丙泊酚麻醉相关死亡的法医学鉴定探讨

收集中山大学法医鉴定中心2018-2020年死亡原因鉴定为丙泊酚麻醉不良反应致死案件5例,通过分析其临床诊疗经过、发病症状及法医学病理学检验结果,总结归纳此类案件的一般特点,并探讨丙泊酚麻醉相关死亡的死亡机制和病理学特征,以期为相关患者的临床治疗及死亡病例的法医学鉴定提供参考.     

癫痫持续状态死亡法医学鉴定1例

<正>1案例1.1简要案情赵某,女,33岁,某日晚与宋某入住宾馆。期间二人发生性关系。00:00,赵某反复出现四肢抽搐、口吐白沫及气喘症状,宋某认为其可自行恢复,故在其发作期间未采取任何救助措施。赵某在症状发作间歇期持续昏迷,于当日17:00死亡。经查赵某生前无颅脑外伤史,有癫痫病史5年余,规律服用抗癫痫药物(奥拉西坦片、左乙拉西坦片、奥卡西平片),死亡前2 d自行停用抗癫痫药物。     

斑蝥中毒死亡法医学鉴定1例

1案例资料丁某,女,28岁,患颈部淋巴结肿大3年余。用偏方治疗:将鸭蛋钻孔,放入5～7个斑蝥虫粉末,置一盛有大米的碗内蒸熟后食用,每日服1枚,连服4枚为一疗程。2004年4月9日下午开始服1枚鸭蛋,当晚感全身不适,头痛、腹痛、腰痛,伴恶心呕吐,呕吐物带血,尿发红。次日问“医者”,“医者”称系用药后正常反应。4月10日上午又服1枚,上述症状加重,并伴有发热、大便带血、尿血。4月11日上午再服1枚,下午病情更为加重,送当地医院救治无效于当日下午4时许死亡。4月12日上午对尸体进行检验。尸体检验尸僵较强,尸斑呈暗紫红色,角膜透明,结膜未见出血点,双…     

毛霉菌性肺炎死亡法医学鉴定1例

1案例资料1.1案情简介吴某,男,32岁。某年8月30日晨10时,被发现死于住房内。生前患肺结核,进行了一段时间治疗,但仍有低热、乏力、咳嗽、咯血症状。死前症状不明。1.2尸体检验尸表检验死后3d进行尸检。尸长171cm。营养差,呈极度消瘦状。前额处有3处片状擦伤,大小分别为3cm×1.7     

爆发性1型糖尿病死亡的法医学鉴定1例

<正>爆发性1型糖尿病(Fulminant Type 1 Diabetes,FT1DM)急性起病,病情凶险,预后极差,病死率较高。本文报道1例爆发性1型糖尿病酮症酸中毒死亡的案例,以期为临床诊治及法医学鉴定提供一定经验。1案例资料1.1简要案情及病史摘要刘某,女,28岁。因“口渴、多饮、恶心、呕吐加重伴心累2 d⁺”入院治疗,入院前2 d⁺无明显诱因出现口渴、多饮、恶心、呕吐,进食差于外院就诊,考虑“急性胃炎”,对症治疗后无明显缓解。1 d前于该院就诊,予以对症支持后症状仍缓解不明显。2 h⁺前患者感上述症状加重,伴心累、心悸、意识障碍急诊入院。急诊指尖血糖HI,血酮：4.8mmol/L,pH:6.97,PCO₂:2.9 mmHg,HCO₃^-:3.1mmol/L,血糖：47.33 mmol/L,果糖胺：3.65 mmol/L,HbA1c:6.8%,血钾：5.37 mmol/L,血钠：126 mmol/L,血氯：90.82 mmol/L。入院诊断...     

钩吻中毒死亡法医学鉴定1例

<正>1案例1.1简要案情王某,女,74岁,某年9月16日,购买中草药“红木香”熬成汤药后与其丈夫陈某一起服用。约10 min后王某出现头晕、昏迷,经送医院治疗后一直处于植物生存状态,直至次年5月13日死亡。陈某在送院途中发生抽搐,经治疗后好转并出院。     

高坠案件法医学鉴定分析1例

正1案例资料1.1简要案情及现场勘察王某,女,25岁。某年8月5日凌晨1时许,与情人白某争吵后从宾馆三楼坠楼身亡。现场位于一临街宾馆三楼房间,房间内柜子及内窗台放有盛满啤酒的瓷杯及塑料杯、矿泉水、啤酒瓶等,室内未见明显搏斗痕迹。内窗台高89cm,窗外墙壁瓷砖上有"X"形擦痕。窗户下方为人行道,有血泊形成。1.2尸体检验尸表检验额部有星芒状创口,创口中心区软组织挫碎,创周片状擦挫伤。眼睑青紫肿胀,左眼     

