A Tissue Distribution Study of Propafenone in an Intentional Fatal Poisoning Case.

Propafenone (PPF) belongs to the class 1C antiarrhythmics and can cause electrocardiogram-associated adverse/toxic effects. Cases of PPF intoxication are rarely investigated. We developed a novel and selective GC-MS/MS method for the determination of PPF and its tissue distribution in an intentional fatal poisoning case, which is applicable to PPF quantification in the range of therapeutic to lethal concentrations in complex post-mortem samples. A simple and effective sample pretreatment was applied to all analyzed samples. PPF was determined without the need for dilution, even in highly complex samples containing a wide range of analyte concentrations. Quantification was performed using the standard addition method, developed and validated according to the ICH M10 guidelines. The obtained results indicated that the PPF concentration in the serum from blood taken while alive, before therapy, was the highest ever reported in the literature. Despite the intensive therapy after the patients' admission, the PPF concentrations in the lungs, spleen, femoral blood and cardiac blood were fatal or abnormally high. On the other hand, the concentrations in the liver and skeletal muscle were lower or approximately the same as observed in cases with therapeutic doses. To the best of our knowledge, the distribution of PPF has not been investigated in fatal intoxication cases and can be helpful in clinical or forensic toxicology.

Morphological peculiarities of the autonomic nervous system in the thoracic region.

BACKGROUND: The aim of the work is to define the morphological peculiarities of the autonomic nervous system (ANS) in the thoracic region. MATERIAL AND METHODS: An anatomical study was performed on 20 cadavers, 17 men and 3 women. We studied cadavers within 24 h of death. We observed the vertebral and prevertebral section of the truncus sympathicus, their morphological peculiarities depending on the type of ANS. To show the intimate relationship of both systems, we also focused on the details of the structure related to the connections of the ANS with the spinal nervous system. RESULTS: In the thoracic region, the segmental arrangement of the truncus sympathicus ganglia prevailed in 16 (80%) cases. Rami communicantes gave anastomoses to spinal nerves. Small ganglia were observed on the rami communicantes to the spinal nerves. In the case of the concentrated type, in 4 cases (20%), we observed a reduction in the number of ganglia, as well as the absence of small ganglia on the connecting branches. Connections between n. vagus and sympathetic branches were poorly developed. We observed right-left asymmetry and differences in the formation of ganglia and anastomoses in the truncus sympathicus in the vertebral and prevertebral section. Variations of distance of n. splanchnicus major were observed in 16 cases (80%). CONCLUSION: This study allowed us to identify and describe the morphological peculiarities of the thoracic ANS. The variations were numerous; their preoperative diagnosis is difficult to impossible. The knowledge gained can be helpful in clarifying clinical signs and symptoms.

A Comparative Study of Intravital CT and Autopsy Findings in Fatal Traumatic Injuries.

Objectives: Traumatic injuries are one of the severe health problems of our time. In the 21st Century, approximately 4.5 million people worldwide die each year due to trauma. Computed tomography (CT) is widely used to diagnose injuries and offers information on the specific location and extent of organ and tissue damage. In cases of severe trauma, whole-body CT is increasingly used as a standard diagnostic technique. An autopsy is the final diagnostic examination and is still considered the gold standard in diagnostic methods in medicine. The aim of the study was to assess the reliability and accuracy of CT scan results, as well as limits in detecting trauma for forensic purposes. It aims to compare traumatic findings in the antemortem CT results to those observed at autopsy. Materials and Methods: We conducted a retrospective-prospective study involving 510 deaths due to trauma. We compared selected traumatic changes in the antemortem CT scan results with the autopsy findings. We obtained data with a detailed analysis of autopsy protocols, photographic documentation from the autopsies, and the interpretation of CT scans from medical documentation. In cases of discrepancies in the findings, we borrowed CT scans, which were repeatedly reviewed by clinical radiologists. Results: By comparing the findings of selected injuries detected by antemortem CT and autopsy, we found a correlation of findings in 75.3% and a discrepancy of findings in 24.7% in a set of 510 cases. After repeated targeted assessment of CT images by clinical radiologists in cases of discrepancies in the findings, which were detected by autopsy and undescribed by CT, the discrepancy decreased to 17%. Conclusions: The results of the study are comparable with data from many studies and professional publications. They show that CT compared to autopsy is a good method for diagnosing gunshot wounds to the head and bone fractures, with a limited diagnosis of cranial base fractures, while an autopsy is better for detecting minor injuries to organs and soft tissues.

