"Drug mules" as a radiological challenge: sensitivity and specificity in identifying internal cocaine in body packers, body pushers and body stuffers by computed tomography, plain radiography and Lodox

Purpose

The purpose of our study was to retrospectively evaluate the specificity, sensitivity and accuracy of computed tomography (CT), digital radiography (DR) and low-dose linear slit digital radiography (LSDR, Lodox^®) in the detection of internal cocaine containers.

Methods

Institutional review board approval was obtained. The study collectively consisted of 83 patients (76 males, 7 females, 16–45 years) suspected of having incorporated cocaine drug containers. All underwent radiological imaging; a total of 135 exams were performed: nCT = 35, nDR = 70, nLSDR = 30. An overall calculation of all “drug mules” and a specific evaluation of body packers, pushers and stuffers were performed. The gold standard was stool examination in a dedicated holding cell equipped with a drug toilet.

Results

There were 54 drug mules identified in this study. CT of all drug carriers showed the highest diagnostic accuracy 97.1%, sensitivity 100% and specificity 94.1%. DR in all cases was 71.4% accurate, 58.3% sensitive and 85.3% specific. LSDR of all patients with internal cocaine was 60% accurate, 57.9% sensitive and 63.4% specific.

Conclusions

CT was the most accurate test studied. Therefore, the detection of internal cocaine drug packs should be performed by CT, rather than by conventional X-ray, in order to apply the most sensitive exam in the medico-legal investigation of suspected drug carriers. Nevertheless, the higher radiation applied by CT than by DR or LSDR needs to be considered. Future studies should include evaluation of low dose CT protocols in order to address germane issues and to reduce dosage.     

Oesophageal and gastric obstruction in a cocaine body packer

While the management of asymptomatic body packers is mainly conservative, few individuals will require surgery for acute toxicity related to packets rupture, intestinal obstruction or very slow progression of the packages. Obstruction of the lower oesophagus or stomach is not frequently reported. We report the case of a 49-year-old woman who had ingested 92 cocaine-containing packages. She was admitted to the hospital after opioid syndrome related to the intake of morphine and codeine to decrease intestinal transit. The presence of more than 80 packages was suspected in the stomach on the initial abdomen computed tomography. Due to the absence of progression of the packages after four days of well-conducted laxative therapy and to major gastric distension at abdomen tomography, surgery was decided and gastrotomy allowed the evacuation of 80 packages that were still present in the stomach or in the lower oesophagus. In addition, 12 other packages had been retrieved either after laxative therapy (9) or by evacuation via the anal canal (3) after palpation of the intestine during the surgical procedure. No complication was observed.     

Drug-related deaths with evidences of body packing: Two case reports and medico-legal issues

Body packing is a general term used to indicate the internal transportation of drug packages, mainly cocaine, heroin, amphetamines, and methamphetamine, within the gastrointestinal tract. We described two cases of accidental drug intoxication, observed over the last year period, with evidence of intracorporeal drug concealment. The first case concerned a body packer transporting 69 drug packages of heroin adulterated with piracetam. The second body packer transported 16 drug packages of cocaine adulterated with levamisole. For both cases, forensic examination and toxicological analysis of drug packages and biological samples were carried out. Authors also wants to highlight the main medico-legal issues that commonly arise in cases of suspected or ascertained body packers.     

Comparison of diagnostic value of multidetector computed tomography and X-ray in the detection of body packing

Objective

Radiologists and other clinicians are facing an increasing number of illegal drug-related medical conditions. We aimed to draw attention to this growing global problem and to highlight some of the important points related to diagnosis and follow-up of body packing. We compare the diagnostic performance of unenhanced multidetector CT (MDCT) and abdomen X-ray for the detection of drug-filled packets.

Materials and methods

Sixty-seven suspects, who underwent both CT and X-ray examinations, have been included in the study. All MDCT and X-ray images were independently and retrospectively reviewed by two observers with different degrees of experience in abdomen imaging. Fifty-two of them were identified as body packers finally. Interobserver agreement, sensitivity, specificity, positive and negative predictive value were calculated.

