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AbstractObjectiveRobot-assisted ventral hernia repair (RVHR) has become a feasible alternative for open ventral hernia repair showing fewer postoperative complications and satisfying short-term results. However, long-term results are scarce in current literature.MethodsAll consecutive patients who underwent robot-assisted surgery for ventral hernias from June 2018 until February 2023 were included. Patient records were retrospectively reviewed for indication, need for conversion, length of stay (LOS), postoperative complications, and postoperative pain.In addition, long-term (>24 months) results (recurrence, chronic pain, and esthetic satisfaction) were assessed by phone questionnaire.ResultsIn total, 177 patients underwent a robot-assisted ventral hernia repair. Indication for surgery was incisional hernia (N = 109) and primary hernia (N = 68), including 124 cases with abdominal rectus diastasis. A TransAbdominal Retromuscular Umbilical Prosthesis (TARUP) was performed in 138 patients. Robotic Transversus Abdominis Release (TAR) and Extended Totally Extraperitoneal Repair (eTEP) were performed in 20 (11%) and 9 (5%) cases, respectively.Median LOS was 2 days for TARUP and 3.5 days for TAR. Minor complications occurred in 22 patients (16 TARUP, 5 TAR, 1 eTEP). The average pain score on the first postoperative day was 1.8/10. No risk factors for morbidity could be identified by uni- and multivariable analysis.Hernia recurrence developed in four (2%) patients. Chronic pain was reported in two (1%) cases. Seven (4%) patients had esthetic complaints.ConclusionRobot-assisted ventral hernia repair is a safe procedure with low postoperative pain and short LOS. Long-term results including recurrence and chronic pain are satisfying.

AbstractPurposesSurgery remains an important treatment option for renal hyperparathyroidism (rHPT). The number of long-term outcome studies of parathyroidectomy is limited.MethodsAll consecutive patients with a parathyroidectomy for rHPT between 09/2009 and 04/2021 in a Belgian tertiary referral hospital were prospectively enrolled. The main outcomes were (long-term) cured proportion and postoperative morbidity (hypocalcemia, recurrent laryngeal nerve (RLN) palsy, re-intervention for bleeding, and wound morbidity).ResultsSixty patients with a median age of 57 years were analyzed, including 23 patients before kidney transplantation, 23 patients without kidney transplantation, and 14 patients after kidney transplantation. Median time to transplant was 15 (6–24) months after parathyroidectomy. Morbidity was low with only two non-urgent returns to theatre (wound infection and non-compressive hematoma), two temporary RLN paralyses, and no 30-day mortality. Length of hospital stay was longer in patients with parathyroidectomy before kidney transplant, due to a more severe and prolonged need for calcium supplementation. After a median follow-up of 63 months, 37 patients (62%) were still alive, and 11 patients (18%) developed a recurrence.ConclusionsThis single-surgeon, single-center cohort with long-term follow-up confirms the safety and excellent ‘cure’ proportions of surgery for rHPT but stretches the importance of long-term follow-up.

Members of the tumor necrosis factor receptor superfamily (TNFRSF) are important therapeutic targets that can be activated to induce death of cancer cells or stimulate proliferation of immune cells. Although it has long been implicated that these receptors assemble preligand associated states that are required for dominant interference in human disease, such states have so far eluded structural characterization. Here, we find that the ectodomain of death receptor 5 (DR5-ECD), a representative member of TNFRSF, can specifically self-associate when anchored to lipid bilayer, and we report this self-association structure determined by nuclear magnetic resonance (NMR). Unexpectedly, two non-overlapping interaction interfaces are identified that could propagate to higher-order clusters. Structure-guided mutagenesis indicates that the observed preligand association structure is represented on DR5-expressing cells. The DR5 preligand association serves an autoinhibitory role as single-domain antibodies (sdAbs) that partially dissociate the preligand cluster can sensitize the receptor to its ligand TRAIL and even induce substantial receptor signaling in the absence of TRAIL. Unlike most agonistic antibodies that require multivalent binding to aggregate receptors for activation, these agonistic sdAbs are monovalent and act specifically on an oligomeric, autoinhibitory configuration of the receptor. Our data indicate that receptors such as DR5 can form structurally defined preclusters incompatible with signaling and that true agonists should disrupt the preligand cluster while converting it to signaling-productive cluster. This mechanism enhances our understanding of a long-standing question in TNFRSF signaling and suggests a new opportunity for developing agonistic molecules by targeting receptor preligand clustering.

