How to reduce the complication rate of multiple burr holes surgery in moyamoya angiopathy

PURPOSE

This study is aimed at analyzing clinical outcome, absence of stroke recurrence, revascularization, and complications and long-term follow-up in the surgical treatment of moyamoya angiopathy (MMA) using the multiple burr holes (MBH) technique with dura opening and arachnoid preservation as a single procedure. To the best of our knowledge, this is the first to describe an MBH technique with arachnoid preservation.

METHOD

We retrospectively reviewed all patients operated from June 2001 to March 2021, for a symptomatic and progressive MMA operated with opening of the dura but arachnoid preservation. Clinical examinations were obtained in all patients, and radiological monitoring was performed by cerebral 3D-magnetic resonance angiography (MRA) with perfusion or single-photon emission computed tomography (SPECT) with acetazolamide.

RESULTS

In total, 21 consecutive patients (6 children and 15 adults) were included with a mean age of 7.4 years in the pediatric group and 36.9 years in the adult group. Initial presentation was permanent ischemic stroke in 15 cases, transient ischemic attack (TIA) in 5 cases, and cerebral hemorrhage in one case. The MBH with dura opening and arachnoid preservation was performed bilaterally in 9 cases (43%) and unilaterally in 12 cases (57%). One patient died due to intraoperative bilateral ischemic stroke. Of the 20 other patients, 30% demonstrated clinical stability and 70% showed partial or complete recovery. Although one patient experienced a perioperative stroke, we did not observe any pseudomeningocele or postoperative ischemic stroke (IS) recurrence in all surviving cases during the average follow-up period of 55.5 months (range: 1-195). These outcomes emphasize the importance of preoperative monitoring to ensure the effectiveness and safety of the intervention. Postoperative angiography studies showed revascularization in 96.3% of treated hemispheres (100% in the adult group vs 80% in the pediatric group).

CONCLUSIONS

Our results on this small cohort suggest that the MBH technique with opening of the dura and arachnoids preservation can prevent recurrent strokes and reduce the risk of pseudomeningocele.

Massive postoperative pulmonary embolism in a young woman using oral contraceptives: the value of a preoperative anesthetic consult

We describe the case of a woman with a history of active tabagism and on the oral contraceptive Yasmin, presenting in the Post-Anesthesia Care Unit (PACU) with a cardiac arrest due to massive pulmonary embolism following transforaminal lumbar interbody fusion surgery. The patient had preoperatively several risk factors for deep venous thrombosis. This case-report emphasizes the value of a preoperative anesthetic visit and eventual temporary cessation of certain oral contraceptives in specific cases.

Transient perioperative visual loss after an elective neurosurgical procedure

OBJECTIVE

To describe a case of reversible visual loss after a neurosurgical intervention and to discuss the role of the prone position as a potential risk factor.

OBSERVATION

A 63-year-old woman without significant medical previous history underwent elective resection of a left parieto-occipital meningioma. Preoperatively, the patient presented a right homonymous lower quadranopsia. The surgical procedure was not complicated. The patient was positioned in prone with a mild inclination of the table in reverse Trendelenburg position. The head was maintained in a Mayfield skull clamp, and ocular compression was excluded. There was no significant hypotension, hemodilution or vasopressors infusion during the procedure. Immediately after recovery from anesthesia, the patient experienced total blindness and flash visual evoked potentials confirmed the absence of retinal, primary or late occipital activities. A progressive, but finally complete recovery started after 24 hours.

CONCLUSION

This case illustrates the individual risk for visual injury after the prone position during some neurosurgical interventions.

Office-based anesthesia in Belgium?

For many years, office based anesthesia (OBA), has been considerably increasing in the US. This type of practice is starting to develop in Belgium. On the other side of the atlantic, legislation concerning this practice is becoming more and more precise, whereas the same isn't true in our country. It seems therefore opportune to try and define the different points of view. This article will define the position of the legislator, insurance companies and finally, of the professional organizations. OBA practice is developping insidiously here, and we should therefore ask ourselves serious questions regarding the legal repercussions that it could have. To conclude, we can say that if for a couple of years, the US have started to legislate and propose guidelines, as well as creating special accreditation organizations to inspect and advise the offices, the same is not the case in Belgium. The OBA phenomenon arrived much later here and is really at its very beginnings, but it seems however important to anticipate and clearly regulate this practice in our country.

