Ketamine in non-hospital and hospital deaths in New York City.

We reviewed all ketamine-positive deaths (87) examined at the New York City Office of Chief Medical Examiner over a two-year period (1997 to 1999). There were 15 non-hospital deaths with 12 due to acute multidrug intoxications, one due to sarcoidosis, and two due to physical injury (blunt and thermal). In no instance was a fatal intoxication caused exclusively by ketamine. Opiates (10/15), followed by amphetamines (7/15) and cocaine (6/15), were the most frequent co-intoxicants. Ethanol was found in only one death. The race of all decedents was white and the majority were men (11/15) between the ages of 18 and 30 years. The remaining 72 instances of positive ketamine findings were hospital deaths following surgical procedures or burns.

HIV seroprevalence rates among homicide victims in New York City: 1991-1993.

This study assessed HIV seroprevalence in homicide victims killed in New York City in 1991-1993, using data from the Office of Chief Medical Examiner. Among 5852 homicide victims there were 344 (5.9%) victims who were HIV positive. Females were just as likely as males to be HIV positive. For females, the highest rates were in the 25-34 year (11.7%) and 35-44 year (12.6%) age categories. For males the highest rates were in the 35-44 year (13.7%) and 45-54 year (11.5%) age categories. Other than there being no HIV positive Asian victims, there were no differences in HIV rates among racial/ethnic groups. The highest rates of HIV infection for homicide victims were among those using both opiates and cocaine (males: 23.0%; females: 27.3%). Women, not men, using cocaine alone had a high HIV positive rate (18.4%). Victims not using these drugs had rates of HIV around 2%. The authors believe that the high risk of HIV among homicide victims, may be due to the use of cocaine and associated risky use of needles and risky sex practices.

Poverty and fatal accidental drug overdoses of cocaine and opiates in New York City: an ecological study.

This ecological study examines the association of the poverty status of urban communities in New York City with their mortality rates of accidental drug overdoses. Mean annual age-adjusted rates of drug overdoses involving cocaine, opiates, or both (n = 1,684) were calculated for each of 59 residential community districts in New York City for 1990-1992. A linear regression analysis was performed to test the association of the mortality rate with the poverty status of the district as measured by the proportion of the district living below the 1989 U.S. poverty line. Poverty status accounted for 69% of the variance in the drug overdose mortality rates of communities (p < .001). This study suggests that mortality rates of overdoses involving cocaine and optiates are significantly associated with the poverty status of communities in New York City.

Accidental fatal drug overdoses in New York City: 1990-1992.

This study of all accidental fatal drug overdoses (N = 1,986) in New York City from 1990 to 1992, using medical examiner data, found that cocaine, often with opiates and ethanol, caused almost three-fourths of deaths, while opiates without cocaine caused roughly one-fourth of fatal overdoses. Only 5% of accidental drug fatalities were caused by drugs other than cocaine or opiates. This is a marked departure from the results of studies in the early 1980s when opiates prevailed as a cause of accidental fatal overdoses. In this study the highest cocaine overdose rates were found among males, African-Americans, and Latinos. Rates of opiate overdose without cocaine did not differ in regard to race/ethnicity except for low rates among Asians and other ethnic groups. There was a marked increase in the rate of combined cocaine and opiate overdoses from 1990 to 1992 and a more gradual but steady increase of overdoses due to opiates without cocaine during that time period. Overdoses due to drugs other than cocaine or opiates showed no increase during that time period.

Histocompatibility antigens in patients with hepatocellular carcinoma.

The distribution of class I (A, B, C) and class II (DR antigens) histocompatibility antigens (HLA) was examined in 82 patients with hepatocellular carcinoma (HCC) and in 147 patients with chronic liver disease as controls. The diagnosis of HCC was confirmed by histological examination of liver tissue. HLA-B15 antigen was found more frequently in the subgroup of HCC patients who were positive for HBsAG (13/36, 36.1%) compared to the control group (8/147; 5.4%) [p < 0.001, Pc < 0.05, RR = 9.8] and a HBsAg positive control subgroup (1/25, 4%) [p < 0.001, Pc < 0.05, RR = 13.6]. No other statistically significant difference was found for any of the HLA antigens examined either in HCC patients as a whole group or in the subgroups according to sex, course of illness, AFP status, alcohol consumption, liver cirrhosis or blood groups. These data are further evidence that there may be a link between hepatitis B viral (HBV) infection and HLA antigens. The association of HLA-B15 antigen and HbsAg supports the idea of some genetic control of HBV infection in the patients with HCC.

[Hepatitis C virus infection in patients on chronic hemodialysis]. / Infekcija virusom hepatitisa C kod bolesnika na hronicnoj hemodijalizi.

