Concentrations of monoethylglycinexylidide in body fluids of deceased patients after use of lidocaine for endotracheal intubation

The objective of this study was to determine whether the postmortem concentrations in body fluids of monoethylglycinexylidide (MEGX), a major active metabolite of lidocaine, reflect the circulatory state during cardiopulmonary resuscitation following endotracheal intubation using lidocaine. The concentrations of lidocaine and MEGX in blood, pericardial fluid, bile and/or urine were measured for sixteen patients who had received endotracheal intubation using Xylocaine jelly, a 2% w/v lidocaine hydrochloride preparation. Lidocaine was detected in all of the sixteen cases. Of six patients who had survived 3 h to 10 d following endotracheal intubation, four were MEGX-positive and two were negative. No MEGX was detected in the other ten patients whose hearts had not resumed beating despite attempts at cardiopulmonary resuscitation. MEGX can be an indicator of the vital state of a patient during cardiopulmonary resuscitation; it shows the antemortem use of lidocaine under normal hepatic conditions.     

A case of sudden death after gingival injection of a therapeutic dose of lidocaine: distribution of lidocaine in whole blood and various tissues

We report a case of sudden death after gingival injection of lidocaine, which made us suspect overdosing or anaphylactic shock. Using liquid chromatography-mass spectrometry (LC-MS), we measured the lidocaine concentrations in whole blood and tissues including the gingivae. The lidocaine concentration in blood (0.70 μg/ml) was lower than the therapeutic level. Lidocaine levels distributed to various organs were also low. Among them, the lung showed the highest level, followed by the liver, brain, and spleen. The concentrations in the gingivae with and without pus were 938 μg/g and 1048 μg/g, respectively. Together with the above analytical data, we made histopathological examinations, and tryptase and immunoglobulin E (IgE) assays as markers of anaphylactic shock. Macroscopically, myocardial ischemic changes were observed over relatively large areas. In such cardiac areas, there were focal necrosis, disarrangement of cardiac muscles, and stromal edema microscopically. The tryptase value was within the normal range. By carefully considering all data obtained from the victim, we diagnosed that the victim died of heart failure under the stress of the dental treatment.     

2015美国心脏协会心肺复苏及心血管急救指南核心更改解读

发布的《2015美国心脏协会心肺复苏及心血管急救指南更新》主要更新点涉及多个方面的内容,包括新增院内成人生存链、修改成人基础生命支持流程、优化了胸外按压的速率及深度、简化复苏药物的使用等方面。作者就最主要的更新点进行解读。     

牙科治疗用卡替卡因和利多卡因麻醉效果比较的Meta分析

目的 系统评价卡替卡因和利多卡因用于口腔局部麻醉的效果比较.方法 采用计算机检索Cochrane图书馆(1991-2010年)、PubMed(1974-2010年)、Medline数据库(1950-2010年)、中国知网医学期刊全文数据库(CHKD,1994-2010年)、万方数据医学文献全文数据库(1986-2010...     

利多卡因对老年肺癌根治术患者围术期脑氧代谢及术后早期认知功能影响

目的探讨利多卡因对老年肺癌根治术患者围术期脑氧代谢及术后早期认知功能的影响。方法选取择期拟在全身麻醉下行肺癌根治术的患者80例为研究对象,采用随机数字表法,将患者随机分为利多卡因组(L组)和生理盐水对照组(C组),每组40例。L组于麻醉诱导前静脉注射利多卡因1 mg/kg,随后以1 mg/(kg·h)的速度输注,于手术结束前5 min停止输注。C组以同样方法静脉输注等容量生理盐水。分别于麻醉诱导前(T_0)、利多卡因给药后30 min(T_1)、2 h(T_2)及手术结束时(T_3)经桡动脉和颈内静脉球部采集血样行血气分析,计算动脉-颈内静脉血氧含量差(Da-jvO_2)和脑氧摄取率(CERO_2)。分别于术前1 d及术后1、3、7 d时测定患者血清S100钙结合蛋白(S-100β蛋白)浓度,并采用简易精神状态检查量表(MMSE)对患者进行认知功能评定。结果与T_0时相比,T_1~T_3时两组患者Da-jvO_2及CERO_2均降低(P<0.05)。与C组相比,L组T_2~T_3时Da-jvO_2及CERO_2降低(P<0.05)。与术前1 d时比较,C组术后1、3、7 d时血清S-100β蛋白浓度升高,MMSE评分降低;L组术后1、3 d时血清S-100β蛋白浓度升高,MMSE评分降低(P<0.05)。与C组比较,L组术后1、3 d时血清S-100β蛋白浓度降低,MMSE评分升高(P<0.05),术后7 d时差异无统计学意义(P>0.05)。结论老年肺癌根治术患者静脉应用利多卡因可降低患者围术期脑氧代谢,改善患者术后早期认知功能。     

