Prevalence and postmortem diagnosis of hemocontact infections in intravenous drug abusers based on forensic medical research data

The spread of viral hepatitis C and B and of HIV was studied among the intravenous drug consumers (IDC) on the basis of 42 forensic-medical autopsies. The enzyme immune-assay (EIA) of blood serum showed, in 95.2% of cases, antibodies to hepatitis C virus, antibodies to HbsAg and HIV were registered in 11.9% in both cases. The possibilities of using the autopsy-blood serum for EIA-diagnosis of viral hepatitis and HIV were demonstrated. Morphological examinations of IDC showed, in them, chronic hepatitis (CH) of minimal, weakly-pronounced and moderate activities. Viral CH in HIV infected IDCs is characterized by a minimal and small-pronounced activity of the process and it is not different, according to its activity, from viral CH in IDCs without HIV.     

Fatal intravenous injection of potassium in hospitalized patients

We describe 4 cases of fatal intravenous injection of potassium in the hospital setting. These cases illustrate the subtlety of findings in such deaths and remind the forensic pathologist to consider this type of event in sudden, unexpected death of hospitalized patients.     

Female drug abusers, narcotics offenders, and legal punishment in China

Drug abuse and narcotics offenses have been surging since the economic reforms in China. Accompanied is the dramatic increase of female involvement in the use of drugs and narcotics offenses. As a response, laws and governmental decrees have been promulgated and modified to curb these emerging and changing crimes and social problems. Courts at all levels in China also devoted more resources in handling and processing these particular criminals and crimes. Whether and how these legal initiatives have been translated into punishment that treats male and female offenders equally who committed similar offenses remains questionable. Citing published criminal court judgment documents, this study addressed this issue empirically and offered some plausible theoretical explanations for the treatment of female drug users and narcotics offenders by criminal courts in China.     

Beta-hydroxybutyric acid--an indicator for an alcoholic ketoacidosis as cause of death in deceased alcohol abusers

We analyzed the postmortem blood of a total of 100 fatal cases for beta-hydroxybutyric acid (BHBA). In 25 cases of sudden and unexpected death of alcoholics we found pathologically increased levels of BHBA of 1260 to 47200 (median 8000) micromol/L. This led us to the diagnosis of an alcoholic ketoacidosis (AKA) as cause of death in these cases. The control group of 69 postmortem cases revealed that BHBA concentrations below 500 can be regarded as normal, and values up to 2500 micromol/L as elevated. Our study shows that BHBA values over 2500 micromol/L could lead to death, if no medical attention is sought. During storage we did not find any indication of postmortem formation or decomposition of BHBA in blood in vitro or in the corpses. In our opinion, BHBA should be considered the diagnostic marker of choice for the postmortem determination of alcoholic ketoacidosis (AKA) as the cause of death. The classical indications of such deaths are: unexpected death of a chronic alcoholic; none or only traces of ethanol in the blood; increased acetone blood concentration; and neither autopsy, histology, microbiology, nor toxicology reveal the cause of death. In six further cases a diabetic ketoacidosis (DKA) was diagnosed as the cause of death.     

Alcohol and drug use among rural and urban incarcerated substance abusers

A number of prisoners use drugs. Limited information is available about the extent to which urban and urban substance abusers differ in their drug use in criminal justice settings. In addition, many believe that rural areas are protected from drug use. However, findings from this study show only marginally statistical significant differences in drug use between incarcerated rural and urban drug users. It was expected that urban drug users would be more drug career involved with consistently higher levels of drug use and associated problems. Specifically, rural drug users in this study were older at age of first use of marijuana and cocaine; report fewer years of cocaine, hallucinogen, and heroin use; and report more alcohol and sedative use. Findings from this study suggest that rural and urban drug users are similar and that rural areas may be protective from some drug use but risky for other drug use.     

Fungal cerebritis from intravenous drug abuse

Three intravenous drug abusers (predominantly cocaine) developed a fulminant fungal cerebritis without any other identifiable predisposing factor. Two died and one survived with a severe neurologic deficit. Zygomycetes (nonseptated fungi) were identified in the brain tissue of two victims and Acremonium alabamensis was cultured from the brain tissue of the third. Fulminant fungal cerebritis in intravenous drug abusers (in the absence of any predisposing illness) may represent a unique variant of the acquired immunodeficiency syndrome (AIDS). Future surviving patients should be evaluated for the possibility of a cellular immune deficiency state in order to confirm this impression.     

