Primary intimal sarcoma of the pulmonary artery misdiagnosed as pulmonary thromboembolism: A case confirmed at medicolegal autopsy

Misdiagnosed PAS confirmed at medicolegal autopsy Pulmonary artery sarcoma (PAS) is a rare disease and usually indistinguishable from acute or chronic thromboembolic disease of the pulmonary arteries. We present a case of pulmonary artery sarcoma in a 54‐year‐old male, who was clinically misdiagnosed as pulmonary thromboembolism. The patient died of disease; however, the actual diagnosis of PAS was made after a medicolegal autopsy. PAS can be a diagnostic challenge for both clinicians and pathologists. In an autopsy case with a clinical suspicion of pulmonary thromboembolism, if there is an abnormal gross appearance in the pulmonary artery, the forensic pathologist should have a high index of suspicion of PAS, which should be ruled out by a histopathologic examination.     

Cervical Arterial Injury After Strangulation—Different Types of Arterial Lesions

After strangulation, cervical arterial injuries (CAI) are uncommon. We report three unusual cases where strangulation induced immediate stroke. CAI were examined using brain CT scan and Doppler ultrasonography in the three cases and then by autopsy in one of the victims. One of the two victims who survived the attempted strangulation had a unilateral carotid dissection, whereas in the other victim, no arterial dissection or thrombosis was observed. As regards the deceased victim, the autopsy confirmed the bilateral dissection showed on CT scan and Doppler ultrasonic examination and revealed that both carotid arteries were dilated up to two times the normal diameter. Microscopic examination showed a major bilateral hemorrhagic dissection of the media with obliterating fibrous endarteritis lesions associated with inflammatory damage. CT scan with arteriography does not demonstrate all the different types of arterial injury, particularly atheromatous embolism, direct compression, or prolonged spasm. Thus, traditional autopsy remains an essential forensic tool after strangulation to show the type of CAI.     

内皮素受体拮抗剂BQ123对蛋用鸡肺血流动力学的影响

给 5 0日龄蛋用鸡经翼静脉注射内皮素 1(endothelin 1,ET 1)ETA受体 (ET 1的选择性受体 )的特异性拮抗剂BQ12 3,采用右心导管法通过生理多导仪测定蛋用鸡肺动脉收缩压和舒张压。结果显示 ,ETA受体拮抗剂BQ12 3能够使蛋用鸡肺动脉收缩压和舒张压明显下降 ,而注射相同容量生理盐水的蛋用鸡肺动脉压没有显著变化 (P≥ 0 .0 5 ) ,而且BQ12 3高剂量 (2 .0 μg/kg)对肺动脉收缩压和舒张压的影响比低剂量 (0 .4 μg/kg)的影响大。试验结果说明 ,ETA受体的特异性拮抗剂BQ12 3能不同程度地降低肺动脉收缩压和舒张压 ,推测ET 1是维持蛋用鸡正常肺动脉压的基本条件之一 ;若ET 1和ETA受体发生变化 ,阻断其生物学作用 ,就能改善蛋用鸡肺血流动力学     

对改进和加强提速干线治安管理工作的思考

随着铁路提速战略实施,铁路公安机关必须积极应对,认真研究落实新举措,不断探索和实践提速线路治安防控工作新机制;必须顺应形势,以求真务实的精神,认真研究当前管内提速线路治安防控的新变化;必须创新机制,抓住关键因素,构建坚固的提速线路治安防控工作体系。     

体位性窒息对心、肺功能影响的实验研究

通过从股静脉将漂浮导管插入肺动脉的方法 ,检测悬挂前、悬挂期间和临终阶段呼吸、肺动脉压、心输出量的变化,探讨体位性窒息对心、肺功能影响及其在死亡中所起作用。结果:(1)悬挂前呼吸频率平稳 ,悬挂期间逐渐加快 ,临终前呈无规律状态 ;(2)悬挂期间及临终时肺动脉压比悬挂前明显升高;(3)悬挂前及悬挂期间的心输出量基本平稳 ,临终时比悬挂前及悬挂期间明显下降。本研究发现 ,悬挂可致呼吸失调 ,机体缺氧 ,导致心、肺功能障碍 ,属肺性死亡。其特征为呼吸停止是原发性的 ,心跳停止是继发的。     

