2 research outputs found
Morphometry of cortical neurons in acute clozapine and ethanol poisoning
The aim of the study is to summarize the histology and morphometry of cortical neurons in acute clozapine and ethanol poisoning. Material and methods. Histological examination of the parietal cortical brain samples of 26 patients died during the Day 1 of acute clozapine and ethanol poisoning (23 males and 3 females aged 22β63 years) was per-formed. The blood ethanol level was 1.4β4.1β°. The level of clozapine in the blood ranged between 0.24 and 5.8 mg%, in the liver between 0.097 and 6.5 mg%, in kidneys between 0.03 and 3.5 mg%. The cortical samples for morphometric examination were placed in 10% neutral paraformaldehyde, the histological sections were done and stained with hematoxylin and eosin, as well as according to Niessl. The morphological analysis was performed using the video light microscopy. The number of damaged neurons (with separate quantification of reversible, intermediate, and irreversible damage) was assessed. The statistical analysis was done using the non-parametric methods. Results. The signs of brain neuronal damage in acute clozapine and ethanol poisoning, as well as forensic chemical tests, might be used for establishing the direct cause of death. Β© 2020, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved
ΠΠΠΠ’ΠΠ ΠΠ£Π ΠΠΠΠ¬Π ΠΠΠΠΠΠ§ΠΠ ΠΠ Π ΠΠ’Π ΠΠΠΠΠΠΠ ΠΠΠΠΠΠΠΠΠΠ Π Π‘ΠΠ§ΠΠ’ΠΠΠΠ Π‘ ΠΠΠΠΠΠΠΠΠ ΠΠΠ‘ΠΠΠ ΠΠΠΠΠ’ΠΠΠ¬ΠΠΠ ΠΠ‘Π‘ΠΠΠΠΠΠΠΠΠ)
Objectives. Systematization of cerebellar Purkinje cell injuries to clarify the pathogenesis of combined clozapine-alcohol poisoning and to substantiate the immediate cause of death. Material and methods. Experimental studies were performed on 25 white outbreed rats divided into 5 groups: control, group I (clozapine 3 hours), group II (clozapine 24 hours), group III (clozapine + alcohol 3 hours), group IV (clozapine+alcohol 24 hours). The assessment of Purkinje cell injury was performed using the classification of neuronal damage. Results. In the control group of animals reversible changes in Purkinje cells prevailed: primary irritation and acute swelling (15-20%). Irreversible changes were detected in 2-5%. In case of clozapine poisoning the number of Purkinje cells with irreversible changes (shrinking, karyocytolysis, severe changes, Ghost-like cells) was increased. The percentage of Purkinje cells with such changes was 30-40%. In case of