Biological effects of surfactants, IV. Effects of non-ionics and amphoterics on HeLa cells.

Surfactants, representing 3 non-ionic and 1 amphoteric series of homologs exhibited marked differences in their lethal and non-toxic effects on HeLa cells. Toxicity of non-ionics generally decreased inversely with increasing hydrophilic chain length and increased with increasing size of the lipophile. Lethal levels of the surfactants coincided with surface tension reduction of the media to 45 dynes cm-1 or below. Surface tensions of non-toxic concentrations were substantially higher than those for toxic levels. Non-toxic doses were, therefore, below the critical micelle concentration of the surfactants evaluated. The data suggest that physical properties are a principal cause of the toxic effects of these detergents on HeLa cells.

Change, disengagement, and renewal: relationship dynamics between young adults and their fathers after divorce.

Little is known about children's perceptions of their parents' divorce or how children construct meaning around the divorce and their subsequent relationships with their parents. The focus of this study was to learn about the experiences and the meanings young adults had constructed about the divorce process and their relationships with their fathers in the years after the divorce. The findings revealed a broad spectrum of experiences and several key issues that gave meaning to both the disengagement and the reengagement with their fathers. Loss, trust, acceptance, availability, and support are a few of the vital issues addressed. Implications for family therapists are discussed.

Differences between fathers with joint custody and noncustodial fathers.

Self-reported data from 212 divorced fathers was used to investigate differences between those with joint custody and those without custody of their children. Results indicated that those with joint custody saw their children more frequently, showed greater satisfaction with their custody arrangement, and had more education than did fathers without custody. Implications for paternal involvement and child support payments are discussed.

[Buprenorphine abuse in a series of 50 drug addicts hospitalized at a Drug Dependence Evaluation hospital in Marseille]. / Déviation d'utilisation de la buprénorphine dans une série de 50 toxicomanes hospitalisés au CHR de Marseille.

Buprenorphine, a synthetic central analgesic, marketed since 1987, was rapidly suspected to be subject to abuse. We tried to confirm this abuse in the context of our analytical activity at the Drug Dependence Evaluation and Information Centre. The study was based on 50 drug addicts admitted to Marseille Hospital between June and October 1992. Buprenorphine and its N-dealkylated metabolite were identified in the urine by high performance liquid chromatography equipped with a diode array detector. Nine (18%) of the 50 samples analysed were positive for buprenorphine and/or norbuprenorphine, with a confidence interval of 8 to 28%, which confirms the existence of abuse of this analgesic.

[Accidental narcotic and buprenorphine poisoning in children notified at the Marseille Poison Center between 1993 and 1999]. / Intoxications accidentelles par stupéfiants et buprénorphine chez les enfants notifiées au Centre Antipoison de Marseille de 1993 à 1999.

To evaluate the frequency and severity of accidental poisoning in children by narcotics or buprenorphine, a retrospective study was carried out: 75 cases were collected by the Marseille Poison Centre between 1993 and 1999. Most of the patients were between 1 and 3 years old and the drugs involved were cannabis and, more recently, Subutex (buprenorphine). These two drugs were responsible for the most severe cases of poisoning, most of which occurred at home.

[Study of narcotics and buprenorphine prescriptions in the Provence-Alps-Côte d'Azur region]. / Etude des prescriptions de stupéfiants et spécialités à base de buprénorphine en région Provence-Alpes-Côte d'Azur.

Following the setting up by the Government of their project for the management of drug addicts, and under the guidance of the CEIP (Centre d'Evaluation et d'Information sur les Pharmacodépendances [Centre for Evaluation and Information on Drug Addiction]) in Marseille, a survey of prescriptions written on controlled-drug prescription pads was performed. The aims were threefold: to study the medicines prescribed, to follow up the legislation and to inform doctors and pharmacists. Copies of the prescriptions, dated between 1 January 1996 and 30 June 1996, which were sent by 81 per cent of the 216 pharmacies contacted in 15 towns in the Provence-Alpes-Côte d'Azur (PACA) region were studied. Various criteria, relating to writing of the prescriptions and distribution of the medicines to the patients, were coded and analysed. This survey showed that of 4 prescriptions, 3 were prescribed for maintenance and one for analgesic therapy. The patients receiving maintenance therapy were male in three-quarters of the cases, and were around 30 years old. Analgesics were prescribed in equal proportions for patients of both sexes, who were around 65 years old. Since it was put on the market, Subutex has been quickly prescribed.

