血液、尿液中氯胺酮及其代谢物去甲氯胺酮的HPLC分析

目的 建立血液、尿液中氯胺酮及其代谢物去甲氯胺酮的高效液相色谱(HPLC)分析方法.方法 以非那西丁为内标,检材加入10%的氢氧化钠溶液调节pH值为14,用甲苯提取,离心后取有机层,水浴下吹干,乙腈定容后进HPLC仪分析.结果 检测血液中氯胺酮和去甲氯胺酮的线性范围均是0.05～10μg/mL(r2＞0.999 3),检测尿液中氯胺酮和去甲氯胺酮的线性范围均是0.01～50 μg/mL(r2＞0.999 5).氯胺酮和去甲氯胺酮在血液和尿液中的检测限分别是0.006 μg/mL和0.003 μg/mL.血液和尿液中氯胺酮和去甲氯胺酮的回收率不低于82.4%.检测血液和尿液中氯胺酮和去甲氯胺酮的日内精密度和日间精密度均小于10.0%.将所建的方法应用于给大鼠氯胺酮后的血液和尿液中的氯胺酮和去甲氯胺酮的测定,得到了氯胺酮和去甲氯胺酮在大鼠的药时曲线和尿排药速率曲线. 结论本方法简便、快捷,适用于血液、尿液中氯胺酮及其代谢物去甲氯胺酮的分析.     

An autopsy case of imipramine poisoning

We present a fatal imipramine poisoning. Quantitative analysis of imipramine and its metabolite, desipramine, was performed by high-performance liquid chromatography. The concentrations of imipramine and desipramine were 18.67 microg/mL and 6.21 microg/mL in heart blood and 6.90 microg/mL and 1.77 microg/mL in the femoral venous blood, respectively. We concluded that the cause of death was due to imipramine poisoning.     

Acephate in biological fluids of two autopsy cases after ingestion of the chemical

Two autopsy cases, where the individuals were suspected of having ingested acephate, an organophosphorous insecticide, are reported. Acephate and its active metabolite, methamidophos (MP), were analyzed in the biological fluids by GC/MS, using the salting out method with liquid-liquid extraction columns. The first case was that of a 70-year-old man whose blood acephate was 149 microg/mL, and MP was 3.0 microg/mL. Serum pseudocholinesterase (ChE) activity was inhibited. No remarkable finding of injury or disease was determined as the cause of his death, but acute poisoning by acephate was mostly suspected. The second case was that of a 60-year-old man. A deep gash in the left neck injured the left common carotid artery in addition to the severely ischemic state of the primary organs. His blood acephate was 46 microg/mL, and MP was not detected. ChE activity was in the normal range. Hemorrhage was mainly suspected as the cause of his death. The concentrations of acephate and MP in human blood after oral ingestion are first reported here, and the acute toxic level of acephate is discussed.     

Methamphetamine body packer: acute poisoning death due to massive leaking of methamphetamine

We encountered three methamphetamine (MA) body packers presenting simultaneously, one of whom died. Three Nigerian men (39, 35, and 37 years old) who attempted to smuggle were found to contain 35 (498 g), 21 (292 g), and 5 packages (73 g) of methamphetamine hydrochloride (MA-HCl) in their stomachs, respectively. Packages were wrapped with plastic film and Scotch tape. The 39-year-old man died with acute poisoning from c. 20 g of MA-HCl that had leaked from the packages into the stomach. His plasma MA concentration was 8.6 microg/mL when he was hospitalized (17 h before his death). Autopsy findings showed extreme pulmonary congestion and edema as well as moderate hepatic edema and several petechiae. Quantitative analysis was performed by gas chromatography/mass spectrometry. Extremely high concentrations of MA and its metabolite amphetamine (AP) were found in cardiac blood (63.5 microg/mL and 1.2 microg/mL), urine (4,518 microg/mL and 72.4 microg/mL), gastric contents (8,490 microg/mL and 16.9 microg/mL), and in all other autopsy samples. These high concentrations confirmed that the cause of death was acute MA poisoning. Furthermore, impurity-profiling analysis of the seized MA revealed that the MA smuggled by the three suspects originated from the same batch.     

