Clinico-morphological parameters of heroin abuse and pathology connected with it

Morphological manifestations of narcomania in heroin users are described. Diseases associated with heroin narcomania and causes of death of heroin users are presented. Morphological manifestations at the site of injections and inflammatory reactions in parenchymatous organs are characterized. The authors pay special attention to the productive inflammation which can serve as one of the signs that confirm narcomania in cases with parenteral injections of crude heroin. The authors refer the granulomas to toxic allergic form of granulomatous hypersensitive inflammation.     

Epidemiologic analysis of ephedrone substance abuse in the Primorye territory

Biochemical effects of ephedrone and their clinical manifestations are described. Statistical data on the prevalence of ephedrone narcomania in the Primorye territory are compared with the prevalence of use of psychostimulating narcotics in other regions (analysis of the files of thanatological department of Bureau of Forensic Medical Expert Evaluations in Moscow). Morphological changes in the viscera are described detail. The authors come to a conclusion on high incidence and multifactorial toxic effects of ephedrone and multilevel somatic involvement in ephedrone narcomania.     

Liver pathology in fatal drug addiction

Liver sections from 273 drug addicts submitted to medicolegal autopsy at the Institute of Forensic Medicine in Copenhagen in the period 1975 – 1979 were studied. In 65% of the cases non-specific portal inflammation only was found. Birefringent foreign material — identified as the mineral talc (magnesium silicate) was observed in 38% of the cases; in these cases non-specific portal inflammation was always present. Changes compatible with acute or chronic persistent hepatitis or hepatitis sequelae were observed in 8% of the cases; cirrhosis in 3%. HBs-antigen was detected in 4%. In 22% fatty infiltration was present; in 4% as the only abnormal finding. Finally no pathological changes were found in 6%. The results were related to anamnestic information of kind and duration of drug abuse and to the cause of death. Furthermore a comparison was performed between the groups with and without birefringent material. The data suggest that the birefringent material may be of importance to the pathogenesis of the non-specific portal inflammation.     

Chapter 19: Alcoholism and Other Drug Addictions

Ethyl alcohol is classified as a narcotic, i.e., a substance that acts primarily on the central nervous system. Repeated use of narcotics leads to addiction, and a morbid need to consume them is called narcomania. As a rule, an organism that has become addicted to frequent use of narcotics reacts pathologically to being deprived of the habitual stimulant. A picture of "narcotic hunger," i.e., a withdrawal syndrome [abstinentsiia], develops. This characteristic phenomenon is similar in its general features for all addicts, regardless of the drug used.     

Morphological study of the corpus striatum in forensic medical diagnosis of chronic opiate abuse

Morphological analysis of the corpus striatum in morphine intoxication was carried out on experimental and autopsy specimens. The resultant morphometrical data characterize various stages of opium narcomania and abstinence. The severity of involvement of neuronal structures and specific features of the glial reaction are described, which can be used in forensic medical diagnosis of such intoxications.     

Spleen and portal lymphnode pathology in fatal drug addiction

Spleen and portal lymphnode sections from 86 drug addicts submitted for medico-legal autopsy at the Institute of Forensic Medicine in Copenhagen in the year 1979 were studied together with tissue sections from 24 "normal" persons. In 70% of the drug addicts the spleen weight was more than 200 g, and in 71% portal lymphnode hyperplasia was found. Birefringent foreign material was found in spleen tissue of drug addicts in 72% and in portal lymphnode tissue in 44%. Signs of antigen stimulation in both spleen and portal lymphnode tissue evaluated by the number of germinal centre and plasma cells were found in more than 80% of the drug addicts compared with about 20% of the "normal" persons. The results were related to anamnestic information of duration of drug abuse, to the spleen weight, to the occurrence of birefringent material and to the liver changes. Examination of lysozyme and immunoglobulin containing cells using the indirect preoxidase technique was performed in a total of 72 cases of spleen tissue, 59 cases of portal lymphnode tissue from drug addicts, 24 cases of spleen tissue and 18 of portal lymphnode tissue from "normal" persons. Lysozyme, IgM and IgG containing cells were found significantly more often among drug addicts than "normal" persons. The results indicate that the splenomegalia and the portal lymphnode hyperplasia often found in drug addicts are caused by continuous antigen stimulation due to repeated injections of various antigens.     

