Pathomorphological study in craniocerebral injury

Time course of the posttraumatic process in craniocerebral injuries is analyzed. Pathomorphological picture of changes in soft tissues of the head, meninx, and brain matter are described. Several periods are distinguished. Factors affecting the course of the posttraumatic process in the above-mentioned structures are discussed.     

家兔颅脑钝性损伤模型的建立

目的采用撞击器模拟棍棒形成的颅脑损伤,建立颅脑钝性损伤动物模型。方法 26只大白兔分为重度损伤组(10只)、轻度损伤组(10只)和对照组(6只),采用第三军医大学设计的Ⅱ型卧式生物撞击器,撞击参数设置为重度损伤:550k Pa/cm2,轻度损伤:450k Pa/cm2,撞击深度(10mm)。撞击后在相同时间内,观察各组家兔临床症状和体征、解剖学及组织病理学变化,组间进行比较。结果对照组未见明显的病理变化。轻度致伤组除轻度的皮下出血、蛛网膜下腔出血、线性骨折外,未见其它损伤,符合AIS评分轻度损伤标准(≤2分)。重度致伤组有明显的骨折、脑挫裂伤和颅内出血,符合重度损伤标准(≥4分)。轻、重度致伤组都未见明显的皮肤挫裂伤。结论本实验建立的重度和轻度损伤模型差异明显,且符合相关标准,该动物模型可以应用于相关研究。     

一例复杂颅脑损伤原因分析

在检案中单纯性的外伤打击致颅脑损伤死亡的案例判断难度不大,但同时伴有摔跌或从车上坠落的情况则不易分析,现报告一例:     

一例复杂颅脑损伤原因分析

在检案中单纯性的外伤打击致颅脑损伤死亡的案例判断难度不大，但同时伴有摔跌或从车上坠落的情况则不易分析，现报告一例：案情：1997年4月2日，甘某在公共小汽车上因车价与司乘人员发生争吵，后从车上坠落地面路肩即昏迷（车速约20公里）送医院抢救无效于6日死亡。因当时无其他乘客，由此引发双方在死者属于跳车和被推下车之间的争论。检验情况：头顶、枕部头皮和腰骶部共有4处条形皮下出血：6．0×4．0、8．0×5．0、15×4．5、9．0×4．5厘米，其中头枕部皮下出血区内夹杂有不规则形的小点片状挫擦伤。双肘伸侧、左腕和左掌背侧有多处轻…     

Difficulties in forensic medical evaluation of some forms of craniocerebral injury

Conclusions of 41 repeated expert evaluations of craniocerebral injuries within the framework of criminal and civil cases investigation are analyzed. Some aspects of clinical and forensic medical diagnosis of lethal and nonlethal injuries to the head, evaluation of the quality of medical care, and qualification of the severity of harm to health are discussed. Causes of typical expert errors and approaches to their prevention are shown.     

Modern aspects of forensic medical diagnostics of the craniocerebral injury

The authors report the results of the investigations of craniocerebral injuries (CCI) including crystallographic studies of brain liquor obtained after the injury and non-traumatic pathological processes. The additional forensic medical criteria for the severity of craniocerebral injuries have been developed and the objective signs of CCI determined to be used for diagnostic purposes in the cases with concomitant diseases and also in the subjects of advanced and declining age. The diagnostic methods for the elucidation of the nature of chronic subdural hematomas and the estimation of the time of their formation have been improved.     

闭合性弥漫性脑损伤早期病理变化的实验研究(Ⅱ)

四、闭合性弥漫性脑损伤病理学变化的发生机制关于DAI发生的机制，认识尚未统一。普遍为学者们接受的机制是由于外力直接作用，神经组织损伤后继发的改变和损伤后修复反应等诸多因素共同介入的结果。1．Holbourn（1943，1945）[57]指出头颅遭受外力打击引起脑损伤的机理，主要是由于旋转加速力（rotationalaccelerationforces）和相伴随的剪切力（shearstrains）作用于不可压缩的、易变形的脑组织，导致神经纤维、血管和突触等结构破坏。被封闭于坚硬的颅骨内的脑组织，对外力反应的唯一方式就是通过滑动和旋转运动发生扭曲变形，导致脑损…     

闭合性弥漫性脑损伤早期病理变化的实验研究(Ⅱ)

四、闭合性弥漫性脑损伤病理学变化的发生机制 关于DAI发生的机制,认识尚未统一.普遍为学者们接受的机制是由于外力直接作用,神经组织损伤后继发的改变和损伤后修复反应等诸多因素共同介入的结果.     

