171例滥用海洛因者的尿样分析

通过 GC/MS分析方法,对 171例滥用海洛因者的尿样进行了分析、统计,结果显示：在所检样品中检出吗啡的占 74.2％,检出海洛因的占 17.6％,检出 O6－单乙酰吗啡的占 52.1％,检出可待因的占 86.5％。因此,从统计学上说,在滥用海洛因者的尿样中检出海洛因是完全可能的。     

20例海洛因滥用相关死亡案例的法医学分析

目的对20例海洛因滥用相关死亡案例进行回顾性分析,为相关案例的法医学鉴定提供参考依据。方法对20例海洛因相关死亡案例死者的一般情况、毒品使用方式、死亡原因、法医学检验情况进行统计分析,总结案例的死亡原因及法医病理学改变。结果本组案例死者多为青壮年,男性多于女性。组织病理学检验为非特异性改变。死亡原因包括海洛因使用(或泄露)后急性中毒死亡(13例,占65%)、滥用海洛因后继发性疾病(3例,占15%)、吸食海洛因致吸入性窒息(2例,占10%)及戒断综合征导致死亡(2例,占10%)四种。结论海洛因滥用相关死亡者的法医学鉴定,需在全面系统的尸体检验基础上,结合实验室对死者体内海洛因及代谢产物的定性、定量分析,综合案情资料、现场勘验情况进行分析。     

小鼠注射海洛因即刻死后体内ACP和SDH活性变化

目前,对海洛因中毒死亡的研究一方面是观察病理组织形态学改变,另一方面是对海洛因滥用者各系统的机能检查和体内活性物质检测。有关注射海洛因导致死亡后的相关酶学变化未见报道。本研究对小鼠静脉注射盐酸海洛因即刻死后,机体内酸性磷酸酶(acid phosphase,ACP)和琥珀酸脱氢酶     

海洛因成瘾大鼠心电图及心肌超微结构改变的研究

目的探讨海洛因成瘾大鼠心电图及心肌超微结构的改变,为海洛因对心脏的损害机制提供研究基础。方法建立大鼠海洛因成瘾模型,观察心电图、HE染色及心肌超微结构改变。结果大鼠海洛因成瘾组心电图改变明显,主要表现在心率减慢、P波及T波压低、时间延长,S-T段压低、时间延长,QT间期延长,上述差异有统计学意义(P<0.05),提示心肌损伤、心肌缺血及心室功能下降。电镜改变主要表现在核浓缩,核变小,核膜皱缩,染色质凝集成块,线粒体嵴排列紊乱、消失及空泡变等,提示海洛因可造成心肌细胞超微结构的病理改变。结论海洛因对心肌可造成损害,并且心肌超微结构改变提示心肌凋亡可能是海洛因造成心肌损伤的机制之一。     

青少年滥用新型毒品与吸食海洛因的比较研究——基于T市的实证调查

基于对T市970名青少年吸毒人员的问卷调查和43例个案访谈,从人口特征、行为模式、社会身份与关系网络等方面对青少年滥用新型毒品和吸食海洛因状况进行比较研究。调查显示,两类吸毒人员构成在总体上呈现出男性多、未婚者多、社会闲散人员多等＂三多＂特点。与滥用新型毒品的青少年相比,海洛因吸食者的年龄结构偏大,受教育水平较低;吸食者的成瘾性较高;其朋友圈子较小,人际关系网络相对脆弱。     

对劳教戒毒工作的再思考

自八十年代中后期开始,海洛因等毒品在我国大肆泛滥,致使海洛因依赖和滥用人数急剧上升,严重损害人体健康,影响社会的安定,成为日益严重的社会问题,引起了党和政府的高度重视,全国人大常委会及时作出了关于禁毒的决定。从此,劳教戒毒成为我国戒毒康复体系的主要组成部分,成为禁毒人民战争的重要阵地,在教育矫治吸毒人员、促进吸毒人员康复、预防和减少违法犯罪等方面发挥着极其重要的作用。近年来,各地深化实施劳教戒毒模式,劳教戒毒工作取得了明显成效,为国家的禁毒工作做出了一定的贡献。但是面对仍然严峻的禁毒形势和劳教戒毒人员解教后…     