Determination of triazolam by GC-MS in two autopsy cases: distribution in body fluids and organs

A detailed procedure for analysis of triazolam by GC-MS was constructed in our laboratory. At the concentration of 100 ng/ml, recoveries of triazolam in plasma and urine were 84.9 and 91.0%, respectively. The coefficients of variation in terms of its recovery were 11.5 (plasma) and 10.2% (urine). The detection limit for quantitation by the method was approximately 5 ng/g. This method was applied to two autopsy cases, giving triazolam distribution in body fluids and organs. In one case (33-year-old woman), concentrations of triazolam in the heart blood, urine, brain, lung, liver, kidney, skeletal muscles and stomach contents were 83.9, 741, 106, 165, 507, 293, 125 and 343 ng/g, respectively. From these toxicological data together with autopsy findings, her cause of death was diagnosed as triazolam poisoning. In the other case (45-year-old man), triazolam concentrations in the urine and stomach contents were 7.81 and 41.1 ng/g, respectively, but it could not be detected in the pleural blood; his cause of death was judged to be a traumatic shock, based on autopsy findings.     

Simultaneous determination of nicotine and cotinine in various human tissues using capillary gas chromatography/mass spectrometry

Summary A reliable and sensitive method for the simultaneous determination of nicotine and cotinine concentrations in various human tissues was developed using capillary gas chromatography/mass spectrometry. Nicotine and cotinine were extracted using a 3-step solvent extraction procedure and quinoline as an internal standard. Quantification was carried out by single ion monitoring using ions of m/z 133 for nicotine, m/z 176 for cotinine and m/z 129 for quinoline. The lower limit of detection was 5 ng/g for nicotine and 10 ng/g for cotinine, in each tissue sample. The calibration curves of various tissues were linear in the concentration range from 5–1,200 ng/g for nicotine and 10–1,500 ng/g for cotinine. The accuracy and precision of this method were examined using human tissues and the results were satisfactory. The distribution of nicotine and cotinine was measured in tissues from 10 human autopsies. Nicotine was detected in every tissue examined at a level seen in habitual smokers. The nicotine concentration was high in the liver, kidney, spleen and lung, and low in adipose tissue. The cotinine level was highest in the liver. The tissue/blood concentration ratios of nicotine and cotinine were most stable in skeletal muscle, where the level of these drugs was close to that in whole blood. Skeletal muscle is, therefore, considered to be the most suitable tissue sample for toxicological examination, when acquisition of blood samples is not feasible.     

Simple and sensitive detection of phencyclidine in body fluids by gas chromatography with surface ionization detection

Phencyclidine (PCP) can be detected in body fluids with very high sensitivity by gas chromatography (GC) with surface ionization detection (SID) using pethidine as internal standard. PCP was extracted with Sep-Pak C₁₈ cartridges from whole blood and urine samples, which gave clean extracts. The calibration curve for spiked whole blood was linear in the range 1.25–20 ng/ml. The detection limit of PCP was approximately 15 pg on-column (0.75 ng/ml sample), which was much lower than by GC-nitrogen phosphorus detection. The recovery of PCP and pethidine from spiked whole blood or urine samples was above 85%. This method seems very useful for the determination of PCP in forensic and clinical toxicology.     

