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Pulmonary histopathology and survival period in morphine-involved deaths
W Grellner1, B Madea, G Sticht
1Institute of Forensic Medicine, University of Cologne, Koeln, Germany.
Abstract:
For an evaluation of the survival period in morphine-involved deaths, changes of pulmonary histopathology were investigated in a total of 90 morphine-associated fatalities. Although pulmonary histopathology proved to be heterogeneous, several distinctive histological patterns emerged. While the subgroup with short courses of intoxication ( < 1 h, n = 15) was mostly characterized by slight/moderate alveolar edema (12/15), severe hemorrhages (12/15) and marked acute emphysema (9/15), the phenomena of massive edema (8/15), missing/slight hemorrhages (8/15) and absent/slight emphysema (11/15) dominated in the group with intermediate survival times (1-24 h, n = 15). Intravascular leukocyte accumulations (shock equivalent) occurred in the first group only once, but in the group with the longer survival time in 10 of 15 cases. Delayed deaths ( > 24 h, n = 4) were mainly characterized by purulent bronchitis/pneumonia. Those fatalities (n = 56) that could not be classified by anamnestic data were assessed by histological criteria. In comparison with the evaluation of the survival period by toxicological analyses, concordance was found in 46 cases. Pulmonary histopathology is not a tool for an exact graduation of survival time, but the combination of several key parameters can provide criteria for a differentiation between short ( < 1 h) and longer courses of intoxication.
Insights
Pulmonary histopathology in morphine-associated deaths reveals distinct patterns correlating with survival times. Specific histological findings help differentiate between short-term (<1 hour) and longer-term intoxication courses.
Area of Science:
- Forensic Pathology
- Toxicology
- Pulmonary Histopathology
Background:
- Morphine-associated fatalities present complex challenges in determining survival periods.
- Pulmonary histopathology offers potential insights into the post-intoxication timeline.
Purpose of the Study:
- To investigate pulmonary histopathological changes in morphine-associated deaths.
- To correlate histological findings with survival periods after morphine intoxication.
- To assess the utility of pulmonary histopathology in differentiating intoxication durations.
Main Methods:
- Examination of pulmonary histopathology in 90 morphine-associated fatalities.
- Categorization of cases based on survival times: short (<1 hour), intermediate (1-24 hours), and delayed (>24 hours).
- Comparison of histological findings with toxicological data for concordance.
Main Results:
- Short-term intoxication (<1 hour) showed alveolar edema, severe hemorrhages, and acute emphysema.
- Intermediate survival (1-24 hours) was characterized by massive edema, minimal hemorrhages, and absent/slight emphysema.
- Delayed deaths (>24 hours) exhibited purulent bronchitis/pneumonia; intravascular leukocyte accumulations were more frequent in longer survival groups.
Conclusions:
- Pulmonary histopathology reveals heterogeneous but distinctive patterns in morphine-associated deaths.
- While not exact, specific histological parameters can differentiate between short (<1 hour) and longer intoxication survival periods.
- Histological assessment showed concordance with toxicological data in a majority of cases.