32例妊娠期死亡法医学病理学研究

目的 探讨妊娠死亡的特点。方法 对1990－2000年华西医科大学法医学院所做32例妊娠死亡尸检病例进行分析。结果 妊娠产妇死亡年龄以25－30岁为多见,职业以农民常见,且绝大多数无产前检查记录,死亡多发生于分娩过程中,区、乡一级卫生院出发。前四位的死因依次为：胎盘残留、输卵管妊娠破裂、产后感染和子宫血管结扎出血,绝大多数妊娠产妇死亡前产下活婴。结论 有必要加强基层与农村医疗保健工作和制订有关的预防措施,以降低妊娠产妇的死亡率。     

监管场所25例非正常死亡的法医学分析

目的通过对监管场所非正常死亡案例进行筛选、收集,分析其影响因素及法医学特点。方法收集某鉴定中心2000—2015年间受理的监管场所在押人员非正常死亡案例25例,从性别、年龄、历年发案数、死亡原因、死亡方式等方面分析其特征,并对公安类监管场所和监狱类场所的案件性质进行对比。结果涉案死者均为男性,中青年人群为高危人群,历年发案数量呈逐年下降趋势。公安类监管场所的伤害案件发生率(64.7%)大于监狱类场所(12.5%),而监狱类场所的自杀率(62.5%)高于公安类(23.5%)。死亡原因以损伤和窒息为主,其他还有中毒和电击等。结论监管场所非正常死亡案件暴露出执法不规范、监管有漏洞、医疗水平差等问题。进行全面、细致的尸体解剖对于查明此类案件的死因有重要意义。     

脑组织与法医学死亡时间推断

目前,通过脑组织推断死亡时间已经成为法医学领域研究的新热点,大量研究资料表明：死亡时间与脑组织细胞DNA、RNA、ATP含量及脑温度、脑组织血管内皮生长因子等变化有高度相关性。脑CT、MRI、磁共振波谱等检查手段对死亡时间的推断也有帮助。本文对国内外相关文献进行综述,以期为相关研究提供参考。     

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].     

178例心源性猝死法医组织病理学诊断分析

目的探讨心源性猝死(SCD)的病理特点与鉴别要点。方法对四川华西法医学鉴定中心2000—2005年尸检出的178例SCD死亡案例进行回顾性分析,主要对其病因、年龄、诱因及病理改变进行分析。结果本组资料显示冠心病、心传导系统病变、心肌炎、心肌病等在SCD中占有较大比例。冠心病猝死是中老年人SCD的最主要原因,青壮年人SCD的病因以非冠心病为主。如传导系统病变、心肌炎、心肌病。在儿童的SCD中先天性心脏病、传导系统病变及心肌炎占主导地位。结论不同的病因,其病理特点不同,其病理变化是法医学鉴定的主要依据。     

低钾型周期性麻痹猝死16例法医学分析

目的 探讨低钾型周期性麻痹猝死案例的法医学鉴定要点.方法 对中山大学法医鉴定中心2004～2010年间受理的16例低钾型周期性麻痹猝死案例进行回顾性分析.结果 16例案例中以20～39岁男性多见,平均年龄(35.12±8.54)岁;血清钾平均水平(2.29±0.60) mmol/L.结论 低钾型周期性麻痹猝死案例缺乏特异性组织病理学改变,法医学检案中应结合临床实验室检测结果综合评定.     

Sudden cardiac death due to giant cell inflammatory processes

Granulomatous inflammation of the myocardium may occur in a number of systemic disease processes including those with infectious etiologies such as fungal, mycobacterial and parasitic infections, as well as hypersensitivity reactions, and rarely autoimmune disorders. In many of these disorders, giant cells are components of the inflammatory infiltrate. Systemic granulomatous processes of unknown pathogenesis, most notably sarcoidosis, may also be associated with involvement of the myocardium. Occasionally, these disorders are associated with sudden death due to pathologic involvement of the heart. In contrast, giant cell myocarditis, also known as idiopathic myocarditis, a rare, frequently fulminant and fatal disorder of unknown etiology, is isolated to the heart and lacks systemic involvement. This disorder is most commonly diagnosed at autopsy. We present two cases in which sudden death resulted from a giant cell inflammatory process affecting the myocardium. Both individuals lacked antemortem diagnoses and collapsed at their respective places of employment. These cases compare and contrast the clinical and pathologic issues involved in the differential diagnoses of the subgroup of sudden cardiac deaths resulting from giant cell inflammatory processes that affect the myocardium, as well as the value of histologic examination and immunohistochemical studies.     

