Dextropropoxyphene concentrations in blood in cases of fatal poisoning

Summary Quantitative determinations of dextropropoxyphene (Doloxene®) in the blood from 20 cases of fatal poisoning with the drug has shown that the minimal fatal concentration of dextropropoxyphene in humans is 2–3 g/ml of blood. An additive effect of the toxicities of dextropropoxyphene and alcohol and of barbiturates is demonstrated. Dextropropoxyphene is shown to be accumulated to a certain extent in the liver, but the liver concentrations vary widely and do not allow an estimate of a corresponding concentration of dextropropoxyphene in the blood.

---

Zusammenfassung Bei 20 tödlichen Vergiftungen mit Dextropropoxyphen (Doloxan®) wurde eine quantitative Bestimmung der Droge im Organmaterial durchgeführt. Beim Menschen wurde die geringste tödliche Konzentration von Dextropropoxyphen mit 2–3 g/ml Blut bestimmt. Es liegen Hinweise für eine additive Wirkung von Alkohol und Barbituraten bei der Dextropropoxyphen-Vergiftung vor. Bis zu einem bestimmten Umfang akkumuliert Dextropropoxyphen in der Leber, doch lassen die hierin bestimmten stark variierenden Konzentrationen keinen Rü ckschluß auf eine entsprechende Konzentration der Droge im Blut zu.

     

Streptococcal toxic shock syndrome with fatal outcome: Report on four forensic autopsy cases

Streptococcal toxic shock syndrome (STSS) is a severe infection most commonly caused by group A streptococcus. It is clinically characterized by rapidly progressive multiple organ failure and septic shock. This report presents four fatal cases associated with STSS. In two cases (cases 2 and 3), the portals of entry may be ulcer and mucosa at the surgical site; the initial symptoms in these cases included fever. In the other cases, the portal of entry was unknown; the initial symptom was pain. In two cases (cases 1 and 3), malpractice was suspected before autopsy. At autopsy, blood culture was positive for group A streptococcus in all of the present cases. Although C-reactive protein levels were increased, procalcitonin levels were not markedly elevated. This is the first report of autopsy cases associated with STSS in which postmortem computed tomography was performed; the swelling of muscles and increased concentrations of peripheral subcutaneous tissue without gas may be characteristic findings. Histology revealed extensive bacterial colonies and necrosis with mild neutrophilic reaction in two cases (cases 3 and 4), and hemophagocytosis in two cases (cases 1 and 4). It is essential to perform appropriate examinations and make a proper diagnosis because STSS still has a high fatality rate and medical malpractice is often suspected. In addition, it is important to evaluate STSS again for the reduction of the fatal cases associated with STSS.     

Specific interpretation of hair concentrations in 2 fatal metformin intoxication cases

Hair analysis is very useful for toxicological investigations since, by providing a wider detection window, it gives the possibility to perform a retrospective study on the historical consumption of a substance. Unfortunately, there are no data available for hair concentrations in metformin-related deaths. In this study, the authors present 2 cases of fatal metformin intoxication in which, for the first time, hair analysis was performed using a specific GC–MS/MS method. Metformin was tested positive in femoral blood (112.3 mg/L and 64.7 mg/L respectively) and cardiac blood (226.9 and 203.2 mg/L) of the two subjects. For case 1, other samples were also tested positive, including vitreous humor (31.1 mg/L) and gastric contents (773.5 mg/L). In case 2, metformin was measured at 844.9 mg/L in urine. Metformin hair concentrations were 28.3–44.8 and 22.5 ng/mg for both cases, respectively. The concentrations found in the 2 fatal cases are clearly higher than those obtained in a previous study with subjects under treatment (0.3–3.8 ng/mg) or those found in 3 post-mortem cases where metformin death was excluded (0.6–1.4 ng/mg). Excessive sweating during the agonal phase due to fatal hypoglycemia could explain these elevated concentrations as sweat can have contaminated the hair.     

