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Biomedical subjects

A Poklis

Publications and source records attributed to A Poklis.

At least 73 records · Page 4Linked to original sources
PubMed1990

Arsenic poisoning: acute or chronic? Suicide or murder?

The case of the death by arsenic poisoning of a 62-year-old white man is presented. One year prior to death, he developed intermittent bouts of severe gastroenteritis with vomiting and diarrhea, hyperpigmentation and keratosis of the skin, neutropenia, and Guillain-Barré-like neuropathy for which he was hospitalized several times. Urine test results 6 months prior to death indicating 36 mg/L arsenic were believed to be in error. At the patient's last admission, he appeared in the emergency room with severe gastroenteritis, hypotension, and dehydration. He died 3 days later. Antemortem as well as autopsy specimens revealed elevated arsenic concentrations. Arsenic micrograms/g analysis by neutron activation of hair pulled from the man's head revealed by centimeter segmental analysis proximal to distal: 226, 104, 28, 56, 41, 40, and 74. The wife of the decedent was charged with murder by arsenic poisoning of this, her fifth, husband. The defense alleged that the decedent had committed suicide. The judge awarded a directed verdict of "not guilty." Particulars of the medical, toxicological, and investigative findings are presented.

Acute Disease↗
PubMed1989

Determination of 3,4-methylenedioxyamphetamine and 3,4-methylenedioxymethamphetamine enantiomers in whole blood.

A method for the determination of the enantiomeric content of 3,4-methylenedioxyamphetamine (MDA) and 3,4-methylenedioxymethamphetamine (MDMA) in microsamples (200 microliters) of whole blood is described. The method involves liquid-liquid extraction of MDA and MDMA from blood and derivatization with the chiral reagent N-trifluoroacetyl-L-prolyl chloride. Separation, identification and quantitation of diastereomeric derivatives is by gas chromatography-mass spectrometry. The analytical range of the assay is from 0.12 ng to 48 ng injected on-column. Details for the synthesis of the enantiomers of MDMA are also provided.

3,4-Methylenedioxyamphetamine↗
PubMed1988

Pentazocine-naloxone experimenters among abusers of pentazocine and tripelennamine from a VA treatment population.

Psychiatric diagnostic profiles, drug and personal histories, and social support measures were obtained for a clinic sample of abusers of pentazocine when the drug was withdrawn and re-released by the manufacturer compounded with the opiate antagonist naloxone. Nearly 50% of the sample (N = 99) reported using the new drug during the following 6 to 9 months, despite its reduced abuse potential. Reinterviews revealed that claimed use of pentazocine dropped to half.

Adult↗
PubMed1988

Evaluation of sudden death in psychiatric patients with special reference to phenothiazine therapy: forensic pathology.

The investigation of sudden unexpected death in psychiatric patients and the ensuing litigation has brought to our attention many unusual features important in the evaluation of such deaths. Certain pathophysiologic mechanisms of death, rarely encountered in routine forensic science practice, may be important in determining the cause of death in psychiatric patients, especially in cases where the autopsy is unrevealing. Of particular concern is a tendency in the current literature to implicate phenothiazines as a cause of death when the death investigation and the autopsies are incomplete. Thus, based on our experience and on a review of the current literature, we have set forth factors that the forensic pathologist should consider when faced with a sudden psychiatric death. A case report illustrates these unique aspects of scene investigation and analysis of terminal events and autopsy findings.

Adult↗
PubMed1987

Drug findings in 'Driving Under the Influence of Drugs' cases: a problem of illicit drug use.

Drug findings in 137 drug positive cases of Driving Under the Influence of Drugs (DUID) occurring in St. Louis, Missouri, U.S.A. from June 1983 through May 1986 are presented. Thirty-two different drugs were detected. A single agent was detected in only 34% (47/137) of cases. The most frequently encountered drugs, expressed as percent of positive cases, were: phencyclidine, 47%; marijuana, 47%; benzodiazepines, 22%; barbiturates, 15%; opiates, 11%; and cocaine, 9%. Most multiple drug cases involved popular illicit drug mixtures, such as cocaine and morphine (speedballs) or phencyclidine on marijuana (whack). All the drivers in this survey had displayed inappropriate or impaired operation of a motor vehicle to the extent that a law enforcement officer had stopped and charged them for DUID. In at least 81% of the drug positive cases, persons impaired in the operation of a motor vehicle from a drug or drugs other than alcohol, were impaired not as the result of side effects of therapeutic drug use, but as the result of deliberate self intoxication with illicit or controlled substances.

