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Items 1 - 21 of 21 |
One page. |
Comment on:
Changes in pediatric toxic dose of acetaminophen.
Burillo-Putze G, Mintegui S, Munne P.
Publication Types:
PMID: 15258883 [PubMed - indexed for MEDLINE]
Comment on:
Copperhead bites and Crotalidae polyvalent immune Fab (ovine): routine use requires evidence of improved outcomes.
Caravati EM.
Publication Types:
PMID: 14747810 [PubMed - indexed for MEDLINE]
Comment in:
Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite.
Lavonas EJ, Gerardo CJ, O'Malley G, Arnold TC, Bush SP, Banner W Jr, Steffens M, Kerns WP 2nd.
Division of Medical Toxicology, Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28232-2861, USA. eric.lavonas@carolinashealthcare.org
STUDY OBJECTIVE: Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) effectively treats patients bitten by rattlesnakes. The copperhead snake (Agkistrodon contortrix) caused 37% of venomous snakebites reported to US poison centers in 2001 and is the major envenomating reptile in the southeastern United States. FabAV has not been tested in human beings envenomated by copperhead snakes. METHODS: In this preliminary study, we performed a retrospective chart review of all copperhead snake envenomations reported to the Carolinas Poison Center that were treated with FabAV. Progression of limb swelling, coagulopathy, and hemodynamic status before and after FabAV administration, adverse effects of FabAV therapy, and recurrence phenomena were recorded. RESULTS: Of approximately 400 copperhead envenomation cases reported to the poison center during the study period, 32 received FabAV and were included. Most patients had moderate envenomation. The median time to FabAV administration was 4.0 hours. The median time to achieve initial control was 1.0 hour, with a median dose of 4 vials of FabAV. A rapid initial response, defined as cessation of the progression of local tissue injury within 4 hours of FabAV administration, occurred in 28 cases (88%; 95% confidence interval [CI] 76% to 99%). Four cases (13%; 95% CI 1% to 24%) were considered treatment failures. Recurrent swelling occurred in 6 cases (19%; 95% CI 5% to 32%). The incidence of recurrent swelling was not reduced by administration of repeated doses of antivenom on a planned schedule. One patient developed late-onset coagulopathy. One minor allergic reaction was observed. CONCLUSION: In this select group of patients bitten by copperhead snakes, local tissue effects of envenomation halted promptly after FabAV treatment in most cases. Treatment failures occurred, and recurrence of swelling and defibrination syndrome was sometimes problematic. Time to return to work and long-term limb function were not assessed. A controlled trial with long-term follow-up is needed to define the role of FabAV treatment for copperhead envenomation.
PMID: 14747809 [PubMed - indexed for MEDLINE]
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Exposure to extremely high concentrations of carbon dioxide: a clinical description of a mass casualty incident.
Halpern P, Raskin Y, Sorkine P, Oganezov A.
Department of Emergency Medicine and Intensive Care Unit, Tel Aviv Sourasky Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. dr_halperin@tasmc.health.gov.il
Clinical reports on unintentional mass exposure to extreme concentrations of carbon dioxide are rare. We describe an industrial incident caused by a container of liquid carbon dioxide that was unintentionally opened in an enclosed working environment. Twenty-five casualties reached our emergency department. Symptoms included dyspnea, cough, dizziness, chest pain, and headache. ECGs (n=15) revealed ST-segment changes in 2 (13.3%) patients, atrial fibrillation in 2 patients, and non-Q wave myocardial infarction in 1 patient. Chest radiographs (n=22) revealed diffuse or patchy alveolar patterns, consistent with pneumonitis, in 6 (27%) patients and pulmonary edema in 2 (9%) patients. Eleven (44%) patients were admitted to the hospital: 8 were discharged 24 hours later and the others within 8 days. No patient died. Exposure to high concentrations of carbon dioxide resulted in significant but transient cardiopulmonary morbidity with no mortality when victims were promptly evacuated and given supportive therapy. Cardiac complications were frequently observed and should be actively sought.
