Search

For forensic toxicological investigations only whole blood, but no serum is often available. Pharmacokinetic data are helpful for interpreting the results, but most of these studies indicate serum or plasma concentrations. In order to obtain reliable conversion factors which also take intersubject variability into account, the blood/serum ratios (B/S) of oxycodone, morphine, fentanyl, hydromorphone, zopiclone, MDMA, dexamphetamine, alprazolam, risperidone and 9-hydroxyrisperidone were determined by LC-MS/MS using authentic samples. Blood and corresponding serum samples were obtained from driving studies performed with controlled or known dosages of the above drugs. The analytes were analysed in blood and serum and the following mean B/S ratios (relative standard deviations) were determined: oxycodone 1.48 (8.19 %); morphine 1.03 (3.59 %); fentanyl 0.87 (13.9 %); hydromorphone 1.04 (8.11 %); zopiclone 0.89 (16.1 %); MDMA 1.19 (8.04 %); dexamphetamine 0.89 (10.9 %); alprazolam 0.81 (5.84 %); risperidone 0.65 (7.52 %); 9-hydroxyrisperidone 0.73 (12.3 %). These mean values are largely in line with those reported in the literature. The B/S ratios did not appear to depend on partition coefficients, whereas there was strong evidence that B/S ratios decreased with increasing plasma protein binding.

Attention-deficit/hyperactivity disorder (ADHD) is characterized by a lack of concentration and/or an altered activation level. People with ADHD are found to violate traffic regulations, to commit criminal offences and to be involved in traffic accidents more often than the statistical norm. Furthermore, they show more deviant behaviour and have an increased co-morbidity regarding substance abuse and dependence. Hence, this disorder is of some forensic importance. The purpose of this case study is to demonstrate that in some cases people with ADHD may show unusual effects after the consumption of THC. A 28-year-old male, who showed abnormal behaviour and seemed to be significantly maladjusted and inattentive while sober, appeared to be completely normal with a very high plasma level of THC. Performance tests conducted with the test batteries ART2020 and TAP provided average and partly above-average results in functions related to driving. Thus, it has to be taken into account that in persons with ADHD THC may have atypical and even performance-enhancing effects.

In the course of the recent years, the policy for the needs of disabled people has started a fundamental paradigm shift. Central elements of the current policy for the needs of disabled people are prevention, rehabilitation and integration. Self-determination instead of care forms the guiding principle. An indistinct definition of chronic disease makes it difficult to obtain a general idea of structures in the care and support for people with chronic diseases. The following compilation examines requirements in social legislation and questions the quality of life by means of the three exemplary aspects: communication, mobility and everyday life. Here the question remains whether the current focus on health neglects any relevant components of chronic diseases. It turns out that people with a chronic illness, although social legislation has improved, are neglected the more support they need. Care as an elementary social principle must be discussed on an interdisciplinary basis and in the context of the whole society.

In the field of forensic DNA typing, the analysis of Short Tandem Repeats (STRs) can fail in cases of degraded DNA. The typing of coding region Single Nucleotide Polymorphisms (SNPs) of the mitochondrial genome provides an approach to acquire additional information. In the examined case of aggravated theft, both suspects could be excluded of having left the analyzed hair on the crime scene by SNP typing. This conclusion was not possible subsequent to STR typing. SNP typing of the trace on the torch light left on the crime scene increased the likelihood for suspect no. 2 to be the origin of this trace. This finding was already indicated by STR analysis. Suspect no. 1 was excluded for being the origin of this trace by SNP typing which was also indicated by STR analysis. A limiting factor for the analysis of SNPs is the maternal inheritance of mitochondrial DNA. Individualisation is not possible. In conclusion, it can be said that in the case of traces which cause problems with conventional STR typing the supplementary analysis of coding region SNPs from the mitochondrial genome is very reasonable and greatly contributes to the refinement of analysis methods in the field of forensic genetics.

At autopsy, visualization of lesions of the bridging veins, a frequent source of subdural bleeding, is difficult due to their anatomical localization. On the other hand their demonstration is of great importance for the assignment to a chronologically defined trauma. For this reason a postmortem method using computed tomography was developed to visualize the intracranial venous system by means of X-ray contrast media. In subdural bleedings, in which the skull had not been opened up, ruptured vessels could be accurately localized with this method, so that targeted dissection was possible during the subsequent autopsy.

