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Fineschi V Cecchi R Centini F Reattelli LP Turillazzi E 《Forensic science international》2001,120(3):189-194
Recent studies suggest that many fatal heroin overdoses are caused by anaphylactoid reaction. In the present study we measured tryptase and eosinophil cationic protein in post-mortem blood of 48 deaths after heroin injection. We also investigated the presence and pulmonary distribution of mast-cells using specific immunohistochemical antibody for tryptase and morphometric evaluation in those cases of heroin-related deaths. The data were compared with 44 subjects who died following head trauma and to 32 cases of fatal anaphylactic shock. In the heroin-related death cases, the measurements of serum tryptase levels and eosinophil cationic protein dosages resulted in particularly elevated concentrations compared with the trauma cases. Nevertheless, the data that our study supplies by immunohistochemical techniques indicate that when mast-cells count in the lung was determined, no definite pattern was obtained between fatal heroin overdose cases and the control groups. Furthermore, the wide range of morphine concentrations found in post-mortem blood samples suggest that the term 'overdose' is relative and does not sufficiently characterize death associated with heroin addiction. Our study confirms that elevated concentrations of serum tryptase are associated with many heroin-related deaths. At this moment to attribute the cause of these deaths to 'heroin overdose' ignores the likely causal contribution of other possible systemic reactions to the mechanism of death. 相似文献
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Vittorio Fineschi Rossana Cecchi Fabio Centini Laura Paglicci Reattelli Emanuela Turillazzi 《Forensic Science International Supplement Series》2001,120(3)
Recent studies suggest that many fatal heroin overdoses are caused by anaphylactoid reaction. In the present study we measured tryptase and eosinophil cationic protein in post-mortem blood of 48 deaths after heroin injection. We also investigated the presence and pulmonary distribution of mast-cells using specific immunohistochemical antibody for tryptase and morphometric evaluation in those cases of heroin-related deaths. The data were compared with 44 subjects who died following head trauma and to 32 cases of fatal anaphylactic shock. In the heroin-related death cases, the measurements of serum tryptase levels and eosinophil cationic protein dosages resulted in particularly elevated concentrations compared with the trauma cases. Nevertheless, the data that our study supplies by immunohistochemical techniques indicate that when mast-cells count in the lung was determined, no definite pattern was obtained between fatal heroin overdose cases and the control groups. Furthermore, the wide range of morphine concentrations found in post-mortem blood samples suggest that the term ‘overdose’ is relative and does not sufficiently characterize death associated with heroin addiction. Our study confirms that elevated concentrations of serum tryptase are associated with many heroin-related deaths. At this moment to attribute the cause of these deaths to ‘heroin overdose’ ignores the likely causal contribution of other possible systemic reactions to the mechanism of death. 相似文献
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目的观察豚鼠过敏性休克死亡肺组织中类胰蛋白酶和胃促胰酶的表达情况,试图为过敏性休克死亡提供客观的诊断依据。方法健康豚鼠24只,随机均分为实验组和对照组,每组再分死亡即时组、冷藏48h组和冷冻7d组,每组4只。实验组将0.5mL人混合血清用生理盐水1∶10稀释,注射于豚鼠后掌皮内,致敏后3周以人混合血清1mL注入心腔诱发过敏性休克致死;对照组采用生理盐水代替混合血清。提取豚鼠心血及肺组织,应用免疫组化染色和图像分析技术观察类胰蛋白酶和胃促胰酶的表达情况。结果对照组豚鼠肺组织中类胰蛋白酶和胃促胰酶阳性细胞数量较少,分布在小血管和小气管周围。实验组肺组织中类胰蛋白酶和胃促胰酶阳性细胞明显增多,多数细胞形态不规则,阳性染色颗粒脱出肥大细胞并弥散到组织间隙。冷藏48h和冷冻7d的条件下对这两种酶的表达无明显影响。结论过敏性休克致死豚鼠肺组织中类胰蛋白酶和胃促胰酶的表达明显增强,在冷藏48h和冷冻7d内的条件下,可作为过敏性休克死亡的一项诊断依据。 相似文献
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Fatal anaphylactic shock during a fluorescein angiography. 总被引:4,自引:0,他引:4
