纵裂人路处理大脑前动脉远段动脉瘤的外科策略:解剖及临床研究

目的探讨处理大脑前动脉远段动脉瘤的外科策略。方法在10具(20侧)尸头上检查大脑前动脉远段区域的显微解剖,并模拟外科入路至大脑前动脉远段动脉瘤,回顾性分析5例大脑前动脉远段动脉瘤的临床资料,均采用纵裂入路手术夹闭。结果胼周-胼缘动脉结合部位于A3段的胼上段和胼下段分别为11侧和9侧。胼缘动脉起始处近端胼周动脉长轴与额底长轴间平均夹角是19.5°,从鼻根部到胼缘动脉起始处近端胼周动脉长轴的延长线与额部交点(PC点)平均距离是31.52 mm。本组5例大脑前动脉远段动脉瘤病人,按GOS评定治疗结果:术后良好4例,死亡1例。随访3例,时间1~5年,无复发、出血及其他手术并发症。结论当采用PC点上方入路时,夹闭动脉瘤前,需切开胼胝体前端,建立有效的近端控制。PC点是制定胼下型大脑前动脉远段动脉瘤外科策略的重要外科标志。     

Unrecognized viral infections and chromosome abnormalities as a cause of fetal death – examination with fluorescence in situ hybridization,immunohistochemistry and polymerase chain reaction

Fifteen to 50% of fetal deaths remain unexplained after post‐mortem examination depending on inclusion criteria and classification systems. Our aim was to examine a selection of unexplained fetal deaths in order to investigate whether any common chromosome aberrations or viral infections were present. Reports from 351 fetal autopsies performed at the Department of Pathology and Medical Genetics at St. Olavs University Hospital from 2001 through 2010 were reviewed. Of these, 105 fetal deaths were classified as unexplained. Tissue samples from 30 cases were further examined with fluorescence in situ hybridization (FISH) to detect abnormalities in chromosomes 13, 18, and 21. The samples were also examined with immunohistochemistry (IHC) and polymerase chain reaction (PCR) to detect infections with cytomegalovirus, parvovirus B19, herpes simplex virus 1 and 2, enterovirus, and parechovirus. In two cases, a possible trisomy 13 mosaicism was found. No viruses were detected. In our selection of 30 unexplained cases, possible trisomy 13 mosaicism was found in two cases, and no viruses were detected. High degree of maceration and missing placental examination often complicate the investigation of fetal death, and extensive ancillary examinations do not necessarily contribute to a more specific diagnosis.     

An approach to industrial post mortems

Industrial-related deaths represent a specialized aspect of autopsy practice. The purpose of this review is to assist the pathologist in the handling of such deaths. The diseases associated with the three most significant mineral dusts (asbestos, coal and silica) are described, together with a selection of less well-known mineral dust diseases. This review addresses the complex issues of ascribing disease to industrial exposures and the role of mineral analysis. The authors discuss the common medical legal issues that are encountered at post mortem and at inquest deposition.     

270例尸体解剖检验分析

[目的]探讨270例尸体解剖检验病例特点.[方法]对270例尸体解剖检验资料进行回顾性分析.[结果]270例中244例为阳性解剖,26例为阴性解剖;病理性死亡原因中循环系统疾病居首位,非病理性死亡原因中脑血管意外居首位;30~50岁为尸体解剖检验的高峰年龄,男性明显多于女性,意外死亡多发生在秋冬季节.     

Levels and causes of maternal mortality in Senegal

OBJECTIVES: To report the findings of a direct, community-based, assessment of maternal mortality and medical causes of death using verbal autopsy in three unique cohorts in rural Senegal. METHODS: Methods from ongoing demographic surveillance systems. We obtained records of all deaths and births in women of age 15-49 over a period of 14 years in Niakhar, 10 years in Bandafassi and 13 years in Mlomp. Relatives of all women who died were interviewed using a standard questionnaire. Causes of death were assigned by three physicians independently. Maternal deaths were defined according to the ninth and tenth revisions of the International Classification of Diseases. RESULTS: The maternal mortality ratio was similar in Mlomp [436 per 100 000 live births (95% confidence interval 209-802)] and Niakhar [516 per 100 000 (413-636)] but significantly higher in the more remote area of Bandafassi [852 (587-1196)] [relative risk compared with Niakhar 1.6 (1.0-2.4)]. Two-thirds of the maternal deaths were from direct obstetric causes, haemorrhage being the most common. Abortion was rare. CONCLUSIONS: Demographic surveillance systems are useful tools for the measurement of maternal mortality provided special studies are carried out to arrive at the levels and causes of maternal death. The estimates of maternal mortality reported here are lower than those published by the WHO and UNICEF but remain extremely high, particularly in the very remote areas with very limited health infrastructure, where as many as one in 19 women may be expected to die as a consequence of childbirth.     

Early psychomotor slowing predicts the development of HIV dementia and autopsy-verified HIV encephalitis

OBJECTIVES- To ask if slowed motor speed predicts later human immunodeficiency virus (HIV) dementia and HIV encephalitis. METHODS- In 100 deceased acquired immunodeficiency syndrome (AIDS) patients prior results from repeated testing of the movement reaction time test were correlated with later clinical signs of HIV dementia and with neuropathological signs of HIV encephalitis. Autopsy was performed in 72 patients. RESULTS- Movement reaction time 1-2 years prior to death, or at the time of clinical AIDS diagnosis predicted both development of HIV dementia (P<0.05) and HIV encephalitis at autopsy (P<0.01). CONCLUSION- Testing for early psychomotor slowing may be used to identify patients at risk of HIV dementia and HIV encephalitis.     

猝死126例尸检分析

[目的]探讨影响猝死发生的因素.[方法]对126例猝死尸检病例进行回顾性分析.[结果]126例猝死病例的死亡原因中心血管系统疾病居首位,而胰腺性猝死的发生率呈上升的趋势;男性猝死病例明显多见于女性;朝鲜族与汉族的猝死率之间无显著性差异;36~60岁人群为猝死高发人群;猝死的日变异性高峰为22:00-6:00;季节变异性高峰为冬季.[结论]性别、年龄、季节及气候等为影响猝死的危险因素.     

Diamniotic Conjoined Fetuses in a Triplet Pregnancy: An Insight Into Embryonic Topology

We present a case of triplets, 2 of whom were monochorionic diamniotic conjoined fetuses, and the other triplet was in a separate chorion. The pregnancy followed in vitro fertilization with 2 embryo transfers and the conjoined fetuses developed from a single embryo. An early ultrasound showed 2 embryos attached to 1 yolk sac. Further monitoring of the pregnancy showed these 2 triplets to be diamniotic with a short umbilical cord/body stalk anomaly. After fetal loss a postmortem examination demonstrated that these fetuses were conjoined with a body stalk anomaly/short umbilical cord syndrome with fusion of the coelomic cavities and small bowel (minimally united/conjoined twins). There were dividing amniotic membranes. This case demonstrates the development of an unusual type of conjoined twin with characteristic features. Conjoined fetuses with this pattern have fused small bowel and cloacal anomalies and often diamniotic placentation, when this is recorded. Various terms including minimally united/conjoined omphalopagus/ischiopagus have been used for this characteristic pattern, but this pattern may warrant a specific term. “Diamniotic vitellopagus” may best reflect the pathogenesis of this pattern. This case was presented at the Paediatric Pathology Society Meeting; Cape Town, South Africa; April 2004