Hepatitis in drug poisonings

In the period between 1983 and 1987 autopsies were carried out on 120 drug victims at the Institute for Forensic Medicine in Hamburg, and 93 cases were serologically tested for hepatitis B. It was found that 50 cases (54%) were positive for anti-HBc, 39 (42%) for anti-HBs, and 5 cases (5%) for HBsAg. The prevalence of hepatitis-B-virus markers was dependent upon the age of the victims. In 81% inflammatory alterations of the liver (including unspecific reactive hepatitis) were diagnosed histologically. The pathogenesis of these serological and pathomorphological findings is discussed. Drug addicts are a group at risk for hepatitis B, and it can spread on account of the epidemiological connection with other risk groups, e.g., prostitutes and homosexuals. Postmortem serological investigations for hepatitis markers proved to be a well-established and reproducible means of differentiating histopathological liver alterations.     

Fatal poisonings with propoxur

The insecticide propoxur (2-isopropoxyphenyl-N-methylcarbamate) acts by blocking cholinesterase. This inhibition is fast and, unlike that brought about by organophosphorus compounds, reversible. The toxicity of propoxur to man is stated to be low compared with that of parathion. Only a small number of fatal intoxications have been published; at the Würzburg University Institute of Legal Medicine eight cases have been observed since 1978. In seven cases death occurred after deliberate oral ingestion of solutions of propoxur with suicidal intent, while in the other, intoxication was accidental, following inhalation of an aerosol containing propoxur. Organs and body fluids were investigated toxicologically and histologically. The results are presented and discussed. Special attention is paid to the combination of propoxur and alcohol.     

Postmortem evaluation of barbiturate poisonings

The evaluation of barbiturate intoxication as the cause of death is often difficult when the concentration in body fluids and organs is not extremely high. The problem arises because of the great capacity of barbiturates to produce tolerance after chronic use, a property that is often unknown. Therefore, the most abused barbiturates were studied to assess whether chronic intake causes morphological liver changes or not. It was found that the chronic abuse of drugs containing seco-, cyclo-, brallo-, and/or pentobarbital produces hypertrophy of the smooth endoplasmic reticulum of hepatocytes corresponding to that of phenobarbital. Neither acute barbiturate overdose (without a history of abuse) nor chronic abuse of opiates causes similar liver changes. In conclusion, barbiturate tolerance can be evaluated postmortem by light microscopic examination of the liver.     

Expert criteria of the degree of severity of the chemical trauma in acute poisonings by organophosphate insecticides

The article deals with quantitative assessment of severity of chemical trauma (according to life-threatening characteristics) in case of acute peroral poisoning with OPI (carbophos and chlorophos). Standard diagrams were plotted which help to assess the life threatening values of the given compounds depending on the initial blood poison level or recorded decrease in enzyme cholinesterase activity. Basic opportunity to assess severity of body lesions in case of poisoning with OPI according to character of specific clinical signs was evidenced.     

The clinico-morphological toxicodynamics of organophosphate insecticide poisonings

The article deals with investigation of dynamics of clinical morphological pattern in acute poisoning with organophosphorous insecticides. For this purpose all specific and non-specific effects of this chemical disease are classified according to the moment of their occurrence after poison exposure. Morphological equivalent of specific clinical manifestations at different stages of thanatogenesis of this poisoning was determined. It was shown that intensity of pathological process or specific density of toxic effects per time-unit is a very important criterium for assessment of severity and prognosis of poisoning.     

Fatal ethanol poisonings in 1984-1986

Analysis of statistical data on the number of fatal ethanol intoxications in 1984-1986 is presented. A steady tendency to reduction in fatal ethanol intoxications is stressed.     

