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儿童癫痫的 50 年随访研究：医疗结局、发病率和药物治疗

描述儿童癫痫的长期预后，尤其侧重于癫痫发作缓解、复发、药物治疗、相关神经系统功能障碍、死亡率和死亡原因。针对 1962 年—1964 年间基于人群总数为 195 例癫痫发作儿童队列的一项前瞻性纵向研究。数据均通过医疗记录和调查问卷收集。来自最初队列 94% 的随访数据显示，无智力或神经功能障碍的患儿，无癫痫发作的长期预后最好。这些患儿发病较晚，癫痫发作的持续时间较短，且通常不使用药物。他们中仅少数曾复发。全面性而非局灶性癫痫，通常较少复发，持续用药更短。 “真正发病”组，即在 1962 年—1964 年间纳入的发病患儿，无癫痫发作的长期预后最好，90% 在 50 年后癫痫无发作。尽管该组中仅 10% 在随访时仍有发作，但 22% 仍使用抗惊厥药物，且常使用传统药物—苯巴比妥或苯妥英钠作为抗癫痫药物之一。整个组的标准化死亡率（Standardized mortality ratio，SMR）为 2.61，且在有无其他神经系统缺陷的患者之间无差异。年轻的死亡患者部分有神经系统损伤，部分死于癫痫相关的情况，而年龄较大的患者死亡通常由非癫痫相关疾病导致。发病组中无患者死于癫痫猝死（Sudden unexpected death in epilepsy，SUDEP）。我们 12 年的随访和以往的报道相比，儿童癫痫患者的 50 年长期随访总体显示出更好的癫痫无发作结局。文章报道了癫痫发作较低的复发率，癫痫发作的缓解并不意味着药物治疗的终止，SUDEP 相关的死亡率也低于以往的报道。

心瓣膜置换术后患者围术期死亡原因分析

摘要： 目的 分析心瓣膜置换术后患者围术期死亡的原因，探讨降低围术期病死率的措施。 方法 回顾性分析2004年1月至2009年1月广西医科大学第一附属医院行心瓣膜置换术后死亡的54例患者的临床资料，男28例，女26例；年龄20～65岁(45.5±11.6岁)。全组均在全身麻醉低温体外循环(CPB)下行心瓣膜置换术，其中37例行中低温(26~28 ℃)心脏停搏手术,17例行浅低温(31～33 ℃)心脏不停跳手术。对围术期死亡的原因进行分析。结果 术中死亡15例,手术死亡率1.78%(15/845)；其余39例患者的死亡时间为术后3 h~106 d（8.2±17.2 d）,死亡原因主要为低心排血量综合征(LCOS)、不能停CPB、心脏及主动脉出血、呼吸功能衰竭、肾功能衰竭、恶性心律失常和多器官功能衰竭等。 结论 选择恰当手术时机、充分术前准备、改善心功能，术中谨慎操作、良好心肌保护、术后加强监护，可提高手术成功率。

Retrospective Analysis of the Causes of Death and Its Clinical Data in 149 of Dead Inpatients with Diabetic Nephropathy

Forensic Pathologic Analysis of Traumatic Brain Injury

【摘要】 目的 探讨颅脑损伤(BI)死亡的法医病理学特点,以及继发性脑干损伤、并发症的发生与死亡之间的因果关系。方法 从性别、年龄、致伤方式、损伤类型、生存时间、死亡原因等方面,对四川大学华西法医学鉴定中心1998年1月-2008年12月127例BI死亡尸检案例进行回顾性统计研究分析。结果 127例法医病理学检案中,原发性BI死亡51例(402%),继发性脑干损伤死亡61例(480%),并发症死亡15例(118%),其中伤后12 h内死亡者直接死因均为严重原发性脑损伤,存活12 h～1周者直接死因以继发性脑干损伤居多,生存时间超过1周者约半数死于并发症。结论 在BI案例的死亡原因确定时,应在全面系统的病理学检验基础上,结合案情及临床资料进行综合分析。【Abstract】 Objective To explore the characteristics of forensic pathology in traumatic brain injury and the relationships between secondary brainstem damage, complications and the causes of death. Methods 127 cases were reviewed from gender, age, manner of injury, survival time and the direct causes of death from January 1998 to December 2008. Results Of the 127 cases, the key direct cause of death was secondary brainstem damage, followed by severe primarily brain injury and complications. For those who died within 12 hours after injury, the direct cause was severe primarily brain injury; for those who survived between 12 hours to one week, secondary brainstem damage was in the majority of the causes and for those who survive more than one week time, complication was an important cause. Conclusion In the cases of traumatic brain injury, we should take comprehensive and systematic examination of forensic pathology, and refer to clinical data at the same time to determine the direct cause of death.

