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Items 1 - 16 of 16 |
One page. |
Fulminant hepatic failure due to chronic acetaminophen intoxication in an infant.
Liu YP, Fang CC, Chen WJ, Ni YH.
Publication Types:
PMID: 15672348 [PubMed - indexed for MEDLINE]
Oral or intravenous N-acetylcysteine for acetaminophen poisoning?
Prescott L.
Publication Types:
PMID: 15795720 [PubMed - in process]
Comment on:
Fasciotomy after envenomation: measure twice and cut once.
Fulton JA, Hoffman RS.
Publication Types:
PMID: 15726066 [PubMed - indexed for MEDLINE]
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Images in emergency medicine. Forearm furuncle resulting from community-associated methicillin-resistant Staphylococcus aureus (MRSA).
Frazee BW.
Department of Emergency Medicine, Alameda County Medical Center-Highland Campus, Oakland, CA, USA.
PMID: 15726044 [PubMed - indexed for MEDLINE]
Aripiprazole-associated dyskinesia.
Sajbel TA, Cheney EM, DeQuardo JR.
Publication Types:
PMID: 15598969 [PubMed - indexed for MEDLINE]
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Antimuscarinic intoxication resulting from the ingestion of moonflower seeds.
DeFrates LJ, Hoehns JD, Sakornbut EL, Glascock DG, Tew AR.
College of Pharmacy, University of Iowa, Iowa City, IA, USA.
OBJECTIVE: To report a case in which ingestion of moonflower seeds resulted in antimuscarinic intoxication. CASE SUMMARY: An 18-year-old man was found at a local convenience store hallucinating and incoherent. Upon presentation to the emergency department, his signs and symptoms included tachycardia, confusion, dilated pupils, and dry, flushed, hot skin. He was admitted to the intensive care unit. Hallucinations and symptoms resolved within 36-48 hours after hospitalization. The patient then reported that he had ingested moonflower seeds. He recovered and was released 4 days after admission. DISCUSSION: Based on the patient's description and clinical presentation, the moonflower seeds were believed to be Datura inoxia. This species of plant is similar to jimson weed, or Datura stramonium. These plants are known to contain high concentrations of anticholinergic substances; ingestion can result in anticholinergic intoxication. Signs and symptoms that commonly occur include hallucinations, tachycardia, dilated pupils, and disorientation. In our patient, use of the Naranjo probability scale indicated a possible relationship between the moonflower seed ingestion and the patient's signs and symptoms. CONCLUSIONS: Ingestion of the Datura species can result in severe toxicity. Each plant varies in the concentrations of alkaloid substances. For this reason, it is very important for individuals to become educated on the toxicities and potential risks associated with recreational use of these plants.
Publication Types:
- Case Reports
- Review
- Review of Reported Cases
PMID: 15572604 [PubMed - indexed for MEDLINE]
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Multiple complications and withdrawal syndrome associated with quetiapine/venlafaxine intoxication.
Precourt A, Dunewicz M, Gregoire G, Williamson DR.
Department of Pharmacy Services, Hopital Ste-Justine, Montreal, Quebec, Canada.
OBJECTIVE: To report a case of quetiapine/venlafaxine intoxication associated with multiple complications and to review their possible relationship with these 2 drugs. CASE SUMMARY: A 53-year-old white man was admitted to the hospital for loss of consciousness secondary to voluntary intoxication with venlafaxine and quetiapine. Several complications were attributable to this intoxication including seizures, prolonged coma, respiratory depression, neuroleptic malignant syndrome, prolonged QRS and QTc intervals, and a possible venlafaxine withdrawal syndrome. DISCUSSION: Quetiapine could be responsible for the neuroleptic malignant syndrome presented in this case. Moreover, venlafaxine intoxication, fever, autonomic instability, and myoclonus presented serotonin syndrome as a differential diagnosis. Potential causes of seizures and prolongation of the QRS and QTc intervals are reviewed. Finally, prolonged coma and late venlafaxine withdrawal are discussed with regard to the pharmacodynamics and pharmacokinetics of drug elimination in the context of intoxication. CONCLUSIONS: Clinicians should be aware of possible complications following intoxication with atypical antipsychotics and anti-depressants, including protracted altered mental status.
