132例自发性脑出血死亡分析

<正> 作者收集了132例自发性脑出血死亡案件资料,并自发性脑出血的死因鉴定,从发病情况、临床表现、临床检验等结合法医病理进行综合分析,可望为脑出血死亡的法医学鉴定和临床确诊提供参考。1 临床资料本组132例中男性87例,女性45例。年龄分布22～86岁,平均年龄59.5岁,其中50～59岁43例,60～69岁65例,70～79岁24例。发病季节多见于1～3月(38例)和10～12月(44例)。发病诱     

利多卡因过敏性休克致死8例

1　案例资料2 0 0 3年 3～ 7月受理 8例手术中局部麻醉注射盐酸利多卡因死亡的法医学鉴定案例。男性 3例 ,女性5例 ,除 1例男性年龄为 6 6岁外 ,7例平均年龄为 34岁。1 1　临床资料8例均为手术中死亡 ,其中用利多卡因作表面麻醉 4例 ,传导麻醉 3例 ,硬膜外麻醉 1例。除硬膜外麻     

7例小脑出血猝死的报告

小脑出血约占脑出血的10％[1]。有人总结国内6篇报告共20例，仅发现1例为生前诊断，说明临床上误诊率甚高[2]，尤以猝死为主要表现者。为进一步探讨小脑出血病因和猝死机理，现将我们所见7例分析报告如下。材料和方法收集本教研室1955～1989年全部尸检材料，发现因小脑出血猝死者共7例，对其脑标本均作全面详细复查，并在其出血部位及附近取材，石蜡包埋，切片后HE染色镜下观察。结果7例小脑出血所致猝死者的临床病理资料见表。讨论小脑出血，或称自发性小脑出血，是指出血原发于小脑，不包括外伤、肿瘤、感染、中毒等引起的出血[3]。临床…     

广东省6～15周岁汉族人牙龄的研究

目的研究广东省6～15周岁人群牙齿钙化的规律,建立根据牙齿钙化程度推断未成年人年龄的方法。方法观测2 710例（男性1 363例,女性1 347例）广东省6～15周岁汉族人全口曲面断层影像片,对其下颌牙齿钙化程度进行评分分级,所得数据经SPSS软件统计分析,建立根据牙齿钙化程度推断年龄的方程,并以100例（男60例、女40例）研究外样本进行盲测。结果数据统计显示,两侧同名牙钙化评分分级值的差异无显著性意义（P〉0.05）,而性别间差异有显著性意义（P〈0.05）;下颌单侧8颗牙齿的钙化评分分级值与年龄相关系数（r）女性为0.552～0.759,男性为0.672～0.838;所建回归模型拟合优度（R2）均在0.7以上,估计值标准误男性为0.91～1.11岁,女性为0.92～0.98岁;盲测推测年龄与真实年龄平均误差男性为0.429±0.282岁、女性为0.399±0.252岁。结论本研究所建方法推断结果准确可靠,可用于广东地区6～15周岁人群年龄推断。     

四川汉族青少年肘关节数字X线影像骨龄特征研究

目的观测四川地区青少年肘关节数字X影像的骨发育特征规律,建立肘关节推断年龄的回归方程。方法拍摄608例8～18岁青少年进行肘关节数字X线片,按性别及年龄分组,选取肘关节6个骨化中心作为观测指标,对发育特征进行分级、赋值。采用SPSS 15.0统计软件对各观测值进行描述性统计学分析,建立推算年龄的回归方程。结果得出男女性青少年肘关节继发骨化中心出现、闭合的年龄范围、平均年龄以及95%置信区间等数据。一元回归方程的复相关系数(R)范围:男性0.874～0.914,女性0.883～0.954;年龄估计值标准误(SE)范围:男性0.934～1.101岁,女性0.561～0.883岁;多元回归方程R值及SE值:男性为0.946、0.750岁,女性为0.964、0.500岁。所有方程均经统计学检验与诊断,具有较好的适用性。结论本文选择的肘关节指标发育特征与年龄有相关性,其中肱骨内上髁、桡骨小头及肱骨小头骨骺均呈高度显著相关,建立的回归方程可用于相关人群年龄推断,且多元回归方程准确性更高。     

