Biomedical subjects

Małgorzata Kłys

Publications and source records attributed to Małgorzata Kłys.

18 recordsLinked to original sources

PubMed2006

Fatality involving vinblastine overdose as a result of a complex medical error.

The purpose of the study is a presentation of a fatal case involving an 83-year-old woman, who died due to an overdose of vinblastine-a cytostatic agent of a vinca alkaloid employed in cancer chemotherapy. The postmortem investigation included an autopsy and histological examination, as well as a toxicological analysis of post-mortem specimens collected in the course of autopsy. The authors performed a toxicological assessment of vinblastine employing liquid chromatography-atmospheric pressure chemical ionization-tandem mass spectrometry (LC-MS-MS-APCI). The determined vinblastine concentration levels amounting to 29 ng/g in blood and 52.5 ng/g in liver were in a considerable excess of values encountered in patients on chemotherapy using the drug. The fatality was investigated in the context of medical error. In the described case, the erroneous and medically unjustified administration of vinblastine was identified by a series of unfortunate events involving as many as three acting consecutively individuals: a physician, a pharmacist and a nurse. The report may thus document the clinical course of vinblastine poisoning along with postmortem changes resulting from the drug action.

Accidents, Traffic↗

PubMed2005

Determination of oxcarbazepine and its metabolites in postmortem blood and hair by means of liquid chromatography with mass detection (HPLC/APCI/MS).

A typical use of hair analysis in forensic toxicology is the documentation of previous drug administration. This is illustrated in a suicidal death of a 58-year-old epileptic patient who was treated with oxcarbazepine and probably with levomepromazine. The toxicological analysis carried out by HPLC/APCI/MS included also the hair (6 cm length) besides postmortem blood. The method was validated for levomepromazine, oxcarbazepine (OXCBZ) and its two metabolites, 10-hydroxycarbazepine (CBZ-10OH) and trans-diol-carbazepine (CBZ-diOH) in various biological matrices. The analysis of the postmortem blood indicated oxcarbazepine and its two main metabolites were present at therapeutic concentrations; levomepromazine was detected at a fatal concentration. In three 2-cm segments of hair, oxcarbazepine and its two metabolites were detected; however, levomepromazine was not detected in this specimen. As a result of complex chemical-toxicological investigation it was confirmed the information that the decedent. was an epileptic patient and was treated with oxcarbazepine for at least 6 months before death. In addition, he took a toxic dose of levomepromazine in order to commit suicide. The analysis revealed differences between the concentration levels of oxcarbazepine and its active metabolite CBZ-10OH in postmortem specimens and hair, suggesting different mechanisms of penetration of metabolites and their precursors into this matrix.

Adult↗

PubMed2005

A fatal clomipramine intoxication case of a chronic alcoholic patient: application of postmortem hair analysis method of clomipramine and ethyl glucuronide using LC/APCI/MS.

Toxicological investigations of postmortem specimens of a 26-year-old man were performed with the use of LC/APCI/MS. They revealed in the blood of the deceased clomipramine (9.49 microg/g) and its main metabolite norclomipramine (1.10 microg/g) at concentrations explaining the fatal outcome. The presence of these xenobiotics in a 12-cm-long strand of hair (clomipramine, 7.60 ng/mg in I segment; 4.19 ng/mg in II segment; 1.86 ng/mg in III segment; norclomipramine, 5.71 ng/mg in I segment; 9.71 ng/mg in II segment; 4.13 ng/mg in III segment) confirmed the fact obtained from the medical history that the deceased had been receiving clomipramine as an antidepressant for 1 year prior to his death. The analysis demonstrated ethanol in autopsy blood (2.5mg/ml) and urine (3.2mg/ml); ethyl glucuronide as a marker of chronic alcohol abuse was detected in the deceased's hair (0.44 ng/mg in I segment; 0.07 ng/mg in II segment; n.d. in III segment). These findings may suggest the contribution of alcohol in the mechanism of drug-ethanol interaction, which in consequence might have affected the biotransformation of clomipramine in the final period of his life and evoked the ultimate toxic effect.

Adult↗

PubMed2005

History of scientific cooperation between Department of Clinical Toxicology and the Chair of Forensic Medicine Jagielionian University Medical College in the period of last four decades as a document of clinical and forensic toxicology integration.

An integration of clinical and forensic toxicologist society enjoys its 40-year tradition. A practice in this field proves that the cooperation can be fruitful in both the scientific and preventative and organizational areas provided the concentration of the participants' efforts is focused. The article shows the examples of such collaboration, the illustration of which are the presented works. The articles constitute the original papers and casuistic works as well concerning problems of contemporary toxicology such as: epidemiology of poisoning, complex evaluation of ethanol, carbon monoxide, pesticides, drugs of abuse, pharmaceuticals and other poisonings.