Former studies have shown that even a single skin contact, resulting in a latent fingerprint, can transfer enough DNA for genetic analysis. However, up to now latent fingerprints have usually not been used for DNA typing. In the present case the smeared trace of a hand was found in the suspect's car and archived. As it could not be evaluated in a classical manner, the evidence had to be examined by molecular genetic methods. DNA was extracted and typed in five different STR loci. Based on the yielded results, the significance of the findings is discussed.

Authentic hair samples from Cannabis users and a drug free hair sample which was separately spiked with tetrahydrocannabinol (THC), cannabidiol (CBD) or cannabinol (CBN) were exposed outside as well as to natural sunlight at prevailing and elevated humidity in quartz glass tubes during 8 weeks. In addition, authentic and spiked hair samples were exposed to xenon arc radiation in a light exposure cabinet for 24 hours. Stability of THC, CBD and CBN in authentic samples differed from that of the spiked hair. The radiation experiment revealed that CBN could not be measured in hair which had been spiked with THC. Under all conditions chosen the concentrations of THC, CBD and CBN decreased. At high humidity the concentrations declined more rapidly. In both authentic and spiked samples THC was most unstable compared to CBD and CBN. Therefore, in hair analysis determination of CBD and CBN seems promising to detect Cannabis exposure even under unfavorable conditions.

We report on four cases of sudden circulatory arrest during the physical restraint of extremely excited and repugnant men by the police. Three persons died, and one became apallic. The excited states resulted from acute schizophrenic disorder in one case, from intoxications (ethanol and drugs including cocaine respectively) in two others, and from encephalitis in the fourth case. In only one case one of the police officers was condemned for involuntary mansloughter, responsability was excluded in the remainder. Similar lethal events in "excited delirium" are given in the American literature, the main etiologic factors being acute psychosis and cocaine intoxication. Most of these events occurred, differing from ours, under "hogtying" which is a technique of physical restraint in a prone position with the wrists and ankles bound behind the back. These events are thought to be cardiac in origin and to result from oxygen-consuming motor hyperactivity, excessive catecholamine release, and impaired breathing. Police officers are recommended to restrict all measures of restraint to a mininum in extremely excited persons, and to avoid any compression of the trunk or neck. A continuous monitoring for vital signs is postulated in order to recognize a medical incident as quick as possible.

An intoxication following an apparent overdose of clozapine (Leponex) and perazine (Taxilan) is reported. There was a wide range of variation in postmortem blood and tissue concentrations of clozapine, desmethyclozapine and perazine. Clozapine/norclozapine blood and tissue ratios and perazine-pill-fragments in the gastric content could be used as a sign of suspected acute clozapine and perazine overdose.

The stability of flunitrazepam, flurazepam, diazepam and some of their metabolites in spiked blood and plasma samples was studied bei GC-ECD analysis at defined time intervals up to 240 days. Validation data of the method are given. The blood or plasma samples were stored either at 22 degrees C or at 4 degrees C, and were exposed to global natural light irradiation or protected from light. All substances considerably decreased during the time interval studied. Flunitrazepam soon disappeared completely at room temperature (22 degrees C), while diazepam and flurazepam proved to be more stable, but a clear pattern of breakdown could not be established. The data obtained suggest a result from a long-term stored sample to be cautiously interpreted. Further investigation concerning the stability of drugs and the establishment of optimal storage conditions seem necessary.

We report on 7 nursing home or hospital patients who died suddenly and unexpectedly during physical restraint. Four of the patients were found dead hanging beside their beds, with their waist restraints displaced to the thorax. In spite of a variety of preexisting diseases, asphyxia by thorax compression was the most probable cause of death. Three other patients, when falling out of their beds, were strangulated by the head opening of a nursing bedcover fixed to the bed. In all instances the fatal accidents resulted from improper handling of the restraint devices, namely from the omission of bed rails as well as of the obligatory waist belt lateral fixations. The bedcover type involved in three fatalities is destined for care purposes but not licensed as a restraint device. Physical restraint fatalities can be avoided to a large extent if the producers' instructions are strictly observed, and only especially trained and supervised personnel is admitted to this field of duties.

The aforementioned case proves very convincingly that a very high dose of alcohol consumed within a short time span can be absorbed completely within 2 hours. Numerical models based on low to moderate alcohol consumption were lower than expected in cases of severe alcohol intake. The claim of alcohol consumption after an event can best be verified by means of a drinking experiment under intensive medical supervision.

