Can a threshold for 11-nor-9-carboxy-Δ9 -tetrahydrocannabinol in hair be derived when its respective concentration in blood serum indicates regular use?

A 100 µg/L or higher concentration of 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH) in blood serum is generally assumed to be associated with regular and/or heavy use of cannabis. At present, determination of the extent of cannabis use by means of the concentration of THC-COOH in hair has not been assessed. Therefore, we aimed at establishing a threshold for THC-COOH concentrations in hair to prove frequent consumption by comparing THC-COOH concentrations in 129 corresponding serum and hair samples, respectively. The concentration of THC-COOH in the serum was analyzed by gas chromatography-mass spectrometry and in the hair by liquid chromatography-tandem mass spectrometry. Data were statistically evaluated using receiver operating characteristic curves and contingency tables. Our results suggest that a THC-COOH concentration of ≥4.2 pg/mg in hair was always accompanied by a THC-COOH concentration of at least 100 µg/L in blood serum. Should this be confirmed by further studies of a larger study population, a hair concentration of 4.2 pg/mg THC-COOH can be set as a threshold to predict regular and/or heavy consumption of cannabis even if no corresponding blood sample is available for analysis.

[Silent death in the recovery room--organizational fault with fatal consequences]. / Stilles Sterben im Aufwachraum--Organisationsverschulden mit Todesfolge.

Cases of death related to simple routine outpatient surgery are repeatedly reported. Minimum standards of staff and medical equipment for postoperative surveillance are deliberately ignored for economic reasons. Using two case studies this article identifies classical types of medical malpractice and organizational fault. Recommendations for criminal investigation in this type of cases are outlined for the competent authorities.

Wound ballistic evaluation of the Taser® XREP ammunition.

The Taser® eXtended Range Electronic Projectile (XREP®) is a wireless conducted electrical weapon (CEW) designed to incapacitate a person from a larger distance. The aim of this study was to analyze the ballistic injury potential of the XREP. Twenty rounds were fired from the Taser®X12 TM shotgun into ballistic soap covered with artificial skin and clothing at different shooting distances (1-25 m). One shot was fired at pig skin at a shooting distance of 10 m. The average projectile velocity was 67.0 m/s. The kinetic energy levels on impact varied from 28-52 J. Depending on the intermediate target, the projectiles penetrated up to 4.2 cm into the ballistic soap. On impact the nose assembly did not separate from the chassis, and no electrical activation was registered. Upon impact, a skin penetration of the XREP cannot be excluded. However, it is very unlikely at shooting distances of 10 m or more. Clothing and a high elasticity limit of the target body area can significantly reduce the penetration risk on impact.

Laminated safety glass as an intermediate target: a wound ballistic study.

Various 9-mm ammunitions (A1, A4, A5, ST, GS, GSb, P.E.P., SeCa, HP, PTP/s, VM, McVG, DM41, PTP, SX2, PT, and MEN frangible) were tested regarding their velocity, energy, angle of impact, and potential wound channel after penetrating a car window at 30° and 90°. Test materials were gelatine, soap, and pig cadavers. The velocities of the projectiles were between c. 288 and 430 m/ses, the energy spread between 394 and 564 J. Handgun bullets fired through vehicular side window glass lose substantial energy reducing the effectiveness of the ammunition. This effect is greater when fired at an angle of 30° compared to 90°. At a shooting angle of 90°, none of the different projectiles showed remarkable differences considering its wound ballistic features. Accuracy is maintained at a 90° angle but seriously impaired at 30°. None of the examined ammunition complied with the demanded wound channel effectiveness of 30-60 J/cm.

The activity ratio of 228Th to 228Ra in bone tissue of recently deceased humans: a new dating method in forensic examinations.

Reliable determination of time since death in human skeletons or single bones often is limited by methodically difficulties. Determination of the specific activity ratio of natural radionuclides, in particular of 232Th (Thorium), 228Th and 228Ra (Radium) seems to be a new appropriate method to calculate the post mortem interval. These radionuclides are incorporated by any human being, mainly from food. So with an individual's death the uptake of radionuclides ends. But the decay of 232Th produces 228Ra and 228Th due to its decay series, whereas 228Th is continuously built up in the human's bones. Thus, it can be concluded that in all deceased humans at different times after death different activity ratios of 228Th to 228Ra will develop in bone. According to this fact it should be possible to calculate time since death of an individual by first analysing the specific activities of 228Th and 228Ra in bones of deceased and then determining the 228Th/228Ra activity ratio, which can be assigned to a certain post-mortem interval.

Functioning and effectiveness of electronic control devices such as the TASER® M- and X-series: a review of the current literature.