“金三角”来源海洛因样品的关联性判别及来源推断

目的海洛因是最常被广泛滥用的毒品之一,具有高度成瘾性、难以戒断性和严重的社会危害性。本文建立"金三角"海洛因样品Pearson相关性数学模型,对云南6个边境州市公安机关缴获的海洛因样品进行了关联性判别及样品来源推断。方法实验将海洛因样品溶于酸性溶剂中并用有机溶剂进行萃取富集,采用超高效液相色谱-串联质谱法(UPLC-MS/MS)对海洛因样品中15种中性/酸性特征杂质进行检测分析,结合数理统计分析方法完成样品分析。结果通过计算,选定0.965为关联性阈值,并筛选出关联性极强的样品组。同时,采用主成分分析法(PCA)初步将样品划分为Ⅰ、Ⅱ、Ⅲ三个区域。结论结合案件信息、关联性分组及主成分分析结果,实现了对489份"金三角"来源海洛因样品的特征分析。     

尿样中海洛因代谢物的测定及海洛因滥用的确认

用ＳＰＥ－ＧＣ－ＮＰＤ法建立了尿样中吗啡、６－单乙酰吗啡及可待因的定性分析方法,适用于海洛因滥用者的尿样分析。尿样中吗啡及可待因的最小检测限均为５０ｎｇ／ｍｌ。方法的相对标准偏差分别为：吗啡１１．３％（ｎ＝５）,可待因１４．２％（ｎ＝５）。方法简便、灵敏、快速,１５ｍｉｎ可完成一例尿样的分析。研究了服用含可待因成分的复方甘草合剂后,尿样中的吗啡及可待因的峰面积比为０．４５７±０．１９７（Ｐ＝９９％）;统计了４０例明确滥用海洛因尿液的分析结果,吗啡与可待因的峰面积比为３．４６±０．８９４,Ｐ＝９９％。可作为判断海洛因滥用的依据。同时与免疫板法比较,附５５例免疫板法阳性尿样的分析结果     

海洛因成瘾者神经、内分泌及免疫系统超微病理变化研究

目的 研究海洛因成瘾者中枢神经、内分泌、免疫及生殖系统的超微结构变化。方法 应用透射电镜技术对 4例海洛因成瘾者中枢神经系统、内分泌系统、免疫系统以及生殖系统进行了观察。结果 神经系统表现为线粒体肿胀、嵴断裂、空泡变、内质网扩张、神经纤维数量减少、细胞器减少;免疫系统表现为淋巴细胞数量减少,胞浆成分减少,死亡细胞增多;内分泌系统表现为线粒体扩张,局部嵴断裂,内质网扩张;生殖系统表现为男性生精细胞减少,细胞器减少。女性未见卵泡结构。结论 海洛因滥用者的亚细胞超微结构呈急、慢性缺氧性变性、坏死改变。     

头发中滥用药物的测定 (二)海洛因

头发中滥用药物的测定(一)中已报导了头发中吗啡的测定,本文将报导海洛因吸食者头发中的海洛因代谢物的检测。海洛因吸毒者的有关头发中代谢物测定报导很少,事实上直接对海洛因进行检测,无论用质谱的直接进样或者GC/MS测定,甚至多离子检测均需较多的样品用量。它们的用量分别为>80mg,50mg及5～10mg。满足不了头发中检测的灵敏度。海洛因的结构为两个羟基均被乙酰化的吗啡,分子中均是进行衍生化的活性基团。但是由于海洛因很不稳定,尤其在体内极易代谢。如在尿中1小时即形成6-乙     

损伤伴心血管系统疾病死亡42例法医病理学研究

目的探讨心血管系统疾病伴外伤死亡案例法医病理学特点,并从伤病的角度揭示两者之间的联系。方法42例心血管系统疾病伴损伤死亡案例均接受系统病理学解剖和组织学观察,且死因明确。结果42例中40岁以上者占到64.28%,男性较女性死者多。擦伤和挫伤在损伤中比例最大共占到80.95%,冠心病和高血压病死亡者各占45.24%、16.67%。损伤和疾病共存死亡案例共20例。结论在死因分析中年龄、性别、损伤类型、疾病分布有其规律性,死者中年龄偏老年化,损伤多为钝器、摔跌所致擦伤、挫伤。疾病中冠心病、高血压为最多。损伤和疾病对死因共同起作用的案例主。     

急性及己中毒的实验病理学研究

目的探讨及己对小鼠毒性作用的病理变化及其毒作用机制。方法应用及己水煎液对小鼠经口急性染毒,进行组织病理学观察血清生化、凝血机能检测。结果及己对小鼠的半数致死量(LD50)为41.12g/kg;染毒小鼠血清ALT和BUN升高;血液血小板计数减少、凝血时间延长;肝、脾、肾器官系数增大;肝、肾、心肌细胞变性、坏死明显,全身诸多器官淤血、出血性改变。结论及己毒作用的主要靶器官或靶组织是肝脏、肾脏、心脏和全身血管。毒作用机制是对线粒体、内质网等膜性结构及体内凝血机制的破坏。     

