Rusya'da akut alkol zehirlenmelerinde, iç organ histopatolojik değişikliklerinin değerlendirilmesi

AMAÇ: Adli tıp otopsilerinde uzmanlar sıklıkla akut alkol zehirlenmesinin ölüm mekanizması üzerine etkisinin derecesini değerlendirmek zorundadırlar. Bu özellikle kalp, beyin ve karaciğer nedenli, mekanik yaralanmalar ve mekanik asfiksi gibi ani ölümlerde daha önemli hale gelmektedir. Bu çalışma kan alkon konsantrasyonunun tekbaşına intoksikasyon ciddiyet değerlendirme kriteri olmaması gerektiği ve bunun patogeneze etkisinin gösterilmesi amaçlanmıştır. YÖNTEM: Üçyüz yirmi tıbbi-hukuki rapor cinsiyet, yaş, etnisite ve diğer özelliklerin etkisinin değerlendirilmesi amacıyla tarandı. BULGULAR: Etanol okside edici enzimi özel histokimyasal incelemesi 167 otopsiden alınan materyalde yapıldı. SONUÇ: Çalışma; morfo-fonksiyonel histokimyasal testlerin, etanol zehirlenmesi kökeni olan, özellikle akut alkol zehirlenmesinin olkol kardiyomiyopatisi ve iskemik kalp hastalığından ayırıcı tanısında postmortem tanısal otopsiye eklenmesi gerektiğini desteklemektedir.

[Determination of regularities in histochemical changes of internal organs under acute alcoholic intoxications in Russia]

AIM: During forensic-medical autopsies experts must very often assess degree and the role of acute alcohol intoxications in mechanisms of death. This becomes more actual in the cases of sudden death from different diseases especially cardiac, brain and liver origin, mechanical injuries, mechanical asphyxia etc. This study aims to show that blood concentration of alcohol must not be only criteria during assessment of severity of intoxications and their influence on tanatogenesis. METHOD: Epidemiological screening of 320 medico-legal reports assesses the role of sex, age, ethnicity and other peculiarities. RESULT: Special histochemical investigations of ethanol oxidizing enzymes were also conducted on materials taken from 167 autopsies. CONCLUSION: Study suggests that morpho-functional histochemical tests must be entered in the list of methods of postmortem diagnostics during autopsies of cases with the background of ethanol poisoning, especially for differential diagnosis of acute alcohol intoxication, alcohol cardiomyopathy and ischemic heart disease.