Academic Medical Centers↗

PubMed2005

Frequency and pattern of poisoning in adult and adolescent Kraków population in 2003 and 1983.

The pattern (frequency, type of exposure, toxic substance) of adolescent and adult poisonings in Kraków in 2003 is compared with 1983. The analysis includes data for poisoned patients treated at the Kraków Department of Clinical Toxicology and all on the spot fatal cases subjected to post-mortem autopsy and toxicological examinations at the Department of Forensic Medicine Jagiellonian University Medical College in both the years. As much as 4341 poisoning cases (2852 males; 1489 females) were treated in 2003 compared with 2132 (1078 males; 1054 females) in 1983. In 1983 in group of 154 poisoned persons who died at the place of accident there were 138 (89.6%) men and 16 (10.4%) women. In 2003 among 121 deaths at the scene there were 93 (76.9%) males and 28 (23.1%) females. Poisonings due to suicidal attempts decreased significantly from 53.6% in 1983 to 19% in 2003. Incidence of poisoning per 10 000 of general Kraków population increased from 36.17 in 1983 to 57 in 2003 or up to 65.7 if the population of adults and teenagers (above 15 years old) was only considered. Pharmaceuticals (40.6%) followed in frequency by ethanol (25%) and ethanol co-ingested with pharmaceuticals (12.2%) and carbon monoxide (10.6%) were the most common reasons for poisoning in 1983. In 2003 the most common cause of poisonings was ethanol (46.2%) followed by pharmaceuticals alone (25%) or co-ingested with ethanol (6.4%) and carbon monoxide (6.2%). An ingestion of mixed pharmaceuticals (55.1%) followed In frequency by non-barbiturate hypnotics and psychotropic drugs (26.3%) were a most common in 1983 whereas a non-barbiturate hypnotics and psychotropic drugs (34.4%) followed by mixed pharmaceuticals (32.9%) in 2003. A mortality both concerning only the people who died in hospital and also those who died on the spot (prior to any treatment) was significantly higher in 1983 compared with 2003.

Adolescent↗

PubMed2005

Usefulness of multi-parameter opiate analysis in hair of drug users and victims of fatal poisonings.

The results of a multi-parameter analysis of opiates in the hair of drug users and victims of fatal poisonings with these xenobiotics have been presented. The analysis was carried out with the use of liquid chromatography coupled with mass spectrometry (LC-MS). The article discusses the monitoring of the drug users' adherence to pharmacotherapy and the usefulness of hair analysis for medico-legal purposes. The authors evaluate the differences in the contents of particular opiates in the hair as related to the origin of a sample (untreated drug user, drug user in the course of treatment, victim of fatal poisoning). The report presents differences between the Polish and American profiles of abuse, providing confirmation that a great part of drug users undergoing methadone treatment do not abstain from opiates and/or amphetamine, the latter as a rule being very often taken with opiates.

Adult↗

PubMed2004

Chemical poisonings among Kraków inhabitants in 1972 and 2002.

The patterns (frequency, poisoning type, toxic agent involved) of adolescent and adult poisonings in Kraków in 1972 and 2002 are presented. The analysis includes data for poisoned patients treated at the Kraków Department of Clinical Toxicology in 2002 and 1972, and all on the spot fatal cases subjected to post-mortem autopsy and toxicological examinations at the Department of Forensic Medicine in both the years. As much as 4116 poisoned cases (males 2722; females 1394) were treated in 2002 compared to 1485 (males 649; females 836) in 1972. There was no substantial difference between a number of poison related fatalities on the spot in years analysed: 126 (males 105; females 21) in 2002 and 122 (males 84; females 38) in 1972. An elevation in poisoning incidence rate per 10,000 of Kraków inhabitants was also noted in 2002 compared to 1972 (54.3 vs. 30.0). A pharmaceuticals (32.9%) followed by CO (18.2%) and mixed pharmaceuticals (16.2%) were mostly involved in poisoning cases in 1972, whereas ethanol (46%), pharmaceuticals (13.2%), pharmaceuticals co-ingested with ethanol (7.8%), narcotics (7.8%), mixed pharmaceuticals (6.7%), and CO (5.2%) were mostly involved in poisoning cases treated in 2002. A mortality rate both concerning only a people who died in hospital or/and those who died on the spot (prior to any treatment) was significantly higher in 1972 compared to 2002.

Adolescent↗

PubMed2004

[A group carbon monoxide poisoning].

