Development of an instrument to measure pain in rheumatoid arthritis: Rheumatoid Arthritis Pain Scale (RAPS)

OBJECTIVE

To develop a valid and reliable clinical instrument for measuring pain in adult patients with rheumatoid arthritis. The resulting Rheumatoid Arthritis Pain Scale (RAPS) is a quantitative, single-score, self-report 24-item instrument.

METHODS

Psychometric evaluation of RAPS was conducted following estimation of content validity and a pilot study. The actual study used a convenience sample of 120 adults, 18 years of age or older, with pain of at least 3 months duration. The setting was a large rheumatology private practice in a metropolitan southwestern city. The gate control and affective motivational theories of pain served as a framework guiding the development of RAPS, which includes items suggestive of the multidimensional pain experience in rheumatoid arthritis. Four subscales, physiological, affective, sensory-discriminative, and cognitive, evaluated numerous pain factors.

RESULTS

Findings indicate a high estimate for internal consistency for the total scale and a moderate to high estimate of internal consistency for projected subscales. Data were analyzed using Cronbach's coefficient alpha, Pearson product-moment correlation coefficients, and exploratory factor analysis. Using Cronbach's coefficient alpha, RAPS showed an internal consistency reliability coefficient of 0.92, a strong indicator of reliability. Reliability assessments for the 4 subscales also indicate reliability, with Cronbach's coefficients ranging from 0.65 to 0.86. Exploratory factor analysis yielded 3 factors with criteria for factor loadings > or = 0.4.

CONCLUSION

The study's findings provided support for RAPS as a reliable and valid measurement of rheumatoid arthritis pain. Assessment of rheumatoid arthritis pain and its relationship to treatment outcomes could significantly impact the treatment interventions.

Transition programs in cystic fibrosis centers: perceptions of pediatric and adult program directors

There is a growing population of adults with cystic fibrosis (CF) and a need for development of adult CF programs. Recommendations for transfer of patients to an adult program include a transition program. Our goal was to assess the current status of transition programs in US CF centers. In addition, we sought to determine the problems related to the transfer of patients to adult programs as perceived by CF center program directors. A survey was sent in 1998 to 110 pediatric and 44 adult program directors at CF centers approved by the Cystic Fibrosis Foundation (CFF), with a response rate of 65.5% and 72.7%, respectively: 22.2% of pediatric centers reported having a non-CFF-approved adult program, and 38.9% had no specific adult program. About one fifth of pediatric centers cited lack of an adult CF physician as an impediment to establishing an adult program. Age (82% of programs; mean, 18.5 years), but not marriage (17.1%) or pregnancy (24.8%), was used as a criterion for transfer. Criteria precluding transfer included patient/family resistance (51.4%), disease severity (50.5%), and developmental delay (46.7%). The concept of transfer is introduced to the patient and family at the time of diagnosis in a minority (14%) of programs. Over one half of the patients did not meet the adult team until the time of transfer. Pediatricians reported higher perceived parent, patient, pediatric staff, and adult staff concerns about transition issues than did adult program directors. We conclude that there is a lack of standardized programs for transfer of CF patients from a pediatric to an adult care setting, and that there are differences between pediatric and adult program directors' perceptions of concerns that CF patients, their families, and the medical teams have about transfer. These differences may impede the successful transition of patients into an adult program.

Floor space needs for laboratory mice: BALB/cJ males or females in solid-bottom cages with bedding

