Forensic Pathology and Experimental Research on Brain Death

1. 在近10年来进行的法医尸检中，对62例脑死亡和5例植物人进行了肉眼和显微镜下的评估。获得了许多重要的发现。在脑死亡持续时间超过5 ~ 6小时的病例中，呼吸机脑的特征性表现在大脑、小脑和脑干中已经被识别出来。在延髓和上颈髓中，即使在脑死亡持续时间相对较短的病例中，也可见明显的神经细胞萎缩和固缩。延髓作为呼吸中枢的这一发现将有助于从形态学上理解脑死亡自发性呼吸消失的原因。对脑死亡患者的心脏、肝脏和肾脏的组织学表现提供了新的有价值的信息，这将成为器官移植的对象。日本法医学学会第71届代表大会、温哥华国际法医学学会第11届会议、1987年雅加达印度尼西亚病理学家协会第9届全国代表大会和1988年北京国际法医学大会均报道了上述结果。脑死亡动物实验以家兔为实验对象。这些动物被麻醉、插管并戴上呼吸机。在所有动物中，脑壁或脑干部分一侧的硬膜外球囊充气引起脑压迫和水肿。实验过程中不断记录脑电图（EEG）和心电图（ECG）。实验采用呼吸机持续停止自主呼吸，脑电图平展，维持脑死亡状态。将脑、心、肝和肾的组织病理学结果与人类脑死亡病例的组织病理学结果进行比较。像人类这样持续时间较长的脑死亡状态尚未出现。死后脑组织的变化，自溶，也进行了讨论。少

1. Among the medico-legal autopsies performed in recent 10 years, 62 cases of brain death and 5 cases of vegetative state were evaluated grossly and microscopically. Many important findings were obtained.Characteristic findings of respirator brain could be already recognized in cerebrum, cerebellum and brdin stem in cases with duration of more than five to six hours' brain death. In medulla oblongata and upper cervical cord, marked shrinkage and pyknosis of nerve cells were seen even in cases with comparatively shorter duration of brain death. Such findings in medulla oblongata, as respira tory center, will be of a help to understand morphologically the disappearance of spontaneous respiration in brain death. New valuable informations were obtained on histological findings of heart, liver and kidneys in cases of brain death which will become the objects of organ transplantation.These results were reported on the 71st Congress of the Medico-Legal Society of Japan, the llth Meeting of th … More e International Association of Forensic Sciences in Vancouver, the 9th National Congress of the Indonesian Association of Patholo gists in Jakarta in 1987 and on the International Congress on Forensic Sciences in Beijing in 1988.2. Animal experiments on brain death were done using rabbits. The animals were anesthetized, intubated and placed on a ventilator. In all animals brain compression and edema were caused by inflating an epidural balloon on one side of parietal or brain Stem portion. During the experiments the electroencephalogram (EEG) and electrocardiogram (ECG) were constantly recorded. Continuous stoppage of spontaneous breathing and flattening of EEG were made and the state of brain death were experimentally maintained using ventilator. Histopathological findings of brain, heart, liver and kidneys were compared with those of the human cases of brain death. Such state of brain death with long duration as human cases has not been produced yet. Postmortem changes of brain tissue, autolysis, were also discussed. Less