Death by ‘ice’: fatal methamphetamine intoxication of a body packer case detected by postmortem computed tomography (PMCT) and validated by autopsy

Fatal acute methamphetamine (MA) poisoning in cases of internal drug trafficking is rarely described in the literature. This case study reports an MA ‘body packer’ who died from fatal methamphetamine intoxication due to leaking drug packages in the alimentary tract. The deceased was examined by postmortem computed tomography (PMCT), and the results were correlated to subsequent autopsy and toxicological findings. The deceased was arrested by the police when he was found disoriented in the city of Kuala Lumpur. He was transferred to the emergency department on suspicion of drug abuse. The initial drug screening was reactive for amphetamines. Shortly after admission to the hospital, he died despite rigorous resuscitation attempts. The postmortem plain chest and abdominal radiographs revealed multiple suspicious opacities in the gastrointestinal tract attributable to body packages. An unenhanced whole body PMCT revealed twenty-five drug packages, twenty-four in the stomach and one in the transverse colon. At least two were disintegrating, and therefore leaking. The autopsy findings were consistent with the PMCT results. Toxicology confirmed the diagnosis of fatal methamphetamine intoxication.     

Are the injuries caused by the "water bombs" dropped by the Canadair airplane blast injuries?]

During the forest fire extinguishing in summer using the fire-fighting amphibia (the Canadair) seven soldiers were injured by the "water bomb" dropped from the amphibia and two soldiers died. The way of injury occurrence as well as type and nature of injuries, imposed the question to the author: could it be a case of blast injuries, especially of primary blast injuries? Except for pure scientific reasons, a positive answer could have a practical importance both in regulation of work of persons engaged in fire combat on the ground during extinguishing of fire by the amphibia as well as for physician's work with those exposed to water impact from the plane and who could be eventually injured. Defining any mechanical injuries as transmission of the corresponding kinetic energy, the author considers that the mechanism of injury occurrence of the internal organs caused by the impact of the "water bomb" from the amphibia is the transmission of the energy impact wave into the body. The author has concluded that the impact of the "water bomb" dropped from the fire fighting amphibia can cause changes in the internal organs which are characteristic of primary blast injury. It is proposed that persons exposed to impact even in the absence of visible changes should be subjected to otorhinolaryngologic, and, in special cases, to pulmonary examinations.     

Drowning—post-mortem imaging findings by computed tomography

The aim of this study was to identify the classic autopsy signs of drowning in post-mortem multislice computed tomography (MSCT). Therefore, the post-mortem pre-autopsy MSCT- findings of ten drowning cases were correlated with autopsy and statistically compared with the post-mortem MSCT of 20 non-drowning cases. Fluid in the airways was present in all drowning cases. Central aspiration in either the trachea or the main bronchi was usually observed. Consecutive bronchospasm caused emphysema aquosum. Sixty percent of drowning cases showed a mosaic pattern of the lung parenchyma due to regions of hypo- and hyperperfused lung areas of aspiration. The resorption of fresh water in the lung resulted in hypodensity of the blood representing haemodilution and possible heart failure. Swallowed water distended the stomach and duodenum; and inflow of water filled the paranasal sinuses (100%). All the typical findings of drowning, except Paltau’s spots, were detected using post-mortem MSCT, and a good correlation of MSCT and autopsy was found. The advantage of MSCT was the direct detection of bronchospasm, haemodilution and water in the paranasal sinus, which is rather complicated or impossible at the classical autopsy.     

Exercise improved rat metabolism by raising PPAR-α

Based on the importance of exercise and crucial role of liver in metabolism, the aim of this study was to determine whether the expression of peroxisome proliferator-activated receptor (PPAR)-α, γ and adiponectin receptor 2 in OLETF rat liver were altered in conjunction with improved metabolism with exercise training. OLETF rats were randomly assigned to 2 groups: sedentary control group (n=26), and long-term exercise-trained group (n=26). Full data were available on 32 OLETF rats (16 for each group). Adiponectin, glucose, insulin, triglyceride and cholesterol were assessed. Livers were taken to determine the expression of PPAR-α, γ and adiponectin receptor 2. Compared with sedentary control group, fasting glucose (9.38 ± 2.99 mmol/L vs. 7.32 ± 1.76 mmol/L, P<0.05), triglyceride (1.73 ± 0.34 mmol/L vs. 0.89 ± 0.12 mmol/L, P<0.05) and cholesterol (4.41 ± 0.75 mmol/L vs. 2.13 ± 0.32 mmol/L, P<0.05) were substantially reduced after exercise, which significantly correlated with increased PPAR-α (P<0.05) in liver. The expression of PPAR-α upstream and target genes, including hepatocyte nuclear factor-4 (HNF4), carnitine palmitoyl transferase 1 (CPT-1), catalase (CAT) and ATPbinding cassette transporter A1 (ABCA1) also increased significantly. Therefore, our findings suggest that increased PPAR-α expression in OLETF rats liver is a contributory factor to the exercise-related improvements in whole-body metabolism.     

