2 Agosto 2001
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Ann Emerg Med 2001 Jul;38(1):79-82
Scott & White Clinic and Memorial Hospital, Scott, Sherwood and Brindley Foundation, Texas A&M University System, Health Science Center College of Medicine, Temple, TX, USA. drjdh@usa.net
A 36-year-old man captured a timber rattlesnake and was accidentally envenomated in the thumb by the severed head. At a local emergency department, hypotension and confusion developed. Facial and glossal edema were also observed. Oxygen was delivered by face mask, and crystalloids and dopamine were administered. Respiratory distress developed with progressive hypoxemia. Intubation was unsuccessful because of massive glossal and epiglottic (laryngeal) edema, and an emergency cricothyrotomy was performed. High-dose antivenom therapy was administered, and mechanical ventilation was started. Recovery was rapid, and the patient was discharged from the hospital a week later. This is the first report of life-threatening upper airway edema caused by snake envenomation not in the vicinity of the head or neck.
PMID: 11423817, UI: 21315023
Ann Emerg Med 2001 Jul;38(1):55-61
West Virginia Poison Center, West Virginia University Charleston Division, Charleston, WV 25304, USA. escharma@wvu.edu
STUDY OBJECTIVE: We sought to evaluate the type and extent of local reactions after copperhead snakebites. METHODS: We performed a retrospective evaluation of copperhead snakebites in West Virginia between January 1, 1995, and September 30, 1999. A local effect scoring system was used to define a clinically significant local reaction. A bite was considered clinically significant if the bitten individual's average local effect score was 3 to 4 (range, 0 to 4). RESULTS: Ninety-two patients met the inclusion criteria; an average local effect score of 3 to 4 was documented in 33% (n=30). The foot was the most common bite location (46% of all bites); 87.5% of bites to the finger (n=8) resulted in a score of 3 to 4. Eight (36%) of 22 patients who presented to the emergency department within 2 hours of a bite and whose highest local effect score was 3 to 4 did not have their highest score until greater than 4 hours after the bite. The average length of stay (score 3 to 4) was 3.4 days compared with 1.1 days for those with a score of 3 or less. CONCLUSION: Clinically significant local effects (eg, pain requiring parenteral analgesics, ecchymosis, swelling of over one half of the bitten extremity) occurred in one third of patients in our study. The generalization of copperhead snakebites as mild or of benign clinical significance should be reconsidered.
PMID: 11423813, UI: 21315019
Ann Intern Med 2001 Jul 17;135(2):142-3
Publication Types:
PMID: 11453719, UI: 21346903
Ann Intern Med 2001 Jul 3;135(1):68-9
PMID: 11434754, UI: 21328582
Arch Dermatol 2001 Jul;137(7):957-62
University of Connecticut School of Medicine, Farmington, USA.
PMID: 11453820, UI: 21346953
BMJ 2001 Jul 21;323(7305):135
School of Psychiatry and Behavioural Sciences, University of Manchester, Rawnsley Building, Manchester Royal Infirmary, Manchester M13 9WL.
[Medline record in process]
Objectives: To determine the effects of a brief psychological intervention (brief psychodynamic interpersonal therapy) for patients after deliberate self poisoning compared with usual treatment. To compare the impact of the active intervention and usual treatment on patients' satisfaction with care. Design: Randomised controlled trial. Participants: 119 adults who had deliberately poisoned themselves and presented to the emergency department of a teaching hospital. Setting: Community based study. Intervention: Four sessions of therapy delivered in the patient's home. Control patients received "treatment as usual," which in most cases consisted of referral back to their general practitioner. Outcome measures: Severity of suicidal ideation six months after treatment as assessed by the Beck scale for suicidal ideation. Secondary outcome measures at six month follow up included depressive symptoms as measured by the Beck depression inventory, patient satisfaction with treatment, and self reported subsequent attempts at self harm. Results: Participants randomised to the intervention had a significantly greater reduction in suicidal ideation at six month follow up compared with those in the control group (reduction in the mean (SD) Beck scale 8.0 v 1.5). They were more satisfied with their treatment and were less likely to report repeated attempts to harm themselves at follow up (proportion repeating 9% v 28% in control group; difference 19%, 95% confidence interval 9% to 30 %, P=0.009). Conclusion: Brief psychodynamic interpersonal therapy may be a valuable treatment after people have deliberately tried to poison themselves.
PMID: 11463679, UI: 21356276
Hum Exp Toxicol 2001 May;20(5):277-8
Department of Pharmacology and Therapeutics, Medical University of Southern Africa, Pretoria.
Scales from the bulb are traditionally used as wound dressing after circumcision and as general wound dressing. Concoctions of the bulb taken orally cause sedation, analgesia, visual hallucinations, irrational behaviour, coma or death. A man ingested 150 ml of a concoction to see who placed a spell on him. He started to hallucinate, thinking that somebody was attacking him. He pulled his gun and fired shots randomly, killing one person and injuring others. A gas chromatograph/mass spectrometer was used to analyze a sample of the concoction. The sample contained buphandrin, buphanine and crinamidine (alkaloids) and eugenol. Buphanine has a pharmacological action similar to that of hyoscine and, when ingested in toxic quantities, leads to excitement, agitation, hallucinations and coma. Eugenol is a volatile oil with analgesic properties. Although itcould not be proved that the concoction was only from Boophane disticha, the components were similar to those found in Amaryllidaceae to which Boophane belongs. The man's behaviour could be ascribed to the ingestion of compounds found in B. disticha.
