Accidental poisoning deaths in British children 1958-77.

In the 20 years 1958-77 598 deaths were registered as due to accidental poisoning in British children under the age of 10-343 boys and 255 girls. Drugs caused 484 deaths, non-medicinal products 111, and plants three. The annual number of deaths reached a peak in 1964 but fell steadily thereafter; 16 deaths occurred in 1977. After 1970 tricyclic antidepressants replaced salicylates as the most commonly fatal poison. The next ten drugs most often recorded in 1970-7 were, in order, opiates (including diphenoxylate/atropine (Lomotil)), barbiturates, digoxin, orphenadrine (Disipal), quinine, potassium, iron, fenfluramine (Ponderax), antihistamines, and phenothiazines. In 20 years paracetamol caused one death, and before 1976 deaths caused by aspirin had fallen to fewer than two a year. Thus the introduction in 1976 and 1977 of safety packaging of these drugs can be expected to have little impact on the mortality from them in childhood.     

Barbiturate Mortality as an Index of Barbiturate Use,Canada, 1950-1963

Changes in Canadian rates of mortality from barbiturates are examined, and their relation to barbiturate use in the general population is discussed. While the number of deaths attributed to barbiturates quadrupled, from 63 in 1950 to 232 in 1963, there has been a concomitant decrease in the number of deaths from inhalation of utility gas.Combined rates for deaths from utility gas and barbiturates declined steadily for most age groups between 1950-52, 1955-57, and 1959-63. It is possible that the increased mortality from barbiturates represents a change in fashion in regard to method of suicide. Changed mortality from barbiturates is not a valid measure of the extent to which consumption of barbiturates has increased in the Canadian population.     

儿童意外吸入磷化铝中毒55例临床分析及文献

目的:分析儿童意外吸入磷化铝中毒的临床特点、治疗方法及死亡原因。方法:对本院儿科2014年5月～2018年8月收治的55例意外吸入磷化铝中毒患者进行回顾性分析,根据病情严重程度将其分为轻度(31例)和重度(14例),统计患儿的年龄、性别、发病季节、中毒吸入时间、中毒就诊时间、临床症状、实验室及心电图检查。结果:55例吸入磷化铝中毒患儿中,死亡10例,存活45例,死亡患者均为重度中毒者,死亡原因为循环衰竭。轻度中毒毒素吸入时间平均为25.1 h,中毒后平均就诊时间14.6 h;重度中毒毒素吸入时间平均为185.4 h,中毒后平均就诊时间38.5 h;临床表现为恶心呕吐55例(100%),头晕、面色苍白14例(25%),心悸16例(29%),呼吸衰竭14例(25%),严重的心律失常8例(14.5%),低血压、心源性休克10例(18%);心电图检查:室上性心动过速1例,室性心动过速4例,II度II型房室传导阻滞1例,窦性心律不齐5例,窦性心动过速26例;实验室检查中心肌酶升高19例(34.5%);肝功能异常12例(21.8%);肾功能异常6例(10.9%);代谢性酸中毒14例(25%)。治疗上主要为对症支持治疗。结论:儿童意外吸入磷化铝中毒以重度中毒病例死亡率高,多为循环衰竭所致,目前无特效解毒药物,早期诊断和早期综合性治疗尤为重要。     

Changing pattern of drugs used for self-poisoning.

In 1967-76 the annual number of admissions to a poisoning treatment centre rose from 964 to 2134. The proportion of admissions caused by taking barbiturate hypnotics and methaqualone fell considerably while that caused by taking benzodiazepines and tricyclic antidepressants increased. As a result the proportion of patients admitted unconscious fell from 23% to 15%. The declining contributions of barbiturates and methaqualone and increased importance of tricyclic antidepressants were significant in all grades of coma. The change in drugs taken, however, has not yet reduced the percentage of unconscious patients needing endotracheal intubation or assisted ventilation, and hypothermia remains as common. Only hypotension has become less frequent as antidepressants replace barbiturates as the main cause of drug-induced coma. The use of salicylates for self-poisoning is declining slowly, and paracetamol poisoning is now as common.     

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.     

A note on wildlife poisoning cases from Kerala,South India

Wildlife poisoning is an important conservation threat for endangered species in India. There are no publications in the scientific literature that identify the specific poisons or chemicals involved in wildlife poisoning cases from the state of Kerala. In this report, all cases of wildlife mortality recorded between 2011 and 2013 at the office of the Assistant Forest Veterinary Officer, Periyar Tiger Reserve in Kerala were reviewed and cases where poisoning was considered as a differential diagnosis were identified. Specific poisons or chemicals were identified in three cases, while in a fourth, poisoning was determined to have occurred based on physical traces of the poison in gut contents. The poisons identified include carbofuran (a carbamate pesticide) in a bonnet macaque (Macaca radiata), warfarin (a rodenticide) in a mortality event involving four wild boars (Sus scrofa), endosulfan (an organochlorine pesticide) toxicity in a gaur (Bos gaurus) and imidacloprid (a neonicotinoid pesticide) toxicity in a wild adult Asian elephant (Elephas maximus). This communication thus reports for the first time on the specific chemical compounds identified in wildlife poisoning cases from Kerala state and argues for greater regulation of the sale and use of such toxic compounds in India.     