191例眶内侧壁骨折损伤的法医学鉴定分析

1　一般资料笔者收集 1998年至 2 0 0 1年伤害他人身体致眶内壁骨折 191例进行分析。 191例受害人均为男性 ;其年龄分布 :2 0～ 2 8岁 117例 (6 1 3% ) ,2 9～ 4 5岁 6 6例 (34 6 % ) ,4 6～ 5 3岁 8例 (4 1% )。其中以 2 0～ 33岁年龄段较多 ;损伤发生时间均发生在白天和夜间11时之前 ;损伤发生的地点多在公共场所 (集贸市场 ,夜市 ) ,田间地头 ;拳击伤 173例 (90 6 % ) ,脚踢伤5例 (2 6 % ) ,板凳砸伤 6例 (3 1% ) ,啤酒瓶砸伤 6例(3 1% ) ,砖砸伤 1例 (0 6 % ) ;其中左眼损伤 14 0例(73 3% ) ,右眼损伤 5 1例 (2 6 7% ) ;130例均是于…     

10例精神病患者杀人案例分析

近10年来,某县发生了10例精神病杀人案,凶手经精神病院鉴定为突发性、间歇性精神分裂症患者。10例精神病杀人案中死20人,伤6人。笔者试图对这些案例所收集的资料作一分析,探讨精神病患者杀人与一般凶杀案在作案特点上的区别。 1 一般资料 1.1 性别、年龄、职业、文化程度与作案的关系 10例精神病杀人案的精神病患者均为男性,21～30岁4例(40％);31～40岁4例(40％),41～50岁2例(20％)。职业:教师1例(10％),农民8例(80％),工人1例(10％);文化程度:中学3例(30％),小     

胸外按摩致肋骨骨折法医病理学分析

目的　探讨胸外按摩致肋骨骨折特点。　方法　对 1990～ 2 0 0 0年间华西医科大学法医学院所做 30例胸外按摩致肋骨骨折的尸检进行法医病理统计分析。　结果　肋骨骨折男性 2 8,女性 2例 ,年龄为 18～ 6 8岁 ,胸外按摩骨折主要发生在疾病、电击伤、溺死及中毒病例 ,以第 6～ 9肋骨的腋前、中线骨折常见 ,多为左侧。　结论　胸外按摩与外伤所致肋骨骨折具有明显的区别。     

计算机图像分析应用于牙齿推断年龄方程的研究

应用计算机多元逐步回归对567颗中国人牙齿结构变化进行图像分析、分级并对数转换的数据分析，从而推导出利用牙齿推断年龄的方程。根据适用范围和牙齿类型的不同，从实验组得到的利用单颗牙齿推断年龄方程的估计标准误分别为4．8岁～5．4岁；各方程测试于对照组标本时，估计标准误分别为2．9岁～5．4岁。各方程测试于广东法医尸体解剖案例的结果表明，用单颗牙齿推断年龄的估计标准误为3．7岁；测试于广西壮族人案例的结果表明，用单颗牙齿推断年龄的估计标准误为2．6岁。用同一个体多颗牙齿推断年龄的研究结果表明，根据不同的年龄分组范围，利用同一个体2颗牙齿推断年龄的估计标准误分别为0．8岁～2．6岁；同一个体3颗～4颗牙齿推断年龄的估计标准误分别为0．6岁～2．3岁。研究结果表明，如果检材条件许可，采用同一个体多颗牙齿推断个体年龄可明显提高推断年龄的准确性。     

