血液灌流临床应用综述

血液灌流是指经患者血液引出并净化的过程,最初只是用于治疗急性中毒患者,目前仍然是其最主要的应用。但随着医学的不断发展创新,发现血液灌流在治疗其他一些病症的方面也起到了明显的作用。如今此技术被逐渐用于治疗尿毒症、危重症、红斑狼疮、重型肝炎等患者的紧急救治中。     

Position paper update: gastric lavage for gastrointestinal decontamination

Context. The first update of the 1997 gastric lavage position paper was published by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists in 2004. This second update summarizes the 2004 content and reviews new data. Methods. A systematic review of the literature from January 2003 to March 2011 yielded few studies directly addressing the utility of gastric lavage in the treatment of poisoned patients. Results. Sixty-nine new papers were reviewed. Recent publications continue to show that gastric lavage may be associated with serious complications. A few clinical studies have recently been published showing beneficial outcomes, however, all have significant methodological flaws. Conclusions. At present there is no evidence showing that gastric lavage should be used routinely in the management of poisonings. Further, the evidence supporting gastric lavage as a beneficial treatment in special situations is weak, as is the evidence to exclude benefit in all cases. Gastric lavage should not be performed routinely, if at all, for the treatment of poisoned patients. In the rare instances in which gastric lavage is indicated, it should only be performed by individuals with proper training and expertise.     

Epidemic of poisoning caused by scopolamine disguised as Rohypnol™ tablets

Objective. An epidemic of scopolamine poisonings occurred in Oslo in 2008 among users of illicit drugs, caused by fake Rohypnol? pills. The clinical features, diagnostic process, and handling of the epidemic are presented. Methods. Suspected cases of scopolamine poisoning were extracted by reviewing registration forms from an ongoing prospective clinical study of acute poisonings in Oslo. Medical records of extracted contacts were examined and cases included according to specified clinical criteria. Results. Forty-four cases of probable scopolamine poisoning were registered. Main clinical features were mydriasis, visual hallucinations, plucking behavior, agitation, and coma. No clinical diagnosis of anticholinergic syndrome was made prior to forensic analysis of the tablets, the most frequent diagnosis up to this point being unspecified drug-induced psychosis. Later in the epidemic, scopolamine poisoning became the dominating diagnosis. Ten patients were admitted to psychiatric hospitals, the rest recovered in medical units, or left health care against medical advice. Discussion. Scopolamine poisonings are rare, but the resulting anticholinergic syndrome is well described. The syndrome was not recognized until the forensic analysis result strikingly changed how the patients were diagnosed and handled. A unique aspect of this epidemic was the intoxicating agent being scopolamine-containing tablets looking like Rohypnol?, sold and used under the impression of being the latter. Conclusion. Recognizing the anticholinergic syndrome is important to provide proper treatment. Forensic analysis was the key to correct diagnosis in this outbreak, demonstrating its importance in verifying an epidemic of poisoning by fake drugs.     

Self-poisonings with drugs by adolescents in the Lund catchment area

Our objective was to investigate which drugs young people who attempt suicide use in the Lund catchment area eight municipalities in Skåne, southern Sweden. All patients aged up to 18 years admitted to Lund University Hospital after deliberate or probably deliberate self-poisoning from 1 January 1991 until 31 December 1995 were included. Forty-nine (58%) had used a single drug; 20 (24%) had used 3 or more drugs. Fifty-two (61%) used analgesics paracetamol was used by 38 (45%) and propoxyphene by 17 (20%). Thirty-one (36%) had ingested psychotropics 13 used benzodiazepines, 10 antidepressants, and 8 antipsychotics. Eleven (15%) had used drugs in combination with alcohol. We conclude that it is important to follow changes in self-poisoning patterns, to monitor the effects of preventive work and discover new trends in drug use.     

Ingestion of a newly described North American mushroom species from Michigan resulting in chronic renal failure: Cortinarius orellanosus

Background. Some mushrooms in the genus Cortinarius are well known to cause acute and chronic renal failure. Until now, there have been no confirmed cases of renal failure due to the ingestion of a Cortinarius mushroom in North America. We describe a case of a woman who ingested mushrooms found under an oak tree in western Michigan and developed chronic renal failure. Methods. Phylogenetic analysis of the internal transcribed spacer (ITS) regions of nuclear-encoded ribosomal RNA was performed between an unconsumed sample of the Michigan specimens, a control sample of Cortinarius orellanus (JFA9859) from Europe, and other closely related ITS sequences of Cortinarius retrieved from GenBank. An additional gene region, rpb2, was also sequenced for comparison. Results. Phylogenetic analysis revealed the Michigan material to be closely related to, but distinct from, other ITS sequences of the Orellani clade in Cortinarius. Divergence is less at the rpb2 locus. No historical taxa from North America are known to match the identification of the Michigan material. Conclusion. The mushrooms ingested by the patient were confirmed to be a new species of Cortinarius closely related to C. orellanus. We introduce a newly described North American species, Cortinarius orellanosus, capable of causing renal failure after ingestion.     