Publication Types:
PMID: 14747808 [PubMed - indexed for MEDLINE]
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Effect of whole bowel irrigation on the pharmacokinetics of an acetaminophen formulation and progression of radiopaque markers through the gastrointestinal tract.
Ly BT, Schneir AB, Clark RF.
Division of Medical Toxicology, Department of Emergency Medicine, University of California-San Diego Medical Center, California Poison Control System, San Diego Division, San Diego, CA 92103-8925, USA. bly@ucsd.edu
STUDY OBJECTIVES: We describe the effects of whole bowel irrigation on a delayed-release acetaminophen preparation. We compare the mechanical effect of whole bowel irrigation on the progression of radiopaque markers through the gastrointestinal tract between an experimental and a control group. METHODS: We performed a 2-armed, prospective, randomized, crossover volunteer study. In the experimental phase, subjects were administered a delayed-release acetaminophen preparation (75 mg/kg) along with a capsule containing radiopaque markers. We initiated whole bowel irrigation at 30 minutes after ingestion and continued until the rectal effluent was clear. Serum acetaminophen concentrations were measured at baseline and from 0.5 to 8 hours. Abdominal radiographs were obtained at the completion of whole bowel irrigation. In the control phase, whole bowel irrigation was not performed. The primary outcome measure was the effect on the area under the acetaminophen concentration versus time curve (AUC) between the 2 groups. RESULTS: Ten subjects participated in the study. We found an 11.5% reduction in the AUC, with the majority of the effect occurring in the delayed-release portion of the curve after the 2-hour mark. This reduction, however, was not statistically significant. Radiographs obtained at the end of whole bowel irrigation revealed radiopaque markers sequestered in the right hemicolon in 8 of 10 subjects. No discernible pattern was noted in the control arm. CONCLUSION: The effect of whole bowel irrigation on reduction of AUC for delayed-release acetaminophen preparation was not statistically significant. Whole bowel irrigation did appear to have a mechanical effect on the progression of radiopaque markers through the gastrointestinal tract, but the clinical significance of this finding is not clear.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14747807 [PubMed - indexed for MEDLINE]
Comment on:
Snakebite suction devices don't remove venom: they just suck.
Bush SP.
Publication Types:
PMID: 14747806 [PubMed - indexed for MEDLINE]
Comment in:
Suction for venomous snakebite: a study of "mock venom" extraction in a human model.
Alberts MB, Shalit M, LoGalbo F.
Department of Emergency Medicine, University Medical Center, University of California, San Francisco, Fresno 93702, USA. hanamakena@earthlink.net
STUDY OBJECTIVE: We determine the percentage of mock venom recovered by a suction device (Sawyer Extractor pump) in a simulated snakebite in human volunteers. METHODS: A mock venom (1 mL normal saline solution, 5.0 mg albumin, 2.5 mg aggregated albumin) radioactively labeled with 1 mCi of technetium was injected with a curved 16-gauge hypodermic needle 1 cm into the right lateral lower leg of 8 supine male volunteers aged 28 to 51 years. The Sawyer Extractor pump was applied after a 3-minute delay, and the blood removed by suction was collected after an additional 15 minutes. A 1991 Siemens Diacam was used to take measurements of the radioactive counts extracted and those remaining in the leg and body. RESULTS: The "envenomation load," as measured by mean radioactivity in the leg after injection, was 89,895 counts/min. The mean radioactivity found in the blood extracted in the 15 minutes of suction was 38.5 counts/min (95% confidence interval [CI] -33 to 110 counts/min), representing 0.04% of the envenomation load. The postextraction leg count was less than the envenomation load by 1,832 counts/min (95% CI -3,863 to 200 counts/min), representing a 2.0% decrease in the total body venom load. CONCLUSION: The Sawyer Extractor pump removed bloody fluid from our simulated snakebite wounds but removed virtually no mock venom, which suggests that suction is unlikely to be an effective treatment for reducing the total body venom burden after a venomous snakebite.
