二丙酰基莲心碱对猪冠状动脉条的影响

目的：观察二丙酰基莲心碱拮抗KCl、乙酰胆碱和组胺所致猪冠状动脉条收缩的作用.方法：体外平滑肌实验方法,观察二丙酰基莲心碱对KCl、乙酰胆碱和组胺所致猪冠状动脉条收缩曲线的影响以及在无Ca2＋克氏液中,对组胺引起猪冠状动脉条第一相收缩和Ca2＋引起第二相收缩的影响.结果：不同剂量二丙酰基莲心碱均可使KCl、乙酰胆碱和组胺所致冠脉条收缩量效曲线呈非竞争性拮抗作用,对冠脉条第一相和第二相收缩都有明显的抑制作用.结论：二丙酰基莲心碱具有扩张冠脉的作用,此作用与拮抗细胞内钙的释放和抑制外钙内流有关.     

Acute Fatal Coronary Artery Dissection Following Exercise‐related Blunt Chest Trauma

Coronary artery injury such as acute coronary dissection is an uncommon and potentially life‐threatening complication after blunt chest trauma. The authors report an unusual autopsy case of a 43‐year‐old healthy man who suddenly collapsed after receiving a punch to the chest during the practice of kung fu. The occurrence of the punch was supported by the presence of one recent contusion on the left lateral chest area at the external examination and by areas of hemorrhage next to the left lateral intercostal spaces at the internal examination. The histological examination revealed the presence of an acute dissection of the proximal segment of the left anterior descending coronary artery. Only few cases of coronary artery dissection have been reported due to trauma during sports activities such as rugby and soccer games, but never during the practice of martial arts, sports usually considered as safe and responsible for only minor trauma.     

Death Due to Coronary Artery Insufficiency Following Blunt Trauma to the Chest

There have been numerous reports of sudden cardiac death following blunt trauma to the chest, but there is lack of such references in forensic literature. It is the court of law which makes decision about trauma precipitating natural events. The forensic pathologist is scientifically trained in the medical field and would be in a better position to give clear picture about the victim's general status at the time of death, exact nature and severity of the illness he is suffering from if any. He can also assess the nature and severity of injuries sustained, and thus, his opinion as to the possible role played by the traumatic event in bringing about the death is valuable. This paper will discuss the mechanism of cardiac injury or possible cardiac injury and sudden death of an apparently healthy 36‐year‐old male following blunt chest trauma sustained during alleged assault by his neighbor.     

Missed Opportunities for Diagnosis of Post‐traumatic Thrombosis: A Case Series and Literature Review

Thrombosis is caused by abnormalities in the composition of the blood, the quality of the vessel wall, and the nature of the blood flow. Herein, we present four cases of fatal thrombus formation after a trauma, which were missed at clinical diagnosis as the symptoms were misinterpreted. We stress that a blunt trauma can be fatal because of its direct and indirect kinetic energy effects at the subacute phase. This report highlights the importance of considering thrombosis in the diagnosis of closed trauma, which is usually missed because of lack of awareness for early diagnosis and treatment or is detected too late for any therapeutic intervention, which can result in avoidable morbidity and mortality.     

颈动脉钝性损伤法医学研究进展

颈动脉钝性损伤的发生率虽低,但死亡率高,易发生于交通事故、扼勒、缢吊、颈部直接外力作用和高坠等案例中。颈动脉钝性损伤有5种基础成伤机制：颈部直接外力作用,颈部过度伸展和旋转,颅底骨折碎片切割,口腔内扁桃体窝处直接外力作用,头胸部复合伤造成颈动脉被牵拉。国外相关研究文献和个案报道较多,而国内未见系统研究,不多的个案报道中,也有错误鉴定案例。本文对颈动脉钝性损伤的致伤方式、解剖学和生物学基础、成伤机制和法医学鉴定注意事项进行综述,希望能引起国内法医技术人员的重视,并为相关研究和应用提供参考。     

Saddle Pulmonary Embolism with Paradoxical Coronary Artery Embolism through a Patent Foramen Ovale

A 35‐year‐old male patient was found in cardiac arrest in his vehicle, with no apparent injuries after a minor motor vehicle collision. The decedent was found to have a saddle pulmonary embolus with a thromboembolus impacted across a patent foramen ovale and a paradoxical embolism in the circumflex coronary artery, as well as significant clotting in the deep veins of both lower extremities. There were no risk factors in his history to explain the deep venous thrombosis; family history suggested the possibility of an unrecognized clotting disorder.     