A Survey of Medication Taken by Chinese Athletes

INTRODUCTIONIn 1999,thousandsofathleteswereavailablefordrugtestingatChinaDopingControlCenter (CDCC) .AlltestswereanalyzedattheCDCClaboratory .Forthetest,ath letesinoroutofcompetitionwereaskedtoprovideurinesamplesforanalysis .Meanwhile ,eachofthemwasaskedtofillinaformof“DopingControlSampleCollection”inwhichtheyansweredthequestion :“Whatmedicationshaveyoutakeninthepast 3days ?”Allformswiththeanswerswerecollectedandturnedintothedataofstatis ticsforthissurvey .Thissurveyrecordedthe…     

Can body volume be determined by PET?

Purpose

To avoid dependence on body weight, the standardised uptake value (SUV) in positron emission tomography (PET) can instead be normalised to the lean body mass (LBM), which can be determined from body volume and mass. This study was designed to answer the following questions: Firstly, can the total body volume in principle be determined using PET? Secondly, is the precision of this measurement comparable to that achieved using an established standard method.

Methods

Ten patients were examined during oncological whole-body PET examinations. The whole-body volume of the patients was determined from the transmission scan in PET. Air displacement plethysmography with BOD POD was used for comparison as the standard method of volume determination.

Results

In all patients, the whole-body volumes could be determined using PET and the standard method. Bland and Altman [23] analysis for agreement between the volumes determined by the two methods (presentation of differences vs means) revealed a very small difference of ?0.14 l. With a mean patient volume of 71.81±15.93 l, the relative systematic error is only <0.1%. On this basis, equality of the volume values determined by the two methods can be assumed.

Conclusion

PET can be used as a supplementary method for experimental determination of whole-body volume and total body fat in tumour patients. The fat content can be used to calculate the LBM and to determine body weight-independent SUVs (SUV_LBM).     

Analysis of “Ecstasy” by capillary electrophoresis

Capillary electrophoresis (CE) and it's applications in forensic toxicology are demonstrated by the investigation of amphetamine derivatives in Ecstasy tablets. The method is based on capillary zone electrophoresis (CZE) with a phosphate running buffer (pH 2.2). The drugs were dissolved in 0.01 N hydrochloric acid, diluted with distilled water and phenylephrine was added to the samples as an internal standard. A separation of the charged substances is obtained by the different velocities in the electric field. The qualitative determination can be made by the migration times or more accurately by the relative migration times. Other possibilities for identification are the UV-spectra using a diode array detector or the on-column standard addition procedure. By this procedure the sample solution is initially injected followed by the standard solution. Both are concentrated in the column before separation begins. CE shows clear advantages in comparison to high-performance liquid (HPLC) or gas chromatography (GC). The quantitative analysis was carried out using the internal standard phenylephrine.The values obtained for 56 Ecstasy tablets and powder containing amphetamine or its derivatives were compared in this study after analysis with CE and HPLC. The results were in very good agreement. Because of it's speed, the high resolving power and the possibility of identification with the on-column standard addition, CE is a powerful alternative to HPLC or GC for the investigation of Ecstasy tablets.     

Is prepubertal growth adversely affected by sport?

PURPOSE: To study the effect of genetic factors, birth weight, early childhood growth, sport, hours of training, and pubertal status on the stature and body mass index (BMI) of children aged 9-13 participating in sports at a competitive level. METHODS: A total of 184 children (96 girls, 88 boys), competing in swimming, tennis, team handball, and gymnastics, were investigated, assessing their height, weight, pubertal development, and BMI. Of these, 137 (76 girls, 61 boys) returned a questionnaire, which enabled us to determine height and BMI at age 2-4, birth weight, and parental heights. RESULTS: Significant differences in standard deviation scores (SDS) for actual height and for height at age 2-4 were found in both sexes between the four sports. In girls, BMI SDS was significantly different between the four sports, whereas no difference was found in boys. Each sport investigated separately showed no change in height SDS and BMI SDS between ages 2-4 and 9-13. A regression analysis showed that target height, height at age 2-4, and pubertal status had a significant impact on actual height. Interestingly, the type of sport and hours of training per week had no effect on height SDS. In boys, BMI at age 2-4 and pubertal status had a significant effect on actual BMI, whereas in girls, only BMI at age 2-4 was significant. CONCLUSIONS: The results suggest that prepubertal growth is not adversely affected by sport at a competitive level and that constitutional factors are of importance for choice of sport in children.     