[Accidental ingestion of paracetamol in the for of the pediatric syrup EFFERALGAN: case studies during the six months following the institution of the child-proof top]. / Ingestions accidentelles de paracétamol sous la forme de sirop EFFERALGAN pédiatrique: étude des observations au cours des six mois qui ont suivi la mise en place d'un bouchon de sécurité.

During the 6 months following the child-proof top commercialisation for the paediatric syrup EFFERALGAN in France, 51 cases of accidental ingestion were collected by the Marseilles Poison Centre. For 21 pour cent of them, the alleged dose taken was greater than the toxic dose. For 2 cases only, the responsible bottle had a child-proof top and was open on the table. For all other cases, it was simple-opening bottles (old bottles still present in houses, or bottles without a special top but sold in order to get rid of stocks). This study proves that such a preventive measure (modification of the top of the syrup bottles) is only fully effective if additional measures are undertaken such as return of unsold stocks or the provision of information to pharmacists and physicians.

[Dependence on psychotropic drugs and substitution treatment: recent trends. The OPPIDUM study of the Centers for Evaluation and Information on Drug Dependence (CEIP), October 1997]. / Dépendance aux psychotropes et traitements de substitution: tendances récentes a propos de l'enquête OPPIDUM des Centres d'Evaluation et d'Information sur les Pharmacodépendances (CEIP) d'octobre 1997.

The aim of this study was to identify the latest trends in psychotropic drug use and the effect of the increase of maintenance treatments for serious opioid addiction. The results are based on data from OPPIDUM, an annual survey primarily concerned with the consumption of licit and illicit drugs. The study involved 1066 drug addicts recruited during the month of October 1997 from 38 French health centres connected with the Centres for Evaluation and Information on Drug Addiction (CEIP). The most frequently reported drugs were benzodiazepines (n = 323), some of which, especially flunitrazepam (Rohypnol, n = 123), are extremely addictive. The data showed a slight decrease in heroin consumption as well as a marked increase in the use of maintenance treatments. The association between benzodiazepines and buprenorphine (Subutex) should consequently be studied, whether buprenorphine is being used illicitly or prescribed as a maintenance treatment.

[Accidental ingestions of paracetamol in the form of EFFERALGAN pediatric syrup: experience of the Marseille Anti-poison Center during 1998]. / Ingestions accidentelles de paracétamol sous la forme de sirop EFFERALGAN pédiatrique: expérience du Centre Antipoison de Marseille au cours de l'année 1998.

In 1998, 77 cases of accidental ingestion of paracetamol paediatric syrup (Efferalgan) in children were notified to the Marseille Poison Centre. In a quarter of them, the alleged dose taken was greater than the toxic dose. Ingestion was mainly due to the child opening the bottle. The proximate marketing of a product with a child-proof top, which should allow the number of accidents to be reduced. Doctors and pharmacists should be informed rapidly, so that they can warn the families who still have the old type of bottle.

[Value of toxicological research in newborn infants of addicted mothers by the study of several samples (urine, meconium, hair)]. / Intérêt des recherches toxicologiques chez les nouveau-nés de mères toxicomanes par l'étude de plusieurs échantillons (urines, méconium, cheveux).

BACKGROUND: Urinary detection of prenatal drug exposure in the neonate may give false-negative results. We report our experience on meconium and hair testing, in addition to urine testing in order to improve diagnosis of fetal drug exposure. POPULATION AND METHODS: Thirty-one infants (aged 1-45 days) whose mothers were confirmed (n = 12) or suspected (n = 19) to be drug-addicted were included in the study. One or more specimens of urine, meconium or hair were collected in the 31 infants, two of the specimens in 17 and three in six. Drugs and their metabolites were detected by immunoenzymologic techniques and positive results were confirmed by gas-exchange chromatography. All the mothers and families were interviewed during admission and the information was compared to those provided by medical and social services; the results of laboratory analysis were not known by the investigators at this time of the study. RESULTS: The maternal drug addiction was confirmed after clinical investigation in 18 cases including the 12 cases detected by prenatal interview (group 1), and recused in 13 other cases (group 2). In group 1, nine infants of 12 had a positive urine test (seven opiate, one cocaine, one cannabis), 11 of 11 a positive meconium test (nine opiate, one cocaine, one cannabis), ten of 19 a positive hair test (eight opiate, one cocaine, one cannabis); all infants in this group had at least one positive result. In group 2, all tests were negative except one urine test positive for opiate after cesarean delivery performed under anesthesia including opiate analgesia. CONCLUSIONS: Urine, meconium and hair testing versus urine testing alone increase the sensitivity of laboratory analysis for detection of prenatal drug exposure.