The Authors describe an extremely rare fatal case (sixth case in the literature) of anaphylactic shock following a fluorescein angiography. This is the first report in which the diagnosis of anaphylactic reaction to the dye was made through laboratory analyses. The diagnosis of fatal shock due to sodium fluorescein was made based on clinical, laboratory and immunohistochemical data. Mast-cell tryptase was dosed in serum and a pulmonary immunohistochemical evaluation was performed. Tryptase, a neutral protease of human mast-cells is a potentially important indicator of mast-cell involvement in anaphylactic events. 相似文献
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肥大细胞类胰蛋白酶的免疫组化染色观察 总被引:3,自引:1,他引:2
目的 观察过敏性休克死亡者咽喉、肺、小肠组织肥大细胞类胰蛋白酶 (MCT) ,探讨过敏性休克死亡法医鉴定的形态学依据。方法 交通事故致严重颅脑损伤死亡者 10例 (对照组 )、明确诊断为过敏性休克死亡者 15例(实验A组 )和羊水栓塞死亡者 8例 (实验B组 )的尸体 ,分别取其咽喉部、肺及小肠组织 ,石蜡切片 ,HE染色及用免疫组化超敏SP法进行MCT染色。结果 实验A组的咽喉部组织充血、水肿 ,咽喉部粘膜下层MCT增多 (MCT颗粒计数为 48 2 3 ) ;实验B组的咽喉部粘膜下层MCT增多 (MCT颗粒计数为 42 72 )。肺间质尤其是小支气管壁及小血管壁上MCT增多 (MCT颗粒计数分别为 46 98和 43 5 0 ) ,小肠粘膜层MCT增多 (MCT颗粒计数分别为 48 2 3和 42 72 )。对照组的咽喉部、肺和小肠MCT颗粒计数较少 ,分别为 7 79、 12 94和 2 0 2 5。实验A组与对照组相比 ,两组具有显著性差异 (P <0 0 1) ;实验A、B组相比 ,两组无显著性差异 (P >0 0 1)。结论 过敏性休克及羊水栓塞死亡的尸体 ,其咽喉部组织、肺组织及胃肠道组织MCT增多。 相似文献
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目的建立卵蛋白致小鼠过敏性休克动物模型。方法将健康小鼠50只随机分为对照组和致敏组,致敏组小鼠于第1天腹腔注射致敏原,1周后加强注射一次,饲养3周后尾静脉注射致敏原诱发过敏性休克。结果致敏组小鼠均出现过敏性休克的典型临床表现及体征,肥大细胞脱颗粒百分数明显高于对照组。结论本实验成功地建立了小鼠过敏性休克动物模型,证明了小鼠对卵蛋白的高敏感性。 相似文献
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Paolo Feltracco M.D. Stefania Barbieri M.D. Helmut Galligioni M.D. Laura Pasin M.D. Rosa Maria Gaudio M.D. Aurelio Tommasi M.D. Alessandro Zucchetto M.D. Paride Trevisiol M.D. Carlo Ori Ph.D. Francesco Maria Avato Ph.D. 《Journal of forensic sciences》2012,57(6):1656-1658
Abstract: The growth in popularity of flying ultralight aircraft and paragliding has been associated with an increased involvement of Emergency Medical Services because of various types of trauma suffered from both inexperienced and skilled individuals. This case presentation reports on a paraglider pilot, who was seen spinning “unusually” rapidly toward the ground, without visible attempts to regain control of the aircraft. Besides the bilateral mydriasis and the absence of any ECG activity, there was a significant swelling of face, lips, neck, and tongue. Upon opening the mouth, a dead bee was found over the tongue, underneath the palate. A fatal anaphylactic shock was the likely cause of death of the pilot while still “in mid‐air.” This case is certainly different from the commonly reported accidents during paragliding. An updated review of the medical literature shows no reported cases of fatal anaphylactic shock during the practice of paragliding. 相似文献
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The comparison of 4 cases of immediate anaphylactic death following the intramuscular injection of antibiotics (different types of penicillin or cephalosporins) with 4 cases of immediate non-anaphylactic death (induced by different causes) recognized splenic eosinophilia, as the main feature for the differential diagnosis, in agreement with isolated previous studies. The use of a stain (pagoda red) little known and seldom employed in Pathology and in Forensic Medicine, showed the concomitant massive presence (immunohistochemically confirmed) of mast cells and degranulated mast cells, the latter mainly located in splenic sinuses. The whole of our findings led us to consider the spleen as the possible shock organ in man. Waiting for further judgment on our hypothesis, we seized the opportunity to remark the employment of the pagoda red stain when the contemporary demonstration of eosinophils, mast cells and degranulated mast cells is required. 相似文献
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D'Errico S Neri M Riezzo I Rossi G Pomara C Turillazzi E Fineschi V 《Forensic science international》2008,179(2-3):e25-e29
