An Analysis of Possible Mechanisms of Unexpected Death Occurring in Hydatid Disease (Echinococcosis)

Abstract:  Most cases of hydatid disease in human populations are due to Echinococcus granulosus. The hydatid life cycle involves passage between definitive hosts such as dogs and intermediate hosts such as sheep. Humans become accidental intermediate hosts following ingestion of food or water contaminated with eggs or by contact with infected dogs. Although hydatid disease may remain asymptomatic, occasional cases of sudden and unexpected death present to autopsy. Causes of rapid clinical decline involve a wide range of mechanisms including anaphylaxis (with or without cyst rupture), cardiac outflow obstruction or conduction tract disturbance, pulmonary and cerebral embolism, pericarditis, cardiac tamponade, myocardial ischemia, pulmonary hypertension, peritonitis, hollow organ perforation, intracerebral mass effect, obstructive hydrocephalus, seizures, cerebral ischemia/infarction, and pregnancy complications. The autopsy assessment of cases therefore requires careful examination of all organ systems for characteristic cystic lesions, as multiorgan involvement is common, with integration of findings so that possible mechanisms of death can be determined. Measurement of serum tryptase and specific IgE levels should be undertaken for possible anaphylaxis.     

颈椎损伤的伤残等级及“三期”法医学评定——附64例分析

目的探讨交通事故致颈椎损伤后伤残等级和休息、护理、营养时限的法医学鉴定,以及颈部损伤、原有疾患与后遗症之间因果关系法医学鉴定的原则与方法。方法收集64例颈椎损伤的伤残等级鉴定案例,对相关资料/数据进行统计分析。收集交警部门反馈的涉及伤病关系案件的处理结果,了解案件双方当事人对鉴定结论的认可程度。结果随着对颈椎损伤后伤残评定案件中原发病的认识逐渐增加,相应颈椎损伤涉及伤病关系鉴定的案件也日益增多;在受理的颈椎损伤伤病关系案件中,均按照伤病关系理论进行鉴定,案件处理机关（交通警察）以及双方当事人对鉴定结论均表示满意。结论对于各种颈椎损伤进行伤残等级和“三期”鉴定的案例,由于损伤机制不同,自身原有颈椎健康程度不同,所造成的后果也不尽相同,鉴定中应考虑原有疾病对伤残等级的影响。     

ELISA抗体水平评价口蹄疫灭活疫苗免疫效果的可行性分析

为了探讨免疫抗体评价口蹄疫灭活疫苗效果的可行性,分别用5批次的口蹄疫O型-亚洲1型二价灭活疫苗(OS/99株+JSL/06株)、5批次的猪口蹄疫O型灭活疫苗(OZK/93株+OS/99株)免疫动物,在攻毒的同时采血分离血清,用液相阻断ELISA测定抗体效价,以分析抗体效价与免疫保护的关系。统计学分析表明,二价灭活疫苗的O型免疫抗体值与攻毒保护率(概率单位)之间呈正相关关系(P<0.01),相关系数为0.986;亚洲1型免疫抗体值与攻毒保护率(概率单位)之间呈正相关关系(P<0.05),相关系数为0.997,猪口蹄疫O型灭活疫苗免疫抗体值与攻毒保护率(概率单位)之间不呈正相关关系(P>0.05)。结果表明,应用抗体水平评价二价灭活疫苗的免疫效果是完全可行的,但用其评价猪O型灭活疫苗的免疫效果不具有可行性。     

NDV感染的鸡胚成纤维细胞TLR7 mRNA表达的动态变化

为研究新城疫病毒(NDV)感染过程中,鸡Toll样受体7(chTLR7)表达的变化情况,采用Trizol法抽提NDV感染组和正常对照组鸡胚成纤维细胞(CEF)的总RNA,反转录成cDNA。以β-actin基因为内参,应用实时荧光定量PCR法检测细胞中chTLR7基因表达的动态变化。结果显示,CEF被NDV感染后第12、24、36、48小时,感染组chTLR7mRNA表达量分别是正常对照组的18.63、0.05、1.37、10.62倍,组间差异均极显著(P<0.01)。结果提示,chTLR7可能参与了NDV感染CEF的早期过程。     

Previously Unreported Complication of Coronary Artery Bypass Grafting: Suture Rupture Resulting in Patient's Death

Traditionally, the manner of death in most hospital autopsy cases is natural, in which death is due to the natural course of disease or reasonably anticipated outcomes of medical interventions. Some cases fall into a potential gray zone between natural and accident, including rare or unanticipated outcomes of medical interventions. We present a case of a patient postcoronary artery bypass graft. Autopsy revealed the proximal anastomosis of the aorta‐to‐first‐diagonal‐coronary‐artery‐to‐second‐obtuse‐marginal‐artery graft was detached from the aorta. A broken suture was present at the disconnected anastomosis, with intact knots but was broken along its length. In‐hospital mortality rates of CABG range from 1% to 3%, with several autopsy studies identifying surgical complications as the cause of death in one‐third of perioperative deaths. No publications were found that described suture rupture as directly relating to the cause of death. This case report describes a previously unreported complication of coronary artery bypass grafting.     

