Car crash after massive ingestion of digoxin and midazolam.

In a case where a 32-year-old man lost control of his vehicle, urine and blood samples were taken 6 h after the crash for toxicological investigations. In the hospital, the driver admitted consumption of some drugs, in particular digoxin and midazolam just before the crash which corresponded to the results of blood analyses. Toxicological findings indicated the presence of digoxin at 12.9 ng/ml and midazolam at 7 ng/ml in the blood. These results suggested that at the moment of the crash digoxin and midazolam blood levels were in the range of toxic and therapeutic concentrations, respectively. Therefore the respective roles of the drugs in the impairment of the ability to drive at the moment of the crash is discussed

Method for quantification of morphine and its 3- and 6- glucuronides, codeine, codeine glucuronide and 6-monoacetylmorphine in human blood by liquid chromatography-electrospray mass spectrometry for routine analysis in forensic toxicology.

Simultaneous determination of opiates and their glucuronides in body fluids has a great practical interest in the forensic assessment of heroin intoxication. A selective and sensitive method for quantification of morphine and its 3- and 6-glucuronides, codeine, codeine glucuronide and 6-monoacetylmorphine (6-MAM) based on liquid chromatography-electrospray ionisation mass spectrometry is described. The drugs were analysed in human autopsy whole blood after solid-phase extraction on a C8 cartridge. The separation was performed on an ODS column in acetonitrile (analysis time 15 min). For the quantitative analysis, deuterated analogues of each compound were used as internal standards. Selected-ion monitoring was applied where the molecular ion was chosen for quantification. The limits of quantification were 0.5 ng/ml for morphine and 6-MAM and 1 ng/ml for the 6-glucuronide of morphine, codeine-6-glucuronide and codeine and 5 ng/ml for the 3-glucuronide of morphine

Bref historique de la culture récente du chanvre en Suisse et problèmes médico-légaux engendrés par cette culture [Brief history of recent hemp cultivation in Switzerland and subsequent medico-legal problems resulting from hemp cultivation]

In March 1995, a decision about cultivation of cannabis was issued by the Swiss Federal Offices of Public Health, Police and Agriculture in order to satisfy the growing interest of farmers and other people in hemp farming. It pointed out that 1)... each hemp plant contains THC and must be therefore considered a drug, 2)... no permission is required for those who grow hemp without the intention to produce drugs ... meaning that the choice of the plant variety was not restricted to those which are characterized by a low THC concentration and grown in a few countries belonging to the European Union. Claiming that natural hemp must contain significant amounts of THC and thanks to the Swiss legislation, areas dedicated to hemp cultivation develop considerably. Most hemp plants which are submitted to our laboratories by the police for THC quantification belong to the drug-type. Nowadays, a great deal of goods (food and beverages, cosmetics, drugs) made of hemp are marketed in Switzerland. Strong suspicions exist however that several of these products could be used as a screen for the illegal market of cannabis. For instance, despite financial support from the state, fiber hemp cultivation remains unsuccessful. No advantage with regard to seed productivity, edible seed and essential oils qualities and yields have been found for drug hemp over fiber hemp by agricultural research stations up to now. Several clues about the possible illicit use of hemp goods rich in THC, especially hemp tea made of flower tops and "therapeutic" pillows filled with cannabis exist. Recently, two Federal edits were issued in order to restrict the selling of hemp seedlings and of hemp foods and beverages to those containing only low amounts of THC. However, the marketing of hemp plants used for decorating remains free partly explaining the recent success of these "beautiful" plants. Broadly speaking, the Swiss and European legislations about hemp have approached mutually during the last years

