Differentiation of Antemortem and Postmortem Appendicular Fractures Using Magnetic Resonance Imaging Signal Intensity Changes in Bone and Soft Tissues,

Intraosseous T1-weighted (T1W) and short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) signal intensity changes—so-called bone marrow edema—may be able to differentiate antemortem and postmortem fractures in human forensic imaging. The primary objective of this study was to investigate this hypothesis using an animal model. Three juvenile Landrace pigs were anesthetized and underwent MRI of both tibiae and both radii using a 1.5 T magnet. T1W, T2-weighted (T2W), STIR, and T2* sequences were included. Antemortem fractures were induced in both tibiae and postmortem fractures in both radii, and MRI was repeated. Two board-certified radiologists blinded to fracture group jointly evaluated the images for intraosseous and soft tissue signal intensity changes. Sensitivity (Se) and specificity (Sp) in identifying antemortem fractures were calculated based on intraosseous, soft tissue, and combined intraosseous and soft tissue signal intensity changes. Intraosseous and soft tissue signal intensity changes, when present, were hyperintense in all sequences. Intraosseous hyperintensity in T1W and T2W sequences yielded Sp of 100% for antemortem fractures. Regardless of sequence, soft tissue hyperintensity was comparatively more sensitive than intraosseous hyperintensity. Sensitivity for each sequence could be maximized by assessment of soft tissue and intraosseous hyperintense signals together; for the T1W sequence, such assessment optimized diagnostic utility yielding a Se of 100% and Sp of 83%. In summary, MRI—particularly the T1W sequence—can differentiate antemortem and postmortem fractures and may be a useful adjunct to the forensic analyses of fractures.     

INFLUENCE OF ACUPUNCTURE ON SEP OF LOCAL CEREBRAL ISCHEMIA IN RATS

选择凝闭大鼠一侧大脑中动脉致局灶性脑缺血为模型，选择大脑皮层体感诱发电位（ＳＥＰ）为指标，观察电针督脉“大椎”和膀胱经“心俞”穴对脑缺血后神经元损伤的保护作用。结果显示：缺血组Ｐ１、Ｎ１波幅明显降低，为正常值的２０％～４０％；Ｐ１、Ｎ１、Ｐ２、Ｎ２峰潜伏期明显延长，随着阻断时间增加延长，与阻断前ＳＥＰ的Ｐ１、Ｎ１、Ｐ２、Ｎ２峰潜伏期相比，有显著或非常显著的差异（Ｐ＜０．０５，Ｐ＜０．０１）。电针组则Ｐ１、Ｎ１波幅虽有降低，为正常值的７０％～８０％；但Ｐ１、Ｎ１、Ｐ２、Ｎ２峰潜伏期未见明显延长，与正常值相比无显著性差异。电针组与缺血组ＳＥＰ的Ｐ１、Ｎ１波幅相比，以及Ｐ１、Ｎ１、Ｐ２峰潜伏期相比，波幅明显增加，潜伏期明显缩短，在１ｈ内有显著或非常显著的差异（Ｐ＜０．０５，Ｐ＜０．０１），表明电针对脑缺血后神经元损伤有保护作用     

原发性蛛网膜下腔出血的讨论——附7例尸检报告

本文报告7例法医病理解剖材料,其中脑血管动静脉畸形引起的5例,动脉瘤与巨细胞性动脉炎引起的各1例。因死亡都是发生在头部外伤之后,故引起申诉。肉眼检查时,7例中有6例未查明病因,诊断系依靠病理组织学检查。本文结合文献复习,重点讨论了检验鉴定的方法和注意事项。文中4个重新鉴定的案例,原结论均未发现本病的病因,甚至有的误认是损伤性蛛网膜下腔出血,此点应引以为戒。     

阿维菌素对鸽脑组织GABAA受体结合作用的影响

在试验组日粮中按40 mg/kg添加阿维菌素(AVM),对照组饲喂不添加AVM的常规日粮,利用3H-蝇蕈醇(3H-muscimol)与鸽脑组织γ-氨基丁酸(GABA)均能与GABAA受体结合的特性,应用放射免疫法测得3H-蝇蕈醇与王鸽大脑GABAA受体结合的平衡解离常数(kd)和最大结合量(Bmax)分别为(44.62±2.07)nmol/L和(3.31±0.10)pmol/mg。结果表明,AVM可使3H-muscimol与王鸽大脑组织GABAA受体结合量增大,AVM可促进GABA的释放,增强GABA的抑制作用。     

脑血管造影在法医学尸体检验中的应用

脑血管造影作为诊断脑血管疾病的"金标准",目前已经广泛地应用于临床医疗活动中,并积累了丰富的理论和实践资料,是趋于成熟的技术方法。由于因脑血管疾病引发的法医学鉴定案件较为多见,故该技术近年开始应用于法医学,显示出在法医学实践中独特而重要的应用价值。本文对脑血管造影术在法医学中的应用价值进行综述,内容包括辅助定位血管病变或损伤部位、明确出血性质、指导尸体解剖与脑组织病理取材等,并在此基础上展望了该技术在法医学中的应用前景。     

