CT在法医病理学中的应用与展望

计算机断层扫描(CT)能够对不同密度的人体组织进行成像,在疾病和损伤的检验中具有重要的应用价值,随着CT技术的不断发展和逐步成熟,它可以对组织脏器进行容积再现、多层面重建、最大密度投影、表面遮盖显示等后处理,在肿瘤、血管畸形等疾病的诊断,骨折、关节异位、脏器破裂、出血等损伤的检验,枪弹、爆炸碎片、吸入物等体内异物的检验中具有重要的应用价值。目前已经有不少学者将其应用到相关研究领域当中。本文对近几年国内外应用CT技术进行法医病理学研究的情况进行综述,以便法医病理学研究者了解CT在法医病理学领域中的应用及研究现状,能够为今后的法医病理学科学研究和实践工作提供新的思路。     

Denied their ‘natural nourishment’: religion,causes of death and infant mortality in the Netherlands, 1875–1899

At the end of the nineteenth century, infant mortality rates started to fall rapidly in the Netherlands. Unfortunately, not all regions benefited from this development. High infant death in the Roman Catholic provinces of North-Brabant and Limburg has often been ascribed to a growing reluctance of Catholic mothers to breastfeed their infants after 1870. This was supposedly caused by the combination of a strict, prudish Roman Catholic norm prohibiting women from baring their breasts and a refusal to accept new medical insights into healthy childcare. The food given to weaned children was generally of such poor quality that many infants succumbed to gastrointestinal diseases. Consequently, infant mortality rates caused by water- and food-borne infectious diseases would have been higher amongst weaned babies. By using recently digitised municipal cause-of-death registration statistics, it is possible to see if there are, indeed, indications of a shift in breastfeeding patterns after 1870. First, the authors look at infant deaths from all causes to see whether Roman Catholic municipalities underwent a rise in the mortality of children under the age of one. Second, the authors do the same for cause-specific infant mortality from typhus, typhoid fever, diarrhoea, dysentery, acute diseases of the digestive system and cholera. Based on the outcomes, there was no homogenous rise in infant mortality in all Roman Catholic municipalities. Furthermore, there is no indication that infant mortality due to digestive diseases increased uniformly in all Roman Catholic communities between 1875 and 1899. Either some communities were able to counteract the negative effects of a shift towards weaning or changes in breastfeeding patterns were not a specific Roman Catholic phenomenon at all.     

Sudden Death as a Complication of Choriocarcinoma

We report the case of a young man with a history of sudden death. On autopsy, a large retroperitoneal mass was found along with secondaries in the liver and lungs. No testicular abnormality was detected on palpation. Based on histopathological examination, it was diagnosed to be a case of choriocarcinoma. Unfortunately, it was not definitively determined whether the retroperitoneal mass represents the primary tumor or secondary involvement with testes being the primary source. It is important that forensic pathologists are aware of this disease as a potential cause of sudden death. The main focus of the paper is the approach of a forensic pathologist to a case of a sudden death when an unexpected and undiagnosed tumor is found in the retroperitoneum and not much information is available about the clinical history of the deceased.     

Spontaneous Coronary Artery Dissection: Case Report and Literature Review

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction and sudden cardiac death. It occurs most commonly in otherwise healthy women during pregnancy or the postpartum period. The true incidence of SCAD is underestimated, as most cases are diagnosed at autopsy. The pathophysiology of SCAD is still not fully understood, and its management can be challenging. This report describes a 35‐year‐old pregnant female who presented with an acute antero‐lateral ST elevation secondary to spontaneous dissection of the left anterior descending artery and the circumflex artery. The diagnosis was established by coronary artery angiography. However, the patient died following cardiac tamponade. The examination of this case represented a starting point for the reviewing of the diagnosis, clinical course, and management of SCAD, and for the placing of this in context with the existing literature. This study highlights the importance of prompt diagnosis and subsequent lifesaving treatment.     

Eosinophilic Coronary Periarteritis with Arterial Dissection: The Mast Cell Hypothesis

A subset of coronary arterial dissections is associated with eosinophilic coronary periarteritis (ECPA); however, the pathogenesis of the process remains unclear. Mast cells normally reside in coronary arterial adventitia and are known mediators of eosinophilic inflammatory conditions such as type I hypersensitivity reactions. We report two cases in which coronary arterial dissection with ECPA was detected at autopsy. Tryptase, CD68, CD4, CD8, and CD1a immunohistochemical staining was performed to better characterize inflammation. While eosinophils represented a prominent periadventitial inflammatory cell, there were slightly more lymphocytes: CD4/CD8 ratios were within expected reference ranges. There were moderate numbers of macrophages, and few neutrophils or dendritic cells. Numbers of mast cells in dissected versus nondissected sections were compared: adventitial mast cell densities were threefold higher in dissected portions and showed a trend toward increased degranulation. These findings suggest that mast cells may play a role in orchestrating inflammation in cases of ECPA.     