Publication Types:
PMID: 14747805 [PubMed - indexed for MEDLINE]
An outbreak of eruptive pseudoangiomatosis-like lesions due to mosquito bites: erythema punctatum Higuchi.
Ban M, Ichiki Y, Kitajima Y.
Publication Types:
PMID: 15178924 [PubMed - indexed for MEDLINE]
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ACE-inhibitor-induced drug eruption resembling lymphocytic infiltration (of Jessner-Kanof) and Lupus erythematosus tumidus.
Schepis C, Lentini M, Siragusa M, Batolo D.
Publication Types:
PMID: 15178923 [PubMed - indexed for MEDLINE]
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Fatal intoxications in a Swedish forensic autopsy material during 1992-2002.
Jonsson A, Holmgren P, Ahlner J.
Department of Clinical Pharmacology, University Hospital, S-581 85 Linkoping, Sweden. anna.k.jonsson@lio.se
Compilations of substances detected in fatal intoxications are important in order to observe changes in intoxication patterns, to monitor effects of preventive work and to discover new trends in drug usage. The aim of the present study was to describe the current pattern of substances detected in fatal intoxications in Sweden. Fatal intoxications investigated at the Department of Forensic Chemistry, Linköping, Sweden, during 1992-2002, were analysed. All suicides, uncertain cases and accidents where the cause of death were fatal intoxications (ICD-9: E950, E980 and E859) were included and substances detected in more than 50 fatal intoxications (in femoral blood) were listed. For each substance, a cut off value was set, above which concentrations were considered toxic. Fatal intoxications were detected by forensic-chemical analyses in 12% (6998/60,314) of the forensic autopsies during the study period. Among the suicides, an average of 3.8 substances were detected per case, the corresponding figure for uncertain cases and accidents were 3.5 and 4.1 substances, respectively. Ethanol was by far the most frequently detected substance, detected in 43% (3039) of the fatal intoxications, of which 32% (960) had toxic concentrations, followed by propoxyphene, detected in 27% (1863) of the fatal intoxications of which 74% (1370) had toxic concentrations. The number of cases where ethanol and propoxyphene were detected decreased during the study period. Moreover, other CNS-active drugs such as antidepressants, analgesics and anxiolytics were also frequently detected. The drugs with high proportions of cases with toxic concentrations detected were propoxyphene, amitriptyline, zolpidem, carisoprodol, alprazolam, thioridazine, methadone and ketobemidone. Selective serotonin reuptake inhibitors (SSRI) and tricyclic antidepressants (TCA) were detected in 12% (833) and 10% (665), respectively. A significantly (P <0.001) higher proportion of cases where TCA were detected had toxic concentrations when compared with cases where SSRI were detected (64% versus 31%).
PMID: 15177630 [PubMed - indexed for MEDLINE]
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Fatal blood and tissue concentrations of more than 200 drugs.
Musshoff F, Padosch S, Steinborn S, Madea B.
Institute of Legal Medicine, Rheinische Friedrich-Wilhelms-University, Stiftsplatz 12, Bonn 53111, Germany. f.musshoff@uni-bonn.de
Fatal drug concentrations in body fluids and tissue samples are presented for more than 200 drugs and chemicals of toxicologic interest. Additionally, a reference list is added with more than 600 original papers concerning intoxications with a lethal outcome. The data can be helpful for the interpretation and plausibility control in own cases of intoxication. However, they should be used with caution, because use of drug data without sufficient knowledge about the patient or victim, the circumstances of the case, and about toxicokinetics and toxicodynamics might give a wrong interpretation in a special case.
PMID: 15172079 [PubMed - indexed for MEDLINE]
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A forensic toxicological dilemma: the interpretation of post-mortem concentrations of central acting analgesics.