Forensic medical diagnostics of chronic narcotic intoxication based on the morphological findings

The objective of the present work was to develop the forensic medical criteria for chronic narcotic intoxication based on the results of morphological studies. The internal organs from 179 cadavers were available for the examination following death from acute poisoning with narcotic substances or as a result of chronic narcotic intoxication. The studies were carried out with the use of routine histological staining techniques and an immunohistological method. The data obtained provided a basis for the development of criteria to be employed in forensic medical diagnostics of acute poisoning with narcotic drugs and chronic narcotic intoxication. These criteria include ischemia of cerebral neurons, pulmonary emphysema with the formation of foreign body-type granulomas and fibrin/erythrocyte thrombi, morphological signs of ventricular fibrillation, the picture of bacterial endocarditis, follicular hyperplasia of the lymphoid organs, chronic portal hepatitis, and nodular degeneration of the adrenal cortex associated with its atrophy.     

Immunoglobulins, binding opioid peptides, biogenic amines, and opiates, in substance abusers

Immunoglobulins binding morphine, biogenic amines, and an opioid peptide dermorphine were measured by solid-phase enzyme immunoassay in patients abusing narcotics. The patients' ages varied from 20 to 40, with the duration of narcotic use 1-17 years. Narcotic dependence was found to involve increased production of immunoglobulins binding opioid and monoamine neuromediators. Enzyme immunoassay of antibodies to opiates detects latent forms of narcomania in cases when the narcotic is not present in the body. These results serve the basis for creating a new method for analysis of narcotic abuse and evaluation of the duration of their use, which can be used in practical medicine and in forensic medical expert evaluations.     

Use of liver morphometry in the differential diagnosis of chronic alcohol and narcotic poisoning

Data on the quantitative histomorphological involvement of the liver in chronic narcotic and ethanol poisoning and their combination are presented. Alcohol use by narcomaniacs augments hepatocyte damage, which manifests by increased fatty degeneration, increased activity of lobular hepatitis, appearance of the neutrophil admixture in inflammatory infiltration, and stimulation of sclerotic processes leading to an increase in the perimeter of portal tract section at the expense of connective tissue growth. Quantitative analysis of these processes is recommended for forensic medical histological differential diagnosis of chronic narcotic and ethanol poisoning.     

Liver histopathology in autopsied drug-addicts

Liver specimens of 150 randomly selected autopsied drug addicts from the province of Milan (Italy) were studied using light microscopy, polarized light and immunohistochemical methods. Simple histological changes and the main diagnoses are described. The main histological diagnoses in order of frequency were: non-specific reactive hepatitis (NSRH) (52%), chronic aggressive hepatitis (CAH) (24%), acute hepatitis (AH) (12%), normal liver (6%), steatosis only (3.3%) and cirrhosis (2%). In 24 cases (16%) one or more viral antigens (HBsAg, HBcAg and Delta Ag) were detected in hepatocytes by immunohistochemical methods. Three liver specimens revealed epithelioid cell granulomas, but in no case was birefringent material identified in the liver. AH and CAH were more frequent in the group of livers with viral antigens. Our histological and immunohistochemical data confirm the current opinion that, in most cases, liver pathology in drug addicts has a viral aetiology, while no significant pathogenic role has been identified for drugs, alcohol or contaminants. Recurrent infections by one or several viruses possibly explain the relatively peculiar histological features of hepatitis in drug addicts.     

Escaping from the crime of inner cities: Church attendance and religious salience among disadvantaged youth

With the theoretical backdrop of social disorganization and “resilient youth” perspectives, we hypothesize that individual religiosity is protective in helping at-risk youths such as those living in poor inner-city areas to escape from drug use and other illegal activities. To test this hypothesis, we draw data from an interview survey of 2,358 youth black males from tracts in poverty in Boston, Chicago, and Philadelphia, conducted in 1979 and 1980. Results from a series of multilevel analyses indicate that church attendance (the frequency of attending religious services) has significant inverse effects on nondrug illegal activities, drug use, and drug selling among disadvantaged youths. Religious salience (the perceived importance of religion in one's life), however, is not significantly linked to reductions in juvenile delinquency. We discuss the implications of our findings, focusing on individual religiosity as a potentially important protective factor for disadvantaged youths.     