SPARC在常染色体显性多囊肾病患者体液中的表达及其分泌研究

目的研究富含半胱氨酸的酸性分泌糖蛋白(SPARC)在常染色体显性多囊肾病(ADPKD)患者体液中的浓度及其分泌来源。方法采用ELISA法测定ADPKD患者血浆、尿液、囊肿液以及正常人血浆、尿液中的SPARC浓度;采用Westernblot方法比较检测人肾小管上皮细胞(HKC)和囊肿衬里上皮细胞培养液中的SPARC蛋白水平。结果ADPKD患者囊肿液中SPARC浓度为3628.75±1445.90ng/ml,显著高于血浆和尿液中的SPARC浓度(P<0.01);ADPKD组尿液中的SPARC含量比对照组明显升高(1253.16±544.81ng/mlvs123.91±28.37ng/ml,P<0.01),而两组血浆中SPARC浓度无明显差别。HKC和囊肿衬里上皮细胞培养液中均检测到SPARC蛋白表达,光密度检测两种细胞所分泌的SPARC蛋白与相应的GAPDH条带光密度比值分别为35.56%和71.15%。结论ADPKD患者囊液和尿液中增多的SPARC可能来自囊肿衬里上皮细胞及扩张的小管和集合系统。     

Role of pre-operative imaging using 99mTc-MIBI and neck ultrasound in patients with secondary hyperparathyroidism who are candidates for subtotal parathyroidectomy

Purpose The purpose of this study was to assess whether pre-operative ^99mTc-methoxyisobutylisonitrile (MIBI) scintigraphy and neck ultrasound (US) are of value in improving the outcome of subtotal parathyroidectomy in patients with secondary hyperparathyroidism. Methods Forty-eight consecutive haemodialysis patients with severe secondary hyperparathyroidism prospectively underwent “blinded” subtotal parathyroid surgery, with 1-year follow-up to establish cure or relapse of their secondary hyperparathyroidism. Double-phase ^99mTc-MIBI scintigraphy and neck US were performed pre-operatively in all patients. When the preserved gland showed ^99mTc-MIBI uptake or an abnormal size on US, it was considered that “^99mTc-MIBI advice” and “US advice”, respectively, had not been followed. Pre-operative and follow-up parathyroid hormone (PTH) levels were obtained in all patients. All data were evaluated on a patient by patient basis. Results Four parathyroid glands were identified in each patient at primary surgery, resulting in an operative success rate of 100%. Their weight ranged from 15 to 7,300 mg (mean 1,120±900 mg). Nine of the 48 patients (19%) showed a recurrence of their secondary hyperparathyroidism. The recurrence rate was 2% (1/48) and 10% (5/48), respectively, when ^99mTc-MIBI and US advice was followed. The sensitivity, specificity, NPV and PPV for pre-operative imaging were 72%, 95%, 97% and 80% respectively for ^99mTc-MIBI, and 55%, 67%, 87% and 28% for US. Conclusion ^99mTc-MIBI scintigraphy is a reliable non-invasive exploratory tool and its preoperative use results in a significant reduction in the number of recurrences in haemodialysis patients with secondary hyperparathyroidism who are candidates for subtotal parathyroidectomy. The use of neck US did not significantly improve the results obtained with ^99mTc-MIBI alone.     

Prediction of vascular involvement and resectability by multidetector-row CT versus MR imaging with MR angiography in patients who underwent surgery for resection of pancreatic ductal adenocarcinoma

Purpose

To compare the diagnostic value of dual-phase multidetector-row CT (MDCT) and MR imaging with dual-phase three-dimensional MR angiography (MRA) in the prediction of vascular involvement and resectability of pancreatic ductal adenocarcinoma.

Methods and materials

116 patients with proven pancreatic adenocarcinoma underwent both MDCT and combined MR imaging prior to surgery. Of 116 patients, 56 who underwent surgery were included. Two radiologists independently attempt to assess detectability, vascular involvement and resectability of pancreatic adenocarcinoma on both images. Results were compared with surgical findings and statistical analysis was performed.

Results

MDCT detected pancreatic mass in 45 of 56 patients (80.3%) and MR imaging in 44 patients (78.6%). In assessment of vascular involvement, sensitivities and specificities of MDCT were 61% and 96% on a vessel-by-vessel basis, respectively. Those of MR imaging were 57% and 98%, respectively. In determining resectability, sensitivities and specificities of MDCT were 90% and 65%, respectively. Those of MR imaging were 90% and 41%, respectively. There was no statistical difference in detecting tumor, assessing vascular involvement and determining resectability between MDCT and MR imaging (p = 0.5).

