Postmortem concentrations of ropivacaine, bupivacaine, and lidocaine in femoral venous blood after hip fracture surgery.

Pain relief in hip fracture patients may be sought by injecting local anesthetic such as ropivacaine, bupivacaine, and lidocaine to the femoral area. As femoral veins are a routine sampling site for postmortem blood, this short report aimed to describe the levels of local anesthetics in ipsilateral (i.e., side of surgery) and contralateral (i.e., opposite side) femoral blood in ten medico-legal autopsy cases that had undergone a hip fracture surgery within 7 days before death. Postmortem blood samples were systematically collected from the ipsilateral and contralateral femoral veins, and toxicological analysis was performed in an accredited laboratory. The sample comprised six female and four male decedents who died at the age of 71-96 years. Median postoperative survival was 0 days and median postmortem interval 11 days. Strikingly, ropivacaine concentration was a median of 24.0 (range 1.4-28.4) times higher on the ipsilateral than contralateral side. The median ipsilateral concentration of ropivacaine clearly exceeded the 97.5th reference percentile measured in this laboratory for ropivacaine in postmortem cases representing all causes of death. The remaining drugs did not show high concentrations or notable differences between the sides. Our data clearly advise against performing postmortem toxicology on femoral blood from the operated side; the contralateral side may constitute a better sampling site. Toxicology reports that are based on blood collected from the operated area should be interpreted with caution. Larger studies are needed to confirm the findings, with accurate records of the dosage and administration route of local anesthetics.

Suicides from 2016 to 2020 in Finland and the effect of the COVID-19 pandemic.

The COVID-19 pandemic has had negative mental health outcomes in populations, but the suicide numbers in Finland have remained unchanged compared with expected levels based on the pre-pandemic period. We included all deaths from suicide verified by the official cause-of-death investigations, including forensic autopsy with analysis of forensic toxicology samples, between 1 January 2016 and 31 December 2020 in Finland. There was a decline in suicide incidence from 2016 to 2020 in men, and a declining tendency in suicide rates for every consecutive month during the COVID-19 pandemic period. The COVID-19 governmental policy responses do not seem to have led to an increase in suicide numbers.

Electrical stimulation of pulp nerves--comparison of monopolar and bipolar electrode coupling.

In the present study monopolar and bipolar electrode couplings were compared in electrical stimulation of intradental nerves. In experiments on cats the threshold current values of A- and C-fibres and the jaw-opening reflex were measured with both techniques using different durations of current pulses (0.2-50 msec). In human studies the perception and pain thresholds were determined in the same manner. In experiments on anaesthetized cats 170 intradental nerve units were recorded. Of these 118 were A-fibres (conduction velocity (CV) greater than 2 m/sec) and 52 C-fibres (CV less than or equal to 2 m/sec). The threshold current values (pulse duration 10 msec) of A-fibres were almost 2-fold (12.2 microA, S.D. = 7.9) and of C-fibres over 2-fold (91.3 microA, S.D. = 52.3) with bipolar stimulation compared to monopolar (6.9 microA, S.D. = 7.3 and 42.5 microA, S.D. = 21.5 respectively). The mean threshold of the jaw-opening reflex obtained with bipolar electrode coupling was about twice the value obtained with monopolar (8.2 microA, S.D. = 3.7 and 3.4 microA, S.D. = 0.7 respectively). In human experiments the mean perception threshold was 11.7 microA (S.D. = 6.7) with bipolar and 7.2 microA (S.D. = 3.2) with monopolar stimulation. The mean pain threshold was also higher with bipolar than with monopolar stimulation, 16.0 microA (S.D. = 8.8) and 10.3 microA (S.D. = 4.5) respectively. The subjective sensations were different with these two electrode couplings; the pain (at pain threshold level) induced by bipolar stimulation was experienced as sharp or cutting and with monopolar stimulation as dull or more indefinite. It is concluded that there is a marked difference in the electrical threshold values of pulpal nerves and perception threshold of individual human teeth between monopolar and bipolar tooth stimulation. The thresholds of the A-fibres measured from the cat canine tooth closely correspond to the perception thresholds of the human tooth, but the threshold values of the pulpal C-fibres were significantly higher.

The effect of temporal parameters on subjective sensations evoked by electrical tooth stimulation.

The effect of stimulus duration and frequency on subjective sensations evoked by electrical tooth stimulation was studied in 12 subjects. The sensory responses were classified using 5 equi-sensation categories (perception threshold, prepain, pain threshold, moderate pain, intense pain). Both continuously increasing and randomised stimuli were applied. A comparison was made with the activation thresholds of intradental A- and C-fibres in the cat. The mean threshold of intradental A-fibres was lower than the perception threshold at all pulse durations. Perception threshold decreased with increasing stimulus frequency. Current intensities which evoked prepain at a stimulus frequency of 1 Hz were rated as pain at 20 Hz. At supraliminal pain levels the effects of summation were more marked. High-frequency stimulation produced intense pain sensations at intensities well below the activation thresholds of pulpal C-fibres in the cat. We conclude that both perception and pain thresholds and supraliminal pain are modified by temporal summation, and that activation of different pulpal fibre populations is not responsible for production of prepain and pain sensations.

Infant botulism acquired from household dust presenting as sudden infant death syndrome.

Clostridium botulinum type B was detected by multiplex PCR in the intestinal contents of a suddenly deceased 11-week-old infant and in vacuum cleaner dust from the patient's household. C. botulinum was also isolated from the deceased infant's intestinal contents and from the household dust. The genetic similarity of the two isolates was demonstrated by pulsed-field gel electrophoresis and randomly amplified polymorphic DNA analysis, thereby confirming that dust may act as a vehicle for infant botulism that results in sudden death.

Reduced adrenal activation in a rat line selected for high alcohol sensitivity.

BACKGROUND: A rat line developed by selective breeding for high alcohol sensitivity has blunted corticosterone responses to alcohol and stress. In the present study, we determined possible differences in adrenal activation after alcohol and motor performance testing between the alcohol-sensitive alcohol-nontolerant and alcohol-insensitive alcohol-tolerant rats. METHODS: The animals received ethanol (2 g/kg, intraperitoneally), and 30 min later they were subjected to a motor function test (i.e., normal selection test used in the breeding of the lines); the control animals for both rat lines received no treatment and minimal handling. Blood corticosterone and ACTH levels at the single time point were determined by radioimmunoassay, and adrenal activation was determined by in situ hybridization of the immediate early gene c-fos, nor1, nurr1, and NGFI-B mRNA expression. RESULTS: The alcohol nontolerant rats had lower corticosterone but normal ACTH levels after ethanol and motor testing. Adrenal early gene expression of all of the genes studied was strongly induced by the treatment in both rat lines, but the inductions of c-fos, nor1, and nurr1 were significantly lower in the alcohol-sensitive animals. Acute treatment with a high dose of ACTH also induced less adrenal gene expression in the alcohol-sensitive animals. CONCLUSIONS: The results suggest that the reduced adrenal activation is associated with high alcohol sensitivity in a genetic animal model, which is in agreement with the human findings of alcohol insensitivity during glucocorticoid treatment.