Narcotic Intoxication Research Articles

CRIMINAL LIABILITY FOR DRUG USE AND DRUG INTOXICATION

The article is dedicated to the study of criminally punishable actions related to narcotics and psychotropic substances (manufacturing, acquisition, possession, transportation, dispatch, etc.), which are committed without the intent to sell and defined in Part 1 of Article 309 of the Criminal Code of Ukraine as forms of the objective side. The authors drew attention to practical situations where a person attempts to ingest (swallow) a purchased narcotic or psychotropic substance in order to evade criminal liability under Part 1 of Article 309 of the Criminal Code. When ingesting such a narcotic substance in non-public places, there is no criminal liability under Ukrainian legislation; only the presence of a public place allows for the qualification of the person’s actions under Article 316 of the Criminal Code. Also, there is no criminal liability when a person is in a public or non-public place in a state of “narcotic intoxication.” In the authors’ opinion, these are shortcomings of the criminal legislation that require correction by supplementing the objective side of Part 1 of Article 309 with new forms related to “drug use” (in any location, not just public) and “being under the influence of narcotics”. Based on the research findings, the authors proposed to present the objective side of Part 1 of Article 309 of the Criminal Code of Ukraine in the following wording: “Illegal production, manufacturing, acquisition, possession, transportation, dispatch, or use of narcotic drugs, psychotropic substances, or their analogues without the intent to sell, as well as being under the influence of narcotics, are punishable by...”. The authors’ proposed amendment to Part 1 of Article 309 of the Criminal Code should function as a general criminal law norm regulating drug use in any location, while the existing Article 316, “Illegal Public Drug Use,” should remain a specific provision applied to cases of drug use in public places. In the authors’ opinion, expanding the content of the objective side in Part 1 of Article 309 by including additional forms will help ensure effective counteraction to drug-related behavior and will have a significant preventive impact on potential drug offenders.

Preventable hand injuries: A national audit

Little is known of the scale of avoidable injuries presenting to medical services on a national level in the UK. This study aimed to assess the type and incidence of preventable wrist and hand injuries (as defined by the core research team) at a national level in the UK. 28 UK hospitals undertook a service evaluation of all hand trauma cases presenting to their units over a 2 week period in early 2021 identifying demographical and aetiological information about injuries sustained. 1909 patients were included (184 children) with a median age of 40 (IQR 25-59) years. The commonest five types of injury were fractures of the wrist; single phalangeal or metacarpal fractures; fingertip injuries; and infection, with the most common mechanisms being mechanical falls and manual labour. This is the first extensive survey of preventable hand injuries in the UK, identifying a need for further work into prevention to reduce healthcare burden and cost. 50% of injuries presenting to hand surgeons are preventable, with the most common injuries being single fractures of the wrist, phalanx and metacarpal. Few preventable injuries were related to alcohol or narcotic intoxication. Further research is needed to identify how to initiate injury prevention measures for hand injuries, particularly focussed towards hand fracture prevention.

Clinical, Diagnostic, and Treatment Features of Body Packing in Brazil: Drugs, Cell Phones, and Beyond.

Introduction: Body packing consists of the concealment of substances (drugs and non-narcotics) or products inside the human body with the purpose of smuggling and may represent an emergency due to the fatal risk of narcotic toxicity, intestinal obstruction, and visceral perforation. However, non-narcotic body packing, especially in developing countries, is under-evaluated. Thus, the objective of this study was to evaluate cases of body packers in Brazil as regards narcotic and non-narcotic contents.Methods: This retrospective study analyzes the medical records of body packers admitted from January 2015 to December 2019 at one of the main tertiary hospitals in central Brazil.Results: Ten cases of body packing were observed. We found that five patients carried drugs, while seven carried non-narcotic substances such as cell phones and accessories. All the patients were male, prisoners, and young adults. In six patients, there was gastrointestinal obstruction, and in three, there was acute narcotic intoxication. Abdominal radiography diagnosed eight of the cases. In nine of the cases, emergency laparotomy was required, but all patients successfully recovered.Conclusion: There was a higher prevalence of body packing of non-narcotic content; however, diagnostic and surgical approaches were similar to those of narcotic content. Clinicians must be aware of both non-narcotic and narcotic body packing.

