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ABSTRACT: The easily available "legal highs", which are products containing psychoactive substances, such as cathinones, piperazines and synthetic cannabinoids, are abused by adolescents in Poland and in the world as alternatives to classic drugs, such as amphetamines or marijuana. The majority of these potentially dangerous substances are still legal and they are associated with a risk of severe poisoning or even death, and provide new challenges in clinical and forensic toxicological practice. Investigations in the field of "designer drugs" may be well illustrated by the case of a suicide of a 21-year old male who ingested a specified dose of a preparation called "Amphi-bi-a" that contains bk-MBDB, chemically 2-methylamino-1-(3,4-methylenedioxyphenyl) butan-1-one, which belongs to the cathinone group, as a synthetic euphoric empathogen and psychoactive stimulant that is chemically similar to MDMA. It is one of more common components of "legal highs" examined in Poland and other countries. The documentation of the case includes a clinical assessment of the patient's health status performed during his almost 4-h hospitalization before death, autopsy and histological examinations supported by toxicological findings revealing bk-MBDB at extremely high concentrations (at 20 mg/l in the blood and 33 mg/kg in the liver); hence, this body of evidence contributes to knowledge in the field of "designer drugs". Inventions of designers of new psychoactive xenobiotics, which are much in demand, especially in view of the dynamic Internet marketing, which drums up narcobusiness, must be balanced by a national strategy developed by medical, legal and educational circles in the modern civilized world in order to prevent the spreading of the phenomenon.
Forensic science international 05/2012; 222(1-3):e1-6. · 2.10 Impact Factor
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ABSTRACT: A detailed procedure for simultaneous analysis of morphine, codeine, 6-monoacetylmorphine, amphetamine, methadone, and its
metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) in human hair segments by liquid chromatography (LC)-atmospheric
pressure chemical ionization (APCI)-tandem mass spectrometry (MS-MS) was established. Hair samples were pulverized and extracted
with methanol. The blank hair obtained from healthy subjects showed no interfering impurity peaks. Good linearity was obtained
for all compounds in the range of 0.2–20 ng/mg. Accuracy and precision data were also satisfactory. Using the established
method, the opiates, amphetamine, methadone, and EDDP in hair segments were measured for 20 patients undergoing methadone
therapy. Complete abstinence was achieved by only 6 of the 20 patients. Other patients failed to abstain from opiate(s) and/or
amphetamine. Our data show that the present hair analysis of multiple drugs of abuse by LC-APCI-MS-MS is useful for monitoring
the success or failure of methadone therapy.
Forensic Toxicology 04/2012; 25(2):69-75. · 3.00 Impact Factor
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ABSTRACT: 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.
Forensic Toxicology 04/2012; 26(1):36-40. · 3.00 Impact Factor
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ABSTRACT: Four nonfatal and six fatal cases of opiate use are presented with careful toxicological analysis. Levels of morphine (M), Four nonfatal and six fatal cases of opiate use are presented with careful toxicological analysis. Levels of morphine (M),
6-monoacetylmorphine (6-MAM), morphine-6-glucuronide (M6G), and morphine-3-glucuronide (M3G) in blood specimens were measured 6-monoacetylmorphine (6-MAM), morphine-6-glucuronide (M6G), and morphine-3-glucuronide (M3G) in blood specimens were measured
by the sophisticated method of liquid chromatography (LC)-electrospray ionization (ESI)-tandem mass spectrometry (MS-MS). by the sophisticated method of liquid chromatography (LC)-electrospray ionization (ESI)-tandem mass spectrometry (MS-MS).
Fatal cases were characterized by much higher levels of free M than the nonfatal cases; this caused lower ratios of M6G/M Fatal cases were characterized by much higher levels of free M than the nonfatal cases; this caused lower ratios of M6G/M
and M3G/M in the fatal cases when compared with the nonfatal cases. Among the six fatal cases, the M6G/M ratios were especially and M3G/M in the fatal cases when compared with the nonfatal cases. Among the six fatal cases, the M6G/M ratios were especially
low in four cases, in which rapid deaths were estimated. The present data are compared with data previously reported by other low in four cases, in which rapid deaths were estimated. The present data are compared with data previously reported by other
groups, and we discuss the utility of the levels of M, M6G, and M3G in blood and their ratios for estimating the antemortem6G, and M3G in blood and their ratios for estimating the antemortem
status of each individual. status of each individual.
