29例云南不明原因聚集性猝死的尸检病理学研究

目的：分析云南不明原因聚集性猝死的病理特点,为其病因探索和实施干预提供依据。方法：收集云南省进行这类猝死监测以来临床与病理资料较完整的尸检材料29例,占同期死亡病例的10．2％。年龄8至69岁（平均32岁）,男16例、女13例。核查心脏标本,观察了主要脏器的组织病理改变,对其中5例还做了心脏传导系统检查。心肌炎的病理诊断参照Dallas标准和世界心脏联合会的共识,标准克山病的病理诊断依据国家相关卫生行业标准。结果：心脏主要病理改变有：淋巴细胞性心肌炎11例、中性粒细胞性心肌炎3例、致心律失常性右室心肌病4例、左室肥厚合并流出道异常肌束2例、缺血性心脏病2例、过敏性支气管炎和慢性支气管炎合并肺气肿2例、主要脏器未找到明显致死性病理形态改变5例。29例中均未见克山病和扩张型心肌病的病理形态改变。心肌炎均为局灶性,5例心脏传导组织检查见2例有希氏束或左束支起始段急性出血,1例炎症波及房室结。4对家庭聚集性病例的病理改变不同,4例首发猝死中3例为心肌炎、1例慢性感染,续发猝死中3例与急性心肌缺血有关,1例为致心律失常性右室心肌病。多数病例伴肺水肿,少数伴呼吸道和肺部感染。部分出现淤血性或缺血性肝细胞坏死。结论：云南不明原因聚集性猝死的基本病理改变不同,多数为心肌炎症、心脏发育异常和其他致死性心肺疾患,未见克山病的病理学证据,致心律失常性右室心肌病等基础性心脏病应引起重视,猝死的聚集性可能是多种因素的综合表现。     

Causes of sudden cardiac death in young Australians

OBJECTIVES: To determine the causes of sudden cardiac death in people aged 35 years or younger. DESIGN AND SETTING: A review of all autopsies performed between 1 January 1994 and 31 December 2002 at a major Sydney forensic medicine department serving an area with over 2 million people. MAIN OUTCOME MEASURES: Incidence of various types of cardiac disease causing sudden death in those aged 相似文献   

Sudden death in young Aboriginal adults with rheumatic heart disease

A retrospective review for the period 1983 to 1988 was made of all sudden deaths in young Aboriginal adults from the Darwin and East Arnhem regions who had known rheumatic heart disease. A total of five cases was identified from autopsy reports. The age range was between 16 and 35 years. All were being treated for asymptomatic heart disease (grade I). The sudden, unexpected death in each of these patients resulted in their deaths all being reported to the coroner. In all cases there was no evidence at autopsy of significant coronary artery disease or bacterial endocarditis. All had evidence of rheumatic valvular heart disease affecting either one or both mitral and aortic valves to varying degrees. No other cause of death was found. This report serves to illustrate the fact that rheumatic heart disease is still a significant contributor to morbidity and mortality in Aborigines, and that while the usual picture of progressive deterioration in exercise tolerance may be the norm, sudden death without any apparent preceding symptomatology can occur.     

Sudden cardiac death in Air Force recruits. A 20-year review

We reviewed the clinical and autopsy records of the 19 sudden cardiac deaths that occurred among the 1,606,167 US Air Force healthy, medically screened recruits (90% male; 17 to 28 years old) during a 42-day basic training period between 1965 and 1985. Sixteen (all male) died suddenly of underlying structural heart disease, whereas no anatomic cause of death was identified in the remaining three. Thirty-two nonsudden, noncardiac deaths occurred during the same period, and only two had structural heart disease. Strenuous physical exertion was associated with sudden death in 17 of 19 cases (0.017 deaths per 50,000 exercise-hours), and the most frequent underlying etiology was myocarditis. Sudden cardiac death, a rare event in healthy young adults, is usually associated with exertion.     

