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.     

Carbon monoxide poisoning and nonoliguric acute renal failure.

Carbon monoxide poisoning in a 37-year-old man was complicated by neurologic damage, skin changes, muscle necrosis and nonoliguric renal failure. The relation between nontraumatic rhabdomyolysis and acute renal failure in carbon monoxide poisoning is reviewed. Recognition of the acute renal failure in such cases is important, for this complication can be fatal; the prognosis is excellent, however, if proper medical management is provided.     

Mushroom Poisoning in Canada: Report of a Fatal Case

At least 150 cases of mushroom poisoning occur in Canada each year, 75% in the Province of Ontario. Eighty per cent of the total are in children under the age of 9, and most do not require hospitalization. Amanita virosa poisoning is a potentially fatal medical emergency which presents as an acute gastroenteritis, progressing to hepatorenal failure. Treatment consists of elimination of undigested mushrooms, rapid rehydration, management of acute liver and renal failure, and prevention of infection during the recovery phase.     

Bilateral peripheral facial nerve palsy in acute poisoning with ethylene glycol

Acute poisonings with polyethylene glycol become more and more frequent. The acute poisoning with polyethylene glycol leads to a considerable metabolic acidosis and acute renal failure. Usually there is no peripheral nervous system involvement. Two cases of the bilateral facial nerve palsy in patients with renal failure due polyethylene glycol poisoning are presented. It seems that it is the first report on the lesions to facial nerve involvement in the course of the acute polyethylene glycol poisoning.     

Diagnosis of acute intoxications in critically ill patients: focus on biomarkers – part 2: markers for specific intoxications

Abstract

In medical intensive care units, acute intoxications contribute to a large proportion of all patients. Epidemiology and a basic overview on this topic were presented in part one. The purpose of this second part regarding toxicological biomarkers in the ICU setting focuses on specific poisons and toxins. Following the introduction of anion and osmol gap in part one, it’s relevance in toxic alcohols and other biomarkers for these poisonings are presented within this publication. Furthermore, the role of markers in the blood, urine and cerebrospinal fluid for several intoxications is evaluated. Specific details are presented, amongst others, for cardiovascular drug poisoning, paracetamol (acetaminophen), ethanol, pesticides, ricin and yew tree intoxications. Detailed biomarkers and therapeutic decision tools are shown for carbon monoxide (CO) and cyanide (CN^-) poisoning. Also, biomarkers in environmental toxicological situations such as mushroom poisoning and scorpion stings are presented.     

洗胃术在抢救急性口服毒物中毒中的应用研究进展

洗胃在我国仍是抢救急性口服毒物中毒的重要措施,口服毒物中毒是生活中误服或有意自服而发生的中毒,是医院急诊科最常见的急症之一,它的发病时间与药物浸入的途经、毒性、剂量等有关。口服毒物中毒,情况紧急严重,若抢救不及时、治疗不当和观察护理不到位,可危及生命,而彻底清除胃肠毒物是抢救口服毒物中毒成功的关键。洗胃用物的合理选择,洗胃液的正确使用以及洗胃方法的不断改进是抢救成功的重要保证。     

National Poisons Information Services: report and comment 1980.

The National Poisons Information Services (NPIS) covering the United Kingdom and the Republic of Ireland currently receive over 40,000 telephone inquiries a year. Over the years there has been little change in the proportion of inquiries related to each of the main categories of poisons (drugs, household, chemical, agricultural, animals, and plants). More detailed analysis, however, shows pronounced changes in the inquiries relating to specific types of poisoning, particularly with drugs. By monitoring these trends and assessing the risks of toxicity, the NPIS has an important role in informing the medical profession of the need for preventive measures and for improved methods of treatment. At present, the NPIS cannot make full use of the available data due to inadequate staffing and lack of computer facilities. It is argued that for a modest increase in funding a much more comprehensive service could be provided.     

