Haemoperfusion with R-004 Amberlite resin for treating acute poisoning.

Eleven patients who had taken overdoses of barbiturates, glutethimide, tricyclic antidepressants, and chloroquine were treated by resin haemoperfusion using an R-004 haemoperfusion cartridge containing XAD-4 resin. All but one patient showed rapid clinical recovery and the drugs were cleared rapidly from the plasma. There were few complications. Resin haemoperfusion is more effective than dialysis and other perfusion methods, especially in poisoning with tricyclic antidepressants. Although haemoperfusion is expensive, it greatly reduces the length of the patient''s stay in an intensive care unit and hence is cost-effective.     

The rabbit as an animal model for haemoperfusion: surgical preparation and use

In this paper the authors describe the surgical procedure to prepare rabbits for haemoperfusion experiments. The carotid artery and jugular vein are cannulated and a simple shunt device inserted to maintain patency of the vessels over a period of time. The cannulas and shunt remain patent and free of infection for some months. Specially designed outflow and inflow extracorporeal tubing sets minimize blood volume outside the body of the rabbit. The authors also illustrate the efficacy of this system in haemoperfusion trials to remove specific antibodies. Recently a system was described to remove mercury from the bloodstream of poisoned animals. The rabbit is a useful experimental animal for this type of haemoperfusion trial.     

Microcapsule artificial kidney: treatment of patients with acute drug intoxication

The microcapsule artificial kidney was used in the treatment of three patients with acute drug intoxication. The apparatus contains 300 g. of microencapsulated activated charcoal with a total membrane area available for diffusion of more than 2m.² The membrane thickness is only 500 A. These properties make possible a compact artificial kidney whose efficiency for the removal of uremic metabolites and drugs is much higher than standard hemodialysis apparatus. The microcapsules are made blood-compatible by coating with human albumin. A roller pump was used to propel the blood through the microcapsule artificial kidney at a flow rate of 300 ml./min. for two to three hours. The clearance values for glutethimide, methyprylon and methaqualone were much higher than those achieved by standard hemodialysis. Hemoperfusion quickly lowered the drug level in the blood with resulting clinical improvement.     

Evaluation of selected parameters in calcium and phosphate metabolism in acute liver failure following poisoning with Amanita phalloides

Serum calcium, phosphate and 25-OHD8 levels as well as calcium and phosphate urine excretion were determined in 21 children between 5 and 7 days after poisoning with Amanita phalloides. Hypophosphatemia was seen in children with the symptoms of moderate intoxication whereas hypocalcemia in severely poisoned patients. Phosphates deficit should be corrected early in all patients poisoned with Amanita phalloides.     

Effect of hemoperfusion on plasma oxidizing capacity and erythrocyte sensitivity to oxidation in patients with chronic uremia

An effect of haemoperfusion on plasma oxidizing capacity and erythrocyte sensitivity to oxidation was investigated in patients with the chronic uremia. It was found that plasma oxidizing capacity measured with NTB reduction is more pronounced in patients with the chronic uremia than in normal subjects. Oxidizing capacity of plasma is increased at the beginning of haemoperfusion. This effect is clearly seen during single pass of blood through the column with activated carbon. Erythrocyte sensitivity to oxidation following their suspension in the normal saline with phosphate buffer and measured with ascorbic-cyanate test does not differ significantly in patients with the chronic uremia and healthy subjects and does not change markedly during haemoperfusion.     

Intensive hemodialysis and hemoperfusion treatment of Amanita mushroom poisoning

Over a period of fifteen years, 41 patients including 23 males and 18 females with Amanita mushroom poisoning were treated at the University Hospital of Lund, Sweden. The intensity of poisoning was graded according to serum transaminase elevations and prothrombin time reductions. Severity was mild in 16 patients (Group A), moderate in 14 (Group B) and severe in 11 (Group C). Members of Group C reported shorter latency periods before the onset of symptoms, (10±1 hours,p<0.05) and longer delays in treatment, (34±4 hours), than did the other patients. Intensive treatment was begun before the results of urine amatoxin assays were reported. Treatment consisted of: fluid and electrolyte replacement, oral activated charcoal and lactulose, IV penicillin, combined hemodialysis and hemoperfusion in two 8 hour sessions, some received IV thioctic acid, others IV silibinin, all received a special diet. This combination of treatment modalities was used to accelerate the elimination of amatoxin from the patients' bodies. The longest period of hospitalization, 13±2 days, was required by the patients of Group C (p<0.01). All patients improved and were discharged from the hospital asymptomatic. No sequelae were later reported for the majority of those moderately and severely poisoned. We have concluded that intensive combined treatment applied in these cases is effective in relieving patients with both moderate and severe amanitin poisoning.     

