muramidase and Wounds--Stab

The distribution of the proteinase inhibitors alpha-1-antichymotrypsin (alpha 1-act), alpha-2-macroglobulin (alpha-2-m) and lysozyme was analysed immunohistochemically in 27 intravitally acquired wounds, 3 postmortem skin lacerations and 9 specimens of undamaged skin. Intravitally acquired wounds demonstrated distinct positive reactions for all antibodies examined (alpha-1-act 66.6%; alpha-2-m 51.9%; lysozyme 25.9%). However the undamaged skin margins opposite the wound margins also gave positive reactions (alpha-1-act 51.8%; alpha-2-m 37.0%; lysozyme 25.9%). Nearly half of the control cases (specimens of undamaged skin) exhibited weak positive reactions for all 3 antibodies. These could be easily distinguished from the strong positive reactions observed in intravitally acquired wounds. False positive reactions were observed due to contamination resulting from contact with serum components, in cases of advanced autolysis of specimens, and as a result of fixation and drying artefacts. Even though immunohistochemical studies of alpha-1-act, alpha-2-m and lysozyme give some indications concerning wound vitality, they cannot be considered as proof because irrefutable differentiation of true positive and false positive reactions is not possible in all cases.

Topics: alpha 1-Antichymotrypsin; alpha-Macroglobulins; Humans; Immunoenzyme Techniques; Multiple Trauma; Muramidase; Postmortem Changes; Skin; Wounds and Injuries; Wounds, Gunshot; Wounds, Stab

In a pilot study paraffin-embedded sections of open skin wounds (stab and slash wounds, lacerations) were investigated to determine the presence of a vital reaction. Granulocytes were detected by naphthol AS-D chloroacetate esterase, the enzyme "lysozyme", and eight proteinase inhibitors by the indirect immunoperoxidase method. The tissue specimens were taken from consecutive autopsy material. The survival time could be determined in 14 cases (10-165 min) and was unknown in 12 other cases of sudden death due to injury of the major vessels or heart. The controls were cases with injuries inflicted after and cases of sudden death due to massive blunt trauma served death. In vital injuries, accumulations of proteinase inhibitors, particularly alpha-2-macroglobulin and alpha-1-antichymotrypsin, were demonstrable in the corium parallel to the wound surface. In comparison, the reaction of proteinase inhibitors that neutralize only enzymes participating in blood coagulation or complement activation (C1-esterase inhibitor and protein C) was absent or weak. Protein accumulation was observed only sporadically in cases of sudden death and never in cases with wounds inflicted after death. No relationship could be established between semiquantitatively estimated staining and survival time. Granulocytes and lysozyme were first observed in the corium after a survival time of more than 60 min.

Topics: alpha 1-Antichymotrypsin; alpha-Macroglobulins; Granulocytes; Humans; Immunoenzyme Techniques; Muramidase; Postmortem Changes; Protease Inhibitors; Skin; Wounds, Nonpenetrating; Wounds, Penetrating; Wounds, Stab