Colchicine Extract Suicidal Lethal Poisoning Confirmation Using High‐Resolution Accurate Mass Spectrometry: A Case Study

A case of suspected acute and lethal intoxication caused by colchicine has been reported. The woman was hospitalized after her suspicion of suicidal poisoning by a rare autumn crocus (Colchicum autumnale). Suspected colchicine poisoning was confirmed using a novel UHPLC method with a modern reversed‐phase stationary phase with a sub 2‐micron superficial porous particle size combined with a QTOF mass spectrometer. Sample preparation procedure included the addition of propiverine as internal standard, protein precipitation using methanol and solid phase extraction. High‐resolution MS only and targeted MS/MS modes are reported for the qualitative analysis and screening of other potential drugs of abuse in blood samples. All Ion MS mode was used for quantitative determination of colchicine afterward. The concentration of colchicine in the blood sample was approximately 41 ng/mL, and more than 200 μg/mL of the plant extract used for the suicide.     

A Fatal Case of Poisoning with Fentanyl Transdermal Patches in Japan

Fentanyl transdermal patches have been used to treat cancer‐ and noncancer‐related chronic pain. However, its inappropriate or illegal application may cause fatal poisoning. We herein present the case of a Japanese woman in her 40s who was found dead with seven 25‐μg/h fentanyl transdermal patches on her body. We established a detailed toxicological analysis procedure to quantify fentanyl, and its metabolite norfentanyl, and other drugs (acetaminophen, allylisopropylacetylurea, celecoxib, estazolam, promethazine, and sertraline) in human whole blood by ultra‐high‐performance liquid chromatography–tandem mass spectrometry. The measured fentanyl and norfentanyl concentrations in the femoral and cardiac blood were 0.051 and 0.072 μg/mL and 0.033 and 0.076 μg/mL, respectively. The decedent's fentanyl concentrations were consistent with previously reported postmortem blood levels for fatal cases of poisoning by fentanyl transdermal patches. Based on the decedent's case history, autopsy findings, and toxicological analyses, the cause of death was identified as intoxication with transdermal fentanyl.     

The Effect of Previous Traumatic Injury on Homicide Risk

Research has reported that a strong risk factor for traumatic injury is having a previous injury (i.e., recidivism). To date, the only study examining the relationship between recidivism and homicide reported strong associations, but was limited by possible selection bias. The current matched case–control study utilized coroner's data from 2004 to 2008. Subjects were linked to trauma registry data to determine whether the person had a previous traumatic injury. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between homicide and recidivism. Homicide risk was increased for those having a previous traumatic injury (OR 1.81, 95% CI 1.09–2.99) or a previous intentional injury (OR 2.53, 95% CI 1.24–5.17). These results suggest an association between homicide and injury recidivism, and that trauma centers may be an effective setting for screening individuals for secondary prevention efforts of homicide through violence prevention programs.     

Fatal intoxication with tianeptine (Stablon)

Tianeptine (Stablon), although structurally similar to tricyclic antidepressants, acts by enhancing the reuptake of serotonin. A fatal case is presented involving a 26-year-old man, found lying in bed with a "mushroom of foam" around his mouth. Empty blister packs of Stablon and a suicide note were found next to the body. A liquid-liquid extraction procedure with n-hexane: ethyl acetate and n-hexane: 2-propanol, followed by LC-DAD-MS analysis, using positive mode electrospray ionization was performed. The detection limit was 0.001 microg/mL. The toxicological results revealed the following tianeptine concentrations in the post-mortem samples: blood 5.1 microg/mL; urine 2.0 microg/mL; liver 23 microg/g; stomach contents 22 mg. Femoral blood analyses also revealed an ethanol concentration of 0.53 g/L. The present method was also developed and validated for the other post-mortem specimens, since no previous published data had confirmed the post-mortem distribution of tianeptine. The absence of other suitable direct causes of death (macroscopic or histological) and the positive results achieved with the toxicological analysis led the pathologist to rule that death was due to an intoxication caused by the suicidal ingestion of tianeptine in combination with alcohol.     