Carboxyhemoglobin concentrations in fire victims and in cases of fatal carbon monoxide poisoning

Summary The study comprises an eleven-year autopsy material of 141 cases from the Institute of Forensic Medicine, Oslo. The fatal level of carboxyhemoglobin concentration is calculate from cases of pure carbon monoxide poisoming. Carboxyhemoglobin concentrations below this level are found in approximately thirty percent of the fire victims. Alcohol intoxication, present in many fire victims, is not related to low corboxyhemoglobin concentrations. Presented at The Sixth Scandinavian Meeting in Forensic Medicine, Helsinki, June 16–19, 1976     

Understanding the postmortem changes in concentrations of methanol in ocular matrices in rabbits

Death due to abuse and accidental ingestion of methanol is widely known around the globe. The paper presents the postmortem changes in concentrations of methanol in the vitreous humor, aqueous humor, and ocular tissues in a rabbit model in methanol intoxication. Rabbits were intoxicated with methanol at a dose of 6.3 ml/kg through oral gavage. After 3.5 h of methanol administration, the rabbits were sacrificed. Vitreous humor, aqueous humor, and ocular tissues were collected both, perimortem (immediately) and postmortem (17 h post-death). Whole blood and plasma samples were also collected to explore the correlation between levels of methanol in whole blood/plasma and ocular fluids/ocular tissues if any. All the samples were analyzed by Headspace Gas Chromatography. The analysis revealed a decrease in methanol levels at postmortem for all the matrices, except for retina-choroid than its perimortem value. For retina-choroid, no significant change in methanol levels at postmortem was found.     

Hypereosinophilic Syndrome: CT Findings in Patients with Hepatic Lobar or Segmental Involvement

Objective

The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved.

Materials and Methods

Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation.

Results

CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis.

Conclusion

Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis.     

脂肪肝患者的肝功能与血脂、血糖检测结果异常的分析

目的:探讨脂肪性肝疾病的临床特点,研究脂肪肝患者的肝功能与血脂、血糖检测结果异常的关系。方法:回顾性分析我院140例住院患者的临床资料,研究脂肪肝患者生化结果中发病的危险因素,以及脂肪肝患者的肝功能与血脂、血糖检测结果异常的联系。结果:140例中共检出脂肪肝患者29例,脂肪肝患者与非脂肪肝患者在性别比、TG、GLU、HDLI、CGR15上存在统计学差异,TG、GLU、HDL均为该疾病的危险因素。ICGR15与GLU有明显的正相关性。结论:脂肪性肝疾病是常见的肝脏疾病,积极控制血糖对于保护肝脏功能可能具有积极的意义。     

中国成年男子元素尿日排出量和同体全血与尿样中含量及其关系

目的测定56种元素在中国成年男子同体全血和24h尿样中浓度和估算尿日排出量，探讨两者元素含量间关系。方法在第3阶段器官组织采样相同4地区各采集10例健康成年男子志愿者同体全血和24h尿样。应用ICP—MS、ICP-AES和GFAAS技术，测定56种元素浓度，并采用分光光度法测定各尿样肌酐浓度。结果获得了中国成年男子同体全血与尿样中56种元素和肌酐的浓度及相应日排出量。结论获得中国成年男子同体全血和尿样中这些元素浓度与尿日排出量新资料，为确定中国参考人元素血液组织负荷量和尿日排出量参数参考值提供了初步依据，探索了中国成年男子同体全血和尿样中元素含量间相互关系和地区差异。     

Focal Eosinophilic Necrosis of the Liver in Patients with Underlying Gastric or Colorectal Cancer: CT Differentiation from Metastasis

Objective

To determine the helical CT findings which help differentiate between focal eosinophilic necrosis (FEN) of the liver and metastasis in patients with underlying gastric or colorectal cancer.

Materials and Methods

In 21 patients with underlying gastric and colorectal cancer examined during a recent 18-month period, the presence of FEN (n=90) was proven at CT. The diagnosis was verified by biopsy in eight patients and by the transient nature of the findings related to peripheral eosinophilia (>10%) in the remainder. For comparison, 20 consecutive patients with pathologically proven hepatic metastasis from gastric or colorectal cancer (n=158) were selected. Single-phase helical CT images (7-mm collimation, pitch 1:1) were independently analyzed in a random order by two blinded readers. The parameters evaluated included the margin (depicted border, fuzzy), shape (spherical, non-spherical), attenuation (subtle hypoattenuation, hypoattenuation), and the presence or absence of rim enhancement.