Daldrup T.
Institute of Legal Medicine, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, D-40225 Dusseldorf, Germany. fortoxi@uni-duessldorf.de
Dora V., a 88-year-old pensioner suffering from a hiatus hernia, died at the home of an orthopaedist and his wife, an anaesthetist, immediately after she had received a dose of 300 mg pethidine via intravenous infusion in a timeframe of about 90 min. One day before her death a befriended notary of the couple visited Dora V. and obtained a blank signature. After her death, a will was forged using this signature, rendering the couple sole heirs of Dora V.'s estate with a value of several million euros. Post-mortem toxicology was performed in three different institutes of legal medicine. The concentrations of pethidine in peripheral venous blood were between 6.1 and 6.5mg/l and 9.5 and 17.2mg/kg in brain. Pharmacokinetic calculation confirms the given dose. There was no doubt that the cause of death was acute pethidine intoxication. The accused couple claimed that this dose of pethidine was indicated to relief pain, and as the pathologists said in their expert opinions that the hiatus hernia could explain her death, the court had to acquit the accused. This very special case demonstrates that preconceived murder of a sick person with suitable analgesics cannot be proven--at least not with the methods available to forensic toxicology and pathology. This has to be taken into consideration if euthanasia will be legalised under special circumstances.
Publication Types:
PMID: 15172078 [PubMed - indexed for MEDLINE]
[Pioglitazone-induced acute severe hepatitis]
[Article in French]
Arotcarena R, Bigue JP, Etcharry F, Pariente A.
Publication Types:
PMID: 15243398 [PubMed - indexed for MEDLINE]
Deadly nightshade (Atropa belladonna) intoxication: an analysis of 49 children.
Caksen H, Odabas D, Akbayram S, Cesur Y, Arslan S, Uner A, Oner AF.
Yuzuncu Yil University, Faculty of Medicine, Department of Pediatrics, 65200, Van, Turkey. huseyincaksen@hotmail.com
Deadly nightshade (Atropa belladonna) intoxication has been infrequently reported in both children and adults in the literature. In this article, the clinical and laboratory findings of 49 children with acute deadly nightshade intoxication are reviewed. Our purpose was to enlighten the findings of deadly nightshade intoxication in childhood. The most common observed symptoms and signs were meaningless speech, tachycardia, mydriasis, and flushing. None of the children required mechanical ventilation or died in our series. The patients were categorized into two groups, mild/moderate and severe intoxication. Children with and without encephalopathy were accepted as severe and mild/moderate intoxication, respectively. While 43 children were placed in the group of mild/moderate intoxication, six were in severe intoxication group. We found that meaningless speech, lethargy, and coma were more common, but tachycardia was less common in the severe intoxication group (children with encephalopathy) (P < 0.05). In the treatment, neostigmine was used in all children because of no available physostigmine in our country. In conclusion, our findings showed that the initial signs and symptoms of acute deadly nightshade intoxication might be severe in some children, but no permanent sequel and death were seen in children. We also showed that meaningless speech, lethargy, coma, and absence of tachycardia were ominous signs in deadly nightshade intoxication in childhood. Lastly, we suggest that neostigmine may be used in cases of deadly nightshade intoxication if physostigmine cannot be available.
PMID: 14992329 [PubMed - indexed for MEDLINE]
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Protective effect of curcumin against lead neurotoxicity in rat.
Shukla PK, Khanna VK, Khan MY, Srimal RC.
Industrial Toxicology Research Centre, PO Box 80, MG Marg, Lucknow 226001, India.
