Ultimo Aggiornamento: Gennaio 2004

1: Acad Emerg Med. 2004 Jan;11(1):71-4.

Out-of-hospital care of critical drug overdoses involving cardiac arrest.

Paredes VL, Rea TD, Eisenberg MS, Cobb LA, Copass MK, Cagle A, Martin TG.

Department of Medicine, University of Washington, Seattle, WA, USA.
vparedes@u.washington.edu

OBJECTIVES: Death from acute drug poisoning, also termed drug overdose, is a
substantial public health problem. Little is known regarding the role of
emergency medical services (EMS) in critical drug poisonings. This study
investigates the involvement and potential mortality benefit of EMS for critical
drug poisonings, characterized by cardiovascular collapse requiring
cardiopulmonary resuscitation (CPR). METHODS: The study population was composed
of death events caused by acute drug poisoning, defined as poisoning deaths and
deaths averted (persons successfully resuscitated from out-of-hospital cardiac
arrest by EMS) in King County, Washington, during the year 2000. RESULTS: Eleven
persons were successfully resuscitated and 234 persons died from cardiac arrest
caused by acute drug poisoning, for a total of 245 cardiac events. The EMS
responded to 79.6% (195/245), attempted resuscitation in 34.7% (85/245), and
successfully resuscitated 4.5% (11/245) of all events. Among the 85 persons for
whom EMS attempted resuscitation, opioids, cocaine, and alcohol were the
predominant drugs involved, although over half involved multiple drug classes.
Among the 11 persons successfully resuscitated, return of circulation was
achieved in six following EMS cardiopulmonary resuscitation alone, in one
following CPR and defibrillation, and in the remaining four after additional
advanced life support. CONCLUSIONS: In this community, EMS was involved in the
majority of acute drug poisonings characterized by cardiovascular collapse and
may potentially lower total mortality by approximately 4.5%. The results show
that, in some survivors, return of spontaneous circulation may be achieved with
CPR alone, suggesting a different pathophysiology in drug poisoning compared
with cardiac arrest due to heart disease.

PMID: 14709431 [PubMed - in process]

2: J Clin Psychiatry. 2003 Nov;64(11):1342-8.

Risperidone for severe tardive dyskinesia: a 12-week randomized, double-blind,
placebo-controlled study.

Bai YM, Yu SC, Lin CC.

Department of Psychiatry, Yu-Li Veterans Hospital, Hua-Lien, Taiwan.
ymbi@ms1.hinet.net

BACKGROUND: Risperidone has been reported to alleviate the severity of tardive
dyskinesia, but without placebo control, the possibility of spontaneous tardive
dyskinesia remission after discontinuing original conventional antipsychotics
cannot be excluded. This 12-week randomized, double-blind, placebo-controlled
study investigated the effect of risperidone on severe tardive dyskinesia.
METHOD: Forty-nine DSM-IV schizophrenia patients with severe tardive dyskinesia
were enrolled in the study. After a 4-week washout period, the subjects were
randomly assigned to treatment with either risperidone or placebo. The
risperidone dose was started at 2 mg/day and gradually increased to 6 mg/day
over 6 weeks; the 6-mg/day dose was maintained for the remaining 6 weeks of the
study. The subjects were evaluated every 2 weeks with the Abnormal Involuntary
Movement Scale (AIMS) and the Extrapyramidal Symptom Rating Scale. The final
mental status was assessed with the Brief Psychiatric Rating Scale. RESULTS:
Twenty-two subjects in the risperidone group and 20 subjects in the placebo
group completed the study; the mean baseline AIMS total score for all subjects
was 15.9 +/- 4.6. At the end of the study, the mean AIMS total score decrease
was 1.1 +/- 4.8 in the placebo group and 5.5 +/- 3.8 in the risperidone group (p
<.05). Fifteen subjects (68%) in the risperidone group and 6 subjects (30%) in
the placebo group were responders (p <.05). The risperidone responders had a
mean AIMS total score decrease of 7.5 +/- 2.1. More significant tardive
dyskinesia improvement among the risperidone group was noted from the eighth
week and was mainly demonstrated in the buccolinguomasticatory a rea rather than
in choreoathetoid movement of the extremities (p <.001). CONCLUSIONS:
Risperidone, 6 mg/day, can improve tardive dyskinesia more significantly than
discontinuing antipsychotics in patients with severe tardive dyskinesia,
especially in the orofacial areas.

Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 14658949 [PubMed - indexed for MEDLINE]

3: J Hepatol. 2003 May;38(5):694-5.

Acute hepatitis associated with montelukast.

Russmann S, Iselin HU, Meier D, Zimmermann A, Simon HU, Caduff P, Reichen J.

Publication Types:
Case Reports
LetterPMID: 12713887 [PubMed - indexed for MEDLINE]

4: J Hepatol. 2003 May;38(5):573-82.

Detection and analysis of intracytoplasmic cytokines in peripheral blood
mononuclear cells in patients with drug-induced liver injury.

Murata H, Shimizu Y, Okada K, Higuchi K, Watanabe A.

The Third Department of Internal Medicine, Toyama Medical and Pharmaceutical
University, 2630 Sugitani, Toyama 930-0194, Japan.

BACKGROUND/AIMS: Idiosyncratic immune response to drugs causes two types of
liver injury, cholestasis or hepatitis. However, the underlying immune
mechanisms of drug-induced liver injury are presently unclear. METHODS: We
examined the cytokine production of peripheral blood mononuclear cells (PBMCs)
from 17 patients with drug-induced liver injury and healthy controls during
their incubation with and without the drug by flow cytometry. We also analyzed
the cytokine production in PBMCs from eight patients after stimulation with the
drug-pulsed HepG2 lysates to examine the possibility that the drug or its
metabolites conjugated with a putative molecule derived from HepG2 cells might
be more immunogenic. RESULTS: Among several cytokines produced by the drug or
the drug-pulsed HepG2 lysates, interferon-gamma production from CD8+ cells was
associated with hepatocellular injury, and tumor necrosis factor-alpha
production from CD14+ cells was with cholestasis. Especially, the latter was
apparent when the drug-pulsed HepG2 lysates were used as stimulants, suggesting
that a complex consist of the drug, or its metabolite, and a putative molecule
derived from HepG2 cells might be more immunogenic than the drug itself.
CONCLUSIONS: The analysis of intracytoplasmic cytokine in PBMCs after
stimulation with the drug or the drug-pulsed HepG2 lysates is useful to analyze
the immune mechanism underlying drug-induced liver injury.

PMID: 12713867 [PubMed - indexed for MEDLINE]

5: JAMA. 2003 Dec 24;290(24):3193-4; author reply 3194.

Comment on:
JAMA. 2003 Sep 10;290(10):1379-81.Farming and slaughterhouse practices to reduce meat-borne disease.

Walker ME.

Publication Types:
Comment
LetterPMID: 14693868 [PubMed - indexed for MEDLINE]

6: Med J Aust. 2003 Oct 20;179(8):455; author 455-6.

Comment on:
Med J Aust. 2003 Jul 21;179(2):88-91.Latrodectism: a prospective cohort study of bites by formally identified redback
spiders.

Wiener S.

Publication Types:
Comment
LetterPMID: 14558881 [PubMed - indexed for MEDLINE]