Aims-To compare blood drug concentrations during life with postmortem drug concentrations measured from a peripheral site and a central site. Methods-Coroner's cases from October 1990 to July 1997 were reviewed. Six cases had data on both antemortem and postmortem blood drug concentrations. The postmortem to antemortem ratio was compared with the postmortem central to peripheral ratio, using cardiac blood as a central site and femoral blood as a peripheral site. Results-Drugs that have a high postmortem central to peripheral ratio; that is, drugs that exhibit considerable postmortem redistribution, also have high postmortem to antemortem ratios. Conclusions-A large degree of error can arise from attempting to estimate antemortem drug concentrations and the ingested dose from postmortem measurements. The chosen site and technique for postmortem blood sampling can greatly influence the concentration of drug measured. (J Clin Pathol 2000;53:282-285) Keywords: postmortem blood sampling; drug concentrations; toxicological analysis Postmortem drug redistribution refers to the processes by which the movement of drugs and other chemical poisons between tissues, organs, and body fluids takes place after death. This phenomenon is well recognised, and was first reported 25 years ago.1 Since then, considerable eVort has gone into elucidating the processes responsible.2-16 Consideration of the redistribution of drugs is important in a variety of situations. Cases of suspected poisoning, either homicidal or suicidal; the role of drugs in "marginally toxic" cases, such as vehicle accidents; and also potential cases of euthanasia or medical negligence might rely upon the toxicological analysis of blood samples.2 The timing, method of collection, and source of the sample might influence the interpretation of toxicological analyses.The processes of postmortem redistribution result in the migration of drugs between blood and tissues. The rate and extent of this movement varies according to several factors, including the nature of the drug and the time interval between death and postmortem specimen collection. Within the torso, the major organs constitute potential drug pools, and the gastrointestinal tract might contain considerable quantities of unabsorbed drug, and thus central blood is subject to redistribution from these local organs. Peripheral blood, such as femoral blood, is subject to redistribution influences only from local tissues-muscle and fat. In general, redistribution into central vessels is greater than redistribution into peripheral vessels. The diVerence between the two sites is known as the central to peripheral (C/P) ratio. For these reasons, the blood specimen of choice for toxicological analysis after death is a femoral venous sample, ideally collected from a ligated vessel, 7 10 although inevitably there will be situations in which such sample collection is not possible.Often, pathologists or toxicologists are requested to estimate the amount of drug present at the time of death, or the number of...

This case of primary peritoneal 'mucin-positive' epithelial mesothelioma demonstrates morphological and histochemical mimicry with diffuse gastric adenocarcinoma. A similar case has not been previously reported in the peritoneum and an awareness of the tumour (with application of suitable ancillary studies) prevents misdiagnosis and assists in potentially difficult medicolegal cases.

Since the experimental work of Koehnlein and Lemperle 1 on the use of glue in operations, biologic glues have become part of the armamentarium used in the surgical management of patients undergoing repair of type A aortic dissection, especially where tissues are frail or where added hemostasis is required. It facilitates the reconstruction of the dissected aortic wall layers adjacent to the prosthetic graft. However, the use of tissue glue can be associated with significant risk, namely aortic wall necrosis leading to acute aortic redissection, 2 coronary ostial stenosis, cerebral embolism, 3 complete heart block, and prosthetic valvular dysfunction. We describe a case in which the glue embolized to the right and left coronary arteries, leading to fatal right ventricular infarction, and also demonstrate the usefulness of postmortem studies with the use of digital technologies for records keeping and educational purposes.

No abstract

A 32-year-old man presented with dyspnea, chest pain, palpitations and ankle edema and was found to have a tumor involving the heart. This was diagnosed as malignant peripheral nerve sheath tumor, a rare sarcoma of the heart. Immunohistochemistry was utilized to establish the diagnosis. The details of the patient's clinical course, and imaging findings with morphological and immunohistochemistry data are reported.