Incidence of leukaemia in young people in the vicinity of Hinkley Point nuclear power station, 1959-86.

The incidence of leukaemia and non-Hodgkin''s lymphoma in young people (aged under 25) living in a predefined area around the nuclear power station at Hinkley Point, Somerset, was examined for the period 1959-86 by using cancer registry data. During the period since Hinley Point began operations--that is, 1964-86--there were 19 cases in the area compared with 10.4 expected from national rates, giving a standardised registration ratio of 1.82 (95% confidence interval 1.10 to 2.85). The incidence in the rest of Somerset was also high, however (standardised registration ratio 1.18; 95% confidence interval 0.98 to 1.41), and the high rate around Hinkley Point may simply have been reflecting the high local incidence (ratio of the two standardised registration ratio''s 1.54; 95% confidence interval 0.90 to 2.52). Analysis of predetermined five year periods showed that the excess cases in the Hinkley Point area were concentrated in the 10 years 1964-73 after commissioning of the station, at a time when rates in the rest of Somerset were close to the national average. In particular the nine cases occurring in the five years 1969-73 were about four times the number expected from national rates (standardised registration ratio 3.96; 95% confidence interval 1.81 to 7.52). Rates in the Hinkley Point area after 1973 were fairly low, especially as compared with the rest of Somerset. In the five years 1959-63 (that is, before Hinkley Point was commissioned) rates throughout Somerset (including the Hinkley Point area) were higher than the national rate. These findings should be interpreted with caution, and further studies are required to test the plausibility of theories relating to radiation and viruses.     

Diagnostic utility of flumazenil in coma with suspected poisoning: a double blind,randomised controlled study.

OBJECTIVE--To assess the diagnostic value and safety of the benzodiazepine antagonist flumazenil in patients with coma of unclear origin with suspected poisoning. DESIGN--Double blind, placebo controlled, randomised study. SETTING--Intensive care unit at a major teaching hospital. PATIENTS--105 Unconscious adults admitted consecutively with suspected drug overdosage during 18 months from a total of 362 cases of poisoning. Exclusion criteria were pregnancy, epilepsy, obvious poisoning with drugs identified unequivocally from information from relatives or others as other than benzodiazepines, and coma score greater than 10 on a scale graded from 4 to 20. Patients were allocated randomly to receive flumazenil (21 men and 32 women) or placebo (25 men and 27 women). INTERVENTIONS--Intravenous injection of flumazenil (10 ml, 0.1 mg/ml) or placebo (10 ml vehicle alone) given double blind over three minutes. MAIN OUTCOME MEASURES--Serum and urine concentrations of benzodiazepines, antidepressants, and several other agents; blood gas tensions; standardised evaluation on admission and five minutes after the injection by means of coma scale score and urgent diagnostic or therapeutic interventions indicated according to the history and clinical examination; standardised interview after the injection to try to ascertain further information; and adverse reactions. RESULTS--Benzodiazepines were found in the serum in 36 of the 53 patients in the flumazenil group and in 37 of the 52 who received placebo. The average coma scale score increased significantly after injection in the flumazenil group (6.4 v 12.1, p less than 0.001) but not in the placebo group. In the flumazenil group several interventions were rendered unnecessary by the injection: gastric lavage and urinary catheterisation (19 patients each), intubation (21), artificial ventilation and computed tomography of the brain (three patients each), blood culture and lumbar puncture (one patient each), and electroencephalography (two). In the placebo group the indications for these procedures did not change in any patient after injection. The 95% confidence interval for the difference in reduction of the frequency of indications for gastric lavage after injection between the two groups was 21% to 51%, that for intubation 25% to 55%, and that for urinary catheterisation 21% to 51%. In the flumazenil group 21 patients gave valuable information on their drug ingestion within 10 minutes after injection compared with only one in the placebo group (p less than 0.001). Nine adverse reactions were recorded in the flumazenil group, eight of which were graded as mild and one severe. The safety of the antagonist was acceptable, even though 60% of the patients in the flumazenil group had multiple drug poisoning including benzodiazepine. No epileptic seizures or arrhythmias were recorded. CONCLUSION--Flumazenil is a valuable and safe differential diagnostic tool in unclear cases of multiple drug poisoning.     

Long-term variation in dates of mass spawning of cod Gadus morhua callarias (Gadidae) in the southeastern part of the Baltic Sea

Long-term data on the numbers of eggs of cod Gadus morhua callarias in ichthyoplankton and the seasonal variation of their distribution in the Gdansk Deep of the Baltic Sea are considered. The spring peak of spawning was observed for the years 1948–1954 and 1960–1964; the spring-summer peak for 1968–1977; and the summer peak for 1955–1959 and 1995–2001. Maximum egg numbers of cod were recorded from the late 1940s to the early 1950s; minimums were recorded in the late 1980s and the late 1990s. The decrease in the numbers of cod eggs in the ichthyoplankton, in general, coincided with a decrease in the proportion of spawners maturing at the beginning of the season of mass reproduction and a decrease in the oxygen content in the near-bottom layer of the Gdansk Deep. It is suggested that a shift of the spawning peak of cod from spring to summer is related to a decrease in the volume of near-bottom waters providing favorable conditions for the reproduction of this population.     