Forensic Toxicology 04/2012; 26(2):87-90. · 3.00 Impact Factor
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ABSTRACT: Parental suspicions that the child may possibly take narcotics may be substantiated by hair analysis, which may not only identify the narcotic abuse profile, but also define the minimum period of narcotic usage.
A toxicological hair analysis aiming at detecting the presence of amphetamines and cannabinoids in children with cardiac complaints of unclear aetiology, with a view of establishing a diagnosis.
The authors analysed hair samples collected from the occipital region of three adolescent patients for the presence of substances of abuse--amphetamines and cannabinoids. Hair strands were subjected to segmentation and chemical processing and subsequently analysed by liquid chromatography-mass detection method.
Indicating the presence of amphetamines and cannabinoids in hair samples, the toxicological analysis allowed for explaining cardiac complaints and personality changes in adolescent patients, with the said changes being associated with addiction to the above xenobiotics extending over some period.
Cardiology in the Young 05/2011; 22(1):8-12. · 0.76 Impact Factor
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ABSTRACT: The Krakow Department of Forensic Medicine was granted a unique opportunity to examine the body of a historical figure, i.e. General Władysław Sikorski, the Prime Minister of the Polish government in exile, deceased in 1943. General Sikorski died in the crash of a Liberator aircraft at Gibraltar, and the British commission investigating the crash decided it had been an accident. In the past several decades, doubts have been repeatedly expressed as to the circumstances of the General's death and the theory of assassination has become very popular. On November 25, 2008, the General's corpse buried in the cathedral of the Royal Castle on Wawel Hill in Krakow was exhumed and the body was thoroughly examined. The examinations demonstrated numerous fractures of the cranium, spine and extremities, the character of which corresponded to effects of an air crash. Based on corpse examination alone it was impossible to establish whether the air crash had been an effect of sabotage or an ill-fated accident. Although no typical evidence of intravitality was found, such as bruises or fat embolisms, yet the character of some fractures suggested that they had been incurred intravitally. These were represented by a spiral fracture of the femoral bone shaft, a fracture of the sustentaculum tali of the calcaneal bone and fractures of the transverse processes of the lumbar vertebrae.
Forensic science international 10/2010; 202(1-3):e29-33. · 2.10 Impact Factor
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ABSTRACT: To our knowledge, the majority of evidence supporting the relationship between the serotonin syndrome and medications that effect 5HT is based on case reports. The justification for taking up this subject has been a fatal outcome of a 21 year-old female following an administration of toxic doses of moclobemide (MAOI) and venlafaxine (SNRI). As a result of complex toxicological investigations including antemortem and postmortem material, antemortem clinical observations and postmortem examinations, the cause of death was identified as overdose with antidepressants--moclobemide and venlafaxine--in the mechanism of the clinically fully developed severe toxic serotonin syndrome. The analysis of a hair strand collected from the victim documented the use of the above-mentioned drugs simultaneously with cocaine in the period of at least 20 months preceding death. The fact is a matter of considerable interest in view of the employed pharmacotherapy, giving rise to suspicion that the woman had not developed the serotonin syndrome during the almost 2-year antemortem period until she took toxic doses of both medications.
Forensic science international 02/2009; 184(1-3):e16-20. · 2.10 Impact Factor
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ABSTRACT: The report describes a fatal outcome in a 5-year-old male who died after drinking a fatal dose of ethanol at the party held by his parents. Urine and blood alcohol level of the deceased was 0.4 and 0.5 g/dL, what might explain the sudden death of the child. In addition, the analysis of the boy's hair demonstrated the presence of ethyl glucuronide (EtG), a marker of alcohol consumption; hair EtG concentration levels indicated that the boy might have occasionally imbibed alcohol prior to death. Pathological lesions of the liver observed in histopathology did not contradict such a hypothesis.
Forensic science international 08/2008; 179(1):e1-4. · 2.10 Impact Factor
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ABSTRACT: The report presents a fatal poisoning of a neonate occurring in the final stage of gestational life and evoked by his mother, who, while 9 months pregnant, took a toxic dose of clozapine aiming at committing suicide. She was also severely poisoned, but ultimately was saved. The woman had been taking the medication due to schizophrenia and depression prior to conception, and the discontinuation of the drug in the course of pregnancy increased the risk of the woman attempting suicide. In the course of comprehensive toxicological analysis based on the developed analytical procedure with the use of LC-APCI-MS, clozapine and its two metabolites, norclozapine and clozapine-N-oxide, were determined in postmortem blood, liver and kidney in concentrations explaining the death of the neonate. The interpretation of the above-described case is complex and--apart from toxicological aspects--also involves issues associated with psychiatry, pharmacotherapy in pregnancy and medicolegal problems.