Postmortem serum uric acid and creatinine levels in relation to the causes of death

Serum uric acid (UA) and creatinine (Cr) mainly derive from skeletal muscle tissues. Although, remarkable postmortem stability of the serum levels has been reported, there appears to be very poor knowledge of the diagnostic value in investigation of death, except for uremia. The aim of the present study was to evaluate postmortem serum UA and Cr levels using 395 forensic autopsy cases, in comparison with blood urea nitrogen (BUN), for investigation of the pathophysiology of death with special regard to the causes of death involving possible skeletal muscle damage, e.g. due to hypoxia, heat or agonal convulsions. Cr and BUN showed relatively good topographic stability in the cadaveric blood, whereas, UA was often much higher in the right heart blood than in the left heart and peripheral blood, independent of postmortem intervals. Moderate to marked elevation of Cr and BUN accompanied with hyperuricemia was observed in delayed death. In the acute death cases (survival time <30 min), UA, especially in the right heart blood, showed a considerable elevation in mechanical asphyxiation and drowning. The Cr level in fire victims with a lower carboxyhemoglobin (COHb) level (<60%) was significantly higher than in those with the possible fatal level (>60%). A similar elevation of Cr was observed in fatalities from heat stroke and methamphetamine (MA) poisoning. The observations suggested that hyperuricemia in acute death may be indicative of advanced hypoxia and that elevated Cr level may reflect the skeletal muscle damage, especially due to thermal influence.     

高血压大鼠挤压伤后心功能指标与伤病关系分析

目的观察高血压病大鼠肢体挤压后的早期心肌损伤情况,并分析其在伤病关系分析中的意义。方法原发性高血压大鼠按打击程度随机分为4组,用自由落体装置打击大鼠右侧大腿,然后观察血压、心率变化,测量血清生化指标(肌酸激酶、肌酸激酶同功酶、乳酸脱氢酶、肌酐、尿素氮、α-羟丁酸脱氢酶、天门冬氨酸转移酶),并观察大鼠心、脑、肾的形态学改变。结果打击后大鼠血压、心率均有不同程度的上升,并且随着打击力度的增加而增加,但打击组间没有显著性差异。各组血清生化物表现为随打击力度的增加而上升,轻中重打击作为整体损伤组与对照组比较有显著性差异,天门冬氨酸转移酶、肌酸激酶、肌酸激酶同功酶在打击组间比较具有显著性差异。结论挤压性打击损伤造成了SHR早期心肌损伤,并且此指标可以运用于高血压病与损伤共存下的伤病关系分析。     

Pulmonary surfactant-associated protein A levels in cadaveric sera with reference to the cause of death

Pulmonary surfactant-associated protein A (SP-A) is an exclusively lung specific protein, and is considered to leak into the blood stream in alveolar septal damage. In this study we examined the serum SP-A level in forensic autopsy materials using an enzyme immunoassay with monoclonal antibodies to assess the postmortem level in relation to the cause and mode of death. Although a gradual postmortem degradation should be taken into consideration, topological relationship of serum level seemed to be fairly stable (arterial> or =venous blood in most cases), indicating no evident influence of postmortem diffusion. Significant elevation of serum SP-A (76.7-250 ng/ml in left heart blood) was observed in hyaline membrane diseases from various causes independent of the postmortem intervals (<30 h). However, mean SP-A levels in postmortem heart blood were usually low in asphyxia including hanging, strangulation and choking (left, 25.5 ng/ml; right, 22.3 ng/ml), polytrauma (left, 13.1 ng/ml; right, 9.0 ng/ml) and stab wound to the neck (left, 34.1 ng/ml; right, 29.4 ng/ml). Prominent elevation was noted in a case of fatal strangulation with complication of idiopathic interstitial pneumonia, and also in some deaths due to drowning, burns in fires, blunt and gunshot chest injuries. These findings indicated that postmortem elevation of serum SP-A levels was associated with alveolar septal damage due to inflammation, mechanical and physical stresses, which caused leakage of SP-A into the bloodstream.     

Fatal outcome of poisoning with the benzodiazepines flunitrazepam and diazepam

On a wintry day a 29-year-old woman was found dead beside her car showing head injuries and signs of hypothermia. Several empty packets of sedative and hypnotic drugs were lying inside the car. Toxicological analysis revealed the presence of flunitrazepam (heart blood of the left and right chamber 0.033 mg/L each), norflunitrazepam (left heart blood 0.029 mg/L, right heart blood 0.027 mg/L), 7-amino-flunitrazepam (left heart blood 0.090 mg/L, right heart blood 0.104 mg/L), diazepam (left heart blood 0.395 mg/L, right heart blood 0.386 mg/L), nordazepam (left heart blood 0.112 mg/L, right heart blood 0.115 mg/L) and temazepam (left heart blood 0.034 mg/L, right heart blood 0.033 mg/L). Neither alcohol nor other drugs were found. It was concluded that benzodiazepine intake led to a disturbance of consciousness. Whether the woman died in this situation due to the icy temperature as a result of hypothermia or whether she died or would have died solely due to benzodiazepine overdosage could not be clarified.     

