Fentanyl patches left on dead bodies -- potential source of drug for abusers

We report a fatal case of fentanyl poisoning in which the decedent apparently obtained the drug from a used transdermal patch removed from a deceased nursing home patient. Fentanyl drug patches, even those previously used, contain a potentially lethal amount of this potent narcotic analgesic and provide a source of fentanyl for drug abusers. This case demonstrates the importance of proper disposal of these drug patches and the need for strict policies and guidelines in patient care settings regarding their disposal. Since fentanyl derivatives may not be detected on routine toxicologic analysis, specific assays should be utilized for the detection of fentanyl in cases of suspected drug overdose.

Mast cell TNF mRNA expression in nasal mucosa demonstrated by in situ hybridization: a comparison of mast cell detection methods

We have used 35S-labelled RNA probes to detect TNF cytokine gene expression in nasal mucosa derived from patients with perennial rhinitis. As mast cells comprise a minor component of the total cell population in nasal mucosa, additional methods are needed to determine whether mast cells contribute to the cytokine mRNA detected by in situ hybridization. We have combined in situ hybridization with alternate methods to detect mast cells (tryptase immunostaining or toluidine blue staining) and determined that in situ hybridization coupled with tryptase immunostaining provides optimal methods to detect mast cell cytokine gene expression in tissue sections. Using in situ hybridization and tryptase immunostaining, we demonstrate that mast cells in nasal mucosa can express TNF mRNA. However, the number of tryptase-, TNF+ cells (1.99 +/- 1.59 cells/mm2) exceeded the number of tryptase+, TNF+ mast cells (0.09 +/- cells/mm2). Mast cells thus comprised a subpopulation of the total number of TNF mRNA positive cells in nasal mucosa.

Bilayer nanotubes and helical ribbons formed by hydrated galactosylceramides: acyl chain and headgroup effects

The molecular basis of bilayer tubule formation in hydrated galactosylceramide (GalCer) dispersions has been investigated by synthesizing different chain-pure GalCers and examining their aqueous mesomorphic phase structure by freeze fracture and negative-stain electron microscopy. Thermotropic characterization of the GalCer species by differential scanning calorimetry provided supplementary information that verified the phase state under which morphological observations were carried out. Under aqueous conditions and at room temperature, N-24:1 delta 15(cis) GalSph, the predominant monounsaturated, nonhydroxy acyl species of bovine brain GalCer (NFA-GalCer), formed cylindrical mesomorphic self-assemblies consisting almost exclusively of "nanotubes," i.e., lipid bilayer tubules of relatively uniform length and diameter (length, 250-400 nm; diameter, 25-30 nm). In contrast, N-24:0 GalSph, the major saturated, nonhydroxy acyl species of bovine brain GalCer, displayed no tendency to form these relatively small "nanotubes." Rather, N-24:0 GalSph formed larger, variable-length ribbon-like structures (length, 5,000-10,000 nm) that often appeared to undulate and, occasionally, appeared to be helically twisted. Interestingly, bovine brain GalCer, which contains high levels of the N-24:1 delta 15(cis) and N-24:0 species as well as 2-hydroxy acyl chains, formed multilamellar liposomes of variable size and showed little tendency to form cylindrical structures. This result suggested that changes to the polar interface/headgroup region imparted by the 2-hydroxy acyl species strongly influenced bilayer tubule and cylinder formation in GalCer. To define this influence more clearly, other sphingoid-based and glycerol-based lipids were investigated. Morphological characterization of N-24:1 delta 15(cis) sphingosylphosphorylcholine (24:1 SM) revealed no evidence of bilayer cylinder or tubule formation. Similar results were obtained with aqueous dispersions of 1-palmitoyl-2-nervonoyl phosphatidylcholine (16:0, 24:1 PC). Hence, the bulkier, more hydrated, zwitterionic phosphocholine headgroup inhibited the formation of bilayer nanotubes and cylinders under physiological saline conditions.

