Status and prospects in developing morphologic studies in forensic medicine

Modern state of forensic medical morphological studies is analyzed. Main trends of research are reviewed (personality identification, diagnosis of acute alcohol and narcotic poisoning, morphology of craniocerebral injury, development of criteria for identifying the time when injuries were inflicted). Shortcomings in these studies and in practical forensic medical histological service are discussed. Prospects for further studies are outlined.     

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.     

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.     

Potentialities of histological examinations of the spleen in the diagnosis of alcoholic and narcotic intoxication

Qualitative changes observed in the spleen in chronic narcotic and alcoholic intoxication are described. The below signs are recommended for use in the diagnosis of chronic exogenous intoxication: an increased thickness and sclerosis of the splenic connective structures and myelosis of the red pulp. The diagnostic criteria of chronic intoxication with intravenous opiates are the below changes in the spleen: hyperplasia of the splenic follicles, germinative foci in the follicles' stases and folds in vessels, edema of the vascular wall, hyperemia of follicular arteries and diapedetic hemorrhages. Hypoplasia of the follicles and venous hyperemia of the spleen should be regarded as signs of chronic alcoholic intoxication. The data obtained within the case study can be used by forensic medical experts in the diagnosis of narcotic and alcoholic intoxication.     

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.     

Aspects of forensic medical diagnosis of acute opiate poisoning

The case study is dedicated to morphological changes occurring in the organs and tissues in lethal outcomes due to acute poisoning with narcotic substances; it is also dedicated to the structure of an acute respiratory insufficiency in unexpected "heroin" death and to delayed death after intoxication. The clinical-and-anatomical analysis of the material, involving the immunological, biochemical, chemical and spectral examination data, has been undertaken.     

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.     

Forensic medical estimation of acute blood loss based on morphologic and functional changes in the internal organs

The objective of the present work was to obtain histological and morphometric characteristics of internal organs available for forensic medical examination from 236 corpses of subjects aged between 23 to 48 years whose death was caused by acute blood loss following a mechanical injury and concomitant alcohol or drug intoxication. Diagnostic signs of acute blood loss have been identified that can be used by forensic medical experts to estimate the length of the terminal period and reveal characteristic features of blood loss associated with alcohol and drug intoxication.     

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.     

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.     

Current status and prospects for developing chemical-toxicological (forensic chemical) studies in the Russian Federation

The authors discuss modern state and prospects of planning and carrying out research in forensic (toxicological) chemistry within the framework of practical forensic medical expert evaluation, state of forensic medical expert evaluation of alcohol and narcotic intoxication, and other pressing problems of forensic medical expert practice.     

毒鼠强中毒的凋亡细胞研究

目的通过动物实验,研究观察在不同剂量下毒鼠强中毒后不同时间各器官的病理学变化,以期为法医学鉴定提供指标。方法建立小鼠毒鼠强中毒的实验模型,通过常规H.E染色及凋亡细胞检测技术对小鼠毒鼠强急、慢性中毒后脑、心、肝、肾等器官的病理学改变进行系统研究,并对研究结果进行计算机病理学图像分析;对中毒实验组的小鼠上述器官检材进行毒物分析。结果慢性中毒组小鼠在中毒后的不同时间段内,脑、心、肝、肾等器官凋亡细胞数均高于正常对照组及急性中毒致死组,且同一器官的凋亡细胞数在不同中毒时间段内有所差异,差别均有显著性;不同器官的凋亡细胞数的峰值在不同中毒时间段内亦有所不同。急性中毒组小鼠各器官的毒物分析结果为阳性,慢性中毒组均为阴性。结论慢性毒鼠强中毒,在临床症状不明显及法医毒物分析难以检测的情况下,应用凋亡细胞检测技术可成功检测出机体的主要器官的病理学改变,表明小剂量、慢性中毒对机体仍有一定的影响。     

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.     

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.     

The characteristic morphological changes of the internal organs in certain forms of combined poisoning

The results of forensic medical investigations of 100 corpses of the persons who died from combined intoxication with two and more poisons are presented. They were compared with clinical observations and summarized uisng the methods of tanatogenetic analysis. The main variants of fatal combined poisoning and the underlying tanatogenetic mechanisms were categorized into cardiac (disturbances of rhythm and conductivity, progressive hypotension, flabby heart muscle, extensive fragmentation of cardiomyocytes), cerebral (coma and massive death of brainstem neurons), and pulmonary (of pneumonia- or pulmonary oedema-type with fibrin precipitation in the alveoli and formation of hyaline membranes). This classification was supplemented by a variety of combinations of the above variants with necrotic nephrosis and disseminated intravascular coagulation syndrome. It is concluded that the results of this study may be of use for forensic medical diagnostics of combined poisoning and the elucidation of the contribution of individual toxic substances to the fatal outcome bearing in mind the low informative value of the relevant forensic medical data.     

