George E. Gantner

Cholesterol Crystals in Synovial Fluid

Excerpt The finding of crystals in synovial fluid has been the subject of much current interest following the recent description by McCarty and Hollander (1) and others (2) of uric acid crystals in...

Phencyclidine and violent deaths in St. Louis, Missouri: a survey of medical examiners' cases from 1977 through 1986

A survey of 104 deaths involving phencyclidine (PCP) occurring from 1981 through 1986 in metropolitan St. Louis, Missouri, is presented. Four black males (22-33 yr) died from fatal PCP intoxication. PCP was detected in an additional 100 deaths: 81 homicides, 13 suicides, and 6 accidental deaths. Seventy-five of these deaths were homicides of Black males (mean age 27 years) typically dying from gunshot wounds, 64 cases. In 50% of deaths where PCP was detected, other drugs were co-administered: ethanol (35%) and cocaine (20%) being the most common mixtures. A dramatic continuous increase in PCP abuse from 1984 through 1986 was demonstrated by drug abuse indicator data: treatment admissions, emergency room episodes, police exhibits, and driving under the influence of PCP arrests. Increased abuse of PCP in St. Louis has been associated with increased medical emergencies and violence against persons.

Tissue Mineral Levels in Victims of Sudden Infant Death Syndrome I. Toxic Metals—Lead and Cadmium

Summary: Lung, liver, kidney, and rib specimens were obtained at autopsy from 66 sudden infant death syndrome (SIDS) infants and 23 infants who died suddenly from other causes between the ages of 4–26 wk. Tissue levels of lead and cadmium were measured by atomic absorption spectroscopy and are expressed as μg/g dry weight. Because these metals are cumulative with age in storage tissues, the levels were corrected for age (adjusted to age 13 wk). The SIDS liver and rib specimens contained significantly more lead than non-SIDS tissues (liver, 1.095 μg/g versus 0.761 μg/g, P < 0.05; rib, 1.754 μg/g versus 1.041 μg/g, P < 0.01, respectively). There were no significant differences in cadmium concentration between the SIDS and non-SIDS tissues. All four tissues showed significant increases with age in both lead and cadmium concentrations in SIDS. The increase in lung lead concentration with age was significantly greater in SIDS than in non-SIDS cases, P < 0.05. In non-SIDS only kidney cadmium showed an increase with age (P < 0.0001). These data collectively suggest an increased exposure of the SIDS infant to lead either prenatally and/or postnatally. Any physiologic effects of the increased tissue lead levels are unknown. They may be only a marker of the known epidemiology of SIDS.

Local application of dimethyl sulfoxide and DMSO combined with triamcinolone acetonide in rheumatoid arthritis.

Dimethyl sulfoxide (DMSO) is a solvent with an unusual capability for permeating the skin. I ts salutary effects have been reported widely for many rheumatic diseases, but there are also contradictory opinions as to its clinical effectiveness for this group of illnesses. Most of the beneficial reports have been in reference to acute muscular, or closely related, conditions. The effectiveness in patients with chronic rheumatoid arthritis has been questioned. The present investigation was, therefore, undertaken to evaluate the usefulness of DMSO in patients with rheumatoid arthritis. This study was perfoMed in two parts. Initially, DMS0,t 90% in water, was applied topically to various inflamed articulations of 21 patients with rheumatoid arthritis. Subsequently, 11 rheumatoid patients were part of a single blind study whereby DMSO, 90% in HzO was compared with DMSO, 90% in H20 combined with 0.1% triamcinolone acetonide (T Actn).t Eight of the patients in this latter comparison study were also subjects in the initial investigation when DMSO was used alone. A total of 24 different rheumatoid patients had DMSO alone or in combination with steroid, and these will be grouped together in reporting the results of the first part of the study. The steroid, T Actn, which was combined with DMSO is a potent corticosteroid that has marked antiinflammatory, antipruritic, and antiallergic actions. DMSO was administered topically to the skin over inflamed articulations with a cotton swab; all peripheral joints were used with no particular predeliction for any one. Administration of DMSO was nat uniform for all patients because of differences in tolerance and because of differences in the amount applied by the subjects studied. In most individuals, attempts were made to have the drug applied four times daily, but fewer daily applications were made in some. The treated surface area was to be covered five times with each application. Total dosages of 5 to 175 cc were administered, averaging about 40 cc per patient. Most patients used the preparation for ten days or more; 30 days was the maximum. The patients were classified according to criteria of the American Rheumatism Association, and there was, in general, representative distribution

An unsuspected arsenic poisoning murder disclosed by forensic autopsy

An unsuspected case of homicidal arsenic poisoning, clinically thought to be a primary hematopoietic disorder, was uncovered by an expanded toxicologic screen which is performed in all medical examiners cases in which the decedent displays gastrointestinal symptoms prior to death. Arsenic concentrations were: blood, 7.2 mg/liter; liver, 15 mg/kg; and kidney, 6 mg/kg.

Tissue mineral levels in victims of sudden infant death syndrome II. Essential minerals: copper, zinc, calcium, and magnesium.