Macro-ripple phase formation in bilayers composed of galactosylceramide and phosphatidylcholine

As determined by freeze fracture electron microscopy, increasing levels of bovine brain galactosylceramide (GalCer) altered the surface structure of 1-palmitoyl-2-oleoyl-phosphatidylcholine (POPC) bilayers by inducing a striking "macro-ripple" phase in the larger, multilamellar lipid vesicles at GalCer mole fractions between 0.4 and 0.8. The term "macro-ripple" phase was used to distinguish it from the P beta' ripple phase observed in saturated, symmetric-chain length phosphatidylcholines. Whereas the P beta' ripple phase displays two types of corrugations, one with a wavelength of 12-15 nm and the other with a wavelength of 25-35 nm, the macro-ripple phase occurring in GalCer/POPC dispersions was of one type with a wavelength of 100-110 nm. Also, in contrast to the extended linear arrays of adjacent ripples observed in the P beta' ripple phase, the macro-ripple phase of GalCer/POPC dispersions was interrupted frequently by packing defects resulting from double dislocations and various disclinations and, thus, appeared to be continuously twisting and turning. Control experiments verified that the macro-ripple phase was not an artifact of incomplete lipid mixing or demixing during preparation. Three different methods of lipid mixing were compared: a spray method of rapid solvent evaporation, a sublimation method of solvent removal, and solvent removal using a rotary evaporation apparatus. Control experiments also revealed that the macro-ripple phase was observed regardless of whether lipid specimens were prepared by either ultra-rapid or manual plunge freezing methods as well as either in the presence or absence of the cryo-protectant glycerol. The macro-ripple phase was always observed in mixtures that were fully annealed by incubation above the main thermal transition of both POPC and bovine brain GalCer before rapid freezing. If the GalCer mixed with POPC contained only nonhydroxy acyl chains or only 2-hydroxy acyl chains, then the occurrence of macro-ripple phase decreased dramatically.

The bisindolylmaleimide GF 109203X, a selective inhibitor of protein kinase C, does not inhibit the potentiating effect of phorbol ester on ethanol-induced phospholipase C-mediated hydrolysis of phosphatidylethanolamine

In fibroblasts, the protein kinase C (PKC) activator phorbol 12-myristate (PMA) either inhibits or stimulates phospholipase C-mediated hydrolysis of phosphatidylethanolamine in the absence or presence of ethanol, respectively. Here, we demonstrate that the specific PKC inhibitor bisindolylmaleimide GF 109203X prevents only the inhibitory, but not the stimulatory, PMA effect.

Selective down-regulation of protein kinase c-epsilon by carcinogens does not prevent stimulation of phospholipase D by phorbol ester and platelet-derived growth factor

It is well established that activators of protein kinase C (PKC) also enhance the activity of phospholipase D (PLD), and that this regulatory mechanism is altered in transformed cells. Here we used the C3H/10T1/2 mouse embryo fibroblast line, a cellular model for the study of carcinogenesis, to examine possible effects of carcinogens on the PKC isoenzyme pattern and on the regulation of PLD by the PKC activators phorbol 12-myristate 13-acetate (PMA) and platelet-derived growth factor (PDGF). Treatment of these fibroblasts with 0.5 microgram/ml 7,12-dimethyl-benz[a]anthracene or benzo[a]pyrene for 24 h greatly decreased (> 80%) the amount of immunoreactive PKC-epsilon. Of the remaining three isoenzymes identified, carcinogens alone had no effect on the cellular status of PKC-alpha and PKC-delta, although they appeared to promote slightly PMA-induced membrane translocation of the cytosolic forms of these isoenzymes in exponentially growing cells. Carcinogens and/or PMA had no effects on the cellular content or distribution of PKC-zeta. Chronic (24 h) treatments with carcinogens resulted in increased or decreased release of [14C]ethanolamine or [14C]choline from the appropriate prelabelled phospholipids, respectively. However, carcinogens failed to block the stimulatory effects of PMA and PDGF on the hydrolysis of phosphatidylethanolamine and phosphatidylcholine or on the synthesis of phosphatidylethanol mediated by PLD. These data indicate that in fibroblasts PKC-epsilon is not a major regulator of PLD activity.