PEGylated cholecystokinin prolongs satiation in rats: dose dependency and receptor involvement

BACKGROUND AND PURPOSE

Acute intraperitoneal (i.p.) administration of cholecystokinin (CCK) is known to induce a significant, but short-lasting, reduction in food intake, followed by recovery within hours. Therefore, we had covalently coupled CCK to a 10 kDa polyethylene glycol and showed that this conjugate, PEG-CCK(9), produced a significantly longer anorectic effect than unmodified CCK(9). The present study assessed the dose-dependency of this response and the effect of two selective CCK(1) receptor antagonists, with different abilities to cross the blood-brain barrier (BBB), on PEG-CCK(9)-induced anorexia.

EXPERIMENTAL APPROACH

Food intake was measured, for up to 23 h, after i.p. administration of different doses (2, 4, 8, 16 and 32 microg kg(-1)) of CCK(9) or PEG-CCK(9) in male Wistar rats. Devazepide (100 microg kg(-1)), which penetrates the BBB or 2-NAP (3 mg kg(-1)), which does not cross the BBB, were coadministered i.p. with PEG-CCK(9) (6 microg kg(-1)) and food intake was monitored.

KEY RESULTS

In PEG-CCK(9)-treated rats, a clear dose-dependency was seen for both the duration and initial intensity of the anorexia whereas, for CCK(9), only the initial intensity was dose-dependent. Intraperitoneal administration of devazepide or 2-NAP, injected immediately prior to PEG-CCK(9), completely abolished the anorectic effect of PEG-CCK(9).

CONCLUSIONS AND IMPLICATIONS

The duration of the anorexia for PEG-CCK(9) was dose-dependent, suggesting that PEGylation of CCK(9) increases its circulation time. Both devazepide and 2-NAP completely abolished the anorectic effect of i.p. PEG-CCK(9) indicating that its anorectic effect was solely due to stimulation of peripheral CCK(1) receptors.

Investigation of fractions present in the stem bark of Annickia kummeriae on their P-glycoprotein inhibitory pump activity

Using MCF-7R cells and rhodamine 6G as the fluorescent probe, a bioassay-targeted purification process was pursued in order to isolate the active P-gp inhibitory fractions from Annickia kummeriae. Of 24 fractions obtained in the first preparative liquid chromatography (p-LC) run, only fraction 1 exhibited activity. Further p-LC fractionation led to the separation of fraction 1 into fractions 1.1-1.8. Fractions 1.4, 1.5 and 1.6 proved to be active by inducing a significant accumulation of rhodamine 6G by 3.3-, 4.5- and 4.9-fold at 10 microg/mL, and by 5.3-, 6.3- and 6.8-fold at 100 microg/mL, respectively. Fraction 1.6 was separated into several fractions by using an analytical liquid chromatography (a-LC) system. Fractions 1.6.18, 1.6.19 and 1.6.20 were active and they induced an accumulation of rhodamine 6G by 3.0-, 1.8- and 3.5-fold at 1x microg/mL and by 4.8-, 6.7- and 6.8-fold at 10x microg/mL, respectively. Afterwards, 28.3 mg of fraction 1.6 was processed by a-LC, and fractions 1.6.18, 1.6.19 and 1.6.20 were collected separately and dried. The amounts of materials recovered were 6.2, 7.4 and <1 mg, corresponding to 21.9%, 26.1% and <3.5% of fraction 1.6, respectively. From the total amount injected and the relative masses represented by these fractions, it can be calculated that the 1x microg/mL level corresponded to ca. 35, 42 and <5 microg/mL, respectively. Fluorescence microscopy revealed that incubation of the cells with rhodamine 6G alone did not show any fluorescence, whereas cells which were incubated in medium containing rhodamine 6G together with fraction 1.4, 1.6 or reserpine, clearly indicated accumulation of the dye intracellularly. This is an indication that the active compounds effected high intracellular fluorescence by inducing accumulation of the dye in the cells through inhibition of the P-gp pump.

