Lead poisoning from homemade wine: a case study.

A 66-year-old man suffered the symptoms of severe lead poisoning for 2 years before diagnosis. The man had a blood lead level (PbB) on admission to hospital of 98 microg/dL. A detailed investigation revealed that the poisoning occurred as a result of drinking a homemade red wine, for which analyses showed a lead concentration up to 14 mg/L--70 times the Australian maximum limit for lead in wine. The source of the lead was a highly corroded enamel bathtub in which grape crushings and juice were stored for a week prior to bottling. The corrosion of the enamel surface of the bathtub had resulted in pitted patches up to 1 mm in depth along the side of the bathtub. Powdering of the tub surface was evident below a level where wine had been in contact with the sides of the tub. The homemade wine had a pH of 3.8, which would have greatly contributed to the solubilization of metals from the glaze. We conducted a test in which commercial red wine of similar pH and containing < 0.2 mg/L lead was placed in this tub for 7 days. Subsequent testing revealed a lead level of 310 mg/L. This high lead concentration is consistent with the surface area of enamel on the bathtub being in contact with a small liquid volume as in the case of the leaching test using commercial red wine. This case study highlights the importance of the use of food-grade materials for the preparation and storage of homemade beverages or food.

Reducing the cost of cyclosporin assays: modification of the EMIT 2000 method.

Cyclosporin is the leading immunosuppressant agent in organ transplantation, and therapeutic drug monitoring forms an integral part of patient management in most institutions. In the authors' laboratory, the cost of cyclosporin assays represents a major fraction of total consumable expenditure. At present, an average of 4,300 patient cyclosporin assays are performed annually using the EMIT 2000 method (Behring-Syva) on the Cobas Mira analyser (Roche), at a cost of AUD$50,000 in kits alone. As a means of reducing laboratory costs, the manufacturer's recommended method was modified by decreasing all of the reagent and sample volumes in the "Analytical" section of the Cobas Mira cyclosporin programme by 33%. Assay performance was monitored over a 10-month period and compared to that of the unmodified method. Calibration curves were stable, requiring a one-point correction on average of once every 12 days, and a full calibration once ever 1.7 months. Interassay variability was not different to that previously reported for the unchanged method, with mean (SD, CV) concentrations for trilevel quality control specimens of 86.5 micrograms/L (10.2, 11.9%), 185.9 micrograms/L (11.4, 6.2%) and 408.5 micrograms/l (28.9, 7.1%). From 24 specimens assayed in an international quality assurance programme, the results of 23 were within 1.2 SD of the group mean for the EMIT method, with an average bias of 0.8%. With the current modifications, we were able to perform an average of 105 patient assays per kit compared to the previous 71, equating to an annual saving the AUD$16,600.

Experiences with the enzyme-multiplied immunoassay cyclosporine specific assay in a therapeutic drug monitoring laboratory.

Cyclosporin-A (CsA) monitoring is well established in the management of most organ transplant patients. The present communication reviews the performance of the recently introduced specific enzyme-multiplied immunoassay (EMIT) CsA method during the first 7 months of its operation and compares costs of providing this service with those of the specific 125I radioimmunoassay (RIA) method previously employed in this clinical laboratory. Results suggest that the EMIT method performed well, giving long calibration curve stability (up to 12 weeks), and only 4.4% of the 31 kits through this period were consumed in assaying calibration standards compared with 20.8% with RIA. However, more quality control assays were performed, with the net result that only a slight improvement in the percentage of kit consumed in patient assays was noted (74.0% compared with 70.3%) with the EMIT method. This method appears to have been well accepted clinically as the CsA assay request rate over this period increased by 23% and, since it is both specific and rapid, is, therefore, recommended as the best CsA method currently available.