The aim of the study was to present the group carbon monoxide poisoning in Kraków in December 2003. Despite the reanimation procedure one fatal case was stated on the spot (HbCO--60% according to post-mortem toxicological examination). CO threshold limit values were significantly exceeded in the whole building. The inhabitants (15 persons) were transported to the Department of Clinical Toxicology Jagiellonian University Medical College. Also 4 staff members of the ambulance and 2 policemen called to the incident, were diagnosed and observed. Totally, toxicology medical care was given to 21 CO exposed persons. In 8 of them acute CO poisoning of minor grade was stated. Any clinical symptoms of poisoning in the rest of CO exposed persons were noted.

Adolescent↗

PubMed2004

[Hair analysis as a document of oxcarbazepine therapy in fatal levomepromazine poisoning].

A development of contemporary analytical methods makes possible to use hairs in toxicological analysis for documentation history of drug administration. An undertaken subject has been illustrated by a suicidal fatal poisoning of 58-year-old man with a neuroleptic drug--levomepromazine. Toxicological analysis carried out by HPLC/APCI/MS, besides of standardized postmortem specimen as blood, urine, liver and cerebrospinal fluid included also victim hairs. As a result of analytical procedure levomepromazine at high concentrations was revealed, which may be responsible for death. Moreover, and antiepileptic drug--oxcarbazepine and two main metabolites at therapeutic concentrations were revealed parallel. In three 2-cm segments of hair oxcarbazepine and two metabolites were detected, levomepromazine, in contrary, was not detected in this specimen. Complex chemical-toxicological investigation confirmed information that victim was an epileptic patient and was treated with oxcarbazepine at least 6 months before death while toxic dose of levomepromazine, as one could suppose, he took to commit suicide.

Anticonvulsants↗

PubMed2003

[Amphetamine and derivatives related death in the aspect of forensic toxicology].

Amphetamine and derivatives are the crucial theme in the problems of forensic toxicology. The paper is based on the study of 20 cases of deaths in which amphetamine and/or derivatives were involved as the cause of death. Toxicological examinations of the autopsy specimens were performed with the use of HPLC/MS method in chemical positive ionization mode (APCI) after liquid--liquid extraction. The toxicological findings obtained in particular cases indicate that the majority of cases under consideration were complex. Among all 20 cases only two, probably suicidal deaths, were a result of amphetamine abuse. Some of them which were violent deaths (murder, gun-shot, hanging, drowning) of people under the influence of drugs. The majority of cases which were probably fatal accidents caused by the interaction of various mixtures of xenobiotics which included also opiates, cocaine, benzodiazepines besides amphetamine and derivatives. The concentrations of xenobiotics detected in these cases fit a relatively large range. One case is worth mentioning. This is a death of a permanent amphetamine user who survived two weeks with hematoma in brain in which amphetamine was detected postmortem. The report also discuss amphetamine and derivatives metabolic problems and contains useful data for medico-legal purposes.

Adult↗

PubMed2003

[Medico-legal aspects of fatal poisoning with special attention to children and young people in the material of the Institute of Forensic Medicine in Cracow in the years 1998-2002].

In this paper based on the archival material of the institute between the years 1998-2002 the deaths of children and young people up to 18 years of age are presented on the background of the general problems of forensic toxicology. Violent death concerns 128 cases, among those 25 were subjected to toxicological investigation. The discussion material includes suicidal and accidental poisonings with drugs and substance of abuse, volatile solvents, carbon monoxide, and deaths in fire. In the list of the discussed cases there are dead bodies of newborns found on rubbish dumps and accidental fatal poisonings of small children.

Adolescent↗

PubMedDate not supplied

[Application of HPLC/MS for evaluation of fatal poisoning with digoxin in the aspect of medico-legal evidence].

This paper presents a case of suicidal poisoning of a woman with digoxin administered by injection. The autopsy of the subject was performed in the Institute of Forensic Medicine CMUJ. Body fluids (blood, urine, perylimph) and tissues (kidney, liver, brain) were collected for toxicological investigation. Digoxin determination was carried out by means of high performance liquid chromatography with mass spectrometry (HPLC/MS) which revealed digoxin in extremely high concentrations in specimens examined. The method is especially useful for analysis of cardiac glycosides in fatal poisonings for medicolegal purposes.

Adult↗

PubMedDate not supplied

[Significance of chromatographic methods coupled with mass spectrometry for identification of drugs for medico-legal purposes exemplified by chlorphenoxamine].

This work presented the death of the 17-year old women M.F. The direct cause of death was violent strangulation. Toxicological investigation made possible a wider explanation of the case, since M.F. was under influence of associative action of diphenhydramine and ethanol which could not avoid having an influence on the tragic events accompanying the death. Besides a comprehensive interpretation of the toxicological results in medico--legal aspect large methodic documentation has been presented which proves the usefulness of chromatographic methods coupled with spectrometry for identification of xenobiotics found.