Paediatric attendances at the emergency department (ED) are often admitted to the hospital less than 24 h to allow time for more extended evaluation. Innovative organisational models could prevent these hospital admissions without compromising safety or quality of delivered care. Therefore, this systematic review identifies evidence on organisational models at the ED with the primary aim to reduce hospital admissions among paediatric patients. Following the PRISMA guidelines, three bibliographic databases (Ovid Medline, Embase, and Cochrane Library) were searched. Studies on organisational models in Western countries, published between January 2009 and January 2021, which applied a comparative design or review and studied at least hospital admission rates, were included. Analyses were mainly descriptive because of the high heterogeneity among included publications. The primary outcome is hospital admission rates. Secondary outcomes are ED length of stay (LOS), waiting time, and patient satisfaction. Sixteen publications described several innovative organisational models ranging from the creation of dedicated units for paediatric patients, innovative staffing models to bringing paediatric critical care physicians to patients at rural EDs. However, the effect on hospital admission rates and other outcomes are inconclusive, and some organisational models may improve certain outcomes in certain settings or vice versa. It appears that a paediatric consultation liaison team has the most consistent effect on hospital admission rates and LOS of paediatric patients presenting with mental problems at the ED. Implementing new innovative organisational models at the ED for paediatric patients could be worthwhile to decrease hospital admissions. However, the existing evidence is of rather weak quality. Future service developments should, therefore, be conducted in a way that allows objective evaluation.

In this work, the performance of mortar made with ferronickel slag (FNS) as cement replacement was investigated. The granulated FNS was ground to obtain a fineness higher than cement. To assess the performance of FNS in fresh and hardened mortar, the workability, flexural, and compressive strength were experimentally assessed. Based on the results obtained, the fluidity of mortar increased with increasing FNS content. It was found that FNS did not promote the compressive strength of mortar in the early days of curing, but at longer curing times the FNS starts to react. Although there is a decrease in flexural strength of mortar containing FNS, this result tends to be better than the compressive strength performance. The presence of FNS in mortar increased the porosity.

Objective: Intrathoracic goiters are a heterogeneous group characterized by limited or extensive substernal extension. Whereas the former can be treated through cervicotomy, the latter sometimes requires a cervicosternotomy. Whether cervicosternotomy leads to more morbidity remains unclear. Methods: In a prospectively gathered cohort undergoing thyroid surgery (2010–2019) intra- and postoperative morbidity of cervicotomy (N= 80) and cervicosternotomy (N = 15) for intrathoracic goiters was compared to each other and to a ‘standard’ thyroidectomy (N= 1500). Results: An intrathoracic extension prior to surgery was found in 95 (6%) of all thyroidectomies. Eighty patients (84%) were operated by cervicotomy and 15 (16%) by cervicosternotomy. The risk of temporary recurrent laryngeal nerve palsy was much higher in the cervicosternotomy group (21%) compared to cervicotomy (4%) and standard thyroidectomy (3%). The risk of temporary hypocalcemia after cervicotomy (28%) was comparable to a standard thyroidectomy (32%) but higher after cervicosternotomy (20%). No cases of permanent hypocalcemia or laryngeal nerve palsy were observed in both groups with substernal extension. The need for surgical reintervention was significantly higher in the cervicotomy group (6%) compared to cervicosternotomy (0%) and standard thyroidectomy (3%). Conclusion: In patients undergoing thyroid surgery for an intrathoracic goiter, cervicosternotomy was associated with more temporary laryngeal nerve palsy, but none of the interventions resulted in higher risks of permanent nerve damage, permanent hypocalcemia, or reintervention for bleeding. Reintervention was even more common after cervicotomy compared to cervicosternotomy. Level of evidence: IV

