Fatal intoxications with chloral hydrate.

An alcoholic man, treated with chloral hydrate (CH) syrup to which he was dependent, was discovered comatose and in respiratory arrest. Death occurred on the ninth day of hospitalization following cerebral oedema. A woman, alcohol addicted, depressed, and epileptic was admitted in the Intensive Care Unit with heart and respiratory failure following CH absorption. She died three days later after a deep coma. In these two cases, CH intoxication was confirmed by toxicological analysis: CH and its major metabolite, trichloroethanol (TCE), were identified and determined in serum and urine using headspace-capillary gas chromatography-mass spectrometry. The concentrations measured were compared with those found in previously published fatalities. The analytical method used can be proposed for both clinical and forensic cases.

Multiresidue determination method for organophosphorus pesticides in serum and whole blood by gas chromatography-mass-selective detection.

This paper describes a rapid, specific and sensitive method for the determination of 29 organophosphorus pesticides in blood and serum, involving a rapid solid-phase extraction procedure using Oasis HLB cartridges and gas chromatography coupled to mass-selective detection. The ionization was performed by electron Impact and acquisition in the single ion monitoring mode followed three specific ions per analyte. Extraction recoveries were satisfactory and ranged between 40 and 108% in blood and serum. Limits of detection ranged from 5 to 25 ng/ml and limits of quantitation (LOQs) ranged from 10 to 50 ng/ml, in blood and serum. An excellent linearity was observed from these LOQs up to 1000 ng/ml. Intra- and inter-assay precision and accuracy were satisfactory for most of the pesticides analyzed.

Sensitive and specific multiresidue methods for the determination of pesticides of various classes in clinical and forensic toxicology.

Original and sensitive multiresidue methods are presented for the detection and quantitation, in human biological matrices, of 61 pesticides of toxicological significance in human. These methods involved rapid solid-phase extraction using new polymeric support (HLB and MCX) OASIS cartridges. Gas chromatography-mass spectrometry (GC-MS) was used for volatile (organophosphate, organochlorine, phtalimide, uracil) pesticides and liquid chromatography-ionspray-mass spectrometry (LC-MS) for thermolabile and polar pesticides (carbamates, benzimidazoles). Acquisition was performed in the selected ion monitoring (SIM) mode. Extraction recovery varied owing to the nature of pesticides, but was satisfactory for all. Limits of detection (LODs) and limits of quantitation (LOQs) ranged, respectively, from 2.5 to 20 and from 5 to 50ng/ml. An excellent linearity was observed from LOQs up to 1000ng/ml for all the pesticides studied. The proposed procedures yielded reproducible results with good inter-assay accuracy and precision. A few cases of intoxication are presented to demonstrate the diagnostic interest of these methods: in two cases were determined lethal concentrations of endosulfan and carbofuran; in four other cases, the procedures helped diagnose intoxication with, respectively, parathion-ethyl, the association of bromacil and strychnine, bifenthrin and aldicarb.

High-performance liquid chromatographic determination of tianeptine in plasma applied to pharmacokinetic studies.

An improved analytical method for the quantitative measurement of tianeptine and its main metabolite MC5 in human plasma was designed. Extraction involved ion-paired liquid-liquid extraction of the compounds from 1.0 ml of human plasma adjusted to pH 7.0. HPLC separation was performed using a Nucleosil C18, 5 microm column (150x4.6 mm I.D.) and a mixture of acetonitrile and pH 3, 2.7 g l(-1) solution of sodium heptanesulfonate in distilled water (40:60, v/v) as mobile phase. UV detection was performed using a diode array detector in the 200-400 nm passband, and quantification of the analytes was made at 220 nm. For both tianeptine and MC5 metabolite, the limit of quantitation was 5 microg l(-1) and the calibration curves were linear from 5 to 500 microg l(-1). Intra- and inter-assay precision and accuracy fulfilled the international requirements. The recovery of tianeptine and its metabolite from plasma was, respectively, 71.5 and 74.3% at 20 microg l(-1), 71.2 and 70.8% at 400 microg l(-1). The selectivity of the method was checked by verifying the absence of chromatographic interference from pure solutions of the most commonly associated therapeutic drugs. This method, validated according to the criteria established by the Journal of Chromatography B, was applied to the determination of tianeptine and MC5-metabolite in human plasma in pharmacokinetic studies.

A non-fatal case of intoxication with foxglove, documented by means of liquid chromatography-electrospray-mass spectrometry.

