Forensic pathology study of wound age estimation in human spleen rupture

目的 观察人脾破裂后不同时间内脾脏组织形态学特点、SMA阳性细胞表达规律和含铁血黄素沉积、巨噬细胞数量的变化规律,为法医实践中脾损伤时间的推断提供依据.方法 收集外伤性脾破裂手术切除标本69例,按破裂损伤时间分为0～6 h组、7～12 h组、13～24 h组、25～48 h组、49～72 h组、73 h～7天组、8～14天组、＞14天组.常规染色观察破裂出血区边缘组织学变化;免疫组化染色观察破裂出血区边缘SMA阳性细胞表达规律;普鲁士蓝染色观察破裂出血区边缘含铁血黄素数量的变化规律.结果 (1)脾损伤时间6 h内者可见纤维素渗出,个别中性粒细胞浸润;(2)脾损伤时间7～12 h者可见纤维素渗出,大量中性粒细胞浸润;(3)脾损伤时间13～24 h者可见少量SMA阳性细胞稀疏散在分布;(4)脾损伤时间25～48 h者可见较多SMA阳性细胞网状分布;(5)脾损伤时间49～72 h者可见大量SMA阳性细胞自出血区边缘呈放射状长入出血区.经统计学处理,上述各组间SMA阳性细胞数量的差异有统计学意义(P＜0.05).(6)73 h～7天组及8～14天组可见肉芽组织形成;(7)＞14天组可见瘢痕形成;(8)正常脾脏组织内可见含铁血黄素,不同破裂损伤时间含铁血黄素含量的差异有统计学意义(P＜0.05).结论 判断脾破裂损伤时间应以破裂出血区边缘组织学变化时为主.纤维素渗出、中性粒细胞浸润、SMA阳性细胞数量及分布特点、肉芽组织及瘢痕形成可作为判断脾破裂损伤时间的指标.含铁血黄素沉积对判断脾破裂损伤时间不可靠.     

创伤性脾破裂的非手术治疗

近10a来,笔者选择18例脾破裂行非手术治疗,成功16例（保守成功率88.9%）,2例因出现延迟性出血而中转手术治愈。全组无死亡。提示在严格掌握适应症和密切动态观察伤情变化的条件下,非手术治疗脾破裂是安全可行的,对非手术治疗期间血液动力不稳定或发生延迟性出血者应及时手术。     

创伤性脾破裂的非手术治疗

近10a来,笔者选择18例脾破裂行非手术治疗,成功16例(保守成功率88.9%),2例因出现延迟性出血而中转手术治愈.全组无死亡.提示在严格掌握适应症和密切动态观察伤情变化的条件下,非手术治疗脾破裂是安全可行的,对非手术治疗期间血液动力不稳定或发生延迟性出血者应及时手术.     

外伤性脾破裂保脾治疗的探讨

探讨外伤性脾破裂保脾治疗的临床经验. 分析了63例外伤性脾破裂保脾治疗的方法和治疗效果. 12例保守治疗治愈,51例手术保脾的患者无一例切口感染,无腹腔内感染,切口一期愈合. 对外伤性脾破裂患者,有条件的情况下,应尽可能采用保脾治疗.     

创伤性脾破裂非手术保脾治疗的观察与护理

脾脏是腹部内脏中最容易受损伤的器官,在腹部闭合性损伤中,脾破裂占20%~40%,在腹部开放性损伤中占10%左右[1],而脾脏具有造血、贮血、毁血功能及免疫作用[2]。随着对脾脏重要功能及解剖认识的提高,脾破裂的外科治疗也发生了变化,既能控制受伤脾出血,又能维持脾脏功能的保脾治疗     

112例外伤性脾破裂保脾手术的临床治疗分析

脾脏是腹部内脏中最容易受损的器官。在腹部闭合性损伤中,脾破裂可高达40%。在腹部开放性伤中,脾破裂也达10%[1]。近年来,脾破裂保脾手术取得了新进展,随之保脾手术也逐渐推广到各级医院临床外科。选择我院及教学医院从2000年1月到2013年1月治疗的脾破裂保脾手术112例的完     

脾动脉栓塞治疗外伤性脾破裂的临床应用

目的探讨脾动脉栓塞治疗外伤性脾破裂的临床疗效及应用价值。 方法穿刺股动脉,行脾动脉造影后行脾动脉栓塞,治疗外伤性脾破裂6例。 结果6例患者术后均出现左上腹不同程度胀痛,术后均出现发热,最高体温38.5 ℃,5例患者出现少量胸腔积液。6例患者术后均未再出现出血,保脾成功,顺利出院。 结论在病情允许情况下,脾动脉栓塞治疗外伤性脾破裂止血效果确切,有效保留脾脏免疫功能,且患者创伤小,恢复快。     