麻果中毒40例临床分析

目的:观察麻果中毒的临床表现,治疗效果和预后。方法:对2009年9月—2010年5月期间因麻果中毒而来我科就诊的40例患者的临床资料进行回顾性分析。结果:吸毒者年龄15～45岁,主要集中在20～35岁;男性28例,占70%,女性12例,占30%。吸毒方式为鼻吸和口服;中毒表现,以神经系统症状、心脏损害及消化道症状为主;治愈31例,无明显改善者9例,治愈率77.5%。结论:麻果中毒者以青年男性居多,临床表现以神经系统,心血管系统损害及消化道症状为主;治疗以祛除毒源、综合对症治疗为主,纳洛酮治疗有效。     

Evaluation of cosmetic product exposures reported to the Milan Poison Control Centre,Italy from 2005 to 2010

Introduction. To the average consumer, “cosmetics” are not considered to cause damage to human health under normal conditions of use. Thus, cosmetic “safety” does not require any particular attention to the possibility that cosmetics may result in a toxic exposure, especially for children. Poison Control Centres (PCCs) provide specialized and rapid information for consumers and health professionals to ensure management of events related to the exposures to different agents, including Cosmetics. Poison Control Centres also represent a unique source of information to investigate the frequency and type of exposures to cosmetic and the related risks. Objective. An analysis of cases concerning human exposures to cosmetics collected from 2005 to 2010 by the PCC at the Ospedale Niguarda Ca’ Granda (Milan, Italy) was performed. Results. During this period, 11 322 human exposure cases related to cosmetics were collected accounting for 4.5% of the total human clinical cases. Almost, all the requests for assistance came from consumers (53%) and hospitals (40%). The most frequently reported site of exposure was the consumer's own residence (94%). The exposures mainly involved children younger than 4 years (77%). No difference in gender distribution was observed (female 49%, male 51%). Almost, all of the exposures were unintentional (94%). Intentional exposures, mainly related to suicide attempts and accounted for 6% of cases involving persons aged more than 12 years. Personal hygiene products (30%), perfumes and hair care products (excluding hair dyes) (both 13%) were the most frequently involved categories. Symptoms were present only in 26% of the exposures and were mostly gastrointestinal (46%). Most of the cases were managed at home (43%) whereas hospital intervention was required in 38%. Conclusion. Since the exposure frequency seems more likely to reflect product availability and accessibility to ingestors, our results call for closer attention to this type of hazard, especially for children younger than 4 years of age.     

Preserving the United States’s Poison Control System

The funding of United States’s poison control centers is threatened. The following Commentary argues for support of the current outstanding poison control system by presenting the evidence for its cost-effectiveness.     

酚类灼伤所致中毒的临床研究

目的：探索酚类灼伤所致酶中毒的影响因素及酚中毒的临床特点，方法：收集并筛选本院近25年酚类灼伤的病例，重点对灼面积、部位、尿液颜色、尿酚含量与酚中毒的关系进行统计学分析。结果：酚中毒及各脏器损害的发生率的尿酚异常率，随灼伤面积增大而增高（P＜0．05－0．01），且在面颈部灼伤者中发生率显著增高（P＜0．05）。酚中毒的临床特点为肾脏是靶器官，中枢神经系统，溶血及心脏损害发生率高，且均为早期表现，肝脏的急性影响相对较少。结论：导致酚中毒的影响因素主要是灼伤面积，部位及创面的早期处理，酚类灼伤可导致多脏器功能障碍综合征，发生时间大多在24－48h内。     

雪卡毒素中毒的诊断与检测

目的:探讨雪卡毒素中毒的诊断与检测方法,为临床及时治疗提供依据。方法:对一起苏眉鱼中毒的26例患者进行临床资料分析并用进口试剂盒检测其标本。结果:26人中除1人雪卡毒素阴性外,外其余25人均检出阳性。阳性率为96.15%。WBC<10.0×109/L有19例占73.08%,10.0×109/L15.0×109/L有2例,血清K <3.5mmol/L有3例,26例尿常规、肝肾功能、心肌酶谱及血胆碱酯酶均正常,大便培养示发现霍乱弧菌、志贺菌及沙门氏菌。结论:雪卡毒素检测具有高特异性,可尽早诊断及时治疗,最大程度上减少对患者的危害性。