急慢性酗酒后脑组织Ngb、Hif-1α表达和Na^＋,K^＋-ATPase活性变化与TSAH的关系

目的探讨急慢性酗酒后脑组织脑红蛋白（Ngb）、缺氧诱导因子1α（Hif-1α）表达和Na＋,K＋-ATPase活性变化及与外伤性蛛网膜下腔出血（TSAH）的关系。方法雄性SD大鼠146只,随机分为急、慢性模型两大组,每组再各分为灌酒打击、灌水打击及单纯灌酒3个组,其中各打击组于最后一次灌胃后2h,用单摆式打击装置制作脑震荡模型;断颈处死大鼠,用免疫组化法观察脑组织Ngb、Hif-1α的表达、用分光光度法检测Na＋,K＋-ATPase。结果急、慢性灌酒打击组TSAH发生率分别为28.6%和82.4%;各灌酒打击和单纯灌酒组Ngb、Hif-1α-IOD值均显著高于各灌水打击组（P〈0.01）;急性单纯灌酒组2-4h Na＋,K＋-ATPas活性明显低于灌水打击组（P〈0.01）;慢性单纯灌酒组2h Na＋,K＋-ATPase活性高于急性灌酒组（P〈0.01）,而低于灌水打击组（P〈0.05）。结论急慢性灌酒后,脑组织Ngb、Hif-1α均呈反应性增强,Na＋,K＋-ATPase活性降低,酒精作用可能参与了TSAH的发生和死亡过程。     

Diagnostic significance of myofibrillar degeneration of cardiocytes in forensic pathology

The incidence of myofibrillar degeneration (MFD) was studied in the following different forensic-pathological diagnostic groups of 25 cases each: acute morphine intoxication, acute carbon monoxide intoxication, hanging, strangulation by hand/ligature, drowning, acute hemorrhagic shock, lethal acute brain injury, explainable death of babies or infants and sudden infant death syndrome, together with 18 cases of intoxication with various drugs. The MFD was demonstrated by the Luxol-fast-blue reaction, with two types of phenomena being differentiated, namely cross-band lesions and diffuse staining. All diagnostic groups included cases of MFD of differing degrees. Cross-band lesions were observed in practically all cases of hanging, strangulation and acute hemorrhagic shock. Diffuse stain was noted particularly in cases of drowning and acute brain injury. The diagnostic significance is discussed.     

缺血修饰白蛋白在急性缺血性心脏病中的法医学应用

目的探讨心包液中缺血修饰白蛋白(ischemia modified albumin,IMA)水平在心脏性猝死诊断中的应用价值及法医学意义。方法应用白蛋白-钴离子结合法检测急性缺血性心脏病组(36例)、急性心肌梗死组(6例)、心肌病组(4例)、对照组(15例)死者的心包液中IMA水平,比较各组之间IMA水平的差异。通过ROC曲线获得最佳IMA水平的截断值以及区分急性缺血性心脏病和对照组的敏感度和特异度。结果急性缺血性心脏病组心包液中IMA水平高于对照组(P0.05);而与急性心肌梗死组、心肌病组心包液中IMA水平比较,差异均无统计学意义(P0.05)。应用ROC曲线分析得出识别急性心肌缺血的IMA的截断值为40.65 U/m L,其诊断急性心肌缺血的敏感度为60.0%,特异度为80.5%。结论心包液中IMA有望作为诊断急性心肌缺血的参考指标,为心脏性猝死的法医学诊断提供客观依据。     

大鼠急性心肌缺血后心肌NF-kB的检测及其法医学意义

目的检测大鼠急性心肌缺血后核因子-kB(NF-kB)在心肌组织内的变化,探讨其在心肌早期缺血死后诊断中的法医学意义。方法30只大鼠随机分为正常对照,缺血0.5h,1h,2h,4h,8h共6组,每组5只建立大鼠急性心肌缺血模型,用免疫组化染色技术(S-P法),观察不同时间缺血心肌中NF-kB阳性着色,并应用图像分析系统进行定量分析。结果大鼠心肌缺血30m in,心肌细胞核出现散在NF-kB阳性染色;缺血60m in,心肌阳性染色细胞核增多;4h达高峰;8h组开始下降;免疫组化染色定量检则的阳性单位:缺血2h、4h、8h分别为20.042±1.084、22.028±3.452和20.524±1.595;正常对照组未见核阳性反应。结论大鼠心肌缺血8h内,心肌细胞核NF-kB阳性染色呈现一定规律性变化,对早期急性心肌缺血的死后诊断具有法医学意义。     

