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Ann Emerg Med 2002 Dec;40(6):619-24
Department of Emergency Medicine, Loma Linda University School of Medicine, Medical Center and Children's Hospital, Loma Linda, CA, USA. famensean@aol.com
STUDY OBJECTIVE: Southern Pacific rattlesnake (Crotalus helleri ) venom is not 1 of the 4 venoms used to produce Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV). There is currently no published clinical experience regarding the efficacy of this new antivenom for confirmed C helleri envenomation, and animal data suggest greatly diminished efficacy. We assessed the efficacy of FabAV for patients with confirmed C helleri envenomation. METHODS: We conducted a prospective observational study of 23 consecutive rattlesnake envenomations that were treated with FabAV at our center. Patients were excluded if the species of snake could not be confirmed, if FabAV antivenom was not given, or if Antivenin (Crotalidae) polyvalent (equine) was given. We collected serial physical examination and laboratory data over a 24-hour period to serially evaluate the severity score and performed follow-up to evaluate delayed reactions. RESULTS: There were 15 patients who received FabAV and had the species of rattlesnake confirmed (9 C helleri, 4 C scutulatus scutulatus, 1 C mitchellii pyrrhus, 1 C ruber ruber ). C helleri envenomations demonstrated similar improvement in serial snakebite severity scores to those of other species. Three patients treated with scheduled dosing had recurrence of progressive swelling (2 C helleri and 1 C mitchellii pyrrhus ) during the 24-hour study period. CONCLUSION: We observed similar improvement in FabAV-treated patients with C helleri envenomation compared with those of other species and conclude that this treatment in standard doses appears efficacious for bites by this species. Progressive swelling may recur despite scheduled dosing.
PMID: 12447339, UI: 22334686
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Ann Emerg Med 2002 Dec;40(6):611-8
Department of Anesthesia, University Health Network, University of Toronto, Toronto, Ontario, Canada.
STUDY OBJECTIVE: We determine whether maintaining normocapnia during hyperoxic treatment of carbon monoxide-exposed research subjects improves cerebral oxygen delivery. METHODS: This experiment used a randomized, single-blinded, crossover design. We exposed 14 human research subjects to carbon monoxide until their carboxyhemoglobin levels reached 10% to 12%. We then treated each research subject with 60 minutes of hyperoxia with or without normocapnia. Research subjects returned after at least 24 hours, were reexposed to carbon monoxide, and were given the alternate treatment. Relative changes in cerebral oxygen delivery were calculated as the product of blood oxygen content and middle cerebral artery velocity (an index of cerebral blood flow) as measured by transcranial Doppler ultrasonography. RESULTS: Maintaining normocapnia during hyperoxic treatment resulted in significantly higher cerebral oxygen delivery compared with standard oxygen treatment (P <.05; 95% confidence interval at 60 minutes 2.8% to 16.7%) as a result of the prevention of hypocapnia-induced cerebral vasoconstriction and more rapid elimination of carbon monoxide due to increased minute ventilation. CONCLUSION: If severely poisoned patients respond like our research subjects, maintaining normocapnia during initial hyperoxic treatment of carbon monoxide poisoning may lead to increased oxygen delivery to the brain. Determining the effect of such a change in conventional treatment on outcome requires clinical studies.
Publication Types:
PMID: 12447338, UI: 22334685
Ann Intern Med 2002 Dec 17;137(12):I24
PMID: 12484742, UI: 22372906
Ann Intern Med 2002 Dec 17;137(12):947-54
Department of Medicine, Gold Coast Hospital, 108 Nerang Street, Southport, QLD 4215, Australia.