PDF

___

1. Kapustin A.V. Determination of alcohol intoxications role in tanatogenesis. Forensic examination. 1999; 42(6): 10-12.
2. Viter V.I, Permyakov AV. Alcoholemia in forensic-medical practice. Contemporary problems of forensic medicine and expert practice. Izhevsk. 1997; 9: 25-29.
3. Kapustin AV., Panfilenko OA, Serebrakova TG. Determination of severity of alcohol intoxication. Forensic examination. 2002; 45(3): 3-5.
4. Gallant DM., Pena JM. One more look at alcohol consumption and risk of coronary disease. Alcoholism: Clin.and Exp. Res. 1992; 16(2): 350.
5. Viter VI, Tolstolutsky VY. Causa proxima of death from acute alcoholic intoxication. Urgent aspects of forensic medicine. Izhevsk. Ekspertiza. 1995; 4: 20-26.
6. Kapustin AV. Blood concentration of alcohol. Forensic examination. 2000; 43(1): 7-11.
7. Kapustin AV. On assessment of alcoholic intoxication degree. Forensic examination. 1994; 37(4): 17-20.
8. Ameno К, Ameno S, Fuke Ch, et al. A survival case with an unusually high blood ethanol concentration. Jap. J. Leg. Med. 1988; 42(3): 345-347.
9. Tomilin VV, Kapustin AV. Most urgent scientific problems of contemporary forensic medicine. Identification problems in forensic medical theory and practice. The materials of IV Russian Congress of forensic physicians. Moscow: Vladimir. 1996, p. 5-6.
10. Viter VI, Permyakov AV. Several aspects of ischemic heart disease and acute ethanol intoxication. Urgent aspects of forensic medicine. Izhevsk: Expertiza. 1993; 3: 32-35.
11. Galeyeva LS. Forensic assessment of morphological changes in human brain and internals under alcoholic intoxication. Novosibirsk: autoreferat of PHD dissertation. 1973, p. 20.
12. Capaeso JM, Peng Li, Guindery G, Malhotra A, Cortesi R, Anversa P. Myocardial mechanical, biochemical and structural alteratious induced by chronic ethanol ingestion in rats. Circ. Res. 1992. 71(2): 346- 356.
13. Bogomolova IN, Bogomolov DV, Pigolkin YI, Bukeshov MK, Mammadov VG, Morozov YY. Forensic-medical diagnostics of ethanol and its surrogates poisonings by morphological data. Moscow: Medical Information Agency. 2003, p. 438.
14. Paukov VS, Ugrumov AI. Pathological anatomy of alcoholic disease (review). News of Science and Technique. Series of medical releases. Alcoholic disease. Moscow: VINITI. 1997; 5: 1-4.
15. Ugrumov A. Organic pathology and causes of death of persons making excessive use of alcohol. Problems ob Narcology. 1990; 3: 47- 50.
16. Tsiplenkova VG. Alcoholic cardiomyopathy and sudden heart death. Moscow: postdoctoral dissertation. p. 305.
17. Zimatkin SM. Ethanol metabolism in brain. Neurochemistry.1995; 12(1): 19-26.
18. Laiho K. Peroxidase activity in traumatic lesions W Z. Rechtsmed.1988; 100(1): 65-72.
19. Zimatkin SM. Aldehyderogenase system of brain: relation to sustainability and alcohol inclination. Contemporary biology success. 1991; 52(5): 654-666.
20. Ostrovskiy YM, Satanovskaya VI, Ostrovskiy SY, et al. Metabolic conditions and sequences of alcohol consumption. Minsk: Science and Technique. 1988, p. 263.
21. Bautista AP, Spitzer J. Kupfer cells are responsible forthe acute ethanol- induced release of superoxide anion by the liver. Abstracts Res. Society of Alcohol. Meeting, 13-18.06.92, San Diego, California. Alcoholism: Clin.and Exp.Res. 1992; 16(2): 364.
22. Morozov YY. Forensic role of histochemical markers of alcoholic intoxication in human brain tissue. Moscow: autoreferat of PhD dissertation. 2002, p. 34.
23. Motavkin PA, Okhotin VE, Konovko OO, Zimatkin SM. Location of alcohol- and aldehyde dehydrogenase in the human spinal cord and brain. Arch. Anat. USSA. 1988; 11: 38-44.
24. Watabiki Т, Tokiyasu Т, Ishida N, Ogawa K. Method of postmortem study of aldehydehydrogenase and alcoholdehydrogenase activities level in internal organs. Acta Histochem. Cytochem. 1989. 22: 397-400.
25. Naumova EY. Postmortem micromorphology of acute alcoholic intoxication. Izhevsk: autoreferat of PhD dissertation. 2001, p. 22.
26. Bautista AP. Chronic alcohol intoxication enchances the expression of CD 18 adhesion molecules on rat neutrophils and release of a chemotactic factor by Kupffer cells. Alcohol Clin Exp Res. 1995; 19(2): 285-290.
27. Bogomolov DV. Forensic diagnostics of narcotic intoxication for morphological data. Moscow: autoreferat of postdoctoral dissertation. 2001, p. 32.
28. Dolzhansky OV. Forensic assessment of morphological changes in human brain under chronic opium addiction. Moscow: autoreferat of PhD dissertation. 2001, p. 26.
29. Deitrich RA. The future of biochemistry in alcohol research. J.Stud. Alcohol. 1990; 51(1): 5.
30. Zimatkin SM. Histochemical study of aldehyde dehydrogenize in the rat CNS. J. Neurochem. 1991; 56: 1-11.
31. Bozhko HK. Medichronal lowers blood ethanol and acetaldehyde and restores the concentration of catecholamines in rat tissues. Ukr. Biokhim. Zh. 1995; 67(2): 108- 112.
32. Nechayev AK. Alcohol consumption and cardiovascular diseases death rate. Problems of narcology. 1992; 3: 86-90.
33. Pigolkin YI, Bogomolov DV, Bogomolova IN, et al. Forensic aspects of internal pathomorphology under alcoholic intoxication. Forensic examination. 2000; 43(3): 34-38.
34. Pigolkin YI, Morozov YY, Mammadov VG. Acute and chronic alcohol intoxication. Moscow, Medical Information Agency. 2003, p. 279.
35. Krasilnikov LN, Novoselov VP. About postmortem diagnostics of acute and chronic acute alcoholic intoxication. Urgent problems of forensic medicine and expert practice. Novosibirsk-Krasnoyarsk. 1995, p. 20-22.
36. Nuzhny VP. Alcoholic disease problems. News of Science and Technique. Series of medical releases. Alcoholic disease. Moscow: VINITI. 1998; 6: 1-8
37. Permakov AV, Viter VI. Pathomorphology and tanatogenesis of alcoholic intoxicaion. Urgent aspects of forensic medicine. Izhevsk: Expertiza. 2002, p. 91.
38. Mammadov VG. Forensic-medical assessment of death mechanisms by internal organs changes under alcohol intoxications. Moscow: postdoctoral dissertation. 2004, p. 301.
39. Pigolkin YI, Bogomolov DV, Shestyul BV, et al. Forensic examination. 2000; 43(6): 41-45.
40. Kapustin AV. Phase-contrast and polarization-microscopical study of myocardium in forensic practice. Forensic examination. 1992; 35(3): 5-10.
41. Pigolkin YI, Bogomolov DV, Bogomolova IN. Liver pathologies of persons with drug addiction. News of Science and Technique. Series of medical releases. Alcoholic disease. Moscow: VINITI.2001; 10: 15.
42. Bogomolova IN. Liver affection by narcotic intoxication. Moscow: autoreferat of PhD dissertation. 2001, p. 30.
43. Pigolkin YI, Bogomolov DV, Bogomolova IN, et al. Stages of ethanol resorbtion and elimination. Forensic examination. 2001; 44(5): 13-16.
44. Porodenko VA. State of ethanol-oxidizing enzyme systems under lethal intoxication of alcohol (forensic diagnostics criteria). Moscow: autoreferat of postdoctoral dissertation. 1997, p. 42.