Results

FEN far more frequently showed a fuzzy margin (81%, 84%), subtle hypoattenuation (89%, 91%), and a non-spherical shape (84% for both readers) than metastasis, for which the respective findings were 6%, 22%; 20%, 39%; and 15%, 23%. Rim enhancement was seldom found in FEN (0%, 2%), but was recognized by both readers in 40% of metastases. For all parameters, the results were statistically significant (p < .01), and showed that both readers correctly differentiated FEN from metastasis in 78% of the patients (32/41). Interobserver agreement was, in addition, excellent (κ= 0.66).

Conclusion

When focal hepatic lesions with a fuzzy margin, non-spherical shape and subtle hypoattenuation without rim enhancement are found, the possibility of FEN should be considered even in patients with underlying gastrointestinal malignancy.     

Musculoskeletal manifestations of sickle cell disease,diagnosis with whole body MRI

Purpose

The aim of work is to define the musculoskeletal abnormalities in patients with sickle-cell disease using whole body MRI.

Patients and methods

Twenty-seven patients with known sickle cell disease were included in this study complaining of acute painful vaso-occlusive crisis. All the patients complaining of bony pain in different body regions. Some patients complaining of bony swellings and joint pain. Whole body (W.B) MRI studies were performed for all the patients .Three coronal (T1, T2, and STIR) sequences were performed for whole-body MR imaging. In selected cases, dedicated examination of certain body parts was performed.

Results

Persistent red marrow, intramedullary bone hyperplasia and bone infarcts were seen in all patients. Vertebral bone infarcts were found in 23 patients. Bilateral proximal femoral head epiphysis avascular necrosis were found in 9 patients. Osteomylitis was diagnosed in 6 patients and septic arthritis in 2 patients.

Conclusion

Whole body MRI can help identifying muscloskeletal abnormalities in sickle cell disease in a single session. MRI is a useful imaging tool in distinguishing acute osteomylitis and bone infarct. Knowledge of the range of imaging findings is crucial in order to accurately depict the complication and initiate appropriate therapy.     

DWI对二氯乙烷中毒性脑病的诊断价值(附7例报告)

目的:探讨二氯乙垸中毒性脑病的DWI表现.方法:对7例二氯乙烷中毒性脑病患者行头颅常规MRI 及DWI检查,并测量病灶的ADC值.结果:7例均可见双侧额颞枕顶叶皮质下及白质、小脑齿状核、豆状核、丘脑、外囊和内囊等区域异常信号,常规MRI上呈长T1、长T2信号,DWI上呈高信号.轻症患者(5例)ADC图上病灶呈高信号,重...     

肝动脉血流对兔VX2肝脏肿瘤冷冻效果的影响

目的 通过建立兔VX2肝脏肿瘤模型,观察肝动脉血流对氩氦超低温冷冻消融治疗效果的影响.方法30只成功建立VX2肝脏肿瘤模型的实验兔,于肿瘤种植后第14天,用数字表法随机等分为3组.调整肝动脉血流,肝动脉完全阻断组为A组,部分阻断组为B组,正常对照组为C组.行CT平扫和灌注扫描,计算各组肿瘤组织血流量(BF)、血容量(BV),采用方差分析法分析3组参数之间的差别.然后行氩氦冷冻治疗,术后即刻处死实验兔,取出肝脏.取肝脏肿瘤冷冻区及其周围组织分别进行氯化硝基四氮唑蓝(TTC)及四甲基偶氮唑(MTT)染色,观察大体及镜下病理改变.结果(1)肿瘤种植后第14天,A组肿瘤组织的BF和BV值分别为(7.23±2.15)ml·100 g-1·min-1和(1.63±0.52)ml/100 g;B组分别为(32.65±6.12)ml·100 g-1·min-1和(9.32±2.63)ml/100 g;C组分别为(61.34±12.15)ml·1130 g-1·min-1和(17.51±3.14)ml/100 g,3组间差异均有统计学意义(F值分别为452.16和421.33,P＜0.01).(2)TTC染色显示,肿瘤组织平均最大冷冻直径A组为(2.3±0.3)cm,B组为(1.5±0.2)cm,C组为(0.8±0.1)cm,3组差异有统计学意义(F值为315.32,P＜0.01).(3)MTT染色可见界限清楚的冷冻区、交界带及周围正常染色区;在未结扎肝动脉的C组可见无染色的冷冻区内部分血管周围组织染色阳性.结论 减少肝动脉血流可明显提高肝癌冷冻治疗的效果.     