Prevalence and postmortem diagnosis of hemocontact infections in intravenous drug abusers based on forensic medical research data

The spread of viral hepatitis C and B and of HIV was studied among the intravenous drug consumers (IDC) on the basis of 42 forensic-medical autopsies. The enzyme immune-assay (EIA) of blood serum showed, in 95.2% of cases, antibodies to hepatitis C virus, antibodies to HbsAg and HIV were registered in 11.9% in both cases. The possibilities of using the autopsy-blood serum for EIA-diagnosis of viral hepatitis and HIV were demonstrated. Morphological examinations of IDC showed, in them, chronic hepatitis (CH) of minimal, weakly-pronounced and moderate activities. Viral CH in HIV infected IDCs is characterized by a minimal and small-pronounced activity of the process and it is not different, according to its activity, from viral CH in IDCs without HIV.     

Death caused by drug addiction: a review of the experiences in Hamburg and the situation in the Federal Republic of Germany in comparison with the literature

Based on criminological experiences and pathomorphological, serological and toxicological studies of more than 300 fatalities, an overview is given of drugs, their intravenous abuse and drug deaths in Hamburg and the Federal Republic of Germany. The number of drug deaths has increased dramatically in Hamburg, where there were more than 50 cases each year in 1987 and 1988. In the F.R.G. approximately 400 cases are registered per annum. The percentage of female intravenous drug abusers is growing and the age of the decedents is increasing. The mean was formerly 25 years, but is now 30 years. Among the histopathological findings, foreign-body granulomas are of special value; infectious diseases, especially hepatitis B and HIV-infection, have to be investigated serologically and morphologically. The prevalence of HIV-1 antibodies among drug deaths in Hamburg is approximately 15%, in comparison with approximately 50% in Berlin. The "supply" of heroin has apparently become so copious that nearly all deaths are caused by overdosage with this substance. An international agreement about a definition of a drug death is a prerequisite for nationwide analyses.     

Heroin associated nephropathy – a post-mortem study

Renal specimens were obtained from 179 autopsies of persons autopsied in the Institute of Forensic Medicine, University of Bonn, from 1987 to 1997. All persons were known as intravenous drug addicts. All renal specimens were examined with hematoxylin-eosin, PAS, Siriusred and Gomori (methenamine silver trichrome stain) and investigated with primary antibody against LCA (leucocyte common antigen), CD 68, IgG and IgM. 105 specimens (61.7%) showed a mono-lymphocytic membranoproliferative glomerulonephritis (MPGN), 48 specimens (45.7%) deposits of IgM. No case with focal segmental glomerulosclerosis (FSGS) as reported in male African–American intravenous drug addicts was found. In 37 out of 54 cases, hepatitis antibodies were detected in serum and three out of these 54 cases were HIV-positive. Chronic hepatitis B and C are known to be associated with glomerulonephritis. We found some cases without detection of hepatitis antibodies but with severe glomerulonephritis. In contrast to African–American drug addicts, European drug addicts do not develop a FSGS but a MPGN, partly due to heroin or other adulterants and apparently independent from hepatitis infection.     

Histopathological findings in 851 autopsies of drug addicts, with toxicologic and virologic correlations

This investigation was carried out on 851 consecutive judicial autopsies of drug addicts who died mostly of heroin overdose from 1977 to 1996. Research of anti-HIV/HBV/HCV antibodies was performed, and histologic sections were retrospectively reviewed. More than 65% were HBV/HCV-positive and about 17% HIV-positive; females were HIV-positive more often than males. Intracranial microhemorrhages were frequently found; cerebral infectious diseases were rare. Inflammatory heart lesions, myocardial fibrosis, and acute ischemia were common. Interstitial nephritis (found in about 8%) was more frequent in females, in older patients, and in those carrying HIV infection; glomerular sclerosis was detected in about 12%. Acute bronchitis and/or pneumonia was demonstrated in 12%, without significant association with HIV infection; pulmonary hemorrhages, foreign body granulomas, and food aspiration were also commonly seen; hyperplasia of pulmonary perivascular lymphatic tissue was rather characteristic. Liver was carrying steatosis in 66.3% and/or hepatitis in 64.5%; acute hepatitis was more frequent in females, chronic hepatitis in older subjects and in those proven positive for hepatotropic viruses; cirrhosis occurred more often in older patients, in those carrying virus infection, and in consumers of nonnarcotics drugs such as ethanol. No pathologic finding was clearly related to drug abuse; therefore, during autopsy, drug addiction can be suspected, but anamnestic and circumstantial data are needed to lead pathologists to request toxicologic analysis to ascertain the cause of death. The present investigation emphasizes that, in addition to the risk of death by overdose, the high incidence of acute and chronic diseases could seriously undermine the health status of heroin and/or other drug consumers.     