AbstractBackgroundDuring thyroid surgery, extreme caution must be taken not to harm the recurrent laryngeal nerve to avoid vocal cord palsy. A non-recurrent laryngeal nerve (NRLN) is a rare anatomical variation that is extremely vulnerable during thyroid surgery.MethodsDescription of two NRLN during thyroid surgery discovered early by using continuous intra-operative vagal nerve neuromonitoring and review of the literature.ResultsDuring thyroid surgery, we use continuous intra-operative vagal nerve neuromonitoring starting with checking vagal nerve signals. It is essential to start stimulation in the most proximal portion of the carotid sheath. An absent pre-dissection signal on the right vagal nerve with a positive signal on the left vagal nerve indicates a non-recurrent course of the right laryngeal nerve. Post-operatively computed tomography scan (CT-scan) was performed and showed an associated extra-anatomical course of the subclavian artery also known as an arteria lusoria.ConclusionThe NRLN is an important surgical challenge because unilateral palsy can lead to permanent hoarseness. This anomaly emphasizes the importance of a thorough surgical dissection and the use of intra-operative vagal nerve neuromonitoring. Our method of continuous intra-operative vagal nerve monitoring makes it possible to predict a non-recurrent laryngeal nerve in an early stage during surgery.

AbstractObjectiveA parathyroidectomy has been the treatment of choice for primary hyperparathyroidism. Especially the improved imaging techniques have led to minimally invasive techniques. Aim of this study was to evaluate our experience with robot-assisted parathyroidectomy through lateral cervical approach.Study designProspective clinical cohort.MethodsAll consecutive patients who underwent a robotic-assisted parathyroidectomy for primary hyperparathyroidism since 2011 were enrolled in this study. Demographic data, biometrics, imaging data and surgery data were collected. Main outcomes were postoperative hypocalcemia, recurrent laryngeal nerve paralysis and other postoperative complications.ResultsTwenty-two patients were enrolled. When patients with conversion were excluded (39%) mean operating time was 69 min. In all patients a normal value of serum PTH-levels was achieved 4 h postoperatively. Mean value of serum calcium was 2.92mmol/L preoperative and 2.33mmol/L postoperative. There was no persistent hypocalcemia in any of our patients. 87% was discharged on the first postoperative day. Esthetic results were excellent.ConclusionsRobotic-assisted parathyroidectomy through lateral cervical approach is a safe and feasible procedure in patients with posteriorly localized parathyroid adenomas. Preoperative imaging techniques are crucial to detect the exact location.

AbstractIntroductionMultinodular goiter associated with preoperative vocal cord palsy is usually indicative of invasive thyroid malignancy. However, benign thyroid disease may also lead to vocal cord paralysis.Case reportWe present a case of a 63-year old woman with a two-month history of hoarseness, loss of vocal pitch, difficulties with swallowing and shortness of breath. Preoperative flexible fiberoptic laryngoscopy showed a left vocal cord paralysis. Left hemithyroidectomy with isthmectomy under intraoperative neuromonitoring for multinodular goiter was performed. Intra-operatively, both ipsilateral recurrent laryngeal nerve (RLN) and vagal nerve (VN) were identified and preserved. Follow-up laryngoscopy 5 weeks postoperatively showed complete recovery of the left vocal cord movement.DiscussionIntuitively, surgeons may assume that preservation of a palsied RLN in patients with preexisting vocal cord paralysis is not meaningful. However, patients with RLN palsy associated with benign thyroid disease can experience full recovery after surgery.ConclusionMultinodular goiter associated with preoperative vocal cord paralysis should be managed with extreme caution and use of intra-operative neuromonitoring. The existing probability of intra-operative recovery of a preoperative RLN palsy underlines the importance of preserving the affected RLN during surgery for benign thyroid disease.

AbstractBackgroundHobnail variant of papillary thyroid carcinoma (HVPTC), also designated as a micropapillary variant, is a rare but aggressive variant of PTC, representing <2% of all PTC. It was adopted in the newest World Health Organization classification. HVPTC is strongly associated with higher mortality in comparison to classic PTC and a high propensity for disease progression. This paper aimed to investigate the clinical course, cytological and histopathological features, and mutational profile of the hobnail variant from a unique case.Case reportA case of a 38-year-old female patient with HVPTC is presented. Total thyroidectomy with central and bilateral, lateral lymphadenectomy was performed. The clinical course showed aggressive features, as lymph node metastasis and extrathyroidal extension were present at the presentation. Molecular and immunohistochemical features are addressed along with a review of the literature.DiscussionThe cytological examination of FNA was in consonance with published literature. The cells showed hobnail features in several segments of both thyroidal lobes on histological examination. The tumour displayed a typical BRAF mutation and Gly12Ala mutation in the KRAS gene, previously not associated with PTC.ConclusionWe aimed to highlight the aggressive, clinicopathological features of this high-risk variant. We emphasise the need to evaluate suspicious thyroid nodules as an adequate diagnosis can prevent delayed therapy. It directly impacts the tumour’s stage and prognosis. In fine-needle aspiration cytology showing papillary architecture carcinomas, HVPTC has to be part of the differential diagnosis.

