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Am J Gastroenterol 2003 Mar;98(3):704-5
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PMID: 12650820, UI: 22537525
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Gastroenterol Clin Biol 2003 Jan;27(1):129-30
PMID: 12594381, UI: 22482425
Gastroenterol Clin Biol 2003 Jan;27(1):120-2
Service d'Hepato-Gastroenterologie, CHU, 49033 Angers Cedex 01.
1,1, 1-trichloroethane is derived from carbon tetrachloride and has been widely used as an industrial solvent since 1954, because of its supposed lack of toxicity. However, several cases of central nervous system toxicity and heart disorders due to intoxication by 1,1, 1-trichloroethane have been reported. Cases of liver injury are infrequent, with less than 10 cases, unlike 1,1, 2-trichloroethane that it replaced. We report a case of hepatotoxicity probably due to 1,1, 1-trichloroethane exposure, characterized by an original pathologic feature of chronic active hepatitis.
PMID: 12594376, UI: 22482420
Int J Dermatol 2002 Dec;41(12):948-9
PMID: 12492999, UI: 22381076
Int J Dermatol 2002 Dec;41(12):841-6
Department of Dermatology, Faculty of Medicine, School of International Health, University of Tokyo, Tokyo, Japan. kadano-der@h.u-tokyo.ac.jp
BACKGROUND: Arsenic contamination in groundwater affects 35 million people in Bangladesh, but the prevalence of arsenic contamination in local communities remains to be clarified. As skin manifestations are sensitive markers of arsenicosis, we examined the skin of adults and adolescents in two villages to elucidate the severity of arsenicosis. METHODS: Five hundred and sixty-one villagers were randomly selected for the evaluation of their skin. Three indicators, i.e. keratosis on the soles, keratosis on the palms, and melanosis and hypopigmentation on the trunk, were quantified for analysis. RESULTS: More than 50% of the villagers showed some skin manifestations due to arsenicosis. Keratosis on the soles was the most sensitive marker for the detection of arsenicosis at an early stage. Interestingly, the skin manifestations were more severe in males than in females. There was no correlation between the age and the severity of skin manifestations. CONCLUSIONS: The prevalence of arsenicosis was quite high and males were more vulnerable to arsenic contamination. Using skin manifestations, especially keratosis on the soles, as useful markers to detect and evaluate arsenicosis, it is clear that there is an urgent need to assess the exact prevalence and severity of arsenicosis in the population of Bangladesh in order to take measures to treat and control this problem.
PMID: 12492966, UI: 22381043
J Emerg Med 2002 Nov;23(4):379-82
Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA.
Lionfish (Pterois volitans) are venomous fish most often found as aquarium pets throughout the United States. Lionfish envenomations frequently occur on the upper extremities, with pain as the predominant symptom. Immersing the injured part in warm (45 degrees C) water is considered the first and foremost important treatment as it is reported to relieve pain and inactivate the venom. Other methods of analgesia are discussed. We present a case of lionfish envenomation that failed to respond to warm water immersion.
PMID: 12480019, UI: 22368597
J Emerg Med 2002 Nov;23(4):329-32
Department of Medical Toxicology, Good Samaritan Regional Medical Center, Phoenix, Arizona 85006, USA.
Respiratory compromise after rattlesnake envenomation (RSE) is an uncommon yet potentially lethal complication. We were interested in determining the frequency of respiratory compromise in patients treated for RSE. The incidence and indications for intubation were also determined. A retrospective chart review was conducted of all patients treated by medical toxicologists at a tertiary referral hospital between July, 1994 and November, 2000. Out of 294 total patients, 289 charts were reviewed. Of all 289 patients, 214 (74%) received Crotalidae Polyvalent Antivenin (Wyeth-Ayerst) and 23 (8%) had clinical evidence of respiratory compromise. Thirteen of 289 patients (4.4%) were intubated following RSE. No one was intubated for antivenin-induced complications. There were no deaths among studied patients during acute hospitalization. Respiratory compromise following RSE is rare, occurring in only 8% of studied patients. Only 2 patients (0.7%) required intubation as a direct consequence of RSE. No one required intubation for antivenin-induced hypersensitivity reactions.
PMID: 12480008, UI: 22368586
J Emerg Med 2002 Nov;23(4):327-8
Good Samaritan Regional Medical and Poison Control Center, Department of Medical Toxicology, Phoenix, Arizona 85006, USA.
To record the outcome, with regard to infection rate, of patients with rattlesnake bites (RSBs) who do not receive prophylactic antibiotics, a prospective observational study was performed of patients with RSBs treated at our institution during a consecutive 18-month period. The inclusion criteria were RSBs <24 h old and completion of follow-up (telephone call, mail reply, medical toxicologist, or private physician examination) 7-10 days following envenomation. Fifty-six consecutive patients (Median age: 32.8 years [range 4-67 years]) were enrolled. One patient was excluded because of presentation 38 h after envenomation and two patients failed to complete the required follow-up. One patient received a dose of antibiotics before transfer. Antibiotics were discontinued upon arrival. Of the total 56 RSB patients, 34 (61%) RSBs involved the upper extremity and 22 (39%) involved the lower extremity. Six patients (11%) applied ice and two (4%) used a tourniquet before evaluation. The mean arrival time was 2.7 h (Range <1-24 h). Forty-three patients (81%) received antivenin. Fifty-three patients (100%) had extremity swelling and 38 patients (72%) had tender proximal lymph nodes. Of the 53 patients who completed the study, 3 (6%) received antibiotics from their primary care physicians at 7-10 day follow-up, with no cases (0%) of documented infection. Prophylactic antibiotics are not indicated in patients with rattlesnake bites.
PMID: 12480007, UI: 22368585
Lancet 2003 Mar 22;361(9362):1001-6
Department of Emergency Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia. simon.brown@utas.edu.au
BACKGROUND: The jack jumper ant Myrmecia pilosula is responsible for about 90% of ant venom anaphylaxis in southeastern Australia. We aimed to establish whether M pilosula venom immunotherapy (VIT) prevents lifethreatening sting anaphylaxis in otherwise healthy adults. METHODS: We did a double-blind, placebo-controlled crossover trial of M pilosula VIT. Participants were randomly allocated either immunotherapy, in accordance with the semirush hyposensitisation regimen, or placebo. The primary endpoint was systemic reaction after a deliberate sting challenge. Analysis was per protocol. FINDINGS: We randomly allocated 68 healthy volunteers (aged 20-63 years) who were allergic to M pilosula venom to placebo (33) and VIT (35). Four on placebo were stopped early and 12 on VIT had their treatment allocations revealed before the sting challenge, thus 29 on placebo and 23 on VIT were included in the primary analysis. Objectively defined systemic reactions to sting challenges arose in 21 of 29 participants (72%) on placebo (8 reactions were associated with hypotension) and none of 23 on VIT (p<0.0001). Of the remaining 12 on VIT who underwent sting challenges after treatment allocations were revealed, only one reacted to sting challenge with transient urticaria that did not require treatment. After crossover of the placebo group to VIT, one of 26 had a reaction to sting challenge (transient urticaria). In all patients who had VIT, we recorded objective systemic reactions in 22 of 64 (34%) during VIT; two of which were hypotensive. INTERPRETATION: In well motivated, highly allergic, but otherwise healthy adults, VIT is highly effective in prevention of M pilosula sting anaphylaxis. The risk of systemic reactions during VIT means that treatment should be given where there is immediate access to resuscitation facilities.
PMID: 12660058, UI: 22547083
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N Engl J Med 2003 Apr 3;348(14):1410-1; author reply 1410-1
PMID: 12672876, UI: 22561067