冠状动脉急性病变斑块内Toll样受体-4表达的研究

目的探讨Toll样受体4（TLR4）与冠状动脉粥样硬化（AS）斑块急性病变的关系。方法从本教研室2004～2007年尸检档案中挑选24例病例及其心脏标本。分为实验组（有冠脉急性病变的SCD者）、对照组Ⅰ（无冠脉急性病变的SCD者）和对照组Ⅱ（冠脉无严重AS的暴力死者）等3组，每组8例。用免疫组化SABC法和图像分析技术定量检测TLR4在各组冠状动脉AS斑块内表达的平均光密度值（OD），所得数据用SPSS14．0统计学软件进行分析处理并比较各组间的差异。结果实验组冠状动脉AS斑块中TLR4表达呈强阳性，对照组Ⅰ呈相对较弱的阳性表达，而对照组Ⅱ冠状动脉壁及轻度增厚的内膜处均未见阳性表达，其OD值（0．4662±0．0190）与两个对照组（分别为0．3361±0．0165，0．2463±0．0190）相比，对照组Ⅰ与对照组Ⅱ相比，其差异均具有统计学意义（P〈0．01）。结论冠状动脉AS斑块中TLR4的表达情况可视作为冠状动脉AS斑块发生急性病变的一个病理诊断指标，也是诊断冠心病猝死的重要依据之一。     

冠状动脉肌桥与心源性猝死

冠状动脉肌桥也称冠脉肌桥或心肌桥,是一种先天性冠状动脉分布走行的发育畸形,为冠状动脉某一段或其分支的某一段走行于心外膜下的心肌层内。这种先天性冠状动脉分布走行的发育畸形可以引起猝死,在尸体解剖中也较为常见。本文对冠脉肌桥的形态学特点、临床影像学与心电图改变、猝死机制以及法医学鉴定中需要注意的问题等方面进行了阐述。     

房室结纤维和脂肪增多与房室结动脉狭窄的关系

目的探讨房室结纤维、脂肪含量与房室结动脉狭窄之间的关系,分析房室结内病理性纤维化和病理性脂肪浸润的原因。方法选取119例心源性猝死案例,用Image-pro plus图像分析软件检测组织切片,计算房室结面积,房室结动脉内径、房室结动脉管腔面积(lumen area,LA)、外周横截面积(perimeterarea,PA),纤维组织面积和脂肪组织面积。将所有案例分为动脉狭窄组和正常对照组组,观察房室结动脉PA/LA值及房室结纤维及脂肪含量的改变。结果狭窄组房室结动脉PA/LA值在21～40岁最大,40岁以下两组房室结脂肪含量和总间质含量差异有统计学意义。结论房室结动脉狭窄与房室结间质含量增多有一定关系。     

Cytoskeleton immunohistochemical study of early ischemic myocardium

Previous studies on cytoskeletal changes of in vitro and in vivo animal models of ischemic myocardium have suggested the possibility of using alterations in cytoskeleton proteins as an early marker for the post-mortem diagnosis of myocardial ischemia in cases of sudden death due to coronary artery disease (CAD). In the present study, using the technique of ABC-immunohistochemistry, we examine the changes of three cytoskeletal proteins: vinculin, desmin and α-actinin in human myocardial samples taken from 14 cases of CAD sudden death and 13 cases of non-CAD death. Results of these examinations are compared with immunohistochemical changes of myoglobin and histochemical staining of hematoxylin and eosin and phosphotungstic acid, and Masson trichrome. Patchy and extensive loss of the three cytoskeletal proteins was demonstrated in the myocardium of victims who died 1 h or later following the onset of symptoms of ischemic myocardium. The pattern of cytoskeleton change is equivocal in the cases of CAD who died less than 1 h after the onset of symptoms and of the cases of non-CAD. In these cases, no significant histological change was observed. With less non-specific background changes and stronger positive staining, immunohistochemical staining of the three cytoskeletal proteins is more reliable than myoglobin, which has attracted the attention of many pathologists searching for anatomic evidence of ischemic myocardium in coronary artery disease.     

介绍两种冠状动脉狭窄程度的检测方法

本文作者提出用相对面积计算和同心圆两种方法检测冠脉狭窄程度，并对其实用价值进行了探讨。