MSCT扫描及图像后处理在难检部位骨损伤鉴定中的应用

1案件简介 收集近2年来笔者存法医门诊中遇到的被鉴定者难检部位疑有骨质损伤17例，其中男性15例，女性2例，男女比例为7．5：1，年龄19岁～72岁，平均年龄为38岁。拳击伤10例，砖石等钝性物体致伤物6例，交通事故1例。导致颜面部致伤8例，     

Mallory-Weiss syndrome as the cause of sudden, unexpected death

The Mallory-Weiss-syndrome is an upper gastrointestinal haemorrhage due to longitudinal mucosal lacerations in the oesophagogastric junction. The mucosal lacerations occur as a sequel of vomiting or any other increase in intraabdominal pressure and account for up to 15% of all upper gastrointestinal bleedings. If death is due to a bleeding Mallory-Weiss-tear, however, massive blood stains on the corpse and around it frequently give rise to the suspicion of an unnatural cause of death. For this reason, autopsy is usually indispensable to elucidate the circumstances in which death occurred. The authors carried out a retrospective analysis of 5958 autopsies performed between 1997 and 2001 at the Institute of Legal Medicine, University of Hamburg, in order to identify all cases of Mallory-Weiss-syndrome as cause of sudden, unexpected death. The results (9 cases, amounting to 0.15% of all autopsies) suggest that Mallory-Weiss-syndrome is probably much more common as a cause of sudden death than previously described. Regarding epidemiological aspects, men clearly predominate; the average age was 48 years. It should also be stressed that in 8 of the 9 cases there was a previous history of chronic alcohol abuse.     

Amount of postmortem bleeding: an experimental autopsy study

An experimental autopsy study was performed on 64 cases (55 male, 9 female; average age 51.5 +/- 16.2 years) of sudden natural (38 cases) and asphyxic deaths (26 cases). The study objective was the amount of postmortem bleeding from postmortem cutting of the thoracic aorta, related to the time since death. The amount of postmortem bleeding ranged from 100 to 1300 cm, 440.6 +/- 268.1 cm on average. The time since death up to the autopsy time ranged from 4 to 72 hours, 19.4 +/- 12.9 in average. A statistically significant correlation between the amount of postmortem bleeding and postmortem time interval was stated: Pearson correlation test value r = -0.461 (P = 0.000): the shorter the time interval, the larger the amount of bleeding. The formula of linear regression was estimated according to this correlation: amount of postmortem bleeding (cm) = -9.571 x time since death (h) + 626.659. This proves that the amount of postmortem bleeding (eg, from aortic blunt rupture) could be about 620 cm.     

Cardiovascular abnormalities in children: a ten-year forensic pathologic study

In order to obtain information on types, incidence, and significance of cardiovascular abnormalities in children, a total of 104 consecutive medicolegal autopsies of children aged 8 days to 16 years during a 10-year period from May 1974 to April 1984 were studied. Extensive histological examination of the hearts was performed in 92 out of 104 cases and complemented with chemical and microbiological analyses. In the natural death group consisting of 53 children, 26 (49%) showed abnormalities: 7 (13%) malformations, 11 (21%) cardiomyopathies, 5 (9%) idiopathic subaortic hypertrophy, and 3 (7%) a heart weight only 50% of the expected weight. In the violent death ("control") group, abnormalities were found in 8 of 39 cases (21%), all of which were cardiomyopathy. Only 5 of 34 cardiovascular abnormalities (every 7th case), all complex malformations, were clinically recognized. In 14 (15%) of the total 92 examined cases the cardiovascular abnormality was the only apparent cause of death, and in 12 (13%) a contributing cause of sudden unexpected natural death, while in 3 (3%) it was related to a fatal accidental injury. In 5 (13%) of the 39 cases of violent death, cardiomyopathy was an incidental finding without any connection to the circumstances or cause of death. The causes of cardiovascular abnormalities were associated with bacterial and viral infections, respiratory disorders, phenytoin sensitivity, or were unknown. Because of the differences in diagnostic criteria employed by previous investigators, it cannot be determined whether the incidence of the cardiovascular abnormalities and sudden cardiac death in children found in this material was higher than in other studies.     

