Pyrogenic reactions and hemorrhage associated with intrinsic exposure to endotoxin-contaminated intravenous solutions.

OBJECTIVE: An epidemiological investigation was conducted to determine risk factors for adverse reactions among patients in hospitals and the possibility of extrinsic or intrinsic contamination of intravenous solutions. DESIGN: A retrospective cohort study was conducted to identify solutions associated with adverse reactions. Implicated lots were cultured for bacteria, and endotoxin concentrations were measured. SETTING: Five hospitals in the state of Pernambuco, Brazil, were investigated from February through March 2002. PATIENTS: Surgical inpatients or outpatients receiving intravenous solutions during the study period. RESULTS: Of 355 surgical patients or outpatients treated at hospitals, 28 (8%) developed illness within a mean of 2.5 hours after exposure to intravenous solutions implicated in adverse reactions; 5 (17.9%) of the case patients died. Laboratory testing of bottles from the lots of Ringer's lactate solution implicated in deaths demonstrated a high mean endotoxin concentration of 88.3 endotoxin units (EU)/mL (range, 9.7-298.0 EU/mL), compared with the permitted limit in Brazil of <0.5 EU/mL. Testing of metronidazole implicated in adverse reactions at another hospital and produced by the same company that manufactured the lots Ringer's lactate solution also showed high endotoxin concentrations (mean level, 8.3 EU/mL [range, 5.0-58.3 EU/mL]). The outbreak was controlled after a national recall of the implicated brand of intravenous solutions. CONCLUSIONS: Case patient status was associated with use of Ringer's lactate solution and metronidazole from large bottles, both of which were produced by the same company. High endotoxin concentrations were demonstrated in unopened bottles of implicated products, which is consistent with intrinsic contamination. The high mortality rate may have been compounded by the fact that clinicians administered additional volumes of contaminated 0.9% isotonic sodium chloride solution in response to hypotension or bleeding to some surgical patients. No additional case patients were identified after a national recall of products, inspection, closure of the implicated company's manufacturing facility, and establishment of random quality-control testing of intravenous solutions.     

Frequency and gravity of human envenomations caused by marine catfish (suborder siluroidei): a clinical and epidemiological study

INTRODUCTION AND OBJECTIVES: Catfish occur in marine and freshwater environments worldwide. They have three serrated venomous bony stings in the dorsal and pectoral fins that are used for defence against predators and are refilled by glandular tissues under the epithelium. However, some catfishes do not have poisonous glands next to the sting and cause traumatic wounds without poisoning. The objective of this study was to provide data for, and comment on, the epidemiological and clinical problems caused by marine catfish. PATIENTS AND METHODS: The authors have observed, followed and documented 127 injuries caused by marine catfish stings during different phases of the envenoming over a time period of 8 years at three points along the Western Atlantic Ocean coast. RESULTS: The patients presented intense pain during the acute phase of envenoming and complications, such as bacterial and fungi infections and retention of bony fragments, in the later phase. Immersion of the affected extremity in hot water was used in about 20% of cases with excellent results. DISCUSSION: Injuries caused by marine catfish are common (about 20% of injuries caused by marine animals in a series of more than 700 injuries recorded by the author) and cause intense pain and later complications. Immersion of the affected extremity in hot water results in improvement in the acute phase, but does not prevent the appearance of secondary infection or foreign body reactions.     

Purification and biological effects of C-type lectin isolated from Bothrops insularis venom

