Delayed cyanide poisoning following acetonitrile ingestion.

Acetonitrile (methyl cyanide) is a common industrial organic solvent but is a rare cause of poisoning. We report the first recorded UK case. Acetonitrile is slowly converted to cyanide, resulting in delayed toxicity. We describe a case of deliberate self-poisoning by a 39-year-old woman resulting in cyanide poisoning 11 hours later which was successfully treated by repeated boluses of sodium nitrite and thiosulphate. The half-life of conversion of acetonitrile was 40 hours and harmful blood cyanide levels persisted for over 24 hours after ingestion. Departments treating or advising in cases of poisoning need to be aware of the delayed toxicity of acetonitrile. Monitoring in an intensive care unit of cases of acetonitrile poisoning should continue for 24-48 hours.     

Intracranial circulation: preliminary clinical results with three- dimensional (volume) MR angiography

The authors assessed the clinical utility of a magnetic resonance angiography technique in the evaluation of intracranial circulation. Eighteen patients with a low likelihood of cerebrovascular disease (control group) and 40 patients with suspected cerebrovascular disease were imaged with a FISP (fast imaging with steady precession) sequence (repetition time of 50 msec, echo time of 15 msec, velocity compensation in the read and section-select directions with acceleration compensation in the read direction, 15 degrees anisotropic volume, and a 1.25-mm partition thickness). Ninety-four percent of images in the control group and 72% of images in the group with cerebrovascular disease were considered useful for diagnosis. This technique can provide accurate images of intracranial circulation and can be performed in conjunction with two-dimensional spin-echo or gradient-echo imaging. It was most useful in the evaluation of patent intracranial aneurysms, vessel displacement, and large-vessel occlusive disease. Disadvantages included limited field of view, persistent signal voids, limited spatial resolution, and inadequate depiction of lesions with slow flow.     

An investigation of urolithiasis in two flocks of laying fowls

Urolithiasis and kidney disease as causes of significant mortality in fowls were investigated in two flocks of commercial laying birds on farms where outbreaks had occurred previously. The investigation, covering the first 10-11 months of egg production, included macroscopic and histological examination of individual cases of the disease, biochemical studies on blood samples collected at regular intervals from marked birds and the analysis of feed samples taken at the same time. The aetiology and pathogenesis of the condition was not established and the various investigations carried out did not reveal any consistent features. The possibility of an association between infectious bronchitis virus and the pathological entity described in the paper is discussed.     

DECISIONS ON RESUSCITATION STATUS OF THE ELDERLY

SUMMARY This study investigated whether consultants and junior staff in geriatric medicine would make similar decisions when presented with simulated patient case histories.