头颈外伤致椎动脉破裂伴颅底蛛网膜下腔出血1例尸检分析

头颈外伤致椎动脉破裂伴颅底蛛网膜下腔出血１例尸检分析易旭夫，刘敏，吴家Ｓｕｂａｒａｃｈｎｏｉｄｈａｅｍｏｒｒｈａｇｅｄｕｅｔｏｒｕｐｔｕｒｅｏｆｔｈｅｖｅｒｔｅｂｒａｌａｒｔｅｒｙａｓｓｏｃｉａｔｅｄｗｉｔｈｈｅａｄｔｒａｕｍａ：ｒｅｐｏｒｔｏｆｏｎ...     

中国东北地区成年人尸体冠状动脉开口直径的观察

目的法医实践过程中在判断冠状动脉开口是否正常时,往往缺乏冠状动脉开口直径的参考值,本文目的为建立中国东北地区尸体解剖案例中成年人固定后心脏标本的左、右冠状动脉开口的直径参考值并分析其与性别、年龄、身高、体重、心脏重量的关系。方法收集中国医科大学法医司法鉴定中心于2010-2016年受理的851例案件,依次测量左、右冠状动脉开口的直径。结果成年人左、右冠状动脉开口的直径与年龄、心脏重量均呈正相关关系。不同性别、身高及体重间的左、右冠状动脉开口的直径不存在显著性差异。结论法医实践中需要结合年龄、心脏重量来判断左、右冠状动脉开口的直径大小。     

心肌桥的研究现状及法医学意义

心肌桥是一种少见的解剖学异常,可引起猝死,近年来已成为临床和法医工作者的一个研究热点。本文依据文献资料从心肌桥的发生率、解剖学特征、病理生理变化、临床表现及法医学意义等方面进行综述。     

Cardiac Sudden Death as a Result of Acute Coronary Artery Thrombosis During Chemotherapy for Testicular Carcinoma

Abstract: We report the first acute coronary fibrin thrombus arising upon atherosclerosis detected at autopsy in a man receiving chemotherapy for testicular carcinoma. The decedent was a smoker with no other known atherosclerotic risk factors. Histology revealed superficial atherosclerotic plaque erosion with endothelial necrosis and no intraplaque hemorrhage. A focus of intimal lymphoid infiltrates was noted away from the plaque. These findings raise the possibility of chemotherapy‐induced vascular damage as a factor in thrombogenesis. A review of Pubmed was performed which documented clinical reports of an association of chemotherapy with acute cardiac ischemia but no well described autopsy findings. Our case highlights the need for careful assessment of the coronary system in chemotherapy patients dying suddenly, particularly in the absence of significant atherosclerotic risk factors. Such postmortem examination will ensure thorough death investigation and may elucidate the pathogenesis of thrombosis with potential reduction in cardiac ischemic risks of chemotherapy patients.     

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.     

兔静脉空气栓塞死后不同间隔时间气体变化的初步研究

目的探讨兔静脉空气栓塞死后不同间隔时间气体变化的规律,为空气栓塞致死的法医学鉴定提供参考资料。方法建立兔静脉空气栓塞动物模型,按死后不同间隔时间分为0h、12h、1d、2d、4d、8d和16d共7组,分别从右心检测气体体积及其中CH4、CO2和N2体积百分比浓度。结果实验组均收集到气体,阴性对照组除了16d组收集到0.95ml外,均未收集到气体（V〈0.1ml）。实验组中,0h、12h和8d3组间所收集气体的差异无统计学意义（P〉0.05）,1d和2d两组之间右心气体体积的差异无统计学意义（P〉0.05）,其它各组两两之间均存在统计学差异（P〈0.05）。实验组检测气体体积呈先下降后上升趋势,CO2浓度上下波动,气体成分均符合典型空气栓塞气体成分标准;16d对照组气体接近于腐败气体。结论兔静脉空气栓塞气体体积在死后16d内呈先轻微下降后上升的规律;静脉空气栓塞死后8d内检测结果准确、可靠,而8~16d的检测结果需结合其他证据综合分析,才能确定是否为静脉空气栓塞致死。     