病毒性心肌炎猝死心肌MCP-1表达及其法医学意义

目的探讨单核细胞趋化蛋白1（monocyte chemoattractant protein-1,MCP-1）在病毒性心肌炎（viral myocarditis,VMC）所致猝死者心肌组织中的表达及其意义。方法运用改良的免疫组织化学方法,观察VMC猝死组和对照组心肌组织中MCP-1的表达情况,应用统计学处理,比较两组间的表达差异。结果20例VMC猝死组中有17例MCP-1染色阳性;而20例非VMC猝死对照组仅4例局部散在MCP-1弱阳性表达,其余均阴性。VMC组MCP-1阳性表达率明显高于对照组（P〈0.01）。结论MCP-1的免疫组织化学检测可作为法医病理学诊断VMC所致猝死较为客观的病理形态学指标之一。     

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.     

Sudden death in infancy due to bicuspid aortic valve

Symptoms of bicuspid aortic valve usually occur in the age group of 50-70 years, but rarely, it can also lead to sudden unexpected death in infancy and early childhood. The autopsy of a 2-month-old baby boy, found dead in his cot, revealed the heart weight as 25 g, and the macroscopic examination showed the circumference of the aortic valve consisting of two leaflets as 8 mm. The thickness of the left ventricle, right ventricle, and septum was measured as 8, 7, and 10 mm, respectively. Microscopically, the heart revealed hypertrophic changes of myocytes. Subendocardial areas displayed necrosis of myocytes, and severe and diffuse ischemic changes characterized by loss of myofibers and vacuolization. Interstitial pneumonia was identified in the lungs. Death occurred as a result of a congenital bicuspid aortic valve obstructing the left ventricular outflow tract complicated by lung infection. As there are only a few reported cases in infancy, and congenital bicuspid aortic valve can lead to sudden unexpected death, this case is presented to the forensic community.     

Sudden death due to an unrecognized cardiac hydatid cyst: three medicolegal autopsy cases

Echinococcosis is a human infection caused by the larval stage of Echinococcocus granulosus. The most common sites of infection are the liver and the lungs. Cardiac hydatid cysts are very rare, even in regions where hydatic cysts are endemic (the Mediterranean, South America, Africa, and Australia). It has been reported that cardiac involvement is seen in about 0.5-3% of human echinococcosis cases. Three cases of cardiac hydatid disease that caused sudden death and which were histopathologically diagnosed are reported. Cardiac echinococcosis is rare, but due to its insidious presentation and affinity to cause sudden death, it is important that it be identified in the histopathological examination.     

Megaesophagus and Possible Mechanisms of Sudden Death

Abstract:  Achalasia is a neurodegenerative condition characterized by esophageal dysmotility and megaesophagus. Two cases are reported that demonstrate unexpected deaths associated with previously unsuspected achalasia. Case 1: A 66-year-old woman was found dead at her home. At autopsy significant stenosing coronary artery atherosclerosis was found with cardiac failure. In addition, a striking finding was narrowing of the distal esophagus with marked proximal dilatation. The esophagus was completely filled with a large amount of soft masticated food and was bulging anteriorly, compressing the left atrium. Death was attributed to ischemic heart disease complicated by previously unsuspected achalasia. Case 2: An 84-year-old man collapsed and suffered a respiratory arrest while eating. Internal examination revealed narrowing of the cardioesophageal junction with marked proximal dilatation of the esophagus that contained approximately 50 mL of soft semi-fluid masticated yellow food paste. Fragments of yellow masticated food remnants were present in upper and lower airways but not within the stomach. There was a history of dementia with symmetrical cerebral ventricular dilatation found at autopsy. Death was attributed to food asphyxia complicating previously unsuspected achalasia with dementia. Megaesophagus may, therefore, be a significant finding at autopsy that may either be a primary cause of unexpected death or else may exacerbate or compound the effects of pre-existing underlying disease.     

Sudden and Unexpected Death in Three Cases of Ehlers‐Danlos Syndrome Type IV*

Abstract: Ehlers–Danlos syndrome (EDS) type IV is a connective tissue disorder characterized by the inability to produce sufficient amounts of collagen or a defect in the structure of collagen. The most serious complications include a rupture of a viscus or vascular rupture with or without mural dissection. Death may result from internal hemorrhage. This report describes three cases of sudden and unexpected death caused by EDS type IV. Two cases involved hemothorax as a result of dissection of the subclavian artery and aorta, respectively. The third case represented spontaneous pulmonary rupture and hemorrhage. A detailed family history should be sought, and additional specimens collected to confirm the diagnosis, including skin fibroblasts for collagen testing and blood for DNA testing. The forensic pathologist should consider the possibility of EDS type IV upon discovery of spontaneous visceral or arterial rupture and should alert the family members of this hereditary and potentially fatal condition.