An autopsy report on multiple system atrophy diagnosed immunohistochemically despite severe ischaemic damage: a new approach for investigation of medical practice associated deaths in Japan
An autopsy report on multiple system atrophy diagnosed immunohistochemically despite severe ischaemic damage: a new approach for investigation of medical practice associated deaths in Japan
复制标题
尽管存在严重缺血性损伤，但仍通过免疫组织化学诊断出多系统萎缩的尸检报告：调查日本医疗实践相关死亡的新方法
作者：
M. Nakajima;H. Kojima;Y. Takazawa;N. Yahagi;K. Harada;K. Takahashi;Kana Unuma;Ken
一名60岁男性，有10年多系统萎缩(MSA)病史，呼吸骤停。经过4个月的呼吸支持和两次败血症休克，他去世了。尸检发现中脑、脑干、延髓和小脑严重萎缩。尽管呼吸骤停和随后4个月的呼吸支持造成了严重的缺血损伤，但胶质细胞胞浆中仍有明显的Galyas-Braak、α-突触核蛋白和泛素阳性包涵体。呼吸骤停的原因尚未确定，但可以通过MSA的自然病史来解释。遇难者家属涉嫌玩忽职守，根据日本政府推动的示范项目中八名专家医生、一名专家护士、两名协调护士和两名律师进行的调查，他们对这一解释感到满意。
A 60-year old man with a 10-year history of multiple system atrophy (MSA) was found in respiratory arrest. After 4 months of respiratory support with two episodes of septic shock, he died. Autopsy disclosed severe atrophy of the mesencephalon, brainstem, medulla oblongata and cerebellum. Gallyas–Braak, α-synuclein and ubiquitin-positive inclusions in the cytoplasm of glial cells were evident, despite the severe ischaemic damage due to respiratory arrest and subsequent respiratory support for 4 months. The cause of respiratory arrest was not identified, but could be explained by the natural history of MSA. The bereaved family, who had suspected malpractice, was satisfied with the explanation based on the investigation performed by eight expert doctors, one expert nurse, two coordinator nurses and two lawyers in the model project promoted by the Japanese government.