肝硬化合并肝癌与肝硬化再生结节螺旋CT双期扫描影像分析

目的:分析肝硬化合并肝癌与肝硬化再生结节螺旋CT双期扫描的影像表现并评价其诊断价值.方法:回顾性分析30例肝硬化合并小肝癌,28例肝硬化再生结节螺旋CT平扫、动脉期、门脉期的CT征象.扫描层厚5～10 mm,对比剂为60%的有机碘水溶液,用高压注射器静脉团注,注射流率3 ml/s,总量80～100 ml.动脉期扫描为注射开始后25～30 s,门静脉期为60～70 s.结果:小肝癌平扫多数为低密度,少数为等密度,动脉期全瘤范围强化,其强化密度高于肝但低于同层主动脉,门脉期肿瘤密度从高于肝迅速降至低于肝,同时也低于同层主动脉密度.肝硬化再生结节表现为平扫一般为等密度或稍高密度,动脉期大多数再生结节不强化或呈低密度,极少有轻度强化,门静脉期再生结节多数为均匀强化,少数为低密度.结论:螺旋CT增强双期扫描对肝硬化合并小肝癌具有诊断意义,特别是与肝硬化再生结节的鉴别诊断具有重要意义.     

Postmortem serum nitrogen compounds and C-reactive protein levels with special regard to investigation of fatal hyperthermia

The present study analyzed serum levels of urea nitrogen (UN), creatinine (Cr), and C-reactive protein (CRP), which are very stable during the early postmortem period, for investigation of the cause of death with special regard to hyperthermia (heat stroke) in serial medico-legal autopsy cases (n = 429), excluding fatal injury, intoxication, and fire fatality. In this series, mechanical asphyxiation, drowning, and sudden cardiac death cases (n = 56, n = 43, and n = 212, respectively) usually showed low levels within postmortem reference ranges for these serum markers, although UN and CRP levels were mildly elevated in cases of sudden cardiac death and cerebrovascular stroke. There were concomitant significant elevations in serum levels of UN (>50 mg/dL), Cr (>2 mg/dL), and CRP (>2 mg/dL) for chronic renal failure, gastrointestinal bleeding, pneumonia, and hypothermia (cold exposure). UN and CRP were especially high for chronic renal failure and pneumonia, respectively. However, hyperthermia cases showed an isolated elevation in the serum Cr level, suggesting an influence of systemic skeletal muscle damage. These serum markers may be practically useful for postmortem investigation of death due to hyperthermia (heat stroke), for which specific pathological and toxicological evidence may not be available.     

Analysis of amphetamine,methamphetamine, methylenedioxyamphetamine and methylenedioxymethamphetamine in whole blood using in-matrix ethyl chloroformate derivatization and automated headspace solid-phase microextraction followed by GC-MS

The in-matrix alkyl chloroformate derivatization method for amphetamine, methamphetamine, methylenedioxyamphetamine (MDA), and methylene-dioxymethamphetamine (MDMA) was adapted for use with the whole blood matrix. This derivatization method was followed by automated headspace (HS)-solid-phase microextraction (SPME) and gas chromatography-mass spectrometry (GC-MS) analysis. The sensitivity of this method, expressed as limit of detection, was approximately 10 ng/ml for these analytes tested in the blood matrix, which was sufficient to detect toxic concentrations of amphetamines in blood. The limit of quantitation for target analytes ranged from 0.05 to 0.2 μg/ml. The intraday precision and accuracy studies generally showed satisfactory results for all target compounds except MDA, in which a larger variation was observed. The in-matrix ethyl chloroformate derivatization of amphetamine, methamphetamine, MDA, and MDMA for HS-SPME was tested in other matrices such as stomach fluid, bile, thoracic cavity fluid, vitreous humor, brain, liver, spleen, and skeletal muscle. As a result, stomach fluid, thoracic cavity fluid, and vitreous humor showed SPME efficiencies higher than that of whole blood; however, this method was not suitable for solid tissue matrices under the present conditions.     