The association between sudden infant death syndrome and immunization is frequently discussed. Serious adverse events following vaccination have generally been defined as those adverse events that result in permanent disability, hospitalization or prolongation of hospitalization, life threatening illness, congenital anomaly or death. They are generally referred to the inherent properties of the vaccine (vaccine reaction) or some error in the immunization process (programme error). The event could also be totally unrelated but only temporally linked to immunization (coincidental event). A fatal case of a 3-month-old female infant, who died within 24 h of vaccination with hexavalent vaccine is presented. Clinical data, post-mortem findings (acute pulmonary oedema, acute pulmonary emphysema), quali-quantitative data collected from immunohistochemical staining (degranulating mast cells) and laboratory analysis with a high level of beta-tryptase in serum, 43.3 microg/l, allows us to conclude that acute respiratory failure likely due to post hexavalent immunization-related shock was the cause of death. 相似文献
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目的观察类胰蛋白酶与类糜蛋白酶在过敏性休克死亡人体肺组织中的表达,并探讨其在过敏性休克死亡法医学鉴定中的意义。方法应用荧光免疫组化法对类胰蛋白酶与类糜蛋白酶进行检测,同时以10例CO中毒死者为对照:采用图像分析仪及Image—pro plus 5.0.2软件进行图像分析,计算阳性肥大细胞数及类胰蛋白酶、类糜蛋白酶荧光表达强度。结果与对照组相比,实验组肺组织中类胰蛋白酶和类糜蛋白酶表达差异有统计学意义(P〈0.05)。结论过敏性休克死亡人体肺组织中类胰蛋白酶与类糜蛋白酶的表达增强.可作为过敏性休克死亡的形态学诊断依据。 相似文献
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Satoshi Watanabe Koichi Terazawa Masaru Asari Kazuo Matsubara Hiroshi Shiono Keiko Shimizu 《Forensic Science International Supplement Series》2008,180(2-3):e6-e10
We report the first autopsy case of fatal gastric dilatation without rupture. A 31-year-old woman who lived alone was found dead in her living room. Despite being very thin, she showed marked abdominal distention. Autopsy and histological findings revealed that a severely distended stomach, of which walls notably thin and displayed transmural necrosis, occupied the entire abdominal cavity. Severe congestion was observed in the intestine and cecum. Theses findings suggest that bulimia nervosa together with anorexia nervosa resulted in rapid dilation of the stomach. We conclude that the cause of death was acute circulatory failure from hypovolemic shock that occurred following compression of the inferior vena cava and superior mesenteric vein, and by loss of circulatory volume to the third space. 相似文献
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Laboratory investigation of deaths due to anaphylaxis. 总被引:11,自引:0,他引:11
J W Yunginger D R Nelson D L Squillace R T Jones K E Holley B A Hyma L Biedrzycki K G Sweeney W Q Sturner L B Schwartz 《Journal of forensic sciences》1991,36(3):857-865
To establish a useful laboratory protocol to investigate possible cases of fatal anaphylaxis, we measured mast-cell-derived tryptase levels and allergen-specific immunoglobulin E (IgE) antibody levels in sera obtained prior to or within 24 h after death from 19 anaphylaxis victims. Elevated serum tryptase levels (range = 12 ng/mL to 150 micrograms/mL) were found in nine of nine Hymenoptera sting fatalities, six of eight food-induced fatalities, and two of two reactions to diagnostic therapeutic agents. Tryptase levels were normal (less than 10 ng/mL) in 57 sequential sera obtained postmortem from six control patients. Tryptase could not be measured in pleural or pericardial fluids for technical reasons. Serum IgE antibodies were elevated in five of the nine Hymenoptera sting fatalities and in eight of the eight fatal food reactions; assays were unavailable for the two diagnostic/therapeutic agents. If elevated, the victim's serum IgE antibodies to food could be used to identify allergens in uneaten portions of foods consumed shortly before the anaphylactic event. IgE antibodies were moderately stable during storage in a variety of anticoagulants at room temperature for up to 11 weeks. Elevated mast-cell-derived tryptase levels in postmortem sera reflect antemortem mast cell activation and may be used as a marker for fatal anaphylaxis. If assays are available for IgE antibodies to relevant allergens, such assays provide evidence for antemortem sensitization; these assays may be modified to identify allergens in foods consumed by victims of food-induced anaphylaxis. 相似文献