尿中氯胺酮及其代谢物检测的研究

目的建立氯胺酮滥用者尿中氯胺酮及其代谢物检测方法。方法尿液用有机溶剂液-液萃取,气相色谱/氮磷检测器、电子捕获检测器、氢火焰检测器和气-质联用仪测定。结果确认了尿液中氯胺酮的主要代谢物,尿液中氯胺酮及去甲氯胺酮的最小检测限均为2ng/mL,脱氢去甲氯胺酮的最小检测限为5ng/mL。结论所建方法快速、灵敏、准确,能够满足氯胺酮滥用者尿液检测的需要。     

Spousal homicide and the subsequent staging of a sexual homicide at a distant location

The case of a 63-year-old man who killed his 52-year-old wife and then staged a sexual homicide at a distant location is reported. A review of all evidence, a forensic psychological interview, and psychological testing indicated that the murder was the result of a narcissistic rage reaction during which the subject beat his wife to death with a paint can, a clothing iron, and a rock. He then drove her body to a field 87.3 miles away, and positioned it in a manner that exposed her breasts and her underwear. He turned himself into the police two days later. There is no controlled empirical research on staging, although this single case supports the criminal investigative theory that staging exists, and is done to deliberately mislead homicide investigations (Douglas et al., 1992).     

Stalking,homicide, and catathymic process: a case study

Despite the proliferation of research on various aspects of stalking, there has been relatively little study of stalkers who commit homicide. In this article, a man who stalked and killed a casual acquaintance is reported. He developed an idea to kill her that, at first, seemed ego-alien and unreal but eventually became fixed and was accompanied by a mounting inner pressure to act. The concept of catathymic process--a change in thinking whereby the offender comes to believe that he can resolve his inner conflict by committing an act of extreme violence against someone to whom he feels emotionally bonded--is of particular help in understanding this case, as well as similar cases of stalking that culminate in homicide.     

Postmortem citalopram concentrations: alone or along with other compounds

Citalopram, an antidepressant whose use has become more widespread in Spain in recent years participates directly and indirectly in the lethal mechanism in voluntary and involuntary poisonings. There were 30 cases of autopsies in the Madrid region where citalopram and other psychoactive substances (psychotropic drugs, alcohol, opiates) were detected in the corpses. The postmortem citalopram levels in relation to the manner and mechanism of death were evaluated, and a significant difference between the toxic and nontoxic cases (p < 0.01) was found. We studied the citalopram blood levels alone and along with other psychoactive products, and these cases were then further divided into those where the compounds were at deadly levels and those which were not. We found a range of citalopram levels between 0.37 and 0.83 microg/mL in which some cases were associated with citalopram toxicity and others were not. Citalopram blood levels of less than 0.35 microg/mL did not lead to fatal poisoning when it was the sole substance detected.     

A fatal case of cocaine poisoning in a body packer

A 27-year-old man was carrying in his digestive tract 99 packages each containing about 10 g of a 86% cocaine powder. The courier died by acute cocaine intoxication due to inflation and rupture of four packages during a flight from Bogotá to Rome. At the autopsy, the external examination was unremarkable. The internal examination showed edema and generalized congestion of the organs. Toxicological analyses were performed by gas chromatography-mass spectrometry after solid phase extraction using Bond Elut Certify columns and derivatization with BSTFA/TMCS. High levels of cocaine and benzoylecgonine were found in blood (4.0 microg/mL and 17.0 microg/mL), urine (152.0 microg/mL and 512.0 microg/mL), bile (99.8 microg/mL and 54.0 microg/mL), vitreous humor (7.1 microg/mL and 5.8 microg/mL), brain (7.5 microg/mL and 3.5 microg/mL), and hair (55.5 ng/mg and 27.7 ng/mg). The presence of the cocaine and its metabolite in the hair suggested that the man was a cocaine user.     

A double homicide as a result of chloroform poisoning

Homicidal poisoning using chloroform has been reported infrequently. Presented is a case of a double homicide involving a 29-year-old male and his 23-year-old fiance. Gas chromatographic methodology and tissue concentrations of chloroform are presented. Evidence strongly suggests forced inhalation using an impregnated cloth.     