Regulators deny access to experimental hepatitis C drug

An application for access to an experimental hepatitis C drug under Canada's Special Access Programme has been turned down. In the process, Canada's drug regulators have created discomfort and uncertainty about how the Special Access Programme is managed.     

Registered Sex Offenders,Residence, and the Influence of Race

ABSTRACT

The current research assesses the characteristics of neighborhoods where registered sex offenders (RSOs) reside and whether or not race influences the locations of these RSOs. Drawing on data from 2,290 RSOs in five urban counties, analysis focuses on assessing the characteristics of census tracts where Black and White RSOs reside, as well as assessing characteristics of census tracts with high concentrations of RSOs in residence. Findings show that census tracts where sex offenders reside display more social disorganization than communities and the nation as a whole. Census tracts where Black RSOs reside are generally more socially disorganized than those where White RSOs reside. Additionally White RSOs are more likely to reside in census tracts with high concentrations of RSOs.     

Esophagoaortic perforation by foreign body (coin) causing sudden death in a 3-year-old child.

We report an extremely unusual consequence to foreign body ingestion in a case of a 3-year-old boy who died suddenly and at autopsy was found to have an esophagoaortic fistula. This fistula was caused by a coin which lodged posteriorly and eroded through the esophagus into the aorta. Serious complications following foreign body ingestion are rare and include stricture formation, intramural abscess, and the formation of fistula tracts. This case illustrates the potentially unpredictable behavior of impacted foreign bodies. The child's parents were initially suspected of child abuse based on the terminal hemoptysis.     

Hepatitis in drug poisonings

In the period between 1983 and 1987 autopsies were carried out on 120 drug victims at the Institute for Forensic Medicine in Hamburg, and 93 cases were serologically tested for hepatitis B. It was found that 50 cases (54%) were positive for anti-HBc, 39 (42%) for anti-HBs, and 5 cases (5%) for HBsAg. The prevalence of hepatitis-B-virus markers was dependent upon the age of the victims. In 81% inflammatory alterations of the liver (including unspecific reactive hepatitis) were diagnosed histologically. The pathogenesis of these serological and pathomorphological findings is discussed. Drug addicts are a group at risk for hepatitis B, and it can spread on account of the epidemiological connection with other risk groups, e.g., prostitutes and homosexuals. Postmortem serological investigations for hepatitis markers proved to be a well-established and reproducible means of differentiating histopathological liver alterations.     

The nature and the occurrence of birefringent material in different organs in fatal drug addiction

Insoluble birefringent tablet filler materials commonly found in tablets used in solution by drug addicts as intravenous injections were investigated microscopically. The following filler materials were investigated: talc, potato- and maize-starch, microcrystalline cellulose, magnesium stearate and siliciumoxid. The morphological characteristics of the different materials are described. Tissue sections (lung, liver, spleen, heart, bone-marrow, kidney, lymph-nodes and endocrine glands) from 33 consecutive fatality cases of intravenous drug addicts autopsied at the University Institute of Forensic Medicine in Copenhagen were studied with special reference to the occurrence and nature of birefringent material. Birefringent material was most often demonstrated in lung tissue (94%), followed by spleen (76%), liver (55%), lymph-nodes (portal: 39%) and bone-marrow (24%). The material was always localized intracellularly. Granulomatous reaction was only seen in the lungs. Except for one case, talc was the only foreign material seen in other organs than the lungs, undoubtedly due to its smaller size. The presence of insoluble foreign material in lung tissue of drug addicts indicates a habit of intravenous administration and the amount of the material indicates whether the addict usually injects tablets or only does so occasionally. The presence of birefringent material in the organs have only rarely any obvious clinical implications.