Comparison of the transmission characteristics of low and high pathogenicity avian influenza A virus (H5N2)

Low pathogenicity avian influenza A strains (LPAI) of the H5 and H7 type are noted for their ability to transform into highly pathogenic counterparts (HPAI). Here we compare the transmission characteristics in poultry of LPAI H5N2 (A/Chicken/Pennsylvania/83) and corresponding HPAI virus by means of transmission experiments. In the experiments, five inoculated animals are placed in a cage with five contact animals, and the infection chain is monitored by taking blood samples, and samples from the trachea and cloaca. The data are analysed by final size methods and a generalized linear model. The results show that HPAI virus is more infectious and induces a longer infectious period than LPAI. In fact, fully susceptible animals are invariably infected when confronted with HPAI virus and die within six days after infection. Animals previously infected with LPAI virus, on the other hand, survive an infection with HPAI virus or escape infection all together. This implies that a previous infection with LPAI virus effectively reduces susceptibility of the host to infection and decreases transmission of HPAI virus. We discuss the implications of these conclusions for the control and evolution of avian influenza viruses.

Mechanism of simmondsin decomposition during sodium hydroxide treatment

Jojoba seed meal shows appetite-suppressing activity due to the presence of simmondsin. This pharmacological activity disappears with treatment of the meal with sodium hydroxide. To elucidate this mechanism of inactivation, the reaction of simmondsin in 1 N NaOH at 20 degrees C was monitored as a function of time. The end products of the reaction as well as intermediates were isolated and identified. The half-life of simmondsin was approximately 60 min with d-glucose and 2-hydroxy-3-methoxyphenylacetonitrile as reaction end products. The reaction mechanism could be elucidated by the isolation of isosimmondsin and a simmondsin lactone derivative. Those compounds were isolated and purified by a combination of column chromatography and HPLC and identified mainly by HRMS and NMR spectroscopy.

Identification of 4,5-didemethyl-4-O-alpha-D-glucopyranosylsimmondsin and pinitol alpha-D-galactosides in jojoba seed meal (Simmondsia chinensis)

The isolation and identification of two pinitol alpha-D-galactosides from jojoba meal are described. The products were isolated by a combination of preparative HPLC on silica gel and TLC on amino silica gel and were identified by MS, NMR spectroscopy, and chemical derivatization as 5-O-(alpha-D-galactopyranosyl)-3-O-methyl-D-chiro-inositol or 5-alpha-D-galactopyranosyl-D-pinitol and 2-O-(alpha-D-galactopyranosyl)-3-O-methyl-D-chiro-inositol or 2-alpha-D-galactopyranosyl-D-pinitol. The same preparative HPLC method on silica gel allowed a new simmondsin derivative to be isolated and identified as 4,5-didemethyl-4-O-alpha-D-glucopyranosylsimmondsin mainly by NMR spectroscopy and high-resolution mass spectrometry.

Teratological studies in defatted jojoba meal-supplemented rats

To look for possible developmental effects in the offspring of jojoba meal-treated Wistar rats, and to distinguish between the effects of reduced food intake and the specific developmental effects of jojoba meal itself, mated female rats were divided into three groups of 20 rats. They received during gestation: (a) normal rodent food (control group); (b) normal rodent food supplemented with 3% defatted jojoba meal (jojoba group); or (c) normal rodent food pair-fed with the jojoba group (pair-fed group). The jojoba meal group showed approximately 30% inhibition of food intake. Ten rats from each group were killed on gestation day 21. Compared to the control group, foetal body weight was reduced in both the jojoba and pair-fed groups, with a greater reduction in the jojoba group. Skeletal ossification was retarded to the same extent in both the jojoba and pair-fed groups. The other 10 rats from each group were left to produce litters. Compared with controls, the body weight of the pups was lower in both the jojoba and pair-fed groups; the reduction was slightly greater in the jojoba group, but this difference disappeared after 1 week. The offspring showed no other abnormalities and reproduced normally. We conclude that, at the dose used, the retardation in foetal skeletal ossification, induced by jojoba meal supplementation during gestation, is due to food intake inhibition. Moreover, the lower birth weight of the young of jojoba-treated dams compared with the pair-fed group is merely due to a lower body weight gain during gestation.

