Expression of CD63 in Lung Tissue of Guinea Pigs Dying of Anaphylactic Shock / 法医学杂志

Objective To study the protein expression of cluster of differentiation 63 （CD63） in lung tissues of guinea pigs that died of anaphylactic shock and discuss the diagnostic value of CD63 for death from anaphylactic shock. Methods Twenty guinea pigs were randomly divided into control group, anaphylactic shock immediate death group, cold storage group （4 ℃ for 48 h） and frozen group （-20 ℃ for 7 d）. The animal model of guinea pigs that died of anaphylactic shock was established with human mixed serum injection. The expression changes of CD63 protein and CD63 mRNA in lung tissues were detected by hematoxylin-eosin （HE） staining, immunohistochemical staining, Western blotting, enzyme-linked immunosorbent assay （ELISA） and real-time RT-PCR. Results HE staining results showed congestion, and edema of lung tissues, and eosinophil infiltration in the anaphylactic shock groups. Western blotting analysis results showed that the expression of CD63 protein in the lung tissues of guinea pigs that died of anaphylactic shock was significantly higher than that in the control group （P<0.05）. Comparison between the anaphylactic shock groups was made, and the differences had no statistical significance. The results of immunohistochemical staining and real-time RT-PCR were consistent with that of Western blotting. ELISA results showed that CD63 protein expression in the immediate death group was higher than that in the control group （P<0.05）. Conclusion The expression of CD63 protein and CD63 mRNA in the lung tissues of guinea pigs that died of anaphylactic shock is significantly enhanced. Animal carcasses which were put in cold storage for 48 h and frozen for 7 d do not affect the examination of the above indicators. CD63 protein is expected to become an auxiliary diagnostic indicator of death from anaphylactic shock.

Profilaxia da síndrome de embolia gordurosa: uma análise atual / Prophylaxis of fat embolism syndrome: a current analysis

INTRODUÇÃO: Analisar dados da internet relacionados a mortes por embolia gordurosa, inicio da doença, e outras informações podem determinar a realidade atual no Brasil relacionada à incidência da síndrome de embolia gordurosa e qualquer repercussão na mídia, e também revisar as metodologias de prevenção e quais são os melhores métodos disponíveis para tratar a doença. MÉTODOS: Uma pesquisa no google foi conduzida de Janeiro de 2000 a Janeiro de 2014 utilizando os descritores "cirurgia plástica" e "morte". Foram incluídos e revisados artigos contendo as palavras "embolia", "embolia gordurosa" e "complicações em (ou de) cirurgia plástica". RESULTADOS: Incluiu-se 235 matérias novas relevantes ao longo dos 14 anos. Houve 45 casos de óbito relacionados com cirurgia plástica que ofereceu poucos dados para individualização. Desses pacientes, 44 eram mulheres. As causas possíveis mencionadas foram embolia pulmonar (cinco casos), perfuração das vísceras (cinco casos), hipertermia maligna (três casos), anestesia (dois casos), choque anafilático (dois casos), embolia gordurosa (um caso confirmado), e "outros" (cinco casos). CONCLUSÃO: Diretrizes de prevenção para embolia gordurosa em cirurgia plástica são requeridas, porém, há também necessidade de mais estudos baseados em evidência para entender mais claramente quais são os melhores métodos.

INTRODUCTION: To analyze data from the internet on deaths from fat embolism, time of onset, and other information that could determine current reality in Brazil regarding fat embolism syndrome incidence and any ,media repercussions, and also to review methods of prevention and what are the best methods available to treat this disease. METHODS: A Google search was conducted from January 2000 to January 2014 using the keywords "plastic surgery" and "death." We included and reviewed articles containing the words "embolism", "fat embolism" and "complications in (or of) plastic surgery". RESULTS: We included 235 relevant news stories over the 14 included years. There were 45 cases of death related with plastic surgery that offered few data for individualization. Of these patients, 44 were women. Possible causes mentioned were pulmonary embolism (five cases), perforation of viscera (four cases), malignant hyperthermia (three cases), anesthesia (two cases), anaphylactic shock (two cases), fat embolism (one confirmed case), and "other" (five cases). CONCLUSION: Guidelines to prevent fat embolism in plastic surgery are needed, however, there is also the need of more evidence based studies to understand more clearly what methods are best.