[Severe potassium dichromate poisoning after accidental nasal introduction]. / Intoxication grave au dichromate de potassium après introduction nasale accidentelle.

BACKGROUND: Nasal foreign body (NFB) is a common situation in pediatrics. Poisoning is a rare complication of NFB insertion. We report a case of acute potassium dichromate poisoning secondary to NFB insertion. CASE REPORT: Six days after insertion of a NFB, progressive occurrence of diarrhea, vomiting, nasal obstruction, acute renal failure, pancreatitis, hepatitis and drowsiness justified hospitalization of a 3-year-old girl in the pediatric intensive care unit. Acute potassium dichromate poisoning was confirmed by high plasma chromium level and by the spectrophotometric analysis of the crystal. Recovery was satisfactory with supportive treatment. An official survey allowed to discover that the crystal was freely sold and that its toxicity was unknown by dealers, while no information was given to the customers. CONCLUSION: Transmucosal absorption of toxics is an unusual severe potential hazard that should be evoked to allow a rapid management. After the discovery and withdrawal of a NFB, occurrence of systemic symptoms, even trivial, must make one suspect a poisoning. In this circumstance, analysis of the foreign body should be done, associated with toxicologic dosages. This case report illustrates that potassium dichromate poisoning is a severe medical condition and that its clinical presentation assume a large widespread of symptoms due to multiple organ involvement.

[A wine pitcher, cause of lead poisoning]. / Un pichet à vin à l'origine d'un cas de saturnisme.

A 35-year-old male nurse hospitalized for recurrent episodes of intolerable abdominal pain was found to have non-hemolytic anemia and saturnism with blood lead level reaching 500 micrograms/l. Search for the source of the lead led to the discovery of an earthenware jug purchased in a Corsica craftsware shop. This jug had been used to hold the patient's daily consumption of wine (estimated at one-half to three-quarters liters per day) in the refrigerator. On the basis of lead release measurements using the method described in the EEC directive 84/500 (maximum tolerated limit for crockery = 4 mg lead/litter contents), it was found that the jug released 216 mg/l and estimated that the patient had ingested 0.8 to 1 mg of soluble lead daily for the past 8 years. The patient was successfully treated with chelator agents. This case of lead poisoning caused by a single earthenware wine jug confirms the need for rigourous governmental directives to control the production and distribution of varnished earthenware.

[Benzodiazepine levels in drivers involved in traffic accidents]. / Imprégnation en benzodiazépines de conducteurs impliqués dans des accidents de la circulation.

A study of benzodiazepine impregnation of 234 drivers involved in road accidents showed a higher level of impregnation than that usually observed in the general population and a different frequency of this impregnation in the two populations. Although a significant correlation was found between responsibility of the driver and positivity of benzodiazepine assays, this result must be interpreted with caution and does not permit to attribute the responsibility for the accident to the presence of benzodiazepine in blood.

[Aetiologies of lithium overdose: 10-year experience of Marseille poison centre]. / Circonstances d'intoxication par sels de lithium: expérience du centre antipoison de Marseille sur 10 ans.

OBJECTIVE: Lithium is used for control of bipolar disorders. In order to precise the different circumstances at the origin of poisonings, the authors present the cases of lithium intoxication observed in the Marseille poison centre between January 1991 and December 2000. STUDY DESIGN: Retrospective study. METHODS: Three hundred and four cases were observed during the studied period (1 patient a case), concerning 6 different circumstances. For 3 of them, the symptoms were mild: accidental ingestion with children (13 cases); mistakes on the quantities of ingested tablets (43 cases); elevation of lithium blood level due to diuretic therapy (8 cases). For 2 other circumstances, the clinical signs were more severe: treated patients who developed renal failure (15 cases, 6 patients managed in intensive care unit [ICU], 1 death) or dehydration (35 cases, 8 patients treated in ICU and 1 death). Finally, the most severe cases were collected with suicide attempts. Fifty-six percent of the patients were managed in ICU, 5% needed haemodialysis, 10% had cardiac (repolarization disturbances) or neurological (seizures) complications, 2% died. CONCLUSION: The severity of lithium poisonings depends of the circumstances. Ingestion of high quantities of sustained released tablets is the most dangerous situation. Accidental ingestion, even with children, must be considered as less severe situations.