Curcumin (diferuloylmethane), an active ingredient of turmeric, is known to have multiple activities, including an antioxidant property, and has been suggested to be of use in treatment of several diseases. The present study has been undertaken to investigate the protective effect of curcumin against lead-induced neurotoxicity in rats. Exposure of rats to lead (50 mg/kg po) for 45 days caused an increase in lipid peroxidation (LPO) and a decrease in reduced glutathione (GSH) levels in cerebellum, corpus striatum, hippocampus and frontal cortex as compared with controls. Lead levels were significantly increased in these rats. Activity of antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) decreased in all the brain regions following lead exposure. Interestingly, cotreatment with curcumin (100 mg/kg po) and lead (50 mg/kg po) for 45 days caused a significant decrease in LPO with concomitant decrease in lead levels in all the brain regions as compared with those treated with lead alone. A significant increase in reduced glutathione (GSH) levels, SOD and CAT activities was also observed in all the four brain regions in rats simultaneously treated with curcumin and lead. The results suggest that curcumin may prevent lead-induced neurotoxicity.
PMID: 14992327 [PubMed - indexed for MEDLINE]
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Hepatocurative and antioxidant profile of HP-1, a polyherbal phytomedicine.
Tasaduq SA, Singh K, Sethi S, Sharma SC, Bedi KL, Singh J, Jaggi BS, Johri RK.
Biochemistry Lab, Division of Pharmacology, Regional Research Laboratory, Canal Road, Jammu-Tawi 180 001, India.
HP-1 a herbal formulation comprising of Phyllanthus niruri and extracts of Terminalia belerica, Terminalia chebula, Phyllanthus emblica and Tinospora cordifolia has been evaluated for hepatoprotective activity against carbon tetrachloride (CCl4) induced toxicity. Results show that HP-1 reversed the leakage of lactate dehydrogenase (LDH) and glutamate pyruvate transaminase (GPT) and prevented the depletion of glutathione (GSH) levels in a primary monolayer culture of rat hepatocytes (in vitro). HP-1 attenuated the serum toxicity as manifested in elevated levels of transaminases (glutamate oxaloacetate transaminase (GOT), and GPT) The antioxidative enzymes in liver (catalase and superoxide dismutase (SOD)) were restored to normal values after the oral administration of HP-1. HP-1 suppressed the formation of the superoxide anion radical and reduced CCl4 mediated lipid peroxidation (LPO). Silymarin and antioxidants (ascorbic acid, beta-carotene and alpha-tocopherol) were used for comparison. The present study showed that HP-1 is a potential hepatoprotective formulation with an additional attribute of being anti-peroxidative.
PMID: 14992325 [PubMed - indexed for MEDLINE]
Delayed cutaneous reactions to heparin in antiphospholipid syndrome during pregnancy.
Kim J, Smith KJ, Toner C, Skelton H.
Department of Dermatology, National Naval Medical Center, Bethesda, MD, 20889-5600, USA.
BACKGROUND: Clinical symptoms related to antiphospholipid antibodies often first occur during pregnancy with the diagnosis of antiphospholipid syndrome (APS). Unfractionated heparin (UFH) and low-dose aspirin are considered as first-line treatments for pregnant women with APS and recurrent fetal loss. However, in addition to an increased incidence of hemorrhagic side-effects and thrombocytopenia there are a number of drug eruptions with cutaneous components secondary to the use of UFH. One of these eruptions has been classified as a delayed type I.V. hypersensitivity reactions at the sites of UFH injections. The majority of these reactions occur in pregnant women. METHOD: We present three pregnant patients who developed delayed hypersensitivity reactions at the sites of UFH injections. Two patients had documented APS and the other patient had two previous spontaneous abortions. RESULTS: The histopathologic and immunohistochemical findings in the biopsy specimens from the sites of the delayed reactions were distinctive. The inflammatory infiltrate contained CD3+ and CD4+ lymphoid cells with plasma cells, and eosinophils. There was a marked increased in mast cells with increased stromal cells within the dermis and increased vascular proliferation. CONCLUSIONS: The distinctive histopathologic and immunohistochemical features seen in the delayed hypersensitivity reactions at the sites of UFH injections may be modulated by the immunomodulatory effects of UFH as well as the hormonal levels and cytokine patterns during pregnancy. Alternative therapies may not always be successful in resolving the reactions.