Morbidity from Acute Carbon Monoxide Poisoning at Three-year Follow-up

Seventy-four survivors of acute carbon monoxide poisoning were followed up for an average of three years. In eight patients gross neuropsychiatric damage was directly attributable to the poisoning. Three patients had committed suicide and eight had died from other causes. Morbidity and mortality in those deliberately and accidentally poisoned was approximately equal.Of 63 patients alive at follow-up eight showed an improvement and 21 (33.3%) a deterioration of personality after poisoning, and 27 (43%) reported a subsequent impairment of memory. Deterioration of personality and memory impairment were highly correlated. The level of consciousness on admission to hospital in the acute phase of poisoning correlated significantly with the development of gross neuropsychiatric sequelae. These findings emphasize the importance of prompt and efficient treatment of carbon monoxide poisoning and the need to follow-up all cases in the anticipation of a relapsing course or the development of sequelae.     

复方丹参对急性汞中毒家兔的保护作用及其机制

目的:探讨复方丹参对急性汞中毒家兔的保护作用及其机制。方法:采用皮下注射1%氯化高汞(Hg-Cl2,1.7ml/kg)溶液,复制家兔急性汞中毒的动物模型。动态观察血尿素氮(BUN)、血浆铜蓝蛋白(CP)、乳酸脱氢酶(LDH)、酸性磷酸酶(ACP)、丙二醛(MDA)及红细胞超氧化物歧化酶(SOD)含量的变化;检测肾皮质、肺、肝、心及脾脏组织匀浆MDA、SOD的含量;同时检测尿蛋白和尿沉渣;并与丹参处理组和生理盐水对照组比较。结果:注射HgCl2后0.5h和9.5h分别给予复方丹参注射液2ml/kg,可使BUN、CP、LDH、ACP及MDA含量降低,且可防止SOD减少,各项指标与汞中毒组比较均有统计学意义(P0.05,P0.01);尿蛋白和尿沉渣中的管型也明显减少。结论:急性汞中毒后不仅损害肾脏,而且累及多个器官组织。复方丹参能通过稳膜作用减轻或在一定程度上防止急性汞中毒过程的进行性加剧。     

The injured lung: clinical issues and experimental models

Exposure of military and civilian populations to inhaled toxic chemicals can take place as a result of deliberate release (warfare, terrorism) or following accidental releases from industrial concerns or transported chemicals. Exposure to inhaled toxic chemicals can result in an acute lung injury, and in severe cases acute respiratory distress syndrome, for which there is currently no specific medical therapy, treatment remaining largely supportive. This treatment often requires intensive care facilities that may become overwhelmed in mass casualty events and may be of limited benefit in severe cases. There remains, therefore, a need for evidence-based treatment to inform both military and civilian medical response teams on the most appropriate treatment for chemically induced lung injury. This article reviews data used to derive potential clinical management strategies for chemically induced lung injury.     

HBO治疗对急性CO中毒后海马不同分区神经细胞凋亡的作用研究

目的:通过研究高压氧(HBO)治疗急性CO中毒大鼠海马不同分区神经细胞凋亡情况,探讨HBO治疗急性CO中毒的应用及机理。方法:利用雄性SD大鼠,建立急性CO中毒模型。应用免疫组织化学以及免疫荧光的方法,测定在染毒和CO中毒HBO治疗后1 d、3 d、7 d、14 d和21d Bcl-2、caspase-3、Neu N、BAX和MMP-9的表达水平的变化。结果:海马CA3区神经细胞对急性CO中毒与HBO治疗比CA1和CA2区更加敏感;急性CO中毒后,海马各区神经细胞凋亡程度随1 d、3 d、7 d、14 d和21 d时间延长而加重;BAX、caspase-3和Bcl-2等凋亡相关因子的表达水平与MMP-9的变化趋势一致:在1d开始增多,3d达到最大值,7d开始减少,14 d与21 d与正常组类似;CO中毒大鼠进行HBO治疗后,海马各区MMP-9、BAX、caspase-3和Bcl-2的表达水平明显降低;且HBO治疗7 d后,海马各区这些凋亡相关因子的表达降低最为明显。结论:海马CA3区神经细胞对急性CO中毒及HBO治疗敏感;海马神经细胞凋亡可能与神经细胞表达MMP-9降解神经细胞周围的基质,表达BAX、caspase-3和Bcl-2等凋亡相关因子促进凋亡发生有关;HBO治疗可降低MMP-9以及BAX、caspase-3和Bcl-2等凋亡因子的表达,抑制神经细胞的凋亡;HBO治疗7d对神经细胞凋亡的抑制作用最明显。     