The non-fatal self-poisoning of a 36-year-old female patient, who ingested a concoction of foxglove (Digitalis Purpurea), is presented. On the admission, initial symptoms were nausea and vomiting, abdominal pain, and cardiovascular shock with sinus bradycardia. Blood and urine were assayed for 17 cardiotonic hetorosides, using a highly specific LC-MS procedure. Serum and urine specimens were collected over five days and analyzed by liquid chromatography-electrospray-mass spectrometry (LC-ES-MS). This accurate procedure allowed the determination of the digitalis glycosides and their metabolites in serum and urine. The serum concentrations of digitalis glycosides were maximum on the first day (gitoxin 13.1 ng/mL, digitoxin 112.6 ng/mL, digitoxigenin 3.3 ng/mL, and digitoxigenin mono-digitoxoside 8.9 ng/mL) and decreased over five days. We observed a peak gitaloxin level (112.6 ng/mL) on the fifth day only. After administration of atropine as well as dimeticone, alginic acid, and metoclopramide, health status improved. The peak urine concentrations were reached at hour 30 and were respectively 91.3 and 69.9 ng/mL for gitaloxin and digitoxin, while those of digitoxigenin, digitoxigenin mono-digoxoside and gitoxin were lower (respectively 0.7, 1, and 5.6 ng/mL). The patient was discharged on the fifth day when there were no residual symptoms.

Methods for the determination of seven selective serotonin reuptake inhibitors and three active metabolites in human serum using high-performance liquid chromatography and gas chromatography.

This paper describes a set of simple and sensitive multiresidue methods for the determination of the specific serotonin reuptake inhibitors (SSRIs) used as antidepressant drugs, and some of their respective active metabolites in human serum. It involves liquid-liquid extraction procedures followed by gas chromatography coupled to nitrogen phosphorus detection or isocratic reversed-phase high-performance liquid chromatography combined with fluorescence detection (HPLC-FL), depending on the analytes. Extraction recoveries were between 71 and 96% for the eight SSRIs and their metabolites analysed by GC and between 41 and 77% for the two of them analysed by HPLC. Limits of detection (LODs) and limits of quantitation (LOQs) ranged, respectively, from 2.5 to 5 microg/l and from 10 to 20 microg/l. Intra-assay and inter-assay precision was studied at three and four concentration levels, respectively, and was less than 19% for all compounds. Accuracy was also satisfactory for all. An excellent linearity was observed from the LOQs up to 1000 microg/l for milnacipram and paroxetine and from each LOQ up to 400 mg/l for the other compounds. The performance of the methods described thus allows the therapeutic drug monitoring of the currently commercialised SSRIs.

Fatal intoxication following self-administration of a massive dose of buprenorphine.

Several drug packages, including Subutex (high-dose buprenorphine, as sublingual tablets) boxes, were found near the corpse of a 25-year-old male drug addict, who apparently had committed suicide. The autopsy revealed a fatal respiratory depression. The toxicological investigations concluded that death resulted from massive burpienorphine intoxication. The determination of buprenorphine (BU) and norbuprenorphine (NBU) in all biological specimens was performed by liquid chromatography-electrospray mass spectrometry (LC-ES-MS) after hydrolysis (for solid tissues), deproteinization of the matrices, and solid-phase extraction of the compounds. Exceptionally high concentrations of BU and NBU were found in blood (3.3 and 0.4 mg/L, respectively), urine (3.4 and 0.6 mg/L), bile (2035 and 536 mg/L and brain (6.4 a nd 3.9 microg/g). The high concentration of BU (899 mg/L) and the absence of NBU in gastric liquid suggested oral intake. High concentrations of amino-7-flunitra/epam, the main metabolite of flunitra/epam, were also found in blood, urine and gastric liquid. This benzodiazepine may have been a co-factor in the toxic effects of BU.

Sensitive and specific determination of midazolam and 1-hydroxymidazolam in human serum by liquid chromatography-electrospray mass spectrometry.

A liquid chromatographic-mass spectrometric technique was designed for the determination of the anaesthetic benzodiazepine midazolam (MID) and its active metabolite 1-hydroxymidazolam (1-OHM), with the aim of conducting pharmacokinetic/pharmacodynamic studies. MID and 1-OHM were extracted from alkalinised (pH 9.5) spiked and clinical serum samples using a single step, liquid-liquid extraction procedure with diethyl ether-2-propanol (98:2, v/v). The chromatographic separation was performed on a Nucleosil C18, 5 microm (150x1 mm I.D.) column, using a gradient of acetonitrile in 5 mM ammonium formate, pH 3.0 as the mobile phase, delivered at a flow-rate of 50 microl/min. The compounds were ionised in the ionspray source of an atmospheric pressure mass spectrometer, fragmented by in-source collisions and the pseudomolecular and fragment ions detected in the selected ion monitoring mode. The recovery was between 79 and 87% for MID, between 83 and 87% for 1-OHM and 81.5% for methylclonazepam. The limit of detection was 0.2 microg/l for MID and 0.5 microg/l for 1-OHM, the limit of quantitation (LOQ) was 0.5 microg/l for both. Linearity was verified from these LOQs up to 2000 microg/l and the method was found accurate and precise over this range. It was successfully applied to a preliminary study to establish the concentration versus time curve of MID and 1-OHM in a patient administered midazolam by continuous infusion.

