大鼠死后肝细胞核DNA的组织化学定量研究

推断死亡时间是法医学尸体检验须解决的重要问题之一。本实验用显微分光光度计定量测定了不同环境温度下（１０℃、２０℃、３０℃）大鼠死后不同时间肝细胞核ＤＮＡ平均含量，发现１０℃、２０℃、３０℃下大鼠死后肝细胞核ＤＮＡ含量与死亡时间呈负线性相关，其相关系数分别为—０．９９０５、—０．９８６３、—０．９７０２，且随环境温度升高ＤＮＡ含量的下降速度明显加快。作者认为ＤＮＡ组织化学定量技术可望成为推断死亡时间的新方法。     

A Rare Presentation of Sudden Death due to Pulmonary Thromboembolism Possibly as a Result of Giant Hepatic Hemangioma

Hepatic hemangiomas are usually detected incidentally when investigating for other nonrelated pathologies. When symptomatic, they are usually large and cause symptoms such as abdominal discomfort or other digestive issues. Occasionally, uncommon presentations such as bleeding with coagulopathy (Kasabach–Merritt syndrome) or even fever of unknown origin may occur. As hepatic hemangiomas are benign, they do not result in tumor emboli and pulmonary thromboembolism due to hepatic hemangiomas is extremely rare. This is a case report of a rare case of a female with no known past medical history who presented with sudden death due to pulmonary thromboembolism, possibly as a result of an underlying giant hepatic hemangioma. Incidentally, she also had three other tumors—pancreatic cystic lymphangioma, cerebral capillary telangiectasia, and papillary thyroid carcinoma, and their potential contribution to the cause of death will be discussed.     

Fatal rupture of hepatic adenomatosis: Autopsy case and review of the literature

Hepatic adenomatosis is a rare disease consisting of multiple adenomas in otherwise-normal liver parenchyma. Though the discovery of this entity goes back several years, its diagnosis is still challenging in terms of its definition and pathophysiology. Clinically, patients may be completely asymptomatic and the diagnosis is only made incidentally through imaging tests. The discovery could be made when complications occur such as intraperitoneal hemorrhage with hypovolemic shock due to the rupture of an adenoma. We report a fatal case of a ruptured adenoma in a case of hepatic adenomatosis discovered at autopsy. In order to achieve a better view of this disease, we conducted a literature review on this subject describing the pathogenesis, manifestations, and autopsy contribution to addressing this entity.     

经皮穴位电刺激不同时间对雷公藤甲素致大鼠急性肝损伤的影响

目的 观察经皮穴位电刺激（transcutanclus electrical acupoint stimulation,TEAS）不同刺激时间对雷公藤甲素致大鼠急性肝损伤的保护作用。方法 将50只SD大鼠随机分为空白组、模型组、TEAS Ⅰ组（刺激20 min）,TEAS Ⅱ组（刺激30 min）、TEAS Ⅲ组（刺激40 min）,以雷公藤甲素灌胃法复制急性肝损伤模型。TEAS各组刺激“足三里”穴,每日1次,连续5 d。观察肝脏组织形态学变化,检测血清天冬氨酸氨基转移酶（aspartate aminotransferase,AST）、丙氨酸氨基转移酶（alanine aminotransferase,ALT）及肝组织丙二醛（malondialdehyde,MDA）、肿瘤坏死因子- α（tumor necrosis factor- α,TNF- α）、白介素- 10（interleukin- 10,IL- 10）、硫化氢的含量。结果 模型组大鼠肝索排列紊乱,肝窦扩张,肝细胞水肿、脂肪变性、坏死;各TEAS组肝脏病理变化较模型组减轻。与空白组比较,模型组大鼠血清ALT、AST及肝组织MDA、TNF- α含量明显升高（P＜0.05）,硫化氢含量明显降低（P＜0.05）,肝组织IL- 10含量无明显变化（P＞0.05）。与模型组比较,TEAS Ⅰ、Ⅱ、Ⅲ组大鼠血清AST、ALT含量和肝组织MDA、TNF- α含量明显降低（P<0.05）或呈降低趋势（P>0.05）,硫化氢含量明显升高（P<0.05）。其中TEAS Ⅲ组与TEAS Ⅰ、Ⅱ组各指标比较,差异均具有统计学意义（P＜0.05）。结论 TEAS能减轻雷公藤甲素对肝组织的损伤,且较长时间（40 min）刺激的保护作用更为明显。     

一例因福尔马林治疗肝包虫病引发的医疗纠纷——以医学与法学为视角

因福尔马林治疗肝包虫病引发的医疗纠纷案例比较罕见。从医学视角看,该案例中造成不良损害后果的机理是因福尔马林对胆道系统的损伤和/或包虫头节阻塞造成梗阻性黄疸,同时在患者本身肝功能受损的共同作用下最终导致了施行肝移植手术。从法学视角看,该案例中选择鉴定机构的方法、损伤参与度的应用及对伤残评定适用标准的探讨对医疗纠纷案件的处理有借鉴意义。