An autopsy case of intraoperative death due to pulmonary fat embolism--possibly caused by release of tourniquet after multiple muscle-release and tenotomy of the bilateral lower limbs

Acute interstitial pneumonitis (AIP), also known as Hamman-Rich syndrome, is a distinct type of idiopathic interstitial pneumonia affecting patients of both genders without pre-existing lung diseases. We describe the case of a fulminant form of AIP and discuss the pathophysiological mechanisms of AIP with reference to the histological pattern. A 15-year-previously-healthy male boy presented to the Hospital with a 6-day history of malaise, fever and cough. The clinical prodromes were followed by the acute onset of increasing shortness of breath rapidly progressing in acute respiratory failure. Chest X-ray demonstrated bilateral diffuse airspace opacification; the high resolution CT confirmed the presence of bilateral, symmetric diffuse ground-glass attenuation. The patient was admitted to the intensive care unit, but died after few hours. An autopsy was performed within 24h. The histological examination of lung specimens showed a pattern of diffuse alveolar damage. immunohistochemical, microbiological and toxicological tests were also carried out. The clinical presentation, the histological findings and the exclusion of infective, traumatic, toxic and metabolic causes of acute respiratory distress syndrome (ARDS) allowed us to conclude that the boy was affected by AIP. In conclusion, AIP is a diagnosis of exclusion. It has a mortality rate ranging about 50%, despite mechanical ventilation. In fatal cases of AIP diagnosis can be based on clinical presentation, radiological, histological and microbiological findings and can be further confirmed by immunohistochemical analysis.     

丹参注射液联合5-氟脲嘧啶腹腔化疗抗鼠胃肿瘤的实验研究

目的:观察丹参注射液对5-氟脲嘧啶(5-FU)抗肿瘤活性的增强作用及其对5-FU毒性和不良反应的减轻作用,为中药对抗肿瘤药的增效减毒作用提供实验依据。方法:应用Walker-256细胞株建立鼠种植性胃肿瘤模型,将60只Wistar雄性胃肿瘤大鼠随机分为3组:9.0 g/L氯化钠注射液(NS)组、5-FU组、5-FU 丹参组。接种后第7天,NS组每只每天腹腔注入NS,5-FU组每只每天腹腔注入5-FU,5-FU 丹参组每只每天腹腔注入5-FU 丹参,3组均连用5 d。于腹腔化疗结束后第7天每组处死10只大鼠。观察肿瘤体积抑制率、血常规、肝肾功能、细胞凋亡、大鼠生存时间。结果:①5-FU组和5-FU 丹参组鼠胃肿瘤生长明显缓慢,肿瘤体积较NS组明显减小(P(0.05,P(0.01),肿瘤体积抑制率分别为36.57%、59.44%(P(0.05);5-FU组和5-FU 丹参组鼠生存时间明显延长,生存时间延长率分别为23.7%、38.7%(P(0.05)。②与NS组相比,5-FU组和5-FU 丹参组外周血WBC、PLT明显减少,血清ALT、AST、Cr、BUN明显升高,差异均有显著性(P(0.05,P(0.01);与5-FU组相比,5-FU 丹参组WBC、PLT显著升高,而ALT、AST、Cr、BUN显著下降(P(0.05,P(0.01)。③与NS组相比,5-FU组和5-FU 丹参组凋亡面积增大,光密度明显升高(P(0.05,P(0.01);而5-FU 丹参组与5-FU组比较,差异也有显著性(P(0.05,P(0.01)。结论:丹参注射液可增强5-FU诱导肿瘤细胞分化与凋亡,并能减轻5-FU所致的骨髓抑制和肝肾功能损害。     

精神损害之界定

明确精神损害的范围是确定精神损害赔偿数额的基础。各国确定精神损害范围的标准各异：在英美法中，凡造成被侵害人精神痛苦，即构成精神损害；大陆法则以寻找并确定侵权客体为进路，将非财产损失作为精神损害的范围，日本还将非财产损失作为法人精神损害的依据。其实，精神损害的确定应以受害人生理、心理（或精神）上的痛苦为标准，故法人不适用精神损害赔偿，精神损害赔偿的功能也仅以抚慰为主。     

