First Dutch national guidelines--pharmacological care for detained opioid addicts.

Heterogenic care of addicted detainees in the various prisons in The Netherlands triggered the National Agency of Correctional Institutions of the Ministry of Justice, to order the Dutch Institute for Health Care Improvement (CBO) to formulate the first national guideline titled 'Pharmacological care for detained addicts'. This article presents the content of this guideline, which mainly focuses on opioid-dependent addicts. In The Netherlands, approximately 50% of the detainees are problematic substance abusers, while again half of this group suffers from psychiatric co-morbidity. In addition, somatic co-morbidity, especially infectious diseases, is also common. Due to the moderate outcome seen with voluntary drug counselling regimes in prison, there is a policy shift to extent utilization of legally enforced approaches. Continuity of care is of great importance. In case of opioid addicts this, in general, means continuation of methadone maintenance treatment. Aftercare immediately after detention and optimalization of medical information transfer is crucial. This guideline aims to realize optimal and uniform management of addiction disorders in the Dutch prison system.

New methods for the release of volatile sulfur compounds from human serum: its determination by Tenax trapping and gas chromatography and its application in liver diseases.

New methods are described for the release of sulfur volatiles from human serum or whole blood and for its determination by Tenax trapping and gas chromatography by use of a specific sulfur detector. Methanethiol (MT) is covalently bound in serum in at least two different ways. One fraction of MT is released by addition of acid and is covalently bound to a compound with a mol wt less than 500, probably as methyl-beta-D-thioglucuronide. Another fraction of MT is released by reaction with dithiothreitol and is covalently bound to proteins in a disulfide linkage. No significant differences were observed in the protein-bound MT fraction between normal individuals and patients with cirrhosis. In contrast, the acid-hydrolyzable MT fraction was significantly elevated (P less than 0.0001) in the group with cirrhosis (0.41 +/- 0.19 mumol/L, mean +/- SD, n = 39) compared with the normal group (0.22 +/- 0.04 mumol/L, n = 21). The acid-hydrolyzable MT fraction is excreted in the urine. The concentration in normal persons amounted to 9 to 37 mumol/L. Dimethylsulfide (DMS) was measured in whole blood. There was a close correlation between venous blood DMS concentration and its concentration in breath. Dimethyldisulfide was not present in detectable amounts in the blood of normal individuals. Ethanethiol was absent in the serum and blood of all studied subjects.

A new sensitive assay for measuring volatile sulphur compounds in human breath by Tenax trapping and gas chromatography and its application in liver cirrhosis.

A new analytical technique is described for measuring volatile sulphur compounds in human breath. The sulphur compounds were trapped and concentrated onto Tenax GC and then assayed by gas chromatography, using a specific sulphur detector. The detection limit amounts to about 0.2 ng/l (0.1 ppb). Among the sulphur volatiles, dimethylsulphide and methanethiol were quantitatively analysed in 100 ml of breath of 20 normal subjects and 35 cirrhotic patients. Dimethylsulphide in the breath of cirrhotics (113.4 +/- 31.9 ng/l, mean +/- SEM) was significantly elevated (p less than 0.05) compared with normals (21.1 +/- 1.7 ng/l). The concentration of methanethiol in the breath of normals and of most cirrhotics was less than 1 ng/l. In only five cirrhotics could methanethiol be detected in 100 ml of breath (3-23 ng/l). Dimethyldisulphide and hydrogen sulphide were not present in detectable amounts in the breath of normals. In cirrhotics, dimethyldisulphide was detected in a few cases. Ethanethiol was absent in the breath of both normals and cirrhotics.