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Featured researches published by Birgitte Kringsholm.


Forensic Science International | 1987

The nature and the occurrence of birefringent material in different organs in fatal drug addiction

Birgitte Kringsholm; Per Christoffersen

Insoluble birefringent tablet filler materials commonly found in tablets used in solution by drug addicts as intravenous injections were investigated microscopically. The following filler materials were investigated: talc, potato- and maize-starch, microcrystalline cellulose, magnesium stearate and siliciumoxid. The morphological characteristics of the different materials are described. Tissue sections (lung, liver, spleen, heart, bone-marrow, kidney, lymph-nodes and endocrine glands) from 33 consecutive fatality cases of intravenous drug addicts autopsied at the University Institute of Forensic Medicine in Copenhagen were studied with special reference to the occurrence and nature of birefringent material. Birefringent material was most often demonstrated in lung tissue (94%), followed by spleen (76%), liver (55%), lymph-nodes (portal: 39%) and bone-marrow (24%). The material was always localized intracellularly. Granulomatous reaction was only seen in the lungs. Except for one case, talc was the only foreign material seen in other organs than the lungs, undoubtedly due to its smaller size. The presence of insoluble foreign material in lung tissue of drug addicts indicates a habit of intravenous administration and the amount of the material indicates whether the addict usually injects tablets or only does so occasionally. The presence of birefringent material in the organs have only rarely any obvious clinical implications.


International Journal of Legal Medicine | 1998

Citalopram concentrations in samples from autopsies and living persons.

Karen Worm; C. Dragsholt; K. Simonsen; Birgitte Kringsholm

Abstract Concentrations of citalopram in medicolegal samples from 92 autopsies and 27 living persons are described. In autopsy cases in which citalopram alone was the cause of death, concentrations ranged from 2.0 to 6.2 mg/kg whole blood. In autopsy cases in which citalopram together with other substances was considered to be the cause of death, the concentrations of citalopram ranged from 0.6 to 5.2 mg/kg whole blood. In autopsy cases toxic concentrations ranged from 0.4 to 0.9 mg/kg whole blood and therapeutic concentrations from 0.03 to 0.6 mg/kg whole blood. In samples from living persons the concentrations of citalopram in whole blood were 0.02 to 0.3 mg/kg.


International Journal of Legal Medicine | 1993

Methadone and drug addicts

Karen Worm; Anni Steentoft; Birgitte Kringsholm

SummaryDrug addicts who had died in Copenhagen City and County in 1981 and 1989 were analysed for methadone. In 1981, 94 cases were analysed of which 16% were found positive for methadone, and in 1989, 70 cases were analysed of which 37% were positive. Methadone alone was found to be the cause of death in 50% more cases in 1989 than in 1981. Only half of the drug addicts who were found positive for methadone had been under methadone treatment. Morphine and benzodiazepines were the most frequently occurring other substances in both 1981 and 1989. Alcohol was found in only about 30% of the methadone-positive cases. The median whole blood concentrations of methadone found in addicts where methadone was the cause of death was 0.3 mg/kg where no alcohol was present and 0.2 mg/kg where alcohol was present. In living persons using methadone, the median was 0.1 mg methadone/kg whole blood with or without alcohol present.ZusammenfassungEs wurden Drogenabhängige, die im Bereich der Stadt und des Kreises Kopenhagen in den Jahren 1981 and 1989 verstarben, hinsichtlich einer Methadoneinnahme untersucht. 1981 wurden 94 derartige Fälle untersucht, von denen 16% einen positiven Methadonbefund erbrachten. 1989 wurden 70 Fälle untersucht, von denen 37 positiv waren. Eine Methadonintoxikation als alleinige Todesursache wurde 1989 50% häufiger diagnostiziert als 1981. Nur die Hälfte der Drogenabhängigen, die Methadonpositiv waren, befanden sich in einer therapeutischen Methadonbehandlung. Morphin und Benzodiazepine waren sowohl 1981 als auch 1989 die am häufigsten nachzuweisenden weiteren Substanzen. Alkohol konnte nur in 30% der Methadon-positiven Fälle detektiert werden. Der Median der Vollblutkonzentration von Methadon betrug in jenen Fällen, in denen eine Methadonintoxikation die Todesursache war und keine zusätzliche Alkoholbeeinflußung vorlag, 0,3 mg/kg, hingegen bei einer zusätzlichen Alkoholbeeinflußung nur 0,2 mg/kg. Bei lebenden Personen, welche Methadon einnahmen, betrug der Median jeweils 0,1 mg Methadon/kg Vollblut unabhängig von der Alkoholbeeinflussung.