combined clozapine-alcohol poisoning the percentage of irreversible Purkinje cells injury increased to 40-60% (especially 24 hours after starting the study). Quantitative differences in irreversible changes in Purkinje cells in the experimental groups were statistically significant if compared to the controls (p<0.05). Conclusion. As a result of the study the most commonly detected injuries of Purkinje cells of cerebellum in clozapine poisoning were revealed. The most prominent damage to Purkinje cells with predominance of irreversible changes were found in cases of combined clozapine-alcohol poisoning. 24-hour duration of the experiment led to the more severe Purkinje cell injuries if compared to the 3-hour duration.Π¦Π΅Π»Ρ. Π‘ΠΈΡΡΠ΅ΠΌΠ°ΡΠΈΠ·Π°ΡΠΈΡ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠΉ ΠΊΠ»Π΅ΡΠΎΠΊ ΠΡΡΠΊΠΈΠ½ΡΠ΅ ΠΌΠΎΠ·ΠΆΠ΅ΡΠΊΠ° Π΄Π»Ρ ΡΡΠΎΡΠ½Π΅Π½ΠΈΡ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π° ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΠΎΡΡΠ°Π²Π»Π΅Π½ΠΈΡ ΠΊΠ»ΠΎΠ·Π°ΠΏΠΈΠ½ΠΎΠΌ Π² ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ Ρ Π°Π»ΠΊΠΎΠ³ΠΎΠ»Π΅ΠΌ ΠΈ ΠΎΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΡ Π½Π΅ΠΏΠΎΡΡΠ΅Π΄ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΠΏΡΠΈΡΠΈΠ½Ρ ΡΠΌΠ΅ΡΡΠΈ. ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠΊΡΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΡΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ Π½Π° 25 Π±Π΅Π»ΡΡ
Π±Π΅ΡΠΏΠΎΡΠΎΠ΄Π½ΡΡ
ΠΊΡΡΡΠ°Ρ
, ΡΠ°ΡΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Π½ΡΡ
Π½Π° 5 Π³ΡΡΠΏΠΏ: ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ, Π³ΡΡΠΏΠΏΠ° I (ΠΊΠ»ΠΎΠ·Π°ΠΏΠΈΠ½ 3 ΡΠ°ΡΠ°), Π³ΡΡΠΏΠΏΠ° II (ΠΊΠ»ΠΎΠ·Π°ΠΏΠΈΠ½ 24 ΡΠ°ΡΠ°), Π³ΡΡΠΏΠΏΠ° III (ΠΊΠ»ΠΎΠ·Π°ΠΏΠΈΠ½ + Π°Π»ΠΊΠΎΠ³ΠΎΠ»Ρ 3 ΡΠ°ΡΠ°), Π³ΡΡΠΏΠΏΠ° IV (ΠΊΠ»ΠΎΠ·Π°ΠΏΠΈΠ½ + Π°Π»ΠΊΠΎΠ³ΠΎΠ»Ρ 24 ΡΠ°ΡΠ°). ΠΡΠ΅Π½ΠΊΡ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠΉ ΠΊΠ»Π΅ΡΠΎΠΊ ΠΡΡΠΊΠΈΠ½ΡΠ΅ ΠΎΡΡΡΠ΅ΡΡΠ²Π»ΡΠ»ΠΈ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠΉ Π½Π΅ΠΉΡΠΎΠ½ΠΎΠ² Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π ΠΊΠΎΠ½ΡΡΠΎΠ»ΡΠ½ΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ ΠΆΠΈΠ²ΠΎΡΠ½ΡΡ
ΠΏΡΠ΅ΠΎΠ±Π»Π°Π΄Π°Π»ΠΈ ΠΎΠ±ΡΠ°ΡΠΈΠΌΡΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΊΠ»Π΅ΡΠΎΠΊ ΠΡΡΠΊΠΈΠ½ΡΠ΅ - ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠ΅ ΡΠ°Π·Π΄ΡΠ°ΠΆΠ΅Π½ΠΈΠ΅, ΠΎΡΡΡΠΎΠ΅ Π½Π°Π±ΡΡ
Π°Π½ΠΈΠ΅ (15-20 %). ΠΠ΅ΠΎΠ±ΡΠ°ΡΠΈΠΌΡΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ Π²ΡΡΠ²Π»ΡΠ»ΠΈ Π² 2-5 %. ΠΡΠΈ ΠΎΡΡΠ°Π²Π»Π΅Π½ΠΈΡΡ
