血清线粒体型门冬氨酸转移酶在百草枯中毒大鼠的价值

目的通过检测SD大鼠血清线粒体型天门冬氨酸氨基转移酶(mAST)的浓度的变化及其余各项血气和生化指标的相关性,探讨百草枯(PQ)中毒损伤的机制及mAST在百草枯中毒早期评估多器官功能中的价值。方法将84只健康SD大鼠随机分为对照组和染毒组,灌胃后0 h、2 h、6 h、12 h、24 h、48 h及72 h分别收集动脉血做血气分析,检测大鼠mAST及其他生化指标的浓度变化。结果 mAST在PQ中毒2 h即明显升高,远远早于动脉血气及动脉血乳酸值,而与反映急性肝功能损伤的指标(AST、ALT、DBIL、TBIL)、反映肝纤维化指标(γGT)、反映肾功能损伤的指标(SRBP)及一些特异性不强的指标(CK,LDH)呈显著正相关。结论 mAST在大鼠中毒早期组织未出现缺氧时即有显著升高且与反映肝肾功能的多个生化指标正相关,提示线粒体损伤可能是百草枯中毒致多器官损伤的发病机制中独立于组织缺氧的一项重要因素,对早期评估百草枯中毒患者肝肾功能损伤程度有参考价值。     

重症手足口病心脏超声结果分析

目的:对重症手足口病患儿心脏超声结果进行分析,了解重症手足口病患儿心脏功能状况.方法:将212例重症手足口病患儿心脏彩超结果与80例正常组小儿心脏彩超结果进行对比分析.结果:与正常组比较,重症手足口病患儿心腔大小改变,心功能改变比较差异均有统计学意义(P<0.05或0.01).结论:重症手足口病患儿心脏彩超结果提示患儿心脏功能下降.     

原发性甲状腺机能亢进并重度甲状腺肿大的外科治疗

目的总结我院12年间收治32例原发性甲亢病（Graves’病）并重度甲状腺肿大的围手术期处理和手术经验。方法对在门诊控制甲亢治疗阶段、围手术期间的处理、手术方式和术后并发症等进行评价。结果本组无死亡病例,术后并发症发生率为23．8％,其中术后并发呼吸道梗阻和暂时性低血钙各2例,轻度甲低3例。结论重度肿大的Graves’病患者手术治疗具有疗效确切、技术要求高,有潜在的高并发症或高风险的特点。充分的术前准备和良好的麻醉以及手术者良好手术操作技巧,术后严密观察和并发症的及时处理,可降低或避免严重并发症的发生.     

传染性非典型肺炎17例临床分析

目的 分析四川地区传染性非典型肺炎(非典)的流行病学和临床特点。方法 对2003年2月以来四川省已临床诊断的非典患进行回顾性分析。结果 迄今四川省已临床诊断非典患17例，均为来自广东和北京疫区的输入性病例，发病年龄以青壮年为主，起病较急骤，88％(15／17)的患体温超过38℃，咳嗽较常见，部分有血丝痰，周围血白细胞计数减少或正常居多，X线片显示多叶多段病变特点，初期进展较快而后期恢复较慢。4例作血清学试验，2例阳性。1例尸检标本在电镜下检出冠状病毒颗粒和衣原体样颗粒，RT-PCR扩增出冠状病毒RNA聚合酶基因片段。死亡2例，已痊愈出院7例。结论 四川地区非典型肺炎均为输入性病例，临床表现与其他地区报道相似，但病情相对较轻，传染性较弱．未造成继发件感染。     

Diarrhetic Shellfish Poisoning,Washington, USA, 2011

Diarrhetic shellfish poisoning is a gastrointestinal illness caused by consumption of bivalves contaminated with dinophysistoxins. We report an illness cluster in the United States in which toxins were confirmed in shellfish from a commercial harvest area, leading to product recall. Ongoing surveillance is needed to prevent similar illness outbreaks.     

