Clitoral metastasis from uterine cervical cancer: A case report and review of the literature.

A 81-year-old woman vaginal bleeding and vulvar pain. Pretreatment work-up revealed a 4.5 cm cervical cancer extended to the lower-third of the vagina and an isolated clitoral metastasis. The patient was treated with a multimodal treatment consisting with radiotherapy followed by clitoridectomy. She recovered uneventfully following the multimodal treatment, and is currently free of disease. Clitoral metastasis is extremely rare, however, this condition should be considered in cervical cancer patients during the pretreatment work-up or follow-up period, especially when patients complain of clitoral pain or enlargement.

Performance of immunoassays in screening for opiates, cannabinoids and amphetamines in post-mortem blood.

Several immunoassay methods for screening of abused drugs in whole blood were evaluated in post-mortem forensic toxicology. Blood samples known to be positive or negative for opiates, cannabinoids or amphetamines by gas chromatography-mass spectrometry (GC-MS) were analysed by EMIT II Plus and EMIT d.a.u., Syva RapidTest and Triage 8 after acetone precipitation. In these experiments, the EMIT immunoassay method was modified by using the Dade Behring VIVA analyser to detect substances more sensitively. Low concentrations of abused drugs were detected in blood samples. The sensitivities of the modified EMIT method for opiates, cannabinoids and amphetamines were 100, 86 and 98%, respectively, whereas the values were below 86% with the other methods. The specificities of all immunoassay methods for opiates and cannabinoids were 83% or above but 51-85% for amphetamines. Sample rejection occurred in a few cases with the EMIT amphetamine assays. The modified EMIT immunoassay system presented here seems to be useful for screening of drugs of abuse in post-mortem blood samples, especially when urine is not available.

Toxicological analysis of chlorhexidine in human serum using HPLC on a polymer-coated ODS column.

A simple and reliable high-performance liquid chromatographic (HPLC) method for analyzing chlorhexidine in human serum was developed. After the addition of an internal standard, levomepromazine, 0.2 mL serum was deproteinized with 10% perchloric acid. The acidic supernatant was neutralized with 1M potassium carbonate solution, and the insoluble salt was removed by centrifugation. An aliquot of the supernatant was applied to HPLC with UV detection (260 nm). HPLC separation was achieved on a polymer-coated ODS column equilibrated with acetonitrile/water containing 0.05% trifluoroacetic acid, 0.05% heptafluorobutyric acid, and 0.1% triethylamine (40:60, v/v). The calibration curve was linear in the concentration range from 0.05 to 50.0 microg/mL, and the lower limit of detection was 0.05 microg/mL. The accuracy and precision of the method were evaluated at concentrations of 0.5 microg/mL and 5.0 microg/mL. The coefficients of variation ranged from 4.0 to 4.5%. The concentration of chlorhexidine in the serum of a patient who died after a suspected intravenous injection of chlorhexidine gluconate was determined.

A sudden death following tetracaine-induced spinal anesthesia.

A 56-year-old Japanese woman died after being given 10 mg of tetracaine to induce spinal anesthesia in preparation for orthopedic surgery. Autopsy findings and microscopic analysis revealed no external injuries or disease, and further toxicological examinations were carried out to determine the cause of death. For this we used gas chromatography-mass spectrometry. Tetracaine was not detected in most tissue samples, but the metabolite, p-butylaminobenzoic acid, was clearly detected in all samples. The concentration of the metabolite in the brain stem (234.7 ng/g) was higher than in the cerebrum (30.5 ng/g), cerebellum (36.7 ng/g), whole blood of the left heart (164.8 ng/ml) and whole blood of the left femoral vein (84.0 ng/ml). These distribution patterns were exactly same as rabbits sacrificed by high spinal anesthesia. Our findings suggest that tetracaine spread to the high regions of cerebrospinal nerves and acted directly on the central nervous system. Therefore, the cause of her death was high spinal anesthesia induced by tetracaine. This is apparently the first toxicologically proven case in which spinal anesthesia affected high brain centers.