Mental Disorders Associated with the Abuse of Synthetic Cannabinoids (Spices)

Introduction: the abuse of synthetic cannabinoids may trigger the development of mental disorders characterized by distortions of disease processes that can cause incorrect diagnosis.Objective: to study the phenomenon of the abuse of synthetic cannabinoids (Spice) as a trigger psychotic episode in psychiatric patients (with schizophrenia and personality disorders) and risk factors for developing paranoid schizophrenia.Patients and research methods: 291 men were examined: 241 with dependence on synthetic cannabinoids — 101 of them were diagnosed with personality and behavior disorders in adulthood, 140 with a diagnosis of paranoid schizophrenia and 50 with a diagnosis of paranoid schizophrenia without drug dependence.Research methods: clinicalpsychopathological, psychometric (SANS, CGI, MMPI), follow-up, statistical R (R version 3.2.4).Results: intoxication conditions caused by synthetic cannabinoids can provoke the development of psychotic episodes and be a trigger for the manifestation of schizophrenia. There are four variants of narcotic intoxication: delirious, schizophrenic, with pseudo-hallucinations, with delirium. The personalities of patients addicted to synthetic cannabinoids are similar in the prevalence of emotionally unstable, rigid, introverted, deviant traits. Patients with personality disorders, dependent on synthetic cannabinoids, differed from typical drug addicts in such patterns of behavior as disorganization, conflict, unpredictability, spontaneity, thoughtlessness of actions, impulsivity, and nonconformity. The stigmatizing signs of the schizophrenic process in patients who are dependent on synthetic cannabinoids are the symptoms of abulia–apathy of mild severity. Patients with schizophrenia, dependent on synthetic cannabinoids, differed from patients without dependence on drugs by the phenomenon of the absence of an emotional defect expressed in the expressiveness of emotions, the desire for communication.Conclusion: the phenomenon of synthetic cannabinoid abuse is a trigger of a psychotic episode in both schizophrenic patients and those with personality disorders in whom antisocial, schizoid and paranoid personality traits prevail. The abuse of synthetic cannabinoids is a risk factor for the development of paranoid schizophrenia, which differs from schizophrenia without drug dependence by a mild degree of stigmatizing symptoms of abulia–apathy and social activity during periods of short-term remissions.

MORPHOGENETIC MECHANISMS OF PATHOMORPHOLOGICAL CHANGES IN THE LIVER IN CHRONIC DRUG POISONING

This article presents the results of the morphogenetic and morphological study of the liver in chronic narcotic intoxication. Three groups of pathomorphological changes and their morphogenetic mechanisms are revealed: dystrophic, discirculatory and cholestatic.The role of drugs in pathogenesis and morphogenetic mechanisms of liver damage is still unclear. Meanwhile, peculiarities of pathomorphological changes at CVHrequire differentiation from structural liver lesions caused by narcotic intoxication based onthe development of morphogenetic and morphological criteria of liver lesions by drugs is possible and can be a basis for forensic histological diagnostics of CDI.Keywords: liver, drug intoxication, morphogenesis, morphology, chronic drug intoxication