Cannabinoid mimics in chocolate utilized as an argument in court

A case is presented involving chocolate cannabinoid mimics which have been utilized in court by the defendant's lawyer in order to clear the accused of smoking and dealing in marijuana after he was found positive for cannabis in a routine urine immunoassay screening test. The argumentation in this case was that the accused had supposedly eaten a massive amount of chocolate which contained anandamide-related lipids. These lipids inhibit anandamide hydrolysis in the brain, act as cannabinoid mimics and, according to the lawyer, were the cause of the positive cannabinoid test. To investigate this in detail, we synthesized N-oleoyl- and N-linoleoylethanolamide and spiked these compounds together with N-arachidonoylethanolamide in urine for immunological investigations. None of the samples were found positive, indicating that no cross-reactivity occurs with cannabinoids. As a result, the lawyer's claim could be refuted and the accused was convicted.

Gas chromatographic analysis of simmondsins and simmondsin ferulates in jojoba meal

A capillary gas chromatographic method was developed for the simultaneous determination of simmondsins and simmondsin ferulates in jojoba meal, in detoxified jojoba meal, in jojoba meal extracts, and in animal food mixtures.

Interaction of p-fluorofentanyl on cloned human opioid receptors and exploration of the role of Trp-318 and His-319 in mu-opioid receptor selectivity

In this study, we investigated the interactions of p-fluorofentanyl, an opioid designer drug, fentanyl, sufentanyl, and morphine on cloned human mu-, kappa-, and delta-opioid receptors coexpressed with heteromultimeric G protein-coupled inwardly rectifying K(+) channels (GIRK1/GIRK2) and a regulator of G protein signaling (RGS4) in Xenopus oocytes. We demonstrate that p-fluorofentanyl more potently activates GIRK1/GIRK2 channels through opioid receptors than fentanyl and that the p-fluoro substitution also changes the potency profile from mu > kappa > delta (fentanyl) to mu > delta > or = kappa (p-fluorofentanyl). A comparison of ligand efficacy revealed that morphine, fentanyl, and its analogs less efficiently activate GIRK1/GIRK2 channels through human mu-opioid receptor than [D-Ala(2),N-Me-Phe(4),Gly(5)-ol]-enkephalin. Using site-directed mutagenesis, we investigated whether mutating residues Trp-318 and His-319 to their corresponding residues in kappa- and delta-opioid receptors provides the molecular basis for mu/delta selectivity and mu/kappa selectivity. Changes in EC(50) values for the W318L and W318Y/H319Y mu-opioid receptors show a partial contribution of these residues to the decreased GIRK1/GIRK2 channel activation by fentanyl analogs through kappa- and delta-opioid receptors. The most pronounced effect was observed for p-fluorofentanyl, suggesting that an interaction between the 4-fluorophenylpropanamide moiety of the drug and residues Trp-318 and His-319 is important for the resulting enhanced GIRK1/GIRK2 channel activation through the mu-opioid receptor. Finally, we demonstrate that mutation of W318L confers delta-like potency for morphine on the mutant mu-opioid receptor.

Prospective analysis of aneurysm treatment in a series of 103 consecutive patients when endovascular embolization is considered the first option

OBJECT

The aim of this study was to evaluate prospectively the results of treating cerebral aneurysms with coil embolization (CE) or with surgical clipping when CE was considered the first option.

METHODS

Whenever an aneurysm was to be treated, CE was first considered by our neurovascular team. Surgical clipping was reserved for cases excluded from CE or cases in which CE failed. The study consisted of 103 consecutive patients with 132 aneurysms, of which 127 were treated. Coil embolization was performed using Guglielmi detachable coils, and surgery was performed using Zeppelin clips. Three groups were defined: Group A consisted of 64 aneurysms that were treated by CE (neck/sac ratio < 1:3); Group B, 63 aneurysms that were surgically clipped; and Group C, 12 aneurysms that failed to be satisfactorily (> or = 95%) embolized and were subsequently clipped. The percentages of residual aneurysm were 31.2% in Group A, 1.6% in Group B, and 0% in Group C. The percentages of patients with poor Glasgow Outcome Scale (GOS) scores (GOS Scores 1-3) were 13.3% in Group A, 6.1% in Group B, and 8.3% in Group C. The percentages of poor outcome (GOS Scores 1-3) in patients with good clinical status before treatment were 10.7% in Group A, 0% in Group B, and 8.3% in Group C.

CONCLUSIONS

Even with preselection, CE remains associated with a significant number of treatment failures and poor outcomes, even in patients with good preoperative clinical status. Surgical clipping can offer better results than CE, even for more complex aneurysms of the anterior circulation, especially for those involving the middle cerebral artery cases. However, because CE can be effective and causes less stress and invasiveness for the patient, it should be considered first in aneurysms strictly selected by a neurovascular team.