ΠΊΠ»ΠΎΠ·Π°ΠΏΠΈΠ½ΠΎΠΌ ΡΠΈΡΠ»ΠΎ ΠΊΠ»Π΅ΡΠΎΠΊ ΠΡΡΠΊΠΈΠ½ΡΠ΅, Π² ΠΊΠΎΡΠΎΡΡΡ
ΡΠ°Π·Π²ΠΈΠ²Π°Π»ΠΈΡΡ Π½Π΅ΠΎΠ±ΡΠ°ΡΠΈΠΌΡΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ (ΡΠΌΠΎΡΡΠΈΠ²Π°Π½ΠΈΠ΅, ΠΊΠ°ΡΠΈΠΎΡΠΈΡΠΎΠ»ΠΈΠ·, ΡΡΠΆΠ΅Π»ΡΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ, Β«ΠΊΠ»Π΅ΡΠΊΠΈ ΡΠ΅Π½ΠΈΒ»), Π²ΠΎΠ·ΡΠ°ΡΡΠ°Π»ΠΎ. Π£Π΄Π΅Π»ΡΠ½ΡΠΉ Π²Π΅Ρ ΡΠ°ΠΊΠΈΡ
ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ ΠΊΠ»Π΅ΡΠΎΠΊ ΠΡΡΠΊΠΈΠ½ΡΠ΅ ΡΠΎΡΡΠ°Π²Π»ΡΠ» 30-40 %. ΠΡΠΈ ΠΎΡΡΠ°Π²Π»Π΅Π½ΠΈΡΡ
ΠΊΠ»ΠΎΠ·Π°ΠΏΠΈΠ½ΠΎΠΌ Π² ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ Ρ Π°Π»ΠΊΠΎΠ³ΠΎΠ»Π΅ΠΌ ΡΠΈΡΠ»ΠΎ Π½Π΅ΠΎΠ±ΡΠ°ΡΠΈΠΌΡΡ
ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠΉ Π²ΠΎΠ·ΡΠ°ΡΡΠ°Π»ΠΎ Π΄ΠΎ 4060 % (ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎ ΡΠ΅ΡΠ΅Π· 24 ΡΠ°ΡΠ° ΠΎΡ Π½Π°ΡΠ°Π»Π° ΡΠΊΡΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΡΠ°). ΠΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠ΅ ΡΠ°Π·Π»ΠΈΡΠΈΡ Π½Π΅ΠΎΠ±ΡΠ°ΡΠΈΠΌΡΡ
ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ ΠΊΠ»Π΅ΡΠΎΠΊ ΠΡΡΠΊΠΈΠ½ΡΠ΅ Π² ΠΎΠΏΡΡΠ½ΡΡ
Π³ΡΡΠΏΠΏΠ°Ρ
ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΊΠΎΠ½ΡΡΠΎΠ»ΡΠ½ΠΎΠΉ Π³ΡΡΠΏΠΏΠΎΠΉ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΡ (Ρ < 0,05). ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ΅ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π½ΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Ρ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΠ°ΡΡΠΎ Π²ΡΡΠ²Π»ΡΠ΅ΠΌΡΠ΅ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΊΠ»Π΅ΡΠΎΠΊ ΠΡΡΠΊΠΈΠ½ΡΠ΅ ΠΌΠΎΠ·ΠΆΠ΅ΡΠΊΠ° ΠΏΡΠΈ ΠΎΡΡΠ°Π²Π»Π΅Π½ΠΈΠΈ ΠΊΠ»ΠΎΠ·Π°ΠΏΠΈΠ½ΠΎΠΌ. ΠΠΎΠ»Π΅Π΅ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΡΠ΅ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΊΠ»Π΅ΡΠΎΠΊ ΠΡΡΠΊΠΈΠ½ΡΠ΅, Ρ ΠΏΡΠ΅ΠΎΠ±Π»Π°Π΄Π°Π½ΠΈΠ΅ΠΌ Π½Π΅ΠΎΠ±ΡΠ°ΡΠΈΠΌΡΡ
ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ, ΠΎΠ±Π½Π°ΡΡΠΆΠΈΠ²Π°ΡΡΡΡ ΠΏΡΠΈ ΡΠΎΡΠ΅ΡΠ°Π½Π½ΠΎΠΌ ΠΎΡΡΠ°Π²Π»Π΅Π½ΠΈΠΈ ΠΊΠ»ΠΎΠ·Π°ΠΏΠΈΠ½ΠΎΠΌ ΠΈ Π°Π»ΠΊΠΎΠ³ΠΎΠ»Π΅ΠΌ. ΠΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΡΠΊΡΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΡΠ° Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡΡ 24 ΡΠ°ΡΠ° ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ Π±ΠΎΠ»Π΅Π΅ ΡΡΠΆΠ΅Π»ΡΠΌ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡΠΌ ΠΊΠ»Π΅ΡΠΎΠΊ ΠΡΡΠΊΠΈΠ½ΡΠ΅ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ 3-ΡΠ°ΡΠΎΠ²ΠΎΠΉ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡΡ ΠΎΠΏΡΡΠ°