Conclusion

MDCT and MR imaging with MRA demonstrated an equal ability in detection, predicting vascular involvement, and determining resectability for a pancreatic ductal adenocarcinoma.     

Multidetector row CT pulmonary angiography and indirect venography for the diagnosis of venous thromboembolic disease in intensive care unit patients

RATIONALE AND OBJECTIVES: To determine the diagnostic quality, performance characteristics and interreader reliability of computed tomography pulmonary angiography (CTPA) and venography (CTV) in intensive care unit (ICU) patients with suspected venous thromboembolism (VTE). MATERIALS AND METHODS: A total of 100 consecutive ICU patient CT examinations performed for clinically suspected VTE on a four-row CT scanner were reviewed. Three readers rated the diagnostic quality of each CTPA and CTV examination as excellent, acceptable, or nondiagnostic. Readers scored the overall determination for pulmonary embolism (PE) and deep venous thrombosis (DVT) using a 5-point scale, and scored the determination for PE by anatomic level. Receiver operator characteristic (ROC) analysis was performed for each reader and the original clinical report, using consensus interpretation as the reference standard. Interobserver variability for PE and DVT was determined using kappa analysis, and was stratified by examination quality. RESULTS: A total of 25% of CTPA examinations were nondiagnostic, most commonly because of motion artifact and poor contrast opacification. A total of 24% of CTV examinations were nondiagnostic, most commonly because of poor contrast opacification and metallic hardware. Using receiver operating characteristic analysis, the areas under the curve (Az) for PE diagnosis were 0.875, 0.923, 0.888, and 0.674 for the three readers and clinical reading, respectively, and for DVT diagnosis were 0.842, 0.859, 0.952 and 0.669. Interobserver agreement for detection of PE was moderate at the supralobar level (kappa = 0.55), very good at the lobar level (kappa = 0.69), and moderate for segmental (kappa = 0.54) and subsegmental arteries (kappa = 0.44). Overall reader agreement was good for excellent/good quality CTPA examinations (kappa = 0.52-0.56), and poor when examination quality was poor (kappa = 0.06). CONCLUSIONS: CTPA and CTV are sufficiently accurate and reliable techniques for evaluating VTE in ICU patients, particularly in light of patient complexity.     

Value of dual time point F-18 FDG-PET/CT imaging for the evaluation of prognosis and risk factors for recurrence in patients with stage I non-small cell lung cancer treated with stereotactic body radiation therapy

Purpose

To investigate prognostic and risk factors for recurrence after stereotactic body radiation therapy (SBRT) in patients with stage I non-small cell lung carcinoma (NSCLC), focusing on dual time point [18]F-fluorodeoxyglucose positron emission tomography (FDG PET).

Materials and methods

We prospectively evaluated 57 patients with stage I NSCLC (45 T1N0M0 and 12 T2N0M0) who had undergone pretreatment FDG-PET/CT and were subsequently treated with SBRT. All patients received a whole-body PET/CT scan at 60 min and a whole-lung at 120 min after the injection. The maximum standardized uptake value (SUV) and retention index (RI) of the lesions were calculated. Local recurrence, regional lymph node metastasis, distant metastasis, and the recurrence pattern were evaluated. Cox proportional hazard regression analyses were performed to evaluate prognostic factors or risk factors of recurrence.

Results

During the median follow-up period of 27 months, local recurrence, regional lymph node metastasis, and distant metastasis were seen in 17 (30%), 12 (21%), and 17 (30%) of the 57 patients, respectively. The 3-year overall survival rate was 63.4%. SUV_max did not affect any recurrence, DFS, OS, or CSS. RI significantly predicted higher distant metastasis (HR 47.546, p = 0.026). In contrast, RI tended to predict lower local recurrence (HR 0.175, p = 0.246) and regional lymph node metastasis (HR 0.109, p = 0.115).

Conclusions

SUV_max at staging FDG-PET does not predict any recurrence, DFS, OS or CSS. In contrast, higher RI predicts higher distant metastasis and tended to predict lower local or regional lymph node metastasis.