Morphological signs of ethanol poisoning, alcohol abstinence and chronic alcoholic intoxication in the mesocorticolimbic dopaminergic system

Forensic medical diagnostics of ethanol poisoning, alcohol abstinence, and chronic alcoholic intoxication of the mesocorticolimbic dopaminergic system remains an unresolved problem and encounters difficulties. This situation is due not only to the marked vulnerability of the neurons of the dopaminergic system but also to the fact that its mechanisms are poorly understood. The objective of the present work was to substantiate and develop diagnostic criteria for ethanol poisoning, alcohol abstinence, and chronic alcoholic intoxication of the neurons both in the mesocorticolimbic dopaminergic system and in other brain regions. The object of the study was the brain of healthy adult subjects who died from alcohol intoxication (in the period of ethanol resorption) and under conditions of alcohol abstinence (completion of the abstinence course). The purpose of the study was to elucidate factors responsible for the different degree of damage to the neurons of various identification groups (intact, hypochromic, picnomorphic, shadow) and macrogliocytes. The cells of all these types were counted at an area of 0.25 sq. mm within 4 squares each having a side of 250 mcm in length. The absolute and relative number of neurons in each group as well as the number of polyneuronal satellite cells per one intact neuron was determined. It was shown that alcohol intoxication is associated with acute swelling of and severe damage to brain neurons caused by the combination of such factors as toxic effect of ethanol, excessive production of catecholamines, and functional overstrain of dopaminergic neurons. The severity of acute alcohol damage to the neurons decreased with the distance from the mid-brain dopaminergic nuclei. Restoration of neurons during alcohol abstinence was due to compensatory activation of interactions between neurons and glial cells. It decreased in the sequence from the paranigral nucleus of the ventral portion of mesencephalic tegumentum to the medial portion of the accumbence nucleus (field 24b, layer III of field la, layer V of field 1) depending on the initial severity of acute damage in the brain region being examined. The severity of damage to the neurons of the mesocorticolimbic dopaminergic system under conditions of chronic alcohol intoxication estimated from the number of shadow neurons was similar to the degree of acute swelling associated with ethanol poisoning and decreases from a maximum in the nuclei of the mesocorticolimbic dopaminergic system to a minimum in layer III of field 1.     

Diagnosis of lethal poisoning with some substances used by toxicomaniacs

The authors analyze 62 expert conclusions on deaths from acute and chronic poisoning with various toxic substances used by toxicomaniacs. Forensic medical examination of corpses and forensic chemical analysis identified drugs, toluene, freon, organophosphorus compounds, and other toxins.     

Forensic medical expert evaluation of lethal poisoning with narcotics

Morphological manifestations of lethal narcotic poisoning are analyzed on the basis of results presented in "Acts of Medical Examination of Corpse" and "Expert Conclusions" on 352 cases with lethal narcotic poisoning, suspected (with good grounds) poisoning, and combined poisoning with narcotics and other agents. Causes of failure to detect narcotics in forensic chemical analysis of biological material from the corpse are enumerated.     

Diagnostic role of organ-specific isoforms of lactate dehydrogenase in blood plasma

Changes in plasm isoenzymic spectrum of lactate dehydrogenase (LDG), a glycolytic enzyme, were studied in death of cardiovascular diseases, ethanol poisoning and a mechanical injury. The tests used electrophoresis in 1% solution of agarose. Isoenzymic composition differed between the groups with acute coronary failure, chronic coronary heart disease, alcohol cardiomyopathy and a mechanical injury. Ethanol poisoning caused two types of characteristic shifts in LDG isoenzymic spectrum. Nomograms were designed for practical application in forensic medical expertise of sudden death.     

Morphometry of cerebral neuroglial complexes in forensic medical diagnosis of substance abuse

A method of morphometric evaluation of neuroglial complexes of the brain by relatively simple and available morphometric technique is described. The gist of the method is measuring the glial distance and glial density, which change during narcotic intoxication and abstinence. The method is addressed to forensic medical expert histologists engaged in microscopic diagnosis of such poisonings on section material.