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Linko, Sweden

Kronstrand R.,National Board of Forensic Medicine | Kronstrand R.,Linko ping University | Roman M.,National Board of Forensic Medicine | Dahlgren M.,National Board of Forensic Medicine | And 4 more authors.
Journal of Analytical Toxicology | Year: 2013

During 2012, the designer drug 5-(2-aminopropyl)indole emerged in Sweden, and became available at different web sites under the name 5-IT or 5-API. This compound is an indole derivative and a positional isomer of alpha-methyltryptamine. In this paper, we report the pathology and toxicology from 15 deaths involving 5-IT. Routine postmortem toxicology was performed in femoral blood, using a targeted screening for pharmaceuticals and drugs of abuse with liquid chromatography time-of-flight technology, and positive results were quantified using chromatographic techniques. For 5-IT, a new method was developed using ultra-high-performance liquid chromatography and tandem mass spectrometry. In 11 cases, intoxication was the cause of death. Two cases were signed out as causa ignota, and they were considered to be natural deaths. All determinations of 5-IT were performed in femoral blood and the concentrations ranged from 0.7 to 18.6 mg/g. Two cases had 5-IT as the only drug identified, while the others presented with other psychotropic drugs or medications in the blood as well. Shortly after this series of deaths, 5-IT was scheduled as a hazardous substance according to the regulation Certain Goods Dangerous to Health on 18 September 2012 prohibiting the handling and selling of the drug. Since then, no positive cases have been found. © The Author (2013). Published by Oxford University Press. All rights reserved. Source


Kronstrand R.,National Board of Forensic Medicine | Kronstrand R.,Linko ping University | Roman M.,National Board of Forensic Medicine | Andersson M.,National Board of Forensic Medicine | Eklund A.,National Board of Forensic Medicine
Journal of Analytical Toxicology | Year: 2013

In recent years, several synthetic cannabinoid compounds have become popular recreational drugs of abuse because of their psychoactive properties. This paper presents toxicological findings of synthetic cannabinoids in whole blood from some cases of severe intoxication including quantitative data from recreational users and a fatal intoxication. Samples were analyzed by liquid chromatography- tandem mass spectrometry in a scheduled multiple reaction mode after a basic liquid extraction. Twenty-nine synthetic cannabinoids were included in the method. In our data set of ~3000 cases, 28% were found positive for one or more synthetic cannabinoid(s). The most common finding was AM-2201. Most of the analytes had median concentrations of <0.5 ng/g in agreement with other published data. The emerging drugs MAM-2201 (n = 151) and UR-144 (n = 181) had mean (median) concentrations of 1.04 (0.37) and 1.26 (0.34), respectively. The toxicity of the synthetic cannabinoids seems to be worse than that of natural cannabis, probably owing to the higher potency and perhaps also to the presence of several different cannabinoids in the smoked incense and the difficulties of proper dosing. The acute toxic effects may under certain circumstances contribute to death. © The Author (2013). Published by Oxford University Press. All rights reserved. Source


Lech B.,Linkoping University | Holmqvist R.,Linkoping University | Andersson G.,Linkoping University | Andersson G.,Linko ping University | Andersson G.,Karolinska Institutet
European Eating Disorders Review | Year: 2012

The aim of the study was to analyse differences in observer rated affect consciousness (AC) between subgroups of patients diagnosed with eating disorders (N = 44; 30 with anorexia nervosa and 14 with bulimia nervosa), and a non-clinical group (N = 40). Another aim was to study the short-term stability of AC over 10-11 weeks of treatment and its relation to self-reported eating pathology and general psychopathology. A moderate short-term stability of AC was found but the levels were not correlated with eating pathology or psychopathology. No differences between the two diagnostic categories were found, but the eating disorder group as whole had significantly lower AC compared with a non-eating disorder reference group. AC seems to be a moderately stable ability that differentiates patients diagnosed with eating disorders from a non-clinical population. However, AC is not related to symptoms of eating disorder or general psychiatric symptoms in this group of patients. © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. Source


Li Y.,Shaoxing Peoples Hospital | Li Y.,Zhejiang University | He R.,Shaoxing Peoples Hospital | Ying X.,Shaoxing Peoples Hospital | And 2 more authors.
Clinics | Year: 2014

OBJECTIVES: Fluid volume optimization guided by stroke volume measurements reduces complications of colorectal and high-risk surgeries. We studied whether dehydration or a strong hemodynamic response to general anesthesia increases the probability of fluid responsiveness before surgery begins. METHODS: Cardiac output, stroke volume, central venous pressure and arterial pressures were measured in 111 patients before general anesthesia (baseline), after induction and stepwise after three bolus infusions of 3 ml/ kg of 6% hydroxyethyl starch 130/0.4 (n = 86) or Ringer’s lactate (n = 25). A subgroup of 30 patients who received starch were preloaded with 500 ml of Ringer’s lactate. Blood volume changes were estimated from the hemoglobin concentration and dehydration was estimated from evidence of renal water conservation in urine samples. RESULTS: Induction of anesthesia decreased the stroke volume to 62% of baseline (mean); administration of fluids restored this value to 84% (starch) and 68% (Ringer’s). The optimized stroke volume index was clustered around 35-40 ml/m2/beat. Additional fluid boluses increased the stroke volume by $10% (a sign of fluid responsiveness) in patients with dehydration, as suggested by a low cardiac index and central venous pressure at baseline and by high urinary osmolality, creatinine concentration and specific gravity. Preloading and the hemodynamic response to induction did not correlate with fluid responsiveness. The blood volume expanded 2.3 (starch) and 1.8 (Ringer’s) times over the infused volume. CONCLUSIONS: Fluid volume optimization did not induce a hyperkinetic state but ameliorated the decrease in stroke volume caused by anesthesia. Dehydration, but not the hemodynamic response to the induction, was correlated with fluid responsiveness © 2014 CLINICS. Source


Vigren P.,Health Science University | Engstro m M.,Health Science University | Engstro m M.,Linko ping University | Landtblom A.-M.,Health Science University
Frontiers in Neurology | Year: 2014

Introduction: Kleine-Levin syndrome (KLS) is a rare syndrome of periodic hypersomnia and behavioral and cognitive symptoms based on clinical criteria. In the setting of differential diagnosis of hypersomnia disorders, an objective diagnostic aid is desirable. A promising modality is single photon emission computed tomography (SPECT). As intraepisodal investigations are difficult to perform, an interepisodal investigation would be very helpful. Another aim of the study was to correlate SPECT findings to prognosis. Methods and materials: 24 KLS-patients were categorized as severe or non-severe based on clinical characteristics. The clinical characteristics were analyzed in relation to SPECT-examinations performed between hypersomnia periods (interepisodal) or after remission, as a clinical routine investigation. Results: 48% of the KLS-patients have hypoperfusion in the temporal or fronto-temporal regions. In patients that have undergone remission, 56% show that pattern. There were no specific findings related to prognosis. Discussion/conclusion: SPECT might be a diagnostic aid, in a setting of hypersomnia experience. With a sensitivity of 48%, interepisodal SPECT alone cannot be used for diagnosing KLS. © 2014 Vigren, Engstro¨m and Landtblom. Source

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