Medical planning for a major event: the Pope's visit to Coventry Airport, 30 May 1982.

The five-hour day visit by the Pope to Coventry Airport on 30 May 1982 required a major exercise in medical planning. First- and second-line first-aid facilities were provided by the British Red Cross Society and the St John Ambulance Association. Hospital facilities were provided in a 30-bed Territorial Army field hospital. The visit attracted a crowd of 350,000; 1424 casualties were seen at first-aid stations and 152 at the field hospital. Twenty patients required transfer to NHS hospitals for further treatment, and one woman died. Most ailments experienced were headaches and effects of heat, blisters, and abdominal symptoms. The field hospital treated a wide range of conditions including cardiac conditions, fractures, premature labour, and acute abdominal emergencies.     

洗胃术在抢救急性口服毒物中毒中的应用研究进展

洗胃在我国仍是抢救急性口服毒物中毒的重要措施,口服毒物中毒是生活中误服或有意自服而发生的中毒,是医院急诊科最常见的急症之一,它的发病时间与药物浸入的途经、毒性、剂量等有关。口服毒物中毒,情况紧急严重,若抢救不及时、治疗不当和观察护理不到位,可危及生命,而彻底清除胃肠毒物是抢救口服毒物中毒成功的关键。洗胃用物的合理选择,洗胃液的正确使用以及洗胃方法的不断改进是抢救成功的重要保证。     

华南常见毒鹅膏菌及其中毒事件分析

根据文献报道和实际调查对华南地区的有毒鹅膏种类进行统计分析,确认了21种常见有毒鹅膏菌,包括急性肝脏损害型的剧毒鹅膏、急性肾脏损害型和神经精神型的毒鹅膏各7种。对2000-2019年20年间发生的有毒鹅膏中毒事件进行统计分析显示,华南地区有毒鹅膏中毒事件共发生45起,163人中毒,60人死亡,病死率为36.8%;毒鹅膏的中毒事件主要发生在3-9月,其中3月份最多。致命鹅膏Amanita exitialis引起的中毒起数、中毒人数和中毒死亡率均占中毒事件总数的70%左右,是华南毒蘑菇中毒的“头号杀手”。本研究对华南地区毒蘑菇中毒的科学精准防控、有效减少中毒事件的发生、以及降低中毒死亡率具有重要意义。     

Long-Term Care Facilities: Important Participants of the Acute Care Facility Social Network?

Background

Acute care facilities are connected via patient sharing, forming a network. However, patient sharing extends beyond this immediate network to include sharing with long-term care facilities. The extent of long-term care facility patient sharing on the acute care facility network is unknown. The objective of this study was to characterize and determine the extent and pattern of patient transfers to, from, and between long-term care facilities on the network of acute care facilities in a large metropolitan county.

Methods/Principal Findings

We applied social network constructs principles, measures, and frameworks to all 2007 annual adult and pediatric patient transfers among the healthcare facilities in Orange County, California, using data from surveys and several datasets. We evaluated general network and centrality measures as well as individual ego measures and further constructed sociograms. Our results show that over the course of a year, 66 of 72 long-term care facilities directly sent and 67 directly received patients from other long-term care facilities. Long-term care facilities added 1,524 ties between the acute care facilities when ties represented at least one patient transfer. Geodesic distance did not closely correlate with the geographic distance among facilities.

