小儿毒鼠药氟乙酰胺、毒鼠强中毒的病理改变

目的:探讨小儿毒鼠药中毒致人体各重要器官损害的病理形态学改变.方法:通过6例临床胃液分析检出氟乙酰胺、毒鼠强中毒死亡病例,常规尸检取出内脏器官检查,经常规石蜡切片,HE染色,光镜检查.结果:6例中的中枢神经系统、肝脏、肾脏、心脏、消化道、肺脏、脾脏、肾上腺及骨髓等均见明显的病理改变.结论:毒鼠药氟乙酰胺、毒鼠强具有中毒量小、毒性大、病变严重的特点,导致多内脏器官功能衰竭而死亡.     

心性猝死—4例主动脉瘤破裂的法医病理学鉴定

目的:探讨主动脉瘤破裂猝死的发病特点和病理学基础,为临床医师提供帮助。方法:对本系2002年12月至2006年l2月期间,所作450例法医病理检案的4例主动脉瘤破裂猝死案例进行分析研究。结果:4例主动脉瘤破裂致死占尸体解剖总数的0.89%,占SCD的4.1%,其中,DAA3例;2例DAA与AS有关。结论:主动脉瘤破裂病程短骤、凶险,是心性猝死的病因之一,早期症状与冠心病酷似,且病死率极高,因此应引起临床医师的高度重视,提高诊治水平。     

口头尸检对河池市5～60岁死亡病例进行死因评估结果分析

目的 分析河池市5～60岁居民死亡主要原因，分析口头尸检(Verlbal Autopsy，VA)进行死因调查的效果。方法 建立死亡监测系统，对所有报告的监测区内5～60岁死亡个案进行口头尸检调查。结果 2002年7月-2003年6月金城江镇、东江镇共死亡624人，全人口总粗死亡率为4．67‰，标化死亡率为5．34‰，男女之比为1．71：1；5～60岁死亡病例248例，粗死亡率为2．10‰；导致5～60岁居民主要死亡原因为意外死亡、恶性肿瘤、心脑血管疾病、消化系统疾病等，其中意外死亡占死亡构成比的1／3；通过VA进行死因调查，使3．000%的错误死因定义得到更正、5．00％的不明死因得到诊断；无因伤寒导致的死亡。结论 交通事故成为当地5～60岁居民死亡的主要因素；随着社会经济发展，伤寒等肠道传染病已不是导致死亡的重要因素；使用VA对于死因的判定比一般的监测系统报告更为准确。     

Prevalence of the Neonatal Autopsy: A Report of the Study Group for Complications of Perinatal Care

Neonatal autopsy findings are valuable additions to the information base for current cases and future perinatal care, so the reported decline in the autopsy rate is disturbing. In order to estimate the prevalence of the neonatal autopsy among a large population of deaths, we surveyed participating institutions of the Study Group for Complications of Perinatal Care. Investigators from 37 neonatal intensive care units, located in 9 children's hospitals, 4 hospitals for women and infants, and 24 full-service pediatric and adult care hospitals, reported their neonatal death and autopsy rates for 1989. The overall neonatal autopsy rate was 51% among 1645 neonatal deaths. The rate was variable, ranging from 22 to 100%. We found the neonatal autopsy rate to be lower than previously reported and not apparently influenced by the type of center or by the type of medical staff at the centers. In order to assess and potentially reverse the current low rate, the influence of neonatal demographic and clinical factors, as well as physician-related factors, must be studied.     

