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Publications (36)11.35 Total impact

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    ABSTRACT: Buprenorphine has been an important advance in care for drug abusers, but the toxic risk may be fatal. We report here two original series of buprenorphine poisoning in opiate abusers on substitution therapy. The first series included 20 males and 9 females, aged 20-35 years (mean = 27.5) with non-fatal poisoning. The second series included 20 subjects (19 males, 1 female) aged 14-48 years (mean = 26.6) with a fatal outcome. All subjects were opiate addicts taking high-dosage sublingual buprenorphine formulation as substitution therapy. Blood concentrations of buprenorphine were found in all cases to remain at a low level (1.0-2.3 ng/ml, m = 1.4 ng/ml, and 1.1-29.0 ng/ml, m = 8.4 ng/ml in non-fatal and fatal cases respectively). Almost all cases involved concomitant intake of psychotropic medications, especially benzodiazepines (18 non-fatal and 17 fatal cases). These observations confirm previously reported data on the danger of buprenorphine-benzodiazepine combinations. Intravenous injection of crushed tablets also appears to be a risk factor (8 deaths and 10 non-fatal poisonings). This series highlights the need for improvement in the recently developed French program for substitution therapy with high-dosage buprenorphine in heroin addicts.
    La Presse Médicale 04/1998; 27(12):557-61. · 1.17 Impact Factor
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    ABSTRACT: The kinetics of alpha and beta amanitin were studied in 45 patients intoxicated with Amanita Phalloides. The amatoxins were analyzed by high performance liquid chromatography in plasma (43 cases), urine (35 cases), gastroduodenal fluid (12 cases), feces (12 cases) and tissues (4 cases). All patients had gastrointestinal symptoms and 43 developed an acute hepatitis. Two patients underwent successful liver transplantation. Eight patients, of whom three were children, died. The detection of amatoxins in the biological fluids was time dependent. The first sample was obtained at an average of 37.9 h post ingestion in the patients with positive results and at 70.6 h in the samples without detectable amatoxins. Plasma amatoxins were detected in 11 cases at 8 to 190 ng/mL for alpha and between 23.5 to 162 ng/mL for beta. In 23 cases amatoxins were detected in urine with a mean excretion per hour of 32.18 micrograms for alpha and 80.15 micrograms for beta. In 10 patients the total amounts eliminated in the feces (time variable) ranged between 8.4 and 152 micrograms for alpha amanitin and between 4.2 and 6270 micrograms for beta amanitin. In three of four cases amatoxins were still present in the liver and the kidney after day 5. Amatoxins were usually detectable in plasma before 36 h but were present in the urine until day 4. The rapid clearance indicates that enhanced elimination of amatoxins requires early treatment. Clearance of circulating amatoxins by day 4 spares the transplanted liver.
    Journal of toxicology. Clinical toxicology 02/1993; 31(1):63-80.
  • A Jaeger, P Sauder, J Kopferschmitt, L Tritsch, F Flesch
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    ABSTRACT: Lithium kinetics were studied in 14 patients with lithium poisoning. Three patients were treated by hemodialysis. Serum lithium peak concentrations ranged between 1.4 and 9.6 mmol/L. The apparent mean serum half-life was 23.16 +/- 9 h, the mean total clearance was 26.5 +/- 13.3 mL/min and the mean renal clearance was 17.2 +/- 5.4 mL/min. The kinetic parameters were dependent on the duration of the study and on the type of the poisoning: acute, acute upon chronic or chronic. During the first 12 h after admission ten patients were in a distribution phase, three were in an elimination phase and one was in an absorption phase. The serum half-life during hemodialysis ranged from 3.6 to 5.7 h and hemodialysis clearance was 63.2 to 114.4 mL/min. The mean volume of distribution calculated in six cases was 0.63 +/- 0.09 L/kg. The evolution of the lithium pools showed a different kinetic pattern between the extra- and the intracellular pool which decreased more slowly. During hemodialysis the decrease of the extracellular pool was about twice that of the cellular pool. Among the factors which may modify lithium toxicity and kinetics, are the type of the poisoning, the presence of an underlying disease and renal impairment. No general and rigid indication for hemodialysis can be set, but the need for hemodialysis should be based on clinical and kinetic data determined during the 12 h following admission.