Studies were initiated to determine the effects of restricted (32.2 cm2 per mouse), normal (96.8 cm2), or excess floor space (129.0 cm2) allowances by using a model of three mice per cage. BALB/cJ mice were bred on-site and weaned at 3 weeks of age into specially designed polycarbonate shoebox cages modified to each space allowance. Cages contained aspen shavings for bedding, and mice were fed and watered ad libitum. Body weight gains, feed and water use, and immunologic measures largely were not effected by floor space allowances. Female BALB/cJ mice were heavier and had increased lymphocyte blastogenesis to phytohemagglutinin (20 microg/mL) when given 32.2 cm2/mouse than when given 129 cm2/mouse. Female mice showed an increase in grooming and sitting behaviors when given 32.2 cm2/mouse, but male mice with restricted floor space spent more time lying down but showed no change in grooming or sitting behaviors compared to mice given more space. Among male mice, limited floor space did not significantly influence growth rates, but male mice given 32.2 cm2/mouse had less mortality than did mice given more space. We conclude that floor spaces as limited as 32.2 cm2/mouse did not cause behavior, health, immune or performance problems for BALB/cJ mice.

Psychological functioning of adults with cystic fibrosis

STUDY OBJECTIVES

The purpose of this study is to assess the psychological profiles of adult patients with cystic fibrosis (CF) and to investigate predictors of patients' psychological status.

PATIENTS AND METHODS

Thirty-four adults with CF completed a battery of psychological testing including the Minnesota Multiphasic Personality Inventory-2, Beck Depression Inventory, and State-Trait Anxiety inventory. These were compared to health status data, including pulmonary function testing and nutritional status measures.

RESULTS

As a group, adults with CF did not demonstrate significant levels of depression, anxiety, or other psychopathology. Results were not affected by age, sex, or severity of disease. Male gender predicted higher scores for depression and anxiety, and better lung functioning predicted less anxiety. Having a higher level of psychosocial support emerged as a strong predictor of better psychological functioning.

CONCLUSIONS

Overall, adults with CF report relatively healthy psychological functioning. Better lung function and a strong social support system predicted better psychological functioning, which may have implications for clinical intervention.

HOE-642 (cariporide) alters pH(i) and diastolic function after ischemia during reperfusion in pig hearts in situ

The specific Na(+)/H(+) exchange inhibitor HOE-642 prevents ischemic and reperfusion injury in the myocardium. Although this inhibitor alters H(+) ion flux during reperfusion in vitro, this action has not been confirmed during complex conditions in situ. Myocardial intracellular pH (pH(i)) and high-energy phosphates were monitored using (31)P magnetic resonance spectroscopy in open-chest pigs supported by cardiopulmonary bypass during 10 min of ischemia and reperfusion. Intravenous HOE-642 (2 mg/kg; n = 8) administered before ischemia prevented the increases in diastolic stiffness noted in control pigs (n = 8), although it did not alter the postischemic peak-elastance or pressure-rate product measured using a distensible balloon within the left ventricle. HOE-642 induced no change in pH(i) during ischemia but caused significant delays in intracellular realkalinization during reperfusion. HOE-642 did not alter phosphocreatine depletion and repletion but did improve ATP preservation. Na(+)/H(+) exchange inhibition through HOE-642 delays intracellular alkalinization in the myocardium in situ during reperfusion in association with improved diastolic function and high-energy phosphate preservation.

Co-ordinated programme of gene expression during asexual intraerythrocytic development of the human malaria parasite Plasmodium falciparum revealed by microarray analysis

Plasmodium falciparum is a protozoan parasite responsible for the most severe forms of human malaria. All the clinical symptoms and pathological changes seen during human infection are caused by the asexual blood stages of Plasmodium. Within host red blood cells, the parasite undergoes enormous developmental changes during its maturation. In order to analyse the expression of genes during intraerythrocytic development, DNA microarrays were constructed and probed with stage-specific cDNA. Developmental upregulation of specific mRNAs was found to cluster into functional groups and revealed a co-ordinated programme of gene expression. Those involved in protein synthesis (ribosomal proteins, translation factors) peaked early in development, followed by those involved in metabolism, most dramatically glycolysis genes. Adhesion/invasion genes were turned on later in the maturation process. At the end of intraerythrocytic development (late schizogony), there was a general shut-off of gene expression, although a small set of genes, including a number of protein kinases, were turned on at this stage. Nearly all genes showed some regulation over the course of development. A handful of genes remained constant and should be useful for normalizing mRNA levels between stages. These data will facilitate functional analysis of the P. falciparum genome and will help to identify genes with a critical role in parasite progression and multiplication in the human host.