Hydrogen peroxide regulates phospholipase D-mediated hydrolysis of phosphatidylethanolamine and phosphatidylcholine by different mechanisms in NIH 3T3 fibroblasts

A major goal of this work was to determine in NIH 3T3 fibroblasts whether the recently described effects of H2O2 on phospholipase D-mediated hydrolysis of phosphatidylethanolamine (PtdEtn) and phosphatidylcholine (PtdCho) are mediated by similar or different mechanisms. While exposure of NIH 3T3 fibroblasts to H2O2 stimulated the hydrolysis of both PtdEtn and PtdCho, the following important differences were noted: (i) prolonged (24 h) treatment of fibroblasts with 400 nM phorbol 12-myristate 13-acetate (PMA) blocked the stimulatory effect of H2O2 on PtdEtn, but not on PtdCho, hydrolysis; (ii) PMA-induced hydrolysis of PtdEtn, but not PtdCho, was inhibited by H2O2; (iii) the stimulatory effect of H2O2 was additive with that of sphingosine or staurosporine, inhibitors of protein kinase C, on the hydrolysis of PtdCho, but not PtdEtn; (iv) with membranes isolated from H2O2-treated fibroblasts, the hydrolysis of PtdCho, but not PtdEtn, was increased compared to values obtained with control membranes. These results imply that H2O2 regulates PtdEtn and PtdCho hydrolysis by different mechanisms. Stimulation of PtdEtn hydrolysis by H2O2, sphingosine, and staurosporine may commonly involve, at least in part, neutralization of an inhibitory protein kinase C isozyme.

Carcinogens stimulate phosphorylation of ethanolamine derived from increased hydrolysis of phosphatidylethanolamine in C3H/101/2 fibroblasts

Many human tumors contain high concentrations of ethanolamine phosphate (EtnP). An important question is whether increased formation of EtnP is merely the consequence of cell transformation, or is it associated with the process of carcinogenesis. Here we show that in C3H/10T1/2 embryonic fibroblasts, an established cellular model for the study of carcinogenesis, the environmental carcinogens, 7,12-dimethylbenz[a]anthracene (DMBA) and benzo[a]pyrene (B[a]P) (0.1-1 microgram/ml concentration; 24 h treatment), stimulate phosphorylation of ethanolamine derived from increased hydrolysis of phosphatidylethanolamine. The results suggest that increased formation of EtnP is associated with the early stages of carcinogenesis. This observation may have prognostic value.

Elicitation of a predominantly lambda light chain-bearing antibody response in BALB/c mice to a novel bifunctional aminocarboxylate chelating agent

A panel of murine monoclonal antibodies has been raised against the aminocarboxylate bifunctional chelating agent PA-DOTA complexed with Samarium. Ninety percent of the antibodies (43 of 48) used a lambda light chain. The binding specificity of 11 of the antibodies was examined by competition assays using several structurally related aminocarboxylate chelating agents containing different metals. Most of the antibodies are directed against the macrocycle ring of PA-DOTA and require the presence of a metal within the structure for binding.

High-resolution CT in simple coal workers' pneumoconiosis. Lack of correlation with pulmonary function tests and arterial blood gas values

