Acute verapamil poisoning. A proposal of a strategy for therapeutic management

Verapamil poisonings are rare, but are associated with a high proportion of deaths. The authors present a case of acute poisoning by verapamil associated with collapsus and a high degree of heart block. They propose a strategy for therapeutic management based on the study of calcium-channel blocker mechanisms of toxicity.     

ATRA and anthracycline-based chemotherapy in the treatment of childhood acute promyelocytic leukemia (APL): A 10-year experience in Tunisia

Reports on childhood APL from developing countries are scarce. We treated 65 APL with two consecutive trials combining ATRA and chemotherapy. Twenty (30.7%) were aged less than 20 years including 11 girls and 9 boys, with a median age of 12 years. Fever at presentation (P = 0.002) and variant APL (P = 0.044) were more frequent in children, while there were no significant difference between children and adults for WBC count, Sanz’s score distribution and additional cytogenetic abnormalities. The CR rate was 95% (19/20) in children and 80% (36/45) in adults (P = 0.13). Differentiation syndrome (DS) was less often observed in children (1/20) than in adults (13/45) (P = 0.031). Two children relapsed and died during salvage therapy, and 2 died in CR from infection and from cardiac failure attributed to anthracyclines, while other children remained alive in CR. With a median follow-up of 4 years, 4-year EFS was 75% in children and 71.1% in adults (P = 0.57), while 4-year OS was 75% in children vs. 73.3% in adults (P = 0.72). Our results suggest that, even in the absence of optimal socio-economic condition, ATRA combined with anthracycline-based chemotherapy gives adequate results in childhood APL, as in adults.     

Maladie de Waldmann. À propos de deux observations

Primary intestinal lymphangiectasia leads to a protein-losing enteropathy due to lymph leak into the intestinal tract. We report observations of two patients who presented oedema, hypoproteinemia and lymphopenia due to protein-losing enteropathy. Radiological, endoscopic and histological investigations revealed primary intestinal lymphangiectasia. Dietary treatment with middle chain triglycerides was partially effective. One patient developed tuberculous spondylodiscitis of the cervical discs and the other patient died.     

Effect of IGL-1, a new preservation solution, on kidney grafts (a pre-clinical study)

Ischemia-reperfusion injury conditions short-term and long-term graft function. The effects of the inversion of K⁺ and Na⁺ concentrations and substitution with polyethylene glycol for hydroxyethyl starch in University of Wisconsin (K-UW) solution were evaluated in isolated perfused rat kidneys and in autotransplanted pig kidneys. In the rat model kidneys were cold-stored for 24 h in K-UW or Na-UW or Na-PEG UW solutions (IGL-1 solution). Fractional sodium reabsorption and glomerular filtration rate was better in kidneys preserved in Na-UW and IGL-1 solution than those preserved in K-UW solution. In the pig model the left kidney was harvested and preserved in K-UW or IGL-1 solution for 24 h and then transplanted. In the autotransplanted pig model, kidneys preserved in IGL-1 solution showed a better function and a significant reduction of MHC class II expression, cellular apoptosis and interstitial fibrosis. In conclusion, kidneys preserved in IGL-1 solution tolerated ischemia/reperfusion injury better than those preserved in K-UW solution.     

Effectiveness of fixed 50% nitrous oxide oxygen mixture and EMLA cream for insertion of central venous catheters in children

BACKGROUND: Although the equimolecular mixture of oxygen and nitrous oxide (EMONO) seems a good choice to relieve procedure-related pain in children, it has not been evaluated for insertion of central venous catheters in children. To assess the safety and the effectiveness of this gas mixture for insertion of central venous catheters, we conducted a prospective observational study. PROCEDURE: This study was performed by the "Centre National de Greffe de Moelle Osseuse." Procedure and inhalation characteristics, as well as pain evaluations and side effects, were reported. RESULTS: Fifty central venous catheters were inserted in 50 consecutive children. Median age was 7 (range, 4-13) years. An anesthesiologist was responsible for delivering EMONO, and provided constant surveillance throughout the procedure. EMLA cream was applied 2 hr before EMONO inhalation. No associated drugs were used. All catheters were inserted by the same experienced physician in the operating theater. Median inhalation length was 5 min (range, 3-6) before starting catheter's insertion and 12 min (range, 9-25) for the total inhalation. Median procedural pain evaluations were 10 (range, 0-30) for children on a 0-100 visual analog scale (VAS). Minor side effects were observed during eight (16%) inhalations. These side effects were euphoria (14%), deep sedation (4%), nausea and vomiting (2%), hallucinations (2%). All side effects were transient and resolved within 5 min after removing the inhalation device. CONCLUSIONS: This study which shows that EMONO is effective for insertion of central venous catheters in children and represents a simple and safe alternative to general anesthesia.     

A preliminary report on the application of noscapine in the treatment of stroke

Background Stroke is the third leading cause of death in most developed countries. Therefore, a need exists for its treatment. Considering the role that is played by bradykinin in pathogenesis of neuronal injury, it has been suggested that bradykinin antagonists may be useful in the treatment of neurological patients. As noscapine can act as an antagonist of bradykinin and can effectively reduce brain injury after hypoxic-ischemic insult in neonatal rats, the present work was carried out to investigate its effectiveness in a clinical setting.Methods Noscapine was administrated orally to ten acute ischemic stroke patients, and the degree of brain injury was evaluated by computed tomography scan and clinical observation. The control group (n=10) did not receive noscapine treatment.Results Our study showed that noscapine effectively improved clinical prognosis and reduced the mortality rate down to 20% compared with 80% in the control group. Our patients did not show any specific side effects due to noscapine.Conclusion It is concluded that oral noscapine can be an effective drug for reducing the mortality rate in stroke; however, further study with a larger number of patients is needed to determine its full potential in stroke.     

Inhibition of glycosidases by Astragalus lusitanicus and correlation with toxicity

This study determined whether Astragalus lusitanicus inhibits glycosidase enzymes other than alpha-mannosidase. Plasma collected from lambs given fresh A lusitanicus inhibited beta-glucosidase and beta-galactosidase, indicating the presence of inhibitors in their blood. The residual activity of these enzymes was also modified in tissues of dead animals. beta-glucosidase activity was reduced in liver and kidney specimens with pronounced effects in tissues of animal that presented with prominent clinical signs of poisoning; beta-galactosidase activity was decreased by 88.5 to 95% in kidney, while that of liver remained unchanged. Fractions of the plant butanol extract inhibited the gycosidase enzymes. Chemical analysis revealed the presence of hypaphorin in the extract of A lusitanicus. As a tryptophan derivative, this alkaloid may play a role in the toxicity of this legume.     

Changes in Helicobacter pylori ultrastructure and antigens during conversion from the bacillary to the coccoid form.

In vitro, Helicobacter pylori converts from a bacillary to a full coccoid form via an intermediate U-shaped form. Organisms with a full coccoid form keep a double membrane system, a polar membrane, and invagination structures. Western blots (immunoblots) of sera from colonized patients show that some high-molecular-mass antigenic fractions are expressed only in coccoids. Conversely, fractions of 30 and 94 kDa were more intensively detected in the bacillary forms. These results suggest that (i) coccoid conversion is not a degenerative transformation and (ii) antigens specific to the coccoid forms are expressed in vivo.