Fatal MDMA-intoxication with postmortem diagnosis of hyperthermia

Hyperthermia is one of the main symptoms of the toxic MDMA effect. In a fatal intoxication, the premortal increase in body temperature may lead to a false assessment of the time of death. The problems of drug-induced hyperthermia faced by forensic pathologists and criminal investigators are discussed on the basis of a death from the autopsy material of the Berlin Institute of Legal Medicine (CCM).     

Effect of hair care and hair cosmetics on the concentrations of fatty acid ethyl esters in hair as markers of chronically elevated alcohol consumption

Fatty acid ethyl esters (FAEE) can be used as alcohol markers in hair. It was investigated in this study whether this diagnostic method is disturbed by hair care and hair cosmetics. Traces of ethyl myristate, ethyl palmitate, ethyl oleate and ethyl stearate were detected in all of 49 frequently applied hair care products by headspace solid phase microextraction (HS-SPME) and gas chromatography-mass spectrometry (GC-MS). The highest concentration was 0.003% in a hair wax. From experiments with separated hair samples of alcoholics as well as from the evaluation of the FAEE concentrations and the data about hair care of 75 volunteers (alcoholics, social drinkers and teetotalers) follows that usual shampooing, permanent wave, dyeing, bleaching or shading are of minor importance as compared to the drinking amount and other individual features. However, false positive results were found after daily treatment with a hair lotion containing 62.5% ethanol, with a deodorant and with a hair spray. As an explanation, it is assumed that FAEE are formed in the sebum glands also after regular topical application of products with a higher ethanol content.     

Suicidal yew poisoning--from Caesar to today--or suicide instructions on the internet

Already the Celts and ancient Germanic peoples knew about the poisonousness of the yew, which played an important part in the mythology of these civilizations. For hunting, the arrows were made poisonous with yew juice, and yew leaves were used for homicide and suicide. In modern times taxine is rarely used with suicidal intent, although this method is actually recommended on the respective Websites. After a 14-year-old boy had intensively studied poisonous plants and methods of suicide on various Websites, he cut leaves from a yew tree (taxus baccata) in his parents' garden, crushed and ingested them and died soon afterwards. At the forensic autopsy pieces of the partially crushed, partially completely preserved yew leaves were found in the stomach. The histological findings were unspecific, e.g. marked general blood congestion of the internal organs and pronounced cerebral and pulmonary edema. When the tree leaves found in the stomach were viewed under the light microscope, a stoma typical of taxus was observed; chemical-toxicological investigations revealed 3,5-dimethoxyphenol in the gastric content, which is considered a marker for the ingestion of taxus.     

An unusual area of injury in postmortem animal feeding beneath clothing

The authors report on a woman who died on the age of 75 years and who was found dead in her dwelling with an extensive injury of the left thigh two days after the last sign of life. Together with the corpse a poodle was present in the dwelling. Due to the unusual localization totally beneath the clothes (trousers) and the morphology of the injury an unnatural cause of death was suspected. According to the autopsy findings and the histological results, postmortal animal scavenging caused by the poodle remained the only explanation for the injury. Supplementary DNA testing yielded final certainty.     

Optimization of extraction parameters for the chemical profiling of 3,4-methylenedioxymethamphetamine (MDMA) tablets

The extraction of impurities from illegally produced 3,4-methylenedioxymethamphetamine (MDMA) has been studied in order to optimize the parameters. Two different MDMA samples were used. Particular attention was paid to the influence of the pH, the evaporation step, and the sample storage. The method used was an extraction of impurities by diethyl ether from a buffer solution at pH 11.5, followed by gas chromatography (GC) mass spectrometric (MS) analyses after a dryness concentration under monitored conditions of the ethereal extract. Repeat extractions of the same sample gave an average relative standard deviation (RSD) of less than 8.5% within day and less than 10.5% between days.     

