Methadone has a long and successful history in the treatment of opioid-addiction. In recent years it has become popular again -as potent and inexpensive analgesic in patients with chronic pain. Since methadone has been used fatalities have been reported. In our study all methadone-associated deaths in Zurich from 1998 to 2007 were analysed. Most of the 146 detected deaths of the past ten years occurred during substitution programmes or illicit intake of methadone while only three of them could be attributed to methadone used as an analgesic. Noticeable in our study was the high percentage of cases of combined drug intoxication (76%). The most frequent co-intoxicants were alcohol and cocaine. Mortalities attributed to methadone intoxication alone were a rare finding and could only be detected in five cases of deceased who had received methadone maintenance treatment.The aim of our study is to assess the trends in the number and nature of methadone-related fatalities in Zurich during the last nineteen years. For this purpose a previous study from Zurich (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997) was included, whereby a very long oberservation period and large number of cases resulted.

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In the case described, a completely uncomplicated pregnancy ended with a fatal outcome. Intrauterine fetal death, which was diagnosed prepartum at 40 weeks of gestation, was caused by hemorrhage of the fetus into the amniotic fluid following rupture of the umbilical vein at the site of furcate insertion of the umbilical cord. This insertion anomaly accompanied by rupture of a vessel occurs only very rarely but represents a placental cause of an abrupt and unpredicted end of a pregnancy. Although this process involved trauma, from a medico-legal point of view, there was no sign of external impact and death could, therefore, be classified as natural.

The postmortem redistribution (PMR) phenomenon complicates interpretation in forensic toxicology. Human data on time-dependent PMR are rare and only exist for blood so far. A new method for investigation of time-dependent PMR in blood as well as in alternative body fluids and tissues was developed and evaluated using automated biopsy sampling. At admission of the bodies, introducer needles were placed in liver, lung, kidney, muscle, spleen, adipose tissue, heart, femoral vein, and lumbar spine using a robotic arm guided by a computed tomography scanner (CT). Needle placement accuracy was analyzed and found to be acceptable for the study purpose. Tissue biopsies and small volume body fluid samples were collected in triplicate through the introducer needles. At autopsy (around 24 h after admission), samples from the same body regions were collected. After mastering of the technical challenges, two authentic cases were analyzed as a proof of concept. Drug concentrations of venlafaxine, O-desmethylvenlafaxine, bromazepam, flupentixol, paroxetine, and lorazepam were determined by LC-MS/MS, and the percentage concentration changes between the two time points were calculated. Concentration changes were observed with both increases and decreases depending on analyte and matrix. While venlafaxine, flupentixol, paroxetine, and lorazepam generally showed changes above 30% and more, O-desmethylvenlafaxine and bromazepam did not undergo extensive PMR. The presented study shows that CT-controlled biopsy collection provides a valuable tool for systematic time-dependent PMR investigation, demanding only minimal sample amount and causing minimal damage to the body.