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41.
目的:提高对移植心脏脏冠状动脉血管病病变的认识。方法:对尸检病例心脏进行HE染色并用免疫组织化学染色及EBER原位杂交检测等方法,对浸润淋巴细胞进行病理分析并文献复习。结果:①移植心脏冠状动脉血管病主要病变表现为不同程度,不同部位的冠状动脉内膜弥散性、同心圆样内膜增生、散在淋巴、单核细胞浸润、部分伴脂质沉积、血栓形成及较少钙化;②心肌细胞可表现为局灶变性、坏死及纤维瘢痕形成,部分出现明显心肌纤维化;③血栓可出现于冠状动脉主干及各分枝、附着于心室壁及肺动脉内;④移植心脏冠状动脉血管病可伴有急性细胞排斥反应,浸润淋巴细胞可单纯出现在心肌间质内,也可以表现为增厚冠状动脉血管内膜同时伴发淋巴细胞浸润,多次发生急性细胞排斥反应,可以加重移植心脏冠状动脉血管病的发病。结论:移植心脏冠状动脉血管病变临床不易早期发现,确诊需要冠状动脉血管造影、血管内超声等影像学检查;移植心脏冠状动脉血管病常伴发急性细胞排斥反应。 相似文献
42.
In forensic investigations, it is important to detect traumatic axonal injuries (TAIs) to reveal head trauma that might otherwise remain occult. These lesions are subtle and frequently ambiguous on macroscopic evaluations. We present a case of TAI revealed by pre-autopsy postmortem magnetic resonance imaging (PMMR).A man in his sixties was rendered unconscious in a motor vehicle accident. CT scans revealed traumatic mild subarachnoid hemorrhage. Two weeks after the accident he regained consciousness, but displayed an altered mental state. Seven weeks after the accident, he suddenly died in hospital. Postmortem computed tomography (PMCT) and PMMR were followed by a forensic autopsy.PMMR showed low-intensity lesions in parasagittal white matter, deep white matter, and corpus callosum on three-dimensional gradient-echo T1-weighted imaging (3D-GRE T1WI). In some of these lesions, T21-weighted imaging also showed low-intensity foci suggesting hemorrhagic axonal injury. The lesions were difficult to find on PMCT and macroscopic evaluation, but were visible on antemortem MRI and confirmed as TAIs on histopathology.From this case, it can be said that PMMR can detect subtle TAIs missed by PMCT and macroscopic evaluation. Hence, pre-autopsy PMMR scanning could be useful for identifying TAIs during forensic investigations. 相似文献
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44.
Mortality has been reported to complicate gastric bypass, with common causes of death attributable to anastomotic leaks, sepsis, hemorrhage, and bowel obstruction. We evaluated autopsy reports from 10 patients having undergone gastric bypass. Medical records were reviewed to identify comorbidities. Data of interest included preoperative electrocardiogram (EKG) abnormalities, cause of death, body weight, anastamosis appearance, heart weight, extent of coronary artery disease, ventricular size, liver weight, and gall bladder status. A total of 7 men and 3 women were autopsied. Average age was 40 years (range, 30-49 years), and mean body mass index at autopsy was 60.3 kg/m(2) (range, 33.2-80.9 kg/m(2)). Evidence of anastomotic leaks was present in 7 cases, resulting in 4 deaths. Death was attributed to pulmonary embolism in one case. There were 5 cardiac-related deaths, all attributed to arrhythmias. Microscopic evidence of coronary artery disease was observed in 6. Cardiomegaly was seen in all patients, left ventricular hypertrophy in 8, right ventricular hypertrophy in 3, and hepatomegaly in all 10. Nine patients were status post cholecystectomy. Of the 8 preoperative EKG available, abnormalities were identified in 5. After gastric bypass, death was attributed to cardiac-related causes, pulmonary embolism, and operative complications. A significant proportion of cardiac-related deaths occured in the absence of atherosclerosis. Most patients had preoperative EKG abnormalities. As a high incidence of cardiomegaly was observed, operative stress associated with the procedure may increase the risk of arrhythmia in morbid obesity. Consequently, in morbidly obese patients, a detailed preoperative cardiovascular evaluation is warranted to reduce postoperative mortality. 相似文献
45.