A sudden death with lung embolism after inadvertent infusion of zinc oxide shake lotion

A 74-year old woman in postoperative treatment after a colonic surgery died immediately after perfusion of about 1.5 mL of a white emulsion which was believed to contain 1% propofol via cardiac catheter into the right atrium. It was strongly suspected that a syringe with a zinc oxide shake lotion (consisting of 20% ZnO, 20% talc, 25% glycerol and 35% water) which was intended for external treatment had been mistaken for the propofol syringe. During autopsy, an anatomic cause of death could not be found. In order to exclude an intoxication and to determine the significance of the perfusion fluid in this context, toxicological and histological investigations were performed. Propofol and other drugs applied to the patient were found in therapeutic or sub-therapeutic range. However, in comparison to a control case, the zinc concentrations determined by AAS were about 200 times higher in lung tissue, 10 times higher in heart blood and 3–4 times higher in kidney and liver tissue. No increase was seen in venous blood. Histology showed a strong embolism of the lung tissue with birefingent sharp-edged crystals, which were identified as the talcum, and an amorphous component (ZnO). The same embolism was seen to a medium extent also in the brain sections and to a low extent in heart, liver, pancreas and kidney. Pulmonary embolism by talcum and zinc oxide was established as the cause of death which occurred by syringe swap due to insufficient security precautions in the drug administration. The results are discussed in context of pulmonary microembolism cases frequently described for drug addicts after injection of crashed talcum containing tablets.     

实验性兔羊水栓塞肥大细胞类胰蛋白酶的含量变化

目的观察家兔羊水栓塞 (AFE)后肺组织中肥大细胞类胰蛋白酶 (MCT)含量的变化。方法分别于健康怀孕家兔耳缘静脉注入羊水、制造羊水栓塞的动物模型 ;取肺组织进行HE染色和免疫组织化学MCT染色 ,镜下观察AFE兔肺组织中MCT的变化。结果对照组兔肺组织MCT呈弱阳性反应 (平均阳性细胞计数 11 2 5个 ) ,注入羊水组和注入胎盘提取液与羊水混合液组肺组织中MCT呈强阳性反应 (平均阳性细胞计数分别为 3 2 98和 45 5 3个 )。结论在羊水栓塞时兔肺组织MCT含量增加     

肥大细胞类胰蛋白酶的免疫组化染色观察

目的　观察过敏性休克死亡者咽喉、肺、小肠组织肥大细胞类胰蛋白酶 (MCT) ,探讨过敏性休克死亡法医鉴定的形态学依据。方法　交通事故致严重颅脑损伤死亡者 10例 (对照组 )、明确诊断为过敏性休克死亡者 15例(实验A组 )和羊水栓塞死亡者 8例 (实验B组 )的尸体 ,分别取其咽喉部、肺及小肠组织 ,石蜡切片 ,HE染色及用免疫组化超敏SP法进行MCT染色。结果　实验A组的咽喉部组织充血、水肿 ,咽喉部粘膜下层MCT增多 (MCT颗粒计数为 48 2 3 ) ;实验B组的咽喉部粘膜下层MCT增多 (MCT颗粒计数为 42 72 )。肺间质尤其是小支气管壁及小血管壁上MCT增多 (MCT颗粒计数分别为 46 98和 43 5 0 ) ,小肠粘膜层MCT增多 (MCT颗粒计数分别为 48 2 3和 42 72 )。对照组的咽喉部、肺和小肠MCT颗粒计数较少 ,分别为 7 79、 12 94和 2 0 2 5。实验A组与对照组相比 ,两组具有显著性差异 (P <0 0 1) ;实验A、B组相比 ,两组无显著性差异 (P >0 0 1)。结论　过敏性休克及羊水栓塞死亡的尸体 ,其咽喉部组织、肺组织及胃肠道组织MCT增多。