The Pathology of Shock Versus Post-mortem Change

Rutty, Guy N.

doi:10.1007/978-1-4471-0637-1_5

Cited by 6 publications

(3 citation statements)

References 34 publications

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“…At the time of post-mortem examination four samples of left ventricle (each quadrant at mid-height), one of right ventricular infundibulum, one sample from each of the upper and lower lobes of both lungs, one sample from each kidney and at least one sample of brain (to include meninges) will be taken for production of histological sections. In addition, the liver (right and left lobes) will be added as it is conceded that hepatic related causes of death could be missed (Kuller et al, 1966;Portmann et al, 1975;Randall, 1980;Chao et al, 1981;Clark, 1988;Hiss et al, 1994;Yuzuriha et al, 1997;Daisley and Simmons, 1999;Tsokoss et al, 2002;Klintschar and Stiller, 2004;Rutty, 2004) and it has been noted that up to a third of macroscopic diagnoses can be discordant with the microscopy of this organ (Beltrami et al, 2001). More attention will be paid to sampling macroscopically abnormal tissues and the sampling of coronary arteries with greater use of decalcification.…”

Section: Discussionmentioning

confidence: 99%

The Use of Histology in 638 Coronial Post-Mortem Examinations of Adults: An audit

Langlois

2006

Med Sci Law

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An audit was performed to determine the effectiveness of histological sampling of forensic post-mortem cases based on a review of three years' data, which comprised 638 adult autopsy cases. During the study period organs and tissues that appeared macroscopically normal and abnormal were extensively sampled. Histology was regarded as in some way contributory (providing, altering or confirming a cause of death) 53% of the time. The use of histology provided the cause of death in 49 (24%) of the 203 cases not given a cause of death after the completion of the macroscopic examination. When an interim cause of death had been supplied following the completion of the gross examination it was changed in 4.8% of cases, but there were no changes of the manner of death. The majority of the histological diagnoses or discrepancies involved the lungs and the heart. All diagnoses relevant to determining the cause of death would have been made if samples had been taken only from the left ventricle, right ventricle, coronary arteries, lungs, kidneys and brain with any tissue or organ that appeared abnormal macroscopically. A macroscopically identified abnormality that appeared to have been responsible for death was not sampled in 20 cases; consequently, more attention will be paid to sampling macroscopically abnormal tissues. As a result of this audit histology sampling practice has been revised and will be re-audited in the future.

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Section: Discussionmentioning

confidence: 99%

The Use of Histology in 638 Coronial Post-Mortem Examinations of Adults: An audit

Langlois

2006

Med Sci Law

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“…Tissues were fixed and stained with hematoxylin and eosin, or frozen for post-hoc analysis. A three-stage veterinary histopathology scoring system (Table S1, http://links.lww.com/SHK/B327) was established as described for lung (16), brain (17), kidney (18), heart (19), liver (20), intestine (21), and skeletal muscle (22).…”

Section: Post-mortem Assessmentmentioning

confidence: 99%

An Ovine Model of Hemorrhagic Shock and Resuscitation, to Assess Recovery of Tissue Oxygen Delivery and Oxygen Debt, and Inform Patient Blood Management

Dyer

Tung

Bassi

et al. 2021

Shock

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Background: Aggressive fluid or blood component transfusion for severe hemorrhagic shock may restore macrocirculatory parameters, but not always improve microcirculatory perfusion and tissue oxygen delivery. We established an ovine model of hemorrhagic shock to systematically assess tissue oxygen delivery and repayment of oxygen debt; appropriate outcomes to guide Patient Blood Management. Methods: Female Dorset-cross sheep were anesthetized, intubated, and subjected to comprehensive macrohemodynamic, regional tissue oxygen saturation (StO 2 ), sublingual capillary imaging, and arterial lactate monitoring confirmed by invasive organ-specific microvascular perfusion, oxygen pressure, and lactate/pyruvate levels in brain, kidney, liver, and skeletal muscle. Shock was induced by stepwise withdrawal of venous blood until MAP was 30 mm Hg, mixed venous oxygen saturation (SvO 2 ) < 60%, and arterial lactate >4 mM. Resuscitation with PlasmaLyte1 was dosed to achieve MAP > 65 mm Hg. Results: Hemorrhage impacted primary outcomes between baseline and development of shock: MAP 89 AE 5 to 31AE 5 mm Hg (P < 0.01), SvO 2 70 AE 7 to 23 AE 8% (P < 0.05), cerebral regional tissue StO 2 77 AE 11 to 65 AE 9% (P < 0.01), peripheral muscle StO 2 66 AE 8 to 16 AE 9% (P < 0.01), arterial lactate 1.5 AE 1.0 to 5.1 AE 0.8 mM (P < 0.01), and base excess 1.1 AE 2.2 to À3.6 AE 1.7 mM (P < 0.05). Invasive organ-specific monitoring confirmed reduced tissue oxygen delivery; oxygen tension decreased and lactate increased in all tissues, but moderately in brain. Blood volume replacement with PlasmaLyte1 improved primary outcome measures toward baseline, confirmed by organ-specific measures, despite hemoglobin reduced from baseline 10.8 AE 1.2 to 5.9 AE 1.1 g/dL post-resuscitation (P < 0.01). Conclusion: Non-invasive measures of tissue oxygen delivery and oxygen debt repayment are suitable outcomes to inform Patient Blood Management of hemorrhagic shock, translatable for pre-clinical assessment of novel resuscitation strategies.

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“…Microscopic changes can occur as early as 18 hours after the insult. There is then a progression through to the formation of hyaline membranes which can take up to 6 days (Rutty 2004). After 8 days intra-alveolar organisation occurs with progression to obliterative fibrosis.…”

Section: Lungsmentioning

confidence: 99%