Sudden Death by Occult Metastatic Carcinoma

A 33-year-old female collapsed and died suddenly after presenting with acute dyspnea and increasing cough over the preceding several months. Autopsy revealed poorly differentiated linitis plastica adenocarcinoma of the stomach. Microscopic examination of the lungs showed features consistent with pulmonary tumor thrombotic microangiopathy (PTTM). PTTM is a well-described complication in patients with adenocarcinoma. The typical presentation involves acute pulmonary hypertension, right-sided heart failure, and sudden death, often before the adenocarcinoma is discovered. The pathophysiology of PTTM remains elusive; it has been suggested that carcinoma cells may produce substances that influence pulmonary vasculature. Our patient had classic clinical and histologic features of PTTM in addition to prominent extravascular compression by intralymphatic tumor cells. These features undoubtedly caused her precipitous decline and lethal pulmonary hypertension, induced by underlying adenocarcinoma. This case demonstrates that sudden death can occur from pulmonary hypertension induced by metastatic carcinoma with remarkably little prior symptomatology.     

Genetic Variants in KCNE1, KCNQ1, and NOS1AP in Sudden Unexplained Death During Daily Activities in Chinese Han Population

Fifty‐six sudden unexplained death (SUD) cases were collected from Chinese Han population, which occurred during daily activities and were autopsy negative in comprehensive postmortem autopsy. The coding exons of potassium channel genes KCNE1, KCNQ1, and nitric oxide synthase gene NOS1AP were sequenced. A synonymous mutation, KCNE1 F54F T>C was identified in 2 SUD cases, which was absent in the control subjects. Neither genotype nor allele frequencies of KCNE1 and KCNQ1 exhibited a significant difference between the SUD and control group. In contrast, the allele frequency (p = 2.7 × 10⁻¹⁰) and genotype frequency (p = 5.9 × 10⁻⁷) of rs3751284, and the genotype frequency (p = 2.9 × 10⁻²) of rs348624 in NOS1AP of SUD were significantly different from that of controls (p < 0.05). Our study suggested that rs3751284 and rs348624 might be susceptibility loci for SUD during daily activities. Larger sample sizes and further molecular studies are needed to confirm or exclude an effect of the NOS1AP SNPs on SUD risk.     

Analytical Challenge in Postmortem Toxicology Applied to a Human Body Found into a Lake after Three Years Immersion

The body of a 30‐year‐old woman was found in Como lake at a depth of about 120 meters in her own car after 3 years of immersion. The aim of this study was to evaluate psychoactive drugs as well as alcohol biomarkers in biological matrices. The following analyses were initially performed: GC‐MS systematic toxicological analysis on biological fluids and tissues; GC‐MS analysis of drugs of abuse on pubic hair; direct ethanol metabolite determination in pubic hair by LC‐MS/MS. After 7 years, the samples, that had been stored at ?20°C, were re‐analyzed and submitted to an LC‐MS/MS targeted screening method, using multiple reaction monitoring mode. These analyses detected citalopram (150–3000 ng/mL), desmethylcitalopram (50–2300 ng/mL), clotiapine (20–65 ng/mL), and ethyl glucuronide (97 pg/mg). The methods showed an acceptable reproducibility, and the concentrations of citalopram and desmethylcitalopram calculated through the two analytical techniques did not significantly differ in biological fluids.     

The Phenomenon of the Urban Mummy

The environmental mummification of a body in an urban setting is an unusual event. Florida is known for its high temperatures and humidity, which typically result in the rapid putrefaction of bodies. However, under certain circumstances, Florida's climate provides an environment suitable for mummification, typically in isolated areas. We previously reported a case of a homicide/suicide in a residential neighborhood in which the mummified remains were undetected for several years. We have subsequently encountered two additional cases in which mummified bodies were discovered in urban settings. Presented in the historical context of the environmental conditions and postmortem processes involved in mummification, these cases illustrate the particular constellation of human behaviors and scenarios, as well as environmental conditions, which must coincide for this phenomenon to occur and highlight the necessity of the multidisciplinary approach to the medicolegal investigation of such deaths and the determination of the cause and manner of death.