Time of drug elimination in chronic drug abusers. Case study of 52 patients in a "low-step" detoxification ward

The elimination time of illicit drugs and their metabolites is of both clinical and forensic interest. In order to determine the elimination time for various drugs and their metabolites we recruited 52 volunteers in a protected, low-step detoxification program. Blood samples were taken from each volunteer for the first 7 days, daily, urine sample for the first 3 weeks, daily. Urine was analyzed using a fluorescence-polarization immunoassay (FPIA) and gas chromatography/mass spectrometry (GC/MS), serum using GC/MS. The elimination times of the drugs and/or their metabolites in urine and serum as well as the tolerance intervals/confidence intervals were determined. Due to the sometimes extremely high initial concentrations and low cut-off values, a few of the volunteers had markedly longer elimination times than those described in the literature. The cut-off values were as follows: barbiturates II (200ng/ml), cannabinoids (20ng/ml), cocaine metabolites (300ng/ml), opiates (200ng/ml). GC/MS detected the following maximum elimination times: total morphine in urine up to 270.3h, total morphine and free morphine in serum up to 121.3h, monoacetylmorphine in urine up to 34.5h, 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (THC-COOH) in urine up to 433.5h, THC-COOH in serum up to 74.3h, total codeine in urine up to 123h, free codeine in urine up to 97.5h, total codeine in serum up to 29h, free codeine in serum up to 6.3h, total dihydrocodeine (DHC) in urine up to 314.8h, free DHC in urine up to 273.3h, total and free DHC in serum up to 50.1h. Cocaine and its metabolites were largely undetectable in the present study.     

An unusual drug death involving maggots

Toxicologic analysis of decomposed specimens provides greater analytical challenges than those encountered with fresh postmortem specimens. Despite the difficulties involved, in cases in which the cause of death is not determined at autopsy or when there is a strong indication of drug intoxication, all reasonable steps must be undertaken to perform as comprehensive a drug screen as possible. An unidentified white male was found in a field near a river. The body was decomposed and skeletonized, and 3- to 4-mm maggots were present on the body. Near the body was an empty bottle of secobarbital that had been prescribed to a female. There was no evidence of injury. Calf muscle and maggots were sent for toxicologic analysis. No volatile substances or drugs were detected in the calf muscle. Because intoxication due to secobarbital was strongly suggested from the scene investigation, the only other specimen available, the maggots, were tested for acid-neutral drugs. Secobarbital was identified by retention time and was confirmed by full-scan electron ionization gas chromatography/mass spectrometry. Based on the available information, the medical examiner ruled that the cause of death was secobarbital intoxication and the manner of death was suicide.     

Circumstances at the time of death in drug fatalities

The circumstances in drug-related deaths were investigated in this study. The basic client sample was composed of 743 drug addicts of the opiate type who had been admitted into the institute's drug-free outpatient program from 1969 to 1982. In this program, 91 clients died during the observation period. In order to be able to judge the various backgrounds adequately, a multiply subdivided classification system was developed for the death cases. Each case was recorded in three main categories: manner of death, cause of death, and phase of addiction. This was a more elaborate procedure than those commonly used since, in general, such death cases are only subdivided into a few groups that differ little from one another. Two manners of death predominated in this sample: accidents caused by poison (62%) and suicide (25%). Within in the various causes of death, poison cases prevailed (80%) and opiate intoxication (single or combined) was predominant (60%). Concerning the phase of addiction two phases were distinguished: the actual drug addiction phase (65%) and the intramural stay in prison or a hospital (25%). There were no significant sex-related differences. Various combinations regarding the mechanism of lethal opiate intoxication of drug addicts were scrutinized, concentrating on three approaches: the lack of opiate tolerance after periods of abstinence, the synergistic effect of simultaneously taking other CNS-depressant drugs, and differences in concentration in the heroin used. Our conclusions are given from the point of view of adequate counseling for drug addicts.     

Causes of death of patients in an institution for the developmentally disabled

The causes of death of 53 severely to profoundly developmentally disabled patients who died in an intermediate care facility were reviewed. Respiratory disease, predominantly pneumonia and aspiration, accounted for 72% of deaths. Seven patients died of nonrespiratory causes, and in 8 patients, no cause of death could be determined, even after a complete autopsy or investigation. The median age at death was 20 years. The weights of these patients' organs at autopsy were lower than those for normal individuals of the same age. The lifespan of these severely impaired individuals continues to be significantly shortened, even with improved methods of care.     

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.     

Fatal intravenous drug abuse secondary to streptomycin overdose

A fatal case of chronic intravenous drug abuse involving the injection of a nonpsychoactive veterinary combination of penicillin G and streptomycin is reported. The circumstances surrounding the death indicate that the decedent died as a result of streptomycin induced paralytic neuromuscular blockade.     