Results

Two types of packets with different characteristics were identified in all body packers. Type 1 packets (solid-state drug) were found in 41 patients and type 2 packets (liquid cocaine) in 11 patients. All statistical analyses concern the detection of any packets. That is, the whole evaluation has been performed per patient. Sensitivity/specificity values of type 1 and type 2 packets for MDCT were 100–98%/100–100% and 100–100%/100–100%, respectively. Besides, sensitivity/specificity values of type 1 and type 2 packets for X-ray were 93–90%/100–91% and 64–45%/73–71%, respectively. In addition, interobserver agreements for detection of any packets were excellent (κ = 0.96) and good (κ = 0.75) for interpretation of MDCT and X-ray, respectively.

Conclusion

Unenhanced MDCT is a fast, accurate and easily used diagnostic tool with high sensitivity and specificity for the exact diagnosis of body packing.     

A body-packer with a cocaine bag stuck in the stomach

Management of patients carrying packets of drugs in the digestive tract is a frequent medical problem.Wereport on a patient who was referred by the police after ingestion of packets of cocaine.After spontaneous elimination of 81 drug packets,the patient had three unremarkable stools.A plain abdominal X-ray disclosed no residual packet but computed tomography(CT) scan showed one in the stomach.As this was not eliminated during the 10 d following ingestion,it was removed through gastrotomy.This case stresses the usefulness of the CT scan to ensure that no residual packet is present before hospital discharge.     

A fatally mistaken fruit juice drink: an unordinary way of cocaine intoxication

Cocaine is one of the drugs of abuse more frequently consumed in Spain. Furthermore, Spain due to its geographical position is used by trafficker's organizations as the port of entrance of cocaine in the European Union. We present here a case of a fatal intoxication caused by a mistake in the cocaine distribution net in our country. Cocaine was concealed in a tropical juice only sold by the Internet.     

Cardiovascular complications of cocaine: Imaging findings

Cocaine is the second most commonly abused illicit drug in the US and the most common one involved in emergency department visits, the majority of which are related to the cardiovascular system. Cardiovascular complications related with cocaine abuse include myocardial ischemia and infarction, myocarditis, hypertrophic cardiomyopathy, dilated cardiomyopathy, aortic dissection, thrombosis, stroke and cerebral hemorrhage, and different forms of visceral ischemia, among others. In an era where cocaine use has reached epidemic proportions, it is necessary for the radiologist to understand the pathophysiology, clinical presentation, and imaging characteristics of its cardiovascular complications.     

Heart rupture as an acute complication of cocaine abuse: A case report

The purpose of this study is to show a very rare complication of acute cocaine poisoning, namely heart rupture. In the present case report, acute cocaine intoxication caused massive myocardial infarction, resulting in heart rupture and cardiac tamponade. A crime scene investigation found a dead body on the street in a drug dealing district. Examination of the body showed no external injuries. A thorough autopsy was performed showing massive cardiac tamponade with 510 ml of blood within the pericardium and full-thickness tissue lesion at the posterior wall of the left ventricle of 3.5 × 3 cm. Histological examination in hematoxylin and eosin was performed and confirmed the interruption of the posterior wall of the left ventricle with the presence of blood. In fact, although the correlation between cocaine and myocardial damage is well established, the relationship between heart rupture and acute cocaine intoxication is an extremely rare event. Moreover, since there are, to date, few reports of similar deaths, our report provides useful information regarding sudden death in a cocaine abuser. It is, therefore, of crucial importance to report this case to the scientific community.     

Death of a female addict due to heroin and cocaine overdoses: a case report with multiparameter evaluation

This study undertook a multiparameter evaluation of the death of a 21-year-old woman known to be an abuser of heroin and cocaine. The toxicological analysis of multiple postmortem specimens such as blood and hair was carried out using liquid chromatography atmospheric pressure chemical ionization tandem mass spectrometry (LC-APCI-MS-MS). The blood specimens of the deceased showed the presence of opium components such as morphine and its glucuronides together with cocaine and benzoylecgonine. The detected xenobiotic levels probably explained the cause of her death resulting from combined action of unintentional illicit drug overdose. By analysis of four 2-cm long hair segments, a heroin-cocaine addiction for at least 8 months antemortem was able to be documented; the presence of 6-monoacetylmorphine (6-MAM), cocaine, and benzoylecgonine was demonstrated. The histopathological findings of lesions of the internal organs of the deceased were consistent with long heroin and cocaine abuse. The use of multiple parameters, such as blood and hair segments as matrices and drug metabolites such as 6-MAM, morphine, glucuronides, and benzoylecgonine as target compounds, gave a well-defined outline of her death.     