猝死50例临床病理探讨

<正> 突然死亡者称猝死。猝死判定标准尚不统一。有的认为在出现致死症状后“立即”死亡者也有的认为在“一小时内”或“24小时之内”甚至“6天内”死亡者均属猝死。多数认为“猝死是指出现症状或体征后立即或在24小时内死亡者”。本文收集了我校28年院外突然死亡的50例临床和尸解资料加以探讨,拟从中总结经验教训,进一步降低病死率。     

Sudden cardiac death in young Danes

Sudden Cardiac Death (SCD) in the young (aged 1-35 years), although presumably rare, is always a tragic and devastating event often occurring in apparently healthy persons. Through the last decades, research have been undertaken to estimate the incidence rate and underlying causes of these deaths. However, because autopsy is not always conducted, the true incidence of SCD might be underestimated. The incidence of sudden infant death syndrome (SIDS) has previously been thoroughly investigated, also in Denmark. However, data has not been precise in sudden unexpected death in infancy (SUDI) estimates. SIDS is a diagnosis of exclusion and an ICD-10 diagnosis (R95.9), but to what extent this diagnosis is being accurately applied has not been investigated in Denmark. A genetic screening for mutations in an otherwise unexplained death, might identify a likely cause of (inherited) death. It would be of great clinical interest if DNA derived from the Danish Neonatal Screening Biobank, containing DNA from all Danes born after 1981, could be used in this respect. In this thesis we provide nationwide data on SCD, SUDI and SIDS in Denmark for the period 2000-2006 by reading death certificates, autopsy reports, and registry data. We report the highest possible incidence rate of SCD in the young. We elaborate on regional differences in post-mortem investigations of sudden death cases in Denmark and validate a method for whole-genome amplification of DNA from Guthrie cards to be used in genetic screening for disease causing mutations. We found 7% of all deaths in the young could be attributed to SCD. A total of 25% of sudden unexpected death in the 1-35 years old were not autopsied. The incidence of SCD of 2.8 per 100,000 person-years--when including non-autopsied cases--was higher than previously reported. Unexplained deaths were abundant and accounted for 22% of all sudden unexpected deaths. Sudden deaths occurring during competitive sports, however, were only seen in few cases. We found that regional differences exist in the investigation of sudden unexpected deaths. Fewer deaths were medico-legally investigated by external examinations ("retsl?geligt ligsyn") in some parts of Denmark compared to other parts. The same was the case in autopsy ratios. In infant deaths we found that almost 1 in 2000 live-borns died suddenly and unexpectedly during their first year of life. The R95.9 diagnosis did not reflect the SIDS cases we identified. We were able to get DNA from the Danish Neonatal Screening Biobank on 93 cases of unexplained deaths (including SIDS). Due to the limited amount of DNA available from the dried blood spots, we performed whole-genome amplification on the DNA (wgaDNA). We investigated the use of wgaDNA for genetic screening and it completely resembled genomic DNA (gDNA). Future research will focus on the genetics substrate of sudden unexplained death. In addition, we will investigate the causes of death in the 36-49 years old, as these may also suffer from cardiac disease that can be predisposed in the family.     

Causes of death in young Australians with type 1 diabetes: a review of coronial postmortem examinations

OBJECTIVE: To determine the causes of death in Australians with type 1 diabetes mellitus who died aged 40 years or younger. DESIGN AND SETTING: Retrospective review of autopsy reports at the Department of Forensic Medicine, Sydney, New South Wales, 1 January 1994-31 December 2006. MAIN OUTCOME MEASURE: Causes of mortality in people with type 1 diabetes aged <40 years. RESULTS: Of the 26 682 autopsy reports, 1914 were for individuals with diabetes (type 1, 400; type 2, 1514). Cardiovascular disease accounted for 51% of deaths (169/333) in people with type 1 diabetes aged >40 years, versus 13% among those aged 相似文献   

SUDDEN CARDIAC DEATH AMONG AUTOPSIED CASES

Sixty-eight sudden cardiac deaths (10.6%) in 642 autopsied cases of cardiovascular diseases were studied. The incidence was highest in ischemic heart disease (29.6%). Cardiac arrest was the most frequent direct cause of death in ischemic heart disease with or without acute myocardial infarction. Embolism was an important immediate cause of sudden death in theumatic heart disease, pulmonary heart disease and infectious endocarditis.     