Adolescent↗

PubMedDate not supplied

[Suicide by propane-butane inhalation: a case report and literature review].

A case of suicide of a 26-year old woman by propane-butane inhalation is presented with a description of the circumstances, postmortem pathomorphological and toxicological findings. The literature relating to deaths due to inhalation of these gaseous substances was briefly reviewed.

Administration, Inhalation↗

PubMedDate not supplied

[Intoxication as an "ever lasting problem"].

Medicolegal opinion of insobriety considering retrospective and prospective calculation, analytical methods and other problems have been constructed for the needs of law and lawyers. Their substantial correctness cornus the basis of a good level of medicolegal expert's opinion. This is the reason that each paper including this one concerning the subject of a key point of an opinion, possible mistakes, traps or controversial aspects of problems contributes to a permanent improvement of opinions related insobriety.

Alcoholic Intoxication↗

PubMedDate not supplied

[Hair analysis in the evaluation of complex drug-poisonings for medico-legal purposes].

Among various alternative materials used in toxicological analysis the most important is hair, in which xenobiotics deposited create a possibility to observe the history of their administration in the period determined by the hair-length. In this paper the authors have tried to outline the course of the application of hair analysis in forensic toxicology for medicolegal purposes. The undertaken subject has been recorded in four cases of complex drug poisonings in which hair analysis was used in the toxicological evaluation. Drugs detected in the hair of the examined subjects inform about the history of pharmacological therapy in confrontation with those administered in order to commit suicide. The analysis confirms a model of dependence and proves drinking of alcohol and use of cocaine during the pharmacological therapy of dependence.

Adult↗

PubMedDate not supplied

[A proficiency test for hair analysis in detecting drug abuse as an index of the quality of toxicologic analysis].

The Society of Hair Testing--SoHT organized a quality control test: "2004 Proficiency Test on Drugs of Abuse in Hair". 23 toxicological units participated in the test, among them the Toxicological Laboratory of The Institute of Forensic Medicine CM UJ. Five hair samples were obtained for analysis comprising four groups of drugs of abuse as follows: opioids (6-monoacethylmorphine, morphine, codeine), amphetamine (amphetamine, methamphetamine, 3,4-methylendioxyamphetamine--MDA, 3,4-methylendioxymethamphetamine--MDMA, 3,4-methylendioxyethylamphetamine--MDEA), cocaine and metabolites (benzoiloecgonine, cocaethylene) and cannabinoids (D9-tetrahydrocannabinol --9-THC, cannabinol--CBN). Obtained results were evaluated positively in all groups of drugs which were the subject of examination. Liquid chromatography coupled with tandem mass spectrometry in chemical ionization under atmospheric pressure option (LC-APCI-MS-MS) and gas chromatography coupled with tandem mass spectrometry and electron-impact ionization mode (GC-EI-MS-MS) were applied for analysis of analytes.

Amphetamine↗

PubMedDate not supplied

[Fatal traffic accidents vs. alcohol consumption in the victims in the archival material collected by the Institute of Forensic Medicine, Collegium Medicum, Jagiellonian University in Cracow, in the years 2000- 2003].

The report presents the issue of fatal traffic accidents, emphasizing in particular blood alcohol levels in victims involved in such fatalities. According to data provided by the Central Police Headquarters, in recent years, the annual number of traffic accidents in Poland has been in excess of 50000; of this number, more than 10% have resulted in fatalities. The number of traffic accidents in the Małopolska province has amounted to 5000, and more than 7% of these accidents have been fatal. In the years 2000-2003, at the Department of Forensic Medicine, Collegium Medicum, Jagiellonian University, a total of 884 victims of fatal traffic accidents that occurred in the Cracow region were autopsied. In the group, car drivers accounted for 26%, passengers - for 16%, while the most numerous subgroup, represented by more than 57% of victims, included pedestrians hit by moving vehicles. In the autopsied car drivers, individuals being under the influence of alcohol and intoxicated accounted for 40-42% in the years 2000-2002 (as compared to the total number of investigated subjects); in 2003, the percentage decreased reaching 31%. Among the passengers, the mean percentage of those being under the influence of alcohol and in drunk was slightly higher in this period, ranging between 27 and 57%. However, the highest percentage of victims included individuals under the influence of alcohol, and especially alcohol intoxicated pedestrians hit by moving vehicles, whose number exceeded 50% of the total group of the autopsied corpses.

Academic Medical Centers↗