Histopathological and ultrastructural changes in opiate-related deaths

ABSTRACT

This study was carried out to highlight histopathological and ultrastructuralchanges in livers, kidneys and lungs of 35 opiate related fatalities. Thestudy also included a comparative study of ten accidental fatalities ofhealthy subjects served as controls. The study revealed that causes of deathin the selected series of autopsy were opiate intoxication [57%], violence[suicide, homicide or accidental, 17%] and medical complications [26%] aspneumonia and acute renal failure. The mean concentrations of morphine inblood were 20.5 +or- 3.7, 2.8 +or- 0.94 and 3.36 +or- 1.1 ug/dL in the threegroups, respectively. Light microscopic examination of the liver revealedcentrilobular sinusoidal dilatation with thickening of perisinusoidal wall andvenular wall in all cases of opiate abuse. However, in the lung, evidence ofpulmonary edema was observed in 86% of the cases with intraalveolar red bloodcells and birefringent materials and siderophages were present in 93% of thecases. Examination of renal tissue showed histologic signs of toxic acutetubular necrosis in 20% of the cases, while other cases showed evidences ofmembranoproliferative glomerulonephritis. Electron microscopic examination ofliver sections revealed that ultrastructural changes may occur as a result ofeither sinusoidal dilatation secondary to terminal hepatic vein damage or adirect cellular effect of the drug causing perisinusoidal fibrosis