Interpretation of a 3,4-methylenedioxymethamphetamine (MDMA) blood level: discussion by means of a distribution study in two fatalities

The amphetamine derivative 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy" is a currently used or abused designer drug and fatalities are frequently encountered in forensic practice. However, the question remains open whether an MDMA blood level can be toxic or even potentially lethal. In order to provide insight in the interpretation of a detected MDMA concentration, the distribution of MDMA and its metabolite 3,4-methylenedioxyamphetamine (MDA) in various body fluids and tissues was studied and discussed in two different fatalities. Apart from peripheral blood samples (such as femoral and subclavian blood), various blood samples obtained centrally in the human body and several body fluids (such as vitreous humour) were examined. In addition, various tissues such as cardiac muscle, lungs, liver, kidneys, and brain lobes were analysed. In contrast to the peripheral blood levels, high MDMA and MDA levels were found in cardiac blood and the majority of the organs, except for the abdominal adipose tissue. The high concentrations observed in all lung lobes, the liver and stomach contents indicate that post-mortem redistribution of MDMA and MDA into cardiac blood can occur and, as a result, blood sampled centrally in the body should be avoided. Therefore, our data confirm that peripheral blood sampling remains "the golden standard". In addition, a distinct difference in peripheral blood MDMA concentrations in our two overdose cases was established (namely 0.271 and 13.508 microg/ml, respectively). Furthermore, our results suggest that, if a peripheral blood sample is not available and when putrefaction is not too pronounced, vitreous humour and iliopsoas muscle can be valuable specimens for toxicological analysis. Finally, referring to the various mechanisms of death following amphetamine intake, which can result in different survival times (e.g. cardiopulmonary complications versus hyperthermia), the anatomo-pathological findings and the toxicological results should be considered as a whole in arriving at a conclusion.     

An unusual case of suicide by means of a pneumatic hammer.

We describe an extraordinary case of a 49-year-old man who committed suicide by using a pneumatic hammer. As an industrial accident was initially assumed, difficulties in determining the manner of death are discussed. In addition, the ability to perform activity and evidence of a protracted agony in a situation of extensive cerebral destruction are considered. To our knowledge, no such case of suicide has ever been reported.     

POLITIC OF LAW OF GROUND WATER EXPLOITATION

One of Indonesia characters is welfare state, reflected in Republic Indonesia Constitution in 1945 （UUD NRI year 1945） on Preamble paragraph 4 mentioning the general welfare is the primary aim of the state. Provision of Article 33 paragraph （2）, （3）, and （4） UUD NRI year 1945 as lives of many people that natural resources inform of water for the greatest prosperity of people＇s and controlled by state. This is in line with the Constitution Act No. 7 year 2004 on water resources, focus on welfare of people and based on the reflection of democracy spirit. Based on the constitution of Local Government Act No. 32 year 2004, the important role to support the achievement of social welfare problems associated with water （ground water）, is crucial. However, the Presidential Decree RI No. 36 year 2010 which provides space for the foreigners to invest in water exploitation orientation, and there was interest~politic of law, so the local government at the beginning prioritize on the welfare of the local people turned into the realm of economic interest to revenue for local government. Based on the statement above, so the problems of people＇s welfare, democracy and justice are neglected.     

An inherited metabolic disorder presenting as ethylene glycol intoxication in a young adult

Despite the abundance of reports emerging in the literature on metabolic disorders, some disorders remain undiagnosed or misdiagnosed, not only in clinical pathology but also in forensic pathology. The authors report a patient who had recurrent episodes characterized by nausea, vomiting, and signs of dehydration necessitating admission to the hospital. At each admission, he was found to have lactic acidosis. On the first admission, glycolic acid was detected in his blood and he was diagnosed as having ethylene glycol intoxication. Only at the third admission, 2 years after the first, was the possibility of an underlying metabolic disorder considered. Laboratory investigations showed a deficiency of complex I in the mitochondrial oxidative phosphorylation. Possible medicolegal implications are discussed.     

Tissue distribution of trichloroethylene in a case of accidental acute intoxication by inhalation

This article describes the toxicological findings in a fatality due to an accidental inhalation of trichloroethylene which took place during wall coating of a poorly ventilated well using trichloroethylene. The man was wearing protective clothing and a mouthmask with adsorbent. He was found dead on the floor of the well 5h after descending. Trichloroethylene was added to the mortar to enhance drying. Identification and quantitation of trichloroethylene in the postmortem samples (blood, lung, liver, kidney, stomach content and bile) and identification of its metabolite trichloroacetic acid in urine was performed using static headspace gas chromatography with mass spectrometric detector. The compounds were separated on a CP-SIL 5CB Low Bleed/MS column using n-butanol as internal standard. The method was linear over the specific range investigated, and showed an accuracy of 104% and an intra-day precision of 11%. Trichloroethylene concentrations of 84mg/l in subclavian blood, 40mg/l in femoral blood, 72mg/kg in liver, 12mg/kg in kidney, 78mg/kg in stomach content, 104mg/l in bile and 21mg/kg in lung were found. Trichloroacetic acid was identified in the urine.     

Endocardial fibroelastosis as a cause of sudden unexpected death

We present a case of primary endocardial fibroelastosis (EFE) which had been diagnosed in a 16-year-old girl who died suddenly and unexpectedly. This exceptional cause of death in adolescence led to a short literature review comparing our findings with previous medicolegal reports.     

Is zinc a reliable biochemical marker of chronic alcoholism in the overall context of a medico-legal autopsy?

The purpose of our investigation is to appreciate the usefulness of zinc determination in the human body with regard to the tracing of chronic alcoholism at forensic autopsies. The analysis of zinc was performed in vitreous humour and in skeletal muscle. Our results tend to prove that, in post-mortem material, zinc is not a suitable marker of chronic alcoholism. Furthermore one has to take into account the frequent contamination during collection and storage of the samples and also the post-mortem increase of zinc in the vitreous humour due to autolysis.