PVA颗粒栓塞肝动脉治疗肝血管瘤(附7例报告)

目的 :探讨PVA颗粒栓塞肝动脉治疗肝血管瘤的临床价值和疗效。方法 :治疗肝血管瘤 7例 ,瘤体最小 2 .0cm× 1.7cm ,最大 12 .5cm× 13.8cm ,采用改良Seldinger法经股动脉插管 ,将导管超选择至肿瘤供血动脉主干 ,予以PVA颗粒栓塞。术后定期复查。结果 :介入治疗后所有瘤体均有不同程度缩小 ,术后无严重并发症发生。结论 :PVA颗粒栓塞肝动脉治疗肝血管瘤安全有效且疗效显著。     

肝海绵状血管瘤25例CT征象分析

目的探讨肝血管瘤的CT表现,提高对肝血管瘤的认识。方法对25例患者行CT平扫加增强扫描,对其影像进行观察分析。结果大多数肝血管瘤CT平扫表现为肝内单发或多发圆形或椭圆形低密度影,增强扫描表现为早期结节样、环形、斑片状强化,随时间进展呈向心性强化,部分直至完全充填,然后强化逐步减退,表现为快进慢出特征。结论肝血管瘤CT表现大多数有典型特点,CT平扫及增强扫描是诊断肝血管瘤的有效方法。     

Histopathological study of multi-systemic AA amyloidosis with cardiac involvement: two fatal cases in forensic practice

In this report, two cases of death in patients diagnosed with multi-systemic AA amyloidosis at autopsy were investigated for any medical errors that may have contributed to their deaths. The patients developed nephrotic syndrome post-operatively and following trauma. The second patient had been on hemodialysis for idiopathic kidney disease prior to the trauma she sustained. Complete autopsies with immunohistochemistry and electron microscopy were used to show the extracellular deposits of amyloid in the kidneys and also in other organs, including the heart. Cardiac involvement for this type of amyloidosis has never been reported in the literature. Post-mortem analysis showed multi-systemic AA amyloidosis as the cause of nephrotic syndrome, and ultimately the cause of worsening clinical outcomes, for the two patients. A comprehensive histopathological study led to a peculiar organ-specific observation of AA amyloidosis, which requires more thorough investigations by clinicians and must be considered in the evaluation by forensic pathologists in cases of professional liability.     

肝炎及肝硬变患者高压氧治疗后门静脉血流量的变化

目的　观察高压氧（ＨＢＯ）治疗降低肝炎及肝硬变患者门脉压的作用。方法　对应用ＨＢＯ治疗肝炎（３８ 例）及肝硬变（１４ 例）的患者,采用彩色多普勒超声仪,进行治疗前、后门静脉血流动力学检测。结果　ＨＢＯ治疗１ 次和１０ 次后,门静脉血流量明显减少,与治疗前比,其差异有非常显著意义。结论　ＨＢＯ治疗可降低门脉压,并能避免其它一些方法中出现的减小门脉压力但同时造成肝血氧供给不足的不良作用     

Cerebral perfusion during anesthesia with fentanyl, isoflurane, or pentobarbital in normal rats studied by arterial spin-labeled MRI.

The influence of anesthetic agents on cerebral blood flow (CBF) was tested in normal rats. CBF is quantified with arterial spin-labeled MRI in rats anesthetized with either an opiate (fentanyl), a potent inhalation anesthetic agent (isoflurane), or a barbiturate (pentobarbital) using doses commonly employed in experimental paradigms. CBF values were found to be about 2.5-3 times lower in most regions analyzed during anesthesia with either fentanyl (with N(2)O/O(2)) or pentobarbital vs. isoflurane (with N(2)O/O(2)), in agreement with findings utilizing invasive measurement techniques. CBF was heterogeneous in rats anesthetized with isoflurane (with N(2)O/O(2)), but relatively homogeneous in rats anesthetized with either fentanyl (with N(2)O/O(2)) or pentobarbital, also in agreement with studies using other techniques. Magn Reson Med 46:202-206, 2001.