Publication Types:
PMID: 15090006 [PubMed - indexed for MEDLINE]
Channelling the Emperor: what really killed Napoleon?
Mari F, Bertol E, Fineschi V, Karch SB.
Department of Forensic Toxicology, University of Florence, Italy.
Arsenic was present in Napoleon's hair before he arrived on Saint Helena and the findings at necropsy are consistent only with the diagnosis of ulcerating, regionally invasive, gastric carcinoma. The question of whether Napoleon died of, or merely with, arsenic poisoning is illuminated by developments in the treatment of promyelocytic leukaemia. Arsenic trioxide induces remission in many, but treatment can be complicated by QT prolongation, torsades de pointes and sudden death. At clinically relevant concentrations, arsenic blocks both I(Kr) and I(ks) channels and, at the same time, activates I(K-ATP) channels. The balance of these forces is easily disrupted, and QT prolongation is worsened by hypokalaemia. Napoleon was chronically treated with tartar emetic for gastrointestinal symptoms, and the day before he died he was given a huge dose of calomel (mercurous chloride) as a purgative. Both treatments would have caused potassium wastage. In addition, the Emperor was being treated with a decoction containing 'bark'-presumably 'Jesuit's bark'. The quinine in Jesuit's bark is another cause of QT prolongation. It is likely that the immediate cause of the Emperor's death was torsades de pointes, brought on by chronic exposure to arsenic and a medication error.
Publication Types:
- Biography
- Historical Article
Personal Name as Subject:
PMID: 15286197 [PubMed - indexed for MEDLINE]
Comment in:
Necrotic arachnidism: the mythology of a modern plague.
Isbister GK.
Clinical Envenoming Research Group, University of Newcastle, Newcastle Mater Misericordiae Hospital, Waratah NSW 2298, Australia. gsbite@ferntree.com
PMID: 15302201 [PubMed - indexed for MEDLINE]
Comment on:
Myths about spider envenomations and necrotic skin lesions.
Vetter RS.
Department of Entomology, University of California, Riverside, CA 92507, USA. rick.vetter@ucr.edu
Publication Types:
PMID: 15302176 [PubMed - indexed for MEDLINE]
Outbreak of aflatoxin poisoning--eastern and central provinces, Kenya, January-July 2004.
Centers for Disease Control and Prevention (CDC).
In May 2004, CDC Kenya, trainees of the CDC-supported Field Epidemiology and Laboratory Training Program (FELTP) in Kenya, the World Health Organization, and CDC were invited by the Kenya Ministry of Health (KMOH) to participate in the investigation of an outbreak of jaundice with a high case-fatality rate (CFR) in the districts of Makueni and Kitui, Eastern Province. Preliminary laboratory testing of food collected from the affected area revealed high levels of aflatoxin, suggesting that the outbreak was caused by aflatoxin poisoning, as was a previous outbreak in the same area in 1981. In the United States, aflatoxin concentrations are limited to 20 parts per billion (ppb), a level also adopted by Kenyan authorities. The 2004 outbreak resulted from widespread aflatoxin contamination of locally grown maize, which occurred during storage of the maize under damp conditions. Urgent replacement of the aflatoxin-contaminated maize with noncontaminated maize proved to be a critical intervention; however, as of July 21, a limited number of new cases continued to be detected. This report summarizes the preliminary results of the outbreak investigation. Aflatoxin poisoning likely will continue to be a public health problem until culturally appropriate storage methods for dry maize are implemented by the local population. In addition, enhanced surveillance for human aflatoxin poisoning and testing of commercially sold maize for aflatoxin levels will lead to long-term improvements in public health.
PMID: 15343146 [PubMed - indexed for MEDLINE]
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