The forensic medical significance of morphometry of the spleen in drug addiction and chronic alcoholic intoxication

Data on histomorphologic damage to the spleen in chronic narcotic and alcoholic intoxication are described. The below features are recommended for the diagnosis of chronic exogenous intoxication: thickening and sclerosis of the spleen connective structures and a lower count of lymphocytes in the white pulp. The diagnosis criteria of chronic intoxication by intravenously administered opiates are: hyperplasia of the spleen follicles as well as a higher quantity of plasmocytes and of eosinophiles in the white pulp. Hypotrophy of the spleen lymphoid follicles and higher counts of monocytes and macrophages in the lymphoid follicles should be also regarded as a sign of chronic alcoholic intoxication. The obtained data can be used by forensic medical experts in the diagnosis of chronic narcotic intoxication and in its differential diagnosis versus alcoholic intoxication.     

The state of brain ventricles and their ependima in different scenarios of traumatic blood loss

The objective of the present study was to evaluate the state of ependima and the subependimal layer of the brain ventricles after death from the traumatic blood loss and in the cases of the blood loss under conditions of acute alcoholic and narcotic intoxication. The methods used for this purpose included light and scanning electron microscopy. It was shown that in subjects who died from the traumatic blood loss during acute alcoholic and narcotic intoxication ependima showed the signs of progressive polymorphism and had extensive areas of discontinued cell layers. Neuropil contained numerous vacuoles and blood effusion sites. The surface of ependima exhibited pathological erythrocytes, agglomerations of detritus, and crystalloid structures. The blood loss during combined alcoholic and narcotic intoxication resulted in more pronounced alterations in the ventricular walls.     

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.     

Morphological changes in the lungs in chronic drug addiction

Morphological studies of the lungs and immune system organs were made in drug addicts with narcotic intoxication. Depletion of the central and peripheral lymphoid organs was found in most cases. It is shown that morphological changes in the lungs in acute and (or) chronic narcotic drug intoxication, the rate of acute and chronic inflammatory lung diseases reflect development of lung inflammation in the presence of aquired immunological deficiency in terminal chronic drug abuse. The documented features of different pathological processes in the lungs can improve diagnosis of acute and chronic drug intoxication by results of section and histological examinations.     

Forensic medical diagnostics of chronic alcoholic intoxication based on histological changes in the soft tissues of oral cavity and salivary glands

Histological studies of oral cavity mucosa and salivary glands in subjects with chronic alcoholic intoxication revealed changes at the surface of the tongue and in the glandular tissues. Specific features of chronic alcoholic intoxication include acinar and ductal hyperplasia, reduction of the adipose tissue mass in salivary gland stroma, predominance of T-lymphocytes in hard palate minor salivary glands and B-lymphocytes in the stroma of labial minor salivary gland, the absence of plasma cells in the stroma of hard palate minor salivary glands and labial mucosa. Leukoplakia, dysplasia, and hyperplasia of the basal epithelial layer of oral cavity mucosa are considered to be the signs of long-term (over 12 months) alcohol consumption.     

Role of alcoholization in pathogenesis of morphological changes in substance abusers

Morphological manifestations of combined intoxication with ethanol and narcotics are described. Special attention is paid to changes in the liver which were studied both qualitatively and quantitatively. Specific features in the pathological processes concomitant with combined intoxication are described; high incidence and expression of morphological markers of alcoholism in subjects abusing both ethanol and narcotics in comparison with "pure" alcoholics were determined. These features can be used in forensic medical and pathological (autopsy) diagnosis of chronic narcotic intoxication and its combination with alcoholism.     

Immune system in chronic narcotic intoxication

The analysis of the literature data demonstrates that secondary immunodeficiency in chronic narcotic intoxication results, primarily, from T-system dysfunction and attenuation of both cellular and humoral reactions. However, some evidence exist on the absence of such effects or even stimulation of the immune system by narcotic drugs. Morphological analysis of changes in the lymphoid organs of drug addicts who had died of different diseases in chronic narcotic intoxication was made by only few researchers, so functional morphology of immune system organs in chronic narcotic intoxication is an issue of the day which requires further investigation.     