Fatal dextropropoxyphene poisonings in Jutland, Denmark

For many years dextropropoxyphene (dxp) has been the medicament most frequently occurring in drug poisoning cases examined at the Institute of Forensic Medicine, University of Aarhus. This study includes 85 cases of acute fatal poisoning examined in the period 1985-1987 in which dxp alone (40 cases) or in combination with alcohol (29 cases) and/or other drugs (16 cases) contributed significantly to death. Two-thirds of the deceased were men and one-third women. The average age was 37 years for both sexes. More than half of the deceased were drug and/or alcohol misusers. Eighteen were drug addicts. Half of the deaths resulted from accidents, while 40% were suicides. Accidental deaths prevailed among younger men. In a majority of the cases the drug had been taken orally. In these cases the median total blood concentration of dxp and the metabolite nordextropropoxyphene (ndxp) was 17 mg/kg in the suicide cases and 7.1 mg/kg in the accident cases. The corresponding figures for dxp without metabolite were 9.4 mg/kg and 2.2 mg/kg, respectively. The median value of the quotient dxp/ndxp was 1.9 in the suicide cases and 0.5 in the accident cases. The quotient, together with the concentrations of the drug, may therefore indicate the manner of death in many cases.     

The forensic medical diagnosis of death-cup poisonings

Comparative analysis and evaluation of all modern methods used for medicolegal diagnosis of poisoning with Amanita phalloides are presented. Imperfection of methods used for laboratory diagnosis of such poisonings requires extensive experimental control using the designed method of liquid chromatography for amanitine and phalloidine assay in the cadaveric organs and tissues.     

Acute nonfatal poisonings by drug preparations]

Acute non-lethal poisonings with drugs within the period of 10 years according to archives data of Toxicological center and medicolegal department of victims' examination in Leningrad medicolegal expert Bureau were analysed. Number of drug poisoning cases increased two-fold and formed 76% of all poisoning cases. Tranquilizers, then antihistaminic, neuroleptic and hypotensive (clofelin) agents were used most often. Drugs were taken with suicidal attempt or with the aim of getting "alcoholic" effect. Poisonings among women were registered three times more often than among men.     

Fatal poisonings by drugs in Moscow in 1988

The structure of 218 cases of poisoning with medical substances according to pharmaco-therapeutic groups is presented. Sex-age distribution among victims, their life-span and causes of death are given.     

Regional indices of alcoholic poisonings and alcoholic psychoses

Interrelations of phenomena preconditioned by alcohol consumption were the starting prerequisite of the case study. The annual lethality rates due the to alcohol poisonings (AP) and alcoholic psychosis (APS) morbidity were investigated in 77 Russia's regions during 1991-1999, when the alcohol consumption used to be dynamic in the country--a sharp growth in 1991-1994, a drop in 1995-1998, and a new increase in 1999. The correlation of studied phenomena was observed only in 33 regions. The ratio of AP level to APS level varied in different regions and during different time periods from 50-fold AP prevalence to 65-fold APS prevalence. The distribution of APS indices was normal, while the distribution of AP deviated from the norm towards a higher dispersion. Two etalons were made use of, i.e. one for AP and the other for APS, to assess the differences between the AP and APS indices. APS differed from the appropriate etalon by far less versus AP. A list of regions with respect for deviations of APS and AP indices was compiled. A conclusion was made to the extent that consciously or unconsciously the postmortem diagnoses of AP were concealed in a majority of Russia's regions; APS were not registered in full either. However, the latter reflect better the alcohol-related situation in regions versus AP.     

Identification of atractyloside by LC-ESI-MS in alleged herbal poisonings

An LC-MS screening method was developed to detect the presence of atractyloside (ATR), the toxic principle of a commonly used medicinal plant in South Africa, Callilepis laureola, in biological matrices such as body fluids and human viscera.     