Death during immersion in water in childhood.

Drowning is a relatively common cause of accidental death in children. Autopsy records at the Adelaide Children's Hospital over a 27-year period from 1964 to 1990 were examined, and 58 cases were found where the cause of death was listed as drowning. In six cases, however, careful examination of the history and postmortem findings provided important additional information that suggested a more complex antemortem sequence of events. Specifically, four patients aged between 6 years, 10 months and 11 years were known to have had epilepsy. A further patient, an 8-year-old boy, died from a subarachnoid hemorrhage due to a bleeding cerebral arteriovenous malformation while swimming. The final patient, an 11-year-old boy who collapsed in a public swimming pool, was found at autopsy to have marked hypoplasia of the right coronary artery. In this series, six of 58 (10.3%) of the pediatric cases had additional underlying medical problems that could either have initiated the drowning episode or caused death due to alternate mechanisms. We present the clinicopathological findings in detail to demonstrate that a high index of suspicion must be maintained in all cases of pediatric drowning, not only for unnatural causes of death but also for additional natural disease processes that may have contributed significantly to the fatal episode. These findings may have particular relevance in jurisdictions where full postmortem examination is not always required by law.     

191例急死死因分析

本文对191例急死法医病理检案资料进行统计分析，结果表明急死年龄以15～59岁为多，共154例（占80．63％）。死因以心血管系统疾病为多，80例（占41．88％），但5岁以下以呼吸系统疾病为多；在191例急风中，以冠状动脉疾病最多，共55例（占28．80％），其次为小叶性肺炎21例（占10．99％）和急性出血性胰腺炎（12例占6．28％）。死亡诱因多为纠纷／或轻微外伤87例（占45．55％），另有51例（占26.70％）死前有轻微临床症状体征，经医生诊治用药后很快死亡，从而引发医疗纠纷。     

Stressful events as a trigger of sudden death: a study of 43 medico-legal autopsy cases

The reports relating emotional stress to sudden death are largely anecdotal. In addition to experimental and electrophysiological studies, an opportunity for a better understanding of possible stress-related sudden death (SSD) may be provided by medico-legal autopsies. The goal of our autopsy study was to analyze cardiovascular pathologic findings in cases of SSD and if possible identify mechanisms by which the stressful event (SE) could be the cause. Forty three cases were studied (29 males and 14 females). In all cases, the SE and the death were witnessed. The age range was 22 to 90 years in males (mean, 52) and 30 to 92 years in females (mean, 64). Death occurred in all cases without premonitory symptoms. In 20 cases, death occurred during the SE and in the other 23 cases occurred within 2 h of the event. SE included fear, 15 cases; altercation, 21 cases; sexual activity, 3 cases; police questioning or arrest, 4 cases. According to police reports, in 40 cases (90%), the victims had no previous clinical history of cardiovascular disease. At autopsy, the heart weight in males ranged from 255 to 1000 g with a mean of 517 g and in females the range was 250–700 g with a mean of 417 g. In only 3 cases, gross and microscopic examination of the heart was normal. In 2 of the remaining 40 cases the subjects died of subarachnoid hemorrhage. In 38 cases, a cardiac cause of death was found as follows: coronary heart disease, 27 cases; cardiomyopathy, 6 cases; aortic valvular stenosis, 2 cases and right ventricular dysplasia, 3 cases. A coronary artery thrombosis was found in 8 cases of sudden coronary death. Post myocardial infarction fibrosis was present in 25 cases (92%) of sudden coronary death. In conclusion, it appears from our autopsy study that SSD occurs primarily in those individuals with severe heart disease, especially coronary heart disease.     

Mountaineering fatalities on Mount Rainier, Washington, 1977-1997: autopsy and investigative findings.