Community-based situation analysis of maternal and neonatal care in South Africa to explore factors that impact utilization of maternal health services

This community situational analysis determined factors impacting the utilization of maternal health services in South Africa. Quantitative and qualitative research methods were used, including semistructured household interviews, case studies of women with no antenatal care and/or home birth, and verbal/social autopsies of maternal and infant deaths, conducted in three diverse sites across the country. Data analysis used quantitative statistics for the semistructured interviews and a qualitative thematic content approach for the case studies and verbal/social autopsies. Each component was analyzed separately and then triangulated. The following themes emerged: 1) transport and distance to care were the biggest problems, particularly in rural areas; 2) providers' communication with families was very poor; 3) health-seeking behavior was better than anticipated; 4) treatment by health providers and quality of care showed mixed results; 5) HIV/AIDS is a major issue; however, basic maternity and neonatal service quality cannot be overlooked; and 6) families and communities are an untapped resource for improving maternal and neonatal health. Implications for maternal and infant health care in developing countries are discussed, with a particular focus on barriers to utilization and involvement of communities and families in maternity care.     

Deaths among women of reproductive age: A forensic autopsy study

Unnatural deaths in women of reproductive age (range 12–49 years) have a serious psychological and social impact on the family and community. Deaths among women of reproductive age reported as medico-legal cases were investigated to see the trend in terms of cause and manner of death. The study group consisted of a series of 328 consecutive forensic autopsies on women in the reproductive age group, performed between 2009 and 2011 at the Government Wenlock District Hospital, Mangalore, India by qualified specialist forensic medicine experts. Unnatural deaths formed 93.6% of the cohort. The top three causes of death included burns, poisoning and hanging forming 69.5% of the cases. The manner of death was suicide in 45.4% cases, accident in 43.6% cases and homicide in 4.6% cases. The circumstances of death were related to alleged medical negligence in 2.4% cases. Death in 4% cases was natural mannered with a disease being the cause of death. Three-fourths of the victims were married. Married women formed 63.1% of the suicidal victims. Homicidal deaths were not reported among unmarried women. The preponderant method of suicide was by poisoning at 42.3% (63 cases), followed by hanging (34.9%), burns (11.4%) and drowning (9.4%). These four methods comprised 98% of the total suicidal deaths in this study cohort. Accidental deaths were predominantly caused by burns (62.2%) and road traffic accident (23.1%). Two-thirds of the homicidal deaths were due to assault caused by blunt-force trauma, ligature strangulation and sharp-force trauma. One-third of the homicidal victims died due to burns. With a clear understanding of the cause and manner of death, it may be possible to predict, and hopefully prevent, future cases of unnatural deaths in women of reproductive age who form a very important group of society.     

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。     

Cardiac Genetic Predisposition in Sudden Infant Death Syndrome

Background

Sudden infant death syndrome (SIDS) is a leading cause of postneonatal mortality. Genetic heart diseases (GHDs) underlie some cases of SIDS.

The real status of sudden infant death (SIDS) in forensic medicine

To comprehend the real status of sudden infant death syndrome (SIDS) in forensic medicine, a statistical study was conducted on 156 cases subjected to medico-legal autopsies at university medical schools throughout Japan from 1987 to 1991 and diagnosed as SIDS. Furthermore, 138 cases that had been subjected to autopsies at the Tokyo Medical Examiner's Office and given the diagnosis of SIDS were evaluated for comparison. It was noted that the incidence of SIDS diagnosed at each facility has increased.     

Rates and causes of child mortality in an area of high HIV prevalence in rural South Africa

OBJECTIVE: To determine child mortality rates in a rural area of South Africa with high HIV prevalence. METHODS: A community-based survey was conducted between 1 January 2000 and 31 December 2002 on deaths in children under the age of 15 years. Children were followed up through four monthly home visits. Cause of death was ascertained by verbal autopsy. Rates were calculated using Poisson regression. RESULTS: Mortality ratios were 59.6 deaths per 1000 live births for infants and 97.1 for children under 5 years of age. Infant and under-5 mortality rates were, respectively, 67.5 and 21.1 deaths per 1000 person-years. HIV/AIDS was attributed to 41% of deaths in the under-5 age group, with a mortality rate of 8.6 per 1000 person-years. Lower respiratory infections caused an estimated 24.9 deaths per 1000 person-years in children under 1 year of age. CONCLUSIONS: In rural South Africa, infant and child mortality levels are high, with HIV/AIDS estimated as the single largest cause of death. Interventions to reduce child mortality are required urgently.