[A specific dosage method for the analysis of 24 antidepressants using gas chromatography-mass spectrometry (GC/SM)]. / Méthode de dosage spécifique de 24 antidépresseurs par couplage chromatographie en phase gazeuse-spectrométrie de masse (CG/SM).

A specific and sensitive method for the analysis of 24 antidepressants in human serum was developed using gas chromatography-mass spectrometry (GC/MS). This method allowed the simultaneous determination of antidepressants belonging to different classes: tricyclic antidepressants (TADs), selective serotonin reuptake inhibitors (SSRIs) and selective inhibitors of monoamine oxidase A (IMAOs). Antidepressants were submitted to liquid-liquid extraction at pH 9.5 using a mixture of heptane/isoamyl alcohol (98.5/1.5; v/v) without derivatization. Cyproheptadine was used as the internal standard (IS). Separation was obtained with a nonpolar PTE5 capillary column (30 m x 0.32 mm; film thickness 0.25 micron). Mass spectrometry consisted of electron impact ionisation (70 eV), and full scan acquisition. Extraction recoveries were over 60% for 22 antidepressants and between 35 and 95% for moclobemide and viloxazine. Limits of quantitation ranged from 20 to 100 ng/ml for most of the antidepressants, except for moclobemide and viloxazine for which it was 500 ng/ml. Intra-assay standard deviation was satisfactory. An excellent linearity was observed from the respective LOQs up to 1000 ng/ml for 22 antidepressants and up to 4000 ng/ml for moclobemide and viloxazine.

Liquid chromatography-electrospray mass spectrometry multi-residue determination of pesticides in apples and pears.

This paper describes a rapid, specific and sensitive multi-residue method for the routine quantitative analysis of pesticides of several classes used for the treatment of apples and pears, down to their respective maximum residue limits (MRLs). It involves a rapid extraction procedure and liquid chromatography coupled to electrospray mass selective detection. Seven pesticides were extracted at pH 4.5 with a mixture of acetone-dichloromethane-hexane (50:20:30, v/v/v). Ionization was performed at atmospheric pressure in an electrospray-type source and detection was carried out using the selected ion monitoring (SIM) mode. Extraction recoveries were between 55 and 98% except for methylthiophanate (< 20%). Limits of detection (LODs) and limits of quantitation (LOQs) ranged, respectively, from 0.01 to 0.02 mg/kg and from 0.02 to 0.05 mg/kg, with relative standard deviation (R.S.D.) less than 19%. An excellent linearity was observed for LOQs up to 5 mg/kg. Intermediate ("inter-assay") precision and accuracy were satisfactory. The method was applied to many fruit samples intended for commercialization.

Sensitive determination of irinotecan (CPT-11) and its active metabolite SN-38 in human serum using liquid chromatography-electrospray mass spectrometry.

A couple of sensitive and accurate liquid chromatography-electrospray mass spectrometry (LC- S-MS) methods for the determination of the total forms of irinotecan and its active metabolite SN-38 in human serum, using the same chromatographic and detection conditions, is presented. Both used camptothecin as internal standard (I.S.). The sample pretreatment for irinotecan involved a simple protein precipitation with acetonitrile, whereas a liquid-liquid extraction was necessary for SN-38. A Symmetry C18, 3.5 microm (150 x 1 mm I.D.) reversed-phase column was used for the chromatographic separation, together with a gradient elution of acetonitrile in 5 mM ammonium formate buffer (pH 3) as mobile phase. After ionisation in the pneumatically-assisted electrospray source and in-source collision induced dissociation, acquisition was performed in the selected ion monitoring mode. Recoveries were 69 and 47% on average, detection limits 2.5 and 0.25 ng/ml and quantitation limits 10 and 0.5 ng/ml for irinotecan and SN-38, respectively. Reproducibility was good and the method was linear from limits of quantitation up to 10,000 ng/ml for irinotecan, and up to 100 ng/ml for SN-38. This sensitive and highly specific method is suitable both for pharmacokinetic studies and routine therapeutic drug monitoring.

Multiresidue determination of pesticides in apples and pears by gas chromatography-mass spectrometry.

This paper describes a rapid, specific and sensitive multiresidue method for the routine analysis of several classes of pesticides used for the treatment of apples and pears, involving a rapid extraction procedure at pH 4.5 with a mixture of acetone-dichloromethane-hexane (50:20:30, v/v/v) and gas chromatography coupled to mass-selective detection, in order to achieve quantitative analysis down to their respective maximum residue limit. Extraction recoveries were between 55 and 98%. Limits of detection and limits of quantitation ranged respectively, from 0.01 to 0.05 mg/kg and from 0.02 to 0.1 mg/kg. Intra-assay relative standard deviation was less than 19% for all compounds. An excellent linearity was observed from these LOQs up to 500 mg/kg. Intermediate (inter-assay) precision and accuracy were satisfactory. The method has been applied to many fruit samples intended for commercialisation.