THE PSYCHOLOGICAL CONTENT OF FUGACITY AS A PLAYFULNESS / LUDIC COMPETENCE COMPONENT

The article purpose: to describe in specific terms and enrich the psychological structure of fugitive as a component of playfulness / ludic competence on the basis of theoretical, methodological and empirical research. The study results has allowed us to make the following conclusions: 1) based on the analysed using of the “fugue” word in the scientific discourses in different fields, we have assumed that “fugue” was used by the Japanese colleagues for one of the of playfulness scales as a paronym of “fugitive”; 2) by generalization of dictionary definitions, we have determined the need to replace the term “fugue” as a component of playfulness with “fugitive”; 3) the distinguished and described levels of playfulness in examined literature, video content and cases allowed us to rethink the content of fugitive and to articulate such a component as the ability to “acquire” a new identity through simulation of feigned states; 4) an “acquired” new identity determines the genre specification of “Holy Fool” ludic position: on the one hand, the variability of its cognitive, affective, behavioural manifestations (in general) and verbal and non-verbal characteristics (in particular), and on the other hand, the stereotyped behaviour imitating the “symptoms” of feigned states; 5) the criteria for the development of fugitive can be: a high level of playfulness, tolerance for uncertainty, openness to new experience, resistance to shame, creativity, the ability for self-observation, an aggressive style of humour. We define fugitive, a component of playfulness, as an ability to “acquire” a new identity through simulation of feigned states, for example, another intellectual level - genius / stupidity / insanity; another stage of moral development; altered states of consciousness - alcoholic (or narcotic) intoxication / trance / ecstasy; a state with a reduced / absent response to the world around us - sleep / fainting / death. At the same time, feigned behaviour reflected by a player him/herself and observed by Other is aimed at enhancing the sense of identity.

Partial Insanity and Other Mitigating Psychological Circumstances Under Albanian Criminal Law

Albanian criminal legislation gives a special place to the mitigating circumstances of a psychological nature applied to the perpetrators of criminal offenses. In the Albanian doctrine, the psychological state is considered part of the subjective component which in itself has, in essence, the existence or not of responsibility and the extent of the perpetrator's guilt. Referring to its formulation, the article of the Criminal Code providing for the mitigating circumstances mentions only one circumstance of a psychological character, psychiatric distress. The same relevance and legal treatment as the mitigating circumstances can be encountered in other institutes, such as the reduction of mental balance or the commission of a criminal offense in a state of intoxication. Thus, this manuscript analyzes the mitigating circumstances provided by the Albanian criminal legislation through the method of comparison while identifying the shortcomings in cases when these circumstances constitute at the same time general institutes of criminal law. Keywords: Albanian criminal law, mitigating circumstances, partial insanity, psychiatric distress, inebriation, narcotic intoxication, emotional state

MORPHOLOGICAL CHANGES OF ORGANS UNDER THE INFLUENCE OF OPIOID

A rapid increase of the number of drug users has led to the emergence of drug profile diseases, multiple organ comorbid pathologies, which along with the great economic and moral damage make drug addiction one of the most important problems in many countries in the world. The indisputable relationship between the depth of hemomicrocirculatory disorders and the duration of opioid exposure has been proved. In pathogenesis of opioid addiction, in opioid users circulatory disorders are found. Histological examination data reveal unevenly bloodfilled vessels, erythrostasis, intramural hemorrhages, spasm of arterioles, sclerosis of the walls of blood vessels. Literary evidence indicates that chronic opioid use leads to substantive structural and functional changes in the nervous system. After 6 weeks of administration of nalbuphine, profound destructive changes in the hemomicrocirculatory bed of the cerebral cortex, radiant crown and corpus callosum are observed. In the literature there is evidence of changes in the structural organization of the skin of rats due to the influence of opioid. Kidney damage against the ground of opioid addiction is described as "heroin nephropathy". Acute changes are manifested by an increase in the glomerulus cellularity due to cell proliferation of mesangium and endothelium, intracellular edema. Chronic narcotic intoxication is accompanied by significant damage to the digestive system. The primary target organ for drug addicts is the liver. In the liver of chronic drug addicts periportal infiltrates of lymphoid, histiocytic, neutrophilic elements, hepatocyte swelling, cholestasis, plethora are determined. Chronic opioid inluence causes significant dystrophic changes in the structural components of the colon mucosa. There are reports in the professional literature regarding the effects of opioids on the organs of the immune and endocrine systems. The analysis of the literature indicates the relevance and importance of studying this medical and social problem. This publication presents features of morphological and structural changes in organs and systems under the influence of opioids.

