A two fatal cases of poisoning involving new cathinone derivative PV8.

α-Pyrrolidinoheptiophenone (PV8) is a representative of α-pyrrolidinophenone derivatives, a new group of synthetic cathinones. PV8 was first detected in illegal products in Japan in 2013. It is closely related to α-pyrrolidinovalerophenone (α-PVP), which was one of the most popular novel psychoactive substance (NPS) in Poland in years 2013-2015. The article presents two cases of fatal poisonings of 36-year-old man and 37-year-old woman, where a new cathinone derivative - PV8 was detected in biological material collected during medicolegal autopsies. The concentration of PV8, measured with LC-MS method, was in the first case - 0.26 µg/mL in blood and 0.11 µg/mL in urine and in the second - 0.07 µg/mL and 0.13 µg/mL, respectively. In both cases medicolegal experts finally have determined that the cause of death was fatal intoxication with the main role of PV8. This substance is another synthetic cathinone which is dangerous for live of the users and requires constant monitoring and further research.

Patient's death as a result of mistakenly injection of pancuronium.

Pancuronium is a typical non-depolarizing, curare-mimetic, very potent muscle relaxant. Besides application in anesthesiology and intensive care, it is used in execution as a part of lethal injection. In medico-legal practice, there are cases of using this substance in order to commit suicide or to deprive other people of their lives. Accidental pancuronium intoxications are very rare. The authors present such case ended in sudden death of hospitalized woman after mistakenly injection of the drug. 57-year-old female alcoholic was admitted to the Acute Poisoning Centre after ethylene glycol ingestion. During the fifth day of treatment the nurse by mistake, instead of furosemide, intravenously administered her pancuronium. Sudden respiratory and circulatory arrest occurred, so she was intubated and resuscitation with artificial ventilation were undertaken, however within 1 hour and 45 minutes the patient died. Due to the vague background of a sudden deterioration in the patient's condition, the case was brought for prosecution. The autopsy and histopathological studies did not reveal the cause of death, but undertaken chemico-toxicological examinations identified the presence of pancuronium in blood, liver and kidney (190 ng/ml, 70 ng/g and 125 ng/g, respectively). Chemico-toxicological analysis proved that the cause of death of the 57-year-old hospitalized woman was pancuronium intoxication due to evident medical error during drug administration. In our case the concentration of pancuronium in blood was in therapeutic range (200-600 ng/ml). However, even a therapeutic pancuronium dose administered to patient the breath of whom is not supported and monitored can be a threat to his life.

[Methods of carbon monoxide determination in postmortem blood--advantages and disadvantages]. / Metody oznaczania tlenku wegla we krwi sekcyjnej--zalety i ograniczenia.

With respect to epidemiology of carbon monoxide poisonings, the diagnostic management of poisonings caused by this xenobiotic is among the fundamental objectives of forensic toxicology. In forensic practice, to determine carbon monoxide, colorimetric and spectrophotometric methods, as well as gas chromatography are used. Based on literature data and their own experience, the authors discuss analytical methods universally applied in determinations of carbon monoxide in postmortem blood. The advantages and disadvantages, as well as the cause of errors resulting from the specificity of the examined material (postmortem blood) are indicated.

[State under the influence of drugs or psychotropic agents--a comparison of toxicological and medical examinations in materials of the Department of Forensic Medicine and Toxicology, Silesian University of Medicine, Katowice]. / Stan "pod wplywem substancji odurzajacych lub psychotropowych" porównanie wyników badan toksykologicznych z ocena lekarska w materialach Katedry i Zakladu Medycyny Sadowej i Toksykologii Sadowo-Lekarskiej Slaskiego Uniwersytetu Medycznego w Katowicach.

In the paper, the authors present the results of toxicological examinations of blood samples taken from drivers during road check procedures or from perpetrators of traffic road accidents, which--taking into consideration the kind of the determined agents and their concentrations--were compared with the results of medical examinations from blood sampling protocols studied in the Department of Forensic Medicine and Toxicology, Silesian University of Medicine. All the blood samples were first analyzed using an immunoenzymatic assay (ELISA). Then, the LC-MS method was used. The positive results of screening for the presence of cannabinols were verified by GC-MS. Out of 329 blood samples, 145 were positive. The presence of cannabinols, amphetamine or MDMA was the most predominant finding. Diazepam was determined in 4 cases and opiates in 1 case. Only in 31% cases did positive results of toxicological examinations correspond to deviations found during the medical examinations constituting the basis for the final diagnosis of state "under the influence". In practice, appraisal of drug influence during medical examination seems to be limited and dependent on variable reactions of the examined individuals to a psychoactive agent, time lapse between the traffic road event and the examination or concomitant symptoms associated with ethylene alcohol activity. The final diagnosis of state "under the influence of drugs" or "under the influence of psychotropic agents" given by the physician does not result from the effect of these substances observed during the medical examination, but is very often formulated based on the medical history or police findings. The analysis of the above mentioned cases where Delta9THC or/and amphetamine was detected showed no correlation between the concentration of the psychoactive agent determined in blood and symptoms triggered by its action as described by the physician.

[Toxicological and medico-legal analyses of sudden deaths resulting from butane inhalation]. / Toksykologiczna i medyczno-sadowa ocena naglych zgonów w przebiegu narkotyzowania sie butanem.

Butane is known to be a suffocating gas with narcotic activity, especially at high concentrations. Within the past five years, a few cases of sudden deaths in teenage boys who had inhaled butane, a component of gas for lighters, were investigated in the Forensic Medicine Department, Medical University of Silesia, Katowice. Analyses of biological materials secured at autopsies and evidence from places of deaths was carried out using GC/FID. Butane was found in blood, lung and brain samples of the deceased. Moreover, histopathological examinations were performed. Results of autopsies and additional analyses were appraised from the point of view of their significance and usefulness in giving medico-legal opinions on the cause of death.

[Smuggling of the cocaine in the gastrointestinal tract ended in sudden death--the first case report from the Upper Silesia]. / Przemyt kokainy w przewodzie pokarmowym zakonczony naglym zgonem--opis pierwszego przypadku na Górnym Slasku.

Fifty-year old man was found dead in the bathroom of his apartment. Forensic autopsy was ordered to determine the cause and manner of death. Autopsy revealed the presence of 55 latex "balls" in the stomach and foregut. In the past the victim was suspected of drug's dealing and smuggling. The content of "balls" and biological material (blood, urine, bloody fluid from internal organs) were analysed with LC MS/MS in the Chair and Department of Forensic Medicine and Forensic Toxicology, Medical University of Silesia in Katowice. The range of cocaine' concentration in the "balls" was 91.2-96.1%, whereas concentration in blood - 107.50 microg/ml, in urine - 284.60 microg/ml and in bloody fluid - 192.30 microg/ml. The cause of death was acute cocaine intoxication.