Forensic science international 09/2007; 171(1):e5-e10. · 2.10 Impact Factor
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ABSTRACT: Drugs of abuse belonging to the amphetamine derivatives, which are often taken by adolescents and young adults, pose a serious risk associated with uncontrolled ingestion that sometimes leads to fatal outcomes. The number of deaths, however, related to Ecstasy is small when compared to the frequency of its use. The report presents a fatal poisoning with MDMA--Ecstasy of a 22-year-old male with a documented history of drug abuse. The observations of witnesses to the event made within the period between the exposition and fatal outcome may document the characteristic behavior of a person in the course of progressive poisoning. Toxicological investigations of the autopsy specimens carried out by means of liquid chromatography-atmospheric pressure chemical ionization-tandem mass spectrometry (LC-APCI-MS-MS) demonstrated the presence of MDMA and its metabolite MDA in the blood of the victim, and the concentration level justified the fatal outcome (MDMA--1.42mg/L, MDA--0.17 mg/L), while the detection of high MDMA levels in a 6-cm long strand of hair separated into three segments (11.64 ng/mg in S1; 8.74 ng/mg in the S2; 15.51 ng/mg in the S3) confirmed the history of drug abuse. The report describing the results of macro and microscopic examinations aiming at assessing internal organ damage suggested a mild hepatic damage.
Legal Medicine 08/2007; 9(4):185-91.
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ABSTRACT: The report presents a segmental hair analysis for the retrospective multi-parameter evaluation of drugs of abuse including opioids, cocainics and amphetamines. The analysis was carried out with the use of liquid chromatography atmospheric pressure chemical ionization tandem mass spectrometry (LC-APCI-MS-MS). The authors have evaluated the differences in the contents of particular opiates in the hair as related to the origin of a sample taken from Polish drug users taking "Polish heroin", and also from heroin abusers from Western European countries taking "Western heroin". The results indicate distinct differences in the 6-MAM concentration values in the Polish and foreigners, suggesting that the foreigners take products containing high concentrations of heroin and the Polish take the poppy product "compote" characterized by its variable and low heroin content. An additional argument for a different abuse profile in the Polish and Western drug users is found in the presence of cocaine detected in hair samples originating from the latter, while cocaine is much less frequently detected in Polish drug users.
Journal of Chromatography B 08/2007; 854(1-2):299-307. · 2.89 Impact Factor
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ABSTRACT: The purpose of the study is a presentation of a fatal case involving an 83-year-old woman, who died due to an overdose of vinblastine-a cytostatic agent of a vinca alkaloid employed in cancer chemotherapy. The postmortem investigation included an autopsy and histological examination, as well as a toxicological analysis of post-mortem specimens collected in the course of autopsy. The authors performed a toxicological assessment of vinblastine employing liquid chromatography-atmospheric pressure chemical ionization-tandem mass spectrometry (LC-MS-MS-APCI). The determined vinblastine concentration levels amounting to 29 ng/g in blood and 52.5 ng/g in liver were in a considerable excess of values encountered in patients on chemotherapy using the drug. The fatality was investigated in the context of medical error. In the described case, the erroneous and medically unjustified administration of vinblastine was identified by a series of unfortunate events involving as many as three acting consecutively individuals: a physician, a pharmacist and a nurse. The report may thus document the clinical course of vinblastine poisoning along with postmortem changes resulting from the drug action.
Cancer Chemotherapy and Pharmacology 02/2007; 59(1):89-95. · 2.83 Impact Factor
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ABSTRACT: The purpose of the study is a presentation of a fatal case involving an 83-year-old woman, who died due to an overdose of vinblastine—a cytostatic agent of a vinca alkaloid employed in cancer chemotherapy. The postmortem investigation included an autopsy and histological examination, as well as a toxicological analysis of post-mortem specimens collected in the course of autopsy. The authors performed a toxicological assessment of vinblastine employing liquid chromatography-atmospheric pressure chemical ionization-tandem mass spectrometry (LC-MS-MS-APCI). The determined vinblastine concentration levels amounting to 29ng/g in blood and 52.5ng/g in liver were in a considerable excess of values encountered in patients on chemotherapy using the drug. The fatality was investigated in the context of medical error. In the described case, the erroneous and medically unjustified administration of vinblastine was identified by a series of unfortunate events involving as many as three acting consecutively individuals: a physician, a pharmacist and a nurse. The report may thus document the clinical course of vinblastine poisoning along with postmortem changes resulting from the drug action.