Heroin body packer's death in Haryana; India: A case report

We report a case of death due to heroin leakage in a body packer, attempting to smuggle the drug by concealing it in his gastro-intestinal tract. The body was recovered 3–5 days of incidence that was confirmed by autopsy. Fifty pellets (packages) were recovered from the body, 42 identical oval shaped “egg” packages were found in the stomach out of which two were damaged, 6 in small intestine, 2 in large intestine. The total weight of the powder was 267 g. Toxicological analysis of the powder samples from the damaged package and other 48 packages was performed and was found positive for heroin, caffeine and codeine. The main pathological findings at autopsy were pulmonary and cerebral edema. This case illustrates the challenges in postmortem evaluation of narcotic fatalities and the need to consider factors such as ante-mortem history, thorough post mortem examination, toxicology results and photography in forensic diagnosis. This case is unique in the sense that cause of death was intoxication caused by leakage of heroin from damaged packages detected at autopsy and demonstrates that body packing is an existing problem in India.     

我国歼击机、轰炸机飞行员身体构成特点的研究

目的：分析我国歼击机、轰炸机飞行员身体构成现状,为飞行员选拔和制定保健措施提供依据。方法：测量64名歼击机和64名轰炸机飞行员的皮褶厚度和部分人体尺寸,对比不同年龄、不同机种飞行员身体构成的特点。结果：≤30岁及＞30岁两组飞行员有3项指标的差别有显著性意义（P＜0．05）;轰炸机和歼击机两组飞行员有4项指标的判别有显著性意义（P＜0．05）;与肥胖密切相关的6项指标间的相关性在0．642－0．894（P＜0．01）;肥胖和消瘦分别占总例数的21．1％和34．4％,且≤30岁及＞30岁组肥胖的例数有显著性差异（P＜0．05）。结论：在年龄较大飞行员肥胖的同时,年轻飞行员的肥胖问题日趋严重,说明还需加强体育锻炼。     

胎儿体蒂异常的MRI表现及病理对照

目的:探讨胎儿体蒂异常的MRI表现及诊断价值.方法:对5例超声诊断体蒂异常的胎儿于3天内行MRI检查,3例在我院引产后回顾分析其MRI表现并行病理对照,2例在外院引产.结果:5例胎儿MRI均显示有复杂畸形,5例均有较大的胸腹壁或腹壁缺损、内脏器官疝入羊膜腔、脊柱异常及脊柱侧后弯、脐带无或过短伴单脐动脉.5例分别并发其它...     

Drug smuggling by body packing: what radiologists should know about it

Body packing is a distinct method for smuggling drugs. What radiologists need to know is discussed in this pictorial review. Radiologists are confronted with diagnostic imaging of body packers because of two main reasons: complications of body packing and identifying drug packets within the gastrointestinal tract. The standard examination used is plain X-ray of the abdomen in an upright and a supine position. Computed tomography is occasionally used but nevertheless described as a very accurate diagnostic tool. Ultrasound and MR imaging do not play an important role in that field. Depending on the purity of the drug, three different forms of attenuation have been described: hashish is denser than stool; cocaine appears similar to stool; and heroin has a gaseous transparence. The packets are of a round to oval form, usually of a particular uniformity and rarely confused with scybala if arranged like a pearl chain; therefore, plain X-ray is the method of choice to detect drug-filled packets within the gastrointestinal tract of body packers.     

Dual energy X-ray absorptiometry positioning protocols in assessing body composition: A systematic review of the literature

Objectives

To systematically identify and assess methods and protocols used to reduce technical and biological errors in published studies that have investigated reliability of dual energy X-ray absorptiometry (DXA) for assessing body composition.