Screening procedure for 21 amphetamine-related compounds in urine using solid-phase microextraction and gas chromatography-mass spectrometry.

A specific, sensitive, and rapid procedure for the screening of 21 amphetamine-related compounds in urine is developed using solid-phase microextraction (SPME) and gas chromatography-mass spectrometry. Very clean extracts are obtained in one step with SPME using silica fibers coated with a 100-micron polydimethylsiloxane stationary phase. Temperature, time, pH, and salt saturation are optimized to obtain consistent extraction. An excellent chromatographic separation of the underivatized analytes is obtained with a specially treated nonpolar capillary column (Supelco PTA-5, 30 m x 0.32-mm i.d., 0.5-micron film thickness) dedicated to amino compounds. Selected ion monitoring of three fragments per analyte and one for each of the three deuterated internal standards elicits a high selectivity and detection limits between 1 and 50 ng/mL (i.e., low enough to verify positive results obtained with immunochemical assays). The method is linear in a narrow range (from the detection limit up to 500 ng/mL) when all the amphetamines are assayed together but shows a good linearity up to 2000 ng/mL when the molecules are determined individually. Repeatability is not satisfactory for all compounds but could probably be improved by strictly controlling the extraction time (e.g., by automating the whole procedure using an autosampler). The use of SPME reduces the interference due to urinary low-volatility organic compounds and avoids the risks related to the use of organic solvents. To our knowledge, this technique is the first one allowing the sensitive determination of such a number of amphetamine analogs.

Simultaneous determination of amphetamine and its analogs in human whole blood by gas chromatography-mass spectrometry.

A sensitive and specific gas chromatography-mass spectrometry (GC-MS) method for the determination of amphetamine (AM), methamphetamine (MA), methylenedioxyamphetamine (MDA), methylenedioxymethamphetamine (MDMA) and methylenedioxyethylamphetamine (MDEA) in whole blood was designed, using the respective pentadeuterated analogs of the analytes as internal standards (I.S.). After alkalinisation of blood samples, the amphetamines were extracted using diethyl ether, derivatized with heptafluorobutyric anhydride, then purified by successive washings with deionized water and 4% NH4OH. Extraction recoveries were 85.2% for AM, 90.9% for MA, 76.5% for MDA, 84.1% for MDMA and 63.6% for MDEA. Chromatographic separation was performed on a non-polar 30 m x 0.32 mm HP 5 MS capillary column using a temperature program. Detection was carried out in the electron-impact, selected ion-monitoring mode, using three mass-to-charge ratios for each analyte and one for each I.S. Limits of detection ranged from 0.5 to 8 ng/ml and limits of quantification were 10 ng/ml for AM, MDMA and MDEA; 20 ng/ml for MA; and 50 ng/ml for MDA. The method was linear from this limit up to 1000 ng/ml for all analytes, with good intra-assay precision and good intermediate precision and accuracy over these ranges. There was no interferences from other sympathomimetic drugs such as ephedrine, norephedrine or methoxyphenamine. This method is thus suitable for clinical and forensic toxicology, as well as for doping control.

High thermal stability and cold-denaturation of an artificial polypeptide.

An amphipathic polypeptide, Pn, with a tandemly repeated LKELPEKL sequence including a proline every eight residues, as well as a series of shorter peptides having the same sequence, P2, P3, P4, P5 and P6, were synthesized. Their conformation in aqueous solution was mainly studied by CD. At low temperature, these peptides and polypeptides are completely unordered and undergo a reversible transition leading to a partly alpha-helical structure upon heating. Such behavior has been demonstrated for a few proteins by other authors and has been called cold-denaturation. The transition temperature of the polypeptide is close to 20 degrees C. The conformational change does not depend on concentration, indicating a monomolecular process. The high-temperature structure seems to be compact as for globular proteins. A model of folded structure is proposed from experimental data and from molecular modelling studies.

Influence of the conformation of a macromolecule on the generation of T-cell proliferative response. A study with model polypeptides.

To study the influence of the conformation of polypeptidic macromolecules on the generation of T-cell epitopes, sequential polypeptides with an octamer repeat unit were designed and synthesized. They adopt mainly unordered and alpha-helical conformations. Among these polypeptides, those containing proline are fully or partly unordered, and are more effective at inducing T-cell proliferation than a proline-free very stable alpha-helical polypeptide. This extremely stable alpha-helical conformation, probably stabilized by aggregation, would enhance its stability against proteolytic processing.