Sudden Unexpected Death Due to Left Subclavian Artery‐esophageal Fistula Caused by Fish Bone

A 53‐year‐old woman was admitted to the hospital due to unexpected dizziness and died the following morning. To investigate the cause of death, a forensic autopsy along with histological examination was performed 3 days after her death. The major findings of the autopsy were that a fish bone had pierced the left subclavian artery after perforating the esophagus with 680 mL of blood in the stomach and bloody and tarry contents were present in the intestines, and the cause of death was confirmed to be subsequent hemorrhagic shock. Unfortunately, none of her family realized that she had eaten a fish 4 days before the tragedy until the fish bone was found. The present case is rare and instructive. The histopathological findings of left subclavian artery‐esophageal fistula induced by a fish bone can be used as a reference in forensic practice.     

白竭散对肛瘘术后创面血管生成的调控机制研究

目的 观察白竭散对肛瘘术后创面新生血管生成的调控作用并探讨其调控机制。方法 将75例肛瘘患者随机分为白竭散组、贝复济组、对照组,每组25例,均予以肛瘘切开挂线术治疗,术后第2天开始分别用白竭散纱条、贝复济纱条、凡士林纱条换药。术后7、14 d,分别于光镜下观察新生毛细血管数,采用免疫组织化学法及Western blot法检测肉芽组织中血管内皮生长因子（vascular endothelial growth factor,VEGF）、血小板内皮细胞黏附分子（platelet endothelial cell adhesion molecules,PECAM 1/CD31）及第Ⅷ因子关联抗原（von willebrand factor,VWF）的表达水平。结果 术后7、14 d,贝复济组、白竭散组毛细血管数均较对照组显著增加（P＜0.05）,白竭散组毛细血管数显著多于贝复济组（P＜0.05）。免疫组织化学法检测结果显示,与对照组比较,贝复济组和白竭散组的VEGF在胞浆内呈大量棕黄色颗粒,数量明显增多;CD31、VWF在胞浆内呈大量棕褐色颗粒,数量明显增多。Western blot检测发现,与对照组比较,术后7、14 d,贝复济组和白竭散组VEGF、CD31、VWF蛋白表达水平均显著增加（P＜0.05）;与贝复济组比较,术后14 d白竭散组VEGF、CD31、VWF蛋白表达水平显著增加（P＜0.05）。结论 白竭散通过增加创面VEGF、CD31、VWF蛋白表达,促进毛细血管新生,提高创面愈合速度。     

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。     

痔瘘洗剂配合改良式手术治疗肛瘘30例

目的 观察痔瘘洗剂配合改良式手术治疗肛瘘的疗效.方法 将60例肛瘘患者随机分为对照组和观察组,每组30例.对照组和观察组患者均予以改良式手术治疗,前者术后予以高锰酸钾溶液熏洗坐浴,后者予以痔瘘洗剂熏洗坐浴.比较两组患者术后第3、7天疼痛、水肿、渗液评分,创面愈合时间,术后创面瘢痕大小及临床疗效.结果 两组患者术后第7天...     

Fatal Hemorrhage from an Arteriovenous Fistula

In this study, we present two cases of sudden deaths of people with end‐stage kidney with arteriovenous fistulas for long‐term hemodialysis treatment. This procedure is associated with a number of known complications. While stenosis, thrombosis, and infection are well known, lethal hemorrhage from arteriovenous fistula is much less commonly encountered. Inspection of the bodies at the scene of the death by a medical examiner suggested that the deaths were due to exsanguination. Autopsies revealed visible defects on the front wall of the arteriovenous fistulas. Microscopic examination showed wall necrosis with infiltration of various inflammatory cells. Deaths were due to exsanguination from the ulcerated arteriovenous fistulas in patients with chronic renal failure. Further investigation revealed that complications in the area around the arteriovenous fistulas were known and were being treated until a sudden rupture of the vessels and hemorrhage from the arteriovenous fistulas resulted in the deaths.     

万花油外用结合物理疗法治疗慢性肾衰竭血液透析患者动静脉内瘘血肿48例

目的观察万花油外用结合物理疗法对慢性肾衰竭血液透析患者动静脉内瘘血肿的临床疗效。方法将96例慢性肾衰竭血液透析动静脉内瘘血肿患者随机分为对照组和治疗组,每组各48例。对照组给予冰敷、热敷及红外照射的物理治疗,治疗组在对照组疗法基础上加用万花油,两组均治疗至血肿消失。比较两组患者治疗3d后血肿消退情况、血肿局部疼痛评分情况及治疗结束后随访6个月时的并发症发生情况。结果治疗组血肿消退情况明显优于对照组(P0.05)。两组治疗后内瘘局部血肿疼痛均明显减轻(P0.05),但治疗组治疗后疼痛评分下降程度显著大于对照组(P0.05)。随访6个月后,治疗组患者内瘘血流不足、静脉炎、内瘘狭窄、血栓形成的发生率均明显低于对照组(P0.05)。结论万花油外用结合物理疗法可促进透析患者动静脉内瘘血肿的消退,减轻局部疼痛,减少并发症的发生。     

Fatal suicidal injury of a radiocephalic arteriovenous fistula

A 59-year-old man was found dead in his living room. His body was covered with blood, but the only injury found was a 31-mm-long, transverse incision on the radial surface of the left forearm. Autopsy revealed that the injured vessel was an enlarged cephalic vein from a radiocephalic arteriovenous fistula (RC-AVF) that had been created 23 years before for hemodialysis. Cephalic vein injury is usually not fatal, but circumstantial evidence, autopsy, and histological findings suggested that hemorrhagic shock and death occurred within a short time after the self-inflicted incised wound. This may be explained by the blood flow rate in the RC-AVF, which can reach 12 ml/s; this is 25 times higher than the normal cephalic vein blood flow.     

中药熏洗联合艾灸治疗对动静脉内瘘早期失功的保护作用

目的 探讨中药熏洗联合艾灸治疗对维持性血液透析患者自体动静脉内瘘早期失功的保护效应。方法 选择首次接受自体动静脉内瘘术的血液透析患者共50例,随机分为治疗组26例和对照组24例,其中治疗组予以中药熏洗联合艾灸治疗,对照组仅予常规术后观察。观察治疗前后2组患者术后3个月内瘘失功例数、内瘘血流速度、内瘘内径变化情况。结果 共8例患者发生术后失功,其中对照组7例,治疗组1例,主要原因为血栓形成。内瘘血流速度、内瘘内径及透析中血流量比较,治疗组优于对照组,但差异无统计学意义（P>0.05）。二项分类Logistic回归分析结果显示,年龄、糖尿病、低血压是内瘘早期失功的危险因素。结论 中药熏洗联合艾灸治疗可减少维持性透析患者自体动静脉内瘘早期失功。