Murder-suicide in New Hampshire, 1995-2000

Combined murder-suicide is defined as homicide(s) followed by the perpetrator's suicide within 1 week of the homicide(s). This phenomenon is observed worldwide with generally similar incidence rates. The authors report data from New Hampshire, a population distinguished from those in previous United States studies by its location, racial homogeneity, nonurban character, and low homicide rate. Sixteen murder-suicide events occurred in New Hampshire between October 1995 and October 2000. This represents an incidence of 0.26 per 100000 person-years, a rate similar to previously reported values. Murder-suicide events accounted for 14.7% of all homicides in the state, higher than previous studies but not unexpected in view of the state's lower homicide rate. Most perpetrators were male (94%), and most victims were female (88%), often in a spousal or consortial relationship. Firearms accounted for the majority of deaths. Various cofactors are examined, and a comparison of two recently proposed classification systems is discussed.     

A Unique Fatal Moose Attack Mimicking Homicide

Fatalities caused by animal attacks are rare, but have the potential to mimic homicide. We present a case in which a moose attacked and killed a woman who was walking her dog in a forest. Autopsy showed widespread blunt trauma with a large laceration on one leg in which blades of grass were embedded. Flail chest was the cause of death. The case was initially conceived as homicide by means of a riding lawn mower. A review of the case by moose experts and analyses of biological trace material that proved to originate from moose, established the true source of injury. The dog probably provoked a moose, which, in response, stomped and gored the victim to death. The injuries resembled those previously reported from attacks by cattle and water buffalo. Fatal moose attacks constitute an extremely rare threat in boreal areas, but can be considered in traumatic deaths of unknown cause.     

三种羟亚胺分析方法的比较

目的建立羟亚胺及氯胺酮定性和定量分析方法。方法分别使用气相色谱质谱联用法(GC/MS)、液相色谱质谱联用法(LC/MS)和液相色谱紫外法(LC/UV)分析羟亚胺,考察各方法的特点及适用范围。结果采用GC/MS法分析时,进样口的高温会导致部分羟亚胺转化为氯胺酮。LC/MS及LC/UV分析则不存在干扰,羟亚胺和氯胺酮的线性范围分别为3.0～300 ng/mL(LC/MS)、0.02～1.00mg/mL(LC/UV);最低检测限分别为1.0ng/mL(LC/MS)、5.0μg/mL(LC/UV)。结论 GC/MS法仅可确定样品中羟亚胺的存在,不能确认是否含有氯胺酮。LC/MS和LC/UV法可分别用于痕量和常量羟亚胺和氯胺酮定性和定量分析。     

389例不同年份的中毒尸检资料对比分析

本文报告近16年来(1983～1998)本教研室检验的中毒尸检158例,并与本教研室1983年以前26年(1957～1982)的中毒尸检231例进行对比分析.发现中毒毒物的种类在近16年虽然仍以有机磷农药为主,但敌敌畏中毒在90年代后则明显减少,相反新型有机磷农药及其它新型农药则逐渐增加;杀鼠剂、醇类、麻醉品及毒品呈明显增多趋势,而金属盐类毒物则减少较明显.90年代后,杀鼠剂投毒及医源性或非法行医所致药物中毒案例显著增多.     

Exhumation examination to confirm suspicion of fatal lead poisoning

Acute poisonings with inorganic lead compounds are exceptionally rare. In all cases of diagnosis, there are two possible sources of error: failing to recognise lead poisoning when it is present, and mistaking other diseases for lead poisoning. If exposure history is carefully taken and proper laboratory techniques are employed, the diagnosis of lead poisoning should not be difficult. In the described case of the death of a 41-year-old-man, no enzymatic disturbances characteristic of congenital erythropoietic porphyria were ascertained, and furthermore, a considerable concentration of lead was found in antemortem material, 5 months before death (blood: 1584 microg/l, urine: 531 microg/24 h). Postmortem tissue lead content in the biological material, exhumed 6 months after death, were as follows: liver, 47.6 microg/g; kidney, 4.75 microg/g; bone, 103 microg/g of sacral vertebra, 20.4 microg/g of femoral bone, 112 microg/g of pelvis; hair, 30.2 microg/g of scalp hair, 33.7 microg/g of pubic hair; nails, 13.6 microg/g. The results indicated a case of acute lead poisoning (with lead(II) oxide, as it later turned out), which manifested as acute intermittent porphyria.