Fatality involving complications of bupivacaine toxicity and hypersensitivity reaction

This case represents unusual findings of elevated bupivacaine and tryptase concentrations following local anesthetic, bupivacaine, administered as a scalene nerve block for elective rotator cuff repair surgery. Following bupivacaine injection, the patient exhibited almost immediate seizure activity, bradycardia, and cardiac arrest. Resuscitative efforts including cardiopulmonary bypass restored a cardiac rhythm. However, the clinical medical status of the patient progressively declined and he died 7 h following administration of the local anesthetic. Autopsy revealed several abnormalities of the heart including cardiomegaly, myocardial bridging, and lipomatous hypertrophy of the intraatrial septum, which may have contributed to bradycardia and arrhythmia. Postmortem toxicology results revealed elevated bupivacaine and tryptase concentrations. Elevated postmortem bupivacaine concentrations 7 h following administration and abrupt onset of seizures indicate unintentional intravascular injection instead of nerve and tissue infiltration. An elevated postmortem tryptase concentration points to the possibility of a hypersensitivity reaction to bupivacaine.     

Quantitative assessment of the percent fat in domestic animal bone marrow

Measurement of the amount of fat in femoral bone marrow can provide a quantitative assessment of the nutritional status of an individual animal. An analytical method is presented for quantitating the percent fat in bone marrow from three domestic species: bovine, canine, and equine. In this procedure, fat is extracted from bone marrow using pentane, and the percent fat recovered is determined gravimetrically. Based on analyses from adult animals (normal body condition scores), the average percentage of fat in the bone marrow was >80%. In cases in which animals have been diagnosed as emaciated or exhibit serous atrophy of fat (body scores of 1 or 2), the femoral bone marrow fat was less than 20%. In domestic animals, bone marrow fat analysis can be a useful, quantitative measure that, when used in conjunction with all other data available, can support a diagnosis of starvation or malnutrition.     

General and maladaptive traits and anger in a combined forensic psychiatric and general population sample

The present study examines the associations between anger and general and maladaptive traits in a combined forensic psychiatric and community sample of men. Thirty-four male forensic psychiatric patients and 219 men from the general population completed the Novaco Anger Scale (NAS; Novaco, 1994), the NEO-PI-R (Costa & McCrae, 1992), the ADP-IV (Schotte & De Doncker, 1994) and the VKP (Duijsens, Haringsma, & EurelingsBontekoe, 1999) at two measurement occasions with a one-year interval. The results of a series of multiple regression analyses showed that general and maladaptive traits accounted for a substantial amount of variance in anger scores. Neuroticism, Agreeableness and Externalizing traits were most prominent in the prediction of anger, while Conscientiousness was acting as a suppressor variable in the regression models. Strengths and limitations of the present study and implications for further research and clinical practice are discussed.     

重伤家兔体内Cu及代谢酶变化与MOF及死亡关系

目的探讨兔重伤后机体内铜（Cu）含量及其代谢酶铜锌超氧化物歧化酶（Cu/Zn-SOD）、细胞色素c氧化酶（CCO）活性变化与继发性多器官衰竭（MOF）及死亡的关系。方法参照国际通用的创伤程度量化评分标准（ISS）,建立致MOF的家兔重伤模型,检测伤后不同时段血清及组织Cu含量与Cu/Zn-SOD和CCO的活性,分析其变化规律与继发MOF及死亡的关系。结果①重伤组家兔（包括死亡组家兔）血清Cu含量在伤后12h显著下降,36h后逐步回复;脑、心、肺组织中Cu含量伤后下降,肝脏组织Cu含量于伤后12h显著升高,36h后回落。伤后死亡组家兔脑、心、肺、肝Cu含量均较对照组降低,其中脑、肝组织Cu含量下降显著。②重伤组家兔血清Cu/Zn-SOD活性伤后12h下降3,6h之后呈升高的趋势,肝脏组织中的Cu/Zn-SOD活性伤后持续显著升高。③重伤后家兔（包括死亡组家兔）大脑皮质、心、肝CCO活性变化不明显,但脑干组织CCO活性显著升高。伤后死亡组家兔脑、心、肺、肝等器官的大体及组织学呈MOF改变。结论严重创伤可引发兔血清和组织Cu水平及Cu/Zn-SOD、CCO活性变化,这些变化可能与继发多器官衰竭和死亡相关。     

中暑死与冻死的法医学鉴定

中暑死与冻死在法医学鉴定实际工作中并不常见,但由于其病理学表现往往不够明显,在法医实际鉴定时易被漏诊。本文作者查阅了国内外相关文献资料,并结合作者实际法医学鉴定经验将中暑死与冻死的法医学鉴定要点作出初步的总结。     

大鼠机械性损伤后皮下肌肉出血的病理学观察

目的 观察生前机械性损伤后不同时间皮下肌肉出血的病理形态学变化.方法 56只SD大鼠随机分成生前损伤组(48只)、死后损伤组(4只)和正常对照组(4只);生前损伤组按不同时间再分为12组,建立机械性损伤模型;用HE及普鲁干蓝染色法观察皮下肌肉出血的病理形态学变化.结果 HE染色:生前损伤6～24h,损伤区见较多红细胞及...     