The vagus nerve is involved in the anorexigenic effect of simmondsin in the rat

Simmondsin, 2-(cyanomethylene)-3 hydroxy 4,5 dimethoxy cyclohexyl beta-D-glucoside, from jojoba meal reduces food intake in rats. We investigated the mechanism of action simmondsin, by studying the effects of fasting or of vagotomy on the food intake reduction. The food intake reduction was significantly less in fasted rats than in non-fasted rats. The reduction of food intake was also significantly diminished after vagotomy. The results of the present experiments suggest that simmondsin reduces intake of food in rats through the augmentation of satiety, in part vagally mediated.

Effects of simmondsin on food intake, growth, and metabolic variables in lean (+/?) and obese (fa/fa) Zucker rats

Incorporation of 2.5 g/kg of the anorexigen, simmondsin, in the diet resulted in food intake reduction in both lean and obese Zucker rats; however, the obese rats were much more sensitive to the food intake-reducing activity of simmondsin. In both obese and lean simmondsin-treated Zucker rats, growth was slower than in control rats, but was the same as that in pair-fed animals. The 24 h heat production pattern showed a smaller diurnal variation and a lower mean in obese rats than in lean rats. Food intake reduction, as a result of either simmondsin treatment or pair feeding, caused a decrease in mean heat production. Simmondsin treatment, but not pair feeding, caused a decrease in the diurnal variation of heat production. Plasma total cholesterol levels were increased in both simmondsin-treated and pair-fed obese and lean Zucker rats compared with control animals; this increase was mainly due to an increase in HDL-cholesterol levels. Blood leptin levels in both obese and lean rats decreased with decreased food intake and decreased fat deposition, but in obese rats, simmondsin treatment resulted in an additional decrease in leptin levels. It is concluded that the food intake-reducing effect of simmondsin is more pronounced in obese Zucker rats than in their lean littermates, and except for the simmondsin-specific effects on leptin and total cholesterol values in obese littermates, the effects of simmondsin are related to food intake restriction in obese and lean Zucker rats.

Comparison of the effects of simmondsin and cholecystokinin on metabolism, brown adipose tissue and the pancreas in food-restricted rats

In this study, we investigated the analogies between the physiological effects of simmondsin, a satiety-inducing glycoside extracted from jojoba seeds, and the gastro-intestinal satiation peptide, cholecystokinin. The effects of intraperitoneal injection of the biological active CCK-octapeptide on the pancreas, interscapular brown adipose tissue, growth performance and energy metabolism in normal-fed, severely food intake-restricted (50 % of normal food intake) or moderately food intake-restricted (65 % of normal food intake) growing rats were compared to the effects of 0.25 % simmondsin mixed in the food, inducing moderate food intake reduction (65 % of normal) in rats. Cholecystokinin induced pancreatic hypertrophy. In normal fed rats, cholecystokinin had no effect on brown adipose tissue or growth, while, in severely food intake-restricted rats, it caused brown adipose tissue hypertrophy and reduced growth. In moderately food intake-restricted rats, both cholecystokinin and simmondsin induced pancreatic hypertrophy, increased brown adipose weight and metabolism and caused a slight decrease in growth. We conclude that cholecystokinin may decrease growth performance in fast growing severely food intake-restricted rats by stimulating brown adipose tissue metabolism, probably because of protein shortage induced by pancreatic hyperstimulation. Simmondsin has similar effects. These results support the hypothesis that endogenous cholecystokinin is involved in the effects of simmondsin in rats.

Reproductive performance of rats treated with defatted jojoba meal or simmondsin before or during gestation

The effects on food intake, growth and reproductive performance parameters of defatted jojoba meal and pure simmondsin, an extract from jojoba meal, were compared in female Wistar rats. Rats fed 0.15% simmondsin or 3% defatted jojoba meal (equivalent to 0.15% simmondsin) for 8 weeks before conception showed a similar reduction in food intake (about 20%) and a similar growth retardation compared with controls. Both treatments induced a reduction in the number of corpora lutea on gestation day 16: this effect could be ascribed to the lower food intake before conception because it was also observed in rats pair-fed to the treated ones. Rats given feed containing 0.15% simmondsin or 3% defatted jojoba meal during days 1-16 of gestation showed a similar reduction in food intake relative to controls. Foetal and placental weights were reduced, relative to controls, to a similar extent in both groups, and the reductions were slightly greater than in the corresponding pair-fed groups. We conclude that the effects on food intake, growth and reproductive performance that were seen after feeding rats defatted jojoba meal were due to the simmondsin content of the meal. The simmondsin induced reduction in food intake and probably also a relative protein shortage.

