Tramadol (Ultram) concentrations in death investigation and impaired driving cases and their significance

We reviewed a series of 66 deaths in Washington State between 1995-2000 in which tramadol (Ultram and Ultracet, Ortho-McNeil) was detected in the decedent's blood, in order to assess the role tramadol was determined to have played. Additionally, we reviewed a series of 83 impaired driving cases in which tramadol was detected in order to establish a non-lethal blood tramadol concentration reference range. In both populations, tramadol was consistently found together with other analgesic, muscle relaxant, and CNS depressant drugs. Death was rarely attributable to tramadol alone. However, tramadol may be a significant contributor to lethal intoxication when taken in excess with other drugs, via the potential interaction with serotonergic antidepressant medications, as well as the potential for increased CNS depression. Although the incidence of tramadol detection has increased consistently over the last eight years, there is no evidence of a corresponding increase in the number of cases in which death was attributed solely to tramadol. Blood drug concentrations in many deaths exceeded the therapeutic serum range of 0.28-0.61 mg/L; however, the concentrations overlapped almost completely with the range identified in living subjects arrested for impaired driving. These findings suggest caution in the interpretation of blood tramadol concentrations outside of the recognized therapeutic range. It also suggests that the drug, even when used in moderate excess, is not a principle cause of death in suicidal or accidental deaths.     

Trace analysis of peroxide explosives by high performance liquid chromatography-atmospheric pressure chemical ionization-tandem mass spectrometry (HPLC-APCI-MS/MS) for forensic applications

An HPLC-APCI-MS(/MS) method for the (trace) analysis of the most commonly encountered peroxide explosives, hexamethylenetriperoxidediamine (HMTD) and triacetonetriperoxide (TATP), has been developed. With this method, HMTD and TATP have been analyzed in the same run. (Pseudo-)molecular ions of these peroxides have been obtained as base peak under the same condition. A series of product ions was produced from these pseudo-molecular ions ([HMTD - 1]+ and [TATP + NH4]+) in the MS/MS analysis. We also pioneered in showing that a TATP molecular ion [TATP + H]+ can be observed with HPLC-MS/MS. The limit of detection for HMTD and TATP was 0.26 and 3.3 ng, respectively, on column by HPLC-MS in the Full Scan mode and 0.08 and 0.8, respectively, by HPLC-APCI-MS/MS in Selected Reaction Monitoring (single mass unit) mode. The method presented has been applied successfully for the identification of peroxides in the bulk solid state (powder sample), as well as in post-blast extracts originating from a forensic case. For the post-blast extracts, the use of tandem MS has been shown clearly to be of crucial importance for the identification and detection of the peroxide explosives.     

The significance of pulmonary interstitial emphysema in live birth determination

The utility of pulmonary interstitial emphysema (PIE) in live birth determination is not well established. Because the distinction between live birth and stillbirth may be important in criminal proceedings, we undertook this study to investigate the relationship between the histologic finding of PIE and live birth. Sixty-six cases of infant death were retrieved and compared with 21 stillborn infants. Histologic sections of the lungs were characterized as "florid PIE," "equivocal PIE," or "absent PIE." Sixteen cases of florid PIE were identified, all in live born infants. Forty-seven cases of equivocal PIE were found in 36 live born and 11 stillborn infants. In 24 cases (14 live born infants and 10 stillborns), no PIE was identified. We examined the relationship between florid PIE in infants with sudden infant death syndrome (SIDS) or "sudden unexpected death in infancy, manner undetermined" (SUDI), and also its relationship to other variables. No association was found. The presence of equivocal PIE may be an artifact of tissue processing. Florid PIE is found only in live born infants. No correlation between the presence of florid PIE and cause of death could be determined.     

A laboratory incubation method for determining the rate of microbiological degradation of skeletal muscle tissue in soil

A controlled laboratory experiment is described, in principle and practice, which can be used for the of determination the rate of tissue decomposition in soil. By way of example, an experiment was conducted to determine the effect of temperature (12 degrees, 22 degrees C) on the aerobic decomposition of skeletal muscle tissue (Organic Texel x Suffolk lamb (Ovis aries)) in a sandy loam soil. Measurements of decomposition processes included muscle tissue mass loss, microbial CO2 respiration, and muscle tissue carbon (C) and nitrogen (N). Muscle tissue mass loss at 22 degrees C always was greater than at 12 degrees C (p < 0.001). Microbial respiration was greater in samples incubated at 22 degrees C for the initial 21 days of burial (p < 0.01). All buried muscle tissue samples demonstrated changes in C and N content at the end of the experiment. A significant correlation (p < 0.001) was demonstrated between the loss of muscle tissue-derived C (Ct) and microbially-respired C (Cm) demonstrating CO2 respiration may be used to predict mass loss and hence biodegradation. In this experiment Q10 (12 degrees C-22 degrees C) = 2.0. This method is recommended as a useful tool in determing the effect of environmental variables on the rate of decomposition of various tissues and associated materials.     

Oxycodone intoxication in an infant: accidental or intentional exposure?

