Anorectic sibutramine detected in a Chinese herbal drug for weight loss

In the presented case, a young healthy woman had ordered a Chinese herbal medicine, called "LiDa Dai Dai Hua Jiao Nang", via internet. She took this product for approximately 1 week, but on the second day she developed severe headache, vertigo and sensation of numbness. After discontinuing medication, symptoms disappeared within 2 days. For identification of the ingredients, a urine sample as well as a sample of the "LiDa" capsule were analysed by GC-MS and HPLC-DAD. One major ingredient was detected in urine as well as in the "LiDa" capsule and was identified as sibutramine. Quantification by HPLC-DAD yielded 27.4 mg sibutramine base, which is approximately two times the amount of the highest authorized single dose available on the pharmaceutical market in Germany. This case demonstrates a common problem with herbal medicines, where adulterations with synthetic therapeutic substances can lead to severe side effects and/or potentially fatal interactions with conventional medicines.     

Survival of severe amlodipine intoxication due to medical intensive care

We report the case of attempted suicide with amlodipine, chlorthalidone and mefenamic acid and subsequent medical intensive care measures which resulted in total recovery of a 42-year-old male. After admission to the medical intensive care unit the intoxicated patient was deeply hypotensive and needed fluid replacement, dobutamine and norepinephrine. Additionally insulin and calcium gluconate were given. Since hypotension persisted and the patient developed oliguria, terlipressin was applied and finally showed an effect on blood pressure and on urinary output. A volume overload of 7 L in the first 24 h resulted in a pulmonary edema. The patient was started on non-invasive ventilation with continuous positive airway pressure (CPAP) and frusemide was added to the therapy with good success. Quantitative determination of amlodipine in plasma samples was performed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The highest amlodipine concentrations was measured in the plasma sample collected approximately 8 h after ingestion of the drug, and was 393 microg/L. Four days later, it was possible to stop the treatment with catecholamines, at that time the amlodipine plasma concentration had declined to 132 microg/L, still tenfold higher than therapeutic (5-18 microg/L). Elimination half-life of amlodipine is approximately 55 h. After 6 days in the intensive care unit the patient was transferred to psychiatric treatment. Intensive care management and plasma levels in this intoxication case are compared to data from literature on other cases.     

The potential of venous air embolism ascending retrograde to the brain

A bench study was performed to investigate the potential of air bubbles entering a central vein via a central venous catheter to ascend retrograde to the brain. The results support the hypothesis that air bubbles may rise retrograde against the venous blood flow, depending on bubble size, central vein diameter and cardiac output. A review of radiological findings in published case reports indicates that the occurrence of retrograde cerebral air embolism is underestimated.     

mtDNA investigations after differential lysis

In order to gain information regarding the ethnic origin of an unknown offender in a murder case it was necessary to sequence the HV1 and 2 regions of the mitochondrial DNA (mtDNA). The only evidentiary material that could be linked to the suspect was DNA, extracted from spermatozoa after differential lysis. The observed mtDNA sequences were identical to the sequences of the victim. Therefore, we had to check if this was a coincidence or the result of a technical limitation of the testing procedure. Subsequently, we performed a systematic study. In cases with complete separation of sperm and female cells it wasn't possible to obtain a mtDNA sequence for the sperm fraction. This phenomena is based on the loss of the sperm's flagellum and mid-piece during the first lysis step and a concomitant loss of the sperm's mitochondria. In our murder case, a minor carry-over of female cells to the sperm fraction was responsible for the sequencing result.     

Assignment of a bite-mark on the victim's skin to the dentition of the perpetrator by means of anomalies in the number and position of the frontal teeth

This report is about a bite mark on the breast of a female corpse. The woman had been killed by ligature strangulation at the age of 76 years. The investigation of the dental casts of a suspected man showed some anomalies in the dentition and orthodontic variations. A comparison of the bite mark with these anomalies demonstrated the correspondence of several details. Consequently, the probability that the suspect was responsible for the bite mark was regarded as being very high. During the further investigations the suspect admitted the offence including the bite injury to the breast. The authors emphasize the importance of an exact photographic documentation as an indispensable prerequisite for an odontological comparison.     

