Orthostatic hypotension in ciguatera fish poisoning.

PURPOSE--The purpose of this study was to investigate the pathophysiology of persistent orthostatic hypotension in a patient with ciguatera fish poisoning. METHODS--A patient who became ill and who developed prolonged and symptomatic orthostatic hypotension with ciguatera fish poisoning after eating barracuda is described. Studies of autonomic function included measurements of plasma catecholamine levels in the supine and standing positions, and pressor responses to infusions of norepinephrine, atropine, and propranolol. RESULTS--Volume depletion was excluded as a cause for hypotension. Our patient showed low plasma catecholamine levels and marked pressor hypersensitivity to norepinephrine infusion. Hypotension and bradycardia were reversed by atropine infusion. The heart rate freed from autonomic influences, ie, after atropine plus propranolol infusion, was normal. CONCLUSIONS--In ciguatera fish poisoning, orthostatic hypotension appears to be a result of both parasympathetic excess and sympathetic failure.     

Diarrhea in ciguatera fish poisoning: preliminary evaluation of pathophysiological mechanisms

Ciguatera fish poisoning is a clinical syndrome consisting of a combination of gastrointestinal and neurological symptoms occurring after eating toxin-containing tropical reef fish; it is a major cause of morbidity in Hawaii, the South Pacific, Australia, and the Caribbean. In an effort to define pathophysiological mechanisms responsible for the diarrheal component of the illness, we examined the effect of crude and fractionated toxin preparations on isolated rabbit ileal tissue in a Ussing chamber model. Both the crude toxin preparation (prepared from toxic Ctenochaetus strigosus) and 10% and 50% methanol-chloroform toxin fraction (prepared from a pool of toxic fish samples) gave a striking increase in transepithelial electrical potential difference and short-circuit current. Enterotoxic activity seemed to be mediated by calcium. When examined by light microscopy, the intestinal mucosa was not damaged by the toxin preparations used. Our data demonstrate that toxins involved in ciguatera fish poisoning directly stimulate intestinal fluid secretion without accompanying tissue damage and suggest that calcium is the "second messenger" mediating the process.     

Puffer fish (Tetrodotoxin) poisoning: an analysis and outcome of six cases

On 24 July 2005, six members of a single family were admitted to the Medicine and Pediatrics Department of Khulna Medical College Hospital, Khulna, Bangladesh, with a history of ingestion of puffer fish. All patients developed toxic manifestations. The cases were clinically analysed with successful outcomes.     

Two patients with ciguatera toxicity: a seafood poisoning in travellers to (sub) tropical areas

Ciguatera toxicity is a type of seafood poisoning caused by the consumption of ciguatoxic reef fish. We describe two patients with characteristic gastrointestinal and neurological symptoms, both of whom had eaten local seafood. Although mortality is low, morbidity can be considerable due to debilitating symptoms. Most cases originate in the (sub)tropics but due to expanding tourism and fish exportation, it may be encountered in more temperate regions. Treatment is supportive, but some benefit from intravenous mannitol has been reported.     

腹腔镜胆总管十二指肠吻合术84例疗效观察

目的评估腹腔镜胆总管十二指肠吻合术（LCD）在治疗晚期恶性梗阻性黄疸中的临床疗效,总结手术技术经验。方法回顾分析自2011年1月至2012年10月完成LCD的84例患者,总结围手术期临床资料,观察指标包括手术时间、术中出血量、术后住院时间、术后排气时间、术后肝功能恢复情况、术后生存期、住院费用、术后并发症。结果成功实施LCD 83例,中转1例,二次手术8例,平均手术时间（103±43）min,术中平均失血量（20±17）ml,术后平均住院时间（9.0±2.1）d,术后肝功能自（3.4±1.6）d开始明显恢复。术后平均排气时间（2.5±1.2）d,住院平均费用为（28359±4523）元。术后随访2～22个月,术后并发症少。结论 LCD具有明显的快速降黄的临床效果,且与传统的胰腺十二指肠切除术相比,患者住院费用明显降低,手术风险小,保证患者快速康复,随访临床效果良好。     

Clinical observations on the antihypertensive response to mebutamate (Capla) in geriatric patients

Nineteen geriatric patients with sustained, mild to moderate hypertension in addition to cerebrovascular disease were studied for 4 months by means of a double-blind crossover technique in which mebutamate was compared to an inert placebo.No significant antihypertensive effect was observed in the 19 geriatric patients treated with mebutamate (Capla). Over 40 per cent of the patients complained of drowsiness while receiving the drug.There was no evidence of renal or hepatic impairment during the period of observation.