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Prolonged gastric emptying half-time and gastric hypomotility after drug overdose.
Adams BK, Mann MD, Aboo A, Isaacs S, Evans A.
Department of Nuclear Medicine, Groote Schuur Hospital, Cape Town, South Africa. bruceka@emirates.net.ae
A prospective study was undertaken to determine if gastric motility and emptying are altered by the ingestion of overdoses of tricyclic antidepressants, acetaminophen, opioid-acetaminophen mixtures, carbamazepine or phenytoin. Gastric scintigraphy was used to measure gastric emptying half-time and assess gastric motility in 104 patients at initial presentation and again at follow-up (n = 85). Patients were imaged for 5 hours after being given 20 MBq of 99mTc tin colloid to drink. Drug serum levels were measured on all patients at initial presentation and at follow-up. We observed markedly prolonged gastric emptying half-times and severe hypomotility at initial presentation compared with follow-up in the vast majority of patients, except for a small group of patients with phenytoin poisoning. Twelve patients had gastric emptying half-times of over 300 minutes, a further 14 had half-times of over 200 minutes and 21 others had half-times of over 120 minutes. Poisoning is associated with hypomotility and a marked delay in gastric emptying that could influence the clinical course and patient management. These abnormalities may not be due to a direct effect of the ingested drug and factors such as stress may play a role.
PMID: 15666259 [PubMed - in process]
Comment on:
Catatonia in psychiatric classification.
Van Den Eede F, Sabbe B.
Publication Types:
PMID: 15569914 [PubMed - indexed for MEDLINE]
Prolonged coagulopathy related to superwarfarin overdose.
Sarin S, Mukhtar H, Mirza MA.
Publication Types:
PMID: 15657170 [PubMed - indexed for MEDLINE]
[Honey bees massive poisoning in an infant.]
[Article in French]
Kouame EK, Brouh Y, Boua N.
Service d'anesthesie-reanimation, CHU de Bouake, Bouake, Republique de Cote-d'Ivoire. kkedmond2002@yahoo.fr
The authors report the case of an infant who survived a massive poisoning of honey bees (>350 bees stings) in 2002. The infant presented convulsions, anaemia, renal failure and haematuria. The main treatment consisted in administration of adrenaline. Systematic and early administration of this drug has limited the severe clinical picture despite massive attack.
Publication Types:
PMID: 15519831 [PubMed - indexed for MEDLINE]
Levodopa-induced changes in synaptic dopamine levels increase with progression of Parkinson's disease: implications for dyskinesias.
de la Fuente-Fernandez R, Sossi V, Huang Z, Furtado S, Lu JQ, Calne DB, Ruth TJ, Stoessl AJ.
Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, BC, Canada.
Peak-dose dyskinesias are abnormal movements that usually occur 1 h after oral administration of levodopa, and often complicate chronic treatment of Parkinson's disease. We investigated by PET with [11C]raclopride whether Parkinson's disease progression modifies the striatal changes in synaptic dopamine levels induced by levodopa administration, and whether this modification, if present, could have an impact on the emergence of dyskinesias. We found that, 1 h after oral administration of standard-release 250/25 mg of levodopa/carbidopa, levodopa-induced increases in synaptic dopamine levels (as estimated by striatal changes in [11C]raclopride binding potential) correlated positively with duration of Parkinson's disease symptoms (for the caudate nucleus, r = 0.79, P < 0.001; for the putamen, r = 0.88, P < 0.0001). Patients with peak-dose dyskinesias had larger 1-h increases in synaptic dopamine levels than stable responders, but there were no between-group differences in [11C]raclopride binding 4 h post-levodopa. The corresponding (time x group) interaction term in the repeated measures analysis of covariance was significant, even after adjusting for between-group differences in duration of Parkinson's disease symptoms (for the caudate nucleus, P = 0.030; for the putamen, P = 0.021). Our results indicate that, at the synaptic level, an identical dose of levodopa induces increasingly larger 1-h changes in dopamine levels as Parkinson's disease progresses. Large levodopa-induced increases in synaptic dopamine concentration can lead to dramatic changes in receptor occupancy, which may be responsible for the emergence of peak-dose dyskinesias in Parkinson's disease.
PMID: 15329355 [PubMed - indexed for MEDLINE]
The impact of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) on skin disease in KwaZulu-Natal, South Africa.
Mosam A, Irusen EM, Kagoro H, Aboobaker J, Dlova N.