Can proprioception really be improved by exercises?

There is little question that ankle disc training can improve ankle muscle motor performance in a unipedal balance task, most likely through improved strength and coordination [62] and possibly endurance. How much of the observed improvement in motor performance is due to improved ankle proprioception remains unknown. We have reviewed a number of theoretical ways in which training might improve proprioception for moderately challenging weight-bearing situations such as balancing on one leg. Although the relevant experiments have yet to be performed to test this hypothesis, any improvement would theoretically help to reduce injuries at these moderate levels of challenge. We question, however, whether these exercises can ever improve the reactive response required to prevent injury under the most challenging time-critical situations. If confirmed, this limitation needs to be acknowledged by authors and practitioners alike. Alternative protective strategies for the most challenging time-critical situations should be sought. We conclude that, despite their widespread acceptance, current exercises aimed at "improving proprioception" have not been demonstrated to achieve that goal. We have outlined theoretical scenarios by which proprioception might be improved, but these are speculative. The relevant experiments remain to be conducted. We argue that even if they were proven to improve proprioception, under the best circumstances such exercises could only prevent injury under slow to intermediate rate provocations to the joint musculoligamentous complex in question.     

Homicide–suicide by oral administration of cyclobarbital

We report fatal cases of cyclobarbital poisoning. A Japanese husband and wife, 89 and 91 years old, respectively, were found dead in their locked home. The postmortem blood concentrations of cyclobarbital in the husband (68 μg/ml) and wife (70 μg/ml) were measured by gas chromatography–mass spectrometry and clearly exceeded the therapeutic range. In the absence of other remarkable autopsy findings, the deaths in these two cases were determined to be caused by cyclobarbital poisoning, which is extremely rare. Despite its current unavailability, cyclobarbital was shown to be the cause of death, emphasizing the importance of toxicological screening for cyclobarbital.     

Cerebral blood flow abnormalities induced by transient hypothyroidism after thyroidectomy —analysis by Tc-99m-HMPAO and SPM96—

The current study is an investigation of alterations in regional cerebral blood flow (rCBF) distribution in patients with transient hypothyroidism after thyroidectomy. In addition, the effects of thyroxine treatment on rCBF changes were studied. METHODS: Noninvasive rCBF measurements using 99mTc-HMPAO SPECT were performed on 24 post-thyroidectomy patients who were in a hypothyroidic state. The measurements were conducted before 131I therapy and after thyroid hormone (thyroxine) replacement. We used adjusted rCBF images (normalization of global CBF for each subject to 50 ml/100 g/min with proportional scaling) to compare these data with age-matched normal control groups (n =15) using SPM96. We also compared the absolute rCBF value of hypothyroidic patients with those of normal control groups. In addition, the association between rCBF alteration and the severity of depression was also analyzed. Finally, the effect of thyroid hormone replacement on rCBF was investigated individually using the Jack-knife test, in which patient data were compared with those from healthy volunteers. According to the result of this test, all cases were categorized into three subgroups, namely, improved, unchanged group and normal. To prove the reversibility of rCBF alteration after thyroid hormone replacement, a group comparison test between the normal controls and the improved group was done before and after thyroid hormone replacement. Similarly a group comparison test between the unchanged group and normal controls was also performed. RESULTS: In the hypothyroidic condition, there was a significant decrease in the posterior part of the bilateral parietal lobes and in part of the bilateral occipital lobes, including the cuneus. These decreased rCBF areas extended to the bilateral prefrontal cortices as deterioration became more profound. On individual analysis, 16 of 24 patients (66.7%) demonstrated rCBF reduction, while 8 patient did not show significant rCBF change (33.3%, the normal group). After thyroxine replacement, improvement of rCBF was noted in nine of 16 patients (56.3%, the improved group). In seven of 16 patients (43.7% the unchanged group), the significant low rCBF area remained unchanged. Compared with the normal controls, the improved group showed significantly decreased rCBF of the bilateral parietal lobe and the occipital lobe in the hypothyroic condition. After thyroid hormone replacement, these abnormal rCBF areas disappeared. In contrast, in the unchanged group, the significant hypoperfusion area became localized but remained. CONCLUSION: 99mTc-HMPAO SPECT and SPM96 analysis demonstrated a significant rCBF decrease in the parietal lobe and part of the occipital lobe in patients with induced transient hypothyroidism after thyroidectomy. This phenomenon might contribute to understanding of the depressive state. Recovery of rCBF after thyroid hormone replacement was confirmed in some patients. However, rCBF improvement did not always occur in every patient during the follow up period. The reversibility of rCBF in transient hypothyroidism may be dependent on individual characteristics during a short-term period.     

