Radioimmunoassay technology in mass drug screening: an evaluation of an absorbent paper disk transport system.

These studies have demonstrated the feasibility of using urine-saturated paper disks in place of urine in the RIA system for drug abuse detection. Results with the disks are consistent with those using urine. A satisfactory procedure has been devised which provides reproducibility of results with no loss of sensitivity or specificity. Further, the procedure is essentially the same as the current procedure requiring urine except that a paper disk punched from a filter paper strip impregnated with urine is used. Complete flexibility is retained to switch from urine to disk. No new or additional equipment is required. It is envisioned that the urine would remain at the collection site and dried filter paper strips containing urine under test be shipped to toxicology laboratories. Sould the disk assay be positive, the urine specimen identified with that disk could then be shipped to the laboratory for confirmation by gas-liquid chromatography or other acceptable methods. The time and expense incurred in shipping large volumes of urine would thus be eliminated.

A semiautomated radioimmunoassay for mass screening of drugs of abuse.

A rapid, semiautomated radioimmunoassay system for detection of morphine, barbiturates, and amphetamines is described. The assays are applicable to large drug abuse screening programs. The heart of the system is the automatic pipetting station which can accomplish 600 pipetting operations per hour. The method uses 15 to 30 mul or urine for the morphine and barbiturate assay and 100 mul for the amphetamine and combined morphine/barbiturate assays. A number of other drugs were tested for interference with the assays and the results are discussed.

An endemic focus of Trypanosoma cruzi infection in a subhuman primate research colony.

Leishmanial forms of Trypanosoma cruzi with multifocal pseudocysts were identified in a deceased adult female rhesus monkey (Macaca mulatta) that had been maintained in an outdoor primate colony in southern Texas. Subsequent clinical investigation of the remainder of the colony identified 20 additional monkeys seropositive for T cruzi. Concurrent epizootiologic surveys confirmed the presence of sylvatic reservoirs and triatomine vectors of T cruzi infection and identified a natural T cruzi transmission cycle. Veterinarians associated with the research colony were informed of the potential for further T cruzi transmission and appropriate insect vector and reservoir animal control programs were implemented..

Urinary morphine excretion during and after morphine anaesthesia for open-heart surgery in children.

The urine of 20 children undergoing complete correction of atrial septal defect (ASD) or tetralogy of Fallot (TF) were analyzed for morphine and its glucuronide conjugation product before and after induction of morphine anaesthesia, throughout the operation and for two hours post-operatively. Children with ASD had a higher, mean urine flow rate during anesthetic induction and during the entire operation than those with TF (P less than 0.01). ASD children excreted a greater percentage of the administered morphine by the time they reached the recovery room and after two hours in the recovery room than those with TF. Urinary morphine in the glucuronide form increased progressively from anaesthetic induction until the post-operative period in both groups and was more than 93% after two hours in the recovery room. Fifty-five per cent of ASD patients had respiratory dynamics that enabled them to be extubated within six hours of the end of their operation. Those that could be extubated after six hours had excreted a significantly greater percentage of morphine than those that couldn't (P less than 0.025). None of the children with TF could be extubated until the day after operation. These data demonstrate that the ability to maintain adequate spontaneous respiration after morphine anaesthesia is directly related to urinary output during anaesthesia and operation.

Urinary excretion of morphine during and after valvular and coronary-artery surgery.

The urines of 34 patients anesthetized with morphine for mitral-valve or aortic-valve replacement operations or for coronary-artery disease revascularization procedures were analyzed for morphine and morphine-3-glucuronide before, during and for two hours after operation. Patients who had coronary-artery disease had higher urinary flow rates and excreted greater proportions of the administered morphine during induction of anesthesia, throughout operation, and for two hours postoperatively than patients with valvular heart disease. Correlation of total urinary output with total free morphine excreted after two hours in the recovery room was high, r = .84. Urinary morphine in the glucuronide form increased progressively from the time of induction of anesthesia to the postoperative period and was greater than 91 per cent for all patients after two hours in the recovery room. Patients who had coronary-artery disease required mechanical postoperative ventilation for significantly shorter periods than did those with valvular heart disease. The duration of postoperative ventilation was negatively correlated with total urinary output and total free morphine excreted in the urine from induction of anesthesia until two hours postoperatively (r = .80 and r = .77, respectively). The data demonstrate that urinary excretion of free morphine and morphine-3-glucuronide during and early after operation is greater in patients who have coronary-artery disease than in those with valvular heart disease. The findings also suggest that duration of mechanical ventilation after morphine anesthesia and operation is inversely related to urinary output and excretion of free morphine. (Key words: Analgesics, narcotic, morphine; Biotransformation (drug), morphine.)