Injury of the vertebral artery in suicidal hanging

The vertebral artery was investigated in suicidal hanging for specific forensic, but also general traumatological reasons. The objective was to establish the extent to which the vertebral artery in its relatively protected position is injured at all and if so, in what form. For this purpose, cervical spine preparations with the posterior space of the skull were fixed in formalin and detached in the sagittal plane in 36 unselected cases of suicidal hanging after angiographic visualization of the vertebral artery. Afterwards, both vertebral arteries were visualized, and vascular injuries were compared with injuries of the soft tissues of the neck, of the cervical spine, and of the external types of hanging. The vertebral artery was shown to be injured quite frequently (rupture, intimal tear, sub-intimal hemorrhage), namely in one quarter of all cases, and indeed in more than half taking into account the perivascular bleeding. In this way, frequencies were found which were far in excess of those of the common carotid artery. The different mechanical behavior of these two paired neck arteries in traction are dealt with and the form of injury explained.     

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.     

推拿治疗椎动脉型颈椎病的时效性研究

目的 探讨推拿治疗时间对椎动脉型颈椎病（cervical spondylosis of vertebral artery,CSA）的影响。方法 选取符合纳入标准的CSA患者90例,按随机数字表法随机分为推拿10 min组、推拿20 min组和推拿30 min组,行常规推拿手法治疗,比较治疗前后所有患者临床疗效、颈椎功能评分以及经颅多普勒（transcranial Doppler,TCD）超声检测情况。结果 3组患者临床疗效的分布比较,差异均具有统计学意义（P<0.05）,推拿20 min组和30 min组临床疗效均明显优于10 min组。推拿10 min组治疗前后颈椎功能评分比较,差异无统计学意义（P＞0.05）,而推拿20 min组和30 min组治疗后颈椎功能评分均较治疗前明显改善（P＜0.05）。推拿20 min、30 min组较10 min组颈椎功能评分改善程度更加明显（P＜0.05）;推拿20 min组和30 min组相比较,颈椎功能评分改善程度差异无统计学意义（P＞0.05）。3组患者治疗前后相比,两侧椎动脉的血流速度均有明显改善（P＜0.05）;与推拿10 min组比较,推拿20 min、30 min组治疗后两侧椎动脉的血流速度改善更加明显（P＜0.05）,推拿20 min和30 min组比较,治疗后两侧椎动脉血流速度的改善程度无统计学意义（P＞0.05）。结论 推拿治疗CSA具有时间累积效应,随着推拿时间的延长,疗效提高,但是到达一定时间疗效不再增加;推拿治疗时间的选择在20 min左右为最佳。     

李业甫筋骨并举整脊法治疗颈性眩晕临床疗效观察

目的 观察李业甫筋骨并举整脊法治疗颈性眩晕的临床疗效.方法 将80例颈性眩晕患者按照随机数字表法分为对照组和观察组,每组40例.对照组患者采用常规推拿治疗,观察组患者采用常规推拿结合李业甫筋骨并举整脊法治疗.比较两组患者临床疗效,治疗前后颈性眩晕症状与功能评分、眩晕残障程度评定量表(dizziness handicap inventory,DHI)评分及椎-基底动脉血流速度.结果 两组患者临床疗效比较,差异有统计学意义(P<0.05),观察组的治疗效果优于对照组.两组治疗后颈性眩晕症状与功能评分均显著升高,DHI评分均显著降低(P<0.05),且观察组改善程度显著优于对照组(P<0.05).两组治疗后左侧椎动脉、右侧椎动脉、基底动脉平均血流速度均有所增加(P<0.05),且观察组改善程度优于对照组(P<0.05).结论 李业甫筋骨并举整脊法可以有效调节椎-基底动脉血流速度以减轻患者的眩晕症状.