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martes, 26 de enero de 2010

61.- HISTOPATHOLOGICAL MARKERS IN FORENSIC PATHOLOGY. V.-MANUAL STRANGULATION.PROF. GARFIA.A

61.-HISTOPATHOLOGICAL   MARKERS  OF VITAL REACTIONS  IN VICTIMS OF MANUAL STRANGULATION.

PROF. GARFIA.A


Histopatología Forense Práctica
Blog 61. Fig. 1
Prof. Garfia.A

Fig. 1.- Manual strangulation. Pharyngeal part of the dorsum of the tonge. Note the haemorrhage (H), located in the lamina propria  of the tongue mucous membrane. FL (follicles of lymphoid tissue). Serous lingual glands of Von Ebner ( g). 
EP= Stratified squamous epithelium.
 Prof. Garfia


Histopatología Forense Práctica
Blog 61. Fig. 2
Prof. Garfia.A
                                                                                                                                          

Fig. 2.- Manual Strangulation. The  Pharyngeal Part of the Tongue. 
     Detail of the haemorrhage (H) located in the lamina propria which is  covered with stratified squamous epithelium (EP). Masson Trichrome Stain. Prof. Garfia.A




Histopatología Forense Práctica
Blog 61. Fig. 3
Prof. Garfia.A
Fig.3.- Manual Strangulation. Transversal section of the carotid arteries. 
   CI=Internal Carotid. CE=External Carotid. Between both arteries can be seen the Glomus Caroticum ( arrow). Note the  
(H) perivascular haemorrhage affecting to both carotid arteries and also to the  Glomus Caroticum. Masson Trichrome Stain. Prof. Garfia.A



Histopatología Forense Práctica
Blog 61. Fig. 4
Prof. Garfia.A
Fig. 4.- Manual Strangulation. Detailed vision showing the Glomus Caroticum (large arrows) located  between the carotid arteries. 
   It is surrounded by an extensive haemorrhage (H). The external carotid arterial lumen (CE) shows three points of  rupture (small arrows) - and detachment of the tunica intima - which are located at the external side of the External Carotid Artery. 
Masson Trichcrome Stain. Prof. Garfia.A 


Histopatología Forense Práctica
Blog 61. Fig. 5
Prof. Garfia.A


Fig. 5.- Manual Strangulation. External Carotid Artery. Intimal Tears.
    To show that  the intimal tears (arrows) produced, during the manual strangulation, are located at the anterolateral wall of the external carotid artery(CE). These tears are not transversally oriented to the axis of  the common carotid artery as we can see in the Amussat's sign ( see photos:  7 and 8 ).  
   In manual strangulation the intimal tears run parallel to the longitudinal axis of the external carotid artery. Such tears are more often found  when a forcible impact or a focal finger pressure has been applied into the neck; normally, much of the skin damage is directly over the position of the underlying carotid artery. 
Prof. Garfia.A



Histopatología Forense Práctica
Blog 61. Fig. 6
Prof. Garfia.A


Fig. 6.- Manual Strangulation. External Carotid Artery. 
    Detail (arrows) to show the rupture and detachment focal of the tunica intima. LU=arterial lumen. 
H=Haemorrhage surrounding the adventitia.
Masson Trichrome Stain. 
Prof.Garfia.A




Histopatología Forense Práctica
Blog 61. Fig. 7
Prof. Garfia.A
Fig. 7.- Hanging. Amussat's sign
       To show the macro and microscopical differences between the horizontal (transversal) tear produced into the intima of the common carotid artery - aproximatelly 1 cm below the carotid sinus - during death by hanging, and the longitudinal tears showed in the photo nº 5, and in the schematic drawing nº 8, produced during manual strangulation. 
Prof. Garfia.A



Histopatología Forense Práctica
Blog 61. Fig. 8. Right
Prof. Garfia.A
Histopatología Forense Práctica
Blog 61. Fig. 8 Left
Prof. Garfia.A
  

                                                   

Fig. 8.- Left. Amussat's sign. Hanging. 
    Small horizontal tear of the inner lining of the common carotid artery.  
Prof. Garfia.A                                                

Fig. 8.- Right. Schematic diagram. 
   Longitudinal intimal tears produced during manual strangulation along the common carotid artery; they are located at the antero-lateral wall  of the common carotid artery. Such tears are more often found when a forcible impact or a focal finger pressure has been applied into the neck. 
Prof. Garfia.A

REFERENCES.-


Garfia.A.- Signs in Forensic Pathology: Amussat's sign.
In: Histopatología Forense Práctica. Nº 6.(http://forensic-histopathology-garfiaa.blogspot.com).


Garfia.A.- Glomus tissue in the vicinity of the human carotid sinus. J. Anat ( 1980), 130,1, pp. 1-ttp12

Garfia. A.- Muerte Súbita o Retardada asociada a la patología del Compatimento Lateral del Cuello: el papel fisiopatológico de los barorreceptores del seno carotídeo y de los quimiorreceptores del Glomus Caroticum.
Cuadernos de Medicina Forense. nº 16-17. Abril-Julio 1999. pp. 85-154. Número Monográfico: el Cuello.