Zinc

The use of zinc in metal alloys and medicinal lotions dates back before the time of Christ. Currently, most of the commercial production of zinc involves the galvanizing of iron and the manufacture of brass. Some studies support the use of zinc gluconate lozenges to treat the common cold, but there are insufficient data at this time to recommend the routine use of these lozenges. Zinc is an essential co-factor in a variety of cellular processes including DNA synthesis, behavioral responses, reproduction, bone formation, growth, and wound healing. Zinc is a relatively common metal with an average concentration of 50 mg/kg soil and a range of 10–300 mg/kg soil. Meat, seafood, dairy products, nuts, legumes, and whole grains contain relatively high concentrations of zinc. The mobility of zinc in anaerobic environments is poor and therefore severe zinc contamination occurs primarily near points sources of zinc release. The recommended daily allowance for adults is 15 mg zinc. The ingestion of 1–2 g zinc sulfate produces emesis. Zinc compounds can produce irritation and corrosion of the gastrointestinal tract, along with acute renal tubular necrosis and interstitial nephritis. Inhalation of high concentrations of zinc chloride from smoke bombs detonated in closed spaces may cause chemical pneumonitis and adult respiratory distress syndrome. In the occupational setting inhalation of fumes from zinc oxide is the most common cause of metal fume fever (fatigue, chills, fever, myalgias, cough, dyspnea, leukocytosis, thirst, metallic taste, salivation). Zinc compounds are not suspected carcinogens. Treatment of zinc toxicity is supportive. Calcium disodium ethylenediaminetetraacetate (CaNa₂EDTA) is the chelator of choice based on case reports that demonstrate normalization of zinc concentrations, but there are few clinical data to confirm the efficacy of this agent.     

Position Statement and Practice Guidelines on the Use of Multi-Dose Activated Charcoal in the Treatment of Acute Poisoning

In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the Boards of the two societies.

The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based.

Although many studies in animals and volunteers have demonstrated that multiple-dose activated charcoal increases drug elimination significantly, this therapy has not yet been shown in a controlled study in poisoned patients to reduce morbidity and mortality. Further studies are required to establish its role and the optimal dosage regimen of charcoal to be administered.

Based on experimental and clinical studies, multiple-dose activated charcoal should be considered only if a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline. With all of these drugs there are data to confirm enhanced elimination, though no controlled studies have demonstrated clinical benefit.

Although volunteer studies have demonstrated that multiple-dose activated charcoal increases the elimination of amitriptyline, dextropropoxyphene, digitoxin, digoxin, disopyramide, nadolol, phenylbutazone, phenytoin, piroxicam, and sotalol, there are insufficient clinical data to support or exclude the use of this therapy.

The use of multiple-dose charcoal in salicylate poisoning is controversial. One animal study and 2 of 4 volunteer studies did not demonstrate increased salicylate clearance with multiple-dose charcoal therapy. Data in poisoned patients are insufficient presently to recommend the use of multiple-dose charcoal therapy for salicylate poisoning.

Multiple-dose activated charcoal did not increase the elimination of astemizole, chlorpropamide, doxepin, imipramine, meprobamate, methotrexate, phenyítoin, sodium valproate, tobramycin, and vancomycin in experimental and/or clinical studies.

Unless a patient has an intact or protected airway, the administration of multiple-dose activated charcoal is contraindicated. It should not be used in the presence of an intestinal obstruction. The need for concurrent administration of cathartics remains unproven and is not recommended. In particular, cathartics should not be administered to young children because of the propensity of laxatives to cause fluid and electrolyte imbalance.

In conclusion, based on experimental and clinical studies, multiple-dose activated charcoal should be considered only if a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline.

This Position Statement was drafted by JA Vale, EP Krenzelok, and GD Barceloux.     