Structure of the bacteriophage phi29 DNA packaging motor

Motors generating mechanical force, powered by the hydrolysis of ATP, translocate double-stranded DNA into preformed capsids (proheads) of bacterial viruses and certain animal viruses. Here we describe the motor that packages the double-stranded DNA of the Bacillus subtilis bacteriophage phi29 into a precursor capsid. We determined the structure of the head-tail connector--the central component of the phi29 DNA packaging motor--to 3.2 A resolution by means of X-ray crystallography. We then fitted the connector into the electron densities of the prohead and of the partially packaged prohead as determined using cryo-electron microscopy and image reconstruction analysis. Our results suggest that the prohead plus dodecameric connector, prohead RNA, viral ATPase and DNA comprise a rotary motor with the head-prohead RNA-ATPase complex acting as a stator, the DNA acting as a spindle, and the connector as a ball-race. The helical nature of the DNA converts the rotary action of the connector into translation of the DNA.

Hyperthermic intraoperative intraperitoneal chemotherapy for peritoneal carcinomatosis and sarcomatosis using a cardioplegia heat exchanger and a two-pump system: a case report

A 34-year-old male diagnosed with pseudomyxoma peritoneii presented for an exploratory laparotomy and hyperthermic intraoperative intraperitoneal chemotherapy. A circuit using two roller pumps and a cardioplegia administration set was assembled to deliver the chemotherapy perfusate at a consistent temperature. The authors discuss a case in which this treatment modality was used, describing the perfusionist's role and the circuit design.

Revalidation and long-term stability of National Institute of Standards and Technology Standard Reference Materials 1566, 1567, 1568, and 1570

Multiple units of Standard Reference Materials (SRMs) 1566 Oyster Tissue, 1567 Wheat Flour, 1568 Rice Flour, and 1570 Trace Elements in Spinach, produced by the National Institute of Standards and Technology (NIST, then the National Bureau of Standards), were analyzed 17-20 years after the original certification dates and 12-15 years after the certificates became invalid. Instrumental neutron activation analysis and thermal neutron prompt gamma-ray activation analysis were used to measure mass fractions for 27 elements in these SRMs to revalidate them for use in quality assurance (QA) programs required for food analysis programs within the U.S. Food and Drug Administration. With the exception of Se in SRM 1567, all element mass fractions were in agreement with certified values and literature data. Some evidence of B loss from SRM 1568 was observed. These materials were judged to be suitable for continued use in QA programs. Findings showed that these matrixes exhibited stability of moisture, mass fraction, and weight basis for far longer (> or =15 years) than was indicated by the 5-year validity statement on the NIST Certificates of Analysis.

Prevalence and patterns of alternative medication use in a university hospital outpatient clinic serving rheumatology and geriatric patients

A random sample of 176 patients seen at least once during 1997 in a University hospital outpatient clinic serving rheumatology and geriatric patients were surveyed in a telephone interview to determine the prevalence of, and reasons for taking, alternative medications. Interviews were conducted from November 1997-March 1998. The survey elicited information about patients' ability to provide self-care, demographics, work status, satisfaction with current disease management, types of alternative medications taken, sources of information about the products, where they obtained the products, and reasons for taking the products. Patients also were questioned as to their knowledge of safety of these products. Statistical comparisons were determined between patients who used alternative agents and those who did not. Prevalence of use was 66%. Most patients thought that the agents were safe and took them because they believed they have "added benefits."

