Search PubMed⌕ Search

Biomedical subjects

J Rajs

Publications and source records attributed to J Rajs.

At least 19 recordsLinked to original sources
PubMed2004

Fatal intoxication as a consequence of intranasal administration (snorting) or pulmonary inhalation (smoking) of heroin.

In recent years we have noticed an increasing proportion of mortalities resulting from an overdose of heroin that involve routes of administration other than injection. Of 239 cases of fatal heroin intoxication examined at our department during the period 1997-2000, 18 deaths were associated with non-parental administration. Seven of these fatalities were experienced heroin users who had begun to use more sporadically, seven were recreational "party-users", while the remaining four persons had relapsed into heroin use following long periods of abstinence. The median blood morphine concentration of these non-injectors was 0.095 microg/g (range: 0.02-0.67 microg/g), significantly lower than that of the injectors. Concurrent use of alcohol, other illicit drugs and/or pharmaceutical preparations was observed in 17 of the 18 cases. However, there were no statistically significant differences between the victims of heroin intoxication by injection or by other routes with respect to the proportion who had simultaneously consumed alcohol or benzodiazepines. Pathological alterations like lung fibrosis, liver cirrhosis, endocarditis, etc. were not found to play a significant role in any of the 18 mortalities. We conclude that snorting or smoking heroin probably involves a reduced risk of obtaining high blood concentrations of morphine but still constitutes a considerable risk of lethal outcome due to high variability in blood concentrations. Furthermore, decreased tolerance resulting from periods of reduced or sporadic use appears to be an important risk factor in connection with heroin overdosing by snorting or smoking, which indicate that some heroin addicts may inaccurately assume that these routes of administration are safe when resuming their use of heroin after a period of abstinence.

Administration, Inhalation↗
PubMed2003

Analysis of the mitochondrial genome in sudden infant death syndrome.

AIM: To investigate the mitochondrial genome and its association with sudden infant death syndrome (SIDS). METHODS: Twenty SIDS infants were screened for previously reported mitochondrial DNA mutations using direct sequencing. The whole mitochondrial genome was also sequenced for six of the infants. RESULTS: Three substitutions, A11467G, A12308G and G12372A, comprising a haplogroup were present in four infants diagnosed as pure SIDS. This haplogroup was also common in a control group. CONCLUSIONS: No specific mutation or polymorphism was found in association with SIDS.

DNA Mutational Analysis↗
PubMed2001

High-dose intravenous infusion of irrigating fluids containing glycine and mannitol in the pig.

BACKGROUND: Large-scale absorption of electrolyte-free irrigating fluid during endoscopic surgery may result in a "transurethral resection syndrome." The severity of the syndrome can probably be modified by using mannitol 5% instead of the most widely used glycine 1.5%. METHODS: Seventeen pigs with a mean body weight of 22 (range 19-26) kg received an intravenous infusion of 100 mL kg(-1) h(-1) of either glycine 1.5% or mannitol 5% over 90 min. Central hemodynamics, whole-body and brain oxygen consumption, intracranial pressure, blood hemoglobin, and the sodium concentrations in serum and urine were monitored for 120 min. Selected measurements were made on 6 other pigs given mannitol 3% and in 2 controls not given any fluid. Morphological examinations of the hearts were conducted. RESULTS: Both glycine 1.5% and mannitol 5% transiently increased cardiac output, the aortic blood flow rate, and arterial pressures, but all of these parameters fell to below baseline after the infusions were ended. The intracranial pressure was lower (P < 0.05) and the oxygen consumption in the brain decreased (P < 0.001) during the infusion of mannitol 5%. Glycine 1.5% expanded the intracellular volume more than mannitol did (P < 0.002). Signs of myocardial damage were graded glycine 1.5% > mannitol 5% > mannitol 3%. CONCLUSIONS: Massive infusion of glycine 1.5% and mannitol 5% left the pigs in a hypokinetic hypotensive state. Glycine 1.5% increased the intracranial pressure and injured the myocardium more than mannitol 5%, which then seems to be a more appropriate irrigating fluid to use during endoscopic surgery.

Animals↗
PubMed2001

Death related to coronary artery fistula after rupture of an aneurysm to the coronary sinus.