Frequency of HCV infection was examined in patients on chronical program of hemodialysis considering the high risk to which they had been exposed because of frequent blood transfusion. We determined anti-HCV antibodies in 57 patients (29 male and 28 female) average age 52.6 years with terminal chronic renal failure. Frequency of anti-HCV antibodies (determined by ELISA Ortho test of first generation) was in correlation with the number of received transfusions and with duration of dialysis treatment and it was compared with anti-HCV antibody findings in hemodialysis staff (the control group of healthy persons). Results of the examination showed that anti HCV antibodies were positive in 38.95% examined patients (n = 57), and it showed that the patients on hemodialysis were a critical group for HCV infection. There was no correlation with the blood groups. Level of transaminases, HBsAg and immunity test in anti-HCV positive patients were in the physiological range. In order to prevent HCV infection in the dialysis centres, it is necessary to conduct routine test in patients and staff, and undertake all measures of protection.

Use of prescription psychotropic drugs among suicide victims in New York City.

OBJECTIVE: The authors examined the rate of prescription psychotropic drug use among suicide victims at the time of their death. METHOD: From a total of 1,970 suicides that occurred in New York City from 1990 to 1992, 1,635 cases that had a complete toxicologic analysis and an injury-death interval of 48 hours or less were assessed at autopsy for the presence of commonly prescribed antidepressants and neuroleptics. RESULTS: Prescription psychotropic medications were detected in only 16.4% (N = 268) of the suicide victims studied. Demographic factors associated with use of these drugs included female gender and white race. Poisoning accounted for 17.9% (N = 293) of all suicides studied, but antidepressants or neuroleptics were detected in less than half of these victims. Among all suicide victims in whom an antidepressant or neuroleptic was detected, almost half had used lethal methods other than poisoning. CONCLUSIONS: In this study, most individuals who committed suicide in New York City were not taking prescription psychotropic medications at the time of their death and either were not receiving pharmacotherapy or were noncompliant.

Fatal injuries after cocaine use as a leading cause of death among young adults in New York City.

BACKGROUND: Cocaine intoxication can lead to fatal cardiovascular and cerebrovascular events. In addition, the neurobehavioral effects of cocaine may increase the likelihood that a user will receive violent fatal injuries. Since New York City is a center for the importation and distribution of cocaine, we sought to determine the extent of cocaine use among city residents with fatal injuries. METHODS: Among a total of 14,843 residents of New York City who received fatal injuries from 1990 through 1992, we determined the proportion who used cocaine shortly before their deaths. We also determined the population-based rates of fatal injuries that were known to follow cocaine use and the proportion of all deaths of New York City residents that was represented by these cases for each demographic stratum. For adults 15 to 44 years of age, fatal injury after cocaine use was ranked with other causes of death as though it was a separate cause. RESULTS: Cocaine use, as measured by the detection of the metabolite benzoylecgonine in urine or blood, was found in 26.7 percent of all New York City residents receiving fatal injuries; free cocaine was detected in 18.3 percent. Approximately one third of deaths after cocaine use were the result of drug intoxication, but two thirds involved traumatic injuries resulting from homicides, suicides, traffic accidents, and falls. If fatal injury after cocaine use was considered as a separate cause of death, it would rank among the five leading causes of death among those 15 to 44 years of age in New York City. CONCLUSIONS: Fatal injuries among cocaine users account for a substantial proportion of all deaths among young adults in New York City.

Cocaine, opiates, and ethanol in homicides in New York City: 1990 and 1991.

Studies using medical examiner cases are useful in monitoring drug use in special populations. This study assesses the presence of cocaine and its metabolite, benzoylecgonine (BE), opiates and ethanol in all homicide victims who were injured and who survived two hours or less after injury in 1990 and 1991 in New York City. There were 2824 homicides in the study period and cocaine and/or BE were found in 884 (31.3%) of cases. In over half of the cases positive for cocaine/BE, ethanol or opiates were found. African-Americans and Latinos were much more likely than whites or Asians to be positive for cocaine/BE. There were no differences between men and women in regard to being positive for cocaine/BE. Cocaine/BE was most frequently identified among victims 25 to 44 years of age. Males were more likely to be positive for ethanol. There were no differences among age groups or ethnic groups in regard to ethanol except for a very low ethanol incidence among Asians. Victims positive for cocaine/BE were more likely to be killed with firearms in open places. The percentage of victims positive for cocaine/BE remains approximately that found by other studies in the late 1980s, however, the percentage of opiate-positive homicides seems to be increasing. Opiates usually were found with cocaine/BE. Two-thirds of the cocaine and/or BE positive cases had cocaine present, thus they were under the influence of the drug at the time they were injured. The authors discuss how the use of cocaine, ethanol and opiates may be related to one's becoming a homicide victim.