Varroa jacobsoni (Acari: Varroidae) is more than one species

Varroa jacobsoni was first described as a natural ectoparasitic mite of the Eastern honeybee (Apis cerana) throughout Asia. It later switched host to the Western honeybee (A. mellifera) and has now become a serious pest of that bee worldwide. The studies reported here on genotypic, phenotypic and reproductive variation among V. jacobsoni infesting A. cerana throughout Asia demonstrate that V. jacobsoni is a complex of at least two different species. In a new classification V. jacobsoni is here redefined as encompassing nine haplotypes (mites with distinct mtDNA CO-I gene sequences) that infest A. cerana in the Malaysia Indonesia region. Included is a Java haplotype, specimens of which were used to first describe V. jacobsoni at the beginning of this century. A new name, V. destructor n. sp., is given to six haplotypes that infest A. cerana on mainland Asia. Adult females of V. destructor are significantly larger and less spherical in shape than females of V. jacobsoni and they are also reproductively isolated from females of V. jacobsoni. The taxonomic positions of a further three unique haplotypes that infest A. cerana in the Philippines is uncertain and requires further study. Other studies reported here also show that only two of the 18 different haplotypes concealed within the complex of mites infesting A. cerana have become pests of A. mellifera worldwide. Both belong to V. destructor, and they are not V. jacobsoni. The most common is a Korea haplotype, so-called because it was also found parasitizing A. cerana in South Korea. It was identified on A. mellifera in Europe, the Middle East, Africa, Asia, and the Americas. Less common is a Japan/Thailand haplotype, so-called because it was also found parasitizing A. cerana in Japan and Thailand. It was identified on A. mellifera in Japan, Thailand and the Americas. Our results imply that the findings of past research on V. jacobsoni are applicable mostly to V. destructor. Our results will also influence quarantine protocols for bee mites, and may present new strategies for mite control.

Anesthesia for the elderly and special needs patient

This article focuses on the elderly patient and developmentally disabled children and adults. Although many individuals in these groups can receive dental care with only the use of local anesthetic, this article focuses on those that require sedation or general anesthesia. Areas in which the management of these patients significantly differs from routine anesthesia are emphasized.

Use of the pediatric symptom checklist in the pediatric neurology population

The purpose of this study was to evaluate the effectiveness of the Pediatric Symptom Checklist (PSC) as a mental health screening instrument in a busy pediatric neurology population in comparison with more lengthy, time-consuming assessment methods. One hundred two children were screened using the PSC. PSC results were compared with scores on the Child Behavior Checklist (CBCL), results from structured interviews, and ratings of adaptive functioning using the Children's Global Assessment Scale (CGAS). Thirty-nine of the patients (38%) scored 63 or above on the CBCL, indicating psychosocial impairment. Using a cutoff score of 22, the PSC correctly identified 35 of these 39 positive cases (sensitivity 89.7) and 48 of the 63 children with CBCL scores below 63 (specificity 76.2). CGAS scores were significantly negatively correlated with PSC scores (r = -0.60, P < 0.05). The PSC correctly identified 85.9% of children who scored 70 or below on the CGAS. Among the 53 children with psychiatric diagnoses on the basis of the interview, 41 scored above the cutoff of 22 on the PSC. Results suggest that the PSC is an efficient and accurate screen for identification of mental health problems in the pediatric neurology population.

A model to explain the various paradoxes associated with mantle noble gas geochemistry

As a result of an energetic accretion, the Earth is a volatile-poor and strongly differentiated planet. The volatile elements can be accounted for by a late veneer ( approximately 1% of total mass of the Earth). The incompatible elements are strongly concentrated into the exosphere (atmosphere, oceans, sediments, and crust) and upper mantle. Recent geochemical models invoke a large primordial undegassed reservoir with chondritic abundances of uranium and helium, which is clearly at odds with mass and energy balance calculations. The basic assumption behind these models is that excess "primordial" 3He is responsible for 3He/4He ratios higher than the average for midocean ridge basalts. The evidence however favors depletion of 3He and excessive depletion of 4He and, therefore, favors a refractory, residual (low U, Th) source Petrological processes such as melt-crystal and melt-gas separation fractionate helium from U and Th and, with time, generate inhomogeneities in the 3He/4He ratio. A self-consistent model for noble gases involves a gas-poor planet with trapping of CO2 and noble gases in the shallow mantle. Such trapped gases are released by later tectonic and magmatic processes. Most of the mantle was depleted and degassed during the accretion process. High 3He/4He gases are viewed as products of ancient gas exsolution stored in low U environments, rather than products of primordial reservoirs.