Acute pancreatitis presenting as sudden, unexpected death: an autopsy-based study of 27 cases

Acute pancreatitis represents a spectrum of disease, ranging from a mild, transitory illness to a severe, rapidly progressive hemorrhagic form, with massive necrosis and mortality rates of up to 24%. The reported incidence of acute pancreatitis diagnosed first at clinicopathologic autopsy ranges between 30% and 42%. To better describe outpatient fatalities due to acute pancreatitis that present as sudden, unexpected death, we retrospectively reviewed the autopsy files at the Institute of Legal Medicine, University of Hamburg, Germany, from 2000-2004. Individual cases were analyzed for sex, age, race, circumstances of death, social background of the deceased and previous medical history, seasonal occurrence of the disease, blood alcohol concentration at the time of death, body mass index, autopsy findings, histopathology, and etiology of acute pancreatitis. Among the 6178 autopsies carried out during the 5-year period evaluated, there were 27 cases of acute pancreatitis that presented as sudden, unexpected death. In all cases, the diagnosis was first made at autopsy. The male:female ratio was 1.7:1 and the mean age was 52 years (range, 30-91 years). Etiologies of acute pancreatitis included alcohol (n=19), gall stones (n=2), other identified etiologic factors (n=3), and idiopathic (n=3). Complications of acute pancreatitis included lung edema and/or acute respiratory distress syndrome, peritonitis, disseminated intravascular coagulation, and sepsis. At least 20 subjects (74%) had lived isolated, with no social contacts. Contrary to the clinical observations of a clear seasonal variation in the onset of acute pancreatitis, we found no correlation between death due to acute pancreatitis and a specific month or season. Many prior studies have suggested that the majority of deaths in severe acute pancreatitis occur in the late phase of the disease as a result of pancreatic sepsis. Conversely, in the present study, the majority of affected individuals died during the very early phase of the disease. While gallstones represent the main etiologic factor in most larger clinical series, biliary etiology seems to play only a minor role in outpatient deaths undergoing medicolegal autopsies. Data derived from medicolegal autopsy studies should be included in future population-based studies of acute pancreatitis.     

急性心肌梗死时人心脏房室结细胞糖蛋白表达

目的观察急性心肌梗死时心传导系统糖蛋白表达。方法运用花生凝集素(PNA),对8例急性心肌梗死亡者的心传导系统标本进行亲和组化染色。结果PNA有7例呈现强阳性,1例出现弱阳性。结论房室结传导细胞在缺血时细胞膜表达PNA受体,提示急性心肌梗死时房室结细胞和工作心肌都不同程度受累,并且细胞病理改变机制可能相关或类似。     

Diagnostic role of acute microscopic changes in myocardium

Forensic medical diagnosis of death from coronary heart disease, acute ethanol poisoning, alcoholic cardiomyopathy, closed cardiac injuries, mechanical injuries incompatible with life which may be directly caused by acute cardiac failure, requires identification and evaluation of diagnostic complexes of acute myocardial changes. The diagnostic significance of such complexes of myocardial changes is characterized for the first time. A method for evaluation of such changes, addressed to expert histologists, is presented.     

Diagnostic criteria in acute ethanol intoxication as cause of death

There are described, in the paper, morphological, chemical and biochemical signs in acute alcoholic intoxication. A complex approach is suggested to diagnosing an acute alcoholic intoxication as death reason.     

