Dangers of bismuth iodoform paraffin paste.
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Biomedical subjects
Publications and source records attributed to A Cailleux.
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Isoprene is present in human breath and in human blood. The fact that isoprene concentrations in breath are linked to states of sleep and wakefulness led us to study its concentration in blood of 12 patients before, during, and after general anesthesia. Isoprene concentrations in blood of patients before anesthesia were 3.3 +/- 1.6 micrograms/liter. During anesthesia, isoprene concentrations decreased to 0.9 +/- 0.5 micrograms/liter. One hour after the end of anesthesia isoprene increased to levels similar to or higher than the preanesthetic ones.
Breath analysis is a non-invasive method for investigation of the volatile compounds produced by humans. Pentane has often been taken as an indicator of lipid peroxidation. Our purpose in this study was to determine its normal concentration in the breath of healthy humans. Using a specific and sensitive gas chromatography-mass spectrometry technique pentane concentrations in breath were lower than 10 pmoles/l. The high levels of pentane found by some authors in healthy humans were probably due to the coelution of pentane with isoprene, a volatile hydrocarbon present in human breath.
The concentrations of isoprene, the main hydrocarbon of human breath, were measured in the blood of humans and of different animal species (rat, rabbit, dog, ewe, cow). In human blood, the concentrations of isoprene were between 15 and 70 nmol/liter (mean value of 37 +/- 25 (SD) nmol/liter). In the blood of the different animal species tested, traces of isoprene were unambiguously detected by mass spectrometry, but the levels were always lower than 1 nmol/liter.
Three cases of iodoform poisoning are described following dressings with 10% iodoform gauze (0.10 x 5 m) on extended wounds. Five, ten and sixteen days after the beginning of dressings, the patients became confuse, hallucinated, and one of them was subsequently comatose. Vomiting, fever, tachycardia with premature ventricular beats and shortening of P-R interval, slight increase of transaminases and proteinuria were observed. Within a few days (3 to 8) after the iodoform dressings were discontinued, the signs of iodoform toxicity disappeared. The toxicity of iodoform is probably unrecognized if the rarity of the observations published and the amount of iodoform gauzes annually sold are compared.
Benzene derivatives can induce severe liver cell necrosis in animals. A case of a 40-year-old man whose daily consumption of alcohol was 200 g and who had a severe monochlorobenzene-induced liver necrosis is described. Liver biopsy specimen showed centrilobular and mediolobular necrosis, similar to that in mice after experimental bromobenzene administration. Monochlorobenzene serum concentration, assayed from day 3 to day 15 after poisoning, decreased monoexponentially with a half-life of 40.3 hours. Prostaglandin E1 was administered from day 3 to day 8. The patient ultimately recovered. The mechanism of monochlorobenzene-induced liver injury and the possible aggravating role of chronic alcohol consumption are discussed.
We use ultraviolet data, acquired with a photodiode-array detector coupled to a reversed-phase liquid-chromatographic system, to identify unknown drugs in plasma samples of acutely poisoned patients. Both retention time and spectra of the peaks obtained with a microbore Hypersil ODS column under gradient elution are compared with a library of approximately 350 compounds. We present our three-year experience with this system, which identifies drugs in less than 1 h, with a high degree of confidence.
Trihalomethanes (THM) present in tap water were also found in dialysis fluid because they were not eliminated by water treatment. THM, absorbed through the dialyser membranes, increased considerably in blood and in expired air of patients on hemodialysis during the dialysis sessions. The uptake of THM during each dialysis session was about 1 mg.
Isoprene is one of the main constituents of endogenous origin in exhaled human breath. The concentration of isoprene seems to vary with states of sleep and wakefulness, increasing during sleep and decreasing sharply just after awakening. Thus, isoprene may be involved in in sleep upholding.
Two high-performance liquid chromatographic methods are described, one for assay of phenol in urine, the other for assay of hippuric acid. Steam distillation was used to hydrolyse the sample and separate the phenol from the matrix. A dilution was the only pretreatment of urine for assay of hippuric acid. The upper reference limits obtained from 42 non-exposed subjects were 7.09 mmol/mol creatinine for urinary phenol and 1,174 mmol/mol creatinine for hippuric acid. The mean concentration of urinary phenol was higher in 190 exposed workers (7.21 +/- 5.05 mmol/mol creatinine; mean +/- SD) than in control subjects (3.97 +/- 1.56 mmol/mol creatinine).
Whole blood cyanide and plasma thiocyanate were measured by a headspace gas chromatographic method and a colorimetric method, respectively, in 16 healthy subjects, in 10 patients with respiratory disease and in 12 patients on chronic dialysis for renal failure. In healthy subjects, whole blood cyanide and plasma thiocyanate concentrations were significantly higher in smokers (1.8 +/- 0.4 mumol/l; 206 +/- 74 mumol/l) than in non-smokers (0.8 +/- 0.4 mumol/l; 74 +/- 19 mumol/l). In renal failure patients on hemodialysis, no difference was noted in cyanide levels (0.6 +/- 0.4 mumol/l), but there was a significant increase in plasma thiocyanate levels during the interdialysis period (62 +/- 24 mumol/l; 91 +/- 24 mumol/l). No difference in cyanide and thiocyanate levels of patients with respiratory disease was seen, in agreement with a weak pulmonary elimination of cyanide.
We describe a capillary gas-chromatographic method for detection and quantification of basic and neutral drugs in the plasma of patients thought to be poisoned after dangerous overdose. Without further derivatization, the drugs are extracted from 1 mL of plasma, at basic pH, into diethyl ether. The extracts are injected onto two fused-silica capillary columns of different polarity (Ultra 1 and CP Sil 19 CB) coupled to nitrogen-phosphorus detectors. Under these conditions, drug-free plasmas give blank chromatograms, with a peak only for the internal standard (RN 927, an antihistamine not being marketed). Plasma samples from patients who have taken drugs show additional peaks, the relative retention times (RRTs) of which are used to identify the drugs. Here we list the RRTs of about 200 drugs on the two columns. Analyses are routinely performed with an automatic injector; overall analysis time is about 1 h per sample. During the last six years, more than 1000 plasma samples per year have been analyzed. We find this method a powerful tool for toxicological analysis, especially in cases of multi-drug intoxications.
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A method for the plasma noradrenaline (NA) analysis by reversed-phase liquid chromatography with electrochemical detection is described. The plasma sample preparation includes two-steps: ion-exchange and alumina adsorption. The use of a data system and an automatic sampler enables the injection of samples in series. Using this technique, determination of plasma NA concentration in 34 healthy subjects (27.4 +/- 7.2 years) gave the following results: 0.28 +/- 0.10 micrograms/l after 30 min of resting in the supine position and 0.52 +/- 0.17 micrograms/l after 5 min of upright position.
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There is an increasing need for the quantitation of drugs that act on the central nervous system in blood of patients suspected of poisoning. A simple method for quantitative determination of neutral and basic drugs is described. The method involves a basic extraction without derivatization. The plasma extracts are injected on a Hewlett-Packard chromatograph using two nitrogen-specific detectors. In most cases, the comparison of relative retention times on the two columns is sufficient for identification of the ingested drugs. But when the method falls, the use of a gas chromatograph/mass spectrometer equipped with a chemical ionization source is necessary.
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