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We report a fatal case of a female for whom the forensic autopsy revealed injuries to the external respiratory orifices indicating smothering. Subsequent postmortem toxicological analysis confirmed heavy amitriptyline acute intoxication. The victim had serious psychological problems, was under long-term treatment with antidepressants and was a systematic alcohol abuser. Forensic autopsy determined damage to the external airways, along with multiple formal petechial hemorrhages (Tardieu) in various parts of the body. The presence of amitriptyline, nortriptyline and 10-hydroxynortriptyline was confirmed by GC-MS and quantified by HPLC in blood (7.0 microg/ml amitriptyline and 7.4 microg/ml nortriptyline). The cause of death was disputed between severe intoxication (poisoning or suicide attempt) and smothering due to controversial evidence.

Background: Acute hyperglycemia has been associated with delayed gastric emptying of solid foods in healthy control subjects. Erythromycin has been found to be a gastrointestinal prokinetic agent in humans. We examined whether acute steady-state hyperglycemia reduces the erythromycin-induced acceleration of gastric emptying of a solid meal after a fasted state in healthy subjects., Methods: Twelve healthy subjects ate standard solid meals that had been radiolabeled. Gastric emptying was measured by scintigraphy during normoglycemia (5-8.9 mmol/L glucose) and hyperglycemia induced by intravenous glucose (16-19 mmol/L glucose) after administration of placebo or 200 mg of erythromycin intravenously. Emptying was measured randomly on 4 different days., Results: Administration of erythromycin during normoglycemia or induced hyperglycemia compared with placebo accelerated the gastric emptying of the solid meal but did not completely normalize the delay caused by hyperglycemia versus normoglycemia (p < 0.001). In both conditions, erythromycin versus placebo significantly reduced the lag-phase duration (9.7 +/- 2.3 min and 22.0 +/- 3.9 min vs. 38.3 +/- 5.7 min and 49.5 +/- 6.0 min, respectively; p < 0.001), gastric emptying of the half meal (39.2 +/- 4.0 min and 52.0 +/- 7.1 min vs. 75.7 +/- 11.8 min and 94.0 +/- 13.4 min, respectively; p < 0.001), and the percentage of meal retained in the stomach 120 min postprandially (p < 0.001)., Conclusion: The erythromycin-induced acceleration effect on gastric emptying was related to the plasma glucose level. Hyperglycemia might have chosen a cholinergic antagonist pathway that delayed gastric emptying of solids. Even though induced hyperglycemia inhibited gastric emptying, erythromycin accelerated the gastric emptying rate through two distinct pathways: cholinergic and noncholinergic.

Two cases of severe fenthion intoxication are presented. The first is a case of a psychiatric patient who attempted suicide with ingestion of the compound, and the second case was of a child exposed to the chemical agent by air spraying. Both patients were treated in the intensive care unit with atropine and pralidoxime and finally survived. Fenthion blood levels on admission were 2.7 and 0.95 microg/mL, respectively. Different concentrations of pralidoxime were added to the first patient's poisoned serum in order to assess in vitro the effect of pralidoxime on cholinesterase reactivation. The clinical and toxicological data of the poisonings are discussed, as well as the potential therapeutic use of pralidoxime in organophosphate intoxication.

Right ventricular cardiomyopathy dysplasia, now a well-established clinical and morphologic entity, was first reported in the medical literature in 1982. The cases of sudden death of two young men are here reported, with macroscopic and histologic findings. The anatomical explanation of such death was a fibrotic, lipomatous, or fibrolipomatous replacement and infiltration of the myocardium of the right ventricle. It is suggested that death due to right ventricular cardiomyopathy seems to be the result of electrical instability of right ventricular myocardium. There were no congenital malformations such as septal defect or valvular deformity. The subjects' heart weights were normal. Signs of myocardial degeneration and necrosis with or without inflammatory infiltrates were not identified.

In the present study samples of cannabis plants presented to us by the Drug Enforcement Units were characterised, based on the analysis of active substances. The fresh samples were dried in a dark room were they were kept until analysis. The samples included leaves, flowers roots and trunks. The analysis was performed by High Performance Liquid Chromatography (HPLC) and Gas Chromatography (GC) using standard solutions of cannabidiol, D-9 tetrahydrocannabinol, D-8 tetrahydrocannabinol and cannabinol. Chemical analysis of the flowers revealed that 80% of the plants were classified as resinous phenotype while the remaining 20% were found to be of the textile phenotype (low concentration of active cannabinoids). The concentration of D-9 tetrahydrocannabinol in the flowers and leaves ranged from 0.014 to 21.06 mg/g, of cannabinol from 0.0002 to 0.350 mg/g and of cannabidiol from 0.03 to 29.6 mg/g. Roots and trunks contained very small quantities of active substances and should not be used for phenotype identification. No delta-8 THC was detected in any sample. Leaves gave less resinous phenotypes than flowers. The use of either mathematical formula, A or B produced the same phenotype character for each separate part of the plant.

We report a midazolam-related death that occurred during endoscopic retrograde cholangiopancreatography (ERCP). The acute intoxication due to midazolam overdose was confirmed by high-pressure liquid chromatography (HPLC) analysis of the blood samples taken from the patient in the intensive care unit (2.8 microg/ml) and postmortem (2.4 microg/ml). The case strongly emphasizes the necessity of the precautions that should be taken when midazolam is intravenously administered.

To elucidate possible causes of recurrences after transurethral resection of the prostate (TURP), we performed an anatomical study of the prostate in 37 cadavers. The anatomical study showed that a significant proportion of the prostatic adenoma laid below the verumontanum. This proportion in relation to the total prostatic length varied from 8.33 to 44.44%, while in relation to the weight it varied from 2.08 to 36.84%. After transurethral resection of the prostatic adenoma, part of the apical lobes below the verumontanum remains intact deliberately to secure continence. These adenomatous tissues left behind create the problem of the residual apical lobe. Recent reports in the literature have shown a higher incidence of prostatic adenomatous recurrences following TURP than after open prostatectomy. From our study and from an extended search in the literature, it seems that a possible reason for adenomatous recurrences can be due to the remaining residual apical lobes that are left behind after TURP, providing that the resection had been complete.

Urinary bladder (extra-adrenal) pheochromocytoma is a catecholamine-producing tumor that arises from chromaffin cells in the extra-adrenal paraganglion system of the urinary bladder. The symptoms and signs result from the release of epinephrine and/or non-epinephrine, which is more prominent during micturition. The most serious consequences of the disease are paroxysmal hypertension during micturition and malignant degeneration. Thus, proper treatment is mandatory.