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Erythema multiforme-like drug eruption with oral involvement after intake of leflunomide.
Fischer TW, Bauer HI, Graefe T, Barta U, Elsner P.
Department of Dermatology and Allergology, Friedrich Schiller University Jena, Jena, Germany.
Leflunomide is an antirheumatic agent of the type of a 'disease-modifying antirheumatic drug'. In rare cases, severe skin reactions up to the extreme expression of toxic epidermal necrolysis have been observed. A female patient with rheumatoid arthritis had been treated with systemic steroids and methotrexate for 2 years. Five weeks prior to admission to our hospital methotrexate was replaced by leflunomide. Three weeks after initiation of leflunomide therapy a progressive generalized erythema with blistering formation occurred accompanied by increase of body temperature, chills and erosive lesions on the lips and oral mucosa. The palmar and plantar surfaces revealed edema, erythema and pulpitis with epidermolysis. On histologic examination necrotic keratinocytes and epidermal spongiosis were observed. After administration of high-dose prednisolone and topical treatment the patient recovered within 14 days. This is one of the few cases of severe drug reaction after intake of leflunomide. Therefore, the indication of this relatively new drug should be considered carefully. Copyright 2003 S. Karger AG, Basel
Publication Types:
PMID: 14657632 [PubMed - indexed for MEDLINE]
Cutaneous relapse of angioimmunoblastic lymphadenopathy-type peripheral T-cell lymphoma mimicking an exanthematous drug eruption.
Yoon GS, Chang SE, Kim HH, Choi JH, Sung KJ, Moon KC.
Department of Pathology, School of Medicine, Catholic University of Daegu, Daegu, South Korea.
Publication Types:
PMID: 14521698 [PubMed - indexed for MEDLINE]
Comment on:
High-potassium haemodialysis in barium poisoning.
Szajewski J.
Publication Types:
PMID: 15083948 [PubMed - indexed for MEDLINE]
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Where is the evidence for treatments used in pesticide poisoning? Is clinical toxicology fiddling while the developing world burns?
Buckley NA, Karalliedde L, Dawson A, Senanayake N, Eddleston M.
Publication Types:
- Editorial
- Review
- Review, Tutorial
PMID: 15083947 [PubMed - indexed for MEDLINE]
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Accidental poisoning with autumn crocus.
Gabrscek L, Lesnicar G, Krivec B, Voga G, Sibanc B, Blatnik J, Jagodic B.
Department of Intensive Internal Medicine, General Hospital Celje, Slovenia.
We describe a case of a 43-yr-old female with severe multiorgan injury after accidental poisoning with Colchicum autumnale, which was mistaken for wild garlic (Allium ursinum). Both plants grow on damp meadows and can be confused in the spring when both plants have leaves but no blossoms. The autumn crocus contains colchicine, which inhibits cellular division. Treatment consisted of supportive care, antibiotic therapy, and granulocyte-directed growth factor. The patient was discharged from the hospital after three weeks. Three years after recovery from the acute poisoning, the patient continued to complain of muscle weakness and intermittent episodes of hair loss.
Publication Types:
PMID: 15083942 [PubMed - indexed for MEDLINE]
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Comparative toxicity of citalopram and the newer antidepressants after overdose.
Kelly CA, Dhaun N, Laing WJ, Strachan FE, Good AM, Bateman DN.
Scottish Poisons Information Bureau, Royal Infirmary, Little France Crescent, Edinburgh, Scotland, UK. cathy.kelly@luht.scot.nhs.uk
OBJECTIVE: To compare the toxicity of citalopram, venlafaxine, mirtazapine, and nefazadone after overdose. METHODS: Two-year retrospective review of consecutive patients admitted to the toxicology unit of Edinburgh Royal Infirmary. Outcome measure included physiological variables, ECG recordings, peak creatine kinase, development of arrhythmias, seizure, tremor or agitation, and the need for admission to a critical care facility. RESULTS: A total of 225 patients were studied. Venlafaxine was associated with a significantly higher pulse rate (p < 0.0001) and tremor (p = 0.007) than other antidepressants. Citalopram was associated with a significantly longer QT interval on ECG recording (p < 0.0001) but mean QTc durations were not significantly different between all drugs studied. No arrhythmias were recorded. Only venlafaxine and citalopram caused seizures and were associated with the need for admission to Intensive Care, but there was no significant difference between them. CONCLUSIONS: Mirtazapine and nefazadone appear safe in overdose and were associated with minimal features of neurological or cardiovascular toxicity. Citalopram is more likely to cause QT prolongation but other features of cardiovascular toxicity were uncommon. Both citalopram and venlafaxine are proconvulsants. Venlafaxine also causes more frequent features of the serotonin syndrome.