Differences in body positional bilateral symmetry between stance and supine positions,and the impact of attention and awareness on postural symmetry

Background and purposePostural asymmetries may cause structural pathological conditions and impaired movement pattern. The influence of body position and awareness towards symmetry has not yet been elucidated. The aim of this study was twofold: First, to compare the body positional bilateral symmetry between standing and supine positions, and second, to examine whether the awareness to symmetry can modify posture perception and body positional bilateral symmetry.MethodsWe analyzed the degree of anterior postural alignment symmetry of 34 healthy subjects by photogrammetric method (three photographs in a standing position and three in a supine position). Each photo captured different state of awareness: Subjective Comfortable Posture (SCP), Subjective Perceived Symmetrical Posture (SPSP), and Guided Posture Protocol (GPP).ResultsThe standing position increased the symmetrical alignment of the neck (p < 0.013) and the upper limbs (p < 0.011). However, the supine position demonstrated increased symmetrical alignment of the upper trunk (p < 0.019) and the feet (p < 0.002). In the standing position, GPP showed greater symmetry of the neck (p < 0.022), the shoulders (p < 0.014), the thorax midline (p < 0.009), the upper trunk (p < 0.000) and the upper limbs (p < 0.029). No significant changes were observed in the supine position between the three states of awareness.ConclusionsStudy results indicate that the supine position shows greater degree of upper trunk's symmetrical alignment than the standing position. It also indicates that while standing, focusing attention into symmetry improves body positional bilateral symmetry. These results might have clinical implications when working with patients who suffer from asymmetric posture.     

Land- versus water-walking interventions in older adults: Effects on body composition

ObjectivesIncreasing physical activity is a priority worldwide, including for older adults who may have difficulty performing traditional forms of exercise, and for whom retention of muscle mass is an important consideration. Water-based exercise may provide an alternative if benefits are comparable. We compared the impact on body composition of 24-week water- versus land-walking interventions in healthy but inactive older adults.DesignRandomised, controlled trial.Methods72 participants (62.5 ± 6.8 yr) were randomised to a land-walking (LW), water-walking (WW) or control (C) group in a supervised centre-based program. The exercise groups trained 3 times/week at matched intensity (%HRR), increasing from 40–45% to 55–65% heart rate reserve (HRR). Height, weight, body mass index (BMI), waist and hip girths were recorded; dual X-ray absorptiometry (DXA) provided fat and lean tissue masses. Participants were re-assessed 24 weeks after completion of the intervention.ResultsThere were no significant changes in body mass or BMI following either exercise protocol, however central adiposity was reduced in both exercise groups, and the WW group increased lower limb lean mass. These benefits did not persist over the follow-up period.ConclusionsExercise can confer beneficial effects on body composition which are not evident when examining weight or BMI. Both WW and LW improved body composition. Water walking can be recommended as an exercise strategy for this age group due to its beneficial effects on body composition which are similar to, or exceed, those associated with land-walking. For benefits to persist, it appears that exercise needs to be maintained.     

Revealing the secrets of the body: medical tests as legal evidence in personal status disputes in modern Egypt

The study seeks to answer the following question: In the field of personal status, what kinds of medical tests have been considered reliable and acceptable by Egyptian courts of law, what kinds have been less accepted, and why? The main finding is that, on the one hand, the judges (qadis) have welcomed tests that seek to determine age or to discover physical diseases and/or mental disorders. On the other hand, they have been reluctant to introduce tests to determine virginity and pregnancy tests, and even more so to introduce paternity tests that might bring into light manifestations of moral laxity within Egyptian society and jeopardize the future of illegitimate children. In conclusion, the main resistance to the reliance on modern medical evidence has not been the lack of modern knowledge and technologies or opposition to this, but rather traditional moral and social perceptions.     

Revealing the secrets of the body: medical tests as legal evidence in personal status disputes in modern Egypt

The study seeks to answer the following question: In the field of personal status, what kinds of medical tests have been considered reliable and acceptable by Egyptian courts of law, what kinds have been less accepted, and why? The main finding is that, on the one hand, the judges (q?d?s) have welcomed tests that seek to determine age or to discover physical diseases and/or mental disorders. On the other hand, they have been reluctant to introduce tests to determine virginity and pregnancy tests, and even more so to introduce paternity tests that might bring into light manifestations of moral laxity within Egyptian society and jeopardize the future of illegitimate children. In conclusion, the main resistance to the reliance on modern medical evidence has not been the lack of modern knowledge and technologies or opposition to this, but rather traditional moral and social perceptions.