Fatal hemorrhage from an isolated scalp injury

By means of 3 casuistics it is illustrated, that fatal bleeding from a single scalp injury can occur under special preconditions. Beside signs of massive loss of blood at the place of discovery and on the corpse, particularly chronic and acute alcohol intoxication with presumably impaired coagulation and prospective anemic history play a dominant role in these courses.     

Crystallographic analysis of liquor for diagnosis and life-time evaluation of craniocerebral injury

Liquor specimens were examined by crystallography in 136 patients with craniocerebral injuries of different severity, hospitalized at the neuroinjury department of Kaliningrad Emergency Hospital and in 12 normal subjects in 1997-1998. The crystallograms were evaluated by a sum of signs, as a result of which specific patterns of colony growth in health and craniocerebral injury of different severity were obtained.     

大鼠机械性损伤后皮下肌肉出血的病理学观察

目的 观察生前机械性损伤后不同时间皮下肌肉出血的病理形态学变化.方法 56只SD大鼠随机分成生前损伤组(48只)、死后损伤组(4只)和正常对照组(4只);生前损伤组按不同时间再分为12组,建立机械性损伤模型;用HE及普鲁干蓝染色法观察皮下肌肉出血的病理形态学变化.结果 HE染色:生前损伤6～24h,损伤区见较多红细胞及...     

Principles of records and coding causes of death as a result of craniocerebral injury

Discusses modern requirements to coding of death causes in cases of craniocerebral injury in accordance with the 10th revision of International Statistical Classification of Diseases and Health-Related Problems (ICD-10). Offers the ways to fill in medical certificates of death with consideration for the items of ICD-10 and classification of craniocerebral injuries.     

Age-specific peculiarities of manifestations of a craniocerebral injury in children and adolescents with a combined blunt trauma

This study was designed to estimate the frequency of head injuries and selected manifestations of craniocerebral traumas in children and adolescents with a fatal combined blunt trauma. It is included 289 cases of death from a combined blunt trauma (101 original observations and data of 188 archival documents). The victims were categorized into 3 age groups. One group was comprised of cases from 0 to 3 years of life, group 2 included children aged from 4 to 11 years, and group 3 those at the age from 12 to 18 years. The age was shown to significantly influence both the frequency of head injuries and their severity. The maximum values of the two variables were recorded in the youngest age group. The frequency of head injuries and the number of selected manifestations of the craniocerebral trauma decreased with age.     

Forensic medical differential diagnosis of craniocerebral trauma in children

It is emphasized that history, complaints, a comprehensive neurological examination, craniography are not often sufficient for differentiation between brain concussion and mild brain contusion in children because of specific characteristics of craniocerebral trauma (CCT) in such patients. To make an adequate forensic medical diagnosis of CCT in children, it is necessary to take into consideration anatomophysiological peculiarities of a child, biomechanical conditions of the brain injury, to apply modern methods of neurovisualization (ultrasonography, computed and MR imaging), to follow up brain function with quantitative electroencephalography. Improvement of differential forensic-medical assessment of CCT severity in childhood should be made according to the principles of evidence-based medicine.     

中空性皮下出血宽度与致伤木棒直径的相关性

目的观察不同直径和不同打击力度的圆柱形木棒对垂直方向打击皮肤所形成的中空性皮下出血形态的相关性。方法采用生物力学击打装置,使用5种不同直径（2.0～4.0cm）木棒,从零递增击打力度（0～2300N）,对活体乳猪背部皮肤进行打击,观察乳猪背部皮肤中空性皮下出血分布范围、色泽及形态特征,并采用SPSS 13．0统计软件对所得数据进行分析。结果中空性皮下出血出现的最小打击力度阈值（230N）,随打击工具直径的增大而阈值增大（230～810N）;同一直径的木棒在不同击打力度下所形成的中空性皮下出血总宽度及中空宽度均没有统计学差异（P〉0.05）。中空性皮下出血的范围随木棒直径的增大而增大（R2=0．953,P〈0．01）;皮下出血总宽度及中空宽度与打击物直径,存在较好的正相关性（R2=0．797,P〈0．01）,符合一元线性回归方程模型。结论本研究可望用于推断垂直打击造成中空性皮下出血的木棒直径的大小,为钝器致伤工具的判断提供初步的理论依据。