Forensic Pathological Analysis of Death Cases after Cardiac Valve Replacement

【摘要】　目的　分析心脏瓣膜置换术后死亡案例的法医病理学特点，探讨有关瓣膜置换术后死亡案例的法医病理学鉴定思路及原则。　方法　从手术方式、术前心脏状况及术中所见、法医病理检验所见、死亡时间、死亡原因等方面，对2008年1月-2010年2月4例心脏瓣膜置换术后死亡案例进行综合研究分析。　结果　4例均患有风湿性心脏病，且术前心功能较差；3例二尖瓣瓣膜置换术，3例主动脉瓣瓣膜置换术，2例三尖瓣成形术；二尖瓣瓣膜置换术1例平行房间沟的左房纵行切口，1例右心房-房间隔切口，1例右心房-房间隔-左房联合切口；主动脉瓣瓣膜置换术均行升主动脉根部斜形切口或S状切口；死亡时间为1例术中，1例术后30 min，1例术后2 d，1例术后8 d；死亡原因为1例心肌炎，1例传导系统出血，2例失血性休克；1例术前有潜在感染灶。　结论　对有关心脏瓣膜置换术后死亡案例的法医病理学鉴定时，应在了解患者瓣膜置换术前心脏情况以及手术方式、手术路径和缝合方法的基础上，结合法医病理组织学检查进行综合分析。【Abstract】　Objective　To analyze the forensic pathological characteristics of those who died after cardiac valve replacement and explore the mentality and principle of documentary evidence of medicolegal expertise.　Methods　Four death cases after cardiac valve replacement between January 2008 and February 2010 were comprehensively analyzed from various aspects of surgery style, preoperational heart condition, peri-operational observations, results of forensic pathological tests, time of death, and causes of death.　Results　All cases were rheumatic heart disease and the preoperational heart function was poor. Of the four cases, three had mitral valve replacement (MVR), three had aortic valve replacement (AVR) and two had tricuspid valvuloplasty. Of the three MVR cases, cutting on the left atrium paralleling the interatrial groove was performed in one case, cutting through right atrium and interauricular septum was performed in one case, and cutting left atrium and right atrium through interauricular septum was performed in another case. For all the three AVR cases, cutting on the root of aorta with the shape of diagonal or ’S’ was carried out. One patient died during operation, one died thirty minutes after operation, one died two days after operation and one died eight days after operation. Among them, one died of myocarditis, one died of hemorrhage in the conducting system and two died of hemorrhagic shock. Besides, one patient had potential bacterial infection before surgery.　Conclusion　For patients who died after cardiac valve replacement, we should acquaintance ourselves with the preoperational heart condition, surgery style, surgical approach and the methods of stitch to make a comprehensive analysis with forensic pathology examination.

Retrospective analysis of death causes and relevant factors in victims of the 2008 W enchuan earthquake

Objective To analyze death causes and relevant factors in victims of Wenchuan earthquake．Methods Medical records of 27 dead patients admitted to W est China Hospital during the first 30 days after Wenchuan earthquake were analyzed retrospectively．Patient census data，diagnoses，dispositions，and prognoses were collected． Results A total of 2702 patients with earthquake related injuries were admitted to West China Hospital．The overall mortality rate was 1％(27／2702 patients)．The death were associated with age≥70．severe cerebral injuries and severe underlying illness．Mortality rate was highest in aged patients with comorbidities．Conclusions Insufficient pre-hospital treatment and inappropriate transfer procedure may contribute to the early death．Complicated with comorbidities is the leading cause of late death．Earlier involvement of intensivist in medical intervention in such a disaster is demanded．