应用改良体积公式计算颅内血肿量

目的 根据球缺体积公式推导出计算颅内血肿体积的改良公式,提出更为准确的计算方法.方法 根据血肿形态类型,采用立体几何中球缺的体积公式,推导出计算颅内血肿的改良体积公式,以计算机软件测得血肿体积作为相对准确的标准,将改良体积公式和多田氏公式计算的血肿体积值分别与之进行比较.结果 改良体积公式计算与软件测量结果的差值明显小于多田氏公式计算与软件测量结果的差值.结论 颅内血肿改良体积公式较多田氏公式的计算结果更为准确,可以用于法医学鉴定.     

The Role of Postmortem Computed Tomography in the Evaluation of Strangulation Deaths

We explored the value of postmortem computed tomography (PMCT) to augment autopsy in evaluating strangulation fatalities. A literature search identified 16 studies describing autopsy findings in 576 deaths and two studies describing autopsy and PMCT findings in six deaths. Similar cases were identified from our institution, yielding 130 deaths with autopsy findings and 14 deaths with both autopsy and PMCT findings. The presence of laryngohyoid fracture and soft tissue hemorrhage was compared from autopsy and autopsy+PMCT cases. The detection rates of fractures in autopsy and autopsy+PMCT cases were not significantly different. PMCT identified all fractures observed at autopsy and five fractures not identified. While PMCT may not detect soft tissue injuries in decomposed remains or subtle internal hemorrhages in neck injury, it is equally able to detect bony injuries as autopsy and might surpass autopsy in detecting subtle fractures. We conclude PMCT is useful to supplement autopsy in strangulation cases.     

Involvement of Amphetamines in Sudden and Unexpected Death

Abstract:  In the present study, the effects of amphetamine-class drugs were examined in cases reported to the Victorian coroner from 2001 to 2005 to determine if death can occur from the use of amphetamine-class drugs alone. A total of 169 cases were reviewed where a forensic autopsy detected amphetamine(s) in the blood. Pathology, toxicology, and police reports were analyzed in all cases to ascertain the involvement of amphetamine-class drugs in these deaths. In Victoria, methamphetamine (MA) is the principal abused amphetamine-class followed by methylenedioxymethamphetamine (MDMA). There were six cases in which a cerebral hemorrhage caused death and three cases in which serotonin syndrome was established as being caused by the interaction of MDMA and moclobemide. There were 19 cases in which long-term use of amphetamines was associated with heart disease. There were three cases where amphetamine-class drugs alone were regarded as the cause of death, of which two cases exhibited high levels of MDMA and lesser amounts of MA and/or amphetamine. There were no cases in which significant natural disease was absent and death was regarded as caused by the use of MA. There was no correlation between blood concentration of drug and outcome.     

A Case of Fatal Spontaneous Varicose Vein Rupture—An Example of Incorrect First Aid

Abstract:  Severe external bleeding due to varicose vein rupture is a rare complication of this frequent venous pathology. Venous bleeding can be very intensive and can be mistaken for arterial hemorrhage. A rare case of fatal varicose vein rupture with an example of an incorrect and ineffective first-aid technique in a 43-year-old man is reported here with a review of the recent literature. The victim was found on a sand stack, not far from his domicile in a large pool of blood. The external examination revealed a flat ulcer on the internal surface of the right shank. On dissection, the lesion contained a perforation that was continuous with superficial veins arising from a varicosed saphenous vein. The man tried to give himself first aid, due to the massive bleeding that he probably predicted arterial bleeding and applied the ligature closer to the heart above the bleeding defect, thereby not stopping the venous bleeding but exacerbating it. Death was caused by a hypovolemic shock because of external hemorrhage from a varicose vein.     

中西医结合治疗脑干出血16例临床分析

目的 通过回顾性分析脑干出血患者的临床资料,为其临床治疗提供依据。 方法 16例脑干出血患者均接受中西医结合疗法,包括常规西药治疗、高压氧治疗、理疗、加减补阳还五汤内服、针灸、推拿,治疗前后分别采用格拉斯哥昏迷量表（Glasgow coma scale,GCS）评价昏迷程度,采用神经功能缺损程度评分减少率评定临床疗效。 结果 治疗前后GCS评分比较,差异具有统计学意义（29.81±6.88 vs 14.88±8.88,t=5.77,P=0.000）。16例脑干出血患者中,基本痊愈3例,显著进步5例,进步4例,无效4例。 结论 中西医结合疗法对提高脑干出血的临床疗效及改善预后有一定意义。