Large coronary fistulas are considered to cause myocardial ischemia due to diversion of the coronary blood flow. In this case the authors report the reverse effect--the spontaneous closure of a large fistulation between the left circumflex artery and the coronary sinus evoked angina pectoris in a middle aged man, who died several years later. Postmortem examination revealed a coronary aneurysm that had ruptured and dissected into the coronary sinus and finally thrombosed. The origin of the aneurysm could be congenital but perhaps also represents a healed stage of Kawasaki disease.

Autopsy↗
PubMed2000

Histologic appearance of fractured thyroid cartilage and surrounding tissues.

Histological appearances of the fractured superior horns (SH) of the thyroid cartilage and their surrounding tissues were reviewed, with particular reference to signs of vital origin of the fracture. Twenty-nine autopsies with either histories or findings indicating asphyxial neck compression, with a total of 39 fractured SHs, and three autopsies with history of suicidal jump from height with a total of two SH fractures, were examined. Fifteen autopsies with finding of 19 artefactually fractured SHs while removing neck organs at autopsy were used as controls. In the cases of neck compression and victims of jump from height haemorrhages, retraction of fractured SH fragments with invagination or squeezing of the perichondrium, contraction bands, contraction band necrosis and 'opaque fibres', in the adjacent muscle fibres could be seen. Fibrin deposition and/or leucocytic reaction were noted in cases where circumstances of death indicated prolonged death struggle (as in incomplete hanging, resuscitation or homicidal neck compression). However, retraction of fractured fragments and invagination of perichondrium between artefactually fractured SH fragments were observed in both control cases and cases with antemortem trauma to the larynx. Many of these histological findings, including haemorrhages and fractures had not been evident at gross examination. We conclude that histological examination of SHs may not only uncover macroscopically overlooked injuries but also may facilitate the clarification of an injury's vital origin.

Adult↗
PubMed2000

[Sex cases of sudden death after snorting heroin analyzed. Reduced tolerance in periodic abuse a danger both in snorting and injecting].

Heroin injection entails a risk of infection and can result in sudden collapse and death. During the past few years alternative routes of heroin use have been introduced. During 1997-1998 we observed six deaths which occurred suddenly following heroin snorting. These victims were all temporary drug users in good health and physical condition. They all died with low morphine concentrations; however, three had relatively high blood alcohol concentrations and two were under the influence of medicinal drugs. Temporary use of heroin is characterized by low drug tolerance; snorting of heroin appears to entail the same risk of sudden death as injection.

Administration, Intranasal↗
PubMed2000

Sudden unexpected death as a consequence of indinavir-induced nephropathy. A case report.

A 60-year-old male had tested in 1986, at age 46, positive for human immunodeficiency virus (HIV). In mid-1996 he was started on a protease inhibitor regimen, which included indinavir, lamivudine and stavudine, and remained on this therapy until his death. In April 1999 he was hospitalized after a fainting episode. Although examination focusing on cardiac disease did not disclose any remarkable findings, he died suddenly one week after being discharged from hospital. At autopsy the kidneys were enlarged, with a total weight of 500 g, patchy pale gray and pinkish. Microscopy showed leukocytic cell casts in many of the tubules and collecting ducts. In many of these casts there were clefts left by crystals. In the interstitium, both in the cortex and the medulla, there was focal inflammation and fibrosis. Death was attributed to sudden cardiac dysfunction, probably ventricular fibrillation as a consequence of severe nephropathy with electrolyte disturbances. It is likely that kidney damage developed secondary to the indinavir treatment as indinavir can cause not only nephrolithiasis but also crystal-induced acute renal failure.

AIDS Dementia Complex↗
PubMed2000

Heart weight in infants--a comparison between sudden infant death syndrome and other causes of death.

UNLABELLED: Heart and body weights were compared with regard to heart pathology and cause of death in well-defined groups of infants under 1 y of age. In the period 1980 to 1998, out of 468 infants autopsied at the Department of Forensic Medicine in Stockholm, Sweden, 331 died of sudden infant death syndrome (SIDS), while 137 died of other causes. Physical violence was the known cause of death in 30 infants and cardiovascular malformations in another 19. Inflammatory alterations of the myocardium were found in 74 cases (16%): in 17 cases (3.6%) myocarditis was interpreted as the main cause of death; in 45 (10%) it was interpreted as contributing to SIDS and in 12 cases (2.5%) it was observed but judged not to be a contributory cause of death in non-SIDS victims. Two of these infants died as a result of physical violence. Body weight was the best predictor for heart weight as analysed by multiple regression, including age, sex, body weight, length, BMI and birth weight. An equation for estimating heart weight from body weight gave an accuracy within the range 0.75-1.25 in 89.2% and 85.0% of the SIDS and non-SIDS groups, respectively. CONCLUSION: Body weight is the best predictor for estimating heart weight. No evidence supported the notion that heart weight, body weight or birth weight of SIDS victims differs from non-SIDS, although heart weight in infants with cardiovascular malformations deviated from observations in the other groups.