35例胰腺出血案例死亡原因分析

３５例胰腺出血案例死亡原因分析刘敏，吴家Ｃａｕｓｅｓｏｆｄｅａｔｈｏｆｐａｎｃｒｅａｓｈｅｍｏｒｒｈａｇｅ：３５ａｕｔｏｐｓｙｃａｓｅｓｒｅｐｏｒｔ￥ＬｉｕＭｉｎ；ＷｕＪｉａｗｅｎ（ＤｅｐａｒｍｅｎｔｏｆＦｏｒｅｎｓｉｃＰａｔｈｏｌｏｇｙ，ＷｅｓｔＣ...     

Does procedural fairness matter for drug abusers to stop illicit drug use? Testing the applicability of the process-based model in a Chinese context

ABSTRACT

This study examined the influences of procedural fairness on Chinese drug users’ efforts to stop substance abuse, with a primary goal to test the applicability of the process-based model in the Chinese context. According to Tyler (1990 Tyler, T. (1990). Why people obey the law. New Haven, CT: Yale University Press. [Google Scholar], Why people obey the law. New Haven, CT: Yale University Press), the core theoretical argument underpinning the process-based model is that if citizens consider the police to be fair in using their powers, they will view the police as legitimate and accordingly cooperate with the police and comply with the law. Using data from a sample of 202 Chinese drug users, this study found that procedural fairness has an indirect effect on drug users’ efforts to stop illicit drug use. Specifically, procedural fairness used by the police increased Chinese drug users’ efforts to stop substance abuse through its prior effects on drug users’ perceptions of police trustworthiness. These findings provide some support for the key arguments of the process-based model of regulation, and have important implications for the direction of efforts to encourage desistance-related behavior among substance abusers.     

Drug abuse in western Denmark during the eighties. II. Fatal poisonings among drug abusers.

Cases of fatal poisoning among drug addicts (n = 246) and abusers of medical drugs (n = 138) are discussed on the basis of the availability of illicit and medical drugs during the eighties. Propoxyphene was frequently the cause of death among both drug addicts and abusers of medical drugs. Deaths caused by analgesics and psychoactive drugs, mainly barbiturates and antidepressants, predominated among abusers of medical drugs. During the late eighties the number of deaths caused by barbiturates and propoxyphene declined as a result of changes in the distribution regulations for both drugs. Heroin/morphine accounted for only one-third of the poisonings in drug addicts. No trends concerning the prevalence of deaths caused by these drugs were observed throughout the decade. The number of deaths caused by the synthetic opiates methadone and ketobemidone, however, increased during the late eighties, probably due to an increased availability of these drugs in the illicit drug market. Alcohol was detected in half of all the poisoning cases and benzodiazepines in one-third.     

30例吸毒者猝死分析

本文收集的30例吸毒者猝死资料均证实有吸毒史，排除损伤、机械性窒息、常见毒物中毒，全部作了尸体解剖检验和病理组织切片检查，发现脑、心、肺、肝、肾等多脏器损害，现报道如下。     

Cause of death and drug use pattern in deceased drug addicts in Sweden, 2002-2003

Compared with their contemporaries, individuals abusing illicit drugs suffer a higher risk of premature death. In Sweden, a simple protocol for registration of fatalities among abusers of alcohol, pharmaceuticals, illicit drugs, or other substances, has been used by the forensic pathologists since 2001. This routine was introduced to allow for an evaluation of the cause and manner of death, and patterns of abuse among different groups of abusers. We explored the data on drug abusers (i.e. abusers of illicit drugs) subjected to a forensic autopsy 2002-2003. The Swedish forensic pathologists examined 10,273 dead victims during the study period and 7% (743/10,273) of the cases were classified as drug abusers. Toxicological analyses were carried out in 99% (736/743) and illicit drugs were detected in 70% (514/736) of these. On average, 3.8 substances (legal or illegal) were found per case. The most common substances were ethanol and morphine, detected in 43 and 35% of the cases, respectively. When exploring the importance of the different substances for the cause of death, we found that the detection of some substances, such as fentanyl and morphine, strongly indicated a poisoning, whereas certain other substances, such as benzodiazepines more often were incidental findings. In total, 50% (372/743) died of poisoning, whereas only 22% (161/743) died of natural causes. Death was considered to be directly or indirectly due to drug abuse in 47% (346/743), whereas evidence of drug abuse was an incidental finding in 21% (153/743) or based on case history alone in 33% (244/743). We believe that this strategy to prospectively categorize deaths among drug addicts constitutes a simple means of standardizing the surveillance of the death toll among drug addicts that could allow for comparisons over time and between countries.