We present a case series (N = 46) of individuals apprehended in Sweden for driving under the influence of drugs (DUID). These cases were selected because the concentrations of amphetamine in blood were abnormally high (> 5.0 mg/L), the highest being 17 mg/L. In comparison, the median blood-amphetamine concentration in a population of DUID offenders (N = 6,613) was 0.70 mg/L. Among the DUID suspects with extremely high blood-amphetamine concentrations there were 38 men (83%) with mean age of 37.8 y (SD 6.8 y) and 8 women (17%) with a mean age of 34.1 y (SD 4.3 y). All had previously been registered in our database (mean 12 times, median 9 times) for drug-related offences, including DUID. The concentration of amphetamine in blood of female offenders was slightly higher than the concentration in male offenders (6.6 mg/L vs. 5.8 mg/L), although this difference was not statistically significant (p > 0.05). The drugs other than amphetamine most frequently encountered in the blood samples were tetrahydrocannabinol and benzodiazepines (diazepam and nordiazepam). The commonest signs of drug use reported by the arresting police officers were bloodshot and glazed (watery) eyes, restlessness, talkativeness, exaggerated reflexes and slurred speech. Unsteady gait and dilated pupils were observed in some but not all individuals. These very high concentrations of amphetamine were tolerated without any fatalities indicating a pronounced adaptation to the pharmacologic effects of this central stimulant. Anecdotal information indicated that those with the very highest concentrations of amphetamine in blood had swallowed the drug to prevent being apprehended in possession of an illicit substance.
The absorption of polychlorinated biphenyls, dibenzo-p-dioxins and dibenzofurans was studied in four breast-fed infants. The absorption was measured by comparing the estimated total intake and the excretion in faeces, during 48 hours, at three different time points; 1, 2 and 3 months post parta. The levels of the analysed compounds in the human milk are typical for Sweden, i.e approximately 20 ppt toxic equivalents for the dibenzo-p-dioxins and dibenzofurans and for the polychlorinated biphenyls approximately 16 ppt toxic equivalents. For most of the congeners the absorption is found to be over 95%. Higher excretion is noticed for heptachlorinated and octachlorinated dioxins.
A case of accidental lethal monochloroacetic acid poisoning is presented, along with a brief review of the mechanisms of intoxication. Although lethal skin exposures have been previously reported, this case appears to be the first instance of oral-route poisoning to be documented.
OBJECTIVES: Powder painting is an alternative to solvent-based spray painting. Powder paints may contain organic acid anhydrides (OAAs), which are irritants to the airways and may cause sensitisation. The aim of this study was to determine the prevalence of respiratory symptoms and immunological response among powder painters and to describe the exposure to OAAs. METHODS: In all, 205 subjects in 32 enterprises participated: 93 exposed and 26 formerly exposed workers in 25 powder paint shops and 86 unexposed workers. They completed a questionnaire about working conditions and symptoms and took part in a medical examination, which included a lung function test. Urine samples, for determination of two OAAs, and blood samples, for analysis of specific antibodies against the OAAs, were taken. In addition, 33 paint samples were analysed for nine OAAs. RESULTS: The powder painters reported more work-related respiratory symptoms than unexposed subjects did. The prevalence of three or more symptoms was 24% in subjects with low exposure, 44% in highly exposed individuals, 46% in formerly exposed subjects and 19% in unexposed workers. Asthma symptoms were frequent, 7%, 40%, 15% and 2%, respectively. Regression analyses of the lung volumes did not show any influence of exposure. IgG, but not IgE, against the OAAs and metabolites of OAAs was found in some subjects, but no associations with the exposure could be observed. OAAs were found in only small amounts in the paint samples. CONCLUSIONS: The exposure to organic acid anhydrides was estimated to be low, and yet, IgG antibodies to OAA were observed in some subjects. The prevalence of work-related symptoms from the eyes and the airways was relatively high among the powder painters, and these symptoms, but not the lung volumes, were clearly related to exposure. The symptoms were probably caused by irritative properties of the powder paint dust.
A previously described method for analysis of organochlorine compounds in human milk was adopted for analysis of brominated diphenyl ethers (BDEs) substituted with three to six bromine atoms. Analytes were extracted from human milk with the lipophilic gel Lipidex 5000. Further purifications were performed on partly deactivated aluminum oxide and silica gel columns, followed by gel permeation chromatography. The concentrations of BDEs were determined by gas chromatography/mass spectrometry (GC/MS). The average recoveries of 2,2',4-triBDE (BDE-17), 2,4,4'-triBDE (BDE-28), 2,2',4,4'-tetraBDE (BDE-47), 2,3',4,4'-tetraBDE (BDE-66), 2,2,3,4,4'-pentaBDE (BDE-85), 2,2',4,4',5-pentaBDE (BDE-99), 2,2',4,4',6-pentaBDE (BDE-100), 2,2',4,4',5,5'-hexaBDE (BDE-153), and 2,2',4,4',5,6'-hexaBDE (BDE-154) added to the samples before extraction ranged from 86% to 102%. Pooled samples of breast milk, collected at eight time periods between 1972 and 1997, were analyzed for PBDEs. BDE-47 was the most abundant PBDE congener in all samples. In total, eight PBDE congeners were identified in the milk. The sum of the concentrations of BDE congeners in human milk increased from 0.07 to 4.02 ng/g lipids during the 25-yr period studied.