Mountain climbing is a popular recreational activity with a growing number of participants and associated fatalities. To define the characteristics of these fatal incidents and the typical autopsy findings in the victims, we reviewed the autopsy and investigative findings of all fatalities that occurred on Mount Rainier from 1977 through 1997. A total of 50 deaths occurred in 29 separate incidents. Fifty-eight percent of accident victims died as the result of a fall; another 34% died as a result of an avalanche. The incidents leading to death occurred at an average altitude of 3652 m (11,977 feet); range, 2073 to 4389 m (6800-14,400 feet). The average age of the victims was 31.2 years (range, 17-55 years), and 47 of the 50 were men (94%). Bodies were not recovered in 13 cases (26%). Autopsies were performed in 30 of the remaining 37 cases. At autopsy, the cause of death was ascribed to multiple injuries in 12 cases (40%), isolated head and neck injuries in 7 cases (23%), and chest injuries in 1 case (3%). Asphyxia and hypothermia were the cause of death in 8 cases (27%) and 2 cases (7%), respectively. The frequency of specific injuries is presented by anatomic region. The unique autopsy and investigative features of mountaineering deaths are discussed.     

Sudden Death Caused by Anomalous Origin of the Coronary Artery During Exercise

Anomalous origin of the coronary artery (AOCA) is a rare, but important cause of sudden cardiac death among young athletes. Nine autopsy cases (8 male, 1 female; mean age, 17.9 years; age range, 11–31 years) of sudden death during or just after exercise caused by AOCA were reviewed. The exercises performed at the time of death were running (4 cases), soccer (2 cases), and baseball, swimming and kendo (Japanese swordsmanship) (1 case each). In 6 cases, the left coronary artery arose from the right sinus of Valsalva, and in 3, the right coronary artery from the left sinus. The coronary arteries passed between the pulmonary artery and the aorta with an acute angle takeoff from the orifice. Three cases had cardiovascular manifestations prior to death. In cases with cardiovascular manifestations, novel imaging methods should be considered to prevent sudden death.     

36例脑血管畸形猝死案例及法医病理学分析

目的探讨脑血管畸形猝死的法医病理学特点和检查方法。方法对1997年至2006年10月四川华西鉴定中心所做36例脑血管畸形猝死病例进行分析。结果脑血管畸形猝死以10~49岁男性为主,有25例(69.44%)。18例(50%)发病前有明显诱因。18例(50%)在发病后1h内迅速死亡。脑血管畸形猝死的病理类型以脑动静脉畸形最为常见,有33例(91.67%)。24例(66.67%)发生于脑底部、桥脑和小脑。破裂出血是脑血管畸形猝死的直接死因,出血类型以蛛网膜下腔出血最为常见,有22例(61.11%)。脑血管畸形部位和形态复杂多变,常规检查方法不能满足鉴定的需要。结论脑血管畸形猝死的鉴定百分之百准确比较困难,熟悉其法医病理学特点,掌握多种检查方法,才能做出客观、全面、准确的鉴定结论。     

白血病死亡的法医学鉴定

材料和方法回顾性研究我所2003～2005年间检案实践中4例白血病死亡的法医学鉴定案件。结果4例死者生前均无明显的血液病症状,其中1例死亡前经临床确诊为急性颗粒增多型早幼粒细胞性白血病（M3）,另外3例均无血液病相应的临床资料。尸体解剖主要所见：（1）多器官（尤其是脑）白血病细胞浸润;（2）肝、脾肿大;（3）凝血功能障碍引起的出血倾向,如：皮肤紫癜、创口渗血或迁延不愈等;（4）可排除暴力死亡。结论白血病细胞脑浸润引起的脑内血肿和血液病的并发症弥漫性血管内凝血（DIC）是导致死亡的常见原因;在白血病患者突发死亡的案例中,死者生前往往缺乏典型的血液病症状,或仅有轻微的症状未引起注意;此类案件的法医学鉴定应注意收集临床资料,必须进行系统的尸体解剖检验,在有检验条件的情况下应进行骨髓细胞学病理检验。