Hair analysis by LC-MS as evidence of nalbuphine abuse by a nurse.

Individuals in any profession can succumb to chemical abuse. Among the healthcare profession, nurses represent a specific group because of their ease of access to drugs, particularly narcotics. Opioids, potentially highly addictive agents, are usually their drug of choice. Nalbuphine, a synthetic opioid analgesic, is prescribed for moderate-to-severe acute pain, for chronic pain syndromes, and in obstetrics to decrease the adverse respiratory effect of opioid epidural administration. The case of a nurse who was suspected of drug misuse after the disappearance of two nalbuphine ampules in an obstetrics service is described. Because of discrepancies in the results of her blood and urine samples, a sample of head hair was subsequently collected from the nurse. A hair analysis of nalbuphine by liquid chromatography-mass spectrometry has not been previously described. Following decontamination and grinding, hair was mixed with a Söerensen buffer, then subjected to ultrasonic treatment (1 h), and extracted with ethyl acetate. A quantitative analysis was performed with two channels (30 and 45 V), and it is based on a m/z 358 for nalbuphine and a m/z 330 for methylclonazepam as an internal standard. The method was linear from 0.020 to 12 ng/mg of hair (R(2) = 0.972), and the limit of detection and limit of quantitation are 0.020 ng/mg. Accuracy (CV), assessed at 0.4 and 1.6 ng/mg of hair, was 6.18% and 5.77%, respectively, for intraday assays and 4.5% and 10.9% for interday assays. Recovery efficiency at 1.6 ng/mg and 8 ng/mg of hair was 100% and 97.4%, respectively. The hair specimen from the nurse (6 cm) was cut into three equal lengths. Nalbuphine, venlafaxine, and nordiazepam were detected. The concentration of nalbuphine was similar in the three hair locks: 5.07, 7.06, and 5.70 ng/mg of hair. A hair analysis revealed the repeated intake of nalbuphine by the nurse. This person was treated for depression for several months with Effexor (venlafaxine) and Nordaz (nordiazepam) prior to the investigation. Hair appears to be a unique matrix to provide evidence for chronic drug exposure by establishing a historic record that is not possible by blood or urine analysis.

Progress in the management and outcome of small-cell lung cancer in a French region from 1981 to 1994.

Recent analyses of series of small-cell lung cancer (SCLC) patients included in clinical trials have shown improved survival over time, but it has been impossible to determine whether this was due to selection biases, stage migration, or true therapeutic improvement. To determine if there has been a true improvement of survival over time, we reviewed the medical records of all consecutive patients diagnosed with SCLC between 1981 and 1994 in the Bas-Rhin in France. Among the 787 patients (median age 63), there was no significant period effect for sex, age, or stage. Staging work-ups became increasingly thorough (significant period effect). The mean number of investigations and of tumour sites detected correlated significantly. The chemotherapy rate increased (from 76.4% in 1981-1983 to 91.7% in 1993-1994, P = 10(-5)) and mediastinal irradiation decreased (to roughly 25% of patients after 1983). Median survival time increased for the overall population from 6.6 months in 1981-1983 to 11.3 months in 1993-1994 (P = 10(-5)), for patients with limited disease (LD) from 9.2 (P = 0.002) months to 14.0 months, and for those with extensive (ED) disease from 3.5 months to 9.6 months (P = 10(-5)). Significant independent prognostic factors were disease extent, clinical trial participation, period, type of chemotherapy, and mediastinal irradiation in LD. Survival time has truly improved as 'state of the art' management of SCLC has changed.