Pages 179-182 of Proceedings of the 12th International Congress on Circumpolar Health, Nuuk, Greenland, September 10-14, 2003. International Journal of Circumpolar Health. 2004;63(Suppl.2)
North-West Public Health Research Center, St. Petersburg, Russia. dudarev@sp.ru
Source
Pages 179-182 of Proceedings of the 12th International Congress on Circumpolar Health, Nuuk, Greenland, September 10-14, 2003. International Journal of Circumpolar Health. 2004;63(Suppl.2)
OBJECTIVES: Investigation was carried out within the framework of the large-scale international project "Persistent Toxic Substances (PTS), Food Security and Indigenous People of the Russian North" under RAIPON/AMAP/GEF aegis. Objectives of the project are to obtain comprehensive information on exposure of indigenous populations to contaminants through food chains (and other sources), and to investigate the possible health effects connected to this exposure. Four regions of Russia are involved in the project: Kola Peninsula (Murmansk oblast), Nenetsk okrug (Pechora river basin), Taimyr Peninsula, Chukotka Peninsula. METHODS: Questionnaire and paired sampling of maternal/cord blood among indigenous women at childbirth (more than 250 persons) as well as among general indigenous population (more than 1,400 persons), additionally breast milk sampling of lactating women (more than 50 persons) in Chukotka was conducted. About 700 blood samples have been analyzed at the Center for Environmental Chemistry, SPA "Typhoon" (Obninsk, Russia), the Regional Center "Monitoring of the Arctic", RCMA (St. Petersburg, Russia), the Norwegian Institute for Air Research, NILU (Tromso, Norway) and at INSPQ (Sainte-Foy, Quebec, Canada). RESULTS AND CONCLUSIONS: On the whole, PTS in human blood of the Russian Arctic natives are similar to those in the coastal areas of Greenland and Canada, and for some POPs such as toxaphenes and mirex, these levels are lower.
The temporal trends and influence of age and gender on levels of selected brominated flame retardants (BFRs) in human serum have been assessed by analyzing archived samples from Norway. Serum from 40 to 50 year old men collected at six time periods during 1977 to 1999 and from eight groups of differing age and gender sampled in 1998 were pooled into six and eight samples, respectively. The BFRs were isolated using solid-phase extraction (SPE) and the serum lipids decomposed bytreatmentwith concentrated sulfuric acid directly on the polystyrene-divinylbenzene SPE column, prior to elution of the BFRs. Following diazomethane derivatization, the samples were analyzed by gas chromatography-electron capture mass spectrometry. Eight BFRs were quantified in the serum samples: 2,4,4'-tribromodiphenyl ether (BDE-28), 2,2',4,4'-tetrabromodiphenyl ether (BDE-47), 2,2',4,4',5-pentabromodiphenyl ether (BDE-99), 2,2',4,4',6-pentabromodiphenyl ether (BDE-100), 2,2',4,4',5,5'-hexabromodiphenyl ether (BDE-153), 2,2',4,4',5,6'-hexabromodiphenyl ether (BDE-154), 2,4,6-tribromophenol (TriBP), and tetrabromobisphenol A (TBBP-A). The serum concentrations of all the BFRs, increased during the entire period with the exception of TriBP, and the sum of the six polybrominated diphenyl ethers increased from 0.44 ng/g lipids in 1977 to 3.3 ng/g lipids in 1999. The BFR concentrations in the serum from the different age groups were relatively similar, except for the age group 0-4 years, which had 1.6-3.5 times higher serum concentrations. Women older than 25 years had lower serum concentrations of BFRs compared to the corresponding group of men. No trend related to age or gender, nor time during the period 1977 to 1999 was observed for TriBP. The present study indicates an ongoing increase in human exposure to BFRs, and the current body burden appears to be independent of age, except for infants (0-4 years old), who seem to experience elevated exposure.
Notes
Comment In: Environ Sci Technol. 2002 May 1;36(9):188A-192A12026967
Between 2001 and 2002, plant collections from wild populations of Norwegian tansy (Tanacetum vulgare L.) were studied with a focus on essential oil (EO) yield and composition in order to characterize the chemotypical EO variability. Tansy collections of 40 different locations from North, Mid-, and South Norway were transplanted to the Apelsvoll Research Centre Div. Kise in 2000 and grown for 2 years before the aerial parts (leaves and flower buds) were harvested in June 2002. The EO from individual plants was isolated from dried plant material by hydrodistillation and analyzed by gas chromatography-mass spectrometry (GC-MS) on a DB5 column at the Plant Biocenter. The EO yield ranged between 0.35 and 1.90% (v/w) (average: 0.81%); the most abundant thujone plants were especially rich in EO volatiles (0.95%). On the basis of GC-MS data, seven chemotypes could be identified as follows: A, alpha-thujone (two individuals); B, beta-thujone (22); C, camphor (six); D, chrysanthenyl acetate/chrysanthenol (three); E, chrysanthenone (two); F, artemisia ketone/artemisia alcohol (three); and G, 1,8-cineole (two). The thujone chemotype was dominated by beta-thujone (81%) associated with alpha-thujone, but tansy plants rich in alpha-thujone were also detected (61%). The chemotypical classification of Norwegian tansy genotypes was underscored by preliminary studies from 2001, indicating the genetic uniformity and biochemical stability of the domesticated plants.