We examined 21 miners by means of standard chest radiography, high-resolution computerized tomography (HRCT), pulmonary function tests, and resting arterial blood gas levels. Using the ILO/UC classification of pneumoconiosis, 7 miners had category 1/0 or 2/1 simple coal workers' pneumoconiosis (CWP). By HRCT, nodules were identified in 12 miners; 4 of 9 were classified as category 0/0 CWP; 2 of 5, 0/1 CWP; 5 of 6, 1/0 CWP; and 1 of 1, 2/1 CWP by chest radiograph. Focal emphysema was identified by HRCT in 7 miners; 4 of 9 were classified as 0/0 CWP; 2 of 5, 0/1 CWP; and 1 of 6, 1/0 CWP by standard chest radiography. Four miners with definite nodules confirmed by HRCT had focal emphysema, while three without nodules had focal emphysema. Pulmonary function testing was not different between miners with or without CWP by standard chest radiography, nor was it different between miners with or without definite nodules evidenced by HRCT. No difference in resting oxygenation was found between any group of miners. The presence of focal emphysema confirmed by HRCT did not significantly affect pulmonary function tests on resting arterial blood gas values. There was, however, a significantly lower FEV1 and mean forced expiratory flow during the middle half of forced vital capacity with lifetime nonsmoking miners. The presence of CWP on chest radiography was significantly correlated with smoking cigarettes but not the years of mining. The presence of nodules on HRCT approached a significant correlation with cigarette smoking, but focal emphysema did not. For detecting evidence of coal dust accumulation in lung parenchyma and identifying focal emphysema, HRCT was more sensitive than standard chest radiography. However, despite earlier detection of parenchymal abnormalities, abnormal pulmonary function attributable to coal dust could not be identified.

A simplified procedure for the determination of free codeine, free morphine, and 6-acetylmorphine in urine

A procedure for detection and quantification of free codeine, free morphine, and 6-acetylmorphine in urine is presented. The analytes were extracted at neutral pH by solid-phase extraction prior to derivatization to their trifluoroacetyl derivatives. The derivatized extracts were analyzed by gas chromatography/mass spectrometry in the electron impact mode. Confirmation of the analytes was accomplished by comparing the ion abundance ratios of the analytes to those of a previously analyzed standard. The qualitative ion abundance ratios were required to be within 20% of those of the standard for acceptance. Quantification was based on the tri-deuterated analogs of the analytes. Linearity was obtained in the range of 10 to 1000 ng/mL, with correlation coefficients of all analytes exceeding 0.999. Percent recoveries were 90% for codeine, 88% for morphine, and 85% for 6-acetylmorphine. No hydrolysis of 6-acetylmorphine occurs during the extraction procedure. The authors also studied the stability of 6-acetylmorphine at various storage conditions of pH, temperature, and chemical preservation. 6-Acetylmorphine was found to be stable for 12 weeks when stored at -17 degrees C.

Impact of arterial blood gas analysis in disability evaluation of the bituminous coal miner with simple pneumoconiosis

The Department of Labor has set guidelines for the use of resting arterial blood gas analysis in determination of total and permanent disability for coal workers' pneumoconiosis. To determine the prevalence with which bituminous coal miners fall below the arterial tensions of both oxygen and carbon dioxide published in the Federal Register, we studied 1012 miners who had both reproducible spirometry and arterial blood gas analysis as part of their disability evaluation. Eighty-seven percent of impaired miners could be identified by the spirometric criteria. Thirteen percent of impaired bituminous coal miners had acceptable pulmonary function but were eligible for black lung benefits by the blood gas guidelines. This population would have been missed if blood gas analysis were excluded from the evaluation process. On the other hand, approximately 25% of the blood gas analyses that were performed could be eliminated if a policy was adopted to do this test only on miners with spirometry that exceed the federal guidelines.

The mandibular third molar position as a predictive criteria for risk for pericoronitis: a retrospective study

