Application of serum total IgE, tryptase and chymase in the identification of death caused by drug anaphylactic shock / 法医学杂志

OBJECTIVE@#To explore the application value of serum total IgE, tryptase and chymase in the identification of death caused by drug anaphylactic shock.@*METHODS@#The general information from 235 cases of non-drug anaphylactic shock and 32 cases of drug anaphylactic shock were analyzed. The serum IgE level had been detected in the cases. Ten cases caused by coronary disease and 10 cases caused by sudden manhood death syndrome were selected from non-drug anaphylactic shock cases for the control group. Expressions of tryptase and chymase in the lung and heart were detected using immunohistochemistry method. The number and IOD of positive mast cells were counted.@*RESULTS@#In the drug anaphylactic shock group, the IgE value of 18 samples (56.25%) was significantly higher than the normal upper limit of 120 IU/mL. In the non-drug anaphylactic shock group, the IgE value of 67 samples (28.51%) was higher than 120 IU/mL. The expressions of tryptase and chymase were significantly increased in lung and myocardial tissue in drug anaphylactic shock group (P < 0.05).@*CONCLUSION@#Tryptase and chymase are more superior than that of the serum total IgE in the diagnosis of death caused by drug anaphylactic shock, and are more suitable in forensic practice.

The improvement of mixed human serum-induced anaphylactic reaction death model in guinea pigs / 法医学杂志

OBJECTIVE@#To increase the death rate of fatal anaphylaxis in guinea pigs and the detectahie level of the tryptase of mast cell in hlood serum.@*METHODS@#Seventy-four guinea pigs were randomly divided into five groups: original model group, original model control group, improved model group, improved model control group, improved model with non-anaphylaxis group. Using mixed human serum as the allergen, the way of injection, sensitization and induction were improved. ELISA was used to detect the serum mast cell tryptase and total IgE in guinea pigs of each group.@*RESULTS@#The death rate of fatal anaphylaxis in original model group was 54.2% with the different degree of hemopericardium. The severe pericardial tamponade appeared in 9 guinea pigs in original model group and original model control group. The death rate of fatal anaphylaxis in improved model group was 75% without pericardial tamponade. The concentration of the serum total IgE showed no statistically difference hetween original model group and original model control group (P > 0.05), hut the serum mast cell tryptase level was higher in the original model group than that in the original model control group (P > 0.05). The concentration of the serum total IgE and the serum mast cell tryptase level were significantly higher in improved model group than that in the improved model control group (P < 0.05).@*CONCLUSION@#The death rate of the improved model significantly increases, which can provide effective animal model for the study of serum total IgE and mast cell tryptase.

The expression of VCAM-1 in organs of rats died of anaphylactic shock / 法医学杂志

OBJECTIVE@#To investigate the effect and expression of the vascular cell adhesion molecule-1 (VCAM-1) in organs of rats died of anaphylactic shock.@*METHODS@#The models of anaphylactic shock in rats were made and the immunohistochemistry of SABC was used to detect as follows: (1) The expression of VCAM-1 in rat lung, heart, brain, kidney, liver, spleen, stomach and intestine. (2) VCAM-1 levels in lungs at 10 min, 30 min after the allergic shock, and the time of death. (3) VCAM-1 levels in lungs of rats after the intervention of anti-VCAM-1.@*RESULTS@#After the death, the expression VCAM-1 in lungs increased significantly relative to the control group and followed the extension of shock. In the rats which were injected with the anti-VCAM-1, the expression of VCAM-1 in lungs reduced.@*CONCLUSION@#(1) The expression of VCAM-1 shows difference in the various organs of rats after anaphylactic shock. The change of VCAM-1 is the most obvious in lungs and would increase followed the extension of anaphylactic shock. (2) After the anaphylactic shock, anti-VCAM-1 can inhibit the expression of VCAM-1 in rat lung.

Twenty autopsy cases of anaphylactic shock induced by cephalosporins / 法医学杂志

OBJECTIVE@#To explore the characteristics of autopsy cases of anaphylactic shock induced by cephalosporins and provide the evidences in forensic medicine.@*METHODS@#Twenty cases of anaphylactic shock induced by cephalosporins were collected from April 2005 to August 2009 in judicial expertise center of China Medical University, and the characteristics of the cases were analyzed retrospectively.@*RESULTS@#The age of decedents ranged from 40 to 60 years. Ninety percent of cases were from local medical centers and private clinics. The symptoms of the shock appeared 30 s-150 min after the administration of the drug, and death occurred 10 min-210 min after the appearance of the shock symptoms. In all cases, various degrees of eosinophil infiltration were observed in trachea and the lungs. Serum IgE detected by ELISA method was normal value in 14 cases.@*CONCLUSION@#In fatal anaphylactic cases, little specific findings are detected during postmortem and microscope examination. For this reason, the determination of cause of death in these cases requires comprehensive analysis combined with clinic information and excludes other diseases leading to the sudden death.

Expression of tryptase and chymase in human lung tissue of anaphylactic shock / 法医学杂志

OBJECTIVE@#To explore the expression of tryptase and chymase in human lung tissue of anaphylactic shock and its value for forensic medicine.@*METHODS@#With ten carbon monoxide poisoning cases as control group, the levels of tryptase and chymase were observed by immunofluorescence and analyzed using the Image Analyze and the Image-pro plus 5.0.2. The positive mast cells were counted and the levels of the tryptase and chymase were calculated respectively.@*RESULTS@#There was a statistically significant difference (P < 0.05) for the tryptase and chymase concentrations in the lung tissue between the anaphylactic shock group and the control group.@*CONCLUSION@#The levels of the tryptase and the chymase expression are greatly increased in human lung tissue of anaphylactic shock, which may provide the morphological evidence and reference for the diagnosis of anaphylactic shock in forensic practice.