不同环境中应用猪眼玻璃体液成分浓度变化推断死亡时间的研究

目的 研究在不同环境中大出血死亡猪眼玻璃体液成分变化及其与死亡时间（postmorteminterval,PMI）的关系。方法 放血处死家猪后取192只猪眼随机分为A、B两组,分别在避光、温度（15±2）℃、湿度（50±5）%的空气中以及浸没于环境温度为（15±2）℃双蒸水的条件下放置2～96 h,采集玻璃体液,运用全自动生化检测仪、超高效液相色谱分析仪（Ultra Performance Liquid Chromatography,UPLC）检测K＋、Na＋、Cl–及次黄嘌呤（hypoxanthine,Hx）浓度;采用SPSS13.0统计软件对检测数据进行回归分析。结果 眼球置于空气中时,玻璃体液中K＋、Hx与PMI相关性较高,回归方程为：PMI=-11.467＋1.954[K＋]-0.017[K＋]2＋0.511[Hx]（R2=0.858）;眼球置于双蒸水时,玻璃体液中Na＋、Cl–与PMI相关性较高,回归方程为：PMI=144.439-1.636[Na＋]＋0.007[Na＋]2-0.961[Cl-]＋0.005[Cl-]2（R2=0.622）。结论 玻璃体液K＋、Hx浓度变化可作为推断死后位于空气中的尸体较为稳定的指标;玻璃体液Na＋、Cl–浓度变化可能对死后抛入淡水尸体的PMI推断具有参考价值。     

腹部损伤延迟性脾破裂40例诊治分析

目的探讨腹部损伤延迟性脾破裂的诊治方法。方法对1996年1月～2005年12月收治腹部损伤延迟性破裂40例的临床资料进行回顾性分析，结果保守治疗10例（25％），30例患者均行手术治疗（75％），无1例发生并发症。结论手术治疗是延迟性脾破裂常选用的治疗方法，保守治疗应严格掌握治疗指征。     

无典型病变心源性猝死的法医病理学研究进展

心源性猝死(sudden cardiac death, SCD)是成人猝死的主要原因。早期心肌缺血、致死性心律失常、冠状动脉痉挛是法医学中常见的SCD原因，其导致的SCD死者无明显心脏病史，发病突然，多在心肌缺血后6 h内死亡，缺乏典型的病理学改变和临床体征，以及死后自溶、尸体保存等因素的影响，使这类案例的死后诊断成为法医界难题。该文就生物化学标志物、病理学形态、组织特殊染色技术和免疫组化在无典型病变SCD法医学诊断中的用途、特点和局限性作一综述。     

Systematic review of spontaneous splenic rupture in dengue‐infected patients

Dengue infection varies from a mild febrile form to more severe disease with plasma leakage, shock, and multiorgan failure. Several serious complications such as cardiomyopathy, encephalopathy, encephalitis, hepatic damage, and neural manifestations cause organ damage in dengue infection. Splenic rupture, a less well known but life‐threatening complication, can occur in dengue. The mechanism of splenic rupture in dengue is still unclear. Optimal therapeutic management is required to save the lives of patients with this complication. The objective of this study was to conduct a systematic review of studies documenting the development of spontaneous nontraumatic splenic rupture in patients with dengue infection. In March 2018, a search was conducted systematically in nine electronic databases, in addition to hand‐ searching. A total of 127 references were exported to Endnote; 47 references remained after removing duplicates. Finally, 16 reports met the inclusion criteria and represented 17 cases. All articles were evaluated and data extracted according to predefined criteria: number of cases, age, sex, severity of dengue disease, days of illness before admission, methods of definitive diagnosis, timing of the event, and management and outcome. A total of 17 individual patients including 13 males and four females were found. Most of the patients were young adults (ranging from 20 to 52 years) and diagnosed with computed tomography scan and managed with splenectomy. Four cases were fatal. Pathological splenic rupture in dengue is a rare, life‐threatening condition where timely management can achieve a favorable outcome.     

Influence of annual mammography from age 40 on breast cancer pathology

The objective of this study was to determine the influence of annual mammography on pathology features of breast cancers in an invited population. We conducted a randomized trial of 53,890 invited and 106,971 control United Kingdom women who were recruited only from those aged 40 years, with central review of cancer histology. We compare the invasive cancer distribution for the categories of size, histological type, grade, and node status in subgroups of the invited population with that of controls. Among 1287 cancers identified in the total population through the end of December 1999, there are major differences among prevalence, incidence, interval, and lapsed-attender and nonattender subgroups for the distribution of cancer numbers in categories of chosen qualitative histological features. These reflect the biases known to affect a population exposed to screening. Comparing cancers from the unbiased group of the invited population with controls shows significant differences in distributions for size, grade, and node status but not histological type. Multivariate logistic regression shows significant reduction (odds ratio, 0.73; P = 0.043) in node-positive status for the unbiased group. We conclude that annual mammography from age 40 years significantly reduces size and positive-node status of invasive cancers in the invited population. The potential for phenotypic drift of grade emphasizes the relevance of screen detection of all grades at sizes smaller than 10 mm.     