75例猝死的临床病理分析

目的探讨猝死的病因、病理基础及防治措施。方法回顾性分析我院75例猝死的临床病理资料。结果 75例猝死中,老年人47例,占62.7％,非老年人28例,占37.3 ％,男女之比约3:1。心原性猝死52例,其中冠心病猝死36例,占69.2％(36/52);非心原性猝死19例,其中以急性出血坏死型胰腺炎所占比例最高42.1％(8/19);4例尸检病理检查未见致死性疾病。冠心病猝死患者主要建立在冠状动脉多支严重病变基础上。结论猝死以老年男性多见,有广泛严重冠状动脉病变的冠心病者猝死发生率高。防治冠心病、改善心肌缺血等综合治疗十分必要。胰源性猝死主要为急性出血坏死型胰腺炎所致,误诊率较高。猝死可发生在无器质性疾病的正常人,应加强心理素质训练。     

Sudden death in Whipple's disease.

Despite antibiotic therapy, some patients with uncomplicated Whipple''s disease die suddenly and inexplicably. We describe one such patient who died following unexplained cardiorespiratory arrest and was found to have chronic active myocarditis related to the causative organism. We postulate myocarditis as a cause of sudden death.     

Deaths from snake bite in Australia, 1981-1991.

OBJECTIVE: To obtain and analyse data relating to snake bite fatalities in Australia. DESIGN: Retrospective analysis of case reports and collation of studies carried out at the Commonwealth Serum Laboratories (CSL). RESULTS: 18 deaths attributed to snake bite were reported to CSL over a 10-year period. Eleven of the victims were males and four of these were bitten after either picking up the snake or playing with it. In most cases, no pathological findings of significance were found at autopsy. Venom was detected in post-mortem samples from nine cases. Brown snakes (genus Pseudonaja) were responsible for 11 deaths; tiger snake (Notechus scutatus) for four, taipan (Oxyuranus scutellatus) two and death adder (Acanthophis australis) one. Death after a brown snake bite was often sudden and unexpected. In three patients bitten by tiger snakes and in one bitten by a brown snake, the presence of cerebral haemorrhage was confirmed at autopsy. CONCLUSIONS: Not all snake bite deaths in Australia are adequately investigated or reported. Under some circumstances death from snake bite is almost inevitable; two infants who received unwitnessed massive envenomations are tragic examples. Had venom absorption from the bitten area been delayed by correct first aid, some of the patients might have survived. The brown snakes (genus Pseudonaja) must now be considered Australia's most dangerous group of snakes because their venom may cause sudden unexpected collapse and death. The increased incidence of intracranial haemorrhage may in some cases be related to the intravenous use of adrenaline. In at least one case, the prompt administration of a clearly needed antivenom might have altered the outcome.     

257例成年猝死患者临床分析

目的分析成年成年猝死患者的病因和猝死时间,为预防成年患者猝死提供临床依据。方法对2008年10月1日-2012年10月30日马鞍山市十七冶医院院257例成年猝死患者的临床资料进行回顾性分析。设定三餐就餐时间：早餐时间6：30—8：30,中餐时间11：00-13：00,晚餐时间18：30—20：30;根据猝死时间是否在就餐时间内分2组,并根据不同就餐时间分3组,组间进行比较;猝死年龄以60岁为界分2组,2组间率的比较采用x。检验,P〈0．05为差异有统计学意义。结果257例猝死患者60岁以上（大于60岁者）183例（71．21％）;小于等于40岁者15例（5．84％）;有冠心病者124例（48．24％）,有糖尿病者88例（34．24％）,有高血压者75例（29．18％）;有脑卒中者61例（23．74％）,不明原因者52例（20．23％）,有慢性阻塞性肺病者26例（10．12％）,有癫痫者10例（3．89％）;小于等于40岁者（总15例）以不明原因死亡者11例;60岁以上组猝死183例,其中猝死时间为就餐时间89例（48．08％）,60岁以下组猝死74例,猝死时间为就餐时间29例（39．19％）,2组间X。检验,x2=14．77,P〈0．01。结论成年猝死患者以印岁以上多见,有冠心病、高血压、糖尿病者多见;年青猝死者以不明原因死亡者多见;年老患者猝死时间以就餐时间多见,故就餐可能是猝死的诱发因素之一。     

猝死42例临床分析

目的探讨猝死的病因、诱因及流行病学特征，为临床防治猝死提供依据。方法回顾性分析42例猝死病例的临床资料。结果猝死的病例中心血管病33例，占78％；糖尿病7例，占17．3％；过度肥胖2例，占4．7％．心肺复苏成功4例，成功率9．5％，结论应重视心率变异性研究，预防猝死高危因素，以提高抢救成功率。     

