Marina Caligara

Drug analysis in blowfly larvae and in human tissues: a comparative study

The present study investigates the correlation between concentrations of drugs in human tissues and Diptera larvae feeding on these tissues. Samples of liver were taken from 18 cases in which preliminary toxicological screening indicated the presence of drugs. Blowfly larvae (Diptera: Calliphoridae) were reared on these samples and subsequently analyzed for drug content. Toxicological analyses were carried out using ONLINE Abuscreen (Roche) and GC/MS for available body fluids (blood, urine and bile) as well as liver samples and maggots. All drugs detected in human tissues were also detected in insect specimens. Opiates, cocaine and barbiturates as well as some antidepressants (clomipramine, amitryptiline, nortryptiline, levomepromezine and tioridazine) were observed. Comparisons of drug concentrations between those in human tissues and blowfly larvae showed different patterns of distribution that may be attributed to differences in physiology. Results confirm the reliability of entomological specimens for qualitative analyses, although quantitative extrapolations are unreliable. All xenobiotics detected were in higher concentrations in human tissues than in maggots. Concentrations in post-feeding maggots were significantly lower than for feeding maggots, suggesting that the feeding state of maggots may affect toxicological analyses as they metabolize and eliminate drugs during development.

Opioid-sparing effect of diclofenac in cancer pain.

This study investigated the opioid-sparing effect of diclofenac using patient-controlled analgesia with oral methadone. Fifteen patients with advanced cancer participated. After achieving adequate analgesia with regular dosing of oral methadone (T1), patient-controlled analgesia with methadone was administered for 3 days (T2). Intramuscular diclofenac 75 mg twice daily was then added to this regimen for 3 days (T3). Compared to T2 values, methadone dose was significantly reduced at T2 and T2, and pain report (recorded on a visual analogue scale) was significantly reduced at T3. A reduction in methadone plasma concentration was also observed at T2 and T3, although it did not attain statistical significance. Significant decreases in the intensity of several symptoms other than pain were also found at T2 and T3. Diclofenac appears to have a relevant opioid-sparing effect when using patient-controlled analgesia with oral methadone.

Subcutaneous fentanyl infusion in a patient with bowel obstruction and renal failure

Inoperable bowel obstruction in patients with renal failure is a difficult clinical situation. In the last days of life, an accumulation of morphine metabolites in patients with impaired renal function may cause opioid toxicity, including terminal agitation. The use of an alternative drug may prevent morphine metabolite accumulation in uremic patients. Fentanyl may be an alternative to morphine. It has a large apparent volume of distribution, a short plasma half-life, and extensive biotransformation without active metabolites. A patient with acute renal impairment and bowel obstruction was successfully treated with a subcutaneous continuous infusion of fentanyl (25 micrograms/hr) and boluses of 12.5 micrograms for the last 2 days of life, limiting the worsening of the dramatic clinical picture of bowel obstruction combined with renal impairment. No local toxicity was evidenced.

Fatal Adverse Reaction to Ketorolac Tromethamine in Asthmatic Patient

A case of an asthmatic woman who collapsed within a few minutes after intramuscular ketorolac tromethamine (KT) injection is reported. Autopsy findings revealed anatomic evidence of a recent asthma attack. KT was found to be present in the blood at a concentration within the therapeutic range and consistent with the administered dose. Based on the timing of the collapse in relation to the KT administration, death was attributed to an adverse reaction to KT, resulting in acute bronchospasm and cardiac arrest, with asthma as an underlying contributing factor. In this case, asthma alone was not responsible for the death of the patient but only a contributing factor. Physicians have to be aware that in asthmatic patients bronchospasm can be induced by drugs among which aspirin or nonsteroidal anti-inflammatory drugs such as KT are the most common; therefore, death may have an iatrogenic cause. The paper also describes the pathogenic mechanism of an adverse reaction to such drugs and analytical methods for the isolation and detection of KT in postmortem blood.

How Reliable are Parenchymal Tissues for the Evaluation of Carbon Monoxide Poisoning? A Pilot Study

Dealing with burnt bodies, the forensic pathologist must first of all answer the question whether the victim was alive at the moment of the fire. This study aims at clarifying whether some human solid tissues may be reliably used for the forensic diagnosis of Co poisoning on burnt bodies providing no collectable blood during the autopsy. From 34 selected cases, both cardiac blood and parenchymal samples were collected to perform CO‐oxymeter, spectrophotometry, and gas chromatography tests: blood CO estimations (blood COHb% and blood[CO]) and parenchymal[CO] values have been compared with special focus on R values. The solid tissues having the best correlations with blood CO amount turned out to be the lung (R 0.84), the liver (R 0.83), the kidney (R 0.79), and the spleen (R 0.92).

Drug Abuse Substances in the Case Record (1988–1992) of the Institute of Forensic Medicine — Milan University

The aim of our study was to assess the diffusion of substances of abuse (drugs, psychopharmaceuticals and alcohol) throughout the population of a metropolitan city such as Milan, not only quantifying the phenomenon, but above all focusing on its trend over the years.

Comparison between Morphine Levels in Subjects Who died of Acute Narcotism and Subjects Who died of Other Causes

Between 1978 and 1992 1435 autopsies were performed at the Milan University Institute of Forensic Medicine; samples of biological fluids and viscera were collected during the postmortem examination and chemical and toxicological tests were carried out; once the presence of morphine was determined, it was then dosed via the radioimmunoassay (RIA). None of the cases had been subjected to any pharmacological therapy.