A case is presented of a 10 month old male who went into cardiac arrest at a local store. The infant subsequently expired and was autopsied at the Office of the Chief Medical Examiner, State of Maryland. The only remarkable finding was the detection of oxycodone in the postmortem specimens; the blood and liver oxycodone concentrations were 0.6 mg/L and 1.6 mg/kg, respectively. Oxycodone was identified and quantitated by gas chromatography-nitrogen-phosphorus detection and confirmed by full scan electron ionization gas chromatography-mass spectrometry. The medical examiner ruled that the cause of death was oxycodone intoxication, and the manner of death was homicide. The key toxicologic question in this case was whether or not it was reasonable for the infant to be exposed to oxycodone exclusively through breast milk or through an alternate source. It was concluded that, at best, there were serious concerns about the likelihood of drug exposure through consumption of breast milk.     

Analysis of nitrite in adulterated urine samples by capillary electrophoresis

A simple method for analyzing nitrite in urine has been developed to confirm and quantify the amount of nitrite in potentially adulterated urine samples. The method involved separation of nitrite by capillary electrophoresis and direct UV detection at 214 nm. Separation was performed using a bare fused silica capillary and a 25 mM phosphate run buffer at a pH of 7.5. Sample preparation consisted of diluting the urine samples 1:20 with run buffer and internal standard, and centrifuging for 5 min at 2500 rpm. The sample was hydrodynamically injected, then separated using -25 kV with the column maintained at 35 degrees C. The method had upper and lower limits of linearity of 1500 and 80 microg/mL nitrite, respectively, and a limit of detection of 20 microg/mL. The method was evaluated using the National Committee for Clinical Laboratory Standards (NCCLS) protocol (Document EP10-A2), and validated using controls, standards, and authentic urine samples. Ten anions, ClO-, CrO4(-2), NO3-, HCO3-, I-, CH3COO-, F-, SO4-, S2O8(-2), and Cl-, were tested for potential interference with the assay. Interferences with quantitation were noted for only CrO4(-2) and S2O8(-2). High concentrations of Cl- interfered with the chromatography. The method had acceptable accuracy, precision, and specificity.     

The application of NIST's Fire Dynamics Simulator to the investigation of carbon monoxide exposure in the deaths of three Pittsburgh fire fighters

A case is reported in which computer fire modeling was used to reevaluate a fire that killed three fire fighters. NIST's Fire Dynamics Simulator (FDS) was employed to model the fire in order to estimate the concentration of carbon monoxide present in the dwelling, which was the immediate cause of death of two of the fire fighters, who appear to have removed their face pieces in order to share available air. This estimate, along with an assumed respiration volume and known blood carboxyhemoglobin, was plugged into a standard equation to estimate the time of exposure. The model indicated that 27 min into the fire, the carbon monoxide concentration had already reached approximately 3600 ppm. At this concentration, and a respiration of 70 L/min, an estimated 3 to 8 min of exposure would have been required to accumulate the concentrations of carboxyhemoglobin (49, 44, and 10%) measured on the fire fighters at autopsy.     

A selection of some of Dr. McCrone's high and low profile cases in the forensic analysis of art

Throughout Dr. McCrone's active professional career of over 60 years, he worked on many cases involving the forensic analysis of art. This is an overview of a small portion of these cases. Included (exposed as fakes) are the Shroud of Turin, the Vinland Map, Mayan pottery illustrations and Larionov pastels. Also included, with strong support for authentication, are three paintings attributed to Manet, Giorgione, and Leonardo da Vinci.     

Organic explosives analysis using on column-ion trap EI/NICI GC-MS with an external source

In this study, a standard method by gas chromatography coupled with mass spectrometry (GC/MS) for the analysis of classical organic explosives was developed. This method was validated in the EI mode, based on the XPT 90-210 standard method. Detection limits (LOD) and quantitation limits (LOQ) were both determined using electronic impact (EI) and negative ion chemical ionization (NICI) modes. These were compared and results showed that in the NICI mode, detection limits were lower than in the EI mode, thus NICI mode appeared to be the best way to analyze nitrate esters. Results of ion trap MS detection were then compared with those obtained in a previous study with single quadrupolar technology. Major ions that were obtained using ion trap MS detection in these two modes were reported.     

Lineup Identification by Children: Effects of Clothing Bias

This study examined effects of clothing cues on children's identification accuracy from lineups. Four- to 14-year-olds (n = 228) saw 12 video clips of individuals, each wearing a distinctly colored shirt. After watching each clip children were presented with a target-present or target-absent photo lineup. Three clothing conditions were included. In 2 conditions all lineup members wore the same colored shirt; in the third, biased condition, the shirt color of only one individual matched that seen in the preceding clip (the target in target-present trials and the replacement in target-absent trials). Correct identifications of the target in target-present trials were most frequent in the biased condition, whereas in target-absent trials the biased condition led to more false identifications of the target replacement. Older children were more accurate than younger children, both in choosing the target from target-present lineups and rejecting target-absent lineups. These findings suggest that a simple clothing cue such as shirt color can have a significant impact on children's lineup identification accuracy.