Clozapine dose-concentration relationships in plasma, hair and sweat specimens of schizophrenic patients

The aim of the present study was to establish an analytical method for the determination of clozapine in sweat and to determine whether the clozapine level in hair and sweat were correlated to the daily dose of clozapine delivered to patients. Twenty-six subjects treated with clozapine at 200-700 mg/day for refractory psychosis were included in the study. Clozapine was determined in plasma by liquid chromatography coupled to a diode array detection system, after extraction with an organic solvent at pH 9.5. Clozapine was extracted from hair and sweat patches specimens by incubation in methanol overnight at 40 degrees C. The residues were analyzed by gas chromatography coupled to mass spectrometry in the electronic impact mode of detection. It was possible to determine clozapine in concentrations ranging from 30 to 1016 ng/ml in plasma (n = 22), from 0.17 to 34.24 ng/mg in hair (n = 23) and from 49 to 5609 ng/patch in sweat (n = 20). Preliminary results suggest a lack of correlation between daily regimen of clozapine and plasma levels of the drug. Therefore, a better dose-concentration relationship was observed in our study between daily dose and hair concentration (r = 0.542, P < 7%) or between daily dose and sweat concentration (r = 0.589, P < 6%), but with wide variations for patients at the same posology. However, the idea of using quantitative drug measurements in hair or sweat to ascertain whether a patient has taken his treatment exactly as prescribed will remain inapplicable.     

Homicidal asphyxia

Homicides due to asphyxia are relatively uncommon. To better understand the presentation of such cases, the files of the Bexar County Medical Examiner's Office were reviewed from January 1, 1985, through December 31, 1998, for all such homicides. A total of 133 cases were found. The largest category was ligature strangulation with 48 deaths (21 male, 27 female). Petechiae were present in the conjunctivae and/or sclerae in 86% of the cases; fractures of the hyoid and/or thyroid cartilage were present in 12.5%. There were a total of 41 deaths from manual strangulation (27 female, 14 male). Petechiae were present in 89% of the cases. In cases of manual strangulation, fractures of the hyoid, thyroid, or cricoid cartilage were found in all the male victims and slightly more than one half of the female victims. Twenty-six cases of suffocation were found; 20 of the victims were < or =2 years of age. Only 1 of these children had petechiae and/or scleral hemorrhage. Five deaths were due to choking. Three of the deaths involved adults who were gagged; 2 deaths involved infants with foreign material pushed into the mouth. Other categories of asphyxia were as follows: 9 deaths due to more than one form of asphyxia; 1 death due to hanging, and 3 deaths due to drowning. Rape was the motive in 66% of the female victims of ligature strangulation and 52% of those due to manual strangulation.     

The role of the high school professional in identifying and managing adolescent suicidal behavior

The ongoing contact of adolescents with high school staff may provide an opportunity for the early identification and effective management of suicidal behavior. In this study, the knowledge, attitude, and experience of 80 high school professionals regarding adolescent suicide were assessed through semistructured personal interviews. Respondents identified more than 30 signs of potential vulnerability — manifestations of depression, verbal and written cues, isolation, and self-destructive behaviors. Among predisposing factors, those related to alienation within the family were most prominent. Other important risk factors were low self-esteem, difficulty in peer relationships, and economic or ethnic differences from other students. When suicidal behaviors occurred, respondents saw students and staff as attempting to be helpful; families were more often viewed as defensive.     

GHB free acid: II. Isolation and spectroscopic characterization for forensic analysis

A reference standard for gamma-hydroxybutyric acid (GHB) free acid is not commercially available, making its analysis in forensic exhibits more difficult. GHB free acid is typically encountered in aqueous solution and in the presence of the lactone, gamma-butyrolactone (GBL), presenting difficulty in Fourier transform infrared (FT-IR) analysis. The strong infrared (IR) absorptivity of the GBL carbonyl band, the shifting of the GBL carbonyl band in aqueous solutions, and the position of the O-H bend for water can mask the main carbonyl band for GHB free acid. Model solutions of beta-hydroxybutyric acid (BHB) and GBL were studied in order to further understand the masking of the GHB free acid carbonyl band in FT-IR analysis. The use of second derivative FT-IR spectroscopy was shown to provide resolution of the free acid carbonyl band, and a presumptive test for GHB free acid was developed and applied. An extension of this work included preparing, for use as a standard reference material, small amounts (< or = 10 mg) of GHB free acid. Preparation was based on the instantaneous reaction of GHB's sodium salt with a stoichiometric amount of hydrochloric acid in aqueous solution, and subsequent isolation of the free acid in neat liquid form. Both FT-IR and proton nuclear magnetic resonance spectra of the neat reference material were obtained and used to verify its identity. The isolation of GHB free acid from actual forensic exhibits is also presented, with identity confirmation using FT-IR.     

Child barbarity and torture: a case report

Penile strangulation with a strand of hair, acting as a tourniquet, and perforation of the eyes with a knife are uncommon accidental injuries in children. In such a situation, a mistreatment must be evoked. We present a case of barbarity and torture involving a young boy 3 years old. He was a victim of penis strangulation and perforation of the eyes, performed on previous surgical and infectious lesions. The mistreatment was performed by his mother's boyfriend. The perpetrator used the previous lesions to hide his misdeed. This amazing case of mistreatment points out the violence of the wounds and their being performed on previous lesions.     

DNA evidence in rape cases and the Debbie Smith Act: forensic practice and criminal justice implications

The Debbie Smith or "Justice for All" Act was passed on November 1, 2004. The act addresses the problem of collecting and analyzing DNA evidence from backlogged rape kits sitting in crime laboratories around the country. Presently, no empirical data exist by which to assess the soundness of the legislation. However, the act clearly affects discrete operations within the forensic and criminal justice systems. This article explores the relative merits of the Debbie Smith law, highlighting changes in Sexual Assault Nurse Examiner (SANE) programs, law enforcement, court administration, correctional treatment, and juvenile justice practices. Concerns linked to the likely impact of the "Justice for All" Act raise significant questions about its overall programmatic utility and treatment efficacy.     

The variant of forensic-medical examination of the hypothalamic-hypophyseal system in cases of death due to a mechanical trauma

The authors propose the method of total isolation of the hypothalamic-hypophyseal system for more effective study of causes of death in craniocerebral injury and pathology in expert practice. The method can be also applied for making an anatomic preparation of the brain and hypophysis in teaching anatomy.