    Journal of toxicology. Clinical toxicology 02/1993; 31(3):429-47.
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    ABSTRACT: A case is reported of a duodenal perforation by a Kimray-Greenfield filter hook in a 66-year-old female patient. This device had been inserted four years before, after a pulmonary embolism. The patient presented with epigastric pain, vomiting and extracellular dehydration with renal failure. A plain abdominal film showed the filter to be tilted 15 degrees to the left, with an opening 28 mm wide. Various investigations were carried out, none of which providing a satisfactory diagnosis. Steroid treatment (1 mg.kg-1 x day-1 of prednisone) was started before admission to intensive care. Only at that time gastroduodenoscopy showed on of the filter's hooks jutting through the duodenal wall. This perforation was located in the posterior wall of the third part of the duodenum, and was associated with an ulcer of the mucosa facing this hook. The diagnosis was confirmed by an abdominal CT scan. The hook was cut and the perforation sealed off during a first laparotomy. Twenty-six days later, the patient developed intestinal obstruction due to a haematoma of the jejunal wall. She later had a cerebrovascular accident, with status epilepticus and deep coma. She died four months after her admission. The late complications of vena caval filters are discussed. The position of these devices should be regularly checked by a plain abdominal film. Abdominal CT scanning is a useful investigation for the diagnosis of intra and extravascular complications.
    Annales Françaises d Anesthésie et de Réanimation 02/1993; 12(1):75-8. · 0.84 Impact Factor
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    ABSTRACT: A case is reported of a duodenal perforation by a Kimray-Greenfield filter hook in a 66-year-old female patient. This device had been inserted four years before, after a pulmonary embolism. The patient presented with epigastric pain, vomiting and extracellular dehydration with renal failure. A plain abdominal film showed the filter to be tilted 15 degrees to the left, with an opening 28 mm wide. Various investigations were carried out, none of which providing a satisfactory diagnosis. Steroid treatment (1 mg · kg−1 · day−1 of prednisone) was started before admission to intensive care. Only at that time gastroduodenoscopy showed on of the filter's hooks jutting through the duodenal wall. This perforation was located in the posterior wall of the third part of the duodenum, and was associated with an ulcer of the mucosa facing this hook. The diagnosis was confirmed by an abdominal CT scan. The hook was cut and the perforation sealed off during a first laparotomy. Twenty-six days later, the patient developed intestinal obstruction due to a haematoma of the jejunal wall. She later had a cerebrovascular accident, with status epilepticus and deep coma. She died four months after her admission. The late complications of vena caval filters are discussed. The position of these devices should be regularly checked by a plain abdominal film. Abdominal CT scanning is a useful investigation for the diagnosis of intra and extravascular complications.
    Annales Françaises d Anesthésie et de Réanimation 01/1993; 12(1):75-78. · 0.84 Impact Factor
  • P SAUDER, C BERTON, H LEVENES, F FLESCH, J KOPFERSCHMITT
    Réanimation Urgences 01/1993; 2(2).
  • J Kopferschmitt, P Meyer, A Jaeger, J M Mantz, M Roos
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    ABSTRACT: The purpose of this prospective survey, conducted over a two years period, was to study the use of psychoactive drugs among six year-old children in the Bas-Rhin administrative "département", of eastern France. The factors analysed were family environment, after-school time, the child's sleep, the locality where the child lived and the drugs used. The child was examined by school doctors, in the presence of the parents, at the compulsory consultation at the start of first-year infant school. The study was exhaustive. Of the 11,274 children examined, 12.1% used a psychoactive drug, although only 1% were considered by their parents to be suffering from insomnia. Of the children using drugs, 32% had used them for more than a year, 24% for more than two years and 11% for more than three years. Consumption was also shown to vary greatly between different localities; in some areas the proportion of children using drugs was more than 50%.
    Revue d Épidémiologie et de Santé Publique 02/1992; 40(6):467-71. · 0.66 Impact Factor
  • A Jaeger, J Kopferschmitt, P Sauder, F Flesch, C Tournoud
    Archives of toxicology. Supplement. = Archiv für Toxikologie. Supplement 02/1992; 15:29-39.