Urine norepinephrine excretion in patients undergoing mitral or aortic valve replacement with morphine anesthesia.

Urine norepinehprine concentration and excretion were measured before, during and after mitral or aortic valve replacement in four groups of patients anesthetized with 1 to 3 mg/kg of morphine plus oxygen or 0.5 to 1.5 percent halothane and oxygen. All patients were similarly premedicated 90 minutes before operation. A bladder catheter was implanted at the time until anesthesia was begun. Urine was also collected during induction of anesthesia, from the first incision until bypass, during bypass, after bypass, and for 2 hours in the recovery room. Urine was analyzed for norepinphrine via the fluorometric method of Vikota. Urine output of patients undergoing the same prodecure were similar during all study periods irrespective of anesthetic. Mean preoperative urine norepinephrine concentrations and excretions of all groups were also similar. Urine norepinephrine concentrations and excretions in patients receiving halothane were unchanged until the postoperative period, when they became significantly increased. Patients given morphine anesthesia had marked increases in urine norepinephrine concentrations and excretions during induction, at all times intraoperatively, and postoperatively. These data suggest that morphine anesthesia increases norepinephrine blood levels in patients with valvular heart disease undergoing surgical correction.

The effects of morphine and halothane anaesthesia on urine norepinephrine during surgery for congenital heart disease.

Urine excretion rates of norepinephrine were measured in 15 children with Tetralogy of Fallot and 25 with atrial septal secundum defects anaesthetized with halothane or morphine before, during and for two hours after surgical correction of their cardiac defects. All patients were paralyzed with d-tubocurarine, the tracheae were intubated and respiration was controlled. Urine was obtained for 90 minutes before induction, during induction, before, during and after bypass and postoperative. Patients with TF had significantly higher pre-operative urine norepinephrine excretion rates than patients with ASD. In TF children anaesthetized with halothane norepinephrine excretion was significantly decreased during induction and during operation but increased post-operatively. Children with ASD and anaesthetized with halothane did not have urine norepinephrine excretion rates that were significantly different from post-operative values until the postoperative period. ASD children anaesthetized with morphine had marked elevations in norepinephrine excretion during induction and all subsequent study periods. On the other hand, morphine anaesthetized TF children did not have a significant increase in urine norepinephrine excretion until bypass had been established. Increased norepinephrine excretion was maintained in these patients during all subsequent study periods. These data, when combined with our results in patients with acquired heart disease, demonstrate that disease can alter norepinephrine responses to morphine anaesthesia. In addition our results suggest that dosage of morphine and morphine blood levels might also modify norepinephrine excretion.

The effects of morphine and halothane anaesthesia on urine norepinephrine during and after coronary artery surgery.

Urine concentrations and excretion rates of norepinephrine were measured in 28 patients anaesthetized with halothane or morphine before, during and for two hours after aortocoronary artery grafting procedures. All patients were paralyzed with d-tubocurarine, intubated and respiration was controlled. Urine was obtained for 90 minutes before induction, during induction, before, during and after bypass and postoperatively. In patients anaesthetized with halothane, urinary norepinephrine concentrations and excretion rates were not significantly different from preoperative values until the postoperative period. Patients anaesthetized with morphine did not have urine norepinephrine concentrations different from preoperative values until bypass, when they became significantly increased. All subsequent urine norepinephrine concentrations and excretion rates were significantly elevated when compared to preoperative values. These findings do not indicate a mechanism but they do demonstrate that morphine anaesthesia is associated with increased urinary and probably also increased plasma levels of norepinephrine during and after cardiopulmonary bypass in patients undergoing coronary artery operations.

