Shock, diaschisis and von Monakow / Choque, diasquise e von Monakow

The concept of shock apparently emerged in the middle of the 18th century (Whyett) as an occurrence observed experimentally after spinal cord transection, and identified as "shock" phenomenon one century later (Hall). The concept was extended (Brown-Séquard) and it was suggested that brain lesions caused functional rupture in regions distant from the injured one ("action à distance"). The term "diaschisis" (von Monakow), proposed as a new modality of shock, had its concept broadened, underpinned by observations of patients, aiming at distinguishing between symptoms of focal brain lesions and transitory effects they produced, attributable to depression of distant parts of the brain connected to the injured area. Presently, diaschisis is related mainly to cerebrovascular lesions and classified according to the connection fibers involved, as proposed by von Monakow. Depression of metabolism and blood flow in regions anatomically separated, but related by connections with the lesion, allows observing diaschisis with neuroimaging.

O conceito de choque aparentemente surgiu em meados do século 18 (Whyett), como ocorrência observada experimentalmente após seção transversa da medula, e foi identificado como fenômeno de "choque" um século mais tarde (Hall). O conceito foi estendido (Brown-Séquard) e sugeriu-se que lesões cerebrais produziam ruptura funcional em regiões distantes à da lesão ("action à distance"). O termo "diásquise" (von Monakow), proposto como nova modalidade de choque, teve seu conceito ampliado, fundamentado em observações em pacientes. Visava distinguir sintomas de lesões cerebrais focais de efeitos transitórios que produziam, atribuíveis à depressão de partes distantes do cérebro conectadas à área lesada. Atualmente, diásquise é relacionada principalmente a lesões cerebrovasculares e classificada de acordo com as fibras de conexão envolvidas, como proposto por von Monakow. Depressão do metabolismo e fluxo sanguíneo em regiões anatomicamente separadas, mas relacionadas por conexões à lesão, permitem observar diásquise por meio de neuroimagem.

Expression of VCAM-1 and caspase-3 in myocardium of persons who died from viral myocarditis / 法医学杂志

OBJECTIVE@#To observe the expression and distribution of vascular cell adhesion molecule-1 (VCAM-1) and caspase-3 in myocardium of persons who died from viral myocarditis and to explore its pathogenesis and death mechanism.@*METHODS@#Twenty cases died from viral myocarditis were selected as the experimental group. Ten cases died from traumatic shock and massive hemorrhage shock after traffic accidents were selected as the control group. The sections of myocardium were stained by immunohistochemistry for VCAM-1 and caspase-3, and observed under microscope. The positive expressions of VCAM-1 and caspase-3 of the two groups were compared with each other by image analysis and statistical analysis.@*RESULTS@#(1) The vascular endothelial cells expressed VCAM-1 with dark-brown colors in the experimental group, and weak expression was observed in the control group. The average optical density in the experimental group was higher than that in the control group (P < 0.05). (2) The caspase-3 positive cells were mostly inflammatory cells around the myocardial vessels with brown-red granules in the experimental group. The positive cell number in the experimental group was higher than that in the control group (P < 0.05).@*CONCLUSION@#VCAM-1 may play an important role in the inflammatory cells exudation caused by viral myocarditis, and may provide the reference for diagnosis of viral myocarditis in forensic pathology. However, the myocardial apoptosis mediated by caspase-3 doesn't affect the lethal mechanism in the late stage of viral myocarditis.