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mettere a disposizione di tutti i laboratori di analisi di sostanze d’abuso a scopo forense uno strumento di riferimento per un corretto approccio alle analisi improntato alla standardizzazione e alla confrontabilità dei risultati

The presentation of this review will focus attention on the area of pediatric forensic medicine and the importance of through investigation of these deaths not only for the appropriate classification of the cause adn manner of deaths, but for complete documentation of toxicological data and pathological findings wich may provide essential informations about the circumstances surrounding the death and possible contributory mechanism.

Introduction: Analgesic preparations containing short-acting barbiturates, especially Butalbital, are most taken by patients with frequent migrainous attacks. Abuse of common prescribed combination analgesics can produce rebound effects and also physical dependence, that was particularly frequent in the '60-'70's; at that time acute intoxications were about 3-4% considering all types of poisoning and 17,5% of barbiturates poisoning. Methods and Results: During the seventies some lethal cases due to Optalidon® intoxication were observed at the Forensic Institute of Milan (Italy). We report two more recent cases: Case 1: 29.11.92 - V.R.R. a 76-year-old woman died in hospital three hours after arrival; resuscitation and intense therapy were ineffective in the unconscious woman. The medical history of V.R.R. revealed a dated depressive syndrome and a past suicide attempt by unidentified drug-poisoning (1980); once at home near the woman Lexotan® ¿ drops and an unidentified powder were found. The autopsy revealed only non specific visceral findings. The toxicological generic screening revealed: Butalbital, Propifenazone, Diazepam and caffeine; the specific, quantitative analyses revealed: Butalbital (blood: 28.13mcg/ml; brain: 21,75mcg/ml), Propifenazone (blood: 66.06mcg/ml; brain: 23.08mcg/ml), Diazepam (blood: 16.64mcg/ml; brain: 18,92mcg/ml). Considering the organ/site-target of Butalbital and Diazepam and their elevated blood/brain concentrations, death was the result of a combined acute intoxication of Butalbital and Diazepam. Case 2: 25.04.02 - P.A. a 52-year-old woman was found dead in her house cellar. External examination of the corpse revealed only some linear, superficial cutting lesions at the wrists covered with curdled blood without remarkable blood loss. At home, empty packaging of Optalidon® and Tavor® were found. The medical history of P.A. revealed a chronic misuse of analgesics and alcohol abuse. The autopsy revealed only non specific visceral findings; the stomach contains abundant material mixed with whitish, friable granules. The toxicological generic screening revealed: Butalbital, Propifenazone and caffeine; the specific, quantitative analyses revealed: Butalbital (blood: 30.46mcg/ml). Considering the organ/site-target of Butalbital and his elevated blood concentration, death was the result of an acute intoxication of Butalbital. Conclusions: Currently the analgesic preparation, Optalidon® (Novartis) available in Italy contains: Butalbital (50mg), Propifenazone (125mg) and caffeine (25mg) in form of tablets or with triple single drug concentrations as suppositories. We discuss the Italian medical prescriptive limitations of Optalidon® and present a brief history of this classic antimigrainous product in term of lethal, "ancient" casuistic and type of toxicological analytical methods applied in the seventies and nowadays by our toxicological laboratory. These two cases showed that lethal abuse or self-poisoning, in medico legal context, is rare to observe and reaffirms the need to discourage prescriptions of analgesic preparations with barbiturate components because of the severe risk of dependence, considering the availability of safer products.

Abuse of common prescribed combination analgesics can produce rebound effects and also physical dependence, that was particularly frequent to observe in the '60-'70's. During that time several lethal cases due to Optalidon (R) intoxication were observed at the Forensic Institute of Milan (Italy). We report two more recent cases that show that lethal abuse or self-poisoning by Optalidon (R) is rare to observe nowadays, but reaffirms the need to discourage prescriptions of analgesic preparations with barbiturate components considering the availability of safer products

The so-called smart-drugs, plant-based substances used for centuries by diverse populations especially of Central America in strict ritualized shamanic context thanks to their psychotropic effects, from the nineties have had wide diffusion across Europe. In Italy smart-drugs business, by passing traditional clandestine labs and illicit channels, was possible by their availability in smart-shops appeared in Milan and Rome and moreover exploiting the ever-expanding internet system. Via the Internet avid surfers have found troublefree accessibility to smart-drugs at low cost with the advantage of difficulties in police control, anonymity and lack of regulations, too. In Italy, between 2001-2003, Postal Police has seized more than five hundred parcels containing suspicious botanical species and tablets sent after on-line purchases by a known Dutch Internet site to Italian buyers. The authors hereby present the results of toxicological analysis on these findings (1167), with evidence of active principles ascribable to different smart-drugs: salvinorine in Salvia divinorum; LSA (ergine) in seeds of Rivea corymbosa, Ipomea violacea, Argyreia nervosa, harmine and harmaline in Peganum harmala, mescaline in Lophophora Williamsii, psilocybin/psilocin in Copelandia Cyanescens, Psilocybe Tampanensis, Psilocybe Cubensis, Philosophers Stones, ephedrine and yohimbine in several pharmaceutical products. Considering smart-drugs an unknown hazard and a potential emerging drug of abuse we give a general overview of the possible psychoactive effects of the most widely used smart drugs in their various forms of intake and their possible harms on man. Furthermore we illustrate the most recent trade restrictions adopted in Italy to limit their diffusion via the Internet.

This document presents a comprehensive overview of biochemistry and physiology of transferrin (Tf) and carbohydrate-deficient transferrin (CDT) and on the role of CDT as alcohol abuse marker. It discusses the characteristics of the available analytical methodologies for CDT determination and finally presents a set of recommendations. CDT measurements should be performed only in accredited laboratories, having a quality system in place and regularly performing IQC and participating in EQAS. Unequivocal patient identification and a documented chain of custody are needed. Non hemolysed serum is the preferred sample and, if it has to be stored for more than 8 h, freezing at -20°C is recommended. Immunological methods are acceptable only as first level testing. A confirmation of positive findings with analytical methods based on different physicochemical principles is recommended. The result should be expressed as percentage of disialo-Tf on total Tf. Each laboratory should establish its own decision limit based on the characteristics of the analytical method used and on the scope for which the measurement is performed. The employed analytical method should be indicated in the final report.

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.