Conducted electrical weapons (CEWs) such as the TASER(®) M- and X-series deliver short high-voltage, low-current energy pulses to temporarily paralyze a person by causing electrical interruption of the body's normal energy pulses. Despite many scientific publications, which classify the health risks of an appropriate use of the TASER device as minor, there still is a continuous uncertainty about possible side effects with human application. Based on a literature search of the National Library of Medicine's MEDLINE database's PubMed system of current publications, the following article describes the mechanisms by which the device operates and discusses possible pathophysiological consequences. The majority of current human literature has not found evidence of clinical relevant pathophysiological effects during and after an exposure of professionally applied CEWs. However, to be able to exclude possible health risks, a medical checkup of people who have been exposed to CEWs is essential.

[Survived stab to the heart in a schizophrenic man]. / Uberlebter Herzstich eines schizophrenen Mannes. Falldarstellung einer ungewöhnlichen Probierverletzung.

Schizophrenia is associated with a significant risk of suicide. According to recent research, 10-15 % of all schizophrenic patients die by suicide. It is not uncommon that the victims show sharp force injuries, so that the forensic pathologist first has to differentiate between self-infliction and involvement of another person. The authors' case report presents a 68-year-old schizophrenic patient who committed suicide by jumping out of a window of his apartment located on the second floor after inflicting multiple stab wounds to his thoracic region. At autopsy, an older stab wound to the apex of the heart was detected. In the criminal investigation, a suicide attempt made 13 days before could be ascertained. As the patient did not want to be taken to a hospital at that time, the injury had never been examined or documented. Since there was no evidence suggesting homicide, the older stab to the heart was interpreted as a tentative injury.

Leigh's Disease: The Acute Clinical Course of a Two-Year-Old Child with Subacute Necrotizing Encephalomyelopathy.

We report the untypical clinical course of a previously healthy two-year-old girl, who died suddenly and unexpectedly after an episode of vomiting. At forensic autopsy no other pathological findings could be diagnosed than multiple reddish, sunken areas in brain stem, mesencephalon, and pons. Histologically they presented as areas of spongiosis of the neuropil with prominent endothelial hyperplasia and vascular proliferation whereas nerve cells were well preserved. On the basis of the characteristic neuropathological findings in combination with the age of the child, we had to take into consideration that the child might have died from subacute necrotizing encephalomyelopathy (Leigh's Disease) despite the untypical, fulminant clinical course.

Fatal diving accidents: two case reports and an overview of the role of forensic examinations.

During the years 2004-2006, seven divers, who had deadly accidents, underwent post-mortem examination at the Institute of Legal Medicine of the University of Munich. The cause of death in all divers was drowning with typical pathomorphological findings. This should be regarded as separated to the triggering reason for drowning. The trigger for accident was established in four of seven cases by technical analysis and police investigation. High risk-taking, lack of technical service, and deficiency of dive equipment care were main reasons for death. We present two of these cases which showed several problems occurring concurrently. Autopsy always is necessary to look for indices for application of force or to exclude competitive reasons for death.

Patterns of response to repetitive transcranial magnetic stimulation (rTMS) in major depression: replication study in drug-free patients.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) has been found to exert modest to moderate therapeutic effects in major depression, but mechanism of action and its clinical relevance have not been clarified yet. Previous trials have reported patterns of symptomatology predicting response to rTMS. As most patients also received concomitant antidepressant medication these response patterns may rather refer to combined treatment than rTMS alone. Thus, this study aims to replicate previous findings and explore patterns of response in drug-free patients. METHODS: In the Munich-Berlin Predictor Study data of 79 patients from two open clinical trials evaluating effects of high-frequency rTMS of the left dorsolateral prefrontal cortex were pooled. Previous models predicting the response to rTMS [Fregni, F., Marcolin, M.A., Myczkowski, M., Amiaz, R., Hasey, G., Rumi, D.O., Rosa, M., Rigonatti, S.P., Camprodon, J., Walpoth, M., Heaslip, J., Grunhaus, L., Hausmann, A., Pascual-Leone, A., 2006. Predictors of antidepressant response in clinical trials of transcranial magnetic stimulation. Int. J. Neuropsychopharmacol. 9, 641-654; Brakemeier, E.L., Luborzewski, A., Danker-Hopfe, H., Kathmann, N., Bajbouj, M., 2007. Positive predictors for antidepressive response to prefrontal repetitive transcranial magnetic stimulation (rTMS). J. Psychiatr. Res. 41, 395-403.] were systematically tested and new explorative regression analyses were conducted. RESULTS: Of the 79 patients, 34.2% showed an antidepressant response. Previous models could not be validated. Explorative regression analysis revealed a significant model with therapy resistance, HAMD items 1 (depressed mood), and 2 (feelings of guilt) as negative and retardation as positive predictors. LIMITATIONS: No controlled study; specific statistical issues; sample size; differences concerning patient population and stimulation parameters between study sites. CONCLUSIONS: In sum, this study does not confirm clinical valid and robust patterns being predictive for a response to rTMS in depression. The only exception is a high level of therapy resistance being associated with poor outcome. Future predictor studies should focus on large and homogenous samples of rTMS multicenter trials and include neurobiological variables.