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La Guyane française est une plateforme tournante du trafic aérien de cocaïne à destination de la Métropole. Les passeurs appelés « mules » transportent la cocaïne par voie extra ou intra-corporelle, l’ingestion de cocaïne sous forme de boulettes ou d’ovules étant appelée « body-packing ». Le body-packing est un phénomène très fréquent et sa détection fait partie intégrante de l’activité médico-légale guyanaise. Les trois principales complications du transport in corporesont l’intoxication aiguë par rupture d’une boulette, l’occlusion intestinale aiguë et la perforation intestinale. En Guyane, la majorité des boulettes de cocaïne étant de fabrication micro-industrielle, la morbi-mortalité rapportée dans la littérature est extrêmement faible. Nous présentons cependant un cas rare d’intoxication aiguë mortelle à la cocaïne, survenue chez un jeune homme ayant ingéré des boulettes de type micro-industrialisées. Ce trafic de cocaïne représente un enjeu important en termes de santé publique, socio-économique, et d’ordre public. Ainsi, une sensibilisation des professionnels et des actions de prévention semblent fondamentales auprès de nos populations les plus précaires pour faire face à ce phénomène en constante augmentation.

Selective serotonin reuptake inhibitors (SSRIs), serotonin noradrenergic reuptake inhibitors (SNaRIs) and noradrenergic and specific serotoninergic antidepressant (NaSSA) are widely used in the treatment of depression. An increase in antidepressant intoxications led to the development of reliable analytical methods for their analysis. A new determination procedure for these compounds (milnacipran, venlafaxine, desmethylvenlafaxine, mirtazapine, desmethylmirtazapine, citalopram, desmethylcitalopram, fluvoxamine, paroxetine, sertraline and fluoxetine) was developed by micellar electrokinetic capillary chromatography (MEKC) with diode array detection (DAD). Separation and determination were optimised on an uncoated fused-silica capillary (600 mm, 75 μm I.D.). The migration buffer consisted of 20 m M sodium borate, pH 8.55, with 20 m M SDS and 15% isopropanol, at an operating voltage of 25 kV. The column temperature was maintained at 40 °C. Injection in the capillary was performed in the hydrodynamic mode (0.5 p.s.i., 15 s). In these conditions, the migration time of the antidepressants was less than 11 min. In most cases, calibration curves were established for 30-2000 ng/ml ( r >0.995). The limit of detection and the limit of quantification were ranged between 10 and 20 and between 20 and 30 ng/ml, respectively, for all the molecules. This method allowed the determination of some of these compounds in biological fluids (blood, urine) in post-mortem cases. Samples (1 ml) were extracted with diethyl ether (5 ml) at pH 9.6 and reconstituted in diluted migration buffer. Similar results were obtained by a HPLC-DAD determination, performed as a reference method. These results suggest that this MEKC method can be useful for the determination of new antidepressants in post-mortem cases.

This study concerns the effects of morphine in tissues on the rate of development of Lucilia sericata(Diptera: Calliphoridae) using those tissues as a food source. Lucilia sericatais a species of fly commonly found on human corpses in Europe during the early stages of decomposition and thus of forensic interest. Three rabbits were administered 12.5, 25.0 and 50.0 mg/h of morphine chlorhydrate via ear perfusion over a period of 3 h. These dosages and duration of perfusion were calculated to give tissue concentrations of morphine similar to those encountered in fatal human overdoses. A fourth rabbit was used as a control. Following administration of the drug, rabbits were sacrificed and 400 eggs of Lucilia sericata, all of the same age, were placed in the eyes, nostrils and mouth of each rabbit. Developing larvae were sampled daily to determine growth rate and weight. Puparia and emerging adult flies were also sampled. Data were analyzed using analysis of variance (ANOVA) and Student's T-test. Results of this study show that an underestimation of the postmortem interval of 24 h is possible if the presence of morphine in tissues is not considered. This study demonstrates again the necessity of considering the possible effects of drugs in tissues on insect growth rates when estimating the postmortem interval using entomological techniques.

In order to establish an animal model for entomotoxicological studies, the kinetics of morphine elimination from blood after a single intravenous injection of morphine and the concentrations of morphine in tissues following a continuous perfusion were studied. The aim of these experiments was to obtain controlled morphine tissue concentrations similar to those encountered in fatal human heroin overdoses. These tissues can be used as a food source for developing fly larvae in entomotoxicological studies. In the single injection experiment, seven rabbits were administered 1 or 2 mg/kg body weight of morphine chlorhydrate via the main ear artery. Blood samples of 200 μL were removed regularly via a catheter. Morphine concentration was determined using RIA techniques. Morphine was found to be first rapidly distributed and then slowly eliminated, following a two-exponential equation. Elimination of morphine from blood can be described as a two-compartment model. Constants of the equation were determined using the Kaleidagraph® program. Using those constants, the main pharmacokinetics parameters were calculated. Results of these parameters showed the following: clearance from 13.3 to 16.2 L.h-1, half-life of the distribution phase from 0.6 to 0.9 min, and half-life of the elimination phase from 21 to 26 min. These results were used to calculate the rate of perfusion of morphine for rabbits to obtain desired, controlled, and constant concentrations of morphine in tissues. In the second experiment, three rabbits received a perfusion of morphine intravascularly at a rate of 2 mg/kg/h for a period of 3 h. These rabbits were sacrificed and analyses performed on several abdominal and thoracic organs. Results showed that the concentrations of morphine differed according to the organ analyzed, but were reproducible for organs between animals. These concentrations were similar to those normally encountered in cases of human death due to heroin overdoses.

