ABSTRACT: Cocaine is known to degrade in vivo and in vitro by several hydrolytic mechanisms. A previous study found that the initial amount of cocaine added to plasma could be accounted for by summing the molar concentrations of cocaine's hydrolysis products and the cocaine remaining after hydrolysis. The present study was undertaken to investigate whether or not relationships might exist between such molar concentration sums for different postmortem bodily fluids. Determinations of cocaine, benzoylecgonine, ecgonine methyl ester, and ecgonine were performed using liquid chromatography/mass spectrometry (LC/MS/MS) with heart blood, femoral blood, vitreous humor (VH), and urine (UR). The results demonstrate a strong correlation between blood and VH concentrations (correlation coefficients of 0.88–0.94), weak correlation between the UR and blood concentrations (correlation coefficients of 0.61–0.64), and weak correlation between UR and VH concentrations (correlation coefficient of 0.59). The results demonstrate that ecgonine is a significant hydrolysate with concentrations on the same order of magnitude as benzoylecgonine. The results are consistent with rapid distribution of the parent drug and its hydrolysates in the blood and VH. The strong correlation between the blood and VH demonstrates that VH is an important medium for toxicology testing when attempting to make a determination of cocaine intoxication.

Although seat belts significantly reduce the extent and severity of injuries sustained by motor vehicle occupants, seat belts are known to be associated with chest and abdominal trauma. Less commonly understood are severe neck injuries caused by the use of two-point automatic shoulder harnesses without concurrent use of a manual lap belt. Such injuries may include cervical spine fractures, craniocervical dislocations and rarely decapitation. Recognizing patterned injuries caused by seat belts and the ability to correlate autopsy findings with the circumstances surrounding the death will allow for correct interpretation of seat-belt related trauma. The four cases described detail fatal neck injuries as a result of improper seat belt use in which an automatic two-point shoulder harness was used without a manual lap restraint. In two of the cases, the victims were decapitated.

A 35-year-old black woman with a history of bronchial asthma collapsed and died after ingestion of three 20-mg tablets of propranolol. She was recently treated in the emergency department at a local hospital for an acute asthma exacerbation and was given a written prescription for prednisone. The prescription was filled and the medication was taken as prescribed. Within minutes after ingestion of the medication, she became acutely short of breath and was witnessed to collapse. Paramedics responded to the scene and initiated resuscitative efforts while en route to the local emergency department. The decedent was unable to be resuscitated and was pronounced dead shortly after reaching the hospital. It was later discovered that the medication she was given by the pharmacy was 20-mg propranolol tablets instead of 20-mg prednisone tablets.

With improved radiologic techniques fine-needle aspiration (FNA) is becoming a rapid, effective diagnostic method in evaluating a wide range of liver masses. Review of six hundred two radiologically guided liver aspirates performed over a ten-year period forms the basis of this report.

Patterned injuries often remain unrecognized by emergency department personnel. Immediate recognition of a simple, superficial patterned injury may result in prompt and possibly life-saving treatment. A fall off a bicycle with a patterned abdominal bruise should suggest potentially life-threatening trauma.