How few cancer cells can be detected by positron emission tomography? A frequent question addressed by an in vitro study

Purpose

Positron emission tomography (PET) has gained widespread use in cancer diagnosis and treatment, but how many malignant cells are required for a tumour to be detected by PET?

Methods

Three human cancer cell lines [glioblastoma and two subtypes of small cell lung cancer (SCLC)] in concentrations from 10⁴ to 10⁷ were seeded on six-well plates or plastic tubes and treated with [¹⁸F]fluorodeoxy-glucose (FDG) in vitro. FDG retention was measured in a PET/CT scanner and in a calibrated well counter. The clinical situation was simulated using a cylinder phantom with a background concentration of FDG.

Results

The theoretical detection limit was found to be around 10⁵ malignant cells. In a cylinder phantom the detection limit was increased by a factor of 10. The FDG retention by the glioblastoma cell line was significantly higher than the activity of the SCLC cell line. FDG retention measured by PET and a gamma counter was closely correlated to the number of cells and a linear relationship was found.

Discussion

The detection limit of PET is in the magnitude of 10⁵ to 10⁶ malignant cells. The experimental set-up was robust and well suited as a platform for further investigations of factors influencing the detection limit of PET.     

Accuracy of appendicular radiographic image interpretation by radiographers and junior doctors in Ghana: Can this be improved by training?

IntroductionAccess to image interpretation in Ghana remains a challenge with the limited number of radiologists. Radiographers with the right skills and knowledge in image interpretation could help address this challenge. The aims of the study were to determine and compare the ability (accuracy, sensitivity and specificity) of radiographers and junior doctors in interpreting appendicular trauma radiographs both before and after training.MethodsAn action research study involving a pre and post training test was carried out to determine the level of accuracy, sensitivity and specificity in abnormality detection by radiographers after undergoing training when compared to junior doctors. Eight radiographers and twelve junior doctors were invited to interpret an image bank of 30 skeletal radiographs, both before and upon completion of an educational program. The participants’ tests were scored against a reference standard provided by an experienced radiologist. Pre and post-test analysis were carried out for comparison.ResultsPost training mean accuracy (radiographers 83.3% vs 68.8%, p = 0.017; doctors 81.9% vs 71.6%, p = 0.003), sensitivity (radiographers 83.3% vs 69.2%, p = 0.042; doctors 77.2% vs 67.8% p = 0.025) and specificity (radiographers 83.3% vs 68.3%, p = 0.011; doctors 86.7% vs 75.6% p = 0.005) of both groups significantly improved. No significant differences were recorded between the radiographers and doctors after the training event.ConclusionThe study revealed that, with a well-structured training program, radiographers and junior doctors could improve on their accuracies in radiographic abnormality detection and commenting on trauma radiographs.     

Homicide followed by suicide: remorse or revenge?

Homicide is followed by the suicide of the assailant in around 4% of homicide-suicide episodes in England and Wales. The assailant is invariably a man who most commonly kills his spouse and/or children. Shooting is the most common method of suicide and homicide in these cases. It has been asserted that the low rate of homicide and relatively high rate of suicide in killers is a result of English killers internalizing their culture's abhorrence of killing. However, examination of homicide-suicide episodes indicate that in most episodes the decision to commit suicide has been taken before the decision to kill and that only a minority of suicides in assailants are out of remorse. Homicide followed by suicide is a distinct category of homicide which has features that differ from other forms of killing. These episodes are complex and do not reflect simple remorse following the killing. Homicide-suicide episodes in England are similar to those in countries with higher homicide rates.     

Radicals Produced by the Reactions of SO−4 with Uridine and Its Derivatives. Studies by Pulse Radiolysis and γ-radiolysis

Summary

Using a pulse radiolysis technique, the sulphate radical, SO^?₄, has been demonstrated to react with uridine, 3′-UMP and 5′–UMP to produce intermediates of a new type, decaying according to a first-order rate law with k = 2·1 4·1, 3·0 × 10⁵ s^?1 respectively at pH7. The rate for uridine increases slightly with increasing pH. With deoxyuridine and 2′, 3′-isopropylidene uridine, on the other hand, OH adduct radicals with longer lives (second-order decay) were found in accordance with the known fact that similar radicals are produced from N(1)-methylated uracils with SO^?₄. On γ-irradiation of similar solutions containing the substrates that produce such short-lived species, chain reactions and high yields of unaltered uracil were found. Some optical properties are detailed and a probable structure of the short-lived species is discussed in relation to the substituent effect at the 2′ position of the sugar part and to its strong reducing ability revealed by the rapid reaction with TNM.