Evaluating the Potential for Unintentional Occupational Exposure to Fentanyl and Fentanyl Analogues Among Medicolegal Death Investigators and Autopsy Technicians

Recent increases in deaths in the United States from synthetic opioids such as fentanyl and fentanyl analogues (fentanyls) have raised concerns about possible occupational exposures to these potent agents. Medicolegal death investigators and autopsy suite staff might perform job tasks involving exposure to fentanyls. The potential for exposure to fentanyls among medicolegal death investigators and autopsy technicians at a state medical examiner's office was evaluated through review of caseload characteristics, injury and illness logs, and procedures and policies and discussions with management and employee representatives. The evaluation showed that this medical examiner's office had low potential for work-related exposure to fentanyls; its standard operating procedures and personal protective equipment requirements should reduce the potential for occupational exposure. Medicolegal death investigation agencies can develop and implement guidance to control exposures and provide workforce education and training to reduce the potential for work-related exposure to fentanyls.     

Sudden Death Caused by Rupture of Spontaneous Ductus Arteriosus Aneurysm in an Adult

A 55-year-old man complained of sudden onset of severe neck pain. This was followed by prompt loss of consciousness and death. Autopsy revealed rupture of a saccular aneurysm, which was considered to have resulted from enlargement of the remaining ductal tissue, and was located on the medial aspect of the uppermost portion of the descending aorta. Dense blood extravasation was noted in the posterior mediastinum and extending to the strap muscles of the neck and larynx. Histological examination of the rupture site revealed disappearance of the medial elastic fibers and thickened intima covered with dense fibrous tissue. Spontaneous ductus arteriosus aneurysm in adults is a rare finding, but widespread use of imaging technologies has revealed that it develops more frequently than previously recognized. Fatal complications may occur even when the aneurysm is relatively small. Therefore, pathologists should be aware of this aneurysm as a potential cause of sudden death.     

对交通肇事案中的死者进行“全面尸检”的必要性及措施

司法机关对出现死亡后果的交通肇事案件的处理往往不能达到法律与社会效果的有效统一,主要原因在于不能对作为案件认定依据的尸体作及时、科学、适当的检验.而司法实践中因为种种原因而缺乏对尸体的正确处置与检验程序规范化建设的缺失,导致检察机关对该类案件的办理存在诸多诉讼风险.鉴于此,建立由检察官主导的全面尸检程序可以成为司法机关正确办理交通肇事案件的基本前提.     

物证检验鉴定在交通肇事案件中的作用

物证检验鉴定中的痕迹检验鉴定和尸体检验鉴定,不仅在一般刑事案件中应用广泛,而且能够为交通管理部门办理交通肇事案件,尤其是交通肇事逃逸或不确定驾驶员的案件提供有力的技术支持,在道路交通肇事案件的处理中为责任的划分和驾驶员的认定起着重要的作用。     

涉及死亡非医疗过失纠纷的类型,死因和发生原因——27年医疗纠纷法医尸检回?

对1992～1998年间206例非医疗过失尸检资料进行回顾性研究,表明涉及死亡的非医疗纠纷中各类疾病死亡占53.88%,难以避免的并发症占39.81%,医疗意外占6.31%.发生原因中对死因怀疑占44.66%,怀疑输液(血)错误占15.05%,怀疑治疗出问题占9.71%,怀疑用药错误或诊治延误各占8.74%,其它13.11%与医护人员态度不好、医院管理有关.     

两地区医疗纠纷法医学尸检鉴定质量的比较研究

目的研究影响涉及医疗纠纷法医学尸检鉴定质量差异的原因。方法两个具有代表性的法医学尸检鉴定机构所涉及医疗纠纷的相关案例,进行字2检验、t检验等统计学研究。结果通过字2检验发现,在设定的10个指标中,有7个指标存在显著性差异,提示两鉴定单位在“涉及医疗纠纷的法医学尸检鉴定”中检验手段和标准、规范性等均存在极大的差异。结论通过研究,提示法医学鉴定人素质、尸检的标准化和规范化、尸检检材的提取标准化、死因或疾病的诊断标准、会诊制度及法医学鉴定书的书写规范化等是法医学尸检鉴定质量控制和管理的重要环节。     

The Homicide–Suicide Phenomenon: Findings of Psychological Autopsies

Homicide–suicide represents a single episode of violence which may decimate an entire family. This study aimed to further describe motives and context of these tragedies. Psychological autopsies were completed for 18 homicide–suicide cases in Dallas, Texas. This included postevent interviews with surviving family members and review of police and coroner records. Two‐thirds of perpetrators had made either verbal or written threats prior to the homicide–suicide. A simplified typology describing victim–perpetrator relationship and motive type is suggested for future studies and clinical ease. Two‐thirds of perpetrators fell into the category of Intimate‐Possessive, most of whom were depressed men who were abusing substances and undergoing separation. Additional categories included Intimate‐Ailing, Filial‐Revenge, Familial‐Psychotic, and Friend‐Psychotic. Further, implications from this psychological autopsy study regarding risk assessment include use of collateral interviews regarding threats and past violence.     

外伤性主动脉破裂死亡30例法医病理学研究

目的　探讨外伤性主动脉破裂法医病理学特点。　方法　对华西医科大学法医学院 1983 -2 0 0 3年 3月所做 3 0例外伤性主动脉破裂病理资料进行回顾性研究。　结果　外伤性主动脉破裂以男性青壮年为主 ( 66% ) ,1983 -1993年以高坠为主 ,1994-2 0 0 3年以车祸为主 ,损伤发生部位以主动脉弓部及起始部为常见 ,且绝大多伤者在 3 0min内死亡。　结论　外伤性主动脉破裂发生 ,应以预防为主。     

围产期母婴医疗纠纷尸检49例分析

围产期母婴死亡所致的医疗纠纷在医疗纠纷的法医学鉴定中占有相当大一部分比例。本文从死者性别年龄、涉及医院、尸检结果、医疗行为过错情况等方面统计分析了49例围产期母婴死亡的医疗纠纷尸检案例,揭示了围产期母婴的常见死亡原因、医疗因素在其中的作用以及医疗纠纷的发生原因等,希望能对该类医疗纠纷的法医学鉴定、医疗纠纷的正确处理和防范提供帮助。     

人体器官肺的体积、密度检测及其医学和法医学意义

目的积累不同种族人体器官组织体积和密度的基本数据。为病理学和法医学尸检提供简便、可靠的诊断方法。方法应用电子智能化体积-密度仪,同步检测正常人及各种疾病死者肺的质量、体积、密度。结果获得正常肺和不同程度弥漫性肺水肿病变器官体积和组织密度;在2例医源性循环超负荷和水中毒案件的法医病理学鉴定中,用肺密度值证实了常规病理组织学形态不典型的严重低渗性肺水肿。结论大体检测器官密度对尸体解剖的综合病理诊断具有一定的辅助意义。