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Aims: The diagnostic type I ECG in Brugada syndrome (BS) is often concealed and fluctuates between the diagnostic and non-diagnostic pattern. Challenge with intravenous ajmaline is used to unmask the diagnostic Brugada ECG. The aim of this study was to evaluate the safety of the test and to identify predictors for the response to an intravenous ajmaline challenge., Methods and Results: In four tertiary referral centres, 677 consecutive patients underwent an intravenous ajmaline challenge for diagnosis or exclusion of BS in accordance with the recommendations of the Brugada consensus conferences. Two hundred and sixty-two ajmaline challenges (39%) were positive. Male gender, familial BS, sudden cardiac arrest (SCA), first-degree AV-block, basal saddleback type ECG, and basal right bundle branch block were identified as predictors for a positive ajmaline challenge. A predictor for negative ajmaline test was the absence of ST-segment elevation at baseline. Six of 12 patients who had experienced SCA, and five of 25 patients with a familial sudden death exhibited a positive response to ajmaline. Only one patient (0.15%) developed sustained ventricular tachyarrhythmias (ventricular fibrillation) during ajmaline challenge, which was terminated by a single external defibrillator shock., Conclusion: Ajmaline challenge is a safe procedure to unmask the electrocardiographic pattern of BS. Electrocardiographic and clinical parameters were identified to predict patients' response to ajmaline. The results of this study guide the clinician in which setting an ajmaline challenge is an appropriate diagnostic step.

The antidiabetic drug metformin is among the pharmaceuticals with the highest production numbers world-wide. This paper presents first data on the occurrence of metformin in sewage and surface waters in Germany. Analysis of metformin is based on pre-concentration of the analyte onto a polymeric solid-phase material and subsequent determination by liquid chromatography and tandem mass spectrometry. Applying the method to sewage and surface waters, recoveries >90% and limits of detection of 10 ng L(-1) could be achieved by pre-concentration of a sample volume of only 10 mL. Measurements in sewage and surface waters showed an almost ubiquitous presence of metformin in the aquatic environment. The measured concentration levels in sewage treatment plant influents correlate nicely to the prescription numbers for metformin in Germany. During sewage treatment a significant reduction of metformin concentrations was observed which seems to be mainly due to microbial degradation. Despite this significant elimination during sewage treatment, metformin was found in all river waters under investigation. Concentration levels depend on the sewage fraction of the receiving waters and for most rivers are in the range of several 100 ng L(-1), i.e. in the same order of magnitude or even higher than for other relevant pharmaceutical residues.

In this paper, results of an extensive monitoring programme for pharmaceutical residues in the river Rhine are presented. For one decade (1997 until 2006), the occurrence of widely used human pharmaceuticals like analgesics, lipid regulators, antiepileptics and others has been studied at four locations along the river Rhine. The results of more than 500 analyses clearly prove that compounds such as carbamazepine or diclofenac are regularly found in the river Rhine in concentrations up to several hundred ng per litre. Combining concentration levels with data on water flow enables the calculation of transports, which e.g. for carbamazepine or diclofenac were in the range of several tons per year. The evaluation of the long-term monitoring data shows that only a slight decrease in concentration levels as well as in annual transports can be observed and thus the contamination of the river Rhine by pharmaceutical residues during the last decade has to be regarded as almost constant. Seasonal variations can be detected for bezafibrate, diclofenac and ibuprofen, for which the concentrations are much lower in the summer months. A more effective removal during wastewater treatment in the warmer periods of the year seems to be the major reason for those variations. For carbamazepine, no comparable seasonal effect can be found.

Aminopolycarboxylic acids, such as ethylenediaminetetraacetic acid (EDTA), nitrilotriacetic acid (NTA), diethylenetriaminepentaacetic acid (DTPA), 1,3-propylenediaminetetraacetic acid (1,3-PDTA), beta-alaninediacetic acid (beta-ADA), and methylglycinediacetic acid (MGDA), are used in large quantities in a broad range of industrial applications and domestic products in order to solubilize or inactivate various metal ions by complex formation. Due to the wide field of their application, their high polarity and partly low degradability, these substances reach the aquatic environment at considerable concentrations (in the microg/L-range) and have also been detected in drinking water. This review evaluates and summarizes the results of long-term research projects, monitoring programs, and published papers concerning the pollution of the aquatic environment by aminopolycarboxylates in Germany. Concentrations and loads of aminopolycarboxylates are presented for various types of water including industrial and domestic waste waters, surface waters (rivers and lakes), raw waters, and drinking waters.

In this paper, analytical methods for the trace-level determination of 60 pharmaceuticals in aqueous samples are presented. The list of compounds amenable to the methods comprises analgesics, antiphlogistics, antirheumatics, beta-blockers, broncholytics, lipid-lowering agents (or their metabolites), antiepileptics, vasodilators, tranquillizers, antineoplastic drugs, iodinated X-ray contrast media, and antibiotics of different kind, mainly sulfonamides, macrolides, and penicillins. All methods are based on automated solid-phase extraction followed by GC-MS (after derivatization of the acid compounds) or HPLC-electrospray ionization MS-MS. After an intense validation, which included the determination of performance data according to the German standard method DIN 32645 (limit of detection, limit of identification, limit of determination), the determination of linearity, recovery, and repeatability and the study of matrix effects, the analytical methods were applied within a monitoring program on the occurrence of pharmaceuticals in groundwaters of Baden-Württemberg. During this monitoring program, it was found that several of the compounds under investigation could be detected in groundwaters and their occurrence could be traced back to an impact of municipal or industrial waste water.