Comparative Clinical Study of Two Hypnotic Drugs

The comparative sleep-inducing and sleep-sustaining effects of glutethimide, 0.5 g., and ethchlorvynol, 0.5 g., were studied in 20 patients hospitalized for a considerable time (average: 21 years; minimum nine years and maximum 32 years) and not receiving psychotropic agents. Assessment of sleep and para-sleep parameters (pre-sleep tension; frequency of awakening at night; post-sleep activity) revealed that patients fell asleep faster (P>.001) and slept for a longer time with ethchlorvynol than with glutethimide.     

Prostacyclin: its biosynthesis, actions and clinical potential

Prostacyclin (PGI2) is the product of arachidonic acid metabolism generated by the vessel wall of all mammalian species studied, including man. Prostacyclin is a potent vasodilator and the most potent inhibitor of platelet aggregation so far described. Prostacyclin inhibits aggregation through stimulation of platelet adenyl cyclase leading to an increase in platelet cyclic AMP. In the vessel wall, the enzyme that synthesizes prostacyclin is concentrated in the endothelial layer. Prostacyclin can also be a circulating hormone released from the pulmonary circulation. Based on these observations we proposed that platelet aggregability in vivo is controlled via a prostacyclin mechanism. The discovery of prostacyclin has given a new insight into arachidonic acid metabolism and has led to a new hypothesis about mechanisms of haemostasis. Reductions in prostacyclin production in several diseases, including atherosclerosis and diabetes, have been described and implicated in the pathophysiology of these diseases. Additionally, since prostacyclin powerfully inhibits platelet aggregation and promotes their disaggregation, this agent could have an important use in the therapy of conditions in which increased platelet aggregation takes place and in which, perhaps, a prostacyclin deficiency exists. Prostacyclin has been used beneficially in humans during extracorporeal circulation procedures such as cardiopulmonary bypass, charcoal haemoperfusion and haemodialysis. Its possible use in other conditions such as peripheral vascular disease or transplant surgery is at present being investigated.     

Synergistic induction of delta-aminolevulinate synthase by glutethimide and iron: relationship to the synergistic induction of heme oxygenase

Relationships between activities of delta-aminolevulinate synthase and heme oxygenase, respectively the rate-limiting enzymes of heme biosynthesis and degradation, have been studied in chick embryo liver cell cultures following exposure of the cultures to glutethimide and iron, a combination known to produce a synergistic induction of both enzymes. In time-course experiments, synergistic induction of heme oxygenase activity by glutethimide and iron preceded that of delta-aminolevulinate synthase by 4 h. Effects of selective inhibitors of both heme synthesis and degradation have also been studied with respect to effects on delta-aminolevulinate synthase and heme oxygenase activities. The synergistic induction of heme oxygenase by glutethimide and iron appears to be dependent upon cellular heme synthesis because addition of inhibitors of heme biosynthesis, 4,6-dioxoheptanoic acid or N-methyl-mesoporphyrin abolishes this synergistic induction. Exposure of cultures to tin-mesoporphyrin, a potent inhibitor of heme oxygenase, prevented the synergistic induction of delta-aminolevulinate synthase produced by glutethimide and iron, or, when added after induction was already established, promptly halted any further induction. These results suggest that the level of activity of heme oxygenase can reciprocally modulate intracellular heme levels and thus activity of delta-aminolevulinate synthase.     

A Clinical Evaluation of Four Hypnotic Agents,Using a Latin-Square Design

A double-blind study with a Latin-square design was undertaken on 25 elderly patients, using a placebo and four hypnotic drugs: ethchlorvynol 500 mg., glutethimide 500 mg., chloral hydrate 500 mg., and secobarbital sodium 100 mg. The trial lasted for five weeks. The drugs were all effective compared with the placebo, differences in sleeping time being statistically significant. Differences between these four drugs were not statistically significant. Sleep was induced soonest by secobarbital and ethchlorvynol. Ethchlorvynol and glutethimide had a relatively somewhat longer period of activity than the others. Glutethimide produced most side effects, especially morning drowsiness. Ethchlorvynol and chloral hydrate produced relatively few cases of drowsiness.     

