Method validation of microcystins in water and tissue by enhanced liquid chromatography tandem mass spectrometry.

A liquid chromatography-electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) method has been developed and validated to identify and quantify trace levels of cyanotoxins or microcystins (MC) in water, bivalves and fish tissue with enhanced sensitivity and specificity. The method enables confirmation and quantification of six MCs (MC-LA, LF, LR, LW, RR and YR) with a single chromatographic run. The applied chromatography also allows determination of certain MC metabolites (Desmethyl-LR and -RR). By using LC-ESI-MS/MS in multiple reaction monitoring (MRM) mode, the limit of detection and quantitation for the microcystins studied, were determined to be between 0.2 and 1 pg on column (5:1 S/N ratio). These values are below the 2 pg detection limits found in the available literature.

Extraction and analysis methods for the determination of pyrethroid insecticides in surface water, sediments and biological tissues at environmentally relevant concentrations.

The aim of this study was to develop and validate chemical methods for measuring pyrethroid insecticides at environmentally relevant concentrations in different matrices. The analytes included six synthetic pyrethroids with the highest agricultural and commercial structural uses in California: bifenthrin, cyfluthrin, cypermethrin, esfenvalerate/fenvalerate, lambda-cyhalothrin, permethrin, and their corresponding stereoisomers, which includes enantiomers, diastereomers and racemic mixtures. Fortified water samples were extracted for analysis of synthetic pyrethroids using liquid-liquid extraction, while fortified sediment and fish tissue samples were extracted using pressurized fluid extraction followed by gel permeation chromatography (GPC) to remove matrix interferences. A florisil column was used for additional cleanup and fractionation of sediment and tissue extracts. Extracts were analyzed using dual column high resolution gas chromatography with electron capture detection (GC/ECD) and confirmation was obtained with gas chromatography mass spectrometry using a quadrupole ion trap detector in MS-MS mode. Method detection limits (MDLs) have been established for water (1-3 ng/L), sediment (0.5-4 ng/g dry weight) and tissue (1-3 ng/g fresh weight). Mean percent recoveries of fortified blanks and samples ranged from 75 to 115% with relative standard deviation (RSD) values less than 20% for all target compounds.

Rattlesnake bite of glans penis.

The envenomation of the glans penis by a western diamondback rattlesnake (Crotalus atrox) is presented. Effects of envenomation, first aid, and hospital management are briefly reviewed.

Prostatic cancer, acid phosphatase, creatine kinase-BB and race: a prospective study.

To examine the effectiveness of prostatic acid phosphatase and creatine kinase-BB determinations in detecting prostatic cancer serum from 594 men more than 40 years was assayed for prostatic acid phosphatase with the thymolphthalein monophosphate substrate and a radioimmunoassay kit. Creatine kinase-BB levels also were measured with a radioimmunoassay kit. Patients with benign prostatic hyperplasia had higher prostatic acid phosphatase levels than normal controls. Accordingly, to avoid a high incidence of false positives in patients with benign prostatic hyperplasia the 92.5 percentile level of the patients with benign prostatic hyperplasia (3.9 ng./ml.) was chosen as the upper limit of normal. With this critical value elevated prostatic acid phosphatase levels were observed in 6 per cent of the patients with clinical stage A disease, 8 per cent with stage B, 35 pr cent with stage C and 68 per cent with stage D. The radioimmunoassay was no more effective than the enzymatic assay in detecting prostatic cancer. A correlation between prostatic acid phosphatase levels and patient race was observed, with 80 per cent of the black patients with extracapsular prostatic cancer having elevated prostatic acid phosphatase levels compared to 34 per cent of the white patients with similar stage disease. Creatine kinase-BB was elevated only in patients with advanced disease and was of little value in the diagnosis of prostatic cancer.

Unreliability of sentinel lymph node biopsy for staging penile carcinoma.

We present a patient in whom unresectable lymph node metastases developed within 6 months of negative bilateral sentinel lymph node biopsies. The management of regional lymph nodes of patients with carcinoma of the penis is discussed.

Effect of mini-dose heparin on lymphocele formation following extraperitoneal pelvic lymphadenectomy.

To evaluate the effect of mini-dose heparin therapy on lymphocele formation after extraperitoneal pelvic lymphadenectomy we reviewed the records of 38 patients undergoing this procedure for prostatic cancer during a 24-month period. All patients had a minimum of 6 months of followup. Lymphoceles occurred in 3 of 8 patients (38 per cent) receiving mini-dose heparin and prolonged lymph drainage occurred in 1 other patient (12 per cent). In contrast, only 1 of 30 patients (3 per cent) not receiving mini-dose heparin had a lymphocele and 1 (3 per cent) had prolonged lymph drainage. The results suggest that mini-dose heparin may delay clotting of lymph and, thus, may be associated with an increased incidence of lymphocele formation after extraperitoneal lymphadenectomy.