The helium paradoxes

The ratio 3He/4He (R) plays a central role in models of mantle evolution that propose an undegassed lower mantle, rich in the primordial isotope 3He. A large primordial volatile-rich reservoir, a feature of recent models, is inconsistent with high-temperature accretion and with estimates of crustal and bulk Earth chemistry. High R can alternatively reflect high integrated 3He/(U+Th) ratios or low 4He abundances, as expected in refractory portions of the upper mantle. I show that high R materials are gas-poor and are deficient in radiogenic 4He compared with midocean ridge basalts. The seemingly primitive (i.e., high R) signatures in "hotspot" magmas may be secondary, derived from CO2-rich gases, or residual peridotite, a result of differential partitioning of U and He into magmas. A shallow and low 3He source explains the spatial variability and the temporal trends of R in ocean islands and is consistent with a volatile-poor planet. A shallow origin for the "primitive" He signature in ocean island basalts, such as at Loihi, reconciles the paradoxical juxtaposition of crustal, seawater, and atmospheric signatures with inferred "primitive" characteristics. High 238U/204Pb components in ocean island basalts are generally attributed to recycled altered oceanic crust. The low 238U/3He component may be in the associated depleted refractory mantle. High 3He/4He ratios are due to low 4He, not excess 3He, and do not imply or require a deep or primordial or undegassed reservoir. 40Ar in the atmosphere also argues against such models.

Results from the Mars Global Surveyor Thermal Emission Spectrometer

The Thermal Emission Spectrometer spectra of low albedo surface materials suggests that a four to one mixture of pyroxene to plagioclase, together with about a 35 percent dust component provides the best fit to the spectrum. Qualitative upper limits can be placed on the concentration of carbonates (<10 percent), olivine (<10 percent), clay minerals (<20 percent), and quartz (<5 percent) in the limited regions observed. Limb observations in the northern hemisphere reveal low-lying dust hazes and detached water-ice clouds at altitudes up to 55 kilometers. At an aerocentric longitude of 224 degrees a major dust storm developed in the Noachis Terra region. The south polar cap retreat was similar to that observed by Viking.

Frictional melting during the rupture of the 1994 bolivian earthquake

The source parameters of the 1994 Bolivian earthquake (magnitude Mw = 8.3) suggest that the maximum seismic efficiency eta was 0.036 and the minimum frictional stress was 550 bars. Thus, the source process was dissipative, which is consistent with the observed slow rupture speed, only 20% of the local S-wave velocity. The amount of nonradiated energy produced during the Bolivian rupture was comparable to, or larger than, the thermal energy of the 1980 Mount St. Helens eruption and was sufficient to have melted a layer as thick as 31 centimeters. Once rupture was initiated, melting could occur, which reduces friction and promotes fault slip.

Influence of the pH of cardioplegic solutions on cellular energy metabolism and hydrogen ion flux during neonatal hypothermic circulatory arrest and reperfusion: a dynamic 31P nuclear magnetic resonance study in a pig model

OBJECTIVES

The pH of cardioplegic solutions is postulated to affect myocardial protection during neonatal hypothermic circulatory arrest. Neither optimization of cardioplegic pH nor its influence on intracellular pH during hypothermic circulatory arrest has been previously studied in vivo. Thus we examined the effects of the pH of cardioplegic solutions on postischemic cardiac function in vivo, including two possible operative mechanisms: (1) reduction in adenosine triphosphate use and depletion of high-energy phosphate stores or (2) reduction of H+ flux during reperfusion, or both.