BACKGROUND: Because acute liver failure is rare, related data have been sparse. Studies have suggested that viral hepatitis is the most common underlying cause of this condition. OBJECTIVE: To describe the clinical features, presumed causes, and short-term outcomes of acute liver failure. DESIGN: Prospective cohort study. SETTING: 17 tertiary care centers participating in the U.S. Acute Liver Failure Study Group. PATIENTS: 308 consecutive patients with acute liver failure, admitted over a 41-month period. MEASUREMENTS: Detailed clinical and laboratory data collected during hospitalization, including outcome 3 weeks after study admission. RESULTS: 73% of patients were women; median age was 38 years. Acetaminophen overdose was the most common apparent cause of acute liver failure, accounting for 39% of cases. Idiosyncratic drug reactions were the presumptive cause in 13% of cases, viral hepatitis A and B combined were implicated in 12% of cases, and 17% of cases were of indeterminate cause. Overall patient survival at 3 weeks was 67%. Twenty-nine percent of patients had liver transplantation, and 43% survived without transplantation. Short-term transplant-free survival varied greatly, from 68% for patients with acetaminophen-related liver failure to 25% and 17% for those with other drug reactions and liver failure of indeterminate cause, respectively. Coma grade at admission appeared to be associated with outcome, but age and symptom duration did not. CONCLUSIONS: Acetaminophen overdose and idiosyncratic drug reactions have replaced viral hepatitis as the most frequent apparent causes of acute liver failure. Apparent cause and coma grade at admission were associated with outcome. Although transplantation may improve patient survival, it was unavailable or unnecessary for most patients.
PMID: 12484709, UI: 22372873
Arch Pediatr 2002 Oct;9(10):1112-3
PMID: 12462849, UI: 22351232
Br J Dermatol 2002 Nov;147(5):1042-4
PMID: 12410735, UI: 22299669
Br J Dermatol 2002 Nov;147(5):1036-7
PMID: 12410732, UI: 22299666
Br J Dermatol 2002 Nov;147(5):1025-6
PMID: 12410725, UI: 22299659
Br J Dermatol 2002 Nov;147(5):926-30
Department of Dermatology, CHU Nantes, 1 place Alexis Ricordeau, 44035 Nantes cedex 1, France.
BACKGROUND: Mechlorethamine is frequently used in the treatment of cutaneous lymphoma, but its application is limited in 30-80% of cases because of cutaneous intolerance. Reducing the concentration to avoid this side-effect has been only modestly successful. OBJECTIVES: To investigate whether a shorter application period could reduce the frequency of intolerance. METHODS: In an open prospective study in 39 patients with cutaneous T-cell lymphoma or parapsoriasis, mechlorethamine was applied according to the usual practices of the participating physicians (number of weekly applications, treatment confined to lesions or performed over the entire body) and then washed off after 1 h in all cases. RESULTS: Cutaneous intolerance was observed in 19 of 39 patients (49%). Six of these patients showed allergic contact dermatitis to mechlorethamine after a mean period of 9.3 weeks, while the other 13 developed irritant contact dermatitis after a longer period. Cutaneous intolerance did not differ significantly according to the number of applications per week or the extent of body area treated. The therapeutic response rate was 69%, and no difference in therapeutic efficacy was noted between daily and intermittent applications. CONCLUSIONS: Comparison with published studies showed no significant difference in the number of cases of cutaneous intolerance after short-term application, although their occurrence was delayed. Therapeutic response was decreased appreciably by short-term application as compared with results in the literature.
PMID: 12410702, UI: 22299636
Gastroenterol Clin Biol 2002 Aug-Sep;26(8-9):804
PMID: 12434090, UI: 22321280
Hum Exp Toxicol 2002 Nov;21(11):579-86
Drug and Toxicology Information Service, Department of Pharmacy, Medical School, University of Zimbabwe, Box A178, Avondale, Harare, Zimbabwe.
[Medline record in process]
Traditional medicines (TMs) have been reported as major causes of hospital admissions in some African countries including Zimbabwe. There is, however, still a paucity of information with regards to their clinical presentations. We carried out a retrospective case series of all cases of traditional medicine poisoning (TMP) at eight main referral hospitals in Zimbabwe January 1998-December 1999 inclusive) to describe the most common signs and symptoms, reasons for, and management of TMP in adults. Where the reasons for taking the TM were known, most cases had taken the medicine for either abdominal pains or aphrodisiac purposes. Nonspecific adverse effects including vomiting, abdominal pains, and diarrhoea were the most commonly encountered. A large proportion of patients with TMP also suffered from genito-urinary tract adverse outcomes especially haematuria and dysuria. Intravenous fluids were the most commonly employed therapeutic modality for TMP, probably in an effort to dilute or increase excretion of the toxins. Further research is required to elucidate the toxic components responsible for the observed ill effects and whether these effects are due to the medicines themselves or to co-existing illnesses.