Summary: After experimental intoxication of rats, gas chromatography — Fourier transform infrared spectrometry with headspace sampling (HS/GC/FT-IR) was used to identify solvents of abuse in biological material (blood, liver, lungs and brain). Limits of detection were measured for acetone, 2-butanone, ether, toluene and trichlorethylene with standard solutions. All the solvents have been identified in the organs of the intoxicated rats. For blood samples a salting-out effect was obtained with potassium carbonate. HS/GC/FT-IR allowed the identification of metabolites of acetone (isopropanol) and of 2-butanone (2-butanol) in blood and organs.

The aim of this study was to compare the value of scintigraphy using technetium-99m methoxy-isobutylisonitrile (MIBI) with that of scintigraphy using gallium-67 citrate in the assessment of Hodgkin's disease and non-Hodgkin's lymphoma and to relate these results with those of CT scan and MRI. Fifty-eight patients were included either for a follow-up examination or for monitoring of their treatment. Twenty-three residual masses were studied. A whole-body scan was performed, followed by single-photon emission computed tomography (SPET) 20 min after injection of 740 MBq of99mTc-MIBI and 72 h after injection of 185 MBq of67Ga citrate. The overall sensitivity of99mTc-MIBI and67Ga citrate was 71% and 68%, respectively, and the overall specificity was 76% and 44%, respectively. For residual masses, the sensitivity was 44% with both tracers and the specificity was 80% with99mTc-MIBI and 53% with67Ga citrate. The positive predictive values were 85% and 68% and the negative predictive values were 59% and 44%, respectively. The signal-to-background ratio was 1.5 for99mTc-MIBI and 2 for67Ga citrate. At present,99mTc-MIBI cannot replace67Ga citrate in the assessment of lymphomas.

To present, in a murder case, toxicological findings of chloralose in non-biological and biological matrices including hair.

This study concerns the determinations of morphine concentrations in fly larvae reared on rabbits administered different concentrations of morphine and a correlation between concentrations of the drug in larvae and tissues. Three rabbits (R1, R2 and R3) were given dosages of 12.5, 25.0 and 50.0 mg/h of morphine over a 3 h period via continuous ear artery perfusion. These dosages and time of perfusion were calculated to create tissue concentrations of morphine similar to those encountered in human deaths due to overdose. Morphine blood level plateau was attained after 1 h of perfusion. A fourth rabbit was used as a control. To evaluate drug concentrations, tissues were sampled using a coelioscopic technique. Approximately 400 eggs of Lucilia sericata, all of the same age category, were placed in eyes, nostrils and mouth of each rabbit carcass. Larvae and puparia were regularly collected from each rabbit for toxicological analysis. The concentrations of the drug in the tissues sampled were determined to be similar to those normally encountered in human overdoses and were correlated with the dosage of morphine that had been administered. Morphine was detected in all larvae and pupae fed on tissues from carcasses administered morphine, except for puparia from the colony fed on the R1 animal which received 12.5 mg/h dosage of morphine. All samples from the control rabbit were negative for morphine. Concentrations of morphine in larvae reared on rabbit carcasses containing morphine were 30 to 100 times lower than the concentrations found in the tissues. A correlation between the tissue concentrations and larval concentrations was found in only 3rd instar larvae (80 to 140 h following hatching). No correlations were found between administered dosages, tissue concentrations and younger larvae, prepuparial larvae or puparia.

[51Cr]EDTA was used as a probe molecule to assess intestinal permeability in 7 healthy control adults. 11 control children, 17 children with Crohn's disease, and 6 children with untreated celiuc disease. After subjects fasted overnight. 75 kBq/kg (=2 μCi/kg) 51Cr-labeled EDTA was given by mouth; 24-h urinary excretion of [51Cr]EDTA was measured and expressed as a percentage of the total oral dose. Mean and SD were as follows: control adults 1.47 ± 0.62, control children 1.59 ± 0.55, and patients with Crohn's disease or celiac disease 5.35 ± 1.94. The difference between control children and patients was statistically significant (p < 0.001). These results show that intestinal permeability to [51Cr]EDTA is increased among children with active or inactive Crohn's disease affecting small bowel only or small bowel and colon, and with untreated celiac disease. The [51Cr]EDTA permeability test could facilitate the decision to perform more extensive investigations in children suspected of small bowel disease who have atypical or poor clinical and biological symptomatology.