[Bradycardia during treatments of weight loss]. / Bradycardies lors de cures d'amaigrissement.

Sinus bradycardia was observed in 10 adolescents participating in a weight loss diet conducted in a health centre. The precise cause was assessed. The subject's age ranged from 10 to 15 years and weight loss ranged from 8 to 24 kg over a period ranging from 8 to 23 weeks. None of the subjects had taken drugs with a bradycardic effect and search for toxic agents in the blood and urine was negative in all cases. Infection was suggested since 8 of the 10 adolescents had a rhinopharyngitis a few weeks before the discovery of bradycardia. This cause was not retained due to the lack of any signs of infection or inflammation and negative virus serology. Nutritional status was therefore retained as the most likely cause in these adolescents who were eating a diet containing < or = 1350 kcal/day. This hypothesis was supported by the results of work reported in 1970 showing arrhythmia in very low calorie diets. The effect is essentially related to the biological value of proteins in the diet, its duration and the initial weight of the subjects. In addition bradycardia is frequently seen in subjects taking hypocaloric diets or with anorexia nervosa and should be considered as an adaptation to hypometabolism rather than a true heart disorder. Thus the biological value of the proteins and the mineral status should be taken into consideration during the course of low calorie diets, even though bradycardia is frequent and does not require a specific treatment. Therefore heart rate and decreasing rate of weight loss should be carefully followed during the course of low calorie diets.

[Doping in sports. Cases reported to the Poison Control Center of Marseille from 1992 to 2000]. / Produits dopants en pratique sportive. Cas notifiés au centre antipoison de Marseille de 1992 à 2000.

OBJECTIVE: To study the doping substances used in sport and their toxicity. METHODS: Retrospective analysis from January 1992 to December 2000 of the cases of use of doping substances in sport reported by telephone to the anti-poison center in Marseilles. RESULTS: Fifty-one cases were reported concerning 48 men and 3 women with a mean age of 30, ranging from 10 to 55 years. Sixty-three percent of cases were reported over the last four years. The sport practiced was bodybuilding, except in 2 cases (cycling in one case and running in the other). The products used were mainly anabolizing hormones (15 times), clenbuterol (14 times) and creatine (7 times). A third of cases concerned associations of substances and 19 cases presented with symptomatology. CONCLUSION: The diversity in nature and status of the substances mentioned and their association requires enhanced vigilance with regard to the use of drugs in sport. The recent measures voted within the framework of the anti-doping law dated 23/3/99 are aimed at increasing surveillance with the development of anti-doping antennae.

[Lead poisoning in adults. Experience of the Poison Control Center of Marseille from 1993 to 2000]. / Le saturnisme des adultes. Expérience du Centre antipoison de Marseille de 1993 à 2000.

OBJECTIVE: Report the experience of the Marseille's anti-poison center with lead poisoning adults. PATIENTS AND METHODS: Between 1993 and 2000, 45 adults patients consulted the poison Centre of Marseille for a history of lead exposure (9 women, 36 men, average age 44 YO, between 22 an 76 YO). The lead sources were mostly occupational (welding, heavy metal industries...), but some were environmental (shooting as a hobby, hunting,...). RESULTS: Ninety-one percent of the patients presented with a clinical feature of possible lead intoxication (asthenia, abdominal pain, anaemia, seizures,...). For 22 patients, calcitetracemate provocation test was negative. 6 patients with a positive test refused to be treated. 16 patients with a positive test were treated with chelation therapy (average lead blood level 566 micrograms/l--mini 320 micrograms/l, maxi 943 micrograms/l--and average lead urine elimination 3,011 micrograms/24 H--mini 789 micrograms/24 H, maxi 7,229 micrograms/24 H. 58 cures were done (1 to 12 cures for each patient). The average quantities of lead eliminated in the urine during the chelation therapy was 30,912 micrograms +/- 29,059 micrograms by case. For 12 patients who stopped the lead exposure after the diagnosis of lead poisoning, the chelaion therapy permitted to decrease the lead blood level of 69%. For 4 patients still exposed during the treatment, the lead blood level decrease of 7% only. For the 16 treated patiEnts, a clinical improvement was noted, and no adverse effects of chelation therapy was observed during the 58 cures.