In 1027 lateral radiograms of the ankle in a Caucasian population, 161 plantar and/or dorsal calcaneal spurs (15.7%) were diagnosed. Plantar spurs were more common than dorsal spurs (11.2 and 9.3% respectively). Prevalence of both spurs increases considerably with the rising age. Dorsal spurs appear slightly earlier than plantar spurs. The spur frequencies are similar in left and right feet. The plantar spurs were significantly (p < 0.0001) more common in women than in men in general, while dorsal spurs were more frequent in men than in women up to the age of 70. The previously reported higher frequencies of plantar and dorsal calcaneal spurs in women than in men are probably a result of a disproportionally higher number of women in higher age in the groups studied. In forensic medicine, calcaneal spurs provide evidence for identity and age of unknown corpses, and to certain extend their profession, physical activities and constitution during life.

The risk of treatment offered by nonmedical practitioners are demonstrated with six casuistic expertise reports. In four cases the treatment had a lethal outcome, because the underlying illnesses had been underestimated or had not been diagnosed. To the authors opinion a patient's consent in a treatment by nonmedical practitioners is inoperative, because a nonmedical practitioner is on principle unable to inform a patient regularly because of his lack of medical knowledge.

Among 31 cases of death by stab or cut from the years 1989 to 1991 a common injury pattern cases was brought out and related to surviving-time and the capacity to act. The results revealed a short surviving-time if a great blood loss can occur in a short time. There was no correlation between the volume of blood loss and the capacity to act or the lungs weight. From these cases, three cases are reported. First, a single throatcut with cut of the trachea and a surviving-time of 30 minutes. Second, one case of a single heart stab in which the victim could run about 100 meters, and third, one case of an isolated cut of the A. pericardiaca and an estimated surviving-time of 4-12 hours.

Parenteral administration of fresh cells, frozen cells (snapfrozen cell suspensions) or lyophilized cells (sicca cells), is known as cellular or cell therapy. While the German Health Office (BGA) provisionally banned the use of dried cell preparations in 1987, injection of fresh cells is still allowed. There have been repeated reports of life-threatening, and even fatal, complications of this type of therapy. Since it involves the administration of heterologous biological material, most of the complications that have been observed have been of the allergic/hyperergic type resembling experimental allergic encephalomyelitis (EAE) and experimental allergic neuritis (EAN). When evaluating the risks of this form of alternative-medical treatment, the well-known risks of injection therapy must also be borne in mind. In the case of cell therapy, too, the hoped for effect must be weighed against the risks of the procedure, and our guiding principle must be: nil nocere.

The distribution of prothipendyl (Dominal) in two cases of fatal poisoning are reported. The highest concentration of prothipendyl were found in liver (1.2 g/kg to 1.8 g/kg) and kidney (0.6 g/kg). Prothipendyl concentrations in these organs far exceeded those in blood. In the first case we found a blood concentration 200 times over the therapeutic range. Prothipendyl was detected in all specimens tested including: lung, muscle and stomach. These results are in agreement with limited, previously reported data and indicate that more then 4 g of prothipendyl is fatal overdose. In this report the survival time and dose are discussed.

The special field of legal medicine represents a very heterogeneous science, which makes it impossible, that a forensic pathologist could be an "expert" in all areas. The most recent achievements of computer-technology have opened up the possibility of being able to use a PC to produce an "expert system", for with large computer programs are needed. Therefore we wanted to test in a pilot project, if it was possible to establish an expert system, which was suitable for supporting forensic pathological diagnosis. We confined ourselves to the differential diagnosis of "death by hanging" where a clear line between vital and postmortal events, respectively suicide, homicide and accident was drawn. The discrepancy between the relatively scanty amount of statistically reliable data on the one hand and the complexity of the manifestation of death by hanging on the other hand proved to be the main problem. Although we are not yet able to make an expert system available which meets all our requirements, we are convinced, that in the future computer-aided diagnosis may be of great use for work in legal medicine.

