HISTOPATHOLOGICAL FINDINGS IN LEGAL MEDICINE CASES.
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AGUIJÓN DE ABEJA, DURANTE UNA PICADURA MORTAL, PENETRANDO EN LA PIEL. PROF.GARFIA.A
1.-Cytotoxic Venom Death in Nonallergic Persons.
Massive bee envenomation can produce both immediate and delayed death due to toxic reaction.
1.1.-Immediate toxic reaction: histopathological findings.
After numerous insect stings, the following findings can be found in the autopsy (Janssen, 1966).
-Pulmonary and cerebral edema.
-Hyperemia of the inner organs.
-Petechial hemorrhages in the skin and serous coats.
-Softening foci in the brain.
-Toxic parenchymal lesions.
The histopathological study can shows:
Anaphylaxis is a severe, life-threatening allergic reaction. It must be diagnosed clinically and must treated immediately. Twenty percent or more of patients with anaphylaxis lack cutaneous manifestations, and patients with chronic asthma are at higher risk of undertreatment, misdiagnosis, and death.
The clinical manifestations of systemic anaphylaxis in man include:
1.-Respiratory distress caused by bronchospasm or angioneurotic edema involving the lariynx.
2.-Diffuse erythema, urticaria, and pruritus.
3.-Vomiting, abdominal cramps, and diarrhea that occasionally is bloody.
4.-Vascular collapse without preceding respiratory distress.
The primary cause of mortality in anaphylaxis can be of two types:
1.-Acute Airway compromise ("respiratory shock").
2.-Cardiovascular collapse (circulatory shock).
Of the deaths through insect stings the median time interval between onset of symptons and cardiopulmonary arrest was less than 1st after the sting.
Fatal anaphylactic reactions are more common in asthmatic patient.
In fatal cases, the postmortem findings fall into two patterns:
1.-Acute Airway Compromise or "Respiratory Anaphylaxis."(Asphyxia Deaths).
1.1.-Edema of the upper respiratory tract (including the hypophariynx, epiglottis, larynx, and even the trachea); acute pulmonary emphysema -revealed by gross and microscopic examination- resulting from obstruction in the upper and lower respiratory tract.
The postmortem examinations of patients who died of asphyxia with secondary vascular collapse reveal acute pulmonary emphysema, edematous laryngeal obstruction, or both.
This is the normal response to insect stings in asmathic patients.
2.-Cardiovascular Collapse without Preceding Respiratory Distress. Circulatory Anaphylaxis (Circulatory Deaths/Anaphylactic Shock).
No significant findings can be seen when the patient has died in a state of shock without antecedent of respiratory difficulty.
The macroscopic and histological findings are uncharacteristic in the inner organs:
1.-Acute vascular congestion.
4.-Subepicardial, subendocardial, and subpleural petechial hemorrhages.
5.-Microcirculatory changes shock-induced (sludging of erythrocytes, platelets aggregations, and multiple megacaryocytes in the pulmonary microcirculation).
1.-Nicoletta Trani, Luca Reggiani Bonetti, Giorgio Gualandri, Giuseppe Barbolini and Margherita Trani (2011). Forensic Investigation in Anaphylactic Deaths, Forensic Medicine - From Old Problems to New Challenges, Duarte Nuno Vieira (Ed.), ISBN: 978-953-307-262-3, InTech, Available from: http://www.intechopen.com/books/forensic-medicine-from-old-problems-to-new-challenges/forensic-investigation-in-anaphylactic-deaths.
Forensic Investigation in Anaphylactic Deaths