Bothrops insularis is a snake from Queimada Grande Island, which is an island located about 20 miles away from the southeastern coast of Brazil. Compared to other Brazilian species of Bothrops, the toxinology of B. insularis is still poorly understood. Its C-type lectin is involved in several biological processes including anticoagulant and platelet-modulating activities. We purified the C-type lectin (BiLec) from Bothrops insularis venom and investigated its effect in the isolated kidney. BiLec was purified after two chromatographic steps; firstly, the whole venom was submitted to an HPLC molecular exclusion chromatography followed by a second purification through affinity chromatography. B. insularis lectin (BiLec) was studied as to its effect on the renal function of isolated perfused rat kidneys with the use of six Wistar rats. The concentration of 10 μg/mL increased perfusion pressure (PP; control₆₀=108.27±4.9; BiLec₆₀=112.9±5.4 mmHg; *p<0.05) and renal vascular resistance (RVR; control₆₀=5.38±0.51; BiLec₆₀=6.01±0.57 mmHg; *p<0.05). The urinary flow reduced significantly at 90 and 120 min of perfusion (UF; control₁₂₀=0.160±0.020; BiLec₁₂₀=0.082±0.008 mL g⁻¹ min⁻¹; *p<0.05). Glomerular filtration rate (GFR; control₁₂₀=0.697±0.084; BiLec₁₂₀=0.394±0.063 mL g⁻¹ min⁻¹; *p<0.05) diminished only at 120 min. BiLec did not change the percentage of sodium (TNa⁺), potassium (TK⁺) and chloride tubular transport (TCl⁻). The histological alterations probably reflected direct injury on glomerular and tubular renal cells, as demonstrated by the rise in permeability of glomerular endothelial cells, revealed by the presence of a proteinaceous material in the Bowman space. We postulate that the C-type lectin B. insularis promoted its effects probably through interactions with endothelial cells or through the release of other mediators by tubular, mesangial and endothelial cells.     

未发现维生素A缺乏导致一美国男孩失明

维生素A缺乏在发展中国家是一个极大的问题，联合国儿童基金会（UNICEF）和其他组织每年两次给那些地方提供超过40亿片的大剂量维生素A。在发达国家很少发现维生素A缺乏。曾有在食物趋附时尚的人和精神患者由于维生素缺乏引起眼干燥症的报道。然而，在发达国家大多数病例归咎于酒精中毒和引起的营养吸收障碍的情况。由于富裕社会有较好的营养标准，致使伴有眼部并发症的维生素A缺乏症罕见，这种缺乏症的早期诊断可能被忽视。我们报道1例居住在纽约市（New York，NY）的6岁亚裔男孩因维生素A缺乏引起双侧角膜软化症，导致双侧不可挽回的失明。     

Autologous rectal mucosal grafts on the conjunctiva of healthy rabbits

We evaluated the feasibility and viability of 10×5 mm autologous rectal mucosal grafts on the superior bulbar conjuctival surface of 25 albino rabbits. After enucleation, histopathological studies revealed a mean goblet cell count of 190 cells per ×400 field and squamous cell metaplasia did not exceed 20%. Rectal mucosa transplantation into the conjuctiva of healthy rabbit’s eyes is possible. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

生存质量测定及其在眼科学中的应用

生存质量测定作为一种较全面的体现新的健康观念和医学模式的评价体系已在医学领域得到了广泛的应用，并已经引入了眼科领域，是传统视功能评价方法的有益补充。对生存质量的基本概念、生存质量测定的方法和常用生存质量测定量表以及生存质量在眼科学中的应用、研究进展和前景等方面进行了介绍和综述。     

Saphenous vein graft bypass from the external carotid artery to the supraclinoid internal carotid artery to treat a giant aneurysm of the cavernous internal carotid: case report

Alternative surgical procedures to treat unclippable aneurysms of the intracavernous carotid artery include proximal vessel occlusion and trapping. Those techniques, even in patients with rich collateral vessels, are associated with risk of hemodynamic compromise and ischemic complications. Therefore, a safe treatment requires revascularization to maintain blood flow to the involved territories. We report the case of a 47-year-old female, with ischemic signs and symptoms and a right third nerve palsy caused by a giant aneurysm, partially trombosed, of the intracavernous carotid artery. The patient was submitted to trapping after a saphenous vein graft bypass from the external carotid artery to the supraclinoid internal carotid artery. The surgical result was good without complications.     

Rathke's pouch cysts: diagnosis and treatment

We studied retrospectively a series of four patients with Rathke pouch cysts and pointed out to their clinical presentation and treatment. They all occurred with female patients. Predominant symptoms were amenorrhea, headache and visual disorders. We present a revision of the literature concerning various series of Rathke's pouch cysts. We conclude that surgery is the best therapeutical procedure and transsphenoidal approach is the best surgical technique.