原发性脑干损伤神经元凋亡及caspase3的表达

目的观察原发性脑干损伤（PBSI）致死者脑干神经元凋亡及caspase3的表达情况,探讨其法医学意义。方法选择法医学检案中30例确定为原发性脑干损伤致死者脑干,按伤后不同存活时间（t≤5min、5min〈t≤15min、15min〈t≤1h、1h〈t≤24h）分为4组,以5例非脑干损伤死亡者脑干为对照组;分别运用常规HE、免疫组化和TUNEL染色检测中脑、桥脑及延脑重要核团内神经元凋亡及caspase3的表达情况。结果原发性脑干损伤后15min～24h出现明显神经元细胞凋亡（23.2%～35.9%）和caspase3阳性表达（28%～54%）,并呈现随损伤时间进行性增加的趋势,与对照组有显著性差异（P〈0.01）。结论原发性脑干损伤早期即出现神经元凋亡及caspase3表达增加,并随损伤时间的延长呈进行性增加,可据此辅助诊断原发性脑干损伤死亡。     

应用FTIR光谱技术推断死亡时间

目的 应用傅立叶变换红外(FTIR)光谱技术分析大鼠死后组织、人体离体组织随死亡时间推移的化学降解过程,为死亡时间推断的研究提供新的途径与方法.方法 大鼠断颈处死后置于4℃、20℃、30℃环境,在不同死亡时间点提取大鼠不同组织;收集有同样死亡时间的人尸体组织,离体取材,并运用FFIR光谱仪测定不同化学基团随死后和离体后...     

大鼠闭合性脑损伤后MAP-2的时序性表达

目的探讨大鼠闭合性颅脑损伤后脑组织微管相关蛋门－2（MAP－2）表达变化规律。方法建立大鼠闭合性颅脯挫伤模型,64只Wistar大鼠随机分为损伤后0．5h、6h、12h、ld、3d、7d、14d7个损伤组及对照组,每组8只。应用免疫组化和蛋h印记Western blot法及图像分析技术,检测脑挫伤后各设定时间点挫伤脯组织中MAP－2的变化。结果免疫纽化染色显示：对照组大鼠脑组织中可见MAP－2阳性表达;实验组伤后0．5h,挫伤灶及周同MAP－2阳性表达下降,伤后6h阳性表达降至最低,伤后12h,阳性表达逐渐增多,伤后14d,仍保持较高水平;蛋白印记结果与免疫组化结果一致。统计学分析显爪：MAP－2的表达各损伤组与对照组比较,差异均有统计学意义（P〈0．05）,伤后12h、3d及14d与上…组比较,差异有统计学意义（P〈0．05）。结论大鼠脑挫伤后14d内,MAP－2存脑组织挫伤灶及其周同呈现先减少后逐渐增多的表达变化,可作为推断脑挫伤经过时间的参考指标之一。     

微束X射线荧光光谱法检测电流损伤皮肤金属化

目的建立微束X射线荧光光谱（μ-probe X-ray fluorescence,μ-XRF）检测电流损伤皮肤金属化的方法。方法新西兰大白兔32只,随机分为黄铜电击组、紫铜电击组、铁电击组、铝合金电击组,每组8只。电极一极固定于左后腿中部,另一极固定于左前腿,建立电击模型。提取左后腿触电部位皮肤,以及对侧右后腿相应部位皮肤作为对照,应用μ-XRF光谱仪对电流损伤皮肤内金属元素进行测定。结果正常对照组皮肤中检测出磷、氯、钾、钙元素成分;在电击组皮肤中,除正常皮肤检出的元素外,黄铜电击组检测出铜、锌元素,紫铜电击组检出铜元素,铁电击组检出铁元素,铝合金电击组检出铝元素。渗透到电流损伤皮肤内的金属元素呈不均匀分布。结论μ-XRF光谱法检测皮肤金属化可作为诊断电流损伤的特征性指标,并可为触电材料的推断提供依据。