Background/Aim: Substances in the middle molecular weight range have been shown to play a significant pathogenetic role in as diverse disorders as end-stage renal disease and multiple organ failure. To overcome the limitations in the amount removed by hemofilters, new sorbents with a high biocompatibility are actively being developed. Furthermore, biocompatible sorbents by their nonspecific adsorptive behavior could have great impact on detoxification treatment in exogenous intoxications. We performed an in vitro evaluation of a newly developed highly biocompatible sorbent cartridge (Betasorb^®), examining its adsorptive capacity concerning therapeutic drugs. Methods: Uremic blood spiked with a range of therapeutic drugs was recirculated for 2 h in an in vitro hemoperfusion circuit containing a Betasorb device for hemoperfusion. The drug concentrations before and after the passage of the cartridge were measured, and the total amount removed was calculated. Results: The sorbent showed effective removal of glycopeptide antibiotics, digoxin, theophylline, phenobarbital, phenytoin, carbamazepine, and valproic acid. Moderate removal could be demonstrated for tacrolimus and cyclosporine A; aminoglycosides were removed to a small extent only. Conclusions: Betasorb hemoperfusion shows a potent adsorptive capacity concerning therapeutic drugs (except aminoglycosides) and could be of major value in the treatment of intoxications. On the other hand, drug monitoring and possible adjustments are necessary during Betasorb hemoperfusion to maintain the therapeutic ranges of the drugs in blood.

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In the 19th Century oil of bitter almonds, which contains hydrocyanic acid (prussic acid) in variable percentages, was the cause of accidental and suicidal poisoning because of its widespread use in cosmetics and preparations used in handicrafts. In this paper I report four cases of oil of bitter almonds poisoning taken from the medical journals of that time, three of which had a favourable outcome and one of which was a fatal acute intoxication. In the reports were described in detail the symptoms and the course of the poisoning following pharmacological treatments. The symptoms and some easy laboratory tests for the differential diagnosis of hydrocyanic acid and nitrobenzene intoxication are also reported. The latter substance was frequently used in place of oil of bitter almonds because of its lower price and the fact that its organoleptic properties are almost identical. IntroduzioneL'essenza (olio essenziale) di mandorle amare si ottiene per spremitura dai semi della varietà selvatica del mandorlo (Amygdalus communis L.), un albero di dimensioni medie diffuso nelle regioni del Mediterraneo (Fig. 1).Già nei tempi antichi era noto il potere venefico delle mandorle amare e delle bacche di lauro ceraso, i cui estratti trovavano però impiego in medicina nelle febbri intermittenti e miasmatiche. Nei primi anni del Settecento i medici cominciano a vedere in queste essenRiassunto Nell'Ottocento l'essenza di olio di mandorle amare, che contiene in percentuale variabile l'acido cianidrico (acido prussico), è causa di avvelenamento accidentale o volontario, essendo largamente utilizzata nelle preparazioni artigianali di cosmetici e liquori. Vengono qui presentati quattro casi di veneficio con essenza di mandorle amare, rilevati da giornali di medicina dell'epoca, tre con esito favorevole e uno che porta a una rapida morte. Sono descritti la sintomatologia di questo tipo di avvelenamento, il suo decorso clinico in risposta alle cure praticate e anche i segni clinici e di "laboratorio" per differenziare l'intossicazione da acido cianidrico da quello da nitrobenzene, sostanza spesso sostituita all'olio di mandorle amare per il suo minor costo a parità di caratteristiche organolettiche.Parole chiave Avvelenamento · Olio essenziale di mandorle amare · Acido prussico · Nitrobenzene

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