冠心病猝死193例尸检分析

本文对193例因冠心病而猝死的尸检材料进行以分析,并对冠状动脉粥样硬化好发部位,病理改变,心脏病理变化,以及冠心病猝死发生机理和诱因等进行讨论。     

病毒性心肌炎和扩张性心肌病中Dystrophin蛋白的表达

目的探讨病毒性心肌炎和扩张性心肌病的发病机制及相互关系,从而提高心性猝死法医学鉴定的可靠性和准确性。方法对17例对照(包括正常心脏、冠心病、高血压性心脏病等),25例病毒性心肌炎和28例扩张性心肌病的心肌组织进行改良的病理学dystrophin免疫组织化学研究。结果dystrophin蛋白在对照组,病毒性心肌炎组和扩张性心肌病组中阳性表达率分别为100%,88%,57%,三组表达差异有显著性(P<0.05),且在病毒性心肌炎和扩张性心肌病组间表达有显著差异(P<0.05),经Spearman等级相关分析呈显著负相关(r=-0.526)。结论病毒性心肌炎和扩张性心肌病心肌中细胞骨架蛋白均有破坏,且随着由病毒性心肌炎进展为扩张性心肌病,dystrophin蛋白表达逐渐降低,说明在病毒性心肌炎和扩张性心肌病的发病机制中可能与dystrophin的被破坏有关,病毒感染并破坏心肌细胞骨架蛋白并最终导致心肌细胞坏死,心功能受损,从而使病毒性心肌炎进展为扩张性心肌病。     

35例胰腺出血案例死亡原因分析

３５例胰腺出血案例死亡原因分析刘敏，吴家Ｃａｕｓｅｓｏｆｄｅａｔｈｏｆｐａｎｃｒｅａｓｈｅｍｏｒｒｈａｇｅ：３５ａｕｔｏｐｓｙｃａｓｅｓｒｅｐｏｒｔ￥ＬｉｕＭｉｎ；ＷｕＪｉａｗｅｎ（ＤｅｐａｒｍｅｎｔｏｆＦｏｒｅｎｓｉｃＰａｔｈｏｌｏｇｙ，ＷｅｓｔＣ...     

评死刑废除论的“人道”错位

每个人都平等地享有"人权",而"人道"的核心就是捍卫每个人的人权."人的宝贵与尊严"对于所有的人都是相同的,当一个人强调自己生命的宝贵与人格尊严的时候,他同时应当尊重他人的生命与尊严.法律追求公正与正义,它保护某个人的生命与尊严同时,对其他所有的人施以同样的保护.一个人如果为追求自己的不当利益,公然践踏法律的明文禁令、残酷剥夺他人只有一次的宝贵生命,那他就同社会准则、道德和秩序格格不入,法律就不能再偏袒他的生命.否则,法律的天平就会失衡,法律的不公就会造成社会的混乱.人们不能在口口声声追求法律公正的同时,却以杀人犯受到法律制裁时的心理感受而决定法律的取舍!     

人权公约与生命权的刑法保护的比较研究

生命权是国际社会公认的基本人权。珍爱生命、保护生命权日益成为联合国国际人权公约和国际社会所致力追求的目标。刑法作为一国法律体系的重要组成部分,由于其保护法益的广泛性、重要性及其对违法行为制裁的严厉性,使得刑法对公民生命权的保护较之其他部门法而言更具举足轻重的意义。但就刑法对生命权的保护方式而言,中外刑法则主要通过对杀人罪的规定与限制和废除死刑两种"相对"的———或称"因果"的方式而完成的。从《公民权利与政治权利国际公约》的角度,就我国刑法对生命权的保护及其立法完善进行探讨,能使现行刑法较好较早地与国际人权公约接轨。     

An unusual case of sudden unexpected death: postmortem investigation and biomechanical analysis of the cervical spine

A naked man died under peculiar circumstances and the postmortem examination revealed unexpected lesions in the cervical spine. Investigations of the cervical spine (computed tomography, magnetic resonance imaging, and histological examination) showed that a piece of bone was torn of the anterior part of vertebra C6 and that there was fresh bleeding in the surrounding tissue. The cause of death remained unclear but was most likely cardiac arrhythmia initiated by beta-2 agonist inhalation due to an acute asthmatic attack. Data from biomechanical investigation using finite element analysis supported the conclusion that the cervical spine injury was secondary to impact during falling as a consequence of the cardiac arrhythmia.     