THE EFFECT OF CHARCOAL ON THE GROWTH OF LEGUMINOUS PLANTS IN SAND CULTURE

The addition of small proportions (0.5-2.0 %) of activated charcoal to the rooting medium of inoculated peas in nitrogen-free sand culture resulted in marked increases in dry weight of the plants and in nitrogen fixation. Wood charcoal in larger proportions had a similar effect, while animal charcoal severely inhibited growth. The number of nodules was greatly reduced in the presence of activated charcoal, but such nodules as formed were much larger and the nodule tissues per unit weight were more active in nitrogen fixation. Activated charcoal also led to an increase in dry weight of non-inoculated peas supplied with inorganic combined nitrogen. It is tentatively suggested that these favourable effects arise from the adsorption by the charcoal of harmful excretions from roots or micro-organisms or of excess nutrients, and from the maintenance of a more favourable pH in the rooting medium. The examination of barley intersown with the peas, and the results of Kjeldahl analyses on the rooting media, provided no evidence that the enhanced fixation in the presence of activated charcoal was attended by any considerable excretion of fixed nitrogen.     

The value of plasma paraquat concentration in predicting therapeutic effects of haemoperfusion in patients with acute paraquat poisoning

Objective

This study was aimed to analyze the scavenging effect of haemoperfusion on plasma paraquat (PQ) and to evaluate the clinical significance of PQ examination in the treatment of patients with acute paraquat poisoning.

Methods

85 patients with acute paraquat intoxication by oral ingestion were admitted in West China Hospital from Jun, 2010 to Mar, 2011. A standardized therapeutic regimen including emergency haemoperfusion was given on all subjects. A total of 91 whole blood samples were taken before (0h), underway (1h after haemoperfusion beginning) and at the end (2h) of the haemoperfusion therapy. The clearance rate was calculated and related factors were analyzed.

Results

As heamoperfusion was going on, the plasma paraquat concentration of the patients kept falling down. After 1 hour of haemoperfusion, the average clearance rate (R₁) was 37.06±21.81%. After 2 hours of haemoperfusion, the average clearance rate (R₂) was 45.99±23.13%. The average of R₁/R₂ ratio was 76.61±22.80%. In the high paraquat concentration group (plasma paraquat concentration (C₀) >300 ng/mL), both the averages of R₁ and R₂ were significantly higher than those of the low paraquat concentration group (C₀≤200 ng/mL) (p<0.05), and there was no significant difference of R₁/R₂ between these two groups (p>0.05).

Conclusions

The dynamic monitoring of plasma PQ concentration was not only critical in the clinical evaluation but also helpful in guiding the treatment of patients with acute PQ intoxication. Haemoperfusion can effectively eliminate paraquat from the plasma in patients with high initial plasma PQ concentration, while in patients with low initial plasma PQ concentration (<200 ng/ml), the clearance effect of harmoperfusion was very limited. Increasing HP time might improve the overall clearance rate of HP on plasma PQ yet decrease the elimination efficiency of HP, while repeated HP treatment was helpful against the rebound phenomena.     

Cerebral fat embolism.

An unusual presentation of fat embolism is reported. Forty-eight hours after severe trauma to her legs the patient became stuporous and her right arm weak. A computerized tomography scan showed diffuse brain swelling. Although the petechiae, thrombocytopenia and lipuria characteristic of the fat embolism syndrome were present, at no time was there any evidence of pulmonary involvement.     

Severe Self-poisoning in Sunderland

One hundred and twenty-nine patients (25·5%) out of 505 consecutive cases of self-poisoning admitted to a non-teaching poisoning treatment centre run as part of an acute medical unit are reviewed in detail. All of them were severely poisoned and would possibly have died without admission to hospital. Despite considerable limitations in the medical, nursing, and laboratory facilities available a very low mortality rate was achieved by practising intensive supportive and conservative care, supplemented on occasion by a forced alkaline diuresis.     

Haemostatic defect in non-immune patients with falciparum malaria: no evidence of diffuse intravascular coagulation.

Nine non-immune patients with imported falciparum malaria were examined for signs of diffuse intravascular coagulation (DIC). Although all had thrombocytopenia initially and some later had a decline in plasma fibrinogen concentrations, DIC was never detected, even in severely affected patients with coma and kidney damage. None of the patients were given heparin and all recovered without residual symptoms. Heparin administration should probably be considered only when clear-cut DIC, which possibly never occurs in falciparum malaria, has been demonstrated.     

Dendrochronology improves understanding of the charcoal production history

Charcoal piles have become a frequent subject of research in recent years as a better understanding of past human activities in forests is sought. The age of charcoal piles is usually determined by radiocarbon dating; dendrochronology is rarely used because of the small size of preserved charcoal remains and the insufficient number of visible tree rings. This paper presents the potential for dendrochronological and ¹⁴C method in research into charcoal piles. From 14 charcoal-burning sites in the Czech Republic, 214 pieces of charcoal were anatomically identified at the genus level and dendrochronologically analysed. Our results show that fir dominated in these charcoal remains, followed by oak, beech, spruce and pine. With an overall dendrochronological dating success of 24 %, fir charcoal was dated most often (65 %) with measurable tree rings ranging from 14 to 90. The oldest charcoals were dendrochronologically dated to summer 1682 CE; conversely, the youngest had end dates in the second half of the 19th century. The relatively poor dating success of oak charcoal very likely resulted from the use of branches for charcoal production rather than tree trunks. Based on an analysis of selected charcoal samples, we confirm that radiocarbon dating provided a very wide range of dates in the post-1650 CE period and the use of the wiggle-matching method was usually challenging because of short TRW series. Based on samples with preserved waney edges, we conclude that charcoal was more commonly made from wood felled in the summer than in the winter. Despite the relatively low level of success of dendrochronological dating, it seems more effective for dating charcoal than the ¹⁴C method, especially with samples from the last 350 years.     

Osteomalacia after Prolonged Glutethimide Administration

Vitamin D deficiency is a previously unreported complication of therapy with hypnotics, and we here report a case of osteomalacia associated with long-term glutethimide administration. There was evidence of pronounced hepatic enzyme induction, and the plasma half-time of ³H vitamin D₃ was decreased by this drug. In addition, raised levels of serum gamma-glutamyl transpeptidase, 5-nucleotidase, and leucine aminopeptidase were observed and the patient excreted large amounts of xylulose. These changes were reversed by stopping the glutethimide.     

The use of activated charcoal for the removal of PCR inhibitors from oyster samples

Activated charcoal is a carbonaceous adsorbent with a high internal porosity, and hence a large internal surface area. Cells of a strain of Escherichia coli O157:H7 seeded into oyster tissue homogenates were completely bound to untreated charcoal after an incubation period of 15 min at room temperature. In contrast, activated charcoal particles coated with cells of Pseudomonas fluorescens resulted in 92.6%+/-3.7 recovery of E. coli O157:H7. This allowed the successful use of the coated activated charcoal for the absorption of PCR inhibitors from seeded tissue samples. With coated charcoal, real-time PCR was able to detect 1x10(3) CFU of E. coli 0157:H7/g of tissue which was equivalent to 50 genomic targets per real-time PCR. In contrast, without the use of treated charcoal, the real-time PCR failed to detect 10(7) CFU/g. This is a promising, and convenient technology that can be applied to increase the sensitivity of the PCR assay without selective enrichment, for the detection of low numbers of pathogenic microorganisms in complex matrices such as foods, clinical, and environmental samples, which frequently exhibit high levels of PCR inhibition.     

A comparative study of three hypnotics: methyprylon,glutethimide and chloral hydrate

A controlled study designed to evaluate the hypnotic potentiality of methyprylon (300 mg.), glutethimide (500 mg.) and chloral hydrate (1000 mg.) was carried out on 50 in-patients experiencing long-standing insomina. The patients ranged in age from 21 to 60 years, the sexes were equally represented and the clinical diagnoses were psychoneurosis, reactive depression, or anxiety reaction. An interesting feature of the experimental design allowed for the exclusion of placebo reactors before the initiation of the main trials. No difference in effectiveness of maintaining sleep could be established among the three hypnotic agents, indicating that at the usual levels of statistical significance, all three agents were equally effective as hypnotics. However, a significant trend (P = .05) was found for methyprylon (Noludar) to be the most effective and chloral hydrate to be the least effective of the three drugs in maintaining sleep. Methyprylon was found statistically (P = .05) to be the fastest sleep-inducing agent, whereas glutethimide (Doriden) proved to be the slowest of the three hypnotics with respect to sleep induction time.