During the 6-month period from mid February 1988 to mid August 1988, 148 patients presented with 154 diagnosed cases of mandibular third molar pericoronitis. All patients were members of the recruit population stationed at the Recruit Training Command, Great Lakes, Illinois. Selected clinical parameters relating to the orientation and eruption status of these third molars were collected and analyzed. The goal was to obtain a predictive clinical profile of the impacted mandibular third molar (MTM) at greatest risk for pericoronitis in the young naval and Marine Corps personnel. The majority of pericoronitis cases, 120 of 148 or 81.0%, involved vertically oriented MTMs; of this total, 79.1% were erupted to the approximate height of the occlusal plane of the arch. The remaining 20.9% were at or below the height of contour of the adjacent tooth. Mesioangular impacted MTMs accounted for only 11.2% of pericoronitis cases. The remaining cases comprised distoangular and horizontally impacted MTMs (3.4% and 3.8%, respectively). Involvement by impinging maxillary dentition was observed in 39.7% of the vertically oriented MTMs, 56.2% of the mesioangular oriented MTMs, 40.0% of the distoangular MTMs, and 14.0% of the horizontally impacted MTMs. The mean value for occlusal coverage by a soft tissue operculum observed for all MTMs in this study was 49%. In the population studied, risk for pericoronitis appears to increase with greater vertical orientation and height of eruption. The absence of impinging maxillary dentition did not eliminate the risk of mandibular third molar pericoronitis. These data have implications for targeting treatment needs of naval and Marine Corps personnel who may be without dental support for extended periods of time.

Enhancement of storage phosphor plate images: a C-language program

A C-language software program has been developed for emulating the image enhancement processing of a storage phosphor plate system. This software has been implemented on a VAX 3400 computer. There are 2,100 lines of C-language code in the program. There are seven parameters used to specify the degree of enhancement. The software is being implemented on a single accelerator board.

Tuberculosis in the intensive care unit: a chemotherapeutic controversy

A survey of 150 practicing pulmonary physicians was conducted to determine chemotherapy preferences for the treatment of the patient suffering respiratory insufficiency secondary to active nonmiliary tuberculosis. An equal sample was selected from both the private sector and academic medicine in order to determine if antituberculous agent selection differed between these two groups. The majority of the 109 physicians who responded to the questionnaire (64.2%) indicated that they would use isoniazid, rifampin, and a third agent. There was no statistical difference in the choice of ethambutol, pyrazinamide, or streptomycin as the third drug. There was no difference between university and community based physicians in the use of three drug combinations or in the selection of the specific third agent. This study suggests that, although the majority of pulmonologists responding would treat the patient with respiratory insufficiency from tuberculosis with an aggressive three drug approach, there is no consensus as to which agent should be the third drug.

A rapid method for the preparation of yeast for immunoelectron microscopy using Lowicryl HM-20

We describe a fixation and embedding procedure for the yeast Saccharomyces cerevisiae using Lowicryl HM-20 which is rapid, gives excellent fixation, and avoids the low temperature handling normally associated with embedding in this resin. This procedure yields superior structural preservation when compared to the commonly used rapid embedding procedure which employs Lowicryl K4M. We demonstrate that sections prepared using our rapid procedure are suitable for use in immunogold labelling experiments.

The severity of diabetes is a major determinant of myocardial damage in the rat

The severity of insulin-dependent diabetes mellitus had a marked effect upon the development of myocardial sequelae in the rat. Even with the same degree of hyperglycemia, glycosuria, polydipsia, and polyuria, moderately diabetic animals did not develop the degenerative ultrastructural changes seen in myocardium from more severely diabetic rats. These included decreased cardiocyte size, loss and disorganization of myofibrils, and loss of sarcoplasmic reticulum and transverse tubules. Since hyperglycemia and glycosuria are frequently used as the primary, and often sole, criteria for identifying diabetes in experimental animals, this study demonstrates the need to more specifically define the severity of the disease in studies of the heart.

The forensic science implications of site and temporal influences on postmortem blood-drug concentrations

The dependence of postmortem blood-drug concentrations on the collection site and on the postmortem interval before specimen collection has been studied. These studies consisted of both sequential sampling from the same collection site at defined time intervals and a comparison of the drug concentrations of postmortem blood simultaneously collected from various sites. A site and time dependence was observed for postmortem blood-drug concentrations. The heart blood-drug concentrations were, in general, significantly higher than those of peripheral specimens. As a result of this phenomenon, the analysis of peripheral blood specimens and solid tissues is often necessary before a definitive interpretation of postmortem toxicological analyses is possible.