The morphological diagnosis of alcoholic embryo- and fetopathy

Principles of morphologic diagnosis of alcoholic embryo- and fetopathy are discussed using data on two cases of this pathology. In the authors' opinion, three conditions are necessary to make diagnosis of alcoholic embryo- and fetopathy (i.e. maternal alcoholism history, morphologic signs of embryo- and fetopathy, ethanol concentration in fetal blood and urine). Alcohol embryo- and fetopathy must be differentiated from acute ethanol intoxication, during which microscopic visceral signs of embryo- and fetopathy are absent and ethanol blood concentration exceeds 2.0%.     

Diagnosis of acute intoxication with ethyl alcohol in expert practice

Significant chemical and biochemical signs of acute alcoholic intoxication are considered tanatologically. A complex approach to diagnosis of acute poisoning with ethyl alcohol is proposed.     

Postmortem differential diagnostics of diabetic and alcoholic ketoacidosis

It was shown that ketoacidosis may be an immediate cause of death in subjects suffering chronic alcoholic intoxication. The authors present a list of biochemical studies and parameters that can be used for differential diagnosis between diabetic and alcoholic ketoacidosis.     

Ethanol-oxidizing enzymes of the adrenal glands in acute alcoholic intoxication

Complex morphological-and-histological examinations of the adrenal glands were performed on actual forensic-medical samples in acute alcoholic intoxication (AAI), i.e. 107 death cases of men and women, aged 17 to 60, due to mechanical trauma, lethal ethanol intoxication and somatic complications of chronic alcoholism. A differentiated distribution of ethanol-oxidizing enzymes was defined, i.e. of alcohol-dehydrogenase and acetyl-dehydrogenase in the structural-and-functional zones of the adrenal cortex and medullary substance. A differential activity of enzymes was established that correlated with the level of exogenous alcoholemia. Sets of morphological signs related with examinations of the adrenal glands, which enabled a differential diagnosis of death causes in AAI, were specified.     

Diagnostic criteria in acute ethanol intoxication as cause of death

There are described, in the paper, morphological, chemical and biochemical signs in acute alcoholic intoxication. A complex approach is suggested to diagnosing an acute alcoholic intoxication as death reason.     

The ultrastructural indices of the morphofunctional state of the heart in acute and chronic alcoholic intoxication

Morphofunctional myocardial characteristics in subjects who died of acute and chronic alcoholic intoxication were studied at ultrastructural level. The resulting new data enhance the level of diagnosis concerning the cause of death, the grounds of thanatogenesis. Possibilities for using the results of investigation in scientific and practical work are shown.     

Forensic medical diagnostics of chronic alcoholic intoxication based on the measurement of bone mineral density in the postcranial skeleton and periodontal complex

The objective of this work was to develop forensic medical criteria for the diagnostics of chronic alcoholic intoxication based on the measurement of bone mineral density in the postcranial skeleton and periodontal complex. The stomatological status of 380 subjects was evaluated. Two hundred patients regularly consumed alcohol (group 1) and 180 ones practically did not use it (group 2). The stomatological status was evaluated based on the simplified oral hygiene index (OHI-s), the decayed, missing and filled teeth (DMF) index, periodontal index (P1) and the papilla bleeding index (PBI). Bone mineral density was measured by X-ray two-photon absorptiometry. The study demonstrated the relationship between variations of the stomatological status and alcohol abuse. Chronic alcoholic intoxication was associated with marked changes of the stomatological status and the loss of bone mineral density that correlated with the results of the orthopantomographic study. It is concluded that the above observations should be taken into consideration in the practical work of forensic medical experts as additional diagnostic criteria of chronic alcoholic intoxication and alcohol-related death.     

Significance of changes in the myocardium for the forensic-medical diagnosis of death as a result of alcoholic cardiomyopathy

Significance, of the weight and dimensions of heart as well as of fat dystrophy of cardiomyocytes and of the related detection methods is demonstrated for the diagnosis of alcoholic cardiomyopathy (ACMP). When such patients die in a state of alcoholic intoxication, the diagnosis should be death of acute alcoholic intoxication. Lethality of ACMP can be diagnosed only in those who die in the sober condition or with an insignificant level of alcohol.     