ВЛИЯНИЕ УПОТРЕБЛЕНИЯ ПСИХОАКТИВНЫХ ВЕЩЕСТВ НА РАЗВИТИЕ АКТИВНОГО ТУБЕРКУЛЕЗА У БОЛЬНЫХ ВИЧ-ИНФЕКЦИЕЙ В ЗАВИСИМОСТИ ОТ КОЛИЧЕСТВА CD4-ЛИМФОЦИТОВ

The objective of the study : to assess the risk to develop active tuberculosis in HIV infected patients with history of substance abuse taking into account their CD4 count. Subjects and methods . A retrospective case-control study was conducted with enrollment of 171 patients: HIV Group included 85 persons, while TB/HIV Group – 86 persons. For screening for chronic alcohol/narcotic intoxication, the CAGE questionnaire was used, and tobacco dependence was detected according to the criteria of World Health Organization. CD4 counts were obtained by the retrospective analysis of medical records. The impact of the studied risk factors on the development of tuberculosis was estimated by calculating the odds ratio with the calculation of the 95% confidence interval. Results. Statistically significant association with the development of active tuberculosis was obtained for all factors studied (tobacco smoking: OR = 8.7, 95% CI 3.6-21.6, p = 0.01; chronic alcohol and narcotic intoxication: OR = 3.5, 95% CI 1.8-6.5, p = 0.001 and OR = 2.5, 95% CI 1.1-5.4, p = 0.026, respectively). In the group of patients with CD4 count above 200 cells/µL, there was a confident effect of smoking and clinically significant substance abuse on the risk to develop active tuberculosis, and the power of their effect increased: for tobacco smoking OR = 12; 95% CI 1,5-98,7, p = 0.012; for drug abuse, OR = 4.8, 95% CI 1.7-13.4, p = 0.002. The tendency of chronic alcohol intoxication providing impact on the risk to develop tuberculosis in patients with CD4 count above 200 cells/ μ l persisted, but there was no statistically significant relationship in calculating the odds ratio OR = 3.1, 95% CI 3.1–9.6, p = 0.082. The obtained data allow considering people living with HIV and possessing history of substance abuse as a group facing the high risk to develop tuberculosis in need close follow-up aimed to prevent tuberculosis.

REFLECTION OF THE INNER WORLD OF A PERSON IN A CHANGED CONDITION OF HIS CONSCIOUSNESS (ON THE MATERIAL OF ARTISTIC TEXTS)

The article presents, on the material of artistic texts, linguistic ways of reflecting the inner world of a person in a state of narcotic intoxication and his perception of the surrounding reality with a view to evaluating these methods from the point of view of specifics compared to methods of reflecting different types of internal state of a person which is normal in the Russian linguistic view of the world. Special attention is paid to the ways of textual reflection of certain phenomena characteristic of the state of drug intoxication: personality split-up, space duplication, hallucinations.
 According to the results of the study, a conclusion is made that there are no specific methods of depicting the state of drug intoxication and the persons perception of the surrounding world in this state: in some cases, metaphorical images are used that are typical for displaying different variants of the emotional, mental, and physiological state in the Russian language world picture in others, typical ways of describing various forms of an altered state of consciousness, known to each person and widely represented in various types of discourse, are involved, including in literary texts: dreams, memories, fantasies, poor health, etc.
 The analysis revealed differences in the assessment of some of the depicted aspects of perception of reality from the standpoint of the person experiencing them, and from the standpoint of the reader. In certain cases (when describing hallucinations, etc.), the means perceived by the reader as figurative (metaphorical) reflect the impressions that are real for the subject of this state, perceived by him sentimentally, in this case the corresponding means are not assessed equally by the speaker (narrator) and by the reader.