The value of TNFalpha testing in evaluation of death due to drug anaphylactic shock / 法医学杂志

OBJECTIVE@#To analyze the changes of the serum TNFalpha level in cadavers of drug anaphylactic shock(DAS) and to explore the significance of the TNFalpha testing in evaluation of death caused by DAS.@*METHODS@#The level of serum TNFalpha from cardiac blood was determined by double antibody-sandwich ELISA method.@*RESULTS@#The level of TNFalpha in the experimental group was (131.6+/-9.4) pg/mL, while the level in the infectious diseases control group and the normal control group were (87.3+/-6.4) pg/mL and (17.2+/-4.5) pg/mL, respectively. There was statistically significant difference among the groups (P<0.05).@*CONCLUSION@#The serum TNFalpha level may be used as one of the indexes for evaluation of death caused by highly suspected drug anaphylactic shock.

Expression of substance P in human laryngopharynx and gastrointestine in sudden erethistic death / 法医学杂志

OBJECTIVE@#To study the expression of substance P (SP) in human sudden erethistic death, and to seek objective morphological supports to diagnose sudden erethistic death for forensic medicine.@*METHODS@#The expression of SP was detected with immunohistochemical technique on 15 human laryngopharynx and gastrointestine of sudden erethistic death, and 20 sudden death of heart attack as control. The images of SP were analyzed by image analyzer, and the positive indexes (PI) were calculated.@*RESULTS@#SP expression in the experimental groups was significantly stronger than that in the control one (P < 0.001).@*CONCLUSION@#SP expression can offer an objective morphological reference support for forensic diagnosing sudden erethistic death.

Analysis on 27 autopsy cases died of anaphylactic shock induced by mainline / 法医学杂志

27 autopsy cases died of anaphylactic shock induced by mainline during 1996-2005 were selected and analyzed. The results showed that most anaphylactic shock induced by mainline were rapid type and more easily happened in individual clinique and lawless clinique, and it could be arisen by either antibiotics or non-antibiotics. In some cases, there may be no pathologic findings by autopsy. So, all the materials must be taken into account for determination the anaphylactic shock, such as drugs, clinic symptom, autopsy findings, and so on.

Present study on the forensic medicine diagnosis of the sudden erethistic death / 法医学杂志

The death caused of anaphylactic shock is common in clinical medicine and medicolegal expertise, but it is a nodus to diagnose sudden death from allergy. In recent years, to provide objective and precise morphological evidence and index of diagnosis for sudden death from allergy, scholars of internal and overseas studied the content of IgE, HT, mast cell tryptase and SP in the serum of the death died of anaphylactic shock, and their immune express in lung and stomach intestine. In this text we reviewed the present study and existing problems of the forensic medicine diagnosis of the sudden erethistic death.

Histamine-potentiating activity in rat anaphylactic pleural fluid: role of serotonin

The identity of the histamine-potentiating activity detected in the rat anaphylactic pleural washing was investigated. Wistar rats of both sexes, weighing 150-200 g, were sensitized by injecting subcutaneously (sc) a mixture of ovalbumin and Al(OH)3 14 days before allergen challenge. In sensitized rats, intrapleural (ipl) injection of ovalbumin (l2 mug/cavity) caused an intense protein exudation. A single ipl administration of compound 48/80 (l2 mug/cavity) exhausted the resident mast cell population and turned the pleural cavity hyporeactive to the allergen challenge performed 5 days later. Allergen-induced exudation occurred in parallel to a dramatic decrease in the amount of cell-stored histamine (from 9.6 ñ 1.4 (N = 8) to 1.3 ñ 0.1 (N = 6) mug/cavity, P<0.001) in the pleural fluid within 10 min. The anaphylactic cell-free pleural washing obtained at this time, as well as histamine at a concentration equivalent to that stored in pleural mast cells (10 mug/cavity), did not induce pleural exudation when injected into normal rats. In contrast the combined administration of histamine and anaphylactic pleural washing led to remarkable pleural exudation, comparable to that obtained with a high dose of histamine (200 mug/cavity) alone. It is noteworthy that the anaphylactic washing from compound 48/80 pretreated rats failed to synergize with histamine. Also, synergism was not reproduced when recipient rats were pretreated with methysergide (50 mug/cavity). Consistently, serotonin (5 mug/cavity) acted synergistically with histamine (1O mug/cavity), producing a greater exudative response than observed with the sum of the effects of each vasoactive amine alone. The results indicate that serotonin accounts for the histamine-potentiating activity noted in the anaphylactic pleural washing, confirming that the synergistic interaction between these vasoactive amines plays a critical role in the rat allergic pleurisy.

Surgical manifestations of Henoch-Schonlein purpura in children

Eleven patients of Henoch-Schonlein purpura presented with surgical conditions between 1988-1994. Of these, three patients, two presenting with gastrointestinal haemorrhage and one with an acute scrotum, were managed conservatively whereas eight patients required laparotomy. The latter group included 5 intussusceptions and one intestinal perforation. The remaining 2 patients had haemorrhagic, but viable, bowel. Continuous evaluation by a surgeon is invaluable in prompt management of these uncommon but potentially lethal complications