道路交通事故侵权损害赔偿补偿体系初探

深入研究交通事故侵权损害赔偿补偿体系建设,建立健全道路交通管理体制和机制,对于进一步提高交通管理水平,维护受害群众根本利益,实现社会公平,确保社会科学发展、有序运行、和谐稳定具有十分重要的作用。而无过失补偿制度是交通事故受害人及时得到救济的重要保证,交通事故侵权责任归责原则仍然是损害赔偿制度的核心问题。     

简论医疗侵权责任的立法

医疗纠纷主要是医疗侵权责任纠纷。在侵权责任法中应统一规定各种医疗侵权责任，而不依医疗事故侵权与非医疗事故侵权区分医疗侵权的民事责任。医疗侵权责任在类型化上应归入专家责任中的一种，医疗侵权责任不宜实行无过错责任，而应坚持过错责任归责原则。应设立合理的医疗过错的认定标准，对于医疗过错实行过错客观化和过错推定。同时应建立权威的医疗损害鉴定制度，以保证鉴定结论的真实性、科学性、客观性和公正性。     

New Forms of Damage in Negligence

Although damage is an essential component of negligence liability, important extensions of the categories of actionable damage occur with little or no analysis or even acknowledgement of the fact. In this article, consideration is given to a number of new forms of actionable damage which appear either to have received recognition by the courts in recent years, or to be close to receiving such recognition. The article is divided into three core sections, dealing with negligent imprisonment, wrongful conception and educational negligence. The principal conclusions are that redress for negligent imprisonment is best achieved through recognition of imprisonment as actionable damage in negligence; that an unwanted pregnancy is a form of personal injury, albeit an unusual one; that the conventional sum award in wrongful conception cases is best analysed as compensation for a diminution in the parents' autonomy; and that while untreated learning disorders are now treated by the courts as a form of personal injury, in the absence of such a disorder educational under-development ought not to be recognised as actionable damage in its own right.     

《公路法》第85条修改之建议

近年来,我国公路建设发展迅速,极大地促进了国民经济的快速发展。为保障公路交通的安全畅通,《公路法》起到了非常大的作用。但在公路行政执法活动中,由于《公路法》第85条对损坏公路路产的索赔方式未作明确全面的规定,导致在司法实践中经常出现被损坏的公路路产赔偿金不能及时回收,一定程度上影响了公路设施的修缮和维护。对该条的修改和完善应当是行政法理论界所探讨的课题之一。     

电针对冷应激致胃黏膜损伤大鼠VIP免疫反应性的影响

目的:观察电针足三里穴对胃黏膜损伤大鼠血管活性肠肽(VIP)免疫反应性的影响;探讨VIP参与针刺对胃黏膜损伤防御性保护作用的机制.方法:40只Wistar大鼠随机分为正常对照组、模型组、针刺组和非穴组.采用冷冻-束缚应激法复制大鼠胃黏膜损伤模型;免疫细胞化学ABC法结合图像分析,观察电针足三里穴对大鼠胃壁和迷走背核复合体VIP神经免疫反应性的影响.结果:冷冻-束缚应激大鼠胃黏膜损伤明显,胃黏膜出现点状、条状出血坏死灶,尤以胃窦部为主.胃壁VIP免疫反应阳性神经纤维数量减少.针刺组与模型组比较,胃壁和迷走背核复合体VIP神经免疫反应性明显增强(P<0.01).结论:电针足三里穴可引起胃黏膜损伤大鼠VIP神经元免疫反应性变化,提示VIP可能作为神经-内分泌-免疫调节网络的信号分子参与了针刺对胃黏膜的防御性保护作用.     

医疗责任保险的潜在缺陷及其弥补

医疗责任保险作为分散和化解医疗职业风险的重要制度,其功能和价值已为我们所认识,但其运行过程中可能出现的潜在缺陷和弊端却为我们所忽视。本文在借鉴保险理论和对国内外有关医疗责任保险实践分析的基础上,总结了医疗责任保险存在的缺陷,并提出了相关的应对措施。     

论刑法第338条的立法缺陷及完善

新刑法自实施至今已有7年光景,但实践中将严重污染环境行为作为犯罪追究的情况却非常少见,我国的环境污染问题依然十分突出.究其原因,刑法第338条的立法缺陷不容回避.刑法第338条应修改补充为两款,对两种不同罪过形式的行为在罪名和量刑上加以区分,以充分体现刑法罪刑相适应原则的要求,更好地保护人类赖以生存的自然环境.