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The article focuses on a study concerning the application of inductively coupled plasma mass spectrometry (ICP-MS) to multielement analysis in fingernail and toenail that will serve as biological indices for metal exposure. It notes that the application of ICP-MS to multielement analysis provides great noninvasive control of domestic, environmental, or domestic exposure and is very helpful for epidemiological studies. Methods involved in the study, as well as the results and findings obtained are also discussed.

Abstract: Intoxications by chromium (Cr) compounds are very life threatening and often lethal. After oral ingestion of 2 or 3g of hexavalent Cr (CrVI), gastrointestinal injury, but also hepatic and renal failure, often occurs which each leads to a fatal outcome in most patients. Cellular toxicity is associated with mitochondrial and lysosomal injury by biologically CrVI reactive intermediates and reactive oxygen species. After CrVI has been absorbed, there is not much that can be done except to control the main complications as the treatment is only symptomatic. The biotransformation of CrVI to CrIII reduces the toxicity because the trivalent form does not cross cellular membranes as rapidly. In fact, more than 80% of CrVI is cleared in urine as CrIII. We report the case of a 58-year-old male patient who was admitted to hospital after accidental oral ingestion of a 30g/L potassium dichromate (the estimated amount of ingested Cr is about 3g). ICP-MS equipped with a collision/reaction cell (CRC) and validated methods were used to monitor plasma (P), red blood cells (RBCs), urine (U) and hair chromium. For urine the results were expressed per gram of creatinine. After 7days in the intensive care unit, the patient was discharged without renal or liver failure. P, RBC and U were monitored during 49days. During this period Cr decreased respectively from 2088μg/L to 5μg/L, 631μg/L to 129μg/L and 3512μg/g to 10μg/g. The half-life was much shorter in P than in RBC as the poison was more quickly cleared from the P than from the RBC, suggesting a cellular trapping of the metal. Hair was collected 2months after the intoxication. We report a very rare case of survival after accidental Cr poisoning which has an extremely poor prognosis and usually leads to rapid death. For the first time, this toxicokinetic study highlights a sequestration of chromium in the RBC and probably in all the cells. [Copyright &y& Elsevier]

The article focuses on a study which developed a method using online extraction coupled to liquid chromatography-tandem mass spectrometry (LC-MS-MS) to determine cyanide (CN) in blood. The method involved the use of cyanide isotope 13C15N as internal standard (IS) for quantification in MS-MS, and derivatization step with naphtalene-2,3-dicarboxyaldehyde (NDA) and taurine. The study showed that the method is suitable for CN identification in blood and in forensic toxicology.

Identification of glyphosate in four cases of poisoning, using nuclear magnetic resonance spectroscopy of biological fluids is reported. It has been performed by using a combination of 1H and 31P NMR analyses. Characterization of the N-(phosphonomethyl) glycine herbicide was achieved by chemical shift considerations and coupling constant patterns: CH2 (P) presents specific resonance at 3.12 ppm and appears as a doublet with a H-P characteristic coupling constant of 12.3 Hz. Moreover, resonances due to isopropylamine were present, confirming the ingestion of the considered trade formulation. After a calibration step, quantitation was performed by 1H and 31P NMR spectroscopy. The benefit and reliability of NMR investigations of biological fluids are discussed, particularly when the clinical picture is quite confusing. [Copyright &y& Elsevier]

Tramadol is a centrally acting analgesic agent used in the treatment of mild to moderate pain. It has a low affinity to opioid receptors and inhibits the reuptake of norepinephrin and serotonin producing an analgesic action by blocking nociceptive impulses in the spine. Although 21 drug-combined fatalities including tramadol have been reported, only two fatal overdoses in adults with tramadol alone have been reported to date. We report four additional lethal intoxications, assess the toxicity of tramadol, the detection method and the possible interaction with other central nervous system (CNS) depressants, particularly benzodiazepines. Similarities between tramadol and buprenorphine are discussed, and a possible cytochrome P450-based interaction between tramadol and benzodiazepine is considered. To our knowledge, this relationship has never been reported in the literature. [Copyright &y& Elsevier]