A Case of Sudden Death Due to Persistent Severe Pulmonary Arterial Hypertension After Late Atrial Septal Defect Closure

Atrial septal defects (ASDs) are one of the most prevalent congenital cardiac anomalies in adults. These interatrial communications can produce changes in the right heart (remodeling and failure) and the lungs (pulmonary hypertension). Most adults with ASDs are surgically treated with excellent results. However, a small fraction of patients is at risk for postoperative complications, particularly the persistence of pulmonary hypertension. A case of a 47‐year‐old woman who was found unresponsive in the bathroom of her house and died despite resuscitative efforts is described. According to medical records, the woman underwent a surgical repair of an atrial septal defect at the age of 37. At the autopsy, macroscopic and microscopic signs of advanced pulmonary hypertension were detected, highlighting the importance for the forensic pathologists to recognize pulmonary hypertension as a cause of sudden death in adults with a history of late surgical closure of an atrial septal defect.     

Intracoronary Thrombus Formation Following Carbon Monoxide Poisoning

Thromboembolic events in the context of carbon monoxide (CO) exposure have been well described in the literature. Six cases of clinically significant coronary thrombosis following CO exposure were previously reported. However, factors affecting the development of coronary thrombus in CO exposure are poorly understood, and the significance of this finding in a forensic context is not clear. This article discusses a case of coronary thrombosis found at autopsy following a death in which CO poisoning was suspected. A 67‐year‐old man was found dead in his garage with four vehicles with their ignition in the “on” position and their tanks empty. At autopsy, severe coronary atherosclerosis and an acute nonocclusive coronary thrombus were found. Given the dissimilarities among cases and the presence of CO exposure, it was suggested that the coronary artery thrombosis is likely due to the inherent prothrombotic mechanism of CO, the only common denominator in all the cases.     

Sudden Death Due to Coronary Arteritis

We report the case of a middle‐aged man, without medical history, who suddenly died at his workplace. The autopsy highlighted a pathological heart macroscopically, with multiple small white areas on the left myocardium. Coronary dissection revealed a pseudotumoural fibromyxoid aspect within the anterior interventricular artery (AIVA) and the left main coronary trunk, including reduction in their diameter with tight stenosis. Microscopic examination of these arteries showed fibroinflammatory wall destruction. In the left myocardium, there were multiple focal ischemic areas at different stages of recovery. Our case is an illustration of primary ischemic heart disease due to coronary arteritis, with a pseudotumoural presentation, which was revealed by sudden death. We discuss the cause of death and the etiological diagnosis preceding coronary arteritis.     

在“非典”防治中国际传染病监控体系的缺陷与改进

"非典"的全球蔓延使一些外国和国际组织的公共健康官员批评中国政府在应对"非典"爆发上的保密性作法与不合作姿态,这就提出了我国政府的作为(或不作为)是否要承担国家责任的问题.实际上,现行国际传染病监控体系的内在缺陷是引起国际社会与我国政府上述争端的深层原因.文章拟就国际传染病监控体系的缺陷作以简要论述,并就改进措施提出一些建议.     

Adult Hirschsprung's disease diagnosed during forensic autopsy

We report a case of fatal Hirschsprung's disease (HD) discovered at autopsy. A 20-year-old man collapsed at home. Emergency medical personnel found him in cardiac arrest and all resuscitative efforts failed. He had a past history of chronic constipation since infancy. Forensic autopsy revealed a megacolon full of gas and stools. Microscopic examination showed absence of ganglion cells in a short segment of the rectum and enterocolitis in the left and transverse colon. HD is rarely described in adults. In many cases, patients complained of constipation since infancy but the affection remained misdiagnosed. The relative good tolerance of the disease is usually due to a short aganglionic bowel segment. Enterocolitis is a frequent and severe complication of HD in children but is rarely described in adults. This case suggests the importance of HD diagnosis in childhood in order to avoid fatal complications with forensic consequences.