Cannabis sativa ssp Helvetica or the serial thriller of hemp in Switzerland

Pour faire à l'intérêt croissant des agriculteurs et d'autres milieux intéressés à la culturedu chanvre en Suisse, les Offices fédéraux de la Santé publique, de la Police et de l'Agriculture diffusèrent en mars 1995 une note informative sur la culture du chanvre précisant que : 1)... chaque plant de chanvre contient du THC et doit par conséquent être considéré comme un stupéfiant... 2) celui qui cultive du chanvre dans un autre but que la production de suipéfiants n'a pas besoin de demander une autorisation. En d'autres termes, le choix de la variété de Cannabis était libre, il ne se limitait pas aux seules variétés caractérisées par un taux de THC inférieur à 0,3 % qui sont cultivées dans plusieurs états membres de l'Union Européenne. Profitant de ce vide juridique et/ou arguant des "avantages" liés à la culture du lin, chanvre naturel" donc riche en THC, les " partisans " du chanvre naturel" plantèrent au cours des dernières années des Surfaces de plus en plus étendues en chanvre "à taux normal de THC". Aujourd'hui, différents produits à base de chanvre sont proposés dans le commerce, allant entre autres des domaines alimentaire, "médical ", cosmétique jusqu'au numismatique! Il existe de très forts soupçons qu'une partie de cette production soit détournée au profit du marché des stupéfiants. Quelques indices le suggèrent, par exemple, la culture du chanvre pauvre en THC, bien que soutenue financièrement par la Confédération, n'a eu qu'un succès très mitigé. Les essais menés à ce jour par les stations fédérales de recherche agronomique n'ont pourtant pas révélé d'avantages déterminants à cultiver des variétés riches en THC, hormis la production de produits stupéfiants. D'autres indices montrent que certains produits (en particulier les thés de fleur de chanvre, les sachets aromatiques, les oreillers et coussins thérapeutiques dont le remplissage est fait de chanvre ainsi que les pièces de monnaie en chanvre pressé) sont en partie détournés de leur usage prévu. Récemment, deux ordonnances fédérales visant à corriger certains des effets pervers de la législation actuelle ont été rendues l'une pour limiter la vente des graines de chanvre à une dizaine de variétés pauvres en THC et l'autre pour fixer des concentrations limites pour le THC contenu dans les produits alimentaires. Le domaine d'application de l'ordonnance réglementant le commerce des graines concerne exclusivement les plants utilisés à des fins agricoles et ne s'applique pas aux semences et plants utilisés à des fins ornementales ... d'où le succès récent du " chanvre naturel ornemental ". D'une manière générale, on constate que la législation suisse se rapproche peu à peu de la législation européenne

Pediatric Patients with Eosinophilic Esophagitis and Their Parents Identify Symptoms as the Most Important Treatment Outcome.

Given the lack of data, we aimed to explore which therapeutic endpoints pediatric patients with eosinophilic esophagitis (EoE) and their parents consider to be relevant. We created an educational brochure on EoE and a questionnaire, both of which were content-validated by pediatric patients and parents. Validated documents were sent to 112 patients and parents. They ranked the importance (5 levels) of short (during next 3 months) and long-term (≥1 year) treatment effect on symptoms, quality of life, endoscopic inflammation, stricture formation, histological inflammation, and fibrosis. A total of 45 parents and 30 pediatric patients ≥11 years completed the questionnaires. Pediatric patients identified improvement in the following domains as most important in the short- and long-term, respectively: symptoms (73% vs. 77%), QoL (53% vs. 57%), histologic inflammation (47% vs. 50%), histologic fibrosis (40% vs. 33%), endoscopic inflammation (47% vs. 40%), and strictures (33% vs. 40%). Parents of children ≥11 years old classified improvement in the following domains as most important in the short- and long-term, respectively: symptoms (70% vs. 83%), QoL (63% vs. 80%), histologic inflammation (67% vs. 77%), histologic fibrosis (47% vs. 63%), endoscopic inflammation (77% vs. 80%), and strictures (40% vs. 53%). Agreement between caregiver and children on the short-term importance of treatment outcomes was as follows: symptoms (77%), QoL (40%), histologic inflammation and fibrosis (47% and 43%), endoscopic inflammation and strictures (50% and 40%). Pediatric patients and parents attributed most importance to improvement in symptoms and QoL. Agreement between parents and patients regarding therapy goals is limited