PMID: 15083939 [PubMed - indexed for MEDLINE]
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Epidemiology of lindane exposures for pediculosis reported to Poison Centers in Texas, 1998-2002.
Forrester MB, Sievert JS, Stanley SK.
Texas Department of Health, Bureau of Epidemiology, 11 W 49th St., Austin, TX 78756, USA. mathias.forrester@tdh.state.tx.us
BACKGROUND: Lindane (gamma-benzene hexachloride), commonly used as a treatment for pediculosis, has been associated with adverse reactions and has recently undergone increased regulation. OBJECTIVE: We sought to describe the patterns of a large number of lindane exposures reported to poison centers in Texas during 1998-2002. METHODS: Data on all lindane exposures for pediculosis reported to the Texas Poison Center Network were analyzed. RESULTS: There were 528 reported human exposures to lindane for pediculosis. The incidence of lindane exposures has decreased by 52% from 1998 to 2002. Misuse or abuse of lindane was reported in at least 87% of the cases. Of those cases with a known patient age, 45% were less than age 6 yrs, 23% age 6-19 yrs, and 32% over age 19 yrs. Female patients accounted for 55% of reported cases. Of those cases with a known medical outcome, 61% reported no effects. The most frequently reported symptoms were vomiting, nausea, and ocular irritation or ocular pain. CONCLUSION: The number of reported lindane exposures in Texas is decreasing. The majority of reported exposures involve misuse or abuse of the product. The pattern of symptoms reported in Texas was consistent with the literature.
PMID: 15083937 [PubMed - indexed for MEDLINE]
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Acute Cycas seed poisoning in Taiwan.
Chang SS, Chan YL, Wu ML, Deng JF, Chiu T, Chen JC, Wang FL, Tseng CP.
Department of Emergency Medicine, Chang-Gung Memorial Hospital, Kweishan Hsiang, Taoyuan, Taiwan.
OBJECTIVE: The seeds of cycads contain cycasin and neocycasin, which belong to the family of cyanogenic glycosides. These glycosides of cycads are considered pseudocyanogenic with little potential to liberate hydrogen cyanide as other cyanogenic glycosides do. This study investigated the clinical spectrum of Cycas seed poisoning and its cyanogenic potential. METHODS: This was a retrospective chart review conducted at the Poison Control Center in Taiwan (PCC-Taiwan) from 1990 to 2001. RESULTS: Twenty-one cases of Cycas seed poisoning were identified. The reasons for seed ingestion were misuse as an edible food (70%), health promotion (10%), cancer prevention (10%), cosmetic use (5%), and gastrointestinal discomfort (5%). All patients had eaten the seeds after washing and cooking them. The time from ingestion to the onset of symptoms ranged from 30 min to 7 h (mean 2.8 h); patients had ingested between 1 to 30 seeds. Respiratory depression did not occur. Severe vomiting was the most striking symptom. All patients except one presented with gastrointestinal disturbance, and 90% sought medical care at the emergency department. Within 24 h, all patients had recovered. Six patients had blood cyanide or thiocyanate levels measured. Although the levels were higher than normal, they did not reach the toxic range. CONCLUSIONS: The cyanogenic potential of Cycas seeds is documented in our cases. The gastrointestinal symptoms were severe enough that most patients sought medical attention but recovery was quick and complete.
PMID: 15083936 [PubMed - indexed for MEDLINE]
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A simple, safe, and efficient way to treat severe fluoride poisoning--oral calcium or magnesium.