PMID: 12507252, UI: 22394939
J Clin Psychiatry 2002 Nov;63(11):1010-1
Department of Neurology, College of Medicine, The University of Arizona, Tucson 85724, USA. labinerd@u.arizona.edu
PMID: 12469685, UI: 22357314
J Clin Psychiatry 2002 Nov;63(11):1012-9
Department of Psychiatry, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio, USA. jrc8@po.cwru.edu
BACKGROUND: The rate of lamotrigine-associated rash in patients with mood disorders has not been well characterized. The objective of this report was to determine rash rates in clinical trials of lamotrigine in DSM-IV unipolar depression or bipolar disorder. METHOD: A retrospective analysis was conducted of rates of lamotrigine-related rash in 12 multicenter studies, including 1 open study, 7 randomized controlled acute trials, and 4 randomized controlled maintenance trials from 1996 to 2001. RESULTS: A total of 1955 patients were treated with lamotrigine in open-label settings (open-label phases preceding or following randomization and 1 stand-alone open-label study); 1198 patients received lamotrigine in controlled settings, and 1056 patients received placebo. In controlled settings, rates of benign rash were 8.3% and 6.4% in lamotrigine- and placebo-treated patients, respectively. Rates of serious rash were 0% with lamotrigine, 0.1% (N = 1) with placebo, and 0% with comparators. In the open-label setting, the overall rate of rash for lamotrigine was 13.1% (N = 257) and of serious rash, 0.1% (N = 2). One mild case of Stevens-Johnson syndrome not requiring hospitalization occurred in a patient treated with lamotrigine. There were no cases of toxic epidermal necrolysis in any setting. CONCLUSION: Serious drug eruptions associated with lamotrigine were rare. Although rash is a potentially life-threatening reaction, the risk of serious rash due to lamotrigine should be weighed against more common risks associated with untreated or undertreated bipolar depression.
PMID: 12444815, UI: 22336569
JAMA 2002 Dec 18;288(23):2967-9
PMID: 12492098, UI: 22377928
JAMA 2002 Dec 18;288(23):2967
PMID: 12492097, UI: 22377927
MMWR Morb Mortal Wkly Rep 2002 Nov 29;51(47):1065-7
Since 1999, health-care professionals in Germany, Switzerland, and the United States have reported the occurrence of severe hepatic toxicity possibly associated with the consumption of products containing kava (i.e., kava kava or Piper methysticum). A total of 11 patients who used kava products had liver failure and underwent subsequent liver transplantation. On March 25, 2002, in response to five such case reports (four in Europe and one in the United States), the Food and Drug Administration (FDA) issued a consumer advisory and subsequently completed an investigation already underway of a similar U.S. case. This report presents the investigation of the two U.S. cases of liver failure associated with kava-containing dietary supplement products and summarizes the European cases. FDA continues to advise consumers and health-care providers about the potential risk associated with the use of kava-containing products.
PMID: 12500906, UI: 22388682
MMWR Morb Mortal Wkly Rep 2002 Nov 22;51(46):1044-7
Three multistate outbreaks of Salmonella serotype Poona infections associated with eating cantaloupe imported from Mexico occurred in the spring of consecutive years during 2000-2002. In each outbreak, the isolates had indistinguishable pulsed-field gel electrophoresis (PFGE) patterns; the PFGE patterns observed in the 2000 and 2002 outbreaks were indistinguishable, but the pattern from 2001 was unique among them. Outbreaks were identified first by the California Department of Health Services (2000 and 2001) and the Washington State Department of Health (2002) and involved residents of 12 states and Canada. This report describes the investigations, which led ultimately to an import alert on cantaloupes from Mexico. To limit the potential for cantaloupe contamination, the Food and Drug Administration (FDA) continues to work with the Mexican government on a food-safety program for the production, packing, and shipping of fresh cantaloupes.
PMID: 12487526, UI: 22375201
Med J Aust 2002 Nov 18;177(10):552-3
Department of Anaesthesia, North West Regional Hospital, Burnie, TAS, Australia.
The introduction of a transdermal delivery system for fentanyl means that it is now more readily available. We present the first documented fatality after intravenous injection of the contents of a transdermal fentanyl patch. Prescribers need to be aware of the potential for misuse of fentanyl patches.
PMID: 12429004, UI: 22317214