Jovan Rajs

Cause and Manner of Death Among Users of Anabolic Androgenic Steroids

Medicolegally investigated deaths among 34 male users of anabolic androgenic steroids (AAS) are described. Nine persons were victims of homicide, 11 had committed suicide, 12 deaths were judged as accidental and 2 as indeterminate. In two cases of accidental poisoning, the levels of pharmaceuticals and illicit drugs were considered too low to be the sole cause of death and AAS was considered part of the lethal polypharmacia. Chronic cardiac changes were observed in 12 cases. In two cases of accidental poisonous deaths, these changes were regarded as contributory cause of death. Homicides, suicides, and poisonings determined accidental or indeterminate in manner were related to impulsive, disinhibited behavior characterized by violent rages, mood swings, and/or uncontrolled drug intake. The observations in the present study indicate an increased risk of violent death from impulsive, aggressive behavior, or depressive symptoms associated with use of AAS. There are also data to support earlier reports of possible lethal cardiovascular complications from use of AAS. Furthermore, a contributing role of AAS in lethal polypharmacia is suggested. Finally, the observations indicate that use of AAS may be the gateway of approach to abuse of other psychotropic drugs.

Patterns in Sharp Force Fatalities—A Comprehensive Forensic Medical Study

A ten-year series of 142 homicidal fatalities caused by sharp force injury was studied with the aim to systematize information inherent in the characteristics of the victim and the pattern of injuries. The population of victims consisted of 112 males (79%) and 30 females (21%); among perpetrators, 125 (88%) were males. Among victims as well as among perpetrators, persons of non-Swedish origin were overrepresented in relation to their share of the nonselected population. In 82 cases (58%), one or two wounds had been inflicted; in 23 cases (16%), ten or more wounds. In the latter group, eleven victims but no perpetrators were female. In the majority of cases victim and perpetrator were known to each other, and in instances of multiple wounding, a close relationship between the two was clearly more common than in the group of one- to two-wound fatalities. Tests for blood alcohol were positive in 86 of 116 victims (74%), the majority being in elimination phase. Furthermore, 96 of 120 perpetrators (80%) had positive tests or were known to be drunk at the time of the killing. In multiple wound fatalities, alcohol inebriation was less common both among victims and perpetrators. In these cases, the two persons involved were usually closely related or intimately known to each other, and in the absence of psychiatric disorder in the assailant, the motive was of a passionate type.

Mu opioid receptor A118G polymorphism in association with striatal opioid neuropeptide gene expression in heroin abusers.

μ Opioid receptors are critical for heroin dependence, and A118G SNP of the μ opioid receptor gene (OPRM1) has been linked with heroin abuse. In our population of European Caucasians (n = 118), ≈90% of 118G allelic carriers were heroin users. Postmortem brain analyses showed the OPRM1 genotype associated with transcription, translation, and processing of the human striatal opioid neuropeptide system. Whereas down-regulation of preproenkephalin and preprodynorphin genes was evident in all heroin users, the effects were exaggerated in 118G subjects and were most prominent for preproenkephalin in the nucleus accumbens shell. Reduced opioid neuropeptide transcription was accompanied by increased dynorphin and enkephalin peptide concentrations exclusively in 118G heroin subjects, suggesting that the peptide processing is associated with the OPRM1 genotype. Abnormal gene expression related to peptide convertase and ubiquitin/proteosome regulation was also evident in heroin users. Taken together, alterations in opioid neuropeptide systems might underlie enhanced opiate abuse vulnerability apparent in 118G individuals.

Post-mortem findings of cardiac lesions in epileptics: A preliminary report

In search of satisfactory cause of death in epileptics an attempt was made to examine the hearts with special regard to microscopic findings. All nine examined cases showed fibrosis of the minor arterial walls as well as interstitial fibrosis connected with atrophy or myofibrillar degeneration. Five cases had subendocardial fibrosis, and 4 leukocytic infiltration resembling focal myocarditis. In one case, a fibroma (hamartoma?) of the atrioventricular bundle could presumably explain the symptoms of epilepsy. The authors conclude that epilepsy may be a possible cause of ischemic or hypoxic cardiomyopathy which can contribute to the cause of sudden death amongst epileptics.

A cluster of fentanyl-related deaths among drug addicts in Sweden

During a 16-month period, nine fatalities occurred among white male drug-addicts, where fentanyl was detected at postmortem toxicological analysis. The street samples associated with these cases confirmed the presence of fentanyl as an additive in low-concentration amphetamine powders with caffeine, phenazone and sugar as cutting agents. In seven of the cases, an acute intoxication by fentanyl was considered to be the immediate cause of death, and in one case, it was likely, but no analysis of fentanyl was performed in blood, and in another case the death was suicide by hanging. This appears to be the first report of a cluster of fentanyl-related deaths outside the United States, and the occurrence of fentanyl in combination with amphetamine has not previously been reported. In addition, in all cases, femoral blood was collected, and samples were handled and analysed according to standardized, quality-controlled procedures. The previous history, circumstances surrounding the death, autopsy findings, histology and toxicology examination of each case are presented. The gas chromatographic-mass spectrometric method for fentanyl is also described. Fentanyl concentrations ranged from 0.5 to 17 ng g-1 blood, and from 5 to 160 ng ml-1 urine. Other drugs found were amphetamine (8 cases), ethanol (5 cases) and benzodiazepines (5 cases). Morphine was found in only one case. The average age of men was 33.9 years (range 22-44); six were found in their own of friends apartment, two inside buildings (stairways) and one was found outdoors. We conclude that fentanyl is a dangerous substance that should be considered in drug-addict deaths even outside the United States, particularly when the remaining toxicology is unremarkable, and the cause of death cannot be ascertained