Automobile Driving↗
PubMed1987

Tissue disposition of cocaine in man: a report of five fatal poisonings.

The disposition of cocaine in five cases of fatal poisoning are presented. The highest concentrations of cocaine were found in urine, kidney, spleen, brain, lung and skeletal muscle. Cocaine concentrations in these organs far exceeded those in blood. Cocaine was detected in all other specimens tested including: bile, heart, liver, vitreous and adipose tissue. These results are in agreement with limited, previously reported, tissue data, and indicate that when urine is not available, kidney, spleen, brain and/or lung should be the specimen of choice for cocaine detection.

Adult↗
PubMed1986

Cardiotoxicity of thioridazine and two stereoisomeric forms of thioridazine 5-sulfoxide in the isolated perfused rat heart.

The cardiotoxic potential of the phenothiazine neuroleptic thioridazine and five of its metabolites, including two stereoisomeric forms of thioridazine 5-sulfoxide (ring sulfoxide), was characterized in the isolated perfused rat heart. Hearts from male Sprague-Dawley rats were perfused using a modified Langendorff technique. After a 30-min control period, hearts were perfused for 30 min with 15 or 30 microM thioridazine, racemic and isomeric forms of thioridazine 5-sulfoxide, or thioridazine 2-sulfoxide. Thioridazine disulfoxide, thioridazine 2-sulfone, and desmethylthioridazine 2-sulfoxide were perfused at 15 microM. Thioridazine (15 microM) severely reduced contractile tension and the rate of tension development (dT/dt), transiently increased coronary flow rate but prolonged conductance through the AV node. No arrhythmias were seen. At 30 microM, ventricular premature contractions and irregular rhythms occurred, progressing to asystole. Thioridazine 5-sulfoxide was arrhythmogenic at 15 and 30 microM. Atrial premature contractions and paroxysmal atrial tachycardia progressed to second degree AV block. Contractile tension and dT/dt declined although not as quickly when compared to thioridazine. Each isomeric form of thioridazine 5-sulfoxide was also cardiotoxic at 15 and 30 microM. There were minor differences in the onset and degree of toxicity but the overall results did not suggest a stereoselective effect. Lactic dehydrogenase and aspartate aminotransferase concentrations were unchanged after thioridazine 5-sulfoxide perfusion indicating no direct tissue damage. Thioridazine 5-sulfoxide induced arrhythmias could not be prevented or reversed by treatment with adrenergic agonists. They were reversible upon washout, however. The other metabolites were not arrhythmogenic at 15 microM. Racemic thioridazine 5-sulfoxide appears to be qualitatively and quantitatively more arrhythmogenic than thioridazine, an action that does not appear to be stereoselective.

Animals↗
PubMed1985

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 examiner's 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.

Adult↗
PubMed1985

Homicide by intravenous injection of naphtha.

A case of homicide by the intravenous injection of Energine, a petroleum distillate spot remover, is presented. This case is the only known homicide committed with naphtha. This elderly man had severe natural disease in addition to chest trauma sustained in the assault leading to death; however, the rapid injection of approximately 25 mL of Energine was the overwhelming cause of death.

Aged↗
PubMed1984

Decline in abuse of pentazocine/tripelennamine (T's and Blues) associated with the addition of naloxone to pentazocine tablets.

From 1977 to 1982, the intravenous use of the combination pentazocine/tripelennamine (T's and Blues) had become a major drug abuse problem in St. Louis, MO, U.S.A. In 1983, the manufacturer of pentazocine tablets removed the drug from the pharmaceutical market and released a new tablet formulation of pentazocine and the narcotic antagonist naloxone. Since 1983 there has been a continuous decline in T's and Blues abuse whereby (a) the new pentazocine tablets do not produce the euphoria sought by addicts; (b) the price of old pentazocine tablets has greatly increased and (c) the availability of heroin and other narcotics has increased.