METHODS

Dynamic 31P spectroscopy was used to measure rates of adenosine triphosphate use, high-energy phosphate depletion, cytosolic acidification during hypothermic circulatory arrest, and phosphocreatine repletion and realkalinization during reperfusion. Neonatal pigs in three groups (n = 8 each)--group A, acidic cardioplegia (pH = 6.8); group B, basic cardioplegia (pH = 7.8); and group N, no cardioplegia--underwent hypothermia at 20 degrees C with 60 minutes of hypothermic cardioplegia followed by reperfusion.

RESULTS

Recoveries of peak elastance, stroke work, and diastolic stiffness were superior in group B. Indices of ischemic adenosine triphosphate use, initial phosphocreatine depletion rate, and tau, the exponential decay half-time, were not different among groups. Peak [H+] in group A (end-ischemia) was significantly elevated over that of group B. The realkalinization rate was reduced in group B compared with that in groups A (p = 0.015) and N (p = 0.035), with no difference between groups A and N (p = 0.3). Cytosolic realkalinization rate was markedly reduced and the half-time of [H+] decay was increased during reperfusion in group B.

CONCLUSIONS

Superior postischemic cardiac function in group B is not related to alterations in ischemic adenosine triphosphate use or high-energy store depletion, but may be due to slowing in H+ efflux during reperfusion, which should reduce Ca++ and Na+ influx.

Determination of sodium in biological materials by instrumental neutron activation analysis

A formalized method for determining sodium in biological materials by instrumental neutron activation analysis is presented. The method includes common procedures from the numerous options available to this historically nonformalized analytical technique. The number of procedural options is restricted to minimize the method's complexity, yet the method is still applicable to a variety of neutron activation facilities. High accuracy and precision are achieved by placing bounds on allowed uncertainty at critical stages of the analysis. Analytical results from the U.S. Food and Drug Administration laboratory and 4 other laboratories demonstrate the method's performance.

Prospective multicenter study of sulfonylurea ingestion in children

OBJECTIVE

Sixty-eight percent of pediatric sulfonylurea ingestions reported to poison centers do not result in laboratory or behavioral effects. Consequently, if all exposed children are admitted overnight or for 24 hours for these exposures, it will result in 600 to 700 hospital admissions per year of children who will remain free of symptoms. We prospectively studied exposures reported to 10 regional poison centers to determine if it were possible to differentiate those patients who would have symptoms from those who would remain symptom free.

METHODS

We analyzed all sulfonylurea exposures in children < or = 12 years old reported to the participating poison centers. Hypoglycemia was defined as blood glucose (BG) concentration < 60 mg/dl.

RESULTS

Hypoglycemia developed in 56 (30%) of 185 exposed patients. Fifty-four of the 56 (96%) hypoglycemic patients had development of hypoglycemia within 8 hours of ingestion. Eighty-seven of the patients were initially managed with oral supplementation only; in 13 cases, treatment advanced to intravenous administration of glucose or glucagon with the onset of hypoglycemia. There was no statistical difference in medical outcome between patients monitored during oral supplementation versus during intravenous infusion of dextrose. Ingestions analyzed by time of day did not predict risk of hypoglycemia. Sufficient data were available for 103 (58%) of the 177 patients who ingested glyburide or glipizide to calculate a toxic dose/weight ratio. Of these 103 patients, 31 of 36 patients who ingested < or = 0.3 mg/kg remained symptom free, whereas 31 of 67 who ingested more than 0.3 mg/kg had BG concentrations < 60 mg/dl (p < 0.005, 95% confidence interval 0.05 to 0.58; sensitivity 86%, specificity 46%).

CONCLUSION

A lack of onset of hypoglycemia (BG > 60 mg/dl) in the first 8 hours after ingestion is predictive of a benign outcome in accidental pediatric sulfonylurea ingestion. Clinical observation of children for onset of hypoglycemia during oral feeding alone appears safe. Some children with symptoms of hypoglycemia need to receive intravenous dextrose therapy. Time of day of ingestion is not predictive of risk of hypoglycemia. Finally, at this time it appears inappropriate to use a milligram per kilogram body weight dose as a guide for management decisions.