Ayahuasca as a Decoction Applied to Human: Analytical Methods, Pharmacology and Potential Toxic Effects.

Ahyahuasca is a term commonly used to describe a decoction prepared by cooking the bark or crushed stems of the liana Banisteriopsis caapi (contains ß-carbolines) alone or in combination with other plants, most commonly leaves of the shrub Psychotria viridis (contains N,N-dimethyltryptamine-DMT). More than 100 different plants can serve as sources of ß-carbolines and DMT, which are the active alkaloids of this decoction, and therefore it is important to know the most accurate composition of the decoction, especially when studying the pharmacology of this plant. The aim was to summarize the latest sensitive methods used in the analysis of the composition of the beverage itself and the analysis of various biological matrices. We compared pharmacokinetic parameters in all of the studies where decoction of ayahuasca was administered and where its composition was known, whereby minimal adverse effects were observed. The therapeutic benefit of this plant is still unclear in the scientific literature, and side effects occur probably on the basis of pre-existing psychiatric disorder. We also described toxicological risks and clinical benefits of ayahuasca intake, which meant that the concentrations of active alkaloids in the decoction or in the organism, often not determined in publications, were required for sufficient evaluation of its effect on the organism. We did not find any post-mortem study, in which the toxicological examination of biological materials together with the autopsy findings would suggest potential lethality of this plant.

Suicides by ingestion of pure caffeine powder. New challenge for public health?

OBJECTIVES: Intentional or unintentional caffeine abuse due to excessive intake of energy beverages is frequent. Fatalities due to caffeine intoxication are presented rarely. Over the last years, cases of caffeine ingestion for purposes of committing suicide have been reported in scientific literature. DESIGN: The aim of this case study is to report a fatal case of a 26-year-old man who intentionally ingested pure caffeine powder. METHODS: Standard autopsy, microscopic examination and toxicological examination using screening method, TLC, GC, and GC/MS were performed. RESULTS AND CONCLUSIONS: The presence of caffeine only at the concentration of 362 ug/mL in blood and 187 ug/mL in urine was revealed. The cause of death was cardiac arrest most likely due to ventricular dysrhythmia. The concentration of caffeine determined in the femoral blood of the decedent was three times higher than the lethal concentrations reported in other published case studies. Based on the investigated circumstances, the manner of death was evaluated as a suicide.

Unusual mechanism of injury in a case of suicide by the jump from height.

Investigation of fatal cases of falls from height as well as jumps from height in suicidal ideation makes up an integral part of forensic practice. In Slovakia, a method of suicide by jumping from height is after hanging the second most chosen method of ending life. In about one third of the cases, the influence of addictive substances is determined. The basic mechanism of injury is a sudden deceleration of body movement when hitting a solid surface. Several factors influence the nature, localization, severity, and frequency of injuries. In most cases, there occur multiple injuries to the skeleton and internal organs caused by blunt objects. The authors demonstrate the case of an unusual mechanism of injury in a 55-year-old man who committed suicide by jumping from the seventh floor of a block of flats. A stepped fall from height resulted in the through knee amputation of both legs by hitting posterior thigh area and knee joints on the railing of the terrace of the block of flats on the ground floor level. The body was found in the basement. In contact with the railing, the mans trousers and pants were pulled off. The autopsy determined the immediate cause of death as polytrauma. Additional toxicological-chemical examination of blood and urine samples collected at autopsy revealed ethanol at the concentration within the extent of laboratory error, caffeine, and nicotine in toxicologically insignificant concentrations and traces of acetone. Motivation of mans suicide remains unknown.