Natural death while driving

Of sudden natural deaths while driving, 126 occurred during 1980 through 1985 in the northern half of Sweden. The mean age of the 69 car driver victims was 59 years, considerably higher than that of traumatic car deaths, and all but 2 were males. The mean age of 57 operators of other vehicles was 66 years, and of these, 6 were women. Seven car drivers were stricken during commercial employment. Most accidents occurred during daytime and the distribution of the weekdays was fairly even. Ischemic heart disease accounted for 112 deaths, and other cardiovascular diseases for an additional 9 deaths. Only 1/5 of the victims experienced previous symptoms of disease. Out of at least 31 other persons at risk in the car deaths, only 2 passengers suffered minor injuries. The trauma in the deceased was in most cases minor in both car and other vehicle deaths. Property damage was also minimal. At least 1/3 of the drivers were able to stop the car before becoming unconscious. In none of the car cases was alcohol detected in the blood, while alcohol was identified in at least 2 of the other vehicle victims. The findings here agree with previous studies that natural deaths at the wheel are fairly uncommon, and that the risk for other persons is not significant. The value of adequate postmortem examinations of drivers dying in traffic is stressed--natural deaths can otherwise be overlooked.     

Fatal outcome of Ecstasy overdose

Consumption of amphetamine derivatives has considerably increased in Germany since the early nineties. Again and again intoxications with lethal outcome have also been reported, especially after physical activities such as intensive dancing. The authors present a case of an obviously suicidal intoxication of a 21-year-old man who was found dead with marked cuts on the right forearm. Toxicological tests showed in particular 3, 4-methylene-dioxymethamphetamine (MDMA). The results of the hair analysis revealed chronic consumption, but no cellular liver damage could be demonstrated. When examining the body fluids and organs, the highest concentrations by far were measured in the lungs (36.6 mg/kg), the liver (29.7 mg/kg) and the brain (29.1 mg/kg). The concentration in heart blood amounted to 10.8 mg/kg and was thus markedly higher than in peripheral blood (7.2 mg/kg). In the muscles concentrations ranged between 14.3 mg/kg and 20.2 mg/kg. On the basis of these concentrations and the available pharmacokinetic data the amount of MDMA probably consumed is assessed. It is demonstrated that for this assessment the concentrations in the muscular system are of special importance, as redistribution of highly lipophilic substances from the surrounding tissue is possible also in peripheral blood.     

Significant Differences in PostMortem Heart Weight Before and After Dissection Using the Short-Axis Dissecting Method

Correctly assessing heart weight can be critical at postmortem examination. The current international guidelines advocate using the short-axis method in dissecting the heart and the heart weighed when the blood is emptied. However, it did not specify at what point the heart should be weighed or how the blood should be emptied. This study compared heart weights at three different time points during the heart examination (immediately after dissecting out of the pericardial sac with blood still in chambers, blood washed/removed from heart chambers without the heart opened, and the heart completely opened, blood emptied, and pad dried). This was to illustrate the variation in measurement and potential errors when the heart is weighed at different time of dissection. The results show that there were statistical and clinical significant differences between the heart weights at each weighing points. We recommend the heart to be completely dissected with any blood and residual washing/rinsing water emptied before being weighed. Although performed in this study, the effect of pad drying the heart on heart weight was not explored and was a limitation in this study.     

The effects of drying the rinsed dissected heart on postmortem heart weight

Blood and blood clots should be removed from the heart chambers before being weighed. The actual method in removing blood and blood clots may vary and can include manual removal with subsequent rinsing the heart in water. It is unclear whether drying the rinsed heart affects the heart weight. The objective of this article was to investigate the effects drying the rinsed dissected heart (residual rinsing water) on postmortem heart weight. The prospective study compared 44 dissected heart weights after being rinsed and after being pat dried. An average 18–20 g of residual rinsing water (4% of heart weight) was present in the dissected heart. The amount of residual rinsing water correlates positively with heart weight. The effects of drying the rinsed dissected heart were considered clinically insignificant. Although being clinically insignificant, this study highlights the lack of standardized approach in weighing the heart and the potential implications in interpreting heart weights.