Examination of Firearms Review: 2007 to 2010 - Interpol

As an inherent part of postmortem toxicology, artifacts may arise from the
antemortem, perimortem and even during specimen collection. In a review
written by Skopp, he opined that knowledge on the degradation mechanisms,
breakdown products, and artifactual formation in specimens is of exceptional
importance to recognize artifacts, and that quantitative analysis is preferably
done on femoral blood [521].
Postmortem redistribution refers to the process of drugs diffusing from tissues
into blood along a concentration gradient between death and time of specimen
collection at autopsy. Fentanyl concentrations were measured in postmortem
specimens collected with mean femoral blood concentrations of 4.6 µg/L and
17.3 µg/L shortly after death (FB1) and at autopsy (FB2), respectively, and the
mean fentanyl heart blood (HB) to FB1 ratio of 8.39 - which was higher
compared with the corresponding HB/FB2 ratio of 3.48 [522]. In another report,
9 fentanyl-positive cases were identified, and the femoral blood fentanyl
concentrations ranged from 2.7 to 52.5 µg/L, liver tissue fentanyl ranged from
37.0 to 179 µg/kg, and heart tissue fentanyl (n = 3) ranged from 52.8 to 179
µg/kg. Liver tissue to femoral blood ratios ranged from 0.85 to 35.8, and heart
tissue to femoral blood ratios ranged from 1.9 to 5.4 [523]. Concomitant heart
and peripheral blood determinations were performed on 40 fatal cases
involving nordiazepam (20 cases) and bromazepam (20 cases). The mean
ratios for the heart and peripheral blood concentrations were 0.95 for
nordiazepam and 0.86 for bromazepam, suggesting that no postmortem
redistribution was observed for these two benzodiazepines [524]. Postmortem
redistribution was evident for flecainide, where antemortem plasma obtained
13 h before death showed a flecainide concentration of 2.5 mg/L, while
postmortem right and left cardiac blood contained flecainide concentrations of
13.8 and 44.2 mg/L, respectively [525].
3.5.3 Pharmacogenomics
Pharmacogenomics is one of the first clinical applications of the postgenomic
era. It promises personalized medicine rather than the established "one size
fits all" approach to drugs and dosages. Despite initial enthusiasm, the use of
pharmacogenetics has remained limited. The main reason is the paucity of
scientific evidence to show that pharmacogenetic testing leads to improved
clinical outcomes, and the challenge in implementation of pharmacogenomics
in routine clinical practice [526,527]. Metabolisms of BZP and TFMPP were
reported to involve the hepatic P450 enzymes CYP2D6, CYP1A2, and
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