Conclusions/Significance

This study demonstrates the extent to which long-term care facilities are connected to the acute care facility patient sharing network. Many long-term care facilities were connected by patient transfers and further added many connections to the acute care facility network. This suggests that policy-makers and health officials should account for patient sharing with and among long-term care facilities as well as those among acute care facilities when evaluating policies and interventions.     

Hepatocyte population dynamics during hydrocortisone and thioacetamide treatment

Summary The orderly organization in a number of discrete classes of weight persists in the hepatocytes during acute and chronic poisoning with thioacetamide and during a prolonged treatment with hydrocortisone, though many striking cytological and structural changes occur in the liver.The number of hepatocyte classes decreases under hydrocortisone treatment and during acute and chronic thioacetamide poisoning, and increases during recovery after acute thioacetamide poisoning and during the late phases of chronic thioacetamide poisoning. This is due to decrements and increments in dry mass of the hepatocytes, which occur by steps, through repeated losses and additions of a constant amount of solids substantially corresponding to the class period.Such a mechanism is similar to that acting in the hepatocyte atrophy due to starvation and in the hepatocyte enlargement occurring during postnatal development. Therefore, the increment and the decrement in dry mass by defined steps takes place in the hepatocytes in both physiological and pathological conditions.This work was supported by a grant of the Consiglio Nazionale delle Ricerche, Rome, Italy.     

北京怀柔“4.23”急性可乐定中毒事件临床救治体会

本研究旨在观察群体性急性可乐定中毒的流行病学特点、临床表现及救治方法,尤其是评价血液灌流（hemoperfusion,HP）治疗急性可乐定中毒的有效性和安全性.通过对北京怀柔4.23急性可乐定中毒事件行流行病学调查,分析所有80例患者的所有流行病学资料,研究病情较重的34例患者的临床表现、治疗方案、预后情况.采用HA230树脂血液灌流器数次HP治疗前后血可乐定、尿可乐定浓度的变化,计算血可乐定浓度下降率,及与常规内科治疗相比HP的排毒效率.观察治疗前患者血压、心率及其他实验室指标如血小板、心肌酶谱、肝酶谱的变化并评价疗效及副作用.研究发现急性可乐定中毒具有隐蔽性强,发病潜伏期短,症状重等特点,HP治疗可显著降低血可乐定水平,短暂升高尿可乐定水平.患者临床症状亦显著改善,血可乐定的下降率为（81±12）%,所有患者经间断HP治疗1～3次后血、尿可乐定水平接近正常.随着患者血可乐定浓度渐趋正常,其临床症状及实验室指标亦能明显改善,短期HP治疗无明显副作用,随访观察半月余,未观察到后遗症.群体性可乐定中毒常常具有危害人群广,症状重风险大,诊治难度大的特点,重者致人死亡,或者造成社会极大恐慌.研究群体性可乐定中毒有浓厚的军事医学意义,HP是治疗可乐定中毒安全有效的治疗手段.     

Who cares for head injuries?

Patterns of management for head injury in the acute and late stages are reviewed in respect of both mild and severe injuries. Because so many disciplines are involved, continuity of care if often difficult to achieve; and no one discipline is concerned with planning for the care of head injuries in a strategic way. The needs of head-injured patients are defined and suggestions made for improving care by the reorganization of existing facilities. What is most needed is to concentrate on patients with head injuries, both in the acute and in the late stages. Only then can medical, nursing, and paramedical personnel become skilled in dealing with the many problems which such patients present.     

Chondromatous hamartoma treated by transpleural bronchotomy; report of a case with review of the literature

Since parathion and other cholinesterase insecticides are being used extensively, safety precautions are important, and the need for prompt and adequate therapy if poisoning does occur must be emphasized. This paper stresses the acute nature of the poisoning and attempts to outline the basic principles of therapy so that practicing physicians may handle cases with more confidence, which should help prevent prolonged periods of functional disturbances due to anxiety following poisoning.