Kao WF, Deng JF, Chiang SC, Heard K, Yen DH, Lu MC, Kuo BI, Kuo CC, Liu TY, Lee CH.
Department of Emergency Medicine, Veterans General Hospital, Taipei, Taiwan, ROC. wfkao@vghtpe.gov.tw
PURPOSE: To examine the efficacy and safety of administration of calcium and magnesium orally and intraperitoneally to treat severe sodium fluoride intoxication. MATERIALS AND METHODS: Mice were initially gavaged a lethal dose of sodium fluoride (NaF) or water. Then, mice were treated with water or varying concentrations of calcium chloride (CaCl2) or magnesium sulfate (MgSO4) via intraperitoneal (IP) route or via oral route. Mice were monitored for 24 h, and the time of death was recorded. RESULTS: IP injections of large amounts of CaCl2 or MgSO4 were dangerous. All mice gavaged with water and then treated with oral CaCl2 or MgSO4 survived and displayed normal activity during the experiment. The survival rate of mice gavaged with a lethal dose of NaF and then treated with a high dose of oral CaCl2 or MgSO4 was significantly higher than those of using low dose. CONCLUSION: Oral administration of a high dose of CaCl2 or MgSO4 is a simple, safe, and effective adjunctive method for treating severe oral fluoride poisoning.
PMID: 15083934 [PubMed - indexed for MEDLINE]
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The clinical picture of olanzapine poisoning with special reference to fluctuating mental status.
Palenzona S, Meier PJ, Kupferschmidt H, Rauber-Luethy C.
Swiss Toxicological Information Centre, Zurich, Switzerland.
BACKGROUND: Olanzapine is an atypical antipsychotic drug that is increasingly used in intentional drug overdoses. Although acute olanzapine overdose is predominantly associated with anticholinergic symptoms and central nervous system depression, miosis and unpredictable fluctuations between somnolence/coma and agitation/ aggression have been suggested as typical signs of olanzapine intoxication in single case reports. AIMS: To confirm the suggestion that fluctuating central nervous system changes and miosis are characteristic signs of olanzapine intoxication. To estimate the dose-response relationship as a guide for the provision of optimal management of olanzapine intoxicated patients. METHODS: Retrospective analysis of all well-documented cases of olanzapine intoxication reported to the Swiss Toxicological Information Centre between January 1997 and October 2001. Inclusion criteria for detailed analysis were patient age > or = 16 yr, acute olanzapine monointoxication, ingested dose > 20 mg, and a causal relationship between olanzapine overdose and clinical effects. The Poisoning Severity Score of the European Association of Poison Centres and Clinical Toxicologists (EAPCCT) assessed the intoxication severity. RESULTS: Out of a total of 131 cases of olanzapine overdose, 26 cases fulfilled the inclusion criteria. The ingested olanzapine doses ranged from 30 to 840 mg. The most frequent findings were somnolence (77%), agitation (42%), and miosis (31%). The Poisoning Severity Score was "minor" in 14 (54%), "moderate" in 11 (42%), and "severe" in 1 (4%) patients. Nine patients (35% of all patients) with moderate olanzapine poisoning (120-840 mg) showed unpredictable fluctuations between somnolence and agitation. Five of these patients also demonstrated marked miosis. All patients recovered within 48h. One patient with severe poisoning (560 mg) had coma and convulsions. Moderate (and severe) symptoms occurred only at ingested doses above 120 mg. There was a statistically significant association between increasing ingested olanzapine doses and poisoning severity. CONCLUSIONS: Although olanzapine is tolerated relatively well in acute overdose, unpredictable and transient fluctuations between central nervous system depression and agitation, frequently associated with miosis, appear to be characteristic findings in moderate to high olanzapine overdoses. They are transient in nature and require careful clinical monitoring but rarely require specific therapeutic interventions.
PMID: 15083933 [PubMed - indexed for MEDLINE]
Comment on:
Viral gastroenteritis in Europe: a new norovirus variant?
Kirkwood C.
Enteric Virus Research Group, Murdoch Childrens Research Institute, Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria 3052, Australia. carl.kirkwood@mcri.edu.au
Publication Types:
PMID: 15001320 [PubMed - indexed for MEDLINE]
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