Publication Types:
PMID: 15562144 [PubMed - indexed for MEDLINE]
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Adverse reactions during imatinib and lansoprazole treatment in gastrointestinal stromal tumors.
Severino G, Chillotti C, De Lisa R, Del Zompo M, Ardau R.
Section of Clinical Pharmacology, Department of Neurosciences, B.B. Brodie, University of Cagliari, Cagliari, Italy.
OBJECTIVE: To report the case of a patient affected by gastrointestinal stromal tumors (GIST) who developed cutaneous adverse drug reactions during treatment with imatinib and lansoprazole. CASE SUMMARY: After 2 months of treatment with imatinib 400 mg/day, a 60-year-old white female affected by GIST developed bilateral palpebral edema with hyperemic conjunctivae and labial edema when lansoprazole 15 mg/day was introduced to treat dyspeptic symptomatology. Treatment was discontinued, and on reintroduction of both drugs, the patient developed Stevens-Johnson syndrome. Two months later, generalized cutaneous reactions appeared immediately following reintroduction of low-dose imatinib with corticosteroid plus lansoprazole treatment. After discontinuation of all drugs, with the exception of the corticosteroid, the progression of cutaneous lesions stopped. DISCUSSION: The use of imatinib is commonly associated with a high dose-dependent rate of rash and edema. Several cases of Stevens-Johnson syndrome have also been described, although not in patients affected by GIST. Severe skin reactions have been reported for lansoprazole including erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Applying Naranjo's algorithm, the adverse events were considered possible due to imatinib and probable due to lansoprazole. CONCLUSIONS: On the basis of the data reported, we conclude that the adverse reactions described may be attributed to either drug alone. However, combined use of drugs may increase the risk of onset of these adverse reactions due to a potential drug interaction involving CYP3A4.
Publication Types:
PMID: 15546944 [PubMed - indexed for MEDLINE]
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A rare case of streptomycin-induced toxic epidermal necrolysis in a patient with tuberculosis: a therapeutic dilemma.
Hmouda H, Laouani-Kechrid C, Nejib Karoui M, Denguezli M, Nouira R, Ghannouchi G.
Medical Intensive Care Unit and Emergency Department, Sahloul University Hospital, Sousse, Tunisia. houssem_hmouda@yahoo.com
OBJECTIVE: To report a case of streptomycin-induced toxic epidermal necrolysis (TEN). CASE SUMMARY: A 55-year-old woman was admitted for treatment of active pulmonary tuberculosis (TB). She was given standard oral anti-TB chemotherapy including isoniazid, rifampin, pyrazinamide, and streptomycin. On the fourth day of therapy, she experienced high fever at 39 degrees C, chills, vomiting, pruritus, and diffuse erythema, followed by extensive bullae formation and skin denudation. Diagnosis of TEN was considered, and all anti-TB drugs were discontinued. Skin biopsy disclosed complete epidermal necrosis with dermal-epidermal cleavage and absence of inflammatory infiltrate, highly suggestive of TEN. The patient was transferred to the intensive care unit. Her general condition and skin lesions improved. A staged-fashion exposure test to the 4 anti-TB drugs allowed the incrimination of streptomycin as the offending agent. DISCUSSION: Anti-TB drugs, mainly rifampin, ethambutol, and isoniazid, have been incriminated in TEN. Streptomycin-induced TEN remains an extremely rare event. However, minor allergic skin reactions (rash, urticaria) have been described with this drug. Our patient presents a rare case of streptomycin-related TEN. Even though dangerous, a step-wise exposure test was necessary to allow safe treatment of active pulmonary TB. It also provided a strong argument of a cause-effect relationship between TEN and streptomycin. An objective causality assessment using the Naranjo rating scale revealed that the adverse drug event was highly probable. CONCLUSIONS: Streptomycin should be added to the list of drugs that induce TEN.
