Walter Till, Meissner Christoph, Oehmichen Manfred
Gesundheitsklinik Stadt Hamburg GmbH, Im Bad 35, D-25826 St. Peter-Ording, Germany.
Leg Med (Tokyo). 2009 Apr;11 Suppl 1:S56-62. doi: 10.1016/j.legalmed.2009.01.112. Epub 2009 Mar 18.
We examined 10 histomorphological alterations of 222 cases of subdural hemorrhages following mechanical closed brain injury (MBI) to determine the posttraumatic interval (PTI). These morphological features included red blood cells (RBCs), polymorphonuclear leukocytes (PMNs), macrophages (Ms), RBC-containing Ms, hemosiderin-containing macrophages, hematoidin, fibroblasts, endothelial cells, collagenous fibers and membrane formation. The interval between the time of brain injury and death ranged from a few minutes to 33 years. Following routine staining and immunohistochemical staining of macrophages (CD68), paraffin sections were examined by light microscopy for the presence of the selected histomorphological features. An apparent correlation was found between the frequency of a given histomorphological phenomenon and the length of the PTI. Half of the cases (group 1; n=111) were used to develop a multistage evaluation system, the other half (group 2; n=111) to check its accuracy of prediction. Applying this multistage evaluation model and a special software, 85 of the 111 control group cases (76.6%) could be correctly classified and further 21 cases (18.9%) being assigned to an interval close to the correct interval. Therefore, classification of the correct PTI or an interval close to the correct PTI could be achieved in 95.5% of all cases.
我们检查了222例机械性闭合性脑损伤（MBI）后硬膜下出血的10种组织形态学改变，以确定创伤后间隔时间（PTI）。这些形态学特征包括红细胞（RBC）、多形核白细胞（PMN）、巨噬细胞（M）、含红细胞的巨噬细胞、含铁血黄素巨噬细胞、类胆红素、成纤维细胞、内皮细胞、胶原纤维和膜形成。脑损伤至死亡的间隔时间从几分钟到33年不等。在对巨噬细胞进行常规染色和免疫组化染色（CD68）后，通过光学显微镜检查石蜡切片中选定的组织形态学特征。发现特定组织形态学现象的出现频率与PTI的长短之间存在明显的相关性。一半病例（第1组；n = 111）用于建立多阶段评估系统，另一半（第2组；n = 111）用于检验其预测准确性。应用该多阶段评估模型和一种特殊软件，111例对照组病例中有85例（76.6%）能够被正确分类，另有21例（18.9%）被归入接近正确间隔的区间。因此，在所有病例中，95.5%能够实现正确PTI或接近正确PTI区间的分类。