A profile of homicides on the streets and in the homes of New York City.

Although prior research has found that homes containing firearms and illicit drug and ethanol users are more likely to be the scene of a homicide than homes that do not contain these elements, the authors studied homicides on the streets as well as in homes so as to assess the role of firearms, cocaine, and ethanol in both settings. Using the files of the Chief Medical Examiner, the authors reviewed all 4,468 homicides occurring in New York City in 1990 and 1991. The most frequent places of occurrence were the streets and other outdoor places (49.6 percent) and the victims' homes (19.3 percent). Firearms were the cause of death for 49.6 percent of homicides in the home and 80.3 percent of those on the streets. Use of cocaine and ethanol was found more frequently among victims killed on the streets than those killed at home. In addition, victims killed on the streets were more likely to be male, ages 15-24 years, and African American. Further research in regard to prevention and intervention strategies is needed, keeping in mind the different patterns of homicide on the streets compared with those occurring in other settings.

Homicide in New York City. Cocaine use and firearms.

OBJECTIVE: To determine differences between racial/ethnic groups in overall rates of death by homicide, proportion of firearm homicides, and the use of cocaine prior to death. DESIGN: Descriptive epidemiologic survey of a complete 2-year sample of homicides. SETTING: New York City, NY (population 7,322,564). SUBJECTS: All residents (N = 4298) of New York City who were victims of homicide during 1990 and 1991. MAIN OUTCOME MEASURES: Using medical examiner data, age- and gender-specific rates of homicide were calculated for African Americans, Latinos, and whites. Separate logistic regression analyses were conducted to examine the association between demographic variables and both recent cocaine use and firearm-related homicides. RESULTS: Young African-American and Latino men were more likely to be victims of homicide than all other demographic groups. Approximately three fourths of all homicides involved firearms. In the subset of homicide victims dying within 48 hours (n = 3890), 31.0% were positive for cocaine metabolites. African Americans (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2 to 2.1), Latinos (OR, 1.4; 95% CI, 1.1 to 1.9), and victims 25 through 34 years of age (OR, 2.9; 95% CI, 2.5 to 3.5) and 35 through 44 years of age (OR, 2.7; 95% CI, 2.2 to 3.4) were more likely to be positive for cocaine metabolites than other groups. Young males and females were equally likely to have used cocaine before death. Victims 15 through 24 years of age were more likely than other age groups to be killed by a firearm. African Americans (OR, 1.7; 95% CI, 1.3 to 2.3), Latinos (OR, 1.5; 95% CI, 1.2 to 2.0), and Asians (OR, 2.2; 95% CI, 1.4 to 3.6) were more likely than whites to be killed by a firearm. Men (OR, 4.8; 95% CI, 4.0 to 5.9) were more likely than women to be killed by a firearm. There was no association between having used cocaine before death and being killed by a firearm. CONCLUSIONS: The high rates of death by homicide among young African Americans and Latinos may be due to the increased involvement with both cocaine use and firearms. New efforts must be made to decrease cocaine use and firearm availability.

[Alcohol and the liver. Present knowledge of pathogenic mechanisms]. / Alkohol i jetra. Savremena shvatanja o patogenetskom mehanizmu.

Intensive longtime experimental and clinically-experimental investigations have not yet succeeded unriddling the intimate mechanism of liver alcoholic damage. Earlier knowledge on accumulation of fats in liver under the influence of alcohol (ethanol) is still actual, but it probably represents only epiphenomenon and does not explain the intimate mechanism of events. It still can be stated that, although the aim has not been achieved, gradually, as a consequence of very studious investigations we have signification information which bring more light in regard to identify the mechanism of this frequent disease of modern mankind. We have tried to summarize the latest knowledge on alcoholic liver damages. However, some of the most simple questions still do not have an answer: why do, for example, some longtime alcoholics, whose everyday intake of alcohol is big, develop liver cirrhosis at the end of their lives, while the others, under the same circumstances, develop it very early?

Determination of alpha-fetoprotein by radioimmunoassay. Ten year experience in applying a locally produced kit.

Increased concentrations of serum alpha-fetoprotein (AFP) occur in several physiological (pregnancy) and pathological (liver regeneration, tumour formation etc.) conditions. Measurement of serum AFP levels may assist in the detection of fetal abnormalities during pregnancy, in the detection of renewed tumour growth and metastases in cases of AFP producing tumours and in monitoring some diseases of the liver. In this paper some results are given concerning the follow-up of some patients with tumours of the testis and the possibilities of determining the source of elevated serum AFP (regenerating hepatocytes, malignant liver cells, hepatic metastases from other tissues) in patients with liver diseases.

The effect of access to lethal methods of injury on suicide rates.