Entomotoxicology-A Juvenile Branch of Forensic Entomological Studies

Entomotoxicology is a relatively new branch of Forensic Entomology. Insect and other arthropods are valuable evidence in death investigation. In addition to their use in detecting drugs and other toxins in decomposing tissue it has been widely demonstrated in death investigation if the distribution, biology, ecology and behavior of insects found at the crime scene are known, it can provide information like when, where and how the crime was committed. The life cycle and the internal composition of the insects uncover a great deal of realities about the crime scene. Entomotoxicology is the analysis of toxins in arthropods that feast upon carcass. In arthropods mainly fly and beetles are considered. Forensic Entomotoxicology studies the usefulness of insects as an alternative toxicological sample. A use of the insects is found over the corpse that is decayed or blood, urine or internal organs are no longer available for testing of toxins. The accuracy of entomological estimates in deaths involving narcotic intoxication has been subject to debate in recent years. Couple of accessible research have demonstrated the impacts of medication contained in disintegrating tissue of life cycle, fly colonization, ovipositional behaviors or in rates of their development in insect feeding on such food sources. These progressions are advantageous as they demonstrate that such body contains lethal substances that may be the reason for death, time since death, development of the remaining parts since death and the anti mortem wounds. Hence, insects play a vital role in crime scene investigation. However, several remarks on the limitations of entomotoxicology have been highlighted recently. In this paper, the implications for the practice of this forensic procedure are fully reviewed.

CHANGES IN GIANT CELLS OF THE RETICULAR FORMATION OF THE MEDULLA OBLONGATA AGAINST THE BACKGROUND OF DIFFERENT TYPES OF HEMORRHAGE

Histological methods have been used to study the magnocytosis of the reticular formation of the medulla oblongata from 22 corpses of people who had died from various types of blood loss, accompanied by intoxication. In acute blood loss, pronounced changes in magnocytes are observed due to hypoxia. With massive hemorrhage, the damage to magnocytes is due to the morphofunctional insufficiency of gliocytes. In the death from massive blood loss on the background of acute, as well as chronic alcohol and narcotic intoxication, the pathology of magnocytes and gliocytes arises from the damage to the vascular system of the medulla oblongata.

АНГИОГЕННЫЙ МОЛНИЕНОСНЫЙ СЕПСИС ПРИ ВИЧ-ИНФЕКЦИИ

The course of sepsis can be peracute in HIV patients, and its initial manifestations could be non-specific (a headache, inadequate behavior etc.) thus it can be difficult to be diagnosed. Sepsis is to be differentiated in intravenous drug users from narcotic intoxication and abstinence. The article presents a clinical case of angiogenic peracute sepsis in a female HIV infected patient, substance abuser, demonstrating that in such patients regardless of their social status the history is to be very carefully taken and thorough clinical examination is to be performed as well as follow-up due to various non-typical manifestations of sepsis.