食管癌患者术后一年非肿瘤原因死亡分析

摘要： 目的 分析食管癌患者术后1年内非肿瘤原因死亡的原因，以提高外科治疗效果。 方法 回顾性分析1997年10月至2002年10月甘肃省肿瘤医院收治的40例食管癌手术后1年内因非肿瘤原因死亡患者的临床资料，其中男35例，女5例；年龄53~76岁（65±13岁）。对40例食管癌手术后死亡患者进行随访，并分析其死亡的原因。 结果 40例非肿瘤复发转移死亡中有27例（67.50％）行食管癌根治手术，22例（55.00％）无淋巴结转移，38例（95.00％）切缘癌阴性。术后因放化疗并发症死亡11例，主要原因是化疗引起肝、肾功能衰竭、 消化道和呼吸道大出血、全身衰竭； 放疗致食管主动脉瘘、食管气管瘘、食管胸膜瘘等。因手术相关并发症死亡18例，主要原因是脓胸胸腔感染、切口感染、坏疽性肠梗阻 、胃功能障、胸胃扩张无法进食致全身衰竭、反流性食管溃疡致上消化道出血和误吸致肺部感染等。因老年合并疾病死亡11例，主要原因是心肌梗死、肺栓塞和脑出血等。 结论 对食管癌患者应重视食管癌术后放化疗并发症的预防，重视出院后远期并发症、老年病的预防和治疗，加强多科的康复治疗。

Forensic Pathologic Analysis of Traumatic Brain Injury

【摘要】 目的 探讨颅脑损伤(BI)死亡的法医病理学特点,以及继发性脑干损伤、并发症的发生与死亡之间的因果关系。方法 从性别、年龄、致伤方式、损伤类型、生存时间、死亡原因等方面,对四川大学华西法医学鉴定中心1998年1月-2008年12月127例BI死亡尸检案例进行回顾性统计研究分析。结果 127例法医病理学检案中,原发性BI死亡51例(402%),继发性脑干损伤死亡61例(480%),并发症死亡15例(118%),其中伤后12 h内死亡者直接死因均为严重原发性脑损伤,存活12 h～1周者直接死因以继发性脑干损伤居多,生存时间超过1周者约半数死于并发症。结论 在BI案例的死亡原因确定时,应在全面系统的病理学检验基础上,结合案情及临床资料进行综合分析。【Abstract】 Objective To explore the characteristics of forensic pathology in traumatic brain injury and the relationships between secondary brainstem damage, complications and the causes of death. Methods 127 cases were reviewed from gender, age, manner of injury, survival time and the direct causes of death from January 1998 to December 2008. Results Of the 127 cases, the key direct cause of death was secondary brainstem damage, followed by severe primarily brain injury and complications. For those who died within 12 hours after injury, the direct cause was severe primarily brain injury; for those who survived between 12 hours to one week, secondary brainstem damage was in the majority of the causes and for those who survive more than one week time, complication was an important cause. Conclusion In the cases of traumatic brain injury, we should take comprehensive and systematic examination of forensic pathology, and refer to clinical data at the same time to determine the direct cause of death.

Forensic Analysis on Cases of Infant Death after Vaccination

ObjectiveTo explore the common causes and the clinical pathological characteristics of infant death which occurred after vaccination. MethodsThe study retrospectively analyzed the data of 13 cases of infant death occurring after vaccination from January 2009 to September 2014 in West China Medico-legal Expertise Center. ResultsAmong the 13 cases of infant death, 12 were dead from lethal respiratory system and cardiovascular system diseases, 1 from mechanic asphyxia caused by milk intake. All cases were coupling disease death and had no direct correlation with vaccination. ConclusionSystematic and comprehensive forensic pathological examination is helpful to clarify the cause of death, reveal the relationship between vaccination and the cause of death, and contribute to proper processing of such incidents.

Analysis of 14 Cases of Maternal Mortality and Intervention Measures

ObjectiveTo explore the corresponding intervention measures to reduce maternal mortality rate by analyzing the causes and problems of maternal deaths. MethodsA retrospective analysis was conducted to analyze all cases of maternal mortality from January 2005 to June 2013 in West China Second University Hospital. ResultsAmong the 14 cases of maternal deaths, the main diseases of the patients were pregnancy complicated with heart disease, hypertensive disorders, obstetric hemorrhage, amniotic fluid embolism and ectopic pregnancy. Four cases got prescriptive prenatal care during pregnancy, accounting for 28.6% (4/14), while 10 cases did not, accounting for 71.4% (10/14). Six patients died in prenatal period which accounted for 42.9% (6/14), while 8 died in postnatal period which accounted for 57.1% (6/14) and 5 died within 24 hours which accounted for 62.5% (5/8). Seven underwent cesarean section and 6 fetuses survived. Two went through trial of labor and no fetus survived. There was no ordered postmortem. ConclusionIntensifying education of prenatal care during pregnancy, improving quality of obstetrical service and diathesis of healthcare professionals, strengthening the supervision of high-risk pregnancy and timely choosing the time and manner of delivery are the main measures to decrease the maternal mortality.