Fatality caused by a combined trimipramine-citalopram intoxication

A 53-year-old woman who was diagnosed as suffering from depression was found dead in her bed. The autopsy revealed no morphological changes sufficient to explain death. Toxicological analysis was performed and the drugs trimipramine (2.33 mg/l), citalopram (4.81 mg/l) and zolpidem (0.07 mg/l) were identified in the femoral blood. A combined drug intoxication resulting in synergistic effects to cardiovascular disorders was proposed as the cause of death. An acute overdose and suicide was suggested by calculation of the parent drug to main metabolite ratios in femoral blood and liver tissue. The trimipramine to desmethyltrimipramine ratios were calculated to be 2.06 and 3.18, the citalopram to desmethylcitalopram ratios were 1.96 and 2.02.     

大鼠急性鲤醇硫酸酯钠中毒血流动力学研究

探讨急性鲤醇硫酸酯钠（SCS）中毒早期死亡机制和死因。草鱼胆汁提取物SCS按3.0LD50、4．0LD50和5.0LD50的剂量给Wistar大鼠腹腔注射，观察大鼠血流动力学、心电图及呼吸的影响。结果表明；大鼠腹腔注射SCS后，动脉血压（SAP、DAP和MAP）下降；左心室功能（LVP、LVEDP和±dp／dtmax）降低；心电图示心电不稳，心肌缺血S-T段抬高或T波倒置，心率、呼吸先加快而后逐渐变慢，有明显的剂量-效应关系。表明SCS对心肌有选择毒性作用，其早期死因为心源性休克。实验结果为鱼胆中毒的诊断、防治及其法医学鉴定和鱼胆毒素的利用提供有关资料。     

草鱼胆汁提取物急性中毒的实验病理

研究草鱼胆汁提取物（鲤醇硫酸酯钠）对小鼠毒性作用的病理变化及其作用机制。按1．5LD50、1．0LD50和0．5LD50的剂量给昆明小鼠1次腹腔注射1％鲤醇硫酸酯钠溶液和按0．5LD50的剂量给昆明小鼠多次腹腔注射1％的鲤醇硫酸酯钠溶液,观察中毒小鼠各主要脏器的病理变化。中毒小鼠主要脏器的病理变化与草鱼胆汁中毒十分相似：心肌细胞水肿,严重者可见灶性肌溶解坏死;肾小管上皮细胞变性、坏死,肾小球滤过膜各层均有不同程度的病变。通过酶组织化学方法发现鲤醇硫酸酯钠对心肌SDH及CCO有明显的抑制作用。鲤醇硫酸酯钠是草鱼胆汁的主要毒性成分之一。     

钾中毒死亡家兔的尸体化学变化

目的研究家兔钾中毒死亡后的尸体化学变化特征,为钾中毒的法医学鉴定提供参考。方法采用浓度为0.3%和1%的KCl葡萄糖溶液分别以全速和100滴/min的速度输给家兔,至其死亡,测定家兔输液前后血、尿电解质浓度,比较两种不同输液方式所致钾中毒死亡后尸体化学变化特征。结果输钾前后,家兔血清K (SK)浓度升高,血清Na 、Ca2 、Cl-及HCO3-浓度均降低,全血K (TK)及血清Mg2 浓度变化无显著性差异。0.3%KCl组致死输液时间长于1%组(P=0.006),致死输钾量无显著性差异(P=0.062);TK、血清Na 、Mg2 及Cl-浓度变化值具有显著差异,SK、Ca2 、HCO3-浓度变化值无显著差异;尿量和尿液各电解质浓度指标未见显著性差异。结论尸体SK、TK及血清Mg2 浓度升高,有助于钾中毒的法医学死后诊断。     

血中安非拉酮的薄层色谱扫描检测研究

建立血中安非拉酮的快速检测方法。用环已烷或氯仿提取,薄层层析分离,薄层扫描定性和定量检测。结果显示：血清中安非拉酮的线性检测范围为0．2～12μm／ml,最小检出浓度为0．1μg／ml。2例服药过量患者血清中安非拉酮含量为3．2mg／L和4．7mg／L。本法可用于安非拉酮中毒的快速诊断和安非拉酮中毒的法医学鉴定。     

Distribution of dimethoate in the body after a fatal organophosphate intoxication