Body Weight↗
PubMed2000

Cause and manner of death among users of anabolic androgenic steroids.

Medicolegally investigated deaths among 34 male users of anabolic androgenic steroids (AAS) are described. Nine persons were victims of homicide, 11 had committed suicide, 12 deaths were judged as accidental and 2 as indeterminate. In two cases of accidental poisoning, the levels of pharmaceuticals and illicit drugs were considered too low to be the sole cause of death and AAS was considered part of the lethal polypharmacia. Chronic cardiac changes were observed in 12 cases. In two cases of accidental poisonous deaths, these changes were regarded as contributory cause of death. Homicides, suicides, and poisonings determined accidental or indeterminate in manner were related to impulsive, disinhibited behavior characterized by violent rages, mood swings, and/or uncontrolled drug intake. The observations in the present study indicate an increased risk of violent death from impulsive, aggressive behavior, or depressive symptoms associated with use of AAS. There are also data to support earlier reports of possible lethal cardiovascular complications from use of AAS. Furthermore, a contributing role of AAS in lethal polypharmacia is suggested. Finally, the observations indicate that use of AAS may be the gateway of approach to abuse of other psychotropic drugs.

Accidents↗
PubMed1999

Anabolic androgenic steroids and suicide.

Eight medicolegally examined cases of suicide, in 21- to 33-year-old males, with a history of current or discontinued use of anabolic androgenic steroids (AAS) are described, five of which were approached by means of systematic interviews with survivors. Five suicides were committed during current use of AAS, and two following 2 and 6 months of AAS withdrawal. In one case it was unclear whether the suicide was committed during current use or after recent discontinuation. In five cases family members had noted depressive symptoms associated with AAS withdrawal. After prolonged use, four persons had developed depressive syndromes. Two subjects exhibited hypomania-like symptoms during the time immediately preceding the suicide. Four subjects had recently committed acts of violence while using AAS. In some cases these acts exacerbated the subjects' problems in personal relationships or at work, which in turn seem to have precipitated the suicides. Only one of them had experienced suicidal ideation before starting to use AAS. In all cases examined by psychological autopsy, risk factors of suicidality likely to be independent of the use of AAS were present. In conclusion, this study presents data suggesting that psychiatric symptoms and conflicts resulting from long-term use of AAS may contribute to completed suicide in certain predisposed individuals.

Adult↗
PubMed1998

Criminal multilation of the human body in Sweden--a thirty-year medico-legal and forensic psychiatric study.

During the 30-year period 1961-1990, a total of 22 deaths with criminal multilation/dismemberment of the human body were registered in Sweden. The multilations occurred in time clusters, mostly during the summer and winter periods, and increased during the three decades, with incidence rates of 0.05, 0.1, and 0.125 per million inhabitants and year, respectively. Multilation was noted 6.6 times more often in large urban areas than in the rest of Sweden. Defensive mutilation, in order to get rid of the corpse or make its identity more difficult, was noted in ten instances, aggressive mutilation following outrageous overkilling in four, offensive mutilation (lust murder) in seven, and necromanic multilation in one instance. In the last-mentioned case the cause of death was natural, while all deaths in the first three groups were homicidal, or homicide was strongly suspected. All perpetrators were males, in six instances assisted by other persons. In more than half of the cases the perpetrator's occupation was associated with application of anatomical knowledge, e.g., butcher, physician, veterinary assistant, or hunter. The perpetrators of the defensive and aggressive mutilations were mostly disorganized, i.e., alcoholics or drug users with previous psychiatric contacts and criminal histories, while the lust murderers were mostly organized, with a history of violent crimes (including the "serial killing" type), drug abuse and mental disorders with anxiety and schizophrenia, in that order to a diminishing degree. There were differences in mode of mutilation, depending on whether the mutilation was carried out by a layman, a butcher, or a physician. In only one case was the perpetrator convicted for the mutilation act itself; in the remaining instances the manslaughter, as a more serious crime, assimilated the mutilation. When the mutilation made it impossible to establish the cause of death, the perpetrators, despite strong circumstantial evidence indicating murder, were acquitted.