Cardiac lesions in intravenous drug addicts

Postmortem findings in 25 intravenous addicts of centrally stimulating amines and centrally depressive narcotics (opiates) have been analysed with special reference to the presence of pathologic findings in the heart, and the cause of death. Most cases exhibited myocardial lesions of varying age, consistent with various phases of myofibrillar degeneration, such as hemorrhages, contraction bands, focal necroses, granulation tissue, stromal condensation, and scarring, indicating an active chronic process in the myocardium and the subendocardium, with a bias toward the conduction system of the heart. The lesions have been found in drug addicts who died immediately following an injection of narcotics as well as in those who, irrespective of their drug influence, have died following intervening injuries or disease. Cardiac lesions in drug addicts seem to have a variety of causative factors: infections, toxic influence, hypersensitivity, influence of catecholamines and general hypoxia. The authors feel that the two latter suggested causes appear most regularly and deserve special attention. The significance of these heart lesions seems to vary, but at times they may be the determining factor in the fatal outcome of a case.

Anabolic androgenic steroids and behavioural patterns among violent offenders

Abstract Objective: the purpose of the study is to give an account of psychiatric symptoms, aggressiveness and violent behaviour among users of anabolic androgenic steroids (AAS). The method used is retrospective evaluation based on information from forensic psychiatric evaluations (FPE), police reports and court records. Fourteen violent offenders were evaluated for current or previous use of AAS. The results suggest that AAS may produce violent behaviour and other mental disturbances, including psychosis. Besides previously described AAS-related violence, termed ‘roid rage’, two new patterns are described: (1) the cold-blooded executioner (‘Terminator’), and (2) the temporary AAS-user who takes the drug for the purpose of encouragement shortly before a criminal act (‘Sturmscknapps behaviour’). The effects of AAS on the central nervous system seem to be particularly detrimental to individuals with an inherent psychiatric disorder. It appears that use of AAS may lead to violent acts in vulnerable persons ...

Isolated rat hepatocytes as an experimental tool in the study of cell injury. Effect of anoxia.

Rat hepatocytes were isolated by liver perfusion in the presence of collagenase and hyaluronidase and incubated in the absence or presence of oxygen. As a result of anoxia, there was a gradual increase in plasma membrane permeability, noted as an increase in succinate-stimulated oxygen uptake, a decrease in trypan blue exclusion frequency, a leakage of cytosolic lactate dehydrogenase activity and an increased proportion of swollen and disrupted cells. After anaerobic incubation for 30 minutes--but not for 60 minutes--there were signs of recovery from anoxic cell injury upon re-oxygenation. The changes in plasma membrane permeability properties in anoxia seemed to be preceded by a marked decrease in cellular ATP level; aerobic incubation of hepatocytes in the presence of an uncoupler of phosphorylation from respiration led to a similar decrease in cellular ATP concentration followed by similar disturbances in plasma membrane permeability properties. It is suggested that a distrubed plasma membrane function caused by a decreased energy level is of primary importance for the initiation of cell death in anoxia.

Interrelationships between ATP levels, enzyme leakage, gluconate uptake, trypan blue exclusion and length/width ratio of isolated rat cardiac myocytes subjected to anoxia and reoxygenation.

Rat cardiac myocytes were isolated by perfusion of the heart with collagenase and subsequently incubated in the absence or presence of oxygen. As a result of anoxia, there was a gradual increase in plasma membrane permeability, as indicated by a decrease in trypan blue exclusion, leakage of cytosolic lactate dehydrogenase, and intracellular accumulation of the isotope [99Tcm]gluconate. These changes in plasma membrane permeability were preceded by a marked decrease in cellular ATP levels and an increased proportion of contracted myocytes. After an initial anaerobic incubation for 10 min, there was complete replenishment of ATP followed by signs of recovery from anoxic cell injury upon reoxygenation. Cell viability could also be followed on the basis of changes in the length/width ratio of myocytes upon anoxia and reoxygenation. The ability of myocytes to resynthesize ATP and to recover from anoxic injury upon reoxygenation decreased in proportion to the length of the initial anaerobiosis during the first 25 min and disappeared completely after 30 min of anoxia. The present model system is a convenient tool for evaluation of interrelationships between energy metabolism, plasma membrane integrity, and the morphology of myocytes subjected to anoxia and reoxygenation.

Morphological and X-ray microanalytical changes in mammalian tissue after overhydration with irrigating fluids.

We compared morphological changes in the heart, brain, liver and kidneys after giving 100 ml/kg of 5 irrigating fluids by intravenous infusion to 30 rabbits. Glycine 1.5% and 1.0%, both with ethanol 1% as a tracer for absorption, received the highest scores for tissue swelling and were sometimes followed by focal necrosis and an inflammatory cell reaction in subendocardial areas of the heart. Three rabbits died shortly after infusion of glycine 1.5% + ethanol 1%, the deaths being preceded by bradycardia and an irregular cardiac rhythm. This solution also lowered the intracellular potassium and chlorine content as shown by X-ray microanalysis of myocardial cells. Mannitol 3% + ethanol 1% produced the most favorable outcome in our evaluation, with the lowest scores for tissue swelling, while sorbitol 2% + mannitol 1% and normal saline took intermediate positions.