Self-mutilation in men--injury pattern and motivation

6 cases of self-inflicted injuries in male individuals are reported. The age of the affected men was between 15 and 46 years whereas the younger age predominated. Alleged incidents were robberies in 3 cases, rape in one case, violation in custody in one case and an assault originating in personal motives in one case. In 4 cases, the typical injury pattern of self-infliction was present showing parallel course and superficiality of the wounds in areas accessable by the persons's own hands. In 2 cases, atypical injuries (i.e. deep cuts and massive signs of strangulation respectively) were found. However, in most cases, the underlying motive was to gain affection. An autoerotic accident was tried to be disguised in one case. Profit was the leading motive in another case.     

Neo-Voluntarism: A New European Social Policy Regime?

Abstract: The essay begins with a recapitulation of core institutional properties of the European Union as they have evolved over several decades. The leading insight deriving from this exercise is that European social policy will always, for all practical purposes, be made simultaneously at two levels, a supranational one and a national one, and will be shaped by complex interactions between them and among the national systems situated in the integrated market economy of the Union. Proceeding from here, the remainder of the paper examines the two levels of social policy-making, beginning with the supranational and moving on to the national, in an effort to identify the kinds of policies that are most likely to emerge given the constraints and opportunities offered by the institutional framework.     

Archived or directly swabbed latent fingerprints as a DNA source for STR typing

Former studies [Nature (1997) 387, Electrophoresis 20 (1999) 2870, P. Van Renterghem, D. Leonard, C. De Greef, Progress in Forensic Genetics, Vol. 8, 2000, p. 501, J. Forensic Sci. 45 (3) (2000) 687] have shown that even a single skin contact, documented by a latent fingerprint, can transfer enough DNA for a genetic analysis. It was proven in these studies that it is possible to swab fingerprints from surfaces [Nature (1997) 387, Electrophoresis 20 (1999) 2870, P. Van Renterghem, D. Leonard, C. De Greef, Progress in Forensic Genetics, Vol. 8, 2000, p. 501] and use them as a DNA source. Usually, however, discovered fingerprints are removed with scotch tape and placed on evidence cards for further investigation.In this study, we tried to assess the potential use of latent fingerprints as a DNA source for STR typing. The materials (magnetic powder, soot powder and scotch tape) used for visualization and archiving fingerprints in Germany were tested for their PCR inhibitory characteristics. Then, fingerprints were placed on clean glass surfaces, visualized and tested for their usefulness as a DNA source.Obtained DNA was quantified and tested in an STR system. Partly it proved possible to type fingerprints taken directly from the surface as well as fingerprints removed from the surface with scotch tape.     

Time-dependent immunohistochemical detection of proinflammatory cytokines (IL-1beta,IL-6, TNF-alpha) in human skin wounds

The proinflammatory cytokines interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha) hold important functions in the early and late courses of inflammation, trauma and wound healing. In the present study, human skin wounds due to sharp force (n = 105) were collected during surgery and autopsy. The wound age mainly varied from several minutes to 5 h, some specimens aged up to 6 weeks. Control specimens from uninjured skin were available in each case. After preparation of cryostat sections, immunohistochemistry was performed according to the APAAP technique, using monoclonal and polyclonal antibodies. The results were evaluated semiquantitatively. All markers were weakly expressed in normal human skin constitutively. However, the staining pattern changed significantly in vital wounds concerning epidermal layers, subepidermal cells, vessels and sweat glands. IL-1beta and IL-6 showed enhanced expression after 15 and 20 min at the earliest (increase of epidermal reactivity). After 30-60 and 60-90 min, respectively, marked expression was observed with these markers. Similar alterations were detectable with TNF-alpha after 15 and 60-90 min. The reactivity of all three markers persisted over several hours, then decreased to basal levels again and sometimes reappeared after days and in granulation tissue. Leukocytes reacting with IL-1beta and IL-6 appeared after approximately 2 h. CONCLUSION: proinflammatory cytokines can serve as a useful tool for the estimation of vitality and wound age, in particular in the early post-traumatic interval prior to leukocyte reaction. Autolysis did not play a role in the samples investigated (postmortem interval up to 8 days). Problems could sometimes rise from constitutive expression. Therefore, it is recommended to examine control samples from the same individual and to compare the reactivity with wound specimens.