Devazepide reverses the anorexic effect of simmondsin in the rat

Simmondsin, a glycoside extracted from jojoba meal (Simmondsia chinensis), causes a reduction in food intake after oral administration. To investigate the mechanism by which simmondsin reduces food intake, fasted and free-feeding rats were given simmondsin-supplemented food and simultaneously injected with devazepide, a specific antagonist of peripheral-type cholecystokinin receptors (CCKA receptors). In free-feeding rats, supplementation of food with 0.5% simmondsin caused a reduction in food intake of +/- 40% in the period of 4 h following food presentation. Intraperitoneal injection of 100 micrograms devazepide/kg body weight prevented this effect. In rats fasted for 20 h, the food intake in the 30 min after presentation of food supplemented with 0.15% or 0.50% simmondsin was reduced in a dose-related manner; this was also inhibited by simultaneous application of devazepide. It is suggested that peripheral CCKA receptors are involved in the effect of simmondsin on food intake. However, a direct effect of simmondsin on CCKA receptors has been excluded, since simmondsin was unable to cause contraction of the guinea-pig gallbladder in vitro.

Influence of long-term simmondsin administration on thyroid hormone levels in adult rats

Treatment of adult rats for 28 days with 0.50% of simmondsin induced a reduction of food intake of about 40%. The degree of emaciation was the same in simmondsin treated rats (SM) and pair-fed controls (PF). Diurnal variation of plasma thyroid hormone concentrations was determined. The reduction in food intake induced a decrease of mean 24 h plasma T3, T4 and TSH concentrations. Plasma T4 concentrations were decreased more in SM than in PF at almost all times of the day. No difference was seen between SM and PF for plasma T3 and TSH concentrations. Liver outer ring deiodinating activity (type I) remained unchanged compared to controls in PF and SM, but liver inner ring deiodinating activity (type III) was increased 4 fold in both SM and PF. It was concluded that the food intake reduction induced by simmondsin produced a decrease in plasma TSH concentrations which in turn reduced plasma T4 concentrations. Decreased plasma T4 concentrations together with an increased degradation of plasma T3 resulted in lower plasma T3 concentrations.

Development of a fluoroimmunoassay for the detection of buprenorphine in urine

The development of a fluoroimmunoassay for the detection of buprenorphine in urine samples is described. Fluorescein-norbuprenorphine and pseudobuprenorphine, the dimer of buprenorphine, were synthesized as tracer molecules. The antibodies were prepared by coupling the 2-diazobenzoic acid derivative of buprenorphine with bovine serum albumine, using the carbodiimide method. The assay was mainly used for the routine detection of buprenorphine in urine specimens of persons suspected of Temgesic abuse. The minimum detectable dose of the immunoassay was calculated to be 20 ng/mL.

Extraction and liquid chromatographic method for the determination of simmondsin in plasma

A solid-phase method for the extraction of simmondsin from plasma was developed along with a liquid chromatographic method for the quantitative measurement of this compound. The extraction of simmondsin is realised with activated carbon. Chromatography is performed on a 25 x 0.46 cm I.D. RP-18, 5-micron HPLC column with a water-methanol (85:15, v/v) mobile phase and ultraviolet absorbance detection at 217 nm. The limit of detection is 100 ng (using 1 ml of plasma). The linear quantitation range is 0.1-200 micrograms/ml.