Drug Combinations↗
PubMed1984

Thioridazine-5-sulfoxide cardiotoxicity in the isolated, perfused rat heart.

The potential cardiotoxicity of a racemic mixture of thioridazine-5-sulfoxide, an oxidative metabolite of thioridazine, was studied in the isolated, perfused rat heart. Thioridazine-5-sulfoxide (ring sulfoxide) was prepared by a new method in which a racemic mixture of the two diastereoisomeric forms of the compound was formed. Hearts from male Sprague-Dawley rats were perfused using a modified Langendorff preparation. Quinidine (31 microM) served as a positive control for the measurements of the electrocardiogram (ECG) and the heart rate. Thioridazine (13 microM) perfusion resulted in a variable heart rate and elevated S-T segment. Perfusate concentrations of the ring sulfoxide as low as 12 microM increased P-R and Q-T intervals, produced delays in A-V and ventricular conduction, premature ventricular contractions and ultimately A-V block. These findings suggest that thioridazine cardiotoxicity may be due in part to the actions of thioridazine ring sulfoxide.

Animals↗
PubMed1984

Tissue distribution of lidocaine after fatal accidental injection.

The accidental death of a 64-year-old heart patient as a result of the injection of an incorrect dose of lidocaine is presented. The attending nurse inadvertently administered an intravenous bolus of 10 mL of 20% lidocaine (2g). The patient should have received 5 mL of 2% lidocaine (0.1 g). Such iatrogenic overdoses of lidocaine arise from confusion between prepackaged dosage forms. Lidocaine concentrations (mg/L or mg/kg were: blood, 30; brain, 135; heart, 106; kidney, 204; lung, 89; spleen, 115; skeletal muscle, 20; and adipose, 1.3. The results indicate that even during cardiopulmonary resuscitation as much as 38% of the administered dose of lidocaine may be found in poorly perfused tissue such as skeletal muscle and adipose.

Accidents↗
PubMed1983

Effects of hemodialysis on theophylline kinetics.

Difficulties encountered in controlling theophylline blood concentrations in an asthmatic patient on hemodialysis prompted us to study the effect of hemodialysis on theophylline kinetics. Plasma theophylline extraction ratios, clearances, and half-lives were determined during dialysis for 11 adults given an intravenous infusion of 4 mg/kg aminophylline. For comparison, eight of these patients were evaluated for theophylline half-lives when not dialyzed. Extraction ratios of theophylline during dialysis ranged from 0.22 to 0.51 (0.35 +/- 0.08) for these patients, indicating that a mean of 36 per cent plasma theophylline was removed during each pass through the dialyzer. This compares with a mean extraction ratio of urea of 0.63 +/- 0.07. Plasma clearance of theophylline during dialysis ranged from 52 to 124 ml/min (83 +/ 20 ml/min). Plasma theophylline half-lives during dialysis ranged from 1.6 to 3.4 hours (2.3 +/- 0.5 hours). Theophylline half-lives when not on dialysis ranged from 3.5 to 8.2 hours (5.0 +/- 1.7). Theophylline clearance was significantly faster in every patient during dialysis. Asthmatics requiring hemodialysis should receive additional theophylline during dialysis if therapeutic blood levels are to be maintained. Routine hemodialysis will significantly increase clearance in a toxic patient in whom life-threatening toxicity is occurring and charcoal hemoperfusion is unavailable.

Adult↗
PubMed1983

Intoxication by aspirin and alcohol in a child. A case of child abuse by medical neglect.

Investigation of child abuse deaths is often hindered by meager or unusual autopsy findings. Circumstantial factors are crucial in such investigations for a thorough understanding of the mechanism and manner of death. We present a case of childhood poisoning from aspirin and alcohol to demonstrate the medical neglect by the parents and the blatant discrepancies between the history provided by the parents and the actual facts preceding the child's death.

Alcoholic Intoxication↗
PubMed1983

Tissue mineral levels in victims of sudden infant death syndrome I. Toxic metals--lead and cadmium.

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 microgram/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 microgram/g versus 0.761 microgram/g, P less than 0.05; rib, 1.754 microgram/g versus 1.041 microgram/g, P less than 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 less than 0.05. In non-SIDS only kidney cadmium showed an increase with age (P less than 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.

Age Factors↗