The time-dependant post-mortem redistribution of antipsychotic drugs

The post mortem redistribution of ten commonly prescribed antipsychotic drugs (APs) was investigated. Femoral blood was collected from 273 cases at admission to mortuary (AD) and at post-mortem (PM). The PM samples were collected at various times up to nine days after admission and the sample pairs analysed using LC-MS/MS. The drugs included in this study were 9OH-risperidone (paliperidone), amisulpride, chlorpromazine, clozapine, haloperidol, olanzapine, promethazine, quetiapine, risperidone, and zuclopenthixol. Haloperidol, quetiapine and risperidone showed minimal changes between AD and PM specimens, whereas the majority of drugs showed significant changes between the sample pairs collected at different time points post mortem (p<0.01) in addition to an average concentration change greater than the uncertainty of measurement of the applied method. Average increases in blood concentrations after admission to the mortuary ranged up to 112% (chlorpromazine and olanzapine) but also decreases up to -43% (9OH-risperidone) were seen. There were large standard deviations between sample pairs and substantial day-to-day unpredictable changes that highlight the difficulty in the interpretation of drug concentrations post-mortem. Based on the presented data, we recommend that specimens for toxicological analysis should to be taken as soon as possible after admission of a deceased person to the mortuary in order to minimise the effects of the PM interval on the drug concentration in blood.     

Identification of 2-hydroxymethyl-olanzapine as a novel degradation product of olanzapine

Olanzapine (OLZ) is amongst the most commonly prescribed antipsychotic drugs and is associated with substantial instability. The aim of this study was to investigate the instability of OLZ and to identify the degradants formed from its breakdown. Three experiments were conducted to monitor the degradation of OLZ and the formation of degradants in blood (1), water (2), and post-extraction at 4 °C (3). All three sample sets were analysed in duplicate and repeated in the absence (A) and presence (B) of 0.25% ascorbic acid. One degradant was identified in sample sets 2A and 3A with m/z 329 and confirmed as 2-hydroxymethyl-OLZ (2-OH-OLZ) using LC-MS techniques. The addition of 0.25% ascorbic acid slowed the degradation of OLZ down in all three experiments and inhibited the formation of 2-OH-OLZ in sample sets 2A and 3A. To investigate the influence of oxygen on the degradation of OLZ and the formation of 2-OH-OLZ in water, an additional experiment (4) was conducted. Sample sets were prepared containing different vortexing or sonication steps in order to alter the oxygen content in the samples. Statistical analysis confirmed that degradation increased significantly following vortexing for 1 min while sonication did not affect the rate of degradation of OLZ further suggesting the involvement of oxygen in the degradative processes. 2-OH-OLZ was only identified as a degradant of OLZ in aqueous solutions. It also degrades over time but its product is currently unknown and is under investigation.     

Sudden death during prolonged religious fasting

Sickle cell trait (SCT) is estimated to occur in 6% to 10% of Africans, and the United Kingdom (UK) prevalence rate has been estimated at 3.2%. Although sudden death in sickle cell disease is well known, its occurrence in SCT is rare and requires extremes of physiological stress. We present a case of a 29-year-old black woman who died suddenly during a period of religious fasting. Her medical history was unremarkable, and there was no family history of sickle cell disease. At postmortem, she was found to be dehydrated, and macroscopically, the main abnormal findings were congested lungs and a small spleen. Histological examination revealed extensive vascular congestion with red blood cell sickling in both lungs, the liver, and the spleen. Electrophoresis on a postmortem blood sample confirmed the clinical suspicion that the patient was a carrier of SCT. The case highlights a novel scenario of SCT associated sudden death. We discuss the potential pathophysiological mechanisms that may have led to the patient's demise. We also remind pathologists to consider this diagnosis as potentially contributing to the cause of death in apparently fit young people of ethnic origin during episodes of physiological stress.     

Laufbahnklassen. Zur empirischen Umsetzung eines dynamisierten Klassenbegriffs mithilfe von Sequenzanalysen

Based on Bourdieu??s notion of trajectory-classes, the article proposes a dynamic concept of social class that accounts for typical patterns of intra-generational mobility. The hypothesis is that social class trajectories cluster into stable as well as upward and downward mobile trajectory-classes. This assumption is tested empirically by applying sequence analysis to individual trajectories of class positions measured by means of the Goldthorpe class scheme. The data are drawn from the German Socio-Economic Panel Study and cover 15 years of individual occupational histories for four different age cohorts of men and women. In addition to a striking stability of class positions, there are also specific patterns of class mobility for men that point to institutional mechanisms of social closure and career paths. Women??s trajectory-classes are shaped by class-specific patterns of labor market (re-)entries and exits. Furthermore, analyzing the process of capital accumulation based on various indicators of economic, cultural and social capital, the trajectory-classes can be interpreted as a result of investment strategies.     

Roentgen image of the hand as a principle for age determination in adolescents

Determination of age can be necessary in cases of juvenile offenders. We studied the relation between the skeletal development of the hand and wrist and the age, using diagnostic methods of orthodontics. An evaluation of 1109 X-ray pictures of the hand and wrist of boys and girls with an age from 9-18 years showed that there is a stochastic correlation between age and certain stages of skeletal development. Skeletal development is influenced by sex and ethnological factors.     

Hochwasserschutz zwischen Enteignungsentschädigung und Amtshaftung*

Der Hochwasserschutz bildet einen gleichermaßen tatsächlich herausfordernden wie rechtlich komplexen Schwerpunkt des geltenden Wasserrechts. Nicht von den genuin wasserwirtschaftsrechtlichen Aspekten zu trennen sind dabei Fragen nach etwaigen Kompensationsansprüchen. Im Folgenden sollen die Grundstrukturen der Haftung für Hochwasserschäden aufgezeigt werden, um eine erste Groborientierung für die rechtliche Bewertung im konkreten Einzelfall zu ermöglichen. *) Erweiterte Fassung eines Vortrags, gehalten am 22. 4. 2004 auf dem 9. Leipziger Umweltrechtssymposium Rechtliche Aspekte des vorbeugenden Hochwasserschutzes. Manuskriptstand: April 2004.     

Postmortem concentrations of citalopram

The postmortem concentrations of citalopram in blood, bile, liver, and vitreous humour were investigated in 14 cases using a specially developed high performance liquid chromatography assay. Concentrations from drug and non-drug related deaths were categorized to determine a postmortem therapeutic and toxic range. Therapeutic citalopram concentrations for blood, bile, liver, and vitreous humour ranged to 0.4 mg/L, 2.1 mg/l, 6.6 mg/kg, and 0.2 mg/L, respectively. In one potentially fatal response to citalopram, concentrations were 0.8 mg/L, 6.0 mg/L, 0.3 mg/L for blood, bile and vitreous humour, respectively.     

Generalisierung von Beschäftigungsrisiken oder anhaltende Arbeitsmarktsegmentation?

The article inquires whether segmentation concepts might shed a new light on the debates about the generalization of employment risks in Germany and develops the concept of firm employment sub-systems. The result of our empirical analyses is that the German labour market structure is shifting from a hegemony of Internal Labour Markets to a tense and instable co-existence of Internal and External markets, with East Germany having taken the lead. There is neither a generalisation of risks nor a stable division of employment. We rather observe dynamic segmentation with shifts between Internal and External Markets and endogenous transformations within segments.