Development of a radioimmunoassay for the determination of buprenorphine in biological samples

The development of a specific and sensitive radioimmunoassay for the detection of buprenorphine in urine samples is described. With minor adjustments, the assay was also applied to the analysis for buprenorphine in plasma samples. The 2-diazobenzoic acid derivative of buprenorphine has been prepared as a hapten. The immunization of rabbits with the hapten-bovine serum albumin conjugate resulted in the production of antibodies, which cross-reacted with N-dealkylbuprenorphine up to about the 90% level. The antibodies showed very low cross-reactivities with the 3-O-glucuronides and with the structural analogue etorphine. The assay was mainly used to pre-screen for buprenorphine in urine samples of persons suspected of Temgesic misuse and to determine buprenorphine in plasma samples. A linear calibration graph for buprenorphine was obtained after logit-log regression [Y = 0.383 (s, 0.059) - 0.535 X (s, 0.025); r = 0.997 (s, 0.001)]. The spiking recovery study showed a linear regression of Y (observed) = 0.94 + 0.84 X (expected); r = 0.997. Intra- and inter-assay relative standard deviations were < 4.35 and < 6.36%, respectively. A comparison study of the high-performance liquid chromatographic determination (X) to the radioimmunoassay (Y) resulted in the following regression equation for the urine samples: Y = 1.44 + 1.64 X (n = 32; r = 0.910) and Y = 0.007 + 1.58 X (n = 10; r = 0.930) for plasma specimens. The minimum detectable dose of the immunoassay was calculated to be 10 pg ml-1 (Student's t-distribution, p = 0.01, degrees of freedom = 8).

Analysis and identification of azaperone and its metabolites in humans

Azaperone, dihydroazaperone, and 4'[fluoro-4-(4-(2-pyridyl)-1-piperazinyl]butyrophenone are identified in the urine of an intoxicated patient. The structures of the metabolites were confirmed by comparison of their TLC, GC, and GC/MS data with those of synthesized materials.

Analysis of buprenorphine in urine specimens

The simultaneous determination of buprenorphine (Temgesic) and its major metabolite, N-desalkylbuprenorphine, in urine samples has been studied. By using reversed-phase high-performance liquid chromatography (HPLC) with electrochemical detection, therapeutic concentrations of unconjugated buprenorphine down to 0.2 ng/mL, and 0.15 ng/mL for the metabolite, can be detected in urine samples. This method has been applied to a variety of urine samples from drug users. The possible analytical interference from several other regulated drugs has been studied. The results were also compared with those obtained from a commercial radioimmunoassay (RIA) test. This test is only capable of detecting buprenorphine concentrations higher than 1 ng/mL.

High-performance liquid chromatography with electrochemical detection of buprenorphine and its major metabolite in urine

A procedure was developed for the simultaneous determination of buprenorphine and its major metabolite. N-desalkylbuprenorphine, by reversed-phase high-performance liquid chromatography with electrochemical detection. The detection limit is about 100 pg/ml for the major metabolite and 250 pg/ml for buprenorphine.

HPLC analysis of diuron and metabolites in blood and urine

A high-pressure liquid chromatographic method for the determination of diuron and its metabolites in human urine and blood is presented. The synthesis of different metabolites and of a suitable internal standard is described and the structure of the compounds is determined by mass spectrometry and nuclear magnetic resonance spectroscopy. The method is applied to an overdose case.

Mercury intoxication after topical application of a metallic mercury ointment

Two cases of mercury poisoning with predominantly dermatological symptoms are reported. The mercury intoxication was caused by the application of an over-the-counter metallic mercury ointment. The calculations of mercury excretion suggest strongly that cutaneous absorption could have been a significant route of entry.

Standardizing 8-methoxypsoralen plasma profiles by using an emulsion form

Uniform 8-methoxypsoralen (8-MOP) absorption from the gastrointestinal tract is necessary to avoid day-to-day variations in 8-MOP plasma levels when treating patients with psoriasis by photochemotherapy. Because of its low water solubility, particle size and crystal form of the 8-MOP can significantly influence its bioavailability. The presentation form is also important, as is shown by the present study in which 8-MOP plasma levels were compared in thirty patients after oral administration in three different forms: formulation A consisted of gelatin capsules containing 8-MOP with a mean particle size of 200 mu; formulation B consisted of gelatin capsules containing 8-MOP in microcrystalline form with particle size between 20 mu and 30 mu; formulation C contained the same microcrystalline 8-MOP but in an emulsion base. Significantly higher plasma levels were found with formulations B and C than with formulation A. Furthermore, the individual differences in plasma profiles were markedly less with the emulsion base than with the capsule forms. Therefore, the clinical use of 8-MOP in emulsion form would constitute a major step in 8-MOP dose standardization and could lead to better control of subjective side effects and better therapeutic results.