Automated headspace solid-phase dynamic extraction for the determination of cannabinoids in hair samples

This article describes a fully automated procedure for detecting cannabinoids in human hair samples. The procedure uses alkaline hydrolysis and headspace solid-phase dynamic extraction (HS-SPDE), followed by on-coating derivatization and gas chromatography-mass spectrometry (GC-MS). SPDE is a further development of solid-phase microextraction (SPME), based on an inside needle capillary absorption trap. It uses a hollow needle with an internal coating of polydimethylsiloxane as extraction and pre-concentration medium.Ten mg of hair were washed with deionised water, petroleum ether and dichloromethane. After adding deuterated internal standards, the sample was hydrolyzed with sodium hydroxide and directly submitted to HS-SPDE. After absorption of analytes for an on-coating derivatization procedure, the SPDE-needle was directly placed into the headspace of a second vial containing N-methyl-N-trimethylsilyl-trifluoroacetamide before GC-MS analysis. The limit of detection was 0.14 ng/mg for Delta(9)-tetrahydrocannabinol, 0.09 ng/mg for cannabidiol, and 0.12ng/mg for cannabinol. Absolute recoveries were in the range of 0.6 to 8.4%. Linearity was verified over a range from 0.2 to 20 ng/mg, with coefficients of correlation between 0.998 and 0.999. Intra- and inter-day precision were determined at two different concentrations and resulted in ranges between 2.3 and 6.0% (intra-day) and 3.3 and 7.6% (inter-day). Compared with conventional methods of hair analysis, this automated HS-SPDE-GC-MS procedure is substantially faster. It is easy to perform without using solvents and with minimal sample quantities, and it yields the same sensitivity and reproducibility. Compared to SPME, we found a higher extraction rate, coupled with a faster automated operation and greater stability of the device.     

Area-specific increased density of mu-opioid receptor immunoreactive neurons in the cerebral cortex of drug-related fatalities

In animal experiments and in cell culture, chronic morphine treatment has been followed by "up-regulation" as well as "down-regulation" of the mu-opioid receptor (OR) number. The present postmortem morphometric study of morphine-related fatalities of drug-addicts (n=13, 20-35 years old, with blood unconjugated morphine levels from 27.1 ng/ml to 458 ng/ml, m.v. 198.5 ng/ml) versus a non-addicted control group (n=13, 10-44 years old) was intended to examine, whether chronic opiate exposure affects the numerical density of mu-OR expressing neurons in the human neocortex (areas 11, 24 and 25 according to Brodmann). For the immunohistochemical procedure, vibratome sections (100 microm) were incubated with a monoclonal antibody against the mu-OR, diluted 1:100, and immunolabelled sites were visualized using an immunoperoxidase protocol. The numerical densities of OR immunoreactive neuronal profiles and Nissl-stained central profiles were assessed morphometrically (camera lucida-drawings). In both groups, the anti-mu-OR-immunoreactivity was mainly localized in pyramidal neurons of layers (L) II/III and V and in multiform neurons of L VI. In the areas 24 and 25, the density of the immunoreactive neuronal profiles did not display a significant difference between the two examined groups. In the area 11, however, the number of immunolabelled neuronal profiles amounted to 2777+/-206 mm(3) in the drug-related fatalities and to 2320+/-124 mm(3) in the control group and thus was significantly increased.     

Tissue distribution of lidocaine in critical care patients after intubation

We investigated tissue distribution of lidocaine in 33 patients after endotracheal intubation with Xylocaine jelly that contains 2% lidocaine hydrochloride. Blood levels of monoethylglycinexylidide (MEGX), an active metabolite of lidocaine, were also determined. Five patients (Group A) were alive on arrival and six patients (Group B) resumed heartbeats after cardiopulmonary resuscitation (CPR). The survival times for Groups A and B ranged from 3 to 72 h. The remaining 22 patients (Group C) did not survive cardiopulmonary arrest on arrival (CPAOA). Systemic distribution of lidocaine was measured in nine patients from Group C. The liver-to-kidney lidocaine ratios and cerebrum-to-cerebrospinal fluid lidocaine ratios were: Group A, 0.1-0.7 and 1.4-3.6, respectively; Group B, 0.2-0.8 and 1.2-2.3, respectively; Group C, 0.1-17 and 0.2-1.0, respectively. MEGX was detected in all blood samples from Group A and only two samples from Group B. No MEGX was detected in samples from Group C. Our results indicate that the absorption of tracheal lidocaine during natural circulation results in a cerebrum-to-cerebrospinal fluid lidocaine ratio of 1.2 or more, whereas absorption during artificial circulation by cardiac massage gives a ratio of 1.0 or less. The cerebrum-to-cerebrospinal fluid lidocaine ratio may be a more useful index to estimate circulatory dynamics of patients during CPR than the liver-to-kidney lidocaine ratio. MEGX was not a useful parameter for monitoring circulatory changes during cardiac massage.