The topical problems of the application of the TASER electroshock devices

The objective of the present study was the analysis of publications in the foreign medical literature concerning the problems of safety, clinical diagnostics, pathological morphology, and treatment of the patients subjected to the impact by various models of the TASER electroshock devices. The materials for this article were borrowed from the available Internet resources and libraries. The methods of scientific analysis were employed to follow up the dynamics of publication and to determine the number of publications on the issues of interest. The main attention was given to the overview of the subject matter of scientific research and experiments. The review covers 74 foreign articles presenting the discussion of various conditions and circumstances of the action of various types of the TASER electroshock devices (ESD) on the man with special reference to their effectiveness and safety as confirmed by numerous experimental impacts on the volunteers and animals. It is shown that the dynamics of relevant publications in the foreign scientific periodicals gives evidence of the strong interest shown by the specialists in various scientific disciplines to the problem of safety of various models of the TASER electroshock devices. The largest number of the articles (60 or 81.1%) published during the period covered by the present study were submitted by the American authors describing their experiments involving the volunteers, anthropometric dummies, and human corpses (n=38 or 51%). The subject matter of these publications included the forensic medical evaluation of the lethal outcomes of the application of the TASER electroshock devices with the related technical problems and characteristic of various ESD models. Despite the extensive studies on the volunteers and the experimental animals, the authors of the publications failed to present direct and conclusive evidence of the lethal consequences of the application of the TASER electroshock devices (ESD) on the man. Some of them recommend to prohibit (or restrict whenever possible) the targeted application of the electric shock weapons to the thoracic region. Experiments on the animals have demonstrated the possibility of development of cardiovascular and respiratory complications following the application of the TASER X2 electroshock devices operating at a frequency of 40 Hz during 30 minutes. The clinical and laboratory studies with the participation of the volunteers in an alcoholic intoxication condition have confirmed the long-term increase in the blood lactate levels under the influence of the electric shocking weapons. The analogous data suggesting the development of pronounced acidosis under effect of the TASER X2 electroshock devices due to the elevation of the lactate concentration in the venous blood have been obtained in the animal experiments. The studies of humans in a narcotic intoxication condition failed to provide direct evidence of induction of psychic disorders in the form of an acute confusional state (delirium) under the influence of the TASER electroshock devices. The evaluation of changes in the skin cover in the form of the punctured or contused wounds in the victims of the application of the electroshock gun projectiles did not revealed any specific signs of the local electrical action.

Negative Pressure Pulmonary Edema Following Naloxone Administration in a Patient With Fentanyl-induced Respiratory Depression

Naloxone is commonly used to reverse narcotic intoxication. However, its use is not entirely free of hazards. For instance, pulmonary edema (PE) has been reported to arise with the mechanism of over-sympathetic discharge caused by release of cat-echolamine or central neurogenetic responses to narcotic reversal. Here, we report a healthy young patient who, after undergoing an uneventful uvulopalatopharyngo-plasty for obstructive sleep apnea hypopnea syndrome, developed PE following administration of naloxone. Fentanyl-induced respiratory depression was found during anesthesia emergence and thus naloxone was indicated for reversal. Unfortunately, upper airway obstruction-induced negative pressure PE occurred following naloxone administration. From this case, we suggest that a patent airway should be ascertained before naloxone administration for treating narcotic-induced respiratory depression.

Plasma glucose, lactate, sodium, and potassium levels in children hospitalized with acute alcohol intoxication

The aim of our research was to study prevalence of changes in plasma levels of lactate, potassium, glucose, and sodium in relation to alcohol concentration in children hospitalized with acute alcohol intoxication (AAI). Data from 194 under 18-year-old children hospitalized to the two only children's hospital in Estonia over a 2-year period were analyzed. The pediatrician on call filled in a special form on the clinical symptoms of AAI; a blood sample was drawn for biochemical tests, and a urine sample taken to exclude narcotic intoxication. The most common finding was hyperlactinemia occurring in 66% of the patients ( n = 128) followed by hypokalemia (<3.5 mmol/L) in 50% ( n = 97), and glucose above of reference value (>6.1 mmol/L) in 40.2% of the children ( n = 78). Hypernatremia was present in five children. In conclusion, hyperlactinemia, hypokalemia, and glucose levels above of reference value are common biochemical findings in children hospitalized with acute AAI.

Membranous Glomerulonephritis May Be Associated With Heavy Marijuana Abuse

It is well documented that drug abuse can cause renal diseases. Nephropathy and proteinuria among heroin addicts has been recognized since the early 1970s. The predominant lesions in heroin-associated nephropathy are segmental glomerulosclerosis in African-Americans and membranous glomerulonephritis (MGN) in the Caucasian population. Cocaine may induce kidney damage, predominantly acute renal failure in the course of rhabdomyolysis. However, there are no case reports of nephropathy associated with marijuana smoking. We report a case of a marijuana-addicted 27-year-old Caucasian man after cadaveric kidney transplantation who developed de novo posttransplant MGN. The long period and high level of narcotic intoxication suggested that de novo MGN may have been associated with heavy marijuana abuse.

