[Fatalities associated with methadone administration in the Geneva canton (1987-1993)]. / Todesfälle im Zusammenhang mit Methadon-Einnahme im Kanton Genf (1987-1993).

In Geneva 41 deaths associated with methadone have been observed between 1987 and 1993. In 11 cases death was caused by heroin overdose in combination with methadone. In 6 other cases (natural death, hanging, murder, road accident, drowning and burning) methadone, although in feeble doses, could have played a role in the circumstances leading to death. In 24 other cases, where methadone was the sole cause of death, 10 of these were in individuals participating in Methadone Maintenance Schemes, but none in the first two weeks of the scheme, 8 occurred in the year following release from prison (3 less than two weeks after release), 11 were associated with a parallel intake of benzodiazepines and 8 with an intake of alcohol.

[Presence of psychotropic drugs in the blood of drivers responsible for car accidents, and who consumed alcohol at the same time]. / Présence de psychotropes dans le sang de conducteurs responsables d'accidents de la route ayant consommé en même temps de l'alcool.

The presence of psychotropic drugs was determined in 383 blood samples of drivers being responsible for car accidents, having taken alcohol as well. Benzodiazepines were detected in 52 cases and cannabinoids in 31 cases. The characterisation of these positive cases showed a majority of classic benzodiazepines (diazepam, nordiazepam, and bromazepam). Even if the specific role of these two families of psychotropic drugs cannot be deduced from this study, the results should make drivers more aware of the dangers of the simultaneous consumption of alcohol and psychotropes.

[Sudden death during performance of sport: forensic medicine elucidation]. / La mort subite lors de la pratique d'un sport: l'éclairage de la médecine légale.

Our study deals with cases of sudden death (non-traumatic death) while playing sport which were examined at the Institute of Forensic Medicine at the University of Geneva, and covers the last ten years: 1980-1989. We discovered 19 cases, all men between the ages of 17 to 67. In the case of the younger sportsmen (under the age of 45-50) or when the causes of mortality were unclear, the police requested an autopsy, which totalled 8 cases. In the other 11 cases, we were asked to make an external examination of the bodies, in order to exclude any signs of violence. Seven sportsmen, aged 36-49, who used to play high-risk sports such as football, tennis, basketball and running were autopsied and presented a myocardial infarct. Its interesting that 2 of these cases had also an old scar of a myocardial infarct. The eighth case was a 17 year old boy who had an already known obstructive cardiomyopathy.

Assessing death by poisoning: does the medical history help?

During one year we sought medical historical data for all medico-legal autopsies with toxicological analysis (n = 51); the same procedure was applied to a control group of autopsies without toxicological analysis. Historical data was available in 70 cases (69%), the proportion being significantly higher among cases where the cause of death was poisoning (84%) than in the non-poisoning cases (48%). In the poisoning cases information was more often available from the emergency service, the psychiatric service and the prison medical service. Autopsy observations revealed a higher proportion of prior pathology than the medical history. But in a minority of cases, potentially significant prior illnesses were shown by the medical history and not at the autopsy (for example, in cases of advanced decomposition and in cases with no pathological lesions: idiopathic epilepsy; HIV infection). Historical data was judged to make some contribution to the conclusions concerning the cause of death in 71% of the cases of poisoning. The most important single contribution was the assessment of dependence status among drug or alcohol abusing subjects.

Morphine in postmortem blood: its importance for the diagnosis of deaths associated with opiate addiction.

This article describes an analytical method for the determination of morphine, the active metabolite of heroin, in post-mortem blood by HPLC with electrochemical detection. An extraction technique allowing the determination of free and total morphine (free morphine + morphine glucuronide) was used. Blood morphine levels in postmortem cases are reported and the ratio of free to total morphine was measured in 52 cases obtained at autopsy. The importance of this ratio is discussed in relation to the circumstances of the death.

[Toxicomania: death beyond risk. Analysis of cause-of-death in drug addicts]. / Toxicomanie: la mort au-delà du risque. Analyse des causes de décès chez le toxicomane.

Violent deaths are of considerable importance among young adults, since they account for half the deaths in this age group (average age 26.4 years). Suicide and accidents (both categories including drug overdoses) are the most frequent categories of deaths from non-natural causes, while in the USA deaths by homicide are also of considerable importance. Current repressive policies have not brought the problem of drug addiction under control. Each year deaths by overdose among drug abusers occur. Nevertheless, 40% of deaths among drug addicts are from other causes, principally accidents and suicides. In the near future, AIDS may well account for the majority of deaths among drug addicts, thus adding to the mortality from overdose, both accidental and suicidal. Has the time come to reconsider the problem of drug abuse and to find radical solutions which would previously have been unthinkable?

[Reversal of positive serology for human immunodeficiency virus (HIV). Apropos of 2 case reports]. / Négativation d'une sérologie positive pour le virus d'immunodéficience humaine (VIH). A propos de deux observations.

The medical history and laboratory data of two persons who have been in contact with HIV-I positive carrier individuals are reported. The serologic data of successive serum samples collected from these persons were first negative, then positive (including antibodies directed against Gag and Env gene products), and finally negative for presence of anti-HIV-I antibodies. Physical examination and other laboratory data, including absolute number of CD4 lymphocytes/mm3, were within the normal range in these two individuals, who presented a reversal of positive serology for HIV-I.

[Responsibility in the prevention of accidents of the most exposed pedestrians: children and elderly persons]. / Notion de responsabilité dans la prévention des accidents chez les piétons les plus exposés: enfants et personnes âgées.

A study has been carried out on the Swiss road accidents statistics involving pedestrians. The most exposed road users (young and aged pedestrians) are the ones best protected by traffic law. However, data suggest that these pedestrians are more frequently declared responsible for the accidents in which they are involved. Arising from this contradiction, both the notion of responsibility and the way the prevention of these accidents is conceived should be queried.

[Alcoholism and driving ability]. / Alcoolisme et aptitude à conduire.

Utilizing reports of expert opinions issued by the Unit of Traffic Medicine and Psychology, Institute of Forensic Medicine, Geneva (908 cases between 1965 and 1977), the authors evaluate the different levels of estimates on driving ability in chronic alcoholics (46 cases). Diagnosis of chronic alcoholism is sometimes difficult. It is necessary that the medical experts get in touch with the family physician and with the neighbourhood of the patient reported. The authors demonstrate that the conclusions of these reports frequently include restrictions regarding limited driving permission or a limitation to a permit for a learner's drivers license.

Experimental evaluation of rigor mortis. IV. Change in strength and evolution of rigor mortis in the case of physical exercise preceding death.

Evolution of rigor mortis in rats exercised before death shows the following characteristics with respect to controls: (1) Its intensity is increased in the initial phase. (2) It reaches its maximum development at the same time. (3) Higher maximum values are reached (in our experiments 1.39 times the maximum values for controls). (4) Higher values are maintained from 100 minutes to 16 hours with statistically significant differences. (5) It attains resolution at the same time.

Experimental evaluation of rigor mortis. III. Comparative study of the evolution of rigor mortis in different sized muscle groups in rats.

The use of new methods and an appropriate apparatus has allowed us to make successive measurements of rigor mortis and a study of its evolution in the rat. By a comparative examination on the front and hind limbs, we have determined the following: (1) The muscular mass of the hind limbs is 2.89 times greater than that of the front limbs. (2) In the initial phase rigor mortis is more pronounced in the front limbs. (3) The front and hind limbs reach maximum rigor mortis at the same time and this state is maintained for 2 hours. (4) Resolution of rigor mortis is accelerated in the front limbs during the initial phase, but both front and hind limbs reach complete resolution at the same time.