A pharmacokinetic comparison in dogs of seven brands of 8-MOP and five new formulations

A pharmacokinetic comparison was carried out with 7 commercially available brands of 8-methoxypsoralen and 5 new formulations. The purpose of the study was to determine the brand or formulation with the least interindividual variation and thus the best standardized 8-methoxypsoralen plasma levels. The experiment was performed on dogs and not on human subjects because each of the 12 preparations had to be given to the same individual. The 8-methoxypsoralen plasma levels were measured by high performance liquid chromatography. One commercial and one self-made formulation showed a significantly earlier peaking time and higher peak concentration than the other brands tested. At 1 hour after administration the same commercial preparation and 4 self-made formulations showed significantly higher plasma levels than the other formulations. At 2 h, however, 10 of the 12 brands or formulations did not show statistically significant differences in 8-methoxypsoralen plasma levels.

Skin determination of the 8-methoxypsoralen concentration in rats

This paper describes a method for determining the amount of 8-methoxypsoralen in rat skin tissue by means of high performance liquid chromatography. The 8-methoxypsoralen was extracted with an organic solvent out of homogenized skin tissue. Following evaporation of the solvent, the extracts could be injected directly into the column without further purification. The procedure is relatively simple.

The relationship between 8-methoxypsoralen skin and blood levels

A method is described to determine the 8-methoxypsoralen (8-MOP) concentration in vivo in the skin by means of high-performance liquid chromatography (HPLC). Skin and blood samples were taken from 80 rats at specific intervals after oral administration of [3H]8-MOP. The pharmacokinetic results obtained for the skin levels were compared to the blood levels. In addition, liquid scintillation counting (LSC) was done on all the samples to compare the concentrations of 8-MOP plus metabolites to the concentrations of 8-MOP alone. There was a good correlation between the 8-MOP skin and blood levels. The values obtained with LSC were higher in function of time than the corresponding values obtained by HPLC, which indicates the presence of metabolites in both the skin and the blood. No statistically significant difference in the time of peaking was noted for the skin and blood levels. The blood levels seem to be a good parameter for the 8-MOP skin concentration.

Biotransformation and excretion of nitromethaqualone in rats and humans

The metabolic disposition of 14C-labeled nitromethaqualone was investigated in rats. Unlabeled nitromethaqualone was used for studies on humans. nitromethaqualone was eliminated from the body after most of it had undergone biotransformation. Both humans and rats reduced the nitro group of nitromethaqualone to the corresponding amino derivative, which was partially transformed to the corresponding acetylated form. Cleavage of the quinazolinone nucleus resulting in 2-methoxyl-4-nitroaniline was also observed in humans. In rats additional major metabolites arose from the oxidation of the 2-methyl group into hydroxymethyl resulting in 2-hydroxymethyl-3-(2'-methoxy-4-nitrophenyl)-4(3H)-quinazolinone and concomitant in vivo reduction of the latter resulting in 2-hydroxymethyl-3-(2'-methoxy-4'-aminophenyl)-4(3H)-quinazolinone. Both metabolites were also excreted as glucuronides. In rats fecal excretion accounted for 55-60% of the administered dose, while 24-27% was excreted in the urine. Protracted excretion in both humans and rats indicated an extensive enterohepatic circulation.

Dietary influences on 8-MOP plasma levels in PUVA patients with psoriasis

To study the effect of diet on 8-MOP plasma levels, these levels were measured three times in twenty PUVA patients with psoriasis; while fasting, after a low-fat breakfast, and after a fat-rich breakfast. No significant differences were found between the maximal 8-MOP plasma levels in the fasting condition and the levels after the low-fat breakfast, both peaking 2 h after ingestion. After the fat-rich breakfast, however, the 8-MOP plasma levels were not only significantly lower at 2 h but also peaked later, reaching their maximum at 3-4 h after intake. The drug should therefore be given in a dietetically standardized way. This raises the question whether some cases of therapy resistance can be dietetically influenced.

Determination at the nanogram range of rilatinic acid in urine after ion-pair extraction

Ion-pair extraction and extractive alkylation of urine allows a simple, rapid, and very sensitive detection by TLC as well as EC-GLC tecnhiques, of rilatinic acid in small urine samples after the oral intake of therapeutic doses of methylphenidate.