肺动脉栓塞猝死的法医病理学检验

对５０例肺动脉栓塞猝死案例分析,结果显示：引起肺动脉栓塞猝死的主要原因为创伤（４２％）,心脏疾病（３２％）,外科手术（２０％）等。血栓栓子多来源于下肢静脉（８０％）;其次为心腔内附壁血栓（２０％）。发生猝死高峰季节为１０～１２月;低峰季节为４～６月。猝死场所多见于医院内。最后提出了该病的法医学鉴定注意事项     

Pulmonary Cement Embolism After Kyphoplasty

Pulmonary polymethylmethacrylate (PMMA) cement embolism after kyphoplasty (KP) surgery is a quite frequent event as well as the pulmonary embolization of central venous catheter fragment. This report shows the case of a subject who, after KP, developed pulmonary embolism and who underwent thoracic surgery. After hospital discharge, the subject advanced a claim for damages toward the hospital where he was operated, complaining sensation of tenderness at the chest surgical scar and esthetic damage. To understand the nature of the embolism (either central venous catheter fragment or cement), chemical investigations were then ordered. Spectrometry identified the PMMA cement used for KP. When doubts rise about the origin of the embolized material, chemical investigations may reveal important data not only for clinical but also for forensic purposes.     

脂肪栓塞中苏丹Ⅲ染色的定量分析

目的探讨苏丹Ⅲ染色如何定量应用于脂肪栓塞的法医学鉴定。方法应用苏丹Ⅲ对11例肺脂肪栓塞猝死的案例和11例其他原因致死的案例进行染色,并结合统计学方法对脂肪栓塞的阳性面积百分率及脂肪栓子数进行定量分析。结果脂肪栓塞致死者肺内苏丹Ⅲ染色阳性面积百分率为（5±1．7）％、脂肪栓子数为（9±2．4）％,均远大于其他原因致死的案例（P〈0．01）。结论苏丹Ⅲ染色法定量分析在脂肪栓塞中的法医学鉴定上结果可靠。     

Paradoxical and double-bind communication in treatment for people who sexually offend

Abstract

At its most fundamental structural level, treatment for people who sexually offend has inherently paradoxical elements. These involve questions about efficacy, the balance of community safety and client autonomy and responsibility for meaningful change. These elements can create further forms of paradoxical and double-bind communication within the treatment experience itself. This paper explores this communication and its potentially harmful effects on clients, therapy and community safety, particularly in light of the schemas, implicit theories and cognitive deficits exhibited by people with histories of sexually offending behaviour. It is intended to suggest topics for consideration in solving clinical dilemmas and preventing harm to therapeutic relationships.     

Occult Adrenocortical Carcinoma and Unexpected Early Childhood Death

A four‐year‐old previously well boy collapsed unexpectedly and was taken immediately to hospital, where he developed seizures and cardiogenic shock with lethal, rapidly progressing multi‐organ failure. At autopsy, the height was >90th percentile and there were indications of early virilization. Internally, a friable tumor of the left adrenal gland was identified that had invaded the left renal vein and inferior vena cava. Histology revealed typical features of an adrenocortical carcinoma with aggregated trabeculae of cells containing abundant eosinophilic cytoplasm and large pleomorphic nuclei. There was strong positive cytoplasmic staining for inhibin; mitochondria were shown on electron microscopy to contain prominent electron‐dense granules. Death was due to massive pulmonary tumor embolism. Although adrenocortical carcinomas are very rare and are more commonly found in adults, the current case demonstrates that they may also occur in childhood and be responsible for unexpected death by the very unusual mechanism of tumor embolism.     

静脉气体栓塞的研究进展

气体栓塞是一种较多见而又威胁生命的医疗操作并发症,在法医学实践中也时有所遇,但易被检验者所忽略;也常因尸体放置较久而给法医学检验和鉴定带来困难。在此综述了静脉气体栓塞的病因、病理生理变化、临床表现及诊断和法医学鉴定的意义及注意事项,认为超声心动图、CT和MRI等现代成像技术在气体栓塞的临床诊断和法医学鉴定中有积极的辅助作用。     

Suture Embolism of the Left Superior Lobar Pulmonary Artery

Endogenous pulmonary thromboemboli are a common cause of noncardiac sudden natural death. Embolism of exogenous material is a rare but potential finding in autopsies following surgeries, medical procedures, penetrating trauma, and nonparenteral drug abuse. This report describes the first case of a suture embolism of the left superior lobar pulmonary artery following complicated abdominal surgery.     

Fatal pulmonary embolism:: A comparative study of autopsy incidence in Hong Kong and Cardiff, Wales

All autopsy reports from 1990–1994 inclusive of the Department of Pathology, University of Hong Kong and the Wales Institute of Forensic Medicine were examined and cases of death due to massive pulmonary embolism were noted. The incidence of this condition was calculated and found to be insignificantly lower in the Hong Kong series than the Welsh series by statistical analysis, both in the crude incidence in all autopsies and when correcting for different case mixes in the two locations. The majority of cases in both locations were in the over-60 age group. The study helps refute the longstanding belief among Hong Kong physicians that fatal massive pulmonary embolism is rare in Hong Kong (with approximately 98% Chinese population) in comparison with a predominantly Caucasian population.     

“内圣外王”与先期儒学发展的张力

孔子"仁"与"礼"的思想体系体现了他的圣王理想的追求,他认为领袖群伦应兼具"圣"与"王"的双重资格.儒学与君主专制的互限互依,它既是儒学发展的张力,又是儒学获得永久活力的限制,使儒学在发展历程中始终无法摆脱君主专制的阴影.     

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。