Appearance of chemical burns resulting from the washing of a deceased body with bleach

The authors report on a case of postmortem washing of a body with bleach. An adult female victim was found nude in an alleyway with both hands removed in the City of Westminster, CO. Cause of death was attributed to severe blunt force trauma to the head. The victim had been dumped in the alleyway within 7 h of discovery. Evidence discovered at the crime scene and autopsy indicated that the murder and subsequent washing of the body with bleach occurred at a secondary location(s). The victim was wet to the touch, presenting a strong odor of bleach. Several "ribbon"-like burn patterns were observed on the victim's back and upper thighs. These burn marks were replicated by dowsing a deceased pig with an over-the-counter concentration of bleach.     

不同死亡方式大鼠心肌组织中ATP、ADP和AMP含量比较

目的比较不同死亡方式对大鼠心肌组织能量物质变化的影响,为判断不同死亡方式及死亡时间提供依据。方法180只大鼠随机分为三组,以不同方式(失血、窒息、断颈)处死,高效液相色谱法检测死后0、0.5、1、1.5、2、3、4、6、8、12、18和24h大鼠心肌组织中的ATP、ADP、AMP含量。结果三组不同死亡方式大鼠心肌组织的ATP、ADP、AMP的含量在大部分时间点做组间比较有明显差异(P<0.05);每组不同死亡方式的大鼠心肌组织中ATP、AMP的含量随时间的变化有明显的差异(P<0.01),而各组中的ADP在死亡一定时间后无明显差异。结论不同死亡方式的大鼠心肌组织中能量物质死后变化可以用作对死亡方式及某种方式不同死亡时间做出判断的依据。     

心外科手术后死亡医疗纠纷尸检分析

目的从尸检角度讨论心外科手术后死亡的死因及诊疗缺陷。方法按临床诊断、手术类型、死亡时间、死亡特点、尸检特点、纠纷特点、诊疗缺陷等方面,比较所选案例的临床、尸检资料特点。结果心瓣膜置换手术4例,冠心病冠脉搭桥手术1例,先心病大动脉转位手术1例。心肌梗死2例,心肌广泛损伤1例。心内膜感染2例,多器官功能衰竭1例。家属怀疑诊疗不当6例。诊疗缺陷主要为手术适应证、手术时机,手术器材的选用,手术操作,术后病情观察、处理不及时,对病情严重程度、手术风险及预后的告知不充分。结论尸检不仅能查明死因,还可帮助评价手术质量、术后处理的诊疗质量,对解决纠纷具有重要的辅助作用。     

Differential accumulation of pulmonary and cardiac mast cell-subsets and eosinophils between fatal anaphylaxis and asthma death: a postmortem comparative study

The distribution profile of infiltrated mast cell-subpopulations and eosinophils in the lung and heart sections of the patients who died of severe allergic hyperresponsiveness, was investigated. Four study groups were designed comprising 9 cases who died in systemic anaphylaxis (Group I), 10 asthmatic individuals whose death were assigned to acute and severe bronchial asthma (Group II), 10 asthmatic cases who died from non-immunological diseases (Group III). Twenty consecutive autopsies of non-allergic subjects who died of unnatural causes (Group IV) served as control group in this study. Utilizing antibodies against human tryptase and chymase and a double immunohistochemical staining method, we distinguished successfully all three subsets of mast cells (MC), MC-TC (containing both tryptase and chymase), MC-T (containing only tryptase) and MC-C (containing only chymase) types, subdivided on the basis of the protease compositions of their secretory granules. In order to immunostaining eosinophils, we used antibody to major basic protein as a marker. We also measured postmortem blood tryptase, specific and total serum IgE. The intriguing finding of this study was the marked differences of cellular composition in the lung between fatal anaphylaxis and asthma death. Significant augmentation of MCs infiltrated in lung and heart sections of anaphylaxis patients and drastic infiltration of bronchial eosinophils in asthmatic death and consequent release of their related inflammatory mediators might explain the differential expression of the associated symptoms in these two groups. The anaphylactic deaths did show neither emphysema nor significant mucous bronchial secretions whereas all asthmatic deaths did. The degree of pulmonary congestion and edema was also more severe in anaphylaxis. This corresponded with the histological findings and the location and number of mast cell-subsets and eosinophils in the different compartments of the lungs. We have demonstrated that the third type of mast cell MC-C is only found in the lungs in anaphylactic deaths. The practical consequence of our study will be that it is now possible to confirm a suspicion of anaphylaxis death not only by measurements of serum mast cell tryptase, but also by immunohistochemical methods.