Publication Types:
PMID: 15485544 [PubMed - indexed for MEDLINE]
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Pseudoporphyria as a result of voriconazole use: a case report.
Dolan CK, Hall MA, Blazes DL, Norwood CW.
United States Naval Reserve, Patuxent River Naval Medical Clinic, Patuxent River, MD, USA.
Voriconazole, a second-generation triazole, has recently been approved by the Food and Drug Administration (FDA) to treat invasive aspergillosis and refractory infections with Scedosporium apiospermum or Fusarium spp. The reported side-effects of voriconazole include visual changes, headaches, elevated hepatic enzymes, Steven-Johnson syndrome, toxic epidermal necrolysis, chelitis, photosensitivity, discoid lupus erythematosus and anaphylactoid infusion reactions. Pseudoporphyria was first described in association with nalidixic acid. It has the same clinical and histologic features as porphyria cutanea tarda (PCT) but is distinguished by normal porphyrin levels in the serum, urine and stool. We present the case of a patient who developed pseudoporphyria after receiving treatment with voriconazole.
Publication Types:
PMID: 15485539 [PubMed - indexed for MEDLINE]
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Insect bite-like reaction associated with mantle cell lymphoma: a report of two cases and review of the literature.
Dodiuk-Gad RP, Dann EJ, Bergman R.
Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
BACKGROUND: An insect bite-like reaction and exaggerated reactions to insect bites are nonspecific phenomena described primarily in association with chronic lymphocytic leukemia (CLL), but also with other hematological malignancies. Two cases of mantle cell lymphoma (MCL), one associated with an insect bite-like reaction and the other with a true hypersensitivity to mosquito bites, have previously been reported in the English language literature. The pathogenesis of the skin eruption may be related to the release of different cytokines that also trigger an IgE elevation and dermal eosinophils. CASE REPORT: We describe two additional cases of MCL associated with an insect bite-like reaction. One patient had been diagnosed with MCL 4.5 years prior to the appearance of the skin eruption, and in the other patient the skin symptoms preceded the diagnosis of the MCL by 2 years and led to its diagnosis. CONCLUSIONS: Insect bite-like reaction may appear in patients with MCL. It is important to recognize this entity because it may be the presenting sign of MCL.
Publication Types:
- Case Reports
- Review
- Review of Reported Cases
PMID: 15485536 [PubMed - indexed for MEDLINE]
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Position paper: gastric lavage.
Vale JA, Kulig K; American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists.
Gastric lavage should not be employed routinely, if ever, in the management of poisoned patients. In experimental studies, the amount of marker removed by gastric lavage was highly variable and diminished with time. The results of clinical outcome studies in overdose patients are weighed heavily on the side of showing a lack of beneficial effect. Serious risks of the procedure include hypoxia, dysrhythmias, laryngospasm, perforation of the GI tract or pharynx, fluid and electrolyte abnormalities, and aspiration pneumonitis. Contraindications include loss of protective airway reflexes (unless the patient is first intubated tracheally), ingestion of a strong acid or alkali, ingestion of a hydrocarbon with a high aspiration potential, or risk of GI hemorrhage due to an underlying medical or surgical condition. A review of the 1997 Gastric Lavage Position Statement revealed no new evidence that would require a revision of the conclusions of the Statement.
Publication Types:
PMID: 15641639 [PubMed - indexed for MEDLINE]
Increase in poisoning deaths caused by non-illicit drugs--Utah, 1991-2003.
Centers for Disease Control and Prevention (CDC).
Deaths caused by drug poisoning of unintentional and undetermined intent are an increasing problem in Utah and elsewhere in the United States. To characterize the trend in drug-poisoning deaths in Utah, CDC and the Utah Department of Health analyzed medical examiner (ME) data for 1991-1998 and 1999-2003. This report summarizes the results of that analysis, which determined that, during 1991-2003, the number of Utah residents dying from all drug poisoning increased nearly fivefold, from 79 deaths in 1991 (rate: 4.4 per 100,000 population) to 391 deaths in 2003 (rate: 16.6). This increase has been largely the result of the tripling of the rate (from 1.5 during 1991-1998 to 4.4 during 1999-2003) in poisoning deaths of unintentional or undetermined intent caused by non-illicit drugs (i.e., medications that can be legally prescribed). Further study is needed to understand these trends and to develop strategies to prevent deaths of unintentional or undetermined intent from non-illicit drug poisoning.
PMID: 15660016 [PubMed - indexed for MEDLINE]
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