Many organophosphate pesticides (OPs) such as dimethoate are used to eradicate household pests, and those occurring in agriculture and forestry sectors. Combinations of two or more different insecticides have been manufactured to increase their effectiveness. A case of death is presented as suspected organophosphates intoxication. Autopsy was unremarkable except for grayish fluid in the stomach, with garlicky odor. A systematic toxicological analysis on post-mortem specimens revealed high concentrations of dimethoate in blood 38 microg/mL, urine 0.47 microg/mL, brain 2.2 microg/g, myocardial muscle 7.6 microg/g, liver 4.6 microg/g, lung 7.6 microg/g, skeletal muscle 21 microg/g, kidney 55 microg/g and gall bladder 31 microg/g. Blood alcohol was 2.85 g/L, cyclohexanone and cyclohexanol were also detected in the blood but not quantified. The cause of death was determined as organophosphate intoxication.     

Case report of a fatal intoxication by citalopram

Citalopram is an antidepressant drug within the group of the selective serotonin reuptake inhibitors (SSRI). It is widely prescribed both in Europe and in United States, and it has always been considered a "safe" drug as pure intoxication with lethal outcome is rare, and most cases of overdose, even with high doses of citalopram ingested, are reported to have an uneventful course.We report the case of a young woman found dead at home. She had been prescribed citalopram by her family doctor 3 weeks before her death for a depressive syndrome. Police found in her house 3 empty blister packages of 28 citalopram tablets (20 mg) and 2 bottles of citalopram oral solution (4%, 15 mL each). The autopsy findings were unremarkable. Nasal swabs, blood from femoral vein, urine, bile and tissue samples were collected for toxicologic investigation. Citalopram separation was performed by solid/liquid method, using Bond-Elute columns. The extracts were analyzed by GLC and GC/MS methods. The toxicologic analysis showed high levels of citalopram in all the examined fluids and tissue samples (blood concentration: 11.60 mg/L). No other drugs and alcohol were detected. Our data confirm that if no other drug is involved, fatal complications occur only after ingestion of very high doses. However, there is no predefined "toxic dose," and the conditions under which the overdose occurs can be very important. We report the exact concentrations of the citalopram in the organs, and wethink that this can be useful in the cases where the blood samples were not available (ie, carbonized or decomposed body).     

Histomorphometric characteristic of human brain in acute alcoholic intoxication

Different brain sections were studied in 20 subjects, who died of ethanol intoxication and in 14 subjects who died of injuries of the heart and main vessels, in order to detect histological changes in the brain and for the purpose of defining spatial and quantitative ratios between cerebral tissue structures in alcoholic intoxication. Different histological, stereometric and morphometric tools were made use of. It was demonstrated that, in alcoholic intoxication, there occur severe disorders of the circulation with affection of vessels in the brain; there are also dystrophic and necrotic changes in neurocytes, glial cells and white substance. The square of neurons shrinks due to death of some of them in the cortex of hemispheres, thalamus and cerebellum. As for the medulla, they are more resistant, there, to ethanol. The diameter of capillaries in the studied brain sections diminishes due to a reduced tonus of cerebral arteries; the quantity of such vessels increases within a standard area, which is conditioned by the compensatory opening of reserve capillaries. All this can be important in dealing with issues of thanatogenesis and of forensic medical diagnosis in death of alcoholic intoxication.     

Dynamic changes of serum protein in rats with acute intoxication of Chinese cobra snake venom by proteomic analysis

To elucidate the toxic mechanism of snake venom at the protein level, proteomics technology was applied to investigate the effect of venom on circulation in the mammalian body. Temporal proteomic analysis was performed to profile the dynamic changes in the sera of Sprague–Dawley rats administered with Chinese cobra venom or saline. Using 8-plex iTRAQ analysis, 392 and 636 serum proteins were identified to be linearly upregulated or downregulated over time in the low-dose group and high-dose group, respectively. These proteins were mainly associated with the acute phase response pathway, complement system, and liver X receptor (LXR)/retinoid X receptor (RXR) and farnesoid X receptor (FXR)/RXR activation pathways. Compared with the low-dose group, the immune response and integrin pathways were inhibited in the high-dose group, although no obvious effect was observed. With consistently higher or lower expression in the high-dose group compared to the low-dose group throughout the whole process of venom poisoning, two proteins, Kininogen-1 (KNG1) and orosomucoid 1 (ORM1), which are involved in metabolism and immune response, occupied a core position in the pathway network and are considered venom dose-dependent biomarker candidates.     

Identification and quantitation of 3,4-methylenedioxy-N-methylamphetamine (MDMA,ecstasy) in human urine by 1H NMR spectroscopy. Application to five cases of intoxication

Identification of 3,4-methylenedioxy-N-methylamphetamine (MDMA, ecstasy) in five cases of intoxication using nuclear magnetic resonance (NMR) spectroscopy of human urine is reported. A new water suppression technique PURGE (Presaturation Utilizing Relaxation Gradients and Echoes) was used. A calibration curve was obtained using spiked samples. The method gave a linear response (correlation coefficient of 0.992) over the range 0.01–1 mg/mL. Subsequently, quantitation of the amount of MDMA present in the samples was performed. The benefit and reliability of NMR investigations of human urine for cases of intoxication with MDMA are discussed.     

Identification of human gender by hand x-ray

A planimetric analysis of hand bones x-ray images is proposed for gender identification. The gender is determined by two methods: by interval estimation of bones size and calculation of the discriminant function and its comparison with group centroid values.     

Identification of blunt objects according to the injuries caused by them

The article presents principles of forensic-medical identification of blunt objects by injuries inflicted with them. It is shown that each injury has its own complexes of identifying signs. It is necessary to consider mechanisms of action of blunt objects inflicting contact, noncontact and other injuries. Mathematical methods should be employed to estimate probability of identification of traumatic blunt object.     

Acute intoxication caused by overdose of flunitrazepam and triazolam: high concentration of metabolites detected at autopsy examination

ABSTRACT: A 52-year-old woman was found dead on the floor of the living room on the first floor of a house, which belonged to the man with whom she shared the house. On visiting the site, her clothes were found to be undisturbed. Packages of flunitrazepam (Silece, 2 mg/tablet) and triazolam (Halcion, 0.25 mg/tablet) were found strewn around the victim. Toxicological analysis was performed, and the concentrations of flunitrazepam, triazolam, and their metabolites in the victim's blood and urine were measured by high-performance liquid chromatography coupled with photodiode array and mass spectrometry. A high blood concentration of 7-aminoflunitrazepam was detected (1,270 ng/g), and further metabolites such as 7-acetamidoflunitrazepam, 7-acetamidodesmethylflunitrazepam, and 7-aminodesmethylflunitrazepam were detected in the blood and urine samples. In addition, 4-hydroxytriazolam and α-hydroxytriazolam were detected in her urine at a concentration of 950 and 12,100 ng/mL, respectively.On the basis of the autopsy findings and toxicology results of high concentrations of both flunitrazepam and triazolam derivatives, the cause of death was determined to be acute intoxication from flunitrazepam and triazolam.     

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.     

Identification of human urinary stains by enzyme-linked immunosorbent assay for human uromucoid

An enzyme-linked immunosorbent assay (ELISA) of the sandwich type for identification of human urinary stains using commercially available anti-human uromucoid was developed. When experimentally prepared urinary stains of humans and animals, 2 by 2 cm in area, were subjected to analysis, human stains could be differentiated from animal ones except chimpanzee and Old World monkey ones. Stains of other human body fluids showed negative reactions. The reactions did not decrease when human urinary stains were stored at room temperature for three months. The present ELISA provides a useful presumptive test for urinary stains of human origin.     

Sudden death caused by tension pneumothorax after rupture of a thoracic aortic aneurysm. Case report

A rare case of fatal tension pneumothorax is reported. An aged Japanese man with marked subcutaneous emphysema of the neck was found collapsed in a betting office. He was ascertained to have left tension pneumothorax, based on radiographic examinations carried out before his death. At autopsy, severe pneumomediastinum was observed, and the descending thoracic aorta with a ruptured dissecting aneurysm was closely adhered to the left lung pleura. The hemorrhage spread into the pulmonary parenchyma and finally spouted out from the surface of the lung apex. Because the blood loss itself was not fatal in quantity, it is concluded that the patient died of tension pneumothorax caused by a lung penetration from the rupture of an aortic aneurysm.