The relationship between the availability of lethal methods of injury and suicide rates is an important, but unresolved question. We investigated this relationship by prospectively classifying lethal methods according to their accessibility in the five counties of New York City. These counties have both similarities and differences in the proportion of their populations with access to specific lethal means. We then compared the age- and gender-adjusted method-specific suicide rates of these counties. There were marked differences in overall crude suicide rates among the five counties. The counties had similar suicide rates involving methods that were equally accessible to all persons in each county (eg, hanging, laceration, suffocation, and burns) as well as methods that were accessible to a smaller, but similar proportion of the population in each county (eg, firearms and drowning in waterways). Virtually all of the differences in overall suicide risk among counties were explained by differences in rates involving methods that were differentially available in the counties, principally fall from height, overdose of prescription medications, and carbon monoxide poisoning. We conclude that differences in suicide rates between communities are, in large part, due to differences in accessibility to lethal methods of injury. Therefore, systematic studies should evaluate the effect of reducing accessibility to specific lethal means on suicide rates.

Cocaine use, risk taking, and fatal Russian roulette.

OBJECTIVE: To examine the association between recent cocaine use and risk taking, particularly in the form of playing Russian roulette, a paradigm for extreme risk-taking behavior. DESIGN: A case-control study. CASES AND CONTROLS: The prevalence of cocaine use among all Russian roulette fatalities (N = 14) was compared with a demographically similar, randomly selected sample (N = 54) of all suicides by handgun during a contemporaneous 4-year period in New York City, NY. RESULTS: Recent use of cocaine, the most common drug found at autopsy, was detected in 64% of Russian roulette fatalities and in 35% of the control group (P less than .05). All Russian roulette fatalities were male and usually young and unemployed. Blacks and Hispanics accounted for 80% of all cases and were overrepresented compared with their numbers in the general population. CONCLUSION: In some populations cocaine may be associated with life-threatening risk-taking behaviors.

Prevalence of cocaine use among residents of New York City who committed suicide during a one-year period.

OBJECTIVE: In the mid-1980s the form of cocaine called "crack" became widely available in New York City. The authors sought to determine the prevalence of cocaine metabolites detected at autopsy in persons who committed suicide in New York City during this period. METHOD: Individual reviews of the autopsy and toxicological records of all persons under the age of 61 who had committed suicide in the city during a 1-year period were conducted to determine demographic characteristics, suicide methods, and cocaine and alcohol use at the time of death. RESULTS: In one of every five cases studied, the person who committed suicide had used cocaine within days of his or her death. The prevalence of cocaine use among young Hispanic males who committed suicide was 45%. Persons who were young, black, or Hispanic and who had used alcohol immediately before the fatal injury were most likely to have been recent cocaine users. After controlling for demographic variables and ethanol use, the investigators found that individuals who committed suicide with firearms were twice as likely to have used cocaine as those who used other methods. CONCLUSIONS: In contrast to the results of regional and household surveys during this period, which suggested that the current prevalence of cocaine use in New York City was 3%-5%, these results suggest a high prevalence of cocaine use in the days immediately preceding death by young persons who commit suicide. Additional studies are needed to determine how cocaine may act as a risk factor for suicide.

Report of a fatal thiamylal intoxication.

A fatality due to the intravenous administration of thiamylal is reported. Quantitation of the drug was accomplished by high-performance liquid chromatography (HPLC) and confirmation was by gas chromatography/mass spectrometry (GC/MS). Postmortem tissue concentrations of thiamylal were as follow: 129 mg/L in blood, 366 mg/kg in liver, and 116 mg/kg in brain. Thiamylal was not detected in the urine, gastric contents, or bile. Analytical caveats involving the quantitation of thiamylal are also discussed.

[Malignant tumors in patients in our hospital 1985-1989]. / Maligni tumori digestivnog trakta u nasih stacioniranih bolesnika u periodu 1985-1989. godine.

An analysis was conducted concerning the data on malignant digestive-tract tumors which were treated in the period from 1985 to 1989 at the Department for Gastroenterology of the Clinical-Hospital Center in Zemun. The research results showed that malignant digestive-tract tumors are not in an increase, they are rare in persons which are younger than 40 years of age (10%) and are two times more frequent in males. The share of malignant tumors of the large intestine in overall morbidity is somewhat more frequent, they occur two times more in males and with 10.6% in persons younger than 40 years. The malignant tumors of the stomach are the only ones which are in a decrease, they are considerably less frequent in younger persons (3.7%), but are also two times more frequent in males. Malignant tumors of the pancreas are somewhat more represented in overall morbidity, they are very rare in young persons (3.7%) and are more frequent in males. The data on malignant tumors of the liver show that in the last few years they are somewhat more represented in overall morbidity, they are rare in persons younger than 40, and are more frequent in males.