Research issues in forensic pathology: a survey of academic institutions employing forensic pathologists

In an effort to characterize research efforts in forensic pathology, a questionnaire was sent to a representative of each of the 14 academic medical centers that employ full-time faculty forensic pathologists. Responses were received from all 14 (100%) of the institutions queried, representing a total of 39 forensic pathology faculty positions; 21 positions were tenure track and 18 positions were clinical or other tracks. Of the 39 positions, 25 positions (64%) at 10 institutions required some degree of research or scholarly output. Of the 25 forensic pathologists with a research imperative, only 3 (12%) were principal investigators or co-investigators on funded forensic pathology-based projects. The major limitation cited by respondents on the performance of forensic pathology research was the lack of protected time from service responsibilities. Fellowship training in forensic pathology was available at 6 of the 14 respondent institutions. Of these institutions, 4 (67%) had a research requirement for trainees, and 4 (67%) provided research training. In conclusion, very few US medical schools currently employ full-time faculty forensic pathologists. Of these, only a small number of institutions prioritize research by these faculty members. Scant federal funds are available to support research in forensic pathology. Few forensic pathology fellowship programs provide research training. To achieve a robust research agenda in forensic pathology that is sufficient to support the needs of the criminal justice and public health systems will require a paradigm shift in the medicolegal death investigative system and investment by federal agencies.     

The human spleen; a histological study in splenectomy specimens embedded in methylmethacrylate

In a series of 316 surgically removed spleens, a histological and supportive immunohistological study was performed on methylmethacrylate sections. The structure of the human white and red pulp differs from the rat spleen in many respects, e.g. the human lacks the marginal sinus and the architecture of the periarteriolar lymph sheath seen in the rat. In man, the lymphoid compartment is in both white and red pulps. In the white pulp separate periarteriolar T-cell areas contain a large lymph-vessel plexus, which was reconstructed in serial sections. The circulation in the red pulp is discussed. The area between the red and white pulp, the perifollicular zone, is not the equivalent of the marginal sinus in the rat. Its anatomy in man suggests that it is an area formed from red pulp during the expansion of new follicles. The micro-anatomy was analysed in 119 controls. In cases of traumatic rupture the white pulp showed evidence of stimulation. A pathognomonic histological picture was not found in idiopathic thrombocytopenic purpura. In haemolytic anaemia the pulp cords were engorged by erythrocytes accompanied by a decreased B/T cell ratio in autoimmune haemolytic anaemia and by an increased B/T cell ratio in congenital spherocytosis.     

Estimation of age of human cadavers by immunohistochemical assessment of advanced glycation end products in the hippocampus

AIMS: Advanced glycation end products (AGEs) are known to accumulate in long-lived tissue proteins during normal ageing. In this study, we examined the expression of AGEs in human hippocampus using immunohistochemistry and determined its utility for estimating the age of cadavers of unknown age. METHODS AND RESULTS: Hippocampus tissues were obtained at autopsy from 31 individuals, including 10 fire victims, aged 0--96 years within 3 days postmortem. Immunostaining using anti-AGE antibody demonstrated that the perikarya of pyramidal neurones in the hippocampus was immunoreactive for the anti-AGE antibody, and the immunoreactivity was increased with age. Quantitative analysis of the AGE-immunoreactivity in the pyramidal neurones of the CA4 region revealed a significant correlation between the AGE-immunoreactivity and the age in nonfire death cases with a correlation coefficient of 0.91 (P < 0.01). The significant correlation could be obtained even in fire death cases affected by the unusual environmental condition. CONCLUSIONS: These results suggest that the immunohistochemical analysis of AGEs in human hippocampus may be useful for the age estimation of cadavers with unknown age.     

A method to establish the relationship between chronological age and stage of union from radiographic assessment of epiphyseal fusion at the knee: an Irish population study

Characteristic changes during epiphyseal union provide a skeletal age, which when compared with age-based standards provides an estimation of chronological age. Currently there are no data on epiphyseal union for the purposes of age estimation specific to an Irish population. This cross-sectional study aims to investigate the relationship between stage of epiphyseal union at the knee joint and chronological age in a modern Irish population. A novel radiographic method that sub-divides the continuum of development into five specific stages of union is presented. Anteroposterior and lateral knee radiographs of 148 males and 86 females, aged 9-19 years, were examined. Fusion was scored as Stage 0, non-union; Stage 1, beginning union; Stage 2, active union; Stage 3, recent union; or Stage 4, complete union. Stage of epiphyseal union is correlated with chronological age in both males and females. Mean age gradually increases with each stage of union and also varies between male and female subjects. A statistically significant difference in mean age was recorded between stages when compared to the previous stage, for the three epiphyses. Irish children are comparable to those from previously published studies with epiphyseal union in females occurring earlier than males. A significant difference was noted between the mean age of union for males and females for each of Stages 1 and 2 for the femur and Stages 0, 1, 2 and 3 for the tibia and the fibula. The results also suggest that the stages of union occur at earlier ages in this Irish population. Implementation of standardized methodology is necessary to investigate if this is due to a secular or population variation in maturation or to a methodology which clearly identifies five stages of union.