Publication Types:
PMID: 15546942 [PubMed - indexed for MEDLINE]
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[Domestic animals and accidents in children.]
[Article in French]
Lavaud J, Vazquez MP, Bordas VC, Duval C.
SMUR pediatrique, hopital Necker-Enfants-Malades, 149 rue de Sevres, 75743 Paris cedex 15, France.
Young French children have 45,000,000 domestic pets, cats and dogs being widely prevalent (40%). Injuries due to domestic animals, especially bites, in particular from dogs, represent 1.9% of all children's injuries. On the quality of first aid in the field, i.e., whether the treatment is the first line in surgical specialized service or not, if it is a vital emergency, will depend the possibility of immediate complications, which include local superinfection (15%), functionals and further aesthetic sequelae. Some injuries due to large animals carry a polytraumatism, which should be treated like all polytraumatisms, whatever the aetiology. Learning to know and respect animals and their needs should remain the priority of families to avoid unexpected injury. Families also need to take charge of the responsible animal.
Publication Types:
PMID: 15694556 [PubMed - indexed for MEDLINE]
Comment on:
Charcoal burning is also popular for suicide pacts made on the internet.
Lee DT, Chan KP, Yip PS.
Publication Types:
PMID: 15761009 [PubMed - indexed for MEDLINE]
Bilateral subthalamotomy in Parkinson's disease: initial and long-term response.
Alvarez L, Macias R, Lopez G, Alvarez E, Pavon N, Rodriguez-Oroz MC, Juncos JL, Maragoto C, Guridi J, Litvan I, Tolosa ES, Koller W, Vitek J, DeLong MR, Obeso JA.
Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba.
We conducted an open label pilot study of the effect of bilateral subthalamotomy in 18 patients with advanced Parkinson's disease. In seven patients, the first subthalamotomy pre-dated the second by 12-24 months ('staged surgery'). Subsequently, a second group of 11 patients received bilateral subthalamotomy on the same day ('simultaneous surgery'). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a battery of timed motor tests and neuropsychological tests. Evaluations were performed in the 'off' and 'on' drug states before surgery and at 1 and 6 months and every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (P < 0.001) reduction in the 'off' (49.5%) and 'on' (35.5%) Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at the last assessment. A blind rating of videotape motor exams in the 'off' and 'on' medication states preoperatively and at 2 years postoperatively also revealed a significant improvement. All of the cardinal features of Parkinson's disease as well as activities of daily living (ADL) scores significantly improved (P < 0.01). Levodopa-induced dyskinesias were reduced by 50% (P < 0.01), and the mean daily levodopa dose was reduced by 47% at the time of the last evaluation compared with baseline (P < 0.0001). Dyskinesias occurred intraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized chorea that gradually resolved within the next 3-6 months. Three patients experienced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dyskinesias. No patient exhibited permanent cognitive impairment. The motor benefit has persisted for a follow-up of 3-6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanced Parkinson's disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Further refinement of the surgical procedure is mandatory.
Publication Types:
PMID: 15689366 [PubMed - indexed for MEDLINE]
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Reversal of dyskinesias in an animal model of Parkinson's disease by continuous L-DOPA delivery using rAAV vectors.
Carlsson T, Winkler C, Burger C, Muzyczka N, Mandel RJ, Cenci A, Bjorklund A, Kirik D.