[Addictive substances in fatal cases of fall/jump from height]. / Návykové látky vo fatálnych prípadoch pádov/skokov z výsky.

The aim of the study is to analyse causes of fatal cases of falls from height focusing on the occurrence of addictive substances. The authors performed a retrospective analysis of cases dealing with falls/jumps autopsied at the Institutes of Forensic Medicine in Bratislava in the years 2005-2014 accounting for a catchment area with approximately 1.2 m population. Selection criteria were met in 360 cases, i.e. approximately 4 % of all cases autopsied. There were 68 % of men and 32 % of women involved. The age interval ranged from 10 up to 93 years (mean age 50 years). Addictive substances were found in a total of 32 % of cases, ethanol alone in 22 % of cases. The cases were divided into groups according to the cause as follows: accidental falls (24%) also involving occupational accidents (11 %), jumps in suicidal ideation (63 %) and cases with the unspecified cause of falling (13 %). Most of the cases with detected addictive substances were in the group of suicidal jumps (35 %). In this group, 32 % of patients were treated for psychiatric disorders. The most common diagnosis was a depressive disorder and schizophrenia. In the group of occupational accidents, ethanol was found in 25 % of cases. The results of the study show that it is essential to pay more attention to psychiatric patients as not even regular psychiatric care and treatment can always prevent suicide. Accordingly, there is a need to strictly monitor the ban on alcohol consumption at work and the observance of safety regulations for working at heights, and thus to minimise the occurrence of falls with fatal outcomes.

[Post mortem investigation of alveolar air in forensic practice]. / Vysetrovanie alveolárneho vzduchu post mortem v súdnolekárskej praxi.

Exhaled air from biological materials is used for the purpose of toxicologico-chemical analysis particularly in detecting of alcohol influence in traffic or within a working process. Similarly, still a more and more actual requirement seems to be a necessity to analyse alveolar air from necroptic material. This necessity is emphasised not only by the fact, that inhalant intoxications in the form of poisoning represent their substantial part, but also a demand to evidence exactly a noxious agent both specifically and also in at least two materials. And particularly this is sometimes a subject to search for evidence in alveolar air. The authors present their authors certificates for Isolation of alveolar air from autopsy material, issued by the Office for Patents and Inventions in Prague, verified in practice, both by destruction of lung tissue, both the evacuation of alveolar air into a defined volume, hermetically closed space that is used for the toxicological analysis of gaseous and volatile xenobiotics. They propose experimentally verified procedures and conditions obtained by time-consuming examination. To isolation procedures were subjected an adequate number of lung lobes from lungs removed in 201 autopsy cases. The authors practically tested the presupposed amount of alveolar air in individuals according to gender and age. Gradually they have validated various prototypes and optimization methods and their application in solving particular inhaled lethal intoxications and deaths in the irrespirable environment.

[Confrontation of knowledge on alcohol concentration in blood and in exhaled air]. / Konfrontácia poznatkov o koncentrácii alkoholu v krvi a vo vydychovanom vzduchu.

The authors of the paper give a brief historical overview of the development of experimental alcohology in the former Czechoslovakia. Enhanced attention is paid to tests of work quality control of toxicological laboratories. Information on results of control tests of blood samples using the method of gas chromatography in Slovakia and within a world-wide study "Eurotox 1990" is presented. There are pointed out the pitfalls related to objective evaluation of the analysis results interpreting alcohol concentration in biological materials and the associated need to eliminate a negative influence of the human factor. The authors recommend performing analyses of alcohol in biological materials only at accredited workplaces and in the case of samples storage to secure a mandatory inhibition of phosphorylation process. There are analysed the reasons of numerical differences of analyses while taking evidence of alcohol in blood and in exhaled air. The authors confirm analysis accuracy using the method of gas chromatography along with breath analysers of exhaled air. They highlight the need for making the analysis results more objective also through confrontation with the results of clinical examination and with examined circumstances. The authors suggest a method of elimination of the human factor, the most frequently responsible for inaccuracy, to a tolerable level (safety factor) and the need of sample analysis by two methods independent of each other or the need of analysis of two biological materials.