甲基苯丙胺和乙醇在染毒大鼠体内联用的实验研究

目的研究甲基苯丙胺（MA）和乙醇联合应用在急性、亚急性染毒大鼠体内的情况。方法以MA1.0 mg/kg剂量对慢性自由饮酒大鼠多次腹腔注射,分别建立急性、亚急性染毒大鼠模型;处死后即时检测血中乙醇浓度、体液和组织样品中MA的浓度。结果多次注入MA药后,亚急性中毒大鼠体内的MA浓度高于急性中毒大鼠;急性和亚急性联合中毒大鼠体内MA浓度均高于急性和亚急性单一药物组。结论无论是否联用乙醇,14d内增加注射次数会在大鼠体内产生不同程度的MA残留;与乙醇联用可加速MA在大鼠体内的吸收,其药物浓度的升高程度随生物样品不同存在差异。     

急性坏死性胰腺炎与死后胰腺自溶病理形态学变化

目的比较大鼠急性坏死性胰腺炎（acute necrotizing pancreatitis,ANP）与各种急性死亡大鼠死后48h胰腺的病理形态学变化,探讨两者的鉴别点。方法参照文献制作ANP和电击、机械性窒息（勒死）、急性毒鼠强中毒动物模型,采用半定量评分和图像分析定量分析,观察死后48h胰腺大体和光镜下组织病理变化。结果ANP组炎细胞浸润、脂肪坏死、钙沉积3项与其他组相比有显著意义（P〈0．05）。结论炎细胞浸润、脂肪坏死、钙沉积是ANP在普通光学显微镜下最重要的特异性形态学病理变化,对区别其他急性死亡和死后自溶胰腺有特别重要意义．     

家兔急性心肌梗死CTnI免疫组织化学实验研究

目的研究CTnI诊断急性心肌梗死的法医病理学意义。方法结扎兔心脏左冠状动脉左旋支的左室支制作心肌梗塞动物模型。应用免疫组织化学法检测心肌梗塞区域CTnI的变化,与HE染色法进行比较。结果早期心肌梗塞组织,HE染色组尚未出现特征性梗死表现,免疫组织化学染色法可见CTnI分布以及含量变化,并且随着时间延长,变化区域扩大,且近心内膜心肌细胞同时出现变化。结论CTnI免疫组织化学检测可以应用于急性心肌梗死的诊断。     

Posttraumatic acute cholecystitis. Relationship to the initial trauma

Posttraumatic acute cholecystitis is an often unrecognized and potentially fatal complication seen among patients hospitalized for trauma, and differs in etiology from cholecystitis which develops de novo. The cause, although not yet clearly defined, is believed to be related to bile stasis, ischemia, bacterial infection, sepsis, the activation of factor XII, and the Shwarzman reaction. A case is described in which a 53-year-old man with pelvic fractures developed acute acalculous cholecystitis and died of multiple organ failure 3 weeks following cholecystectomy. The histopathological findings are also reported; these are most likely attributed to the Shwarzman reaction or the activation of the factor XII pathways. There has been a tendency to regard posttraumatic acute acalculous cholecystitis as induced by trauma, and calculous as mere coincidence. We believe, however, that it is not calculous but histopathological findings that determine whether acute cholecystitis following trauma was more than coincidence or just mere coincidence. Although progress in clinical care has improved the chances of survival of severely traumatized patients, posttraumatic acute cholecystitis has been increasing in frequency. We cannot be careful enough in judging the relationship of this fatal complication to the initial trauma.     

Under-recording of ethanol intoxication and poisoning in cause-of-death data: causes and consequences

In the present study we examined how consistently and completely the role of acute alcohol (ethanol) intake as a cause of death is reported on death certificates, how complete and specific the statistical recording of cause-of-death data on acute alcohol-induced deaths is, and how the information ultimately appears in the national mortality statistics. Data on all alcohol-positive deaths with blood alcohol concentration of ≥ 0.5‰ (g/kg) in Finland in 2005 (N = 2348) were reviewed. Overall, a concentration-dependent association was found between forensic-toxicologically determined blood alcohol concentrations and acute alcohol-specific cause-of-death diagnoses. Based on a medico-legal re-evaluation of death certificates, acute alcohol-specific causes were found to be underreported nationally at a rate of 8%. For accidental alcohol poisonings alone, the figure was about 1%. This underreporting was not corrected during recording of the cause-of-death data, though individual corrections and changes were observed. Especially, recording of multiple causes suffers from this underreporting of acute alcohol-specific causes. ICD-10 seems to do well in fulfilling the demands for a specific classification of uncomplicated alcohol poisoning. In combined alcohol-drug poisonings, however, ICD-10 shows a bias towards drugs over alcohol, even when alcohol has been specified and reported as the most toxic component by the medico-legal pathologist. Since the national statistics is based on the underlying causes, this state of affairs is likely to result in the underestimation of the role of acute alcohol intake as a cause of death. This observation of underreporting of acute alcohol-specific causes on death certificates should result in a harmonisation of education and principles and practices used in death certification. To increase the coverage and specificity of mortality statistics, based on the underlying causes of death, the coding of all components of alcohol-drug combinations and their classification according to the most important intoxicant or combination of intoxicants is recommended.     