Study of sudden cardiac deaths in young athletes

Sudden cardiac deaths in athletes are usually due to underlying cardiovascular disease. The final pathway is usually ventricular fibrillation following hypertrophic cardiomyopathy and coronary artery anomalies in young persons below the age of 30 years. Sudden cardiac death in young is rare but remains as a source of concern. A postmortem study was conducted to ascertain the cardiac causes of sudden death in persons below the age group 30 years following exercise in games or otherwise. Out of 15 cases in autopsy finding, hypertrophic cardiomyopathy (n=7) was the commonest cause followed by coronary artery anomalies (n=4). Sudden unexpected death is a source of concern and careful screening of history and physical examination for potential athletes should identify majority of people at risk.     

提高心脑血管患者追踪监测和干预防治的效果

目的探讨如何提高对在健康体检中筛出的重点心脑血管疾病患者进行追踪监测和干预防治的效果。方法选择高血压患者172例、心脏疾患31例,比较重点追踪监测和干预防治前后的监测率、防治率和发病猝死率。结果经过对重点人群追踪监测和干预防治等措施,高血压稳定127例,心脏疾患稳定24例,较以前有明显改善,有效率分别达到73.83%和77.41%,没有发生发病导致猝死现象,实现发病猝死率为零。结论提高对心脑血管患者人群重点追踪监测和干预防治有明显的效果。     

长沙地区12万人口1985,1986两年死亡调查报告

本文报告长沙地区12万人口中1985,1986两年30岁以上死亡者共1494人;其主要死因为心血管疾病,脑中风、肿瘤次之。心血管疾病中,以肺源性心脏病死亡率最高,冠状动脉性心脏病次之。猝死111人,60岁以上者猝死率明显增加。     

心脏传导系统简易检查法及常见致猝死病变(附51例观察)

报告一种适用于常规检查心脏传导系统的简易取材法,采用该法检查了70例正常人和51例无心外原因猝死者(按WHO规定起病后24h内死亡为猝死)的心脏传导系统(CCS)。CCS的病变有炎症、出血、脂肪浸润、纤维化、神经病变、窦房结和房室结动脉壁增厚、结构变异和淋巴细胞聚集等。51例中有15例(29％)应认为猝死系由CCS病变所致,包括炎症(8例)、出血(4例)、重度脂肪浸润(2例)和纤维化(1例)。     

冠心病猝死病例心肌细胞免疫组化研究

目的：探讨冠心病猝死病例的死因诊断方法。方法：应用LSAB法对22例疑诊为冠心病猝死病例的心肌细胞进行纤维连接蛋白、肌动蛋白及肌红蛋白的免疫组化研究，并以15例非心性死亡病例作对照。结果：22例冠心病猝死可疑病例心肌中，纤维连接蛋白染色，20例呈阳性，2例阴性；肌动蛋白染色，15例明显缺失，5例轻度缺失，2例无缺失；肌红蛋白染色，13例明显缺失，6例轻度缺失，3例无缺失。15例非心性死亡阴性对照病例，纤维连接蛋白均呈阴性，肌红蛋白及肌红蛋白均无缺失。结论：心肌细胞免疫组化检测是冠心病猝死病例死因诊断的有效手段。     

Late prognosis of viral myocarditis

85 cases of virologically proved viral myocarditis were followed up for 96.45 +/- 23.7 months for a better understanding of the late prognosis of this disease. Among these cases, 63 (74.1%) were cured, 14 (16.5%) remained with sequelae, 8 (3.5%) became chronic and 5 (5.9%) of the patients died. Most of the abnormal findings, i.e. physical signs, x-ray, ECG and UCG changes, originally existing on admission of the survived patients disappeared. The clinical features of the chronic cases resemble those of cardiomyopathy. The main causes of death were heart failure and sudden death. In order to reduce mortality, sequelae and chronicity, the importance of early virological examination, early clinical diagnosis and early and persistent treatment are stressed.     

病毒性心肌炎的发病机制

病毒性心肌炎是一种由多种致病因素所引起的复杂疾病,且易发生心源性猝死,是临床及法医尸检中常见的现象。本文综述了有关病毒侵入心肌的分子机制、T细胞免疫应答的新进展、多种细胞因子的参与、抗心肌抗体和细胞凋亡以及心肌胶原的重构在病毒性心肌炎发病中的重要意义。