The blood levels and the elimination kinetics of flurazepam and its major metabolites in blood were investigated in 10 volunteers after application of 60 mg flurazepam (Dalmadorm). Hydroxyethylflurazepam and desalkylflurazepam are the metabolites suitable for proving a previous flurazepam ingestion. Splitting of glucuronides is helpful for the determination of hydroxyethylflurazepam as the maximum blood concentration of the unconjugated metabolite does not exceed 1/3 of the concentration after glucuronidase splitting. Because of the different half-lives of formation and of elimination a characteristic time dependent pattern of flurazepam and its metabolites is observed in blood during 24 h after a single dosing. From this, conclusions may be drawn about the period of time between ingestion and sampling of the blood specimen. The accumulation of desalkylflurazepam is indicative of the dose applied or of previous multiple dosing. Parallel to the rise of the blood concentration of the metabolites the excretion of the corresponding hydroxyethylflurazepam glucuronide is detectable in urine. Within 30 min the concentrations are suitable for thin-layer chromatographic quantitation. An impaired performance of the volunteers was observed essentially during the absorption and the early distribution phase.

After an accidental injury of the bowel during a hysterectomy, the patients peritoneal cavity was irrigated for disinfection with a solution containing a mercury-compound. The patient died 40 days after this "peritoneal lavage" with a 0.2% solution of mercury-II-oxycanide. The disinfection with the toxic compound during operation can be judged as a medical mistreatment leading to death of the patient. The mercury concentration in blood (0.1 mg Hg per 100 g blood), taken during autopsy, exceeded normal values severalfold. The cause of death was diagnosed as a "multiorgan-failure", caused by an "iatrogenic mercury poisoning". The results of toxicological analysis, histological examination and the findings of autopsy are presented.

Iatrogenic cardiac injury due to diagnostic sternal puncture occurred in 5 patients, 2 women and 3 men, aged 14 to 37 years. Four cases ended fataly but 1 patient survived after immediate thoracotomy and suture of the damaged heart. Perforation of the anterior wall of the right ventricle resulting in pericardial tamponade was present in all patients. All fatalities resulted in conviction, under criminal law, of the clinician who carried out the puncture (Paragraph 222 StGB--causing death through negligence).

Based on the personal computer software "dBase III plus", we have developed a database program for storage and analysis of data obtained from forensic autopsies. It has been designed to handle administrative data as well as aspects of pathological and forensic findings. To assure the comparability of data with those of other institutes, the data were encoded using the SNOMED nomenclature. This system is characterized by a well differentiated, hierarchical structure, and is commonly used internationally. The entry of data is done by choosing among more than 3,000 terms, which are displayed in a system of selective menus. There terms can be supplemented at any time for specific purposes. Thus it is necessary to record the results of an autopsy in a standardized and well-defined way. The data-base can be used for statistical evaluation of autopsy results, but is also intended as a basis for the development of an expert system to help to determine the cause of death.

Investigations comparing dynamics and kinematics in volunteers and postmortem human subjects (PMHS) under the same collision conditions are rare, although such results are of elementary importance in order to estimate the suitability of PMHS as injury indicators in crash tests. Under this aspect, a report on 12 experimental frontal collisions has been made where PMHS were loaded and restrained by a 80 mm broad double shoulder lap-step belt. The impact velocity amounted 60 km/h, the mean vehicle decelerations were at 11 g and 15 g. In the Naval Biodynamics Laboratory in New Orleans, the comparing collective of 9 volunteers in the age range of 18 to 22 years has been investigated by a mean deceleration of 11 g at otherwise comparable conditions. Optical targets have been fixed at the 1st thoracic vertebra, the occiput and the top of the head in the PMHS, the collision phase has been documented by a laterally to the sled mounted high-speed camera with a frame rate of 1000 p/s. The accelerations have been measured tri-axial at the top of the head, at the clivus and the 1st thoracic vertebra. For the simulation of the muscle tonus of the volunteers, formaldehyde has been injected into the neck muscles. In the PMHS as well as in the volunteers no thoracic- or abdominal injuries occurred during the above mentioned loads. However, the spinal column of the PMHS remained uninjured only in 3 cases, in 7 cases hemorrhages in the intervertebral disc, lacerations of the ligamentum flavum or hemorrhages in the vertebral joints were observed.

We report on the chemical preparation of the NAD+ analog P1, P2-(5'-beta-nicotinamideribofuranosyl-3"-adenosyl)-diphosphate (N3"AD+) by applying the 1,1'-carbonyldiimidazole activation method. The importance of how adenosine is linked to the nicotinamide mononucleotide phosphoriboride (NMNPR+) moiety is discussed with respect to the coenzyme activity in the lactate dehydrogenase catalyzed reaction.