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    ABSTRACT: Six cases of acute verapamil poisoning are reported. The dose ingested ranged between 1.2 and 9.6 g. In all cases other drugs had also been ingested and especially betablockers in two cases. Symptomatology included a cardiogenic shock in two cases and an atrioventricular block in four cases. A hemodynamic study in one case showed a cardiogenic shock with increased systemic vascular resistances. The treatment of cardiogenic shock included artificial ventilation, several vasopressors and inotropic agents and cardiac pacing in one case. All patients recovered without sequelae. A toxicokinetic study performed in two cases showed plasma half lives of 7.9 and 13.2 hours, total body clearances of 425 and 298 ml/min. Only 2 to 4.2 per cent of the dose ingested were eliminated in urine. These results confirm the severity of verapamil overdose and the efficacy of symptomatic treatment by inotropic agents. The high rate of spontaneous elimination by hepatic metabolism does not justify drug removal by extra-corporeal methods.
    Journal de toxicologie clinique et expérimentale 01/1990; 10(4):261-70.
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    ABSTRACT: The authors report three cases of diltiazem overdose with hypotension and atrio-ventricular conduction disturbances. Hemodynamic study in 2 cases showed a hyperkinetic state with a decrease of systemic vascular resistances. Diltiazem kinetics studied in 2 cases showed a plasma half life of 5.4 and 8.3 hours, a prolonged absorption until the 28th hours in one case. Treatment included gastric lavage, oral activated charcoal (2 cases), plasma expanders and in 2 cases vasopressors with alpha effects. All three patients recovered.
    Journal de toxicologie clinique et expérimentale 01/1990; 10(4):243-8.
  • J M Mantz, J Kopferschmitt, P Sauder, F Flesch, J Juif, A Jaeger
    La Revue du praticien 01/1989; 38(30):2223-9.
  • J M Mantz, J Kopferschmitt, P Sauder, F Flesch, S Gayol, A Jaeger
    La Revue du praticien 01/1989; 38(30):2255-60.
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    ABSTRACT: A 27 year-old man developed after ingestion of mercury chloride, 6 g, a hypovolemic shock, an acute renal failure and a necrosis of the stomach which required a total gastrectomy. The anuria did not improve and required 42 hemodialyses. Subsequent evolution showed numerous complications and the patient died on the 91st day. On admission mercury plasma concentration was 5 mg/L and decreased slowly with an apparent half-life of 226 hours. Hemodialyses were ineffective for mercury elimination: mercury clearances varied between -10 and + 1.5 ml/min. Seventeen mg of mercury were removed by six plasma exchanges: the mercury clearance was mean 17.3 ml/min. Among the extracorporeal elimination methods, plasma exchange appears to be the most efficient for inorganic mercury and it could be usefull in association with chelation therapy at the early phase of the intoxication.
    Journal of toxicology. Clinical toxicology 02/1988; 26(3-4):189-97.
  • A Jaeger, F Flesch, J Kopferschmitt, P Sauder
    La Revue du praticien 01/1988; 37(47):2881-6.