Nurses: act now!

Drawing from the tradition of the theater, we can create a new paradigm for creating humor, health and happiness. The basis of this paradigm: we become what we do. In other words, we can become healthier and more successful by consciously modeling (acting) the happy, healthy traits we desire. In addition, staging, scripting, costuming and acting the part can stimulate our bodies to produce neuropeptides such as endorphins and other chemicals that bolster the immune system and promote well being.

Prospective multicenter evaluation of tramadol exposure

BACKGROUND

Tramadol is a novel analgesic possessing both opiate and noradrenergic effects. Its low potential for abuse suggests increasing use, but there are limited data on the toxicity in overdose.

METHODS

Multicenter prospective case series. All exposures from October 1995 through August 1996 reported to seven Poison Centers were evaluated.

RESULTS

There were 126 cases of which 87 were tramadol alone. Of the tramadol alone cases, 51 were female (59%). Age ranged from 1 to 86 y with a mean and median of 26.8 y (SD 17.2) and 25 y, respectively. There were 15 cases of children less than 6 years old. Symptoms reported with overdose were: lethargy 26 (30%), nausea 12 (14%), tachycardia 11 (13%), agitation 9 (10%), seizures 7 (8%), 4 each (5%) of coma and hypertension, and respiratory depression 2 (2%). All seizures were brief. Naloxone reversed sedation and apnea in 4 of 8 patients. One patient experienced a seizure immediately after administration of naloxone. Other treatments were: diazepam (3 patients), and phenytoin, lorazepam and nifedipine (1 patient each). Tramadol 500 mg was the lowest dose associated with seizure, tachycardia, hypertension or agitation while 800 mg was the lowest dose associated with coma and respiratory depression. Urine drug screens performed on 19 patients were negative for opiates. All symptomatic cases exhibited effects within 4 h of ingestion. Mean hospital stay was 15.2 h (range 2-96 h, SD 15.8). Nineteen patients were admitted to an intensive care unit with a mean stay of 25 h (SD 20).

DISCUSSION

Much of the toxicity in tramadol overdose appears to be attributable to the monoamine uptake inhibition rather than its opioid effects. Agitation, tachycardia, confusion and hypertension suggest a possible mild serotonin syndrome. No arrhythmias beyond tachycardia were seen.

CONCLUSION

This study suggests significant neurologic toxicity from tramadol overdose. Serious cardiovascular toxicity was not seen.

Nondestructive determination of lead, cadmium, tin, antimony, and barium in ceramic glazes by radioisotope X-ray fluorescence spectrometry

Quantitation capabilities of radioisotope X-ray fluorescence spectrometry (RXRFS) for determining lead, cadmium, tin, antimony, and barium in ceramic glazes were investigated. Twenty-one air-dried glazes and 85 fired glazes on test tiles were analyzed by using 109Cd and 57Co excitation sources. Accurate Pb determinations, with limits of detection (LODs) of about 0.3 mg/cm2 for 5 min counting times, were achieved by using the 75 keV K alpha 1 X-ray photopeak and a Pb foil calibration procedure. Cd, Sn, Sb, and Ba concentrations were determined with LODs from about 0.5 to 1.5 mg/cm2. For Pb and Ba, results obtained by using absorption corrections based only on element concentrations determined by RXRFS and an iterative approach led to analytical biases of < or = 4% relative to results obtained by using corrections based on known total element compositions. Biases were more severe for Cd, Sn, and Sb because lower X-ray energies were involved and sensitivities varied as a function of matrix Pb content. Pb concentrations were above LODs (1.3-40 mg/cm2) in 39 of 47 fired "food-safe" glazes and in 33 of the other 38 fired glazes (0.4-39 mg/cm2).