, Enterococcus faecalis and Aeromonoas spp. Equine plasma, human blood and urine samples were inoculated with these and an additional micro-organism (Pseudomonas aeruginosa) and incubated at 22 degrees C for 1 month. Following comparison with control samples and pre-inoculation concentrations, the data indicated an apparent production of GHB in unpreserved P. aeruginosa inoculated blood (2.3 mg/l). All other fluoride-preserved and unpreserved samples (including controls) had GHB concentrations <1mg/l. Although this concentration is lower than is typically associated with "endogenous" post-mortem GHB concentrations, this paper proposes a potential microbial production of GHB with time.     

APM染色法在羊水栓塞诊断中的应用价值

目的　探讨APM染色法在羊水栓塞 (AFE)病理学诊断中的应用价值。方法　采用APM染色法对 1988年至 2 0 0 1年确诊为AFE的 19例病例 (AFE组 )和羊水吸入性肺炎的胎儿 3例 (阳性对照组 )、其它死因的 10例产妇 (阴性对照组 )重新进行染色和组织学检查 ,对其检验结果进行比较分析。结果　阳性组全部检出羊水成分 ,阴性组部分病例检出羊水成分 ,发现漏诊、误诊各 1例。与HE染色相比较 ,APM染色能提高角化上皮和粘液的检出率。结论　APM染色能提高羊水成分的检出率 ,有助于提高AFE诊断的准确性 ,可用于AFE病理学诊断。     

The effect of conditions of putrefaction on species determination in human and animal teeth

Tooth fragments freshly extracted from humans and rats were stored at either 4 degrees C or room temperature in dry or humid conditions for periods ranging from 1 to 6 months. The fragments were reduced to powder and antigens were extracted. Comparison of these samples was carried out using Counter Current Electrophoresis. Extracted sera were tested against known specific antisera and resultant precipitin reactions stained for examination. Correct species identification was possible both from desiccated and humid fragments but there was species variation in the sensitivity of the method. All the extracts from human teeth were positive against human antisera. In the rat some test specimens were initially negative but became positive following further dilution of the extracts.     

Toxicologic survey of findings in putrefied corpses. Corpse putrefaction in air

Autopsies were conducted on 234 putrefied corpses (exposed to the air, not buried) at the Institute for Forensic Medicine of the University of Hamburg from January 1979 to May 1983. Estimating the time it had taken to reach the respective degree of putrefaction was almost impossible. Only anamnestic clues provided evidence to ascertain the approximate time of death (between 3 days and 46 months ago). The cadavers were found in different locations: outdoors, inside heated or non-heated rooms. Some corpses wore clothes; others were naked; some were covered with blankets or other material. Chemicotoxicological analyses consisted of routine methods and additional modern sophisticated techniques: capillary gas chromatography, combined GC/MS, infrared spectrometry, radio- and enzyme-immunological tests. In organ specimens and body fluids of 47 corpses organic medicaments or poisons could be detected. Nearly all of these 47 forensic autopsies were carried out by request of the legal authorities to rule out legal intoxication as well as the influence of illegal drugs or medicaments. Unlike 20 years ago, today it is possible to detect and quantify organic drugs and poisons as well as their metabolic products, especially minor or major tranquilizers or barbiturates, in highly putrefied specimens. In spite of analytical progress, interpretation of some chemotoxicological results remains difficult. Poor anamnestic data provide insufficient clues. Therefore, pathologicoanatomical and histological results have special significance for the final conclusions. Good cooperation between the pathologist and toxicologist is one of the imperative prerequisites to come to a satisfying result.     

Rates of putrefaction of dental pulp in the Northwest coast environment

Cytological stability is of interest to criminal investigators in instances where remnants of soft tissue have been preserved, since such tissue can aid in the identification of human remains, helping to determine either the sex of the individual or his or her identity. This study based on seven experiments shows that, in Northwest coast outdoor environments in both summer (three experiments) and winter (three experiments), the stability of dental pulp nuclei ranges from 4 days to 2 weeks. The seventh experiment serves to describe the morphological sequence observed in nuclear putrefaction. The specimens included human and pig extracted teeth and unextracted pig teeth. Deposition of the specimens was made both on the surface and in the subsurface (30-cm depth), and the environmental variables were recorded.     

Identification and significance of delta-aminovaleric acid in putrefaction materials (author's transl)]

During former putrefaction experiments regularly a proteogenic substance has been found which by means of modern analytical methods now was identified as delta-aminovaleric acid (DAVA). DAVA seems to appear in guinea pig as well as human organs and some body fluids under experimental conditions never before the 3rd (20 degrees C) to 5th day (10 degrees C). It is characterized by statistically significant increases until the end of the 2nd (20 degrees C) to 5th week (10 degrees C) and relatively stable values thereafter. Considering storage temperature measurement of DAVA concentration can be of relevance for the estimation of the time of death in cases of putrescent corpses.     

The significance of blocked arteries in the pathogenesis of hemorrhages and of minor hemorrhagic infarctions in the human lung in fat embolism (author's transl)

The significance of blocked arteries with regard to minor hemorrhagic infarctions in the lung in venous and systemic fat embolism is discussed. In an experiment it is proved that blood in the anastomoses between the arteria bronchialis and arteria pulmonalis (blocked arteries) contains fat emboli. It is suggested that these fat emboli may in addition be transported into an area of the lung, which is no longer functional following embolic occlusion of a branch of the arteria pulmonalis.     

羊水栓塞诊断的方法学研究进展及法医学意义

羊水栓塞(amniotic fluid embolism,AFE)是指分娩过程中羊水进入母血循环,引起肺栓塞、休克甚至死亡等一系列严重症状的综合征。目前对于AFE的诊断为排除性诊断,方法缺乏灵敏性和特异性。因此随着以AFE为死因的孕产妇病死率的升高,寻找更精确的AFE诊断方法成为了法医学研究的重点。本文结合相关文献概述了AFE诊断方法的研究进展,希望能为法医学鉴定提供方法学参考。     

Specific features of kidney injuries altered by disease

The degree of development of subcutaneous fat and muscles of the back, filling of the gastrointestinal tract, increase in intra-abdominal pressure, and pathological processes, specifically, cysts, hydronephrosis, tumors, pelvic stones, etc., play a significant role in the development of renal injuries. A case with a kidney rupture resultant from a slight trauma in a 19-year-old soldier is presented. Analysis of nephrectomy, review and intravenous excretory urography, and pathological examination of the removed kidney showed third-stage hydronephrosis. This diagnosis was significant for evaluation of the severity of corporal injuries and for determining the punishment for the guilty subject.     

The use of casts in studying stab-cutting wounds of the lungs

Possibilities of using casts of wound canals after organ stretching and fixation for determination of type of instrument used in case of stab-cut lung injuries were studied. In 70% of cases it was possible to make a conclusion on type and some parameters of cutting surface of an instrument used.