  • A Jaeger, P Sauder, J Kopferschmitt, F Flesch
    La Presse Médicale 11/1987; 16(33):1658-9. · 1.17 Impact Factor
  • A Jaeger, P Sauder, J Kopferschmitt, F Flesch
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    ABSTRACT: The toxicities of antimalarial drugs vary because of the differences in the chemical structures of these compounds. Quinine, the oldest antimalarial, has been used for 300 years. Of the 200 to 300 compounds synthesised since the first synthetic antimalarial, primaquine in 1926, 15 to 20 are currently used for malaria treatment, most of which are quinoline derivatives. Quinoline derivatives, particularly quinine and chloroquine, are highly toxic in overdose. The toxic effects are related to their quinidine-like actions on the heart and include circulatory arrest, cardiogenic shock, conduction disturbances and ventricular arrhythmias. Additional clinical features are obnubilation, coma, convulsions, respiratory depression. Blindness is a frequent complication in quinine overdose. Hypokalaemia is consistently present, although apparently self-correcting, in severe chloroquine poisoning and is a good index of severity. Recent toxicokinetic studies of quinine and chloroquine showed good correlations between dose ingested, serum concentrations and clinical features, and confirmed the inefficacy of haemodialysis, haemoperfusion and peritoneal dialysis for enhancing drug removal. The other quinoline derivatives appear to be less toxic. Amodiaquine may induce side effects such as gastrointestinal symptoms, agranulocytosis and hepatitis. The main feature of primaquine overdose is methaemoglobinaemia. No cases of mefloquine and piperaquine overdose have been reported. Overdose with quinacrine, an acridine derivative, may result in nausea, vomiting, confusion, convulsion and acute psychosis. The dehydrofolate reductase inhibitors used in malaria treatment are sulfadoxine, dapsone, proguanil (chloroguanide), trimethoprim and pyrimethamine. Most of these drugs are given in combination. Proguanil is one of the safest antimalarials. Convulsion, coma and blindness have been reported in pyrimethamine overdose. Sulfadoxine can induce Lyell and Stevens-Johnson syndromes. The main feature of dapsone poisoning is severe methaemoglobinaemia which is related to dapsone and to its metabolites. Recent toxicokinetic studies confirmed the efficacy of oral activated charcoal, haemodialysis and haemoperfusion in enhancing removal of dapsone and its metabolites. No overdose has been reported with artemesinine, a new antimalarial tested in the People's Republic of China. The general management of antimalarial overdose include gastric lavage and symptomatic treatment.(ABSTRACT TRUNCATED AT 400 WORDS)
    Medical toxicology 08/1987; 2(4):242-73.
  • G N Lambrou, J Kopferschmitt, A Jaeger, A Brini
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    ABSTRACT: Considerable enthusiasm has been raised in the past about the use of Hyperbaric Oxygen (HBO) in various diseases, usually otherwise untreatable. Recently, special attention has been drawn on its hypothetical beneficial effects on multiple sclerosis (MS). We have witnessed a rare, though known, side-effect of HBO on a patient suffering from MS. She developed an acute, bilateral, centro-caecal scotoma, from which she slowly recovered several days after. The forementioned case led us to a review of the literature concerning: Various attempts to employ HBO in ophthalmology Side-effects of oxygen on eye and vision Possible mechanisms of ocular toxicity of oxygen. It appears from this review that we should be extremely cautious about using HBO on MS patients, particularly able to develop such side-effects.
    Journal Français d Ophtalmologie 02/1987; 10(1):51-9. · 0.36 Impact Factor
  • A Jaeger, P Sauder, J Kopferschmitt, M L Jaegle
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    ABSTRACT: A 66-year old female on long-term lithium therapy, developed neurologic toxicity with coma and convulsions. The treatment consisted artificial ventilation, fluid and electrolyte infusions and a six hour hemodialysis (HD) on days 2, 3 and 4. The convulsions disappeared on day 4; the patient regained consciousness on day l2 and recovered with slight sequelae. Toxicokinetic studies were conducted for a period of 12 days. The lithium (Li) serum concentration fell from 4.4 mmol/l on admission to 2.16 before HD and 0.35 after three HD. Li serum half life was 54 hours before HD, 25 hours during the three days on which HD was carried out and 106 hours thereafter. The Li cerebrospinal fluid/Li serum ratio ranged between 0.4 and 0.6 and was not influenced by HD. Mean renal clearance was 10.6 ml per min. During hemodialysis, Li serum half life decreased to 3.5 - 4.9 hours and clearance was 108 ml/min. A total amount of l28.6 mmol lithium was excreted; 84.3 mmol by HD and 44.3 mmol in urine. Patient's clinical course and electroencephalographic signs were correlated with the calculated cellular pool of Li but not with Li serum concentrations. This study confirms the effectiveness of HD to decrease the cellular pool of lithium. However, rather than considering only the absolute Li serum concentration, the presence of a rebound peak after HD may be viewed as indication for further hemodialysis.
    Journal of toxicology. Clinical toxicology 01/1986; 23(7-8):501-17.
  • La Presse Médicale 01/1984; 12(46):2948-9. · 1.17 Impact Factor
  • J M Mantz, J Kopferschmitt, A Jaeger, J D Tempé, P Sauder
    La Revue du praticien 12/1983; 33(51):2721-32.