Successful recovery of a patient with thallium poisoning.

We describe a patient suffering from protracted and life-threatening thallium poisoning. She was treated with Prussian blue and forced diuresis, and made a good recovery. Cisapride may be effective in improving gastric emptying and relieving constipation resulting from the thallium and the treatment. Haematological abnormalities occurred in the early phase of the poisoning, with a prolonged fall in the CD4/8 lymphocyte ratio during recovery.

Achievement of therapeutic concentrations of cefuroxime in early preterm gestations with premature rupture of the membranes.

OBJECTIVE: To determine whether therapeutic cefuroxime concentrations can be achieved in maternal plasma, amniotic fluid (AF), neonatal plasma, placenta, and membranes in women with premature rupture of the membranes (PROM) at 27-33 weeks' gestation. METHODS: In an open nonrandomized, dose-response study, nine patients with PROM at 27-33 weeks' gestation received 1.5 g of cefuroxime intravenously three times daily. Maternal plasma and AF specimens were collected during pregnancy, and umbilical cord plasma, placenta, and membrane specimens were collected after delivery to assay cefuroxime concentrations using high-performance liquid chromatography. RESULTS: A high rate of placental transfer of cefuroxime was found. Bactericidal concentrations could be demonstrated in maternal plasma and in AF leaking from the vagina. A concentration-time curve in AF could be detected, with a peak concentration 3-4 hours after infusion. Therapeutically active levels were present in the newborns. The resorption of cefuroxime by the fetal membranes was high. CONCLUSIONS: Therapeutic concentrations of cefuroxime were found in all body fluids and tissues studied. Further study to establish the clinical utility of cefuroxime prophylaxis in PROM seems appropriate.

Pharmacokinetics of cefuroxime in pregnant patients with preterm premature rupture of the membranes.

To 6 pregnant patients with preterm premature rupture of the membranes, cefuroxime prophylaxis was given 1,500 mg three times daily intravenously. Cefuroxime concentrations were assayed in maternal plasma and amniotic fluid during pregnancy and in umbilical cord blood, placenta, and membranes after delivery. Our results showed a high rate of transplacental transfer of cefuroxime. Bactericidal levels could be demonstrated in maternal plasma, and in amniotic fluid leaking from the vagina. Therapeutically active levels were present in the newborns. The absorption of cefuroxime by the foetal membranes was high. Although the neonatal morbidity in this high-risk population was low, the data are still too preliminary to advise the routine prophylactic use of cefuroxime to pregnant patients with preterm premature rupture of the membranes.

Temafloxacin in acute purulent exacerbations of chronic bronchitis.

Temafloxacin hydrochloride, a new fluoroquinolone, was given orally in doses of 300 or 600 mg twice daily for ten days to 36 patients, all hospitalized because of severe acute purulent exacerbations of chronic bronchitis. Sputum cultures before, during and after treatment showed that the infection was eliminated in 12/18 evaluable patients given 300 mg and in 13/16 receiving the 600 mg doses. Haemophilus influenzae, Branhamella catarrhalis and Streptococcus pneumoniae were effectively eliminated, but only half the Pseudomonas aeruginosa infections were eradicated. MICs for most pathogens were 1 mg/l or less (including the majority of the pneumococci) but the MICs for Ps. aeruginosa ranged from 0.5 to greater than 16 mg/l, those for 10 of the 22 strains being greater than 2 mg/l. Pharmacokinetic studies on serum and sputum specimens showed serum Cmax values of 3.5 and 6.0 mg/l, the sputum Cmax being 2.35 and 4.17 mg/l after the different doses. No interaction with concomitant theophylline could be found. Two patients complained of moderate nausea or water-brash. Temafloxacin can be considered safe and effective at these dosages, but for Ps. aeruginosa infections higher dosages need to be investigated.

Determination of low levels of bupivacaine (Marcaine) in plasma during epidural analgesia.

A rapid method is described for the determination of plasma levels of bupivacaine used for epidural analgesia during childbirth. Data obtained in a clinical study are also given.

A gas chromatographic method for the estimation of phenprocoumon, 3-(1-phenyl-propyl)-4-hydroxycoumarin (Marcoumar, Liquamar), in human serum or plasma.

A rapid and reliable gas-chromatographic method is described for the estimation of phenprocoumon from human serum or plasma. No interference was found from other usual oral anticoagulant drugs. The method can be used for therapeutic and toxic levels. The appearance of two volatile derivatives of phenprocoumon (in constant ratio) is discussed.

Quantitative determination of sodium-o-[(2,6-dichlorophenyl)-amino]phenylacetate (diclofenac) in human blood plasma or serum.

A rapid method for the estimation of sodium-(o-[(2,6-dichlorophenyl)-amino]-phenyl)-acetate (diclofenac-Na, Voltaren) used in the treatment of rheumatic diseases, in human blood plasma is described. The substance is extracted from acidified plasma with dichloromethane and acetylated after evaporation of the organic solvent, whereupon quantitation is performed by gas-liquid chromatography on a 10% OV-17 column, F.I. detection.