Three-day treatment of urinary tract infections.

There is little rationale to support the currently accepted 10 to 14-day treatment period for urinary tract infection. To assess the cure rate in patients given 3 days compared to the standard 10-day period of antimicrobial therapy a prospective trial was designed to test the over-all effectiveness of each treatment. Sixty patients were randomized to either penicillin-G or trimethoprim-sulfameth-oxazole for either 3 or 10 days. Urine and external vaginal cultures were done before therapy was instituted, at day 3 while on therapy and 7 days after the completion of treatment. The over-all cure rate in the short-term treatment group was 86 per cent and in the long-term treatment group it was 88 per cent. Patients receiving trimethoprim-sulfamethoxazole had a much better response to clearance of the pathogenic bacteria from the external vagina but this did not correlate with clearance of the bladder bacteriuria. Bacterial sensitivities on the external vaginal cultures suggest that in some patients 10 days of therapy actually may aid in the development of bacterial resistance noted in subsequent bladder infections. Finally, a cost-benefit analysis revealed that the use of a 3-day regimen as standard treatment for urinary tract infections would result in a savings to our patients conservatively estimated at $62,000,000 yearly.

A re-appraisal of treatment in chronic bacterial prostatitis.

The pH of normal human expressed prostatic secretion in 136 samples from 93 men was 7.28 +/- 0.04. In 41 samples from 14 patients with documented chronic bacterial prostatitis the alkalinity of prostatic fluid was increased 10-fold (1 pH unit) and was 8.32 +/- 0.07. We believe these studies account for the failure of trimethoprim to eradicate human bacterial prostatitis effectively despite the experimental data documenting diffusion and concentration of trimethoprim in the acidic prostatic fluid of the normal dog. The factors governing drug diffusion into the prostate and the influence of pH on the concentration of trimethoprim in the expressed prostatic secretion are discussed.

Single stage urethroplasty as treatment for stricture disease.

The use of a full thickness free skin graft for a single stage urethroplasty in stricture disease has been popularized recently by Devine and Horton. From 1973 to 1977, 40 patients at our hospitals have been treated with single stage urethroplasty using this technique. Excellent results have been noted on followup evaluation.

Pelvic lipomatosis: 5-year followup.

Followup of 5 cases presented in 1971 and report of 8 additional cases confirm the initial conclusions that pelvic lipomatosis is a benign but potentially progressive process leading to ureteral obstruction. Young black subjects are affected most commonly. More than 40 per cent of the patients have required permanent urinary diversion.

Paraganglioma of urinary bladder wall.

A classic case of pheochromocytoma of the urinary bladder is presented. The history of headaches and palpitations during micturition is the result of sudden release of catecholamines into the general circulation. The diagnosis using selective arteriography as well as the medical and surgical management are described.

Significant hematuria secondary to sickle cell trait in a white family.

A 21-year-old blond, white woman was evaluated for recurrent episodes of significant painless gross hematuria. She was found to have sickle cell trait, and hematologic evaluation made through four generations isolated the trait to the paternal side.

Angiography in pheochromocytoma of the urinary bladder. Report of a case.

A case of pheochromocytoma of the urinary bladder in a 20-year-old female is reported. This is the 36th reported case in the English language literature. The patient had classical symptoms of vesical pheochromocytoma with sudden onset of headache, palpitations, and blood pressure elevation during voiding. The provisional diagnosis was arrived at on clinical history, laboratory investigations, including the estimation of catecholamines and vanil mandelic acid (VMA). The diagnosis was confirmed and the tumor was exactly localized by means of angiography. The angiographic appearance of pheochromocytoma of the urinary bladder is not pathognomonic and is similar to that previously described for adrenal pheochromocytoma. Angiography is, with adequate precautions, a safe and useful procedure for ruling out synchronous adrenal or extra-adrenal tumors and for exact localization of the bladder tumor.

Chyluria.

A twenty-four-year-old black female presented through the outpatient department complaining of "white urine". Pertinent history, physical examination, and diagnostic studies are reviewed with special emphasis on lymphangiography. The literature is reviewed particularly with regard to laterilization of the fistula, thoracic duct obstruction, and methods of therapy.

External sphincterotomy: its effect on erections.

External urethral sphincterotomy on 129 paraplegics had little effect on erections. In the 101 patients with post-injury erections only 2 had cessation of erectile capacity. Subjectively, 16 per cent had partial loss and 13 per cent had an increase. The remaining 69 per cent had no change. When the data were correlated with level and completeness of injury, age, time since injury, time since sphincterotomy, postoperative delayed hemorrhage and effect on leg and bladder spasms, no conclusions could be drawn concerning the etiology of altered erections.