Histomorphometric characteristic of human brain in acute alcoholic intoxication

Different brain sections were studied in 20 subjects, who died of ethanol intoxication and in 14 subjects who died of injuries of the heart and main vessels, in order to detect histological changes in the brain and for the purpose of defining spatial and quantitative ratios between cerebral tissue structures in alcoholic intoxication. Different histological, stereometric and morphometric tools were made use of. It was demonstrated that, in alcoholic intoxication, there occur severe disorders of the circulation with affection of vessels in the brain; there are also dystrophic and necrotic changes in neurocytes, glial cells and white substance. The square of neurons shrinks due to death of some of them in the cortex of hemispheres, thalamus and cerebellum. As for the medulla, they are more resistant, there, to ethanol. The diameter of capillaries in the studied brain sections diminishes due to a reduced tonus of cerebral arteries; the quantity of such vessels increases within a standard area, which is conditioned by the compensatory opening of reserve capillaries. All this can be important in dealing with issues of thanatogenesis and of forensic medical diagnosis in death of alcoholic intoxication.     

Infectious endocarditis in drug addicts

Clinicomorphological features of infectious endocarditis (IE) were studied on autopsy material from chronic drug addicts. Of special interest were morphological changes in the lymphoid organs. The experience of the author and literature data suggest that IE in drug addicts is a manifestation of secondary immunodeficiency syndrome on the background of chronic narcotic intoxication.     

Histochemical changes in the hypothalamus, hypophysis, and adrenal glands observed in ethanol poisoning

A comprehensive morphological-and-histochemical study of neuroendocrinal internals in cases of ethanol poisonings was undertaken. Actual forensic medical materials were used (62 cadavers) to make morphometry examinations of the hypothesis and adrenal glands. Besides, the distribution of alcohol dehydrogenase and acetaldehyde dehydrogenase was investigated in the mediatory differential brain sections, i.e. cerebellum, locus coeruleus, dorsal raphe nucleus, hypothalamus and adrenal glands. A differential distribution of ethanol-oxidizing enzymes as well as their changes in ethanol lethal poisoning were established; additionally, a variety of morphological signs were defined, which enable the differential diagnosis of a death reason in acute alcoholic intoxication.     

Alcoholic hepatosis in pathogenesis of hepatic encephalopathy

The problem of chronic alcoholism has a great social importance. In the literature there are not methodological grounds for verification of causes and mechanisms of unexpected death caused by chronic alcoholic intoxication. Given literature data show the reasonability of study of hepatic encephalopathy in combination with pathomorphological, histochemical and biochemical analyses in comparison with forensic chemical analysis of alcohol concentration in human organism. That will make possible to determine the mechanisms of tanatogenesis of alcoholic intoxication.     

The diagnostic value of determining the level of acetaldehyde in blood,urine, and cerebrospinal fluid

The contents of acetaldehyde (AA) in biological fluids obtained from the dead with the confirmed lethality causes, i.e. ischemic heart disease (IHD), alcoholic cardiomyopathy (ACMP) and mechanical traumas (MT), were examined on an actual forensic-medical material (AFMM). 14 death cases of males, aged 18 to 45, were studied. The method of gas-liquid chromatography (GLC), or rather its variation of vaporphase analysis, was used to state the presence and to assess the concentration of acetaldehyde. The results revealed differences between concentrations of acetaldehyde in the examined groups depending on the presence or absence of alcoholemia. Thus, the AA concentrations were found in trace quantities in the MT group free of alcoholic intoxication; while, when it was present in this group, the concentrations went up several-fold. A higher AA content was typical of the ACMP group in all examined subjects both with and without alcoholic intoxication. The final study results are suggestive of that the AA determination in blood, urine and liquor by GLC could be used, within the forensic medical practice, in assessing a severity degree of alcoholic intoxication while establishing the lethal outcome cause due to chronic pathologies and MT.