PMID: 11476161, UI: 21368398
Hum Exp Toxicol 2001 May;20(5):255-8
Department of Biochemical Diagnostics, Medical Academy, Bialystok, Poland.
The activities of alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) were measured with fluorogenic naphthaldehydes in the stomach and small intestine homogenates of rats dosed with 6 g methanol/kg bw after 6, 12, 24 h and 2, 5, 7 days. After intoxication with a sublethal dose, the ADH activity measured with these naphthaldehydes and ALDH activities in the stomach and small intestine were significantly decreased. This inhibition is stronger in the stomach and probably depends on cell damage and protein denaturation. We conclude that the activity measured with 6-methoxy-2-naphthaldehyde (MONAL-62) may be due to the activity of rat ADH-1 isoenzyme, and the activity detected with 4-methoxy-1-naphthaldehyde (MONAL-41) to the activity of rat ADH-2 isoenzyme.
PMID: 11476158, UI: 21368395
J Emerg Med 2001 Jul;21(1):27-9
Department of Emergency Medicine, St. Barnabus Hospital, Bronx, New York, USA.
A 39-year-old woman presented to the Emergency Department complaining of nausea and vomiting. The patient was given intravenous cimetidine for epigastric pain and subsequently developed a dystonic reaction. Administration of cimetidine, an H2 receptor antagonist, is an uncommon cause of dystonic reaction. We discuss the pathophysiology, diagnosis, and treatment.
PMID: 11399384, UI: 21293171
J Hepatol 2001 Feb;34(2):346-50
INSERM U1481 and Service d'Hepatologie, H pital Beaujon, Clichy, France.
BACKGROUND: Sublingual buprenorphine is used as a substitution drug in heroin addicts. Although buprenorphine inhibits mitochondrial function at high concentrations in experimental animals, these effects should not occur after therapeutic sublingual doses, which give very low plasma concentrations. CASE REPORTS: We report four cases of former heroin addicts infected with hepatitis C virus and placed on substitution therapy with buprenorphine. These patients exhibited a marked increase in serum alanine amino transferase (30-, 37-, 13- and 50-times the upper limit of normal, respectively) after injecting buprenorphine intravenously and three of them also became jaundiced. Interruption of buprenorphine injections was associated with prompt recovery, even though two of these patients continued buprenorphine by the sublingual route. A fifth patient carrying the hepatitis C and human immunodeficiency viruses, developed jaundice and asterixis with panlobular liver necrosis and microvesicular steatosis after using sublingual buprenorphine and small doses of paracetamol and aspirin. CONCLUSIONS: Although buprenorphine hepatitis is most uncommon even after intravenous misuse, addicts placed on buprenorphine substitution should be repeatedly warned not to use it intravenously. Higher drug concentrations could trigger hepatitis in a few intravenous users, possibly those whose mitochondrial function is already impaired by viral infections and other factors.
PMID: 11281569, UI: 21177173
J Hepatol 2001 Feb;34(2):334-6
PMID: 11281565, UI: 21177169
JAMA 2001 Jul 11;286(2):153-4
PMID: 11448262, UI: 21342228
MMWR Morb Mortal Wkly Rep 2001 May 4;50(17):337-9
Data from the National Health and Nutrition Examination Survey and national childhood blood lead surveillance data from 19 states indicated that average blood lead levels (BLLs) in young children decreased during the late 1990s (1-3). The proportion of children tested who had BLLs >10 microg/dL declined from 10.5% in 1996 to 7.6% in 1998, although the proportion was higher in certain counties (3). To determine whether a similar decline had occurred in Boston, Massachusetts, where a high proportion of children are tested each year, and whether any changes were similar in high- and low-risk neighborhoods, CDC, in collaboration with the Boston Childhood Lead Poisoning Prevention Program (BCLPPP) performed an analysis of BLLs among children aged 6-72 months in Boston during 1994-1999. The results indicate that BLLs in Boston declined during this period, but because of the geographic variation in lead exposure, continued surveillance will be necessary to eliminate childhood lead poisonings.
PMID: 11465903, UI: 21358456
Med J Aust 2001 Jul 2;175(1):29-31
National Office of Animal and Plant Health, Agriculture, Fisheries and Forestry-Australia, Canberra, ACT. llehane@yahoo.com
Paralytic shellfish poisoning (PSP) is a serious illness in which neurological symptoms predominate. Recovery is usually complete and uncomplicated, but in severe cases there may be respiratory paralysis and death. Most cases follow consumption of bivalve molluscs that have filter-fed on toxic marine microalgae (phytoplankton). Microalgae capable of causing the intoxication have been recorded in all States of Australia, and major toxic blooms have occurred in Tasmania, Victoria and South Australia.
PMID: 11476199, UI: 21368439
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