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目的研究利多卡因过敏性休克死者利多卡因血药浓度及其与死因的关系。方法采用高效液相色谱法(HPLC),分别对使用利多卡因麻醉术中各项指标均正常的8例术中因利多卡因过敏性休克死者的血液和11例顺利完成手术患者的血液进行利多卡因浓度的检测,对比分析两者结果。结果 8例死者利多卡因血药浓度(1.61mg± 0.45mg/L)低于11例正常患者利多卡因血药浓度(2.44mg±0.47mg/L)。结论利多卡因过敏性休克死者血药浓度在正常值范围内,与发生过敏性休克致死无关。 相似文献
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过敏性休克死亡动物肾脏免疫复合物的实验研究 总被引:3,自引:0,他引:3
采用ABC法、PAP法和LAB法对青霉素和血清过敏性休克死亡动物的肾脏,进行免疫组织化学研究。结果发现,当Ⅰ型变态反应过敏性休克发生时,伴有免疫复合物型(Ⅲ型)变态反应。在肾小球系膜、肾小管间毛细血管和小动脉的内皮细胞上,血管外周组织中有免疫复合物沉积。复合物中除检见有抗原成分,如青霉素或异种血清外,其抗体成分有IgE和IgG。检见该复合物中的IgE,可为过敏性休克死亡的法医学鉴定提供依据,并可与其他原因沉积的免疫复合物相区别。过敏性休克死亡后,经室温下放置6、12小时或冰箱内48小时后取肾检验,仍可获得清晰的阳性染色结果,表明在实际检案中运用本文方法的可能性和实用性。 相似文献
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The distribution profile of infiltrated mast cell-subpopulations and eosinophils in the lung and heart sections of the patients who died of severe allergic hyperresponsiveness, was investigated. Four study groups were designed comprising 9 cases who died in systemic anaphylaxis (Group I), 10 asthmatic individuals whose death were assigned to acute and severe bronchial asthma (Group II), 10 asthmatic cases who died from non-immunological diseases (Group III). Twenty consecutive autopsies of non-allergic subjects who died of unnatural causes (Group IV) served as control group in this study. Utilizing antibodies against human tryptase and chymase and a double immunohistochemical staining method, we distinguished successfully all three subsets of mast cells (MC), MC-TC (containing both tryptase and chymase), MC-T (containing only tryptase) and MC-C (containing only chymase) types, subdivided on the basis of the protease compositions of their secretory granules. In order to immunostaining eosinophils, we used antibody to major basic protein as a marker. We also measured postmortem blood tryptase, specific and total serum IgE. The intriguing finding of this study was the marked differences of cellular composition in the lung between fatal anaphylaxis and asthma death. Significant augmentation of MCs infiltrated in lung and heart sections of anaphylaxis patients and drastic infiltration of bronchial eosinophils in asthmatic death and consequent release of their related inflammatory mediators might explain the differential expression of the associated symptoms in these two groups. The anaphylactic deaths did show neither emphysema nor significant mucous bronchial secretions whereas all asthmatic deaths did. The degree of pulmonary congestion and edema was also more severe in anaphylaxis. This corresponded with the histological findings and the location and number of mast cell-subsets and eosinophils in the different compartments of the lungs. We have demonstrated that the third type of mast cell MC-C is only found in the lungs in anaphylactic deaths. The practical consequence of our study will be that it is now possible to confirm a suspicion of anaphylaxis death not only by measurements of serum mast cell tryptase, but also by immunohistochemical methods. 相似文献
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过敏性休克导致死亡的案例在法医学实践中常有发生,然而由于缺少特异的病理形态学指征,导致过敏性休克死亡的法医学鉴定面临一定的困难。IgE作为介导I型超敏反应的关键介质,其死后生化学检测对过敏性休克死亡案例的法医学鉴定具有辅助作用。但在实际应用中,血液等检材常受溶血等死后变化因素影响,尤其我国尸体保存以冷冻为主,溶血程度更加严重,对IgE等生化学指标的检测造成极大干扰。本文就目前IgE死后生化学检测的研究现状、生物学检材的选取及检测方法进行综述,并对现实应用中所面临的问题进行探讨。 相似文献
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142例过敏性休克死亡法医病理学分析 总被引:1,自引:0,他引:1
目的 探讨过敏性休克死亡案例的特点.方法 对142例过敏性休克死亡案例进行回顾性分析,并对过敏性休克死亡案例与62例非过敏性休克死亡案例的血清IgE水平进行统计分析.结果 过敏性休克死亡大多发生于医疗机构,占77.46%.采用单纯静脉给药方式致过敏性休克死亡案例占53.53%.β-内酰胺类抗生素、糖皮质激素类药物、中药制剂在过敏性休克死亡案例生前治疗药物中占有重要比例.过敏性休克死亡案例多无特异性组织病理学改变,与非过敏性休克死亡组的血清IgE水平的差异具有统计学意义(P<0.05).结论 过敏性休克死亡案例死因鉴定应根据案情、解剖检验结果及血清IgE水平等检测指标进行综合分析判定. 相似文献