AbstractObjectivesThis study aims to identify the facilitators and barriers to governance models of hospital collaborations. The country-specific characteristics of the Belgian healthcare system and legislation are taken into account.MethodsA case study was carried out in six Belgian hospital collaborations. Different types of governance models were selected: two health systems, two participant-governed networks, and two lead-organization-governed networks. Within these collaborations, 43 people were interviewed.ResultsAll structures have both advantages and disadvantages. It is important that the governance model fits the network. However, structural, procedural, and especially contextual factors also affect the collaborations, such as alignment of hospitals’ and professionals’ goals, competition, distance, level of integrated care, time needed for decision-making, and legal and financial incentives.ConclusionThe fit between the governance model and the collaboration can facilitate the functioning of a collaboration. The main barriers we identified are contextual factors. The Belgian government needs to play a major role in facilitating collaboration.

The service life of steel reinforced concrete in aggressive marine environments could be increased substantially by embedding a self-healing mechanism that ensures autonomous healing of cracks upon their occurrence. Previous proof-of-concept experiments have shown that the incorporation of encapsulated polymer-based healing agents (HAs) counts as a very appropriate way to achieve this goal. Over the years, several polymer-precursor-capsule systems have been developed in that perspective at our laboratory. Cementitious materials containing either commercial or in-house developed encapsulated HAs have been subjected to preliminary feasibility tests (water absorption, permeability tests, etc.). However, these experiments did not yet allow for a fast and straightforward assessment of the self-healing efficiency (SHE) in relation to the expected durability and service life performance of the material. This approach would have many advantages when having to select the most suitable polymer-precursor-capsule system for a particular concrete application. In this paper, a modified chloride migration test based on the one prescribed in NT Build 492 has been proposed to support the development of self-healing concrete for marine environments. Four polymer-based HAs have been screened that way, i.e. an in-house developed high-viscosity polyurethane (PU) precursor, a commercial low-viscosity PU precursor, the same commercial PU precursor with addition of accelerator and benzoyl peroxide (BPO), and an in-house developed 2-component acrylate-endcapped precursor + cross-linker. For now, a highly repeatable SHE value of 100% could only be obtained for the second option.

L’hypoparathyroïdie postopératoire, résultant de l'ablation et/ou de la dévascularisation d’une ou plusieurs glandes parathyroïdes, est une complication redoutée de la thyroïdectomie totale. Deux formes, qui se distinguent par leur fréquence, leurs délais de survenue et leur durée ainsi que leur présentation, doivent être individualisées : l’hypocalcémie postopératoire précoce, souvent secondaire à une hypoparathyroïdie précoce, qui est une situation fréquente survenant dès les premiers jours après la chirurgie ; et l’hypoparathyroïdie définitive, plus rare, qui se manifeste lorsque la fonction parathyroïdienne reste altérée plus de 6 mois après la chirurgie. Du fait de leur sévérité, ces situations doivent être connues et prévenues au mieux lors d’une thyroïdectomie totale. L’objectif de cet article est de fournir aux chirurgiens des recommandations pratiques pour la prévention, le diagnostic et le traitement de l’hypoparathyroïdie après thyroïdectomie totale. Ces recommandations, qui font l’objet d’un consensus médico-chirurgical, ont été développées par l’Association francophone de chirurgie endocrinienne (AFCE), la Société française d’endocrinologie (SFE) et la Société française de médecine nucléaire et imagerie moléculaire (SFMN). Le contenu, le grade et le niveau de preuve de chaque recommandation ont été définis après concertation au sein d’un panel d’experts, sur la base de l’analyse de la littérature récente.