BACKGROUND: Both the illicit drug heroin and the prescription drug codeine are metabolized to morphine, which tends to complicate interpretation of opiate-positive samples. We report here the concentrations of morphine and codeine, the morphine/codeine ratios, and 6-acetylmorphine (6-AM) in blood specimens from individuals arrested for driving under the influence of drugs (DUID) in Sweden. The results were compared with positive findings of 6-AM in urine as evidence of heroin intake. METHODS: In 339 DUID suspects, both blood and urine specimens were available for toxicologic analysis. In another 882 cases, only blood was available. All specimens were initially analyzed by immunoassay, and the positive results were verified by isotope-dilution gas chromatography-mass spectrometry. In routine casework, the limits of quantification (LOQs) for unconjugated opiates were 5 ng/g for blood and 20 microg/L for urine. RESULTS: The median concentration of morphine in blood was 30 ng/g with 2.5 and 97.5 percentiles of 5 and 230 ng/g, respectively (n = 979). This compares with a median codeine concentration of 20 ng/g and 2.5 and 97.5 percentiles of 5 and 592 ng/g, respectively (n = 784). The specific metabolite of heroin, 6-AM, was identified in only 16 of 675 blood specimens (2.3%). This compares with positive findings of 6-AM in 212 of 339 urine samples (62%) from the same population of DUID suspects. When 6-AM was identified in urine, the morphine/codeine ratio in blood was always greater than unity (median, 6.0; range, 1-66). In 18 instances, 6-AM was present in urine, although morphine and codeine were below the LOQ in blood. The morphine/codeine ratio in blood was greater than unity in 85% of DUID cases when urine was not available (n = 506), and the median morphine and codeine concentrations were 70 ng/g and 10 ng/g, respectively. When morphine/codeine ratios in blood were less than unity (n = 76), the median morphine and codeine concentrations were 10 ng/g and 180 ng/g, respectively. CONCLUSIONS: Only 2.3% of opiate-positive DUID suspects were verified as heroin users on the basis of positive findings of 6-AM in blood. A much higher proportion (62%) were verified heroin users from 6-AM identified in urine. When urine was not available for analysis, finding a morphine/codeine concentration ratio in blood above unity suggests heroin use and not medication with codeine. This biomarker indicated that 85% of opiate-positive DUID blood samples were from heroin users.
Division of Occupational and Environmental Medicine and Psychiatric Epidemiology, Department of Laboratory Medicine, University Hospital, SE-221 85 Lund, Sweden. lars.rylander@med.lu.se
BACKGROUND: Experimental evidence supports the hypothesis that persistent organochlorine pollutants (POPs) may cause type 2 diabetes mellitus, whereas there is no fully convincing epidemiological evidence for such an association. In Sweden the most important source of POP exposure is fatty fish. We have assessed the association between serum levels of POPs and prevalence of diabetes in Swedish fishermen and their wives, with high consumption of fatty fish from the Baltic Sea. METHODS: In 196 men (median age 60 years) and 184 women (median age 64 years), we analyzed 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) and 1,1-dichloro-2,2-bis(p-chlorophenyl)-ethylene (p,p'-DDE) in serum using gas chromatography-mass spectrometry. The participants were asked if they had diabetes and, if so, since which year and about medication and diet. The Odds Ratios (OR) for diabetes with respect to continuous exposure variables were analyzed with logistic regression, adjusting for potential confounders. Moreover trends of diabetes prevalence with respect to trichotomized exposure variables were tested with Jonckheere-Terpstra's test. RESULTS: Six percent of the men and 5% of the women had diabetes. After confounder adjustment CB-153 was significantly associated with diabetes prevalence using both categorized and continuous exposure data (an increase of 100 ng/g lipid corresponded to an OR of 1.16, 95% confidence interval [CI] 1.03, 1.32, p = 0.03). Similar associations were observed for p,p'-DDE (an increase of 100 ng/g lipid corresponded to an OR of 1.05, 95% CI 1.01, 1.09, p = 0.006). Gender stratified analyses showed among men consistent positive associations with CB-153, but a more ambiguous pattern with respect to DDE. In contrast, among the women the associations with p,p'-DDE were stronger than with CB-153. CONCLUSION: The study provides support that POP exposure might contribute to type 2 diabetes mellitus.