Analysis of 59 Anaphylactic Death Cases / 法医学杂志

OBJECTIVE@#To analyze the cases of anaphylactic death cases and explore the standards of judicial expertise of anaphylactic death for providing evidence for judicial expertise.@*METHODS@#Fifty-nine cases death due to allergic reaction in Shanghai were collected. And details of medical history, clinical manifestation of anaphylactic reaction and postmortem examination findings were reviewed for all cases.@*RESULTS@#In the 59 cases, there were 58 cases died from drug allergy, including 77.6% of them were antibiotics. The rates of treating in standard hospital and illegal clinic were 37.3% and 61.0%, respectively. The allergic symptoms were dyspnea and facial cyanosis. The time from contacting allergens to death ranged from 1 min to 3 d. The concentration of total serum IgE ranged from 50 to 576.92 IU/mL. The results of clinical manifestation and pathological anatomy had obviously changes.@*CONCLUSION@#Based on the exclusion of all other cause of death and synthetically analysis of details of cases, medical history, clinical manifestation and anatomy, the conclusion of anaphylactic death can reached. The details of cases including clinical history, exposure to allergens, and clinical manifestation play an important role in diagnosis of anaphylactic death.

Intoxicação por enrofloxacina em um cão da raça Pinscher Miniatura: relato de caso / Enrofloxacin poisoning in a Miniature Pinscher: a case report

Uma cadela da raça Pinscher Miniatura foi medicada pelo proprietário com enrofloxacina, na dose de 50mg/kg, uma vez ao dia, por dois dias (dose diária 10 vezes maior que a prescrita). Ao exame clínico o animal apresentou-se deprimido, em cifose lombar, hipotérmico, com mucosas pálidas, dispnéia, sialorréia, vômitos e anúria, evoluindo para parada respiratória, convulsões e coma. Foi realizado tratamento sintomático. O fluxo urinário retornou ao normal em 12 horas e as convulsões foram controladas, mas o animal permaneceu em coma, morrendo 72 horas após o início do tratamento. A necropsia e o histopatológico confirmaram insuficiência renal e hepática agudas, e choque hipovolêmico, compatível com intoxicação por enrofloxacina.

A Miniature Pinscher bitch was treated by the owner with enrofloxacin at dose of 50 mg/kg, once a day, for two days (daily dose rate 10 times greater than prescribed). Physical examination showed depression, lumbar cifosis, hipotermia, pale mucosa, dispneia, drewling, vomiting and anuria, followed by respiratory failure, seizures, and coma. Symptomatic treatment was performed, and the urinary flow returned to normal in 12 hours, and seizures were controlled. However, the animal stayed in coma, and died 72 hours after the beginning of the treatment. Acute renal and hepatic failure, and hipovolemic shock, compatible with enrofloxacin intoxication, were observed through necropsia and histopatology.

Mortalidade materna: Hospital Geral de Fortaleza (1975-1991) / Maternal mortality: Hospital Geral de Fortaleza (1975-1991)

Quarenta e três mortes maternas ocorreram na Clínica Obstétrica do Hospital Geral de Fortaleza Sistema Estadual de Saúde (HGF-SES), no período de janeiro de 1975 a julho de 1991. As causas obstétricas diretas contribuiram com um maior percentual (69,77 por cento), sendo eclâmpsia, hemorragia e infecçao as principais afecçoes em ordem decrescente de freqüência, seguidas pelas causas obstétricas indiretas (ll,63 por cento)e as nao-obstétricas (6,98 por cento). Comparamos dois períodos: janeiro de 1975 a dezembro de 1987, com um coeficiente de mortalidade matema (CMM) de 206, e janeiro de l988 a julho de l99l, comum CMM de lO4, everificamos uma diminuiçao significativa do mesmo, apesar de este ser ainda alto, visto que nosso serviço atende gestantes de risco. Observamos, ainda, que a maioria das mortes matemas sao evitáveis, sendo necessária a instalaçao de um melhor programa de saúde pública.