L’hématome cervical post thyroïdectomie (HCPT) nécessitant une réintervention survient chez moins de 5 % des patients mais peut conduire au décès ou à des séquelles neurologiques graves s’il est compressif. Les facteurs de risque sont discutés en dehors des traitements anticoagulants. La prévention préopératoire repose sur le respect des recommandations de la Société française d’anesthésie-réanimation (SFAR) pour la gestion des antiagrégants et anticoagulants avant et après l’intervention. La prévention peropératoire s’appuie sur une hémostase soigneuse, aidée éventuellement de dispositifs de coagulation et d’agents hémostatiques sans qu’une preuve de leur efficacité sur la survenue des HCPT n’ait pu être démontrée. Le dogme du drainage systématique de la loge thyroïdienne n’est plus d’actualité pour prévenir la formation des HCPT. En postopératoire, le maintien d’une tension artérielle normale est indispensable pour prévenir les HCPT, ainsi que le contrôle des douleurs, de la toux, et des nausées et vomissements. Afin de diminuer le risque de complications graves, les équipes médicales et paramédicales doivent impérativement être formées à la reconnaissance d’un hématome et à sa prise en charge pour une évacuation en extrême urgence, éventuellement au lit du malade, puis un traitement de sa cause au bloc opératoire.

Chemokines and chemokine receptors are key modulators in inflammatory diseases and malignancies. Here, we describe the identification and pharmacologic characterization of nanobodies selectively blocking CXCR2, the most promiscuous of all chemokine receptors. Two classes of selective monovalent nanobodies were identified, and detailed epitope mapping showed that these bind to distinct, nonoverlapping epitopes on the CXCR2 receptor. The N-terminal–binding or class 1 monovalent nanobodies possessed potencies in the single-digit nanomolar range but lacked complete efficacy at high agonist concentrations. In contrast, the extracellular loop-binding or class 2 monovalent nanobodies were of lower potency but were more efficacious and competitively inhibited the CXCR2-mediated functional response in both recombinant and neutrophil in vitro assays. In addition to blocking CXCR2 signaling mediated by CXCL1 (growth-related oncogene α) and CXCL8 (interleukin-8), both classes of nanobodies displayed inverse agonist behavior. Bivalent and biparatopic nanobodies were generated, respectively combining nanobodies from the same or different classes via glycine/serine linkers. Interestingly, receptor mutation and competition studies demonstrated that the biparatopic nanobodies were able to avidly bind epitopes within one or across two CXCR2 receptor molecules. Most importantly, the biparatopic nanobodies were superior over their monovalent and bivalent counterparts in terms of potency and efficacy.

Chemokines and chemokine receptors are key modulators in inflammatory diseases and malignancies. Here, we describe the identification and pharmacologic characterization of nanobodies selectively blocking CXCR2, the most promiscuous of all chemokine receptors. Two classes of selective monovalent nanobodies were identified, and detailed epitope mapping showed that these bind to distinct, nonoverlapping epitopes on the CXCR2 receptor. The N-terminal–binding or class 1 monovalent nanobodies possessed potencies in the single-digit nanomolar range but lacked complete efficacy at high agonist concentrations. In contrast, the extracellular loop-binding or class 2 monovalent nanobodies were of lower potency but were more efficacious and competitively inhibited the CXCR2-mediated functional response in both recombinant and neutrophil in vitro assays. In addition to blocking CXCR2 signaling mediated by CXCL1 (growth-related oncogene α) and CXCL8 (interleukin-8), both classes of nanobodies displayed inverse agonist behavior. Bivalent and biparatopic nanobodies were generated, respectively combining nanobodies from the same or different classes via glycine/serine linkers. Interestingly, receptor mutation and competition studies demonstrated that the biparatopic nanobodies were able to avidly bind epitopes within one or across two CXCR2 receptor molecules. Most importantly, the biparatopic nanobodies were superior over their monovalent and bivalent counterparts in terms of potency and efficacy.

Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures.

A thin layer chromatographic procedure for the detection of bipyridylium compounds in post-mortem human tissues is described. To verify the suitability of the method, human biological samples originating from two fatal poisoning cases, are analyzed. In the first case, an amount of Gramoxone® (Paraquat) was taken orally. Death occurred after ± 30 hours without any specific treatment. The second case is concerned with an ingestion of Reglone® (Diquat), followed by death after 5 days of intensive care treatment.