Economic impact of a botulism outbreak. Importance of the legal component in food-borne disease.

Legal expenses arising from food-borne outbreaks have not been reported in the medical literature, to the best of our knowledge. Expenses of an outbreak of food-borne botulism involving 34 victims in 1978 exceeded +5.8 million. These included outbreak investigation and control (3.2% of total), medical care for patients with botulism from April 1978 through October 1981 (12.3%), and settlements and legal charges (84.4%). Legal actions following food-borne outbreaks must be recognized for several reasons. First, the delay between the outbreak and the conclusion of legal activity (three years in this instance) mandates prompt and meticulous written documentation of investigation and control work. Second, legal expenses may make a large contribution to the total societal impact of food-borne disease outbreaks. Finally, awareness of the legal expense strengthens the rationale for public and private expenditures on food-borne disease prevention in this country.

Epidemiologic Surveillance for Staphylococcus epidermidis infections related to cardiopulmonary bypass.

Epidemiologic investigation of 20 Staphylococcus infections among valvular and aortocoronary bypass graft patients indicated a broad spectrum of clinical illness in these two groups. The highest infection rate (9.3%) and case specific mortality rate (54.5%) were noted among those patients undergoing cardiovalvular replacement surgery with protheses. The median onset of infection was 6 days suggesting infection during the intraoperative period. Using the epidemiologic data from this investigation, a transmission pattern was formulated and a series of control measures designed to interdict the routes of transmission were instituted wigh marked success. These measures significantly reduced the incidence of S. epidermidis infections among these high risk patients.

Epidemic rubella in military recruits.

Between Dec 1 and Feb 18, 1976, 320 cases of rubella occurred among recruits and dependent children at two Air Force bases in Illinois and Texas. Only 28 cases (9%) were identified in patients aged 17 and under. Routine serosurveilance before the outbreak revealed protective immunity in 89.1% of trainees. This outbreak emphasizes the changing epidemiology of what was formerly considered a childhood illness, and underscores the failure of herd immunity.

Epidemiologic features and phage types associated with nosocomial infections caused by Staphylococcus epidermidis.

An apparent problem with increased numbers of nosocomial infections caused by Staphylococcus epidermidis at a large hospital was studied in a clinical-epidemiological investigation. Thirty-six cases of S. epidermidis infection were confirmed on the thoracic surgery, general surgery, nursery and pediatric services during a 3-year period. Nine cases were fatal and six of these occurred in patients following cardiovascular surgery with implanted prothesis. The majority of cases (25/36) occurred following cardiovascular surgery. The median onset of infection was six days from the date of surgery, suggesting infection during the intraoperative period. Although the number of cases studied remains small, two phage types, 71/108/275a/459 and 407-2, did predominate among these clinical infections. Interestingly, during this same time interval these same types predominated among surgical staff members closely associated with these patients. Resistance to antimicrobials was high among isolates tested, with more than 50% of the strains resistant to six or more antimicrobial agents.

Rubella screening and vaccination program for US Air Force trainees: an analysis of findings.

A preventive medicine program of rubella control for trainees at the Air Force Military Training Center, Lackland AFB, Texas, was begun in October 1977. Incoming trainees were screened for rubella susceptibility, and female trainees were additionally screened for pregnancy. During the period October 1977 to December 1978, an overall rubella susceptibility rate of 17.3 per cent was determined for 71,387 trainees entering basic training. Flights (50 persons each) to which these trainees are assigned varied widely in susceptibility from 0.0-47.7 per cent. Comparisons of susceptibility rates for trainees for for geographic areas and states indicated the highest overall percentage of susceptibles were from the Pacific geographic area with California showing the highest susceptibility (24.5 per cent). Race specific susceptibility rates were found to differ significantly between Whites and Blacks, 17.6 vs 14.8 per cent, respectively. The immunization program was effective as judged by a dampening of the incidence of clinical rubella at the basic training center and at other secondary training centers.