Transmission des certificats de décès au CépiDc-Inserm en cas de mort suspecte en France,depuis 2000
Background
The purpose of this study is to assess variability in death certificates’ transmission related to suspicious deaths.Methods
The medical part of death certificates of suspicious deaths (violent or sudden deaths, unknown or ill-defined causes of death) were examined. We studied the frequency of suspicious deaths, in France, for deaths aged under 65, from 2000 to 2013, searching for temporal (2000–2013) and spatial correlations between unknown causes of death and other suspicious causes, and report of an autopsy. These results were compared with external data.Results
Standardized proportion of deaths by unknown cause more than doubled during the study period (from 3.4 to 7.5%). The spatial correlation was strongly negative between standardized proportions of unknown causes of death and violent deaths (ICC = ?0.80). Report of autopsy varied with cause of suspicious death and estimated zone of the forensic institute. The distribution was consistently distributed with external data, except for homicides.Conclusion
Information transmission to CépiDc-Inserm needs to be improved in case of suspicious death, in particularly from forensic institutes. This study emphasizes the urgent need for a complementary form to the death certificate. 相似文献46.
中毒性表皮坏死松解症按病因不同可分为两型,即金葡菌感染型和非金葡菌感染型。通过3例尸解组织学观察,阐述该病的发病机理及系统组织学变化,提出上述两型皮肤损害的不同及其与重症多形红斑的鉴别诊断。 相似文献
47.
Calcium, as one of the main extracellular ions, maintains a key role in numerous biologic functions. For forensic purposes, it was analyzed mostly for estimation of postmortem interval (PMI). We have designed our experiment with the concept that the repetitive withdrawal of vitreous humor (VH) might clarify the postmortem metabolism of calcium in greater detail to estimate the PMI. Accordingly, 248 samples of VH from 31 autopsy cases were evaluated over three years; samples (0,1 mL of VH) were taken and analyzed at equal time intervals after death—every three hours until 24 h after death. Each sample was centrifuged and analyzed using the ARCHITECT C SYSTEM 8000. Moreover, functional relationship between PMI and calcium concentration was established: PMI (hours) = [Ca2+] × 13.696–7.843. Although the concentration of calcium in VH in the analyzed group increases with time, the coefficient of variation for the regression (CVreg = 46.8%) indicates that this correlation is not so strong, meaning that the level of predictiveness of calcium for estimation of time since death is poor when is not used in combination with other relevant substances. 相似文献
48.
49.
Gordijn SJ Erwich JJ Khong TY 《European journal of obstetrics, gynecology, and reproductive biology》2007,132(1):3-7
Western Europe is in a demographic transition with increasing multicultural societies. Health professionals have to understand the background, religious and cultural aspects of parents to counsel them regarding an autopsy in the event of a perinatal loss. Autopsy rates have declined over the past decades, the major limiting factor being the granting of permission for an autopsy, possibly because of adverse publicity or reluctance of doctors to obtain consent. Autopsy has proved its value in revealing unsuspected findings. The public can be convinced of this utility by means of good information notwithstanding their religious or cultural background. 相似文献
50.
急性肺水肿是输液相关性死亡的主要原因 总被引:9,自引:0,他引:9
目的探讨输液相关性死亡的病理学特点及死亡原因.方法对1990年~2001年间医疗纠纷尸检档案中28例输液相关性死亡的资料进行分析.结果输液过程中死亡以中老年男性为主,输液相关死亡多发生在基层医疗单位内科性质科室.死亡多发生在输液4 h内,绝大多数患者在临死前有呼吸困难的表现.尸检发现死者大体呈溺死肺样改变,重量增加1~2倍.结论输液引起死亡的原因以急性肺水肿为主,其次为输液过多致动脉瘤破裂. 相似文献