A 65-year-old Caucasian female developed an intermediate syndrome seven days after an acute cholinergic crisis, caused by the ingestion of fenthion.

OBJECTIVE: To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. Design Cross sectional surveys of patients and nurses. Setting Nurses were surveyed in general acute care hospitals (488 in 12 European countries; 617 in the United States); patients were surveyed in 210 European hospitals and 430 US hospitals. Participants 33 659 nurses and 11 318 patients in Europe; 27 509 nurses and more than 120 000 patients in the US. MAIN OUTCOME MEASURES: Nurse outcomes (hospital staffing, work environments, burnout, dissatisfaction, intention to leave job in the next year, patient safety, quality of care), patient outcomes (satisfaction overall and with nursing care, willingness to recommend hospitals). RESULTS: The percentage of nurses reporting poor or fair quality of patient care varied substantially by country (from 11% (Ireland) to 47% (Greece)), as did rates for nurses who gave their hospital a poor or failing safety grade (4% (Switzerland) to 18% (Poland)). We found high rates of nurse burnout (10% (Netherlands) to 78% (Greece)), job dissatisfaction (11% (Netherlands) to 56% (Greece)), and intention to leave (14% (US) to 49% (Finland, Greece)). Patients’ high ratings of their hospitals also varied considerably (35% (Spain) to 61% (Finland, Ireland)), as did rates of patients willing to recommend their hospital (53% (Greece) to 78% (Switzerland)). Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and patient satisfaction. In European hospitals, after adjusting for hospital and nurse characteristics, nurses with better work environments were half as likely to report poor or fair care quality (adjusted odds ratio 0.56, 95% confidence interval 0.51 to 0.61) and give their hospitals poor or failing grades on patient safety (0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care (1.11, 1.07 to 1.15) and poor or failing safety grades (1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (1.16, 1.03 to 1.32) and recommend their hospitals (1.20, 1.05 to 1.37), whereas those with higher ratios of patients to nurses were less likely to rate them highly (0.94, 0.91 to 0.97) or recommend them (0.95, 0.91 to 0.98). Results were similar in the US. Nurses and patients agreed on which hospitals provided good care and could be recommended. CONCLUSIONS: Deficits in hospital care quality were common in all countries. Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction.

For many drugs the salivary concentration corresponds to the free plasma drug concentration, which may be more closely related to drug activity or toxicity than the total plasma drug concentration. In this study a preliminary investigation was undertaken to determine the feasibility of monitoring saliva levels of disopyramlde, an antiarrhythmic drug, for clinical and toxicological purposes. Single oral doses of this compound were administered to healthy volunteers. Stimulated mixed saliva and plasma levels were measured by the EMIT technique. The concentrations of disopyramlde in the stimulated mixed saliva tended to be lower than those found in the corresponding plasma sample (fp 0.3–0.5), and the saliva-to-plasma concentration ratio increased with a decreasing salivary pH (pH 6.89, S/P=0.25; pH 8.15, S/P=0.08). The correlation between the saliva and the total plasma concentrations was significant but relatively poor, however. Consequently, mixed salivary disopyramide concentrations are a poor indicator of plasma concentrations, even if correction is made for pH change.

A fatal intoxication due to the ingestion of tilidine, a narcotic analgesic, in conjunction with ethanol, is described. Tilidine and its two active metabolites, nortilidine and bisnortilidine, were identified and quantitated in the biological fluids and tissues by thin-layer chromatography (TLC), gas-liquid chromatography with sensitive nitrogen-phosphorus detection (GLC/NPD) and gas-liquid chromatography with mass spectrometric detection (GC/MS). The toxicological results are compared with previously reported 14C-tilidine tissue distributions in rats following oral administration and limited tissue data in a previously reported human fatality. In the present case, the death was attributed to the combined central nervous system-depressing effects of ethanol and tilidine.

Capillary GC is applied to the toxicological analysis of illicit heroin samples. The combined use of a permanently deactivated fused silica capillary column, and a nitrogen-phosphorus detector (NPD), allows the separation and determination of nanogram amounts of underivatised opiates, using a direct injection technique.