Forensic Science International | 1988

Deaths among drug addicts in Denmark in 1987-1991.

Birgitte Kringsholm; Elisabet Kaa; Anni Steentoft; Karen Worm; Kirsten Wiese Simonsen

In the period 1987-1991 a total of 739 fatalities among drug addicts was investigated at the three University Institutes of Forensic Medicine in Denmark. The annual number rose from 130-140 in the first 4 years to 192 in 1991, and 80% were males. The mean and median age for both males and females increased by 1 year in the period. The main drug of abuse was heroin, in most cases supplemented by various other drugs, and in almost all cases taken intravenously. In about one-third of the cases each year there was information of abuse of alcohol in addition. In the poisoning cases, the main drug of poisoning was morphine/heroin, constituting 35-55% of the cases each year. As regards methadone-poisoning cases, the number increased significantly in 1991 compared to the first 4 years. Furthermore, the number and proportion of addicts dying while in methadone treatment increased during the 5-year period. In about half of the methadone poisoning cases, there was information of methadone treatment at the time of death. The other half obviously obtained the methadone completely illegally. Ketobemidone was the third most frequent drug of poisoning, while propoxyphene and barbituric acid only were found in a very few cases each. The results are compared to those from an earlier investigation concerning drug deaths in Denmark in 1968-1986. The importance of registering drug deaths is emphasized.


Forensic Science International | 1980

Sniffing-associated deaths in Denmark

Birgitte Kringsholm

An account is given of 20 deaths, which occurred in association with sniffing during the period 1959--1978. The annual number of deaths was almost constant during the period. Most of the deaths occurred in males. Ether and trichloroethylene were the predominant toxic substances. The material was divided into two groups. Group A, 14 cases, included real sniffing deaths, the cause of death being poisoning by the substance inhaled. In group B, 6 cases, sniffing was a contributory factor to death: 2 cases of suffocation by obstruction, one case of carbon monoxide poisoning during fire, one case of septicemia/severe anemia caused by bone marrow depression, and one case of bleeding to death from stab wounds inflicted by a sniffer against a non-sniffer. The circumstances before and at the time of death are reported, together with the autopsy and toxicological findings when these were performed.


International Journal of Legal Medicine | 1993

Clozapine cases with fatal, toxic or therapeutic concentrations

Karen Worm; Birgitte Kringsholm; Anni Steentoft

SummaryThe neuroleptic drug clozapine is used in the treatment of schizophrenia and is characterized by not having the extrapyrimidal side-effects usually shown by neuroleptics. Unfortunately clozapine has other side-effects, which limit its use. This study presents methods for the analysis of clozapine and desmethylclozapine in whole blood and tissue. Case histories and pathology findings are described for 3 autopsy cases with fatal concentrations of clozapine, 5 with toxic concentrations and 2 with therapeutic concentrations together with the concentrations found in a living person.ZusammenfassungDas Neuroleptikum Clozapin, welches für die Behandlung der Schizophrenie benutzt wird, ist dadurch charakterisiert, daß es nicht die extrapyrimidal-motorischen Nebenwirkungen hat, welche Neuroleptika gewöhnlich aufweisen. Die Anwendung von Clozapin ist hingegen durch andere Nebenwirkungen stark begrenzt. Die vorliegende Untersuchung stellt Methoden zur Analyse von Clozapin und seinem Metaboliten Desmethylclozapin in Vollblut und Gewebe vor. Vorgeschichte und pathologische Befunde bei 3 Autopsiefällen mit tödlichen Konzentrationen von Clozapin sowie Ergebnisse von 5 Fällen mit toxischen Konzentrationen und 2 Fällen mit therapeutischen Konzentrationen werden zusammen mit den Medikamentspiegeln bei einer lebenden Person vorgestellt.


Forensic Science International | 1982

Liver pathology in fatal drug addiction

Birgitte Kringsholm; Per Christoffersen

Liver sections from 273 drug addicts submitted to medicolegal autopsy at the Institute of Forensic Medicine in Copenhagen in the period 1975-1979 were studied. In 65% of the cases non-specific portal inflammation only was found. Birefringent material--identified as the mineral talc (magnesium silicate) was observed in 38% of the cases; in these cases non-specific portal inflammation was always present. Changes compatible with acute or chronic persistent hepatitis or hepatitis sequelae were observed in 8% of the cases; cirrhosis in 3%. HBs-antigens were detected in 4%. In 22% fatty infiltration was present; in 4% as the only abnormal finding. Finally no pathological changes were found in 6%. The results were related to anamnestic information of kind and duration of drug abuse and to the cause of death. Furthermore a comparison was performed between the groups with and without birefringent material. The data suggest that the birefringent material may be of importance to the pathogenesis of the non-specific portal inflammation.