Aims: To evaluate if oxaliplatin is likely to vaporize under HIPEC conditions and to see if it could be a source of pulmonary contamination for surgeons., Methods: Three oxaliplatin concentrations (230, 460 and 920 mg oxaliplatin/l), 3 heating temperatures (41, 43 and 45 degrees C) and 3 bubbling durations (30, 60 and 90 min) were tested. Drug vaporization was evaluated by using inductively coupled plasma mass spectrometry (ICP-MS) to analyze platinum concentrations in the trap solutions., Results: At all concentrations of oxaliplatin solutions, heating temperatures and bubbling trap periods, the quantities of vaporized platinum were always insignificantly lower than 1 microg/l., Conclusions: The experimental risk of pulmonary contamination of hospital staff during HIPEC procedure appears to be negligible. However a monitoring study with an analysis of samples of the operating theatre and urine from surgical personnel should be carried out to confirm these conclusions.

Decisive analytical progress for biological cannabis testing has been achieved over the past ten years. These major contributions allow to accurately identify and quantify in detail the substances present in the body following cannabinoid exposure. Fast and reliable onsite urine testing is used to implement the French law on narcotic drugs and its relationship to motorway safety. A positive test result will indicate a very recent exposure which is detectable up to five days following intake. Then a clinical examination and blood collection are performed by a physician, with a subsequent blood tetrahydrocannabinol (THC) analysis by authorized professionals registered at the judicial court of appeal. A result higher than the cut-off value is associated with a very recent cannabis exposure. Blood, urine, saliva and sweat cannabis determination are assessed according to the most recent pharmacokinetic and analytical data.

The famous Lafarge affair which took place in Tulle (Corrèze, France) in 1840, has never ceased to interest the general public because some doubts have remained even after the pronunciation of the judgment. Another hypothesis than arsenicum poisoning has been formulated in 1980 by Professor P. Lepine who believes in a paratyphoid fever occuring after food poisoning. This assumption and the discovery of exceptional family documents in 2004 by Edouard de Lamaze, a distant cousin of Emma Pontier, the confidante of Marie Lafarge, sheds a new light on this mysterious affair.

A 57-year-old pharmacist was found dead 11 days after his disappearance. At the autopsy, samples of blood, urine, gastric content were obtained. Presence of ethanol, cyanide and mercury were detected in some samples. Cyanide and mercury were identified and quantified using high-performance liquid chromatography with diode array detector (HPLC) in fluorescence mode and ICP with mass selective detector (ICP-MS) respectively. Whole blood concentrations of ethanol was 1.72 g/L. Cyanide and mercury concentrations in whole blood were respectively 0.16 and 3.8 mg/L. Concentrations of cyanide (27 mg/L) and mercury (150 mg/L) in gastric contents prove a massive oral ingestion of mercuric cyanide or mercuric oxycyanide occurred. In this case report, the death was attributed to the combined toxicity of cyanide and mercury.

The members of the joint group "Toxicology and Clinical Biology" of the French Society of Clinical Biology (SFBC), the French Society of Analytical Toxicology (SFTA), and the Society of Clinical Toxicology (STC), suggest guidelines to meet the requirements of clinical biologists who are not specialized in toxicology. Based on good laboratory practice they propose a number of guidelines. Three synthetic tables have been established. They are not only toxicity biomarkers and metabolic disorders associated with the main severe intoxications, but also clinical signs that are observed during these intoxications, finally biological sampling as a precautionary measure. The table also takes into account approximately fifty xenobiotics: main clinical signs emergency, identification or quantification of the suspected product, useful biological markers, therapeutic, quantitations necessary to take into consideration patient care, and poison antidotes, are described. Recommendations regarding medical and forensic techniques are also proposed by the group. It is also necessary to collect and store biological samples when the individual patients are in charge. These samples will be analyzed or not depending on the individual case history.