Cancer Chemotherapy and Pharmacology 12/2006; 59(1):89-95. · 2.83 Impact Factor
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ABSTRACT: Toxicological investigations of postmortem specimens of a 26-year-old man were performed with the use of LC/APCI/MS. They revealed in the blood of the deceased clomipramine (9.49 microg/g) and its main metabolite norclomipramine (1.10 microg/g) at concentrations explaining the fatal outcome. The presence of these xenobiotics in a 12-cm-long strand of hair (clomipramine, 7.60 ng/mg in I segment; 4.19 ng/mg in II segment; 1.86 ng/mg in III segment; norclomipramine, 5.71 ng/mg in I segment; 9.71 ng/mg in II segment; 4.13 ng/mg in III segment) confirmed the fact obtained from the medical history that the deceased had been receiving clomipramine as an antidepressant for 1 year prior to his death. The analysis demonstrated ethanol in autopsy blood (2.5mg/ml) and urine (3.2mg/ml); ethyl glucuronide as a marker of chronic alcohol abuse was detected in the deceased's hair (0.44 ng/mg in I segment; 0.07 ng/mg in II segment; n.d. in III segment). These findings may suggest the contribution of alcohol in the mechanism of drug-ethanol interaction, which in consequence might have affected the biotransformation of clomipramine in the final period of his life and evoked the ultimate toxic effect.
Legal Medicine 11/2005; 7(5):319-25.
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ABSTRACT: A typical use of hair analysis in forensic toxicology is the documentation of previous drug administration. This is illustrated in a suicidal death of a 58-year-old epileptic patient who was treated with oxcarbazepine and probably with levomepromazine. The toxicological analysis carried out by HPLC/APCI/MS included also the hair (6 cm length) besides postmortem blood. The method was validated for levomepromazine, oxcarbazepine (OXCBZ) and its two metabolites, 10-hydroxycarbazepine (CBZ-10OH) and trans-diol-carbazepine (CBZ-diOH) in various biological matrices. The analysis of the postmortem blood indicated oxcarbazepine and its two main metabolites were present at therapeutic concentrations; levomepromazine was detected at a fatal concentration. In three 2-cm segments of hair, oxcarbazepine and its two metabolites were detected; however, levomepromazine was not detected in this specimen. As a result of complex chemical-toxicological investigation it was confirmed the information that the decedent. was an epileptic patient and was treated with oxcarbazepine for at least 6 months before death. In addition, he took a toxic dose of levomepromazine in order to commit suicide. The analysis revealed differences between the concentration levels of oxcarbazepine and its active metabolite CBZ-10OH in postmortem specimens and hair, suggesting different mechanisms of penetration of metabolites and their precursors into this matrix.
Journal of Chromatography B 11/2005; 825(1):38-46. · 2.89 Impact Factor
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ABSTRACT: The results of a multi-parameter analysis of opiates in the hair of drug users and victims of fatal poisonings with these xenobiotics have been presented. The analysis was carried out with the use of liquid chromatography coupled with mass spectrometry (LC-MS). The article discusses the monitoring of the drug users' adherence to pharmacotherapy and the usefulness of hair analysis for medico-legal purposes. The authors evaluate the differences in the contents of particular opiates in the hair as related to the origin of a sample (untreated drug user, drug user in the course of treatment, victim of fatal poisoning). The report presents differences between the Polish and American profiles of abuse, providing confirmation that a great part of drug users undergoing methadone treatment do not abstain from opiates and/or amphetamine, the latter as a rule being very often taken with opiates.
Przegla̧d lekarski 02/2005; 62(6):585-90.