Summary: Deficiencies of various vitamin and minerals per se have been suggested as possible causes of sudden infant death syndrome (SIDS). Further, a deficiency of essential minerals may lead to enhanced toxicity of toxic elements, in particular, lead and cadmium. To explore the possibility of mineral deficiencies or interactions with the toxic metals, lead and cadmium, lung, liver, kidney, and rib specimens were obtained at autopsy from 66 SIDS infants and 23 infants who died suddenly from other causes. Tissue copper, zinc, calcium, and magnesium were measured by atomic absorption spectroscopy. No differences were found between SIDS and non-SIDS for any element in any tissue except for more magnesium in the liver (P < 0.0001) and less copper in the lungs (P < 0.02) in the SIDS group. Only sporadic interactions between toxic and essential elements could be found. We found no evidence of any essential mineral deficiencies per se or significant interactions of essential and toxic minerals that might potentiate the effects of toxic metals. The physiologic significance, if any, of the higher liver magnesium and lower lung copper found in SIDS is unclear.

A Case of Suicide Involving the Concomitant Intravenous Injection of Barbital and Oral Ingestion of Arsenic

A case of suicide involving the intravenous injection of barbital and the oral ingestion of arsenic trioxide is reported. The pathologic and toxicologic findings are discussed.

Triamcinolone Therapy in Rheumatoid Arthritis

The introduction of cortisone as an anti-inflammatory agent stimulated the search for newer steroids with greater anti-rheumatic effect, but with fewer associated side-reactions. Shortly afterwards, hydrocortisone became available, and, although its anti-rheumatic effect was slightly greater, undesirable physiological responses were more or less similar. Fried and Sabo (1953) synthesized a corticosteroid analogue with a halogen atom at the 9 carbon position of the steroid nucleus called 9-alpha-fluoro-hydrocortisone. It was very much more potent than hydrocortisone, about ten times greater in anti-inflammatory effect, and with approximately 125 times the mineralocorticoid action (Liddle, Richard, and Tomkins, 1956; Boland, 1955). Marked sodium retention with this halogenated derivative precluded its application for practical use as an antiphlogistic agent in the treatment of rheumatoid arthritis, but it was of some value for patients with Addisons disease where the exaggerated mineralocorticoid effect was desirable. In 1955, a very important chemical structural change resulted in the formulation of prednisone and prednisolone (Herzog, Nobile, Tolksdorf, Charney, Hershberg, Perlman, and Pechet, 1955) when a double bond was inserted between carbon atoms 1 and 2 of cortisone and hydrocortisone, respectively. These newer compounds were equally potent; they were approximately four times as great as their predecessors in glucocorticoid effect, whereas the mineralocorticoid action was diminished. In the usual maintenance dosages for treatment of rheumatoid arthritis, for example, electrolyte changes induced by these delta-1 analogues of cortisone and hydrocortisone proved no problem in clinical management of patients. However, other undesirable physiological reactions still occurred. In the hands of some investigators (Bunim, Pechet, and Bollet, 1955; Bollet, Black, and Bunim, 1955; Boland, 1956), complications with these latter steroids, such as peptic ulceration, have been reported with even greater frequency. In 1955 and 1956 a series of methylated corticosteroids were synthesized. Boland and Liddle (1957) reported that one of these, 6-methyl-prednisolone (Medrol), differed in no essential way from prednisolone itself. The sodium-retaining and potassium-losing activities of this compound were thought to be slightly less than those of prednisolone, but this was not definitely established. The hormone appeared to be at least as powerful as prednisolone in producing nitrogen-wasting; 41 patients with rheumatoid arthritis who received the drug as initial therapy showed no significant difference in degree or character of improvement from that anticipated with prednisone or prednisolone. Dosages were alike. Although the authors stated that their study was not sufficiently extensive properly to evaluate the complications of this new compound, they thought that most of the adverse reactions seen with the older preparations were also observed with 6-methyl-prednisolone. Bernstein, Lenhard, Allen, Heller, Littell, Stolar, Feldman, and Blank (1956) synthesized a new preparation, by adding a 16-alpha-hydroxyl group to the 9-alpha-fluoro-prednisolone structure, and triamcinolone (16-alpha-hydroxyl-9-alpha-fluoroprednisolone) was formulated. This compound eliminated the marked sodium-retaining potency of the previous analogue without diminution of glucocorticoid activity. Animal investigations (Perrine, Bell, Bortle, Heyder, Ross, and Ringler. In the press) revealed that triamcinolone was ten to forty times more active than hydrocortisone and three to twelve times more active than prednisolone in inducing glycogen deposition in fasted adrenalectomized rats. Diuretic and natriuretic potency exceeding that of prednisolone or hydrocortisone was also demonstrated in both adrenalectomized and normal animals. No hypertensive effect was observed in

On the Improvement of Suicide Determination

Simply stated, suicide is intentional self-destruction. It is tempting to think of it as a clear-cut phenomenon with discrete borders. But every medical examiner and coroner knows the problem of deciding intent when the blood alcohol level is high and the barbiturate level low. The presence of a suicide note, verified to be in the victims handwriting, may be accepted as reliable proof of suicide. But a note is found in no more than one third of cases judged to be suicide [1,2]. The criteria employed in the remainder of cases are unstated, although physical circumstances at the scene and toxicologic findings must be assumed to carry much weight. No set of established criteria or indices exists to guide the decision.

Effect of Cortisone on Ethionine-Induced Pancreatitis in the Rat

Summary Typical pancreatic changes were induced by ethionine, which were not altered by addition of cortisone. The high incidence of gastric ulceration and hemorrhage found with ethionine alone was doubled in rats receiving cortisone also.