Wallenberg Neuroscience Center, Division of Neurobiology, Lund University, Lund, Sweden. Thomas.Carlsson@mphy.lu.se
Dyskinesias are a major complication of long-term l-3,4-dihydroxyphenylalanine (L-DOPA) treatment in Parkinson's disease, and are believed to result from the intermittent and pulsatile supply of L-DOPA. Daily injections of L-DOPA can prime similar abnormal involuntary movements of the limb, orolingual and axial muscles in rats rendered parkinsonian by destruction of the nigrostriatal dopamine (DA) neurons. In this study we used 33 rats with severe nigrostriatal dopamine depletion and showed that in vivo gene transfer of the DA-synthetic enzymes tyrosine hydroxylase (TH) and GTP cyclohydrolase 1 (GCH1) using recombinant adeno-associated virus vectors can provide a constant source of DOPA production locally in the striatum, at a level that is effective in reducing L-DOPA-induced dyskinesias by >85%, and reverse lesion-induced motor impairments. Furthermore, the abnormal expression of DeltaFosB, prodynorphin and preproenkephalin mRNA within the striatal projection neurons normally seen in dyskinetic animals was completely reversed by TH-GCH1 gene transfer. These findings form a strong basis for replacing, or supplementing, conventional systemic L-DOPA therapy by continuous intrastriatal DOPA using in vivo gene transfer in the treatment of patients with advanced Parkinson's disease.
PMID: 15659429 [PubMed - indexed for MEDLINE]
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[Drug-induced liver injury; fourteenth updated edition of the bibliographic database of liver injuries and related drugs]
[Article in French]
Biour M, Ben Salem C, Chazouilleres O, Grange JD, Serfaty L, Poupon R.
Centre Regional de Pharmacovigilance, Hopital Saint-Antoine, Paris. michel.biour@chusa.jussieu.fr
Publication Types:
PMID: 15646539 [PubMed - indexed for MEDLINE]
Prospective, noncomparative open study from Kuwait of the role of intravenous immunoglobulin in the treatment of toxic epidermal necrolysis.
Al-Mutairi N, Arun J, Osama NE, Amr Z, Mazen AS, Ibtesam el-A, Nazeha el-B.
Farwaniya Hospital, Ministry of Health, State of Kuwait. nalmut@usa.net
BACKGROUND: High-dose intravenous immunoglobulin (IVIG) is emerging as a promising new therapy for treating the rare but potentially fatal drug reaction toxic epidermal necrolysis (TEN). Experimental in vitro studies support that IVIG can block the Fas-FasL-mediated apoptosis in TEN. METHODS: Twelve consecutive patients (7M, 5F) with TEN admitted over a 5-year period from January 1998 to December 2002 were treated with a dose of 0.5-1.0 g/kg/d of IVIG for 4-5 days along with standard care protocol. Clinical outcome in terms of average duration to arrest the progression, complete healing, hospital stay, side-effects and complications were determined to find the efficacy of IVIG treatment. RESULTS: Average age was 27.16 years (7-50 years). There were four children (2M, 2F) aged 7-12 years. One patient had an underlying malignancy. No patient had HIV infection. The average total body surface area involvement was 57.5% (30-90%). An IVIG infusion was started, on average, 1.58 days (1-3 days) after admission. All patients responded well to the treatment. There was no mortality. The disease progression was arrested in a mean of 2.83 days (1-5 days). Time taken for complete healing (re-epithelialization) was 7.33 days (5-13 days). The average duration of hospital stay was 12.5 days (7-21 days). No side-effects of the IVIG treatment were observed in these patients. The drugs triggering TEN in these patients were phenytoin (four patients), followed by penicillin (three), cotrimoxazole (two), phenobarbital and furosemide (one patient each), respectively. In one patient, the offending drug could not be ascertained. CONCLUSION: Our experience of treating 12 patients with TEN using IVIG, in Kuwait, confirms that it is a safe and effective treatment for these patients.
Publication Types:
PMID: 15533072 [PubMed - indexed for MEDLINE]
The serotonin syndrome.
Boyer EW, Shannon M.
Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts, Worcester, USA. edward.boyer@tch.harvard.edu
Publication Types:
PMID: 15784664 [PubMed - indexed for MEDLINE]
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