European Journal of Epidemiology | 2006

Surveillance of HIV and viral hepatitis by analysis of samples from drug related deaths

Peer Brehm Christensen; Birgitte Kringsholm; Jytte Banner; Jørgen Lange Thomsen; Susan Cowan; Gabriela Felicia Stein; Gitte Wulf Jürgensen; Kari Grasaasen; Jørgen Georgsen; Court Pedersen

Objectives:To determine the prevalence of antibodies against HIV, hepatitis B (HBV) and hepatitis C (HCV) in postmortem samples from drug related deaths (DRDs) in Denmark.Design:Prospective cohort study. Postmortem samples tested for anti-HIV, anti-HCV anti-HBc and anti-HBs. Comparison to pre-mortem testing when possible. DRDs were searched for in the national register of drug treatment, national prison registers, and the national infectious disease register.Setting:National level.Participants:Drug related deaths admitted to Danish Institutes of Forensic Medicine during 2004.Main outcome measures:Prevalence of antibodies, injection drug use, drug treatment experience and prevalence of cirrhosis.Results:Samples for analysis were obtained from 78% (233/299) of DRDs. The prevalences of anti-HIV, anti-HCV and anti-HBc were 4% (9/214), 51% (110/215), and 35% (74/209), indicating a persisting low prevalence of HIV and a declining prevalence of HCV and HBV. Injecting ever was detected among 45% of DRDs and this was associated with a significantly higher prevalence of hepatitis B and C. Among the DRDs 56% received drug treatment and 12% had cirrhosis at autopsy. Evidence of vaccination against HBV was found among 16% (21/128).Conclusions:Monitoring of viral hepatitis and HIV among DRDs is feasible, and our survey indicates a falling prevalence among Danish drug users. Surveillance based on drug users in treatment may overestimate the true prevalence.


Forensic Science International | 1981

Deaths among narcotic addicts in Denmark in 1978 and 1979

Birgitte Kringsholm; Jørgen Voigt; Jørgen B. Dalgaard; Jørn Simonsen

Since 1968 the number of deaths registered among narcotic addicts has increased considerably from 9 deaths in 1968 to 121 in 1979. Data concerning 215 deaths among narcotic addicts in 1978 and 1979 examined at the three Danish University Institutes of Forensic Medicine are presented. Four-fifths of the cases were males; the average age in both males and females was 26 years. In most cases a mixed abuse was present, the predominant drug being heroin. In 27% of the cases there was an abuse of alcohol. The material was divided into two groups. Group A included 181 cases in which the cause of death was poisoning by one or more drugs. In group B (34 cases) narcomania was a contributory factor to death. The place of death, gross autopsy findings and toxicological data are reported. The manner of death was in 62% of the cases stated as accident, in 19% as suicide, in 14% as accident?/suicide?, in 3% as natural death and finally in 1% as homicide. Next to traffic accidents narcotic addiction today is the greatest single cause of death in the age group 18 - 35 years. These facts call for active political steps against narcotic addiction.


Forensic Science International | 1989

The occurrence of HIV antibodies in drug addicts autopsied at the University Institute of Forensic Medicine in Copenhagen in 1987

Birgitte Kringsholm; Peter Theilade; Preben Geertinger

In 1987 a total of 89 intravenous drug addicts were admitted to medico-legal autopsy at the University Institute of Forensic Medicine in Copenhagen. Totally 10 cases were reactive by the Elisa test and five of these, or 7% of the total material tested, could be confirmed by the immuno-blotting test. The other five cases must be considered as false positive, possibly due to antibodies against cellular antigens. Among the five real positive cases, four were known before-hand while in one case the HIV-positivity was not known. These findings - together with the possibility of false negative reactions - especially regarding persons with acute HIV-infection, requires special precautionary measures when autopsies of drug addicts are performed.

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Karen Worm

University of Copenhagen

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Anni Steentoft

University of Copenhagen

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Peter Theilade

University of Copenhagen

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Jørgen Lange Thomsen

University of Southern Denmark

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Court Pedersen

Odense University Hospital

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