A high selective screening test for methamphetamine in human urine

A high selective screening test (Ad-Tip method) for methamphetamine in human urine has been devised. The method involves a brief extraction from a urine sample with an Ad-Tip (ODS-silica minicolumn), washing, eluting with modified Simon's reagent, and coloration with carbonate buffer. Detection limit of methamphetamine in urine is 1 microgram/ml and the test takes within 3 min/sample. The results of the Ad-Tip method were almost identical to those of laboratory analyses.     

Chloroquine as a poison in murder. Report of fatalities after criminal or suicidal chloroquine administration

Presented is a case of murder by means of chloroquine, committed on a 36-year-old male. The wife of the deceased had confessed to have secretely administered chloroquine-containing tablets to her husband. She was lawfully sentenced to life-imprisonment. The toxicological findings of this case are compared to the results of two chloroquine suicide cases and discussed in the context of the referring literature. An additional case where chloroquine intoxication was doubtful is introduced because of the unusual circumstances under which it occurred.     

Commotio cordis, revisited

Nonpenetrating cardiac injuries due to direct precordial blunt impacts are a commonly encountered phenomenon in medicolegal offices. These injuries vary from contusions to valvular lacerations, or papillary muscle rupture to coronary arterial injury with resulting infarction. A less commonly occurring manifestation of nonpenetrating injury is a concussion of the heart (commotio cordis), often with dramatic physiological consequences but no morphologic cardiac injury. We describe four case reports of this entity. The cases were collected over a 5-year period (1978-1983) from the Wayne County Medical Examiner's Office in Detroit, Michigan.     

Sudden unexpected nocturnal death syndrome in the Mariana Islands

Sudden unexpected nocturnal death syndrome (SUNDS) is a distinct clinical entity in previously healthy, young, Southeast Asian males. It is well known in the Philippines and more recently recognized in the U.S. by nonspecific autopsy findings, with no evidence of underlying disease and absence of toxic drug or alcohol levels. In 1973-89, 14 cases of apparent SUNDS came to coroner's autopsy in the Commonwealth of the Northern Marianas (CNMI) and Guam. All 14 cases, with the exception of one Yapese, were previously healthy, male Filipinos, aged 23 to 55, who were either found dead in bed, or described by their colleagues as having nocturnal seizure activity consisting of gurgling, frothing, and tongue biting immediately prior to death. Autopsy findings showed no anatomic findings to account for death. Comprehensive serum and urine drug analyses were negative. All decedents showed absence of significant atherosclerosis or grossly detectable structural cardiac anomaly, while four showed cardiomegaly. Migrants from Southeast Asia carry with them a pre-disposition to this syndrome, which appears to decline with longer residence in the new country. The mechanism of death in SUNDS is believed to be ventricular fibrillation, possibly precipitated by sudden sympathetic discharge. Studies suggest at least some deaths may be associated with an abnormal cardiac conduction system. Acute pancreatitis has been a finding in some series, but not our cases. Why the condition is virtually limited to males and seemingly sleep-triggered, has not been adequately explained. Stress and depression are believed to be predisposing factors.