Fatal drug poisonings: medico-legal reports and mortality statistics

The entire fatal drug poisoning panorama in Finland is considered in terms of three catergories: accidental, self-inflicted and undetermined (whether accidental or with intent to harm) deaths. The study material consisted of all 500 deaths in 1997 that medical examiners, after examination(s) at the Forensic Toxicology Division (FTD) of the Department of Forensic Medicine, University of Helsinki, officially certified as resulting from drug poisoning. These deaths were matched with data on the same deaths registered at Statistics Finland (SF), the national mortality statistics office. The SF register included 72 additional instances of deaths resulting from drug poisoning. In all but two of these cases, the cause-of-death determination was based on a medico-legal inquest with autopsy and forensic toxicological examination(s) and was certified, in most of the cases, as due to the alcohol component in multiple-toxicant combinations. Reclassifying these deaths at SF to the category of drug component is in accordance with current International Classification of Diseases (ICD-10) regulation of coding "to the medicinal agent when combined with alcohol"; the principle and practice, which is recommended to be amended to equalize the status of alcohol and drug when explicitly stated by a forensic examiner as the principal toxicant in combined poisonings. With regard to manner-of-death, the agreement rates between medico-legally proven deaths from drug poisoning and those registered at SF were 79.8% for accidents, 98.5% for suicides and 0% (nil) for undetermined deaths, at the level of three-character external cause codes (E-code). All deaths originally certified as undetermined were re-assigned, most frequently to the category of accidental death. Since within an advanced and sophisticated medico-legal system, a medical examiner's evidence-based statement, even when the conclusion reached is undetermined (as to intent), should be taken as a compelling argument, the practice of reclassification cannot be considered advisable because assembled information is lost. Concerning the assigned drug-specific groups, the agreement according to the manner-of-death between certifications and registrations was fairly good. From among the accidents, however, opioid poisonings were re-assigned in 11 (29.7%) cases, mostly to the drug abuse/dependence categories, i.e. they were considered as natural deaths by the statistics office. The drug-specific observations were possible only by using the codes from the Anatomical Therapeutic Chemical (ATC) classification of drugs. This is why the incorporation of ATC codes into the ICD system, whenever reasonable, is recommended.     

The trend in lethal poisonings with narcotic substances in Moscow

The analysis of the 1989-2005 records of the Moscow Bureau of Forensic-Medical Examinations, statistics on lethal narcotic poisonings by gender, age, education, social and family status has revealed that the trend to reduction of the number of narcotic substances (NS) poisonings stopped in 2003. There was a 238.4% rise in the above poisonings in 2004. The highest rise was in the age group of 21-25-year-olds (35.7%; CI = 0.34-0.37; p = 0.05) and 26-30-year-olds (29.6%; CI = 0.28-0.31; p = 0.05). Among lethal cases one-third were unemployed (35.8%; CI = 0.34-0.37; p = 0.05) and one-forth were workers (22.2%; CI = 0.20-0.24; p = 0.05). By the family status, most of the dead were unmarried (57%; CI = 0.55-0.59; p = 0.05). This study gives a complete and accurate picture of the structure of narcotic drug poisonings. Relevant preventive measures are proposed.     

Accidental poisonings involving carbon monoxide, heating systems, and confined spaces

Eleven incidents of carbon monoxide (CO) intoxication resulting in sixteen fatalities are reported. All of the cases involved heating systems as either the source or the means of distributing the CO. Blood samples were analyzed for ethanol and CO. Elevated blood CO saturations were found in 14 of the 16 victims while none of the victims had a blood ethanol concentration greater than 0.10% (w/v).     

Suicidal and accidental carbon monoxide poisonings due to charcoal fires in closed spaces

The number of fatal carbon monoxide poisonings has significantly decreased since the introduction of natural gas. Apart from their occurrence during house fires, accidental and suicidal carbon monoxide poisonings are only rarely seen nowadays. We report on 7 cases of unintentional and intentional fatal carbon monoxide poisoning (CO-Hb concentrations between 56.4% and 74%) due to improper handling of charcoal fires in closed spaces. Autopsy findings and results of the toxicological analysis are presented and discussed.     

A chemical-toxicological analysis of combined poisonings by psychotropic preparations with a tricyclic structure

Conditions for chromatographic separation of melipramine with aminazine and melipramine with amitriptyline mixtures were stated. Method of chemical toxicological analysis in combined poisonings with psychotropic agents of tricyclic structure (melipramine in combinations with amitriptyline and aminazine) was suggested. Method was tested experimentally using animals.     

Massive ovarian cyst and sudden death

ABSTRACT: Massive enlargement of an ovarian cyst is an uncommon cause of morbidity and a rare cause of mortality due in large to part to noninvasive imaging techniques that usually permit early detection. When an ovarian cyst reaches giant proportions, it produces abdominal enlargement often with a fluid wave resulting in a condition that mimics ascites, called pseudoascites. Despite their impressive appearances, such cysts often are operable for cure. We describe a case of a middle-aged woman who presented 3 years before her death with symptoms from an undiagnosed giant cyst and given a diagnosis of ascites of undetermined etiology. She subsequently died at home unexpectedly, and at autopsy, she was found to have a massively enlarged but otherwise benign mucinous cystadenoma.