Acute Poisoning Types and Prevalence in Shanghai,China, from January 2010 to August 2011

In recent years, the number of cases of acute poisoning has increased in China, yet; currently, there is no detailed report published that addresses acute poisoning in the mainland of China. We collected biological samples from 466 cases of suspected acute poisoning at the hospitals in Shanghai, China, and examined them using spectroscopy, chromatography and chromatography/mass spectrometry. Of the 466 cases, 230 cases (100 men and 130 women) were positively confirmed as acute poisonings. There were 80 types of compounds identified in this study. Medications were the most frequent substances identified, and the other substances included pesticides, multiple compounds, volatile compounds, natural toxins, and others. The results of this study indicate a need for strengthening the education about and management of the rational and safe use of drugs in Shanghai.     

Sudden death of an alcoholic elderly man with acute esophageal necrosis (black esophagus)

We report a fatal case of acute esophageal necrosis (black esophagus) in an elderly male with alcohol abuse who was found dead with coffee-ground vomiting. A postmortem examination revealed severe anemia and marked black coloring of the esophagus from the upper to the bottom end. This was accompanied by histologic evidence of extensive mucosal necrosis. Alcohol abuse and esophagitis-related vomiting were both considered to be factors that led to the acute fatal esophageal necrosis. The cause of death was undetermined. We discuss the possible role of acute esophageal necrosis in the cause of sudden death.     

Morphological changes in the lungs in chronic drug addiction

Morphological studies of the lungs and immune system organs were made in drug addicts with narcotic intoxication. Depletion of the central and peripheral lymphoid organs was found in most cases. It is shown that morphological changes in the lungs in acute and (or) chronic narcotic drug intoxication, the rate of acute and chronic inflammatory lung diseases reflect development of lung inflammation in the presence of aquired immunological deficiency in terminal chronic drug abuse. The documented features of different pathological processes in the lungs can improve diagnosis of acute and chronic drug intoxication by results of section and histological examinations.     

Acute selenium poisoning: suicide by ingestion

Selenium is a ubiquitous element in the environment essential to the human diet and widely utilized in industrial processes. Fatal human selenium intoxication is rare. The authors report a case in which investigators recovered a bottle of gun-bluing agent beside a 24-year-old man. He exhibited signs and symptoms typical of acute selenium intoxication presenting with nausea and vomiting, followed by pulmonary edema and rapid cardiovascular collapse approximately 3 to 4 h after ingestion. Classic electrocardiographic (EKG) changes, which have been reported to occur in acute selenium intoxication, included sinus tachycardia with ST wave alteration. Toxicological results confirmed elevated blood and tissue concentrations. The cause of death was ascribed to acute selenium intoxication, which ensued rapidly after oral consumption. The manner of death was suicide. This case report, which presents an overview of acute and chronic selenium poisoning, underscores the value of thorough toxicologic analyses of tissue and body fluids in humans.     

Microscopic lesions of the myocardium in acute coronary heart disease

A statisticomathematical analysis of microscopic changes in the myocardium has established pathognomonic and differential-diagnostic morphological signs for diagnosis of acute ischemic heart disease--acute coronary failure and acute myocardial infarction at the prenecrotic stage. The results of chromotrop 2B water blue staining of histological preparations and polarization microscopy were compared.     

Sudden unexpected natural death in young persons

In a series of 1920 medico-legal autopsies, 78 cases fulfilled the criteria of sudden unexpected natural death in the age group 2-30 years. In 39 (50%) of these cases a health hazardous condition was known. A large group included epileptics, alcoholics, obstetric/gynecologic conditions, and drug addicts. For prophylactic reasons the medical intervention should focus on earlier detection, if possible, of acute myocarditis, better instruction to epileptics as to thorough medication and information of parents. Physicians should be reminded about the danger of inflammatory processes in the upper respiratory tract, especially acute tracheobronchitis and acute epiglottitis.