Jährliche Schwankungen der Individuenzahl in einer nordwestdeutschen trockenen Heide II

Summary The vegetation of a permanent quadrat situated in a Northwest German Calluno-Genistetum typicum community has been analysed every year from 1955 to 1959 (cf. Vegetatio X, p. s53–56, 1961) and again from 1960 to 1964.In the winter of 1955/56, when there were temperatures of –27° and an incomplete snow-cover, Calluna vulgaris had died in large amount. Nevertheless it increased again during the following years. The dry year of 1959 again caused a 35% reduction of this heather, but by 1960/61 a good recovering of Calluna was observed. Again from 1961 to 1964 Calluna decreased from 85% to 30%, but we have no satisfactory explanation for this fact.Probably the decline from 1959 to 1960 of the young plants of Quercus robur has been caused by the cutting off, the reduction from 1962 to 1964 by sheep grazing. The increase from 1960 to 1961 may have been caused by sowing by jays. The sudden appearance of Betula verrucosa and B. pubescens (1961) and their remarkable increase is the result of the invasion of large numbers of seeds and of the small vegetation-cover of the soil, perhaps also the result of the damaging of the cover of heathhumus by the sheep. Certainly the other higher plants have been imported by rabbits or sheep. They partially disappeared again after a few years.Perhaps the dryness of the year 1959 also caused the retrogression of the moss from 1958 (50%) to 1959. Maybe the sheep caused the further diminution of the moss and the decline of the cladonias. As expected, the macrofungi and the thalli of Parmelia physodes f. minor appeared during wet summers in especially great number, while dry periods caused their decay.     

广西大新黑洞哺乳动物化石

<正> 本文研究的材料是1955年初,由裴文中教授领导的野外考察队在广西大新、武鸣、柳州、崇左、扶绥等县进行古人类和第四纪哺乳动物洞穴调查时发现的。这批材料发现于大新县正隆乡牛睡山黑洞(野外编号:5657),计有巨猿等多种哺乳动物化石。巨猿牙齿化石已由裴文中、吴汝康共同研究并于1956年发表了专题报告。报告中曾提到,与巨猿同时发现的其它哺乳类化石有猩猩、大熊猫、剑齿象和巨獏等,其地质时代为更新世中期。     

4. SEA BIRDS OBSERVED ON AN EAST COAST VOYAGE

Skead, D. M. 1974. Habitats and feeding preferences of birds on the S.A. Lombard Nature Reserve, Transvaal. Ostrich 45:15-21.

The topography, climate and habitats of the S.A. Lombard Nature Reserve are described. The status of the 183 species recorded while the author was resident on the reserve, July 1964 to June 1967, was arranged into the various habitat types. It was found that 25% were residents while 65% of the residents occurred in the “Indifferent” category. Birds with a mixed diet predominated, 48,9%, while insect-eaters rated second, 35,8%.     

Manganese Intoxication

We have reported two cases of chronic manganese poisoning. Case 1 followed exposure to manganese fumes in cutting and burning manganese steel. Case 2 resulted from exposure to dusts of manganese dioxide, an ingredient used in glazing of ceramics. There were initial difficulties in establishing the correct diagnosis. Prominent clinical features were severe and persistent chronic depressive psychosis (Case 1), transient acute brain syndrome (Case 2) and the presence of various extrapyramidal symptoms in both cases.Manganese intoxication has not previously been reported as occurring in California. With increasing use of the metal, the disease should be considered in the differential diagnosis of neurologic and psychiatric disease.Our observations were made in the period 1964 through 1968. Recently the prognosis of victims of manganese poisoning has been improved dramatically by the introduction of levodopa as a therapeutic agent.     

A BARBITURATE ANTIDOTE—Use of Methylethylglutarimide in Barbiturate Intoxication and in Terminating Barbiturate Anesthesia

Methylethylglutarimide was administered to 488 patients ranging in age from 7 to 89 years, in a study on sleep-reversal after harbiturate anesthesia. Sodium surital or sodium pentothal were the barbiturates used. The drug was administered intravenously in doses varying from 25 to 200 mg. Dosage below 25 mg. was found to be ineffective. Almost all patients showed signs of awakening as evidenced by the return of corneal and conjunctival reflexes, the opening of the eyes, and stirring or moving about. Many responded to questioning. Almost all showed evidence of greater responsiveness within five minutes. No untoward reactions were noted. No convulsions were produced.Five patients ranging in age from 24 to 70 years were treated for barbiturate poisoning with Mikedimide® given intravenously in doses varying from 550 mg. to 1950 mg. All recovered consciousness within 30 minutