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Items 1 - 13 of 13 |
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Comment on:
Inducing high levels of carbon monoxide in a tent.
Hampson NB, Hampson LA.
Department of Medicine, Center for Hyperbaric Medicine, Virginia Mason Medical Center, Seattle, WA 98101, USA. neil.hampson@vmmc.org
Publication Types:
PMID: 15765348 [PubMed - indexed for MEDLINE]
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The electrocardiographic toxidrome: the ECG presentation of hydrofluoric acid ingestion.
Holstege C, Baer A, Brady WJ.
Department of Emergency Medicine, University of Virginia Medical Center, Charlottesville, 22908, USA.
The clinician can approach the poisoned patient using the toxidrome system of toxin identification; this approach makes use of findings noted on the physical examination, highlighting the importance of abnormalities in blood pressure, heart rate, respiratory effort, body temperature, mental status, pupillary size, skin color, diaphoresis, and gastrointestinal sounds. Such a method provides structure and guidance to the clinical evaluation, providing the clinician with rapid diagnostic information and suggesting urgent management issues. A case of hydrofluoric acid poisoning is used as an example of this diagnostic approach. The patient demonstrated systemic toxicity accompanied by oral irritation and electrocardiographic abnormality (QRS complex widening and QT interval prolongation). The constellation of these findings suggested the possibility of a caustic agent (history and examination) with potential effect on potassium and calcium metabolism (electrocardiographic abnormalities). Such a constellation strongly suggested hydrofluoric acid as the culprit toxin.
Publication Types:
PMID: 15765339 [PubMed - indexed for MEDLINE]
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Incidence and severity of recovery agitation after ketamine sedation in young adults.
Green SM, Sherwin TS.
Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, CA 92354, USA. stevegreen@tarascon.com
PURPOSES: Psychic recovery reactions after ketamine administration are not uncommon in adults, but yet are rare in children 15 years old and younger. The nature of such reactions has not been previously described in young adults, and accordingly we wished to quantify the incidence and severity of recovery agitation after ketamine sedation in patients aged 16 to 21 years. BASIC PROCEDURES: We prospectively collected data on 26 young adults aged 16 to 21 years who received ketamine for emergency department procedures, and treating physicians rated recovery "agitation," "crying," and "unpleasant hallucinations or nightmares" each on a 100-mm visual analog scale (0 mm="none," 100 mm="worst possible"). MAIN FINDINGS: Treating physicians rated agitation and crying as entirely absent (rating 0 mm) in 25 of the 26 patients, and unpleasant hallucinations or nightmares as entirely absent (0 mm) in all 26. The single occurrences each of agitation (rating 46 mm) and crying (rating 23 mm) were not severe and resolved spontaneously without treatment. PRINCIPAL CONCLUSIONS: In this small sample of young adults we observed no serious psychic recovery reactions, mirroring the low incidence of such responses well documented with children 15 years old and younger. This supports the expansion of ketamine use to young adults aged 16 to 21 years.
Publication Types:
PMID: 15765332 [PubMed - indexed for MEDLINE]
Case report: compartment syndrome after a suspected black widow spider bite.
Cohen J, Bush S.
Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA.
Widow spider envenomations generally produce systemic neurologic syndromes without significant local injury. We report a patient who sustained a black widow spider bite to the left forearm and presented to the emergency department with rhabdomyolysis and compartment syndrome. We documented a decrease in symptoms and compartment pressure after administration of antivenom. No surgical intervention was performed. We believe this report to be the first documenting compartment syndrome associated with black widow spider bite.
Publication Types:
PMID: 15795721 [PubMed - indexed for MEDLINE]
Tramadol Exposures Reported to Statewide Poison Control System.
Marquardt KA, Alsop JA, Albertson TE.
California Poison Control System, Sacramento Division; Associate Clinical Professor of Pharmacy, Division of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco; Clinical Professor of Medicine, Section of Medical Toxicology and Clinical Pharmacology, Division of Pulmonary and Critical Care, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA.
BACKGROUND: Tramadol is a unique analgesic that has been associated with seizures on overdose. OBJECTIVE: To determine the toxic effects associated with tramadol exposure. METHODS: A retrospective chart review of tramadol exposures reported to a multisite, state-wide poison control system over a 2.5-year period was performed. RESULTS: A total of 602 cases were retrieved; 190 had sufficient data for study evaluation. Cases with coingestants or unknown outcomes were eliminated. Of the 190 remaining cases, 55% were females. Acute ingestions represented 90.0%, chronic ingestions 7.9%, and acute on chronic 2.1% of the overdoses. Ages of the patients ranged from 9 months to 80 years. Suicide attempts represented the largest group of exposures. Main symptoms included central nervous system (CNS) depression (27.4%), nausea and vomiting (21.1%), tachycardia (17.4%), and seizures (13.7%). Dosage ranged from a taste amount to 5000 mg. The smallest amount of tramadol associated with seizure was 200 mg, and 84.6% of seizures occurred within 6 hours of time of ingestion. Logistic regression analysis showed an association between seizures and tramadol use in males, chronic use, suicide attempts, intentional abuse or misuse, and tachycardia (HR >100 beats/min). No effect was seen in 36.3% of patients, minor effects in 43.7%, moderate effects in 19.5%, and major effects in 0.5%. Symptoms resolved within 24 hours in 96.7% of the 121 patients who had symptoms. Naloxone improved CNS depression in 7 of 8 patients in whom a response was documented. CONCLUSIONS: Tramadol overdoses frequently cause CNS depression, nausea/vomiting, tachycardia, and seizures. Symptoms generally resolve within 24 hours. Accidental ingestions in children were well tolerated, primarily causing sedation.
PMID: 15870139 [PubMed - as supplied by publisher]
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Atomoxetine ingestions in children: a report from poison centers.
Spiller HA, Lintner CP, Winter ML.
Kentucky Regional Poison Center, Louisville, KY.
BACKGROUND: Atomoxetine uses a novel nonstimulant approach to the treatment of attention deficit hyperactivity disorder. There is limited information on overdose of atomoxetine in children or adults. OBJECTIVE: To provide information on atomoxetine in overdose. METHODS: Case series were conducted at 3 regional poison centers for atomoxetine ingestion in children (age </=17 y). Exclusion criteria were polypharmacy or lack of follow-up. RESULTS: Forty patients were included (25 boys; 63%) in the study. The mean +/- SD age was 6.1 +/- 4.9 years (range 9 mo-17 y). Twenty-five patients were managed at home, 14 in hospital emergency departments (3 children were admitted), and 1 patient was managed in a physician's office. Symptoms reported were tachycardia, drowsiness, nausea, hypertension, and vomiting. A seizure was reported in one child who had recently started atomoxetine therapy. No arrhythmias beyond sinus tachycardia were reported. Mean maximum heart rate in patients with tachycardia was 131 +/- 14 beats/min. The mean dose ingested, categorized by medical outcome, was: no effect (n = 22), 40 +/- 32 mg; minor effect (n = 14), 167 +/- 221 mg; and moderate effect (n = 4), 249 +/- 326 mg. There were no major outcomes or fatalities. The lowest dose ingested that resulted in hypertension was 480 mg, in a 14-year-old girl (BP 136/95 mm Hg). CONCLUSIONS: In this case series, clinically significant cardiovascular effects requiring direct intervention did not occur. Activated charcoal and/or observation appear to be sufficient for accidental ingestion. Further investigation may be needed to indicate whether seizures occur from atomoxetine ingestion.
PMID: 15870137 [PubMed - in process]
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Serious psychiatric symptoms after chloroquine treatment following experimental malaria infection.
Telgt DS, van der Ven AJ, Schimmer B, Droogleever-Fortuyn HA, Sauerwein RW.
Department of General Internal Medicine and Center for Clinical Malaria Studies, Nijmegen University Medical Centre, 6500 HB Nijmegen, Netherlands.
OBJECTIVE: To report serious psychiatric symptoms after standard chloroquine treatment following human malaria infection induced for research. CASE SUMMARY: A 34-year-old healthy woman volunteered to participate in a study of malaria treatment. She was infected on day 0 with a chloroquine-susceptible strain of Plasmodium falciparum and was treated with a standard 3-day course of chloroquine from day 9 onward, following a positive blood smear (parasitemia 0.001%). On day 10, the blood smear became negative. On day 11, she developed a psychotic disorder not otherwise specified, most probably caused by chloroquine use, with symptoms of depersonalization and anxiety. The diagnosis of delirium was considered but ruled out because of clear consciousness with lack of diurnal fluctuations. She refused to take antipsychotic medication. Three weeks later, the woman still encountered serious concentration problems. All complaints gradually subsided over the next 4 months, after which she felt completely recovered. Plasma chloroquine concentrations were within the therapeutic range. DISCUSSION: Chloroquine may achieve high concentrations in the brain and has a long half-life. As quinolines, the antimalarials may have the same pathologic activity as the fluoroquinolone antibiotics in acting as N-methyl-d-aspartate agonists and gamma-aminobutyric acid antagonists. Application of the Naranjo probability scale indicated that, in this patient, chloroquine was the probable cause of the serious psychiatric symptoms. CONCLUSIONS: Our unique observation demonstrates that serious psychiatric symptoms can emerge as a rare occurrence during standard chloroquine therapy. This adverse effect may persist for several months.
Publication Types:
PMID: 15728331 [PubMed - indexed for MEDLINE]
 
Incidence and risk factors for non-alcoholic steatohepatitis: prospective study of 5408 women enrolled in Italian tamoxifen chemoprevention trial.
Bruno S, Maisonneuve P, Castellana P, Rotmensz N, Rossi S, Maggioni M, Persico M, Colombo A, Monasterolo F, Casadei-Giunchi D, Desiderio F, Stroffolini T, Sacchini V, Decensi A, Veronesi U.
Liver Unit, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Corso di Porta Nuova 23, 20121 Milan, Italy. savino.bruno@fbf.milano.it
OBJECTIVE: To assess the incidence, cofactors, and excess risk of development of non-alcoholic fatty liver disease, including non-alcoholic steatohepatitis, attributable to tamoxifen in women. DESIGN: Prospective, randomised, double blind, placebo controlled trial. SETTING AND PARTICIPANTS: 5408 healthy women who had had hysterectomies, recruited into the Italian tamoxifen chemoprevention trial from 58 centres in Italy. INTERVENTION: Women were randomly assigned to receive tamoxifen (20 mg daily) or placebo for five years. MAIN OUTCOME MEASURE: Development of non-alcoholic fatty liver disease in all women with normal baseline liver function who showed at least two elevations of alanine aminotransferase (> or = 1.5 times upper limit of normal) over a six month period. RESULTS: During follow up, 64 women met the predefined criteria: 12 tested positive for hepatitis C virus, and the remaining 52 were suspected of having developed non-alcoholic fatty liver disease (34 tamoxifen, 18 placebo)--hazard ratio = 2.0 (95% confidence interval 1.1 to 3.5; P = 0.04). In all 52 women ultrasonography confirmed the presence of fatty liver. Other factors associated with the development of non-alcoholic fatty liver disease included overweight (2.4, 1.2 to 4.8), obesity (3.6, 1.7 to 7.6), hypercholesterolaemia (3.4, 1.4 to 7.8), and arterial hypertension (2.0, 1.0 to 3.8). Twenty women had liver biopsies: 15 were diagnosed as having mild to moderate steatohepatitis (12 tamoxifen, 3 placebo), and five had fatty liver alone (1 tamoxifen, 4 placebo). No clinical, biochemical, ultrasonic, or histological signs suggestive of progression to cirrhosis were observed after a median follow up of 8.7 years. CONCLUSIONS: Tamoxifen was associated with higher risk of development of non-alcoholic steatohepatitis only in overweight and obese women with features of metabolic syndrome, but the disease, in both the tamoxifen and the placebo group, after 10 years of follow up seems to be indolent.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15746106 [PubMed - indexed for MEDLINE]
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Our experiences with fatal ecstasy abuse (two case reports).
Karlovsek MZ, Alibegovic A, Balazic J.
Institute of Forensic Medicine, Medical Faculty, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia.
Ecstasy is a psychostimulative drug (ab)used mostly by teenagers and young adults in discotheques and on the "rave" parties. Older adults ecstasy abusing cases are very rare. Among four cases of ecstasy abuse with fatal outcome noticed and examined in Slovenia, two were examined at our Institute of Forensic Medicine in Ljubljana. The first case was the accidental intoxication with 3,4 methylenedioxymethamphetamine (MDMA) on "rave" party, the second case was suicidal intoxication with combination of insulin and MDMA. Because of the increasing popularity of MDMA, it is important for all emergency physicians to be well educated in prompt recognition of MDMA intoxication symptoms. It is important that emergency physician carefully examines the death scene.
Publication Types:
PMID: 15694737 [PubMed - indexed for MEDLINE]
[Probable sildenafil (Viagra) induced acute hepatitis in a patient with no other risk factors]
[Article in French]
Balian A, Touati F, Huguenin B, Prevot S, Perlemuter G, Naveau S, Chaput JC.
Publication Types:
PMID: 15738907 [PubMed - indexed for MEDLINE]
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Philip Landrigan: children's health crusader.
Pirisi A.
Publication Types:
- Biography
- Historical Article
Personal Name as Subject:
PMID: 15823369 [PubMed - indexed for MEDLINE]
Inhibition of matrix metalloproteinases minimizes hepatic microvascular injury in response to acetaminophen in mice.
Ito Y, Abril ER, Bethea NW, McCuskey RS.
Department of Cell Biology and Anatomy, College of Medicine, University of Arizona, Tucson, Arizona, 85724-5044, USA.
The acetaminophen (APAP)-induced hepatic centrilobular necrosis is preceded by hepatic microcirculatory dysfunction including the infiltration of erythrocytes into the space of Disse. The purpose of this study was to examine the involvement of matrix metalloproteinases (MMPs) in the hepatic microvascular injury elicied by APAP. Male C57Bl/6 mice were pretreated with 2-[(4-biphenylsulfonyl) amino]-3-phenyl-propionic acid, an MMP-2/MMP-9 inhibitor (5 mg/kg, ip) 30 min before oral gavage with 600 mg/kg of APAP. The hepatic microvasculature in anesthetized mice was observed using established in vivo microscopic methods 2 and 6 h after APAP. The levels of mRNAs and activities of MMP-2 and MMP-9 in the liver were increased from 1 h through 6 h after APAP gavage. APAP increased alanine transferase (ALT) levels (41.1-fold) and resulted in centrilobular hemorrhagic necrosis at 6 h. Pretreatment with 2-[(4-biphenylsulfonyl) amino]-3-phenyl-propionic acid attenuated ALT values by 71% as well as the necrosis. APAP decreased the numbers of perfused sinusoids in centrilobular regions by 30% and increased the area occupied by infiltrated erythrocytes into Disse space. 2-[(4-Biphenylsulfonyl) amino]-3-phenyl-propionic acid restored the sinusoidal perfusion to 90% of control levels and minimized extrasinusoidal area occupied by erythrocytes. The present study showed that increased MMPs during APAP intoxication are associated with hepatocellular damage and with hepatic microcirculatory dysfunction including impaired sinusoidal perfusion and infiltration of erythrocytes in Disse space. 2-[(4-Biphenylsulfonyl) amino]-3-phenyl-propionic acid attenuated APAP-induced parenchymal and microvascular injury. These results suggest that MMPs participate in APAP hepatotoxicity mediated by sinusoidal endothelial cell injury, which results in impairment of microcirculation.
PMID: 15456921 [PubMed - indexed for MEDLINE]
Bromobenzene-induced hepatotoxicity at the transcriptome level.
Heijne WH, Slitt AL, van Bladeren PJ, Groten JP, Klaassen CD, Stierum RH, van Ommen B.
Department of Biomolecular Sciences, TNO Nutrition and Food Research, PO box 360, 3700 AJ Zeist, The Netherlands. Heijne@voeding.TNO.nl
Rats were exposed to three levels of bromobenzene, sampled at 6, 24, and 48 h, and liver gene expression profiles were determined to identify dose and time-related changes. Expression of many genes changed transiently, and dependent on the dose. Few changes were identified after 6 h, but many genes were differentially expressed after 24 h, while after 48 h, only the high dose elicited large effects. Differentially expressed genes were involved in drug metabolism (upregulated GSTs, mEH, NQO1, Mrps, downregulated CYPs, sulfotransferases), oxidative stress (induced HO-1, peroxiredoxin, ferritin), GSH depletion (induced GCS-l, GSTA, GSTM) the acute phase response, and in processes like cholesterol, fatty acid and protein metabolism, and intracellular signaling. Trancriptional regulation via the electrophile and sterol response elements seemed to mediate part of the response to bromobenzene. Recovery of the liver was suggested in response to BB by the altered expression of genes involved in protein synthesis and cytoskeleton rearrangement. Furthermore, after 48 h, rats in the mid dose group showed no toxicity, and gene expression patterns resembled the normal situation. For certain genes (e.g., CYP4A, metallothioneins), intraday variation in expression levels was found, regardless of the treatment. Selected cDNA microarray measurements were confirmed using the specific and sensitive branched DNA signal amplification assay.
PMID: 15056800 [PubMed - indexed for MEDLINE]
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