Adolescent↗
PubMed1997

A cluster of fentanyl-related deaths among drug addicts in Sweden.

During a 16-month period, nine fatalities occurred among white male drug-addicts, where fentanyl was detected at postmortem toxicological analysis. The street samples associated with these cases confirmed the presence of fentanyl as an additive in low-concentration amphetamine powders with caffeine, phenazone and sugar as cutting agents. In seven of the cases, an acute intoxication by fentanyl was considered to be the immediate cause of death, and in one case, it was likely, but no analysis of fentanyl was performed in blood, and in another case the death was suicide by hanging. This appears to be the first report of a cluster of fentanyl-related deaths outside the United States, and the occurrence of fentanyl in combination with amphetamine has not previously been reported. In addition, in all cases, femoral blood was collected, and samples were handled and analysed according to standardized, quality-controlled procedures. The previous history, circumstances surrounding the death, autopsy findings, histology and toxicology examination of each case are presented. The gas chromatographic-mass spectrometric method for fentanyl is also described. Fentanyl concentrations ranged from 0.5 to 17 ng g-1 blood, and from 5 to 160 ng ml-1 urine. Other drugs found were amphetamine (8 cases), ethanol (5 cases) and benzodiazepines (5 cases). Morphine was found in only one case. The average age of men was 33.9 years (range 22-44); six were found in their own of friend's apartment, two inside buildings (stairways) and one was found outdoors. We conclude that fentanyl is a dangerous substance that should be considered in drug-addict deaths even outside the United States, particularly when the remaining toxicology is unremarkable, and the cause of death cannot be ascertained

Adult↗
PubMed1997

Unexpected death in two young infants mimics SIDS: autopsies demonstrate tumors of medulla and heart.

A total of 423 medicolegal autopsies of infants under the age of 1 year were done during a 15-year period (1980-1994) at the Department of Forensic Medicine in Stockholm. Only two instances with findings of tumors occurred. One was a unilateral oligodendroglioma involving the medullary reticular formation and inferior olivary nucleus with associated myocardial alterations; the other was a fibroma of the left heart ventricle. Both are interesting with regard to their localization--the medulla oblongata and the heart--and by causing death in a way that mimics the sudden infant death syndrome (SIDS). In the heart of the infant with oligodendroglioma, a single fascicle of hamartomatous, immature appearing heart muscle fibers was found, making the interpretation of the cause of death more intricate.

Brain Neoplasms↗
PubMed1997

Mortality and causes and manner of death among drug addicts in Stockholm during the period 1981-1992.

A cohort of 1640 hospitalized drug addicts was studied over an 8-year period, and consisted of 678 heroin users, 578 amphetamine users and 384 users of other drugs. In total, 234 addicts were HIV-positive, most of them heroin users. During the observation period, 214 deaths occurred in the cohort. The total mortality was 2.2% annually. Death linked to injection of heroin was the main cause of death not only among heroin users but also among subjects classified as users of amphetamines or other drugs. During the observation period, a total of 222 addicts (115 of whom were HIV-positive) entered the methadone programme. No deaths occurred among the HIV-negative subjects who were participating in the methadone programme. A total of 15 HIV-positive subjects died while taking part in the programme--13 of these subjects from natural causes (mostly HIV/AIDS).

Adult↗
PubMed1997

Unnatural causes of death among drug addicts in Stockholm: an analysis of health care and autopsy records.

The aim of this study was to assess causes of death among 258 unnaturally deceased drug addicts who had been part of an earlier longitudinal follow-up of 1,630 patients treated in Stockholm County. An evaluation of the causes of death was carried out on the basis of hospital records and autopsy protocols. The majority of deaths were caused by accidents (39%) and suicides (31%). Intoxications were involved in 67 of the 101 accidents. Violent methods were employed in 40 of the 79 suicides. An exceptionally large proportion (28%) of the fatalities occurred during or immediately after hospitalization, which calls for increased attention to this patient group by the health services.

Adolescent↗