Evaluation of morphological changes of the liver caused by heroin abuse in forensic practice

Abstract

In the investigated group of i.v. heroin addicts, the liver autopsy samples showed degenerative vesicular and fat changes, chronic hepatitis, cirrhosis, sedimentation of pathologic protein amyloidosis, dysplastic changes, reduction in the amount of glycogen in hepatocytes, as well as the change in the number of Kupfer and endothelial cells. The established changes correlated with the duration of i.v. heroin abuse, whereas sinusoidal macrophages were activated in cases with active hepatitis, and no significant change in their number was found in hepatocytes with alcohol-related fatty changes. CONCLUSION. The study showed that the most present change in the hepatocytes of drug addicts was vesicular degeneration, and it is the only direct consequence of the effect of heroin. Other morphological changes were present due to viral infections and they correlated with the duration of narcotic abuse. The finding of dysplastic changes in this susceptible population of young people is particularly significant. The forensic significance of the established changes in the liver tissue is in the possibility of their practical application for determination of the immediate cause of death of i.v. heroin addicts, as well as the differential diagnosis of not only heroin, but also alcohol, sedative and other substances abuse, and all that on the basis of morphological damages of the liver.

Drawing attention to a neglected injecting‐related harm: a systematic review of AA amyloidosis among people who inject drugs

“…Included studies represented studies conducted in eight countries (Table ): 24 were conducted in the United States , 12 in Europe and one in India .…”

“…No papers were published in journals whose aims and scope were related to harm reduction, drug dependency or addiction. More than half were published in medical or pathology journals ( n = 21) , with 13 in nephrology journals (Table ). The majority of studies were case reports ( n = 24) or case–series ( n = 3) , relating to 59 PWID (Table ).…”

“…Five cohort and biopsy review studies (retrospective and prospective) followed a total of 100 PWID from renal biopsy or AA amyloidosis diagnosis . Four post‐mortem reviews considered 40 , 105 , 150 and 292 PWID. One paper presented two cross‐sectional studies comprising 35 PWID .…”

“…Four post‐mortem studies, from Germany , New York and Serbia , provided an indication of the proportion of PWID with AA amyloidosis in these populations (Table ). The German study employed a retrospective analysis of all forensic autopsies carried out on 129 illicit drug users from January 2009 to April 2011 in Frankfurt/Main .…”

Drugs of abuse and addiction: A slippery slope toward liver injury

“…Degenerative vesicular observed, changes in fat, chronic hepatitis, cirrhosis, sedimentation of pathologic protein amyloidosis, dysplastic changes [14].…”