Use of a lipid emulsion in a patient with refractory hypotension caused by glyphosate-surfactant herbicide

Context. Circulatory shock is a major cause of mortality in glyphosate-surfactant herbicide (GlySH) poisoning, and this condition responds poorly to conventional therapies. We report a case of GlySH poisoning with shock that was refractory to vasopressors but responsive to intravenous fat emulsion (IFE). Case details.?A 52-year-old man was brought to the emergency department by ambulance. He was found unconscious in his living room along with an empty bottle of GlySH herbicide, which contained glyphosate, polyoxyethyleneamine (POEA) surfactant, and water. He was drowsy at presentation. His heart rate was 44 beats/min, his blood pressure could not be measured with an arm cuff, but he had a palpable femoral pulse. After about 2.5 h of supportive care after admission, he remained hypotensive, and his systolic blood pressure was 80 mmHg. A 500 mL bottle of 20% IFE product was prepared. As a bolus, 100 mL of IFE was injected, and the remaining 400 mL was then infused. His blood pressure was 100/60 mmHg 1 h after the bolus injection. At 5 h after IFE injection, his blood pressure reached 160/100 mmHg and vasopressors were tapered. Conclusion.?IFE should be considered in cases of refractory hemodynamic instability caused by GlySH after aggressive fluid and vasopressor support.     

Cardiovascular Effects of Buccal Exposure to Dermal Nicotine Patches in the Dog: A Comparative Evaluation

Objective: Safety concerns have been raised over the possible effects of inappropriate exposure to transdermal nicotine patches. This study was initiated to determine whether placement of these products into the mouth could affect cardiovascular function. Methods: In a series of 10 anesthetized beagle dogs, Nicoderm®, Habitrol®, ProStep® I (Intact), ProStep® D (Damaged) transdermal nicotine products or the Skoal Bandit® smokeless tobacco plug were placed in the buccal cavity for 5 minutes. Systemic arterial blood pressure and the electrocardiogram were monitored for up to 90 minutes after exposure with blood samples at intervals during the first 10 minutes for plasma nicotine concentration. Results: The systolic and diastolic arterial blood pressures and heart rate increased within 2 minutes of buccal exposure to either the intact or the damaged ProStep nicotine product. Ventricular arrhythmias were observed in 6 of 10 dogs exposed to the intact patch and 7 of 10 dogs exposed to the damaged patch during the period of maximal cardiovascular response. Modest increases in systemic blood pressure and heart rate were seen with the Nicoderm and Habitrol products but not with the Skoal Bandit. The increases in systemic arterial pressure and heart rate occurring after exposure to ProStep were significantly more severe than those observed after Nicoderm and Habitrol. Mean peak nicotine levels of 9.8 μg/mL (ProStep I), 5.4 μg/mL (ProStep D), 3.4 μg/mL(Habitrol), 2.5 μg/mL (Nicoderm), and 0.12 μg/mL (Skoal Bandit) were detected within 2 to 10 minutes after buccal placement of the product. Conclusions: Certain transdermal nicotine patches, when applied to a nondermal site such as the buccal cavity for a short period (5 minutes) can rapidly provoke significant cardiovascular alterations (hypertension, tachycardia, and ventricular arrhythmias). The magnitude of the cardiovascular responses occurring after buccal exposure to a product such as ProStep could pose a risk to susceptible individuals.     

Two cases of acute poisoning with acetamiprid in humans

Introduction. Acetamiprid is a potent and a relatively new neonicotinoid insecticide. Animal studies have indicated that it has a low toxicity to mammals. Despite wide usage, human exposure resulting in toxicity is quite limited, and this is the first report in the English literature about acute acetamiprid poisoning in humans. Case Details. We herein describe two cases of acute poisoning with an insecticide formulation containing acetamiprid for suicidal purposes. Both cases experienced severe nausea and vomiting, muscle weakness, hypothermia, convulsions, and clinical manifestations including tachycardia, hypotension, electrocardiogram changes, hypoxia, and thirst in the case with the higher serum concentration of acetamiprid. The symptoms were partially similar to acute organophosphate intoxication. Supportive treatments for a variety of symptoms were sufficient for recovery, and both individuals were discharged without any complications 2 days after ingestion.