Tularemic pneumonia mimicking Legionnaires' disease with false-positive direct fluorescent antibody stains for Legionella

Pleuropulmonary tularemia may mimic atypical pneumonia caused by other common etiologic agents, including Legionella. The correct identification of the pathogen responsible for the atypical pneumonia is usually made serologically or with the use of special stains and cultures. We have reported a case of pleuropulmonary tularemia whose diagnosis was confounded by false-positive direct fluorescent antibody stains for Legionella.

Pulmonary complications after tricyclic antidepressant overdose

We studied 82 consecutive patients admitted to the ICU with predominant tricyclic antidepressant overdose (mean plasma tricyclic level, 1,025 ng/ml) to determine the nature and incidence of respiratory complications. The majority of patients (80.4 percent) had a decreased arterial to alveolar oxygen tension ratio (PaO2/PAO2) on initial emergency room arterial blood gas analysis (mean, 0.56). Mechanical ventilation was required in 76.8 percent of the patients for a mean duration of 46.2 h. Chest radiograph abnormalities developed during the first 48 h in 32/82 patients (39 percent). The group with radiographic abnormalities had higher mean drug levels than the group without (p less than 0.05). Of 82 patients, nine (11 percent) developed radiographic evidence of bilateral alveolar infiltrates suggestive of acute lung injury. This group had significantly higher mean drug levels than the groups with other types of radiographic abnormalities (p less than 0.001). Charcoal was recovered from the airway of 18/72 patients who received activated charcoal slurry by nasogastric tube in the emergency room after endotracheal intubation. The group who aspirated did not show statistically significant difference in the incidence of chest radiograph abnormalities, gas exchange, or survival compared with the group that did not aspirate.

Cigarette smoking and federal black lung benefits in bituminous coal miners

The records of 1000 consecutive coal miners applying for benefits under the Federal Coal Mine Health and Safety Act were examined to determine the contribution of age, dust accumulation, and cigarette smoking to the profile of the miner who satisfies the current pulmonary criteria for disability. Using the presence of pneumoconiosis on chest radiograph as the indication of significant coal dust accumulation, the miners were separated into Group A--those without pneumoconiosis (n = 316) and Group B--those with pneumoconiosis (n = 684). The federal spirometric criteria for disability identified 55/316 miners in Group A (14.5%) and 99/684 miners in Group B (17.4%) potentially eligible for an award (P = .27). The mean ages of miners in both groups did not differ significantly, nor was there difference in the mean ages of groups that did or did not meet the federal criteria. In both groups, those miners potentially eligible for a financial award smoked more cigarettes than did their counterparts (Group A, 31.0 v 18.5 pack-years, P less than .001; Group B, 31.3 v 23.6 pack-years, P less than .001). There was no difference in the smoking histories of the miners from either group who met the federal criteria. Our data indicate that, in the case of bituminous coal miners, the present federal legislation intended to identify and remunerate those who suffer lung impairment from chronic occupational exposure to coal dust is biased in favor of those who sustain additional damage to their ventilatory capacity by smoking cigarettes.

Resting gas exchange in nonsmoking bituminous-coal miners with simple pneumoconiosis

Gas exchange at rest under normoxic conditions was studied in 2,297 nonsmoking bituminous-coal miners with and without simple coal workers' pneumoconiosis (CWP). Measurements of arterial oxygen tension (Pao2) and arterial carbon dioxide tension (Paco2) from blood gas samples obtained at rest in the seated position were used to calculate the alveolar-arterial oxygen tension difference, (A-a)Do2, using the classic alveolar-air equation. We then recalculated the (A-a)Do2 using the age-predicted Pao2 for each miner. The difference between the actual and the predicted (A-a)Do2 was measured and the mean difference for each category of simple CWP was analyzed. We found no evidence that the resting gas exchange differs significantly from the age-predicted (A-a)Do2 in the nonsmoking bituminous-coal minor with simple CWP. Likewise, there is no significant change in (A-a)Do2 with change in the category of simple CWP.