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ABSTRACT: The pattern (frequency, type of exposure, toxic substance) of adolescent and adult poisonings in Kraków in 2003 is compared with 1983. The analysis includes data for poisoned patients treated at the Kraków Department of Clinical Toxicology and all on the spot fatal cases subjected to post-mortem autopsy and toxicological examinations at the Department of Forensic Medicine Jagiellonian University Medical College in both the years. As much as 4341 poisoning cases (2852 males; 1489 females) were treated in 2003 compared with 2132 (1078 males; 1054 females) in 1983. In 1983 in group of 154 poisoned persons who died at the place of accident there were 138 (89.6%) men and 16 (10.4%) women. In 2003 among 121 deaths at the scene there were 93 (76.9%) males and 28 (23.1%) females. Poisonings due to suicidal attempts decreased significantly from 53.6% in 1983 to 19% in 2003. Incidence of poisoning per 10 000 of general Kraków population increased from 36.17 in 1983 to 57 in 2003 or up to 65.7 if the population of adults and teenagers (above 15 years old) was only considered. Pharmaceuticals (40.6%) followed in frequency by ethanol (25%) and ethanol co-ingested with pharmaceuticals (12.2%) and carbon monoxide (10.6%) were the most common reasons for poisoning in 1983. In 2003 the most common cause of poisonings was ethanol (46.2%) followed by pharmaceuticals alone (25%) or co-ingested with ethanol (6.4%) and carbon monoxide (6.2%). An ingestion of mixed pharmaceuticals (55.1%) followed In frequency by non-barbiturate hypnotics and psychotropic drugs (26.3%) were a most common in 1983 whereas a non-barbiturate hypnotics and psychotropic drugs (34.4%) followed by mixed pharmaceuticals (32.9%) in 2003. A mortality both concerning only the people who died in hospital and also those who died on the spot (prior to any treatment) was significantly higher in 1983 compared with 2003.
Przegla̧d lekarski 02/2005; 62(6):446-52.
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ABSTRACT: The patterns (frequency, poisoning type, toxic agent involved) of adolescent and adult poisonings in Kraków in 1972 and 2002 are presented. The analysis includes data for poisoned patients treated at the Kraków Department of Clinical Toxicology in 2002 and 1972, and all on the spot fatal cases subjected to post-mortem autopsy and toxicological examinations at the Department of Forensic Medicine in both the years. As much as 4116 poisoned cases (males 2722; females 1394) were treated in 2002 compared to 1485 (males 649; females 836) in 1972. There was no substantial difference between a number of poison related fatalities on the spot in years analysed: 126 (males 105; females 21) in 2002 and 122 (males 84; females 38) in 1972. An elevation in poisoning incidence rate per 10,000 of Kraków inhabitants was also noted in 2002 compared to 1972 (54.3 vs. 30.0). A pharmaceuticals (32.9%) followed by CO (18.2%) and mixed pharmaceuticals (16.2%) were mostly involved in poisoning cases in 1972, whereas ethanol (46%), pharmaceuticals (13.2%), pharmaceuticals co-ingested with ethanol (7.8%), narcotics (7.8%), mixed pharmaceuticals (6.7%), and CO (5.2%) were mostly involved in poisoning cases treated in 2002. A mortality rate both concerning only a people who died in hospital or/and those who died on the spot (prior to any treatment) was significantly higher in 1972 compared to 2002.
Przegla̧d lekarski 02/2004; 61(4):251-5.
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ABSTRACT: The aim of the study was to present the group carbon monoxide poisoning in Kraków in December 2003. Despite the reanimation procedure one fatal case was stated on the spot (HbCO--60% according to post-mortem toxicological examination). CO threshold limit values were significantly exceeded in the whole building. The inhabitants (15 persons) were transported to the Department of Clinical Toxicology Jagiellonian University Medical College. Also 4 staff members of the ambulance and 2 policemen called to the incident, were diagnosed and observed. Totally, toxicology medical care was given to 21 CO exposed persons. In 8 of them acute CO poisoning of minor grade was stated. Any clinical symptoms of poisoning in the rest of CO exposed persons were noted.
Przegla̧d lekarski 02/2004; 61(4):397-400.
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ABSTRACT: A development of contemporary analytical methods makes possible to use hairs in toxicological analysis for documentation history of drug administration. An undertaken subject has been illustrated by a suicidal fatal poisoning of 58-year-old man with a neuroleptic drug--levomepromazine. Toxicological analysis carried out by HPLC/APCI/MS, besides of standardized postmortem specimen as blood, urine, liver and cerebrospinal fluid included also victim hairs. As a result of analytical procedure levomepromazine at high concentrations was revealed, which may be responsible for death. Moreover, and antiepileptic drug--oxcarbazepine and two main metabolites at therapeutic concentrations were revealed parallel. In three 2-cm segments of hair oxcarbazepine and two metabolites were detected, levomepromazine, in contrary, was not detected in this specimen. Complex chemical-toxicological investigation confirmed information that victim was an epileptic patient and was treated with oxcarbazepine at least 6 months before death while toxic dose of levomepromazine, as one could suppose, he took to commit suicide.
Przegla̧d lekarski 02/2004; 61(4):414-8.