[51Cr]EDTA was used as a probe molecule to assess intestinal permeability in 7 healthy control adults. 11 control children, 17 children with Crohn's disease, and 6 children with untreated celiuc disease. After subjects fasted overnight. 75 kBq/kg (=2 µCi/kg) 51Cr-labeled EDTA was given by mouth; 24-h urinary excretion of [51Cr]EDTA was measured and expressed as a percentage of the total oral dose. Mean and SD were as follows: control adults 1.47 ± 0.62, control children 1.59 ± 0.55, and patients with Crohn's disease or celiac disease 5.35 ± 1.94. The difference between control children and patients was statistically significant (p < 0.001). These results show that intestinal permeability to [51Cr]EDTA is increased among children with active or inactive Crohn's disease affecting small bowel only or small bowel and colon, and with untreated celiac disease. The [51Cr]EDTA permeability test could facilitate the decision to perform more extensive investigations in children suspected of small bowel disease who have atypical or poor clinical and biological symptomatology.

Description de plusieurs cas originaux de soumissions chimiques, soit par le mode opératoire utilisé (victimes utilisatrices de sites Internet spécialisés), soit par la nature de la substance employée (décoction d’Ayahuasca), documentés par les analyses toxicologiques.

Le dispositif DC-Tox a pour but de collecter les décès pré-hospitaliers par toxiques en Île-de-France et d’identifier les principales substances impliquées afin de permettre l’identification de signaux émergents. Une étude pilote avait été menée pendant une période de 4 mois en 2014 [1]et nous présentons ici les résultats pour l’année 2016.

Présenter le cas d’un nourrisson décédé des suites d’une intoxication aiguë au fentanyl, et discuter au plan médico-légal de son origine accidentelle ou volontaire (homicide).

Si les centres antipoison et toxicovigilance (CAPTV) représentent à ce jour l’observatoire des intoxications aiguës le plus complet, une sous-notification des intoxications bénignes et des plus graves est constatée. Coordonnée par la Cire Île-de France-Champagne-Ardennes (IDFCA) et l’Agence régionale de santé Île-de-France (ARSIDF), une étude pilote a été initiée pour évaluer la faisabilité et l’intérêt d’un dispositif de surveillance intégrant différents acteurs afin de renforcer la connaissance de la morbi-mortalité liée aux intoxications aiguës en région Île-de-France (IDF).

Décrire un cas de syndrome de Münchhausen par procuration, forme particulière de maltraitance infantile souvent difficile à diagnostiquer, chez un enfant de 16 mois, documenté par des analyses toxicologiques, notamment capillaires.

The use of cannabis has been linked to an increased risk for acute psychosis, especially delirious episodes or schizophrenicspectrum disorders. Self-mutilation and dissociative disorders are rare (Bergua A et al. Ophthalmologica 2002;216:269–71). On the contrary, according to some authors, cannabis resin consumption would reduce these disorders (Passie T et al. Drug Test Anal.2012;4:649-59). We report on original case of death by automutilation in a patient with cortical dysplasia following consumption of a highly concentrated resin cannabis.

L’identification des nouveaux produits de synthèse (NPS), phénomène qui a émergé au cours des années 2000, semble en progression en Europe depuis plusieurs années. Ces produits sont de nature très variable, disponibles à la vente sur Internet, et leur distribution bénéficie largement des brèches juridiques des pays vers lesquels ils sont vendus aux consommateurs. Afin d’avoir une idée plus précise de la fréquence d’identification de ces substances dans les saisies de produits qui nous sont confiées pour analyse, nous avons, de manière rétrospective, repris l’ensemble des données collectées sur 3 années pour y rechercher les cas relatifs à ces nouvelles drogues.

Présenter un cas original de tentatives répétées d’homicide volontaire par administration de multiples molécules.

Neriifolin is a cardenolide structurally closed to digoxin and is contained in the fruit kernel of the red-eye-sea mango tree (Cerbera manghas), on which the coconut crab feeds. We previously reported lethal neriifolin poisonings following the consumption of New Caledonian coconut crabs Birgus latro(Maillaud etal., Toxicon 2010). This led us to consider digoxin-specific Fab antibody fragments (Fab) as a specific treatment. This presentation focuses on two cases of successful Fab use.

Ricin is a highly toxic protein from the castor bean plant (Ricinus communis) and is among the deadliest natural poisons available. We report the case of a 23 year-old man who committed suicide through both oral and intravenous self-administration of a castor bean extract.

In apparently localized amyloidosis, there is no appropriate test to determine whether systemic deposits exist. We studied the value of serum amyloid P component (SAP) scintigraphy and labial salivary gland (LSG) biopsy on patients with apparently localized amyloidosis in 12 patients who had neither clinical nor biological evidence of systemic amyloidosis. All patients had an LSG biopsy and echocardiography. lodine-123-labelled serum amyloid P component (123I-SAP) scintigraphy was performed in all patients. Whole-body scintigraphy was done, and tissue retention was evaluated at 24 h and 48 h. Of these 12 patients, three had amyloidosis in their LSG and had abnormal 123I-SAP scintigraphy; these three had a secondary clinical history of systemic amyloidosis. Three other patients had abnormal 123I-SAP scintigraphy without detectable systemic amyloid deposits, but one had a previous history of bilateral carpal tunnel syndrome treated with infiltration. 123I-SAP scintigraphy in association with LSG biopsy may be helpful in determining the localized or systemic character of amyloid disease.