窦房结间质增生与年龄及右冠状动脉病变程度的关系

目的研究年龄及右冠状动脉粥样硬化病变程度对窦房结间质增生的影响。方法选择右冠状动脉有粥样硬化病变的心脏标本,登记年龄,复查并登记右冠状动脉病变,窦房结取材,常规制片,HE染色及Massom三色染色,用图像分析系统分析窦房结间质增生程度及右冠状动脉粥样硬化斑块病变的阻塞程度。结果右冠状动脉粥样硬化病变程度及年龄对窦房结间质增生的影响都有统计学意义(P0.001);右冠状动脉粥样硬化病变程度对窦房结间质增生的影响强度约为年龄的2.16倍。结论年龄及右冠状动脉粥样硬化病变程度均与窦房结间质增生有线性关系,右冠状动脉粥样硬化病变程度导致窦房结间质增生较年龄因素更为明显。     

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。     

An Analysis of Possible Mechanisms of Unexpected Death Occurring in Hydatid Disease (Echinococcosis)

Abstract:  Most cases of hydatid disease in human populations are due to Echinococcus granulosus. The hydatid life cycle involves passage between definitive hosts such as dogs and intermediate hosts such as sheep. Humans become accidental intermediate hosts following ingestion of food or water contaminated with eggs or by contact with infected dogs. Although hydatid disease may remain asymptomatic, occasional cases of sudden and unexpected death present to autopsy. Causes of rapid clinical decline involve a wide range of mechanisms including anaphylaxis (with or without cyst rupture), cardiac outflow obstruction or conduction tract disturbance, pulmonary and cerebral embolism, pericarditis, cardiac tamponade, myocardial ischemia, pulmonary hypertension, peritonitis, hollow organ perforation, intracerebral mass effect, obstructive hydrocephalus, seizures, cerebral ischemia/infarction, and pregnancy complications. The autopsy assessment of cases therefore requires careful examination of all organ systems for characteristic cystic lesions, as multiorgan involvement is common, with integration of findings so that possible mechanisms of death can be determined. Measurement of serum tryptase and specific IgE levels should be undertaken for possible anaphylaxis.     

羊水栓塞死亡医疗纠纷案件的法医学分析

目的分析引发医疗纠纷的羊水栓塞死亡病例的相关因素,以帮助提高对羊水栓塞诊治能力,减少医疗纠纷。方法对我中心2006～2009年间鉴定的8例医疗纠纷相关羊水栓塞死亡病例的临床资料及过失认定进行回顾性分析。结果（1）医疗因素分析：7例具有使用催产素史;3例发生于产前破膜后,5例发生于产后;具有典型临床症状5例,不典型临床症状3例;早期诊断7例;3例实施子宫次全切除术;发生在二级医院以下6例。（2）法医学鉴定分析：催产素使用不当及观察记录缺陷占87.5%（7/8）;7例早期诊断羊水栓塞,但在供氧、解痉和子宫切除方面存在治疗缺陷。结论提高对产前、产后羊水栓塞症状特点的认识和处置能力,强化病历记录规范、完整及充分告知说明,是减少医疗纠纷案件的关键,也是法医学鉴定判断的重要依据。     

Previously Unreported Complication of Coronary Artery Bypass Grafting: Suture Rupture Resulting in Patient's Death

Traditionally, the manner of death in most hospital autopsy cases is natural, in which death is due to the natural course of disease or reasonably anticipated outcomes of medical interventions. Some cases fall into a potential gray zone between natural and accident, including rare or unanticipated outcomes of medical interventions. We present a case of a patient postcoronary artery bypass graft. Autopsy revealed the proximal anastomosis of the aorta‐to‐first‐diagonal‐coronary‐artery‐to‐second‐obtuse‐marginal‐artery graft was detached from the aorta. A broken suture was present at the disconnected anastomosis, with intact knots but was broken along its length. In‐hospital mortality rates of CABG range from 1% to 3%, with several autopsy studies identifying surgical complications as the cause of death in one‐third of perioperative deaths. No publications were found that described suture rupture as directly relating to the cause of death. This case report describes a previously unreported complication of coronary artery bypass grafting.     

Intracoronary Thrombus Formation Following Carbon Monoxide Poisoning

Thromboembolic events in the context of carbon monoxide (CO) exposure have been well described in the literature. Six cases of clinically significant coronary thrombosis following CO exposure were previously reported. However, factors affecting the development of coronary thrombus in CO exposure are poorly understood, and the significance of this finding in a forensic context is not clear. This article discusses a case of coronary thrombosis found at autopsy following a death in which CO poisoning was suspected. A 67‐year‐old man was found dead in his garage with four vehicles with their ignition in the “on” position and their tanks empty. At autopsy, severe coronary atherosclerosis and an acute nonocclusive coronary thrombus were found. Given the dissimilarities among cases and the presence of CO exposure, it was suggested that the coronary artery thrombosis is likely due to the inherent prothrombotic mechanism of CO, the only common denominator in all the cases.