Surface contamination of chemotherapy drug vials and evaluation of new vial-cleaning techniques: results of three studies.

PURPOSE: The results of three studies that describe the external contamination of chemotherapy drug vials are presented. New techniques for the improved decontamination of vials containing cisplatin are also described. SUMMARY: Study 1 evaluated the external contamination of drug vials with cyclophosphamide and ifosfamide in a pharmacy setting. Widespread contamination of the outside of drug vials was found with each drug. Study 2 evaluated the surface contamination of drug vials with cyclophosphamide and fluorouracil in three pharmacies. Sporadic contamination with fluorouracil was detected, while cyclophosphamide was found on most vials. In study 3, investigators compared the decontamination abilities of a standard decontamination procedure at the manufacturer level with an improved decontamination procedure and the use of sleeves to further decrease contamination. Though the methods of each study reported herein differed, the outcomes were similar. All chemotherapy drug vials studied demonstrated levels of contamination with the drug well above the limit of detection. Improved decontamination procedures, combined with the use of protective sleeves, reduced the level of platinum contamination by 90%, suggesting that standard decontamination procedures should be reconsidered. CONCLUSION: The results of these studies are consistent with several others that have reported contamination of the outside surface of drug vials for a number of chemotherapy drugs. Contamination can be reduced by using decontamination equipment and protective sleeves during the manufacturing process.     

External fixator use in comminuted gunshot fractures of the proximal phalanx.

Comminuted low velocity gunshot fractures of the proximal phalanx were stabilized with an external fixator in 15 patients. This device was found to be useful. It allowed healing of the fracture in good alignment in 13 patients. And motion of the metacarpophalangeal joint was preserved.     

Vertical Fluxes and Accumulation of Trace Metals in Superficial Sediments of the Río de la Plata Estuary, Argentina

Superficial sediments and settling material collected in Buenos Aires coastal area were analyzed to evaluate the accumulation and sources of trace metals. Residual elements showed homogeneous sedimentary concentrations (Fe: 23,846 ± 4,367; Ni: 10 ± 2.7; Mn: 706 ± 314 μg g⁻¹) whereas anthropogenic metals presented exponentially decreasing offshore gradients (Zn: 98 ± 69; Cr: 28 ± 21; Cu: 19 ± 15; Pb: 18 ± 13 μg g⁻¹). Anthropogenic impact was evaluated through metal-Fe relationships, Fe-normalized enrichment factors and sediment quality guidelines. The slopes of metal-Fe regressions from background sites were comparable to upper crust metal ratios, excepted Cr which is impoverished, and Mn which is diagenetically enriched. Metal-Fe relationships also hold for most 2.5 km offshore sites but with higher slopes denoting human influence, and are completely lost in 1–2.5 km sediments and trap material which plot over the regressions and exceed sediment quality guidelines.     

Trace Metals in Settling Particles from the Sewage Impacted Buenos Aires Coastal Area in the Río de la Plata Estuary, Argentina

Sediment traps deployed in Buenos Aires sewage outfall area collected a substantial amount of material (average mass flux 22 ± 12 g cm ² year^?1) with very high metal concentrations, mostly in the range of hazardous exposition for organisms (Zn: 138–671, Cu: 41–273, Cr: 44–255 and Pb: 26–260 μg g^?1). The combination of high mass fluxes and concentrations results in huge metal fluxes (0.005–0.7 to 3.6–31 g m^?2 day^?1 for minor elements and Fe, respectively). Metal concentrations were correlated to the total mass flux and total organic carbon but with different trends for redox-sensitive Fe and Mn (negative) and anthropogenic elements (positive). This reflects the key role of organic discharges promoting anoxia with Fe and Mn evasion, and also contributing toxic metals.