Morphological changes in genesial system of men: medico-legal aspects

With the purpose of perfection of examination the character of structural changes in testicles and prostate is investigated; the comparative qualitative and quantitative analysis of cellular reactions of persons with chronic somatopathies (rheumatic disease, idiopathic hypertensia) and chronic household intoxications (alcoholic illness, narcomania) is carried out. The work is carried out on 50 corpses of male persons, 18–35 years old, who died of chronic drunkenness (13 observations), narcomania (20), idiopathic hypertensia (9), and rheumatic disease (8). The suppression of testicles was characterized by disturbances of spermatogenesis at a level of the cell population, characteristic for a zero and first degree of spermatogenesis activity especially expressed in chronic narcotic intoxication. The damage to a prostate was stacked in a picture of a chronic relapsing prostatitis and chronic indurative prostatitis with the outcome of cirrhosis of prostata, being most typical for chronic alcohol intoxication. Morpho-functional investigation of a prostate and testicles affected by chronic somatopathies and chronic household intoxications, both qualitative and quantitative, testify to reduction of function of activity of these organs (hormonal imbalances, mail sterility, sex frustration). Thus, the persons suspected of violent actions of a sexual nature should be examined in order to reveal both erectile dysfunctions and disruption of spermatogenesis.

Pseudo-Subarachnoid Hemorrhage of the Head Diagnosed by Computerized Axial Tomography: A Postmortem Study of Ten Medical Examiner Cases

In this report, we describe ten cases of pseudo-subarachnoid hemorrhage on computer axial tomography (CT) scan of the head. A pseudo-subarachnoid hemorrhage is a false positive finding by CT of the head in which the scan is interpreted as being positive for a subarachnoid hemorrhage not substantiated by subsequent neuropathologic findings. This study is a retrospective review of postmortem cases brought into the Office of the Chief Medical Examiner for the State of Maryland over a three-year period (from 1997 to 2000). We compared the clinician's impression of the CT scan with the postmortem neuropathology. The clinical diagnosis of subarachnoid hemorrhage was based on misinterpretation of non-contrast CT scans of the head. In six of the ten cases, the reading was performed by a radiologist and in four cases by nonradiologist physicians (emergency room physician, neurologist, or neurosurgeon). All the patients survived between a few hours to a few days after being admitted to the hospital. For most of the cases (80%), the neuropathology showed hypoxic/ischemic encephalopathy. The most common cause of death (four out of ten cases) was narcotic intoxication. This report is submitted so that clinicians and pathologist become more familiar with this entity.

The interpretation of cocaine and benzoylecgonine concentrations in postmortem cases

This study examined cocaine and benzoylecgonine concentrations in 100 consecutive deaths where either compound was identified in blood or urine specimens to determine whether any relationship between these concentrations and cause of death can be found. Forty-seven of the 100 cases were deaths attributed to cocaine, narcotic or combined cocaine and narcotic intoxication. There were 13 cases of cocaine intoxication where no psychoactive substance other than ethanol was detected. The mean cocaine concentration in these deaths was 908 ng/ml; three cases had cocaine concentrations greater than 2000 ng/ml, while the other ten cases had cocaine concentrations less than or equal to 700 ng/ml. The mean cocaine concentration in non-cocaine deaths where no psychoactive substance other than ethanol was detected was 146 ng/ml. This difference was not statistically significant. However, the average blood benzoylecgonine concentration in the 13 cocaine deaths was significantly higher than in the 19 non-cocaine deaths. A review of combined cocaine and narcotic deaths suggest that the narcotic is the main causative agent in these deaths.