Studies on Morphological Changes of Organs due to Traumatic Shock

利用法医解剖病例，对肺、肾上腺和心脏进行病理研究，揭示其特征性的休克相关变化。103例肺病理研究显示，肺水肿、出血或充血是一种非特异性发现。然而，如果统计肺泡毛细血管中的多形中性粒细胞（PMN），并确定PMN/肺泡比值大于1的病例为阳性，则出血、头部损伤和心脏填塞以及休克状态下死亡的病例的阳性病例发生率相对较高，分别为56%、43%、40%和55%。另一方面，窒息和火灾死亡的病例显示为阴性。此外，在强钝器伤和刺伤和/或切口伤中，PMN也分别增加了50%和71%。因此，PMN的增加发生在受伤后不久，可以成为法医尸检案件中揭示病理方面的重要发现之一。在一项对60例尸检病例的肾上腺研究中发现，在头部损伤和出血的病例中观察到肾上腺皮质坏死，在休克状态下发生死亡的病例中分别占50%，31%和50%。因此，肾上腺皮质坏死也可以被认为是损伤后不久发生的重要表现之一。就心脏而言，主要检查了10例在休克状态下死亡的病例。心肌细胞弥漫性染色7例，收缩带坏死5例。因此，这些发现被认为是重要的，这些发现发生在损伤后不久，并解释了法医尸检案件中心脏的病理状况。

The lung, adrenal gland and heart were studied pathologically to reveal their characteristic shock-related changes, using medicolegal autopsy cases. Pathological studies of the lung, using 103 cases, revealed that pulmonary edema, hemorrhage or congestion was a non-specific finding. However, if polymorphoneutrophiles (PMN) in the alveolar capillaries were counted and a case in which PMN/alveolus ratio was over 1 was determined positive, cases sustained by hemorrhage, head injuries and cardiac tamponade, and cases in which deaths occurred in a state of shock showed relatively high incidence of positive cases, 56%, 43%, 40% and 55%, respectively. On the other hand, cases sustained by asphyxia and cases dead by fire revealed negative. Moreover, PMN increased also in cases sustained by strong blunt force and cases sustained by stab and/or incised wounds, 50% and 71%, respectively. Thus, increase of PMN occurs shortly after receiving injuries and can become one of the important findings to reveal pathological aspects in medicolegal autopsy cases. In a study of the adrenal gland using 60 autopsy cases which showed a little postmortem changes, adrenal cortical necrosis was observed in cases sustained by head injuries and hemorrhage, and cases in which deaths occurred in s state of shock, 50%, 31% and 50%, respectively. Thus, adrenal cortical necrosis can be also considered one of the important findings which occurs sortly after receiving injuries. So far as the heart, 10 cases in which deaths occurred in a state of shock were mainly examined. Diffuse staining of the cardiac myocyte was observed in 7 cases and contraction bands necrosis was observed in 5 cases. Thus, these findings are considered important ones which occur shortly after injuries and explain pathological condition of the heart in medicolegal autopsy cases.