Intravenous amphetamine abuse, primary cerebral mucormycosis, and acquired immunodeficiency

Two intravenous amphetamine abusers had fatal, rapidly progressive cerebral mucormycosis with abscess formation in the presence of absolute lymphopenia. Postmortem examination confirmed the primary nature of the fungal cerebritis, documented by postmortem culture and histology. The clinical and pathologic features of these cases are compared to previously reported occurrences of primary fungal cerebritis (and abscess) among intravenous drug abusers, including cocaine users. Primary fungal cerebritis associated with intravenous abuse of stimulant drugs is discussed as a possible variant of the acquired immunodeficiency syndrome.     

挥发性有机溶剂的危害及滥用

本文简要介绍了挥发性有机溶剂对人体的危害及其存在的可能性,分析了几类人群对此类物质形成滥用、依赖的因素及与此相关的部分规定,提醒注意此类具有隐匿性的滥用物质。     

Childhood history of abuse and adult child abuse potential

The experience of aversive interactions within the family of origin is believed to increase the probability of parental physical child abuse. To test this hypothesis, 375 subjects were given a Childhood History Questionnaire (CHQ) and the Child Abuse Potential (CAP) Inventory. The CHQ contained a series of questions about the presence and frequency of various abusive behaviors and associated sequelae that were received and/or observed before and/or after puberty. The CAP Inventory was used to measure adult physical child abuse potential. As expected, a childhood history of physical abuse was significantly related to adult physical child abuse potential; and, as chronicity increased, so did abuse potential. The experience of physical abuse prior to puberty produced higher abuse scores than the experience of physical abuse after puberty. The study provides preliminary data indicating the childhood experience of a caring adult and / or caring friend moderates adult child abuse potential.     

Thymus alterations related to intravenous drug abuse.

It has been noticed on forensic material that Hassall's corpuscles of the thymus are more often calcified in intravenous drug abusers than in healthy persons. Thymuses of 15 intravenous heroin addicts were histologically examined and compared with thymuses of 15 healthy persons. Acute bleeding and dystrophic calcification in the thymocyte's parenchyma were more common among intravenous drug abusers (p = .005 and p = .001, respectively). The degree of physiologic involution measured by fatty replacement and the clarity of border between cortex and medulla was equal. No significant diversity was found in the features of Hassall's bodies. Our study emphasizes the necessity for a defined criteria of morphologic changes in the thymus that could be expected in intravenous drug abusers. In that way it would be possible to complete the forensic findings as well as to examine immunologic system alterations of that risk population.     

The use and abuse of the rape treatment center.

The author acknowledges the fact that the new system of managing alleged rape victims via the RTC is superior to the former method. The RTC has performed very well, giving aid and succor to rape victims. However, it appears that the unit has attracted some individuals who are not completely truthful and have given fraudulent accounts to investigators. Methods have been suggested to screen out these persons.     

The eyes of child abuse victims: autopsy findings.

The authors studied 77 pairs of eyes removed from children who had died of suspected child abuse. Forty-seven of the cases had retinal hemorrhages. Those showing retinal hemorrhages were younger children and had fewer other stigmata of child abuse. Hemorrhages are more likely to occur in cases where the child was shaken or swung than in those with severe direct head trauma. The authors recommend that examination of the eyes be included in the autopsies of all small children who died without an obvious cause of death. Experience in both processing and reading of ocular material is necessary for reliable results.     

Control of fraud and abuse in Medicare and Medicaid.

This Comment explores issues concerning the control of fraud and abuse in health programs financed with public funds, specifically the Medicare and Medicaid programs. It summarizes the nature, scope, and possible causes of what some regard as a fraud and abuse "crisis," and points out the difficulties and obstacles facing those who attempt to develop legislative and executive action aimed at controlling fraud and abuse. Recent federal initiatives in fraud and abuse control are examined, and a brief summary of key provisions of H.R. 3 (the Medicare-Medicaid Anti-fraud and Abuse Amendments, which may prove to be a landmark piece of legislation in this area) is provided. The author emphasizes that more effective control of fraud and abuse is necessary if further expansion of government financing of health programs, including national health insurance, is to occur in the near future. At the same time, caution must be taken not to neglect the appropriate use of other mechanisms necessary for reducing the costs of medical care and improving its quality. In addition, it is likely that efforts to stem fraud and abuse will raise important medicolegal and public policy issues that will require careful interdisciplinary consideration.     

Masque ecchymotique. Specific or nonspecific indicator for abuse

An unusual case of nonfatal asphyxia related to child abuse is presented. The clinical presentation and the investigation findings are discussed.     

A semiautomated radioimmunoassay for mass screening of drugs of abuse.

A rapid, semiautomated radioimmunoassay system for detection of morphine, barbiturates, and amphetamines is described. The assays are applicable to large drug abuse screening programs. The heart of the system is the automatic pipetting station which can accomplish 600 pipetting operations per hour. The method uses 15 to 30 mul or urine for the morphine and barbiturate assay and 100 mul for the amphetamine and combined morphine/barbiturate assays. A number of other drugs were tested for interference with the assays and the results are discussed.     

Flunitrazepam: an evaluation of use, abuse and toxicity.

The benzodiazepine flunitrazepam is extensively prescribed to patients with insomnia in many countries, but has also become popular among alcohol- and drug abusers. Several reports indicate that it is used as a date rape drug and suggest that it may precipitate violent behavior. Furthermore, flunitrazepam is involved in many fatal intoxications in Sweden. This study was designed and conducted to explore the negative consequences of flunitrazepam abuse in Sweden, and to assess the trends in its use and abuse. The occurrence of flunitrazepam in cases referred to the Department of Forensic Chemistry in Link?ping, Sweden 1992-1998, was investigated in detail. The detections were studied separately for different groups; medicolegal death investigations, drug abuse cases, driving under influence cases, and other medicolegal cases. These data were further compared with the sales, and seizures by the Swedish Customs and the Swedish Police. During 1992-1998, 641 fatalities occurred, where the cause of death was attributed to intoxication with flunitrazepam solely (130) or in combination with other drugs, or concomitant conditions (511). In 78% of all driving under influence cases, where flunitrazepam was detected, the analyses also disclosed the presence of illicit drugs. A similar association was seen in drug abuse cases. The seizures reported by the Swedish Customs revealed a substantial and increasing illegal trade. Cases, where flunitrazepam seemingly induced violent behavior were identified, and one of these is described in some detail. It is concluded that the abuse pattern and the toxicity of flunitrazepam should be kept in mind by forensic investigators and that this panorama also should be considered when decisions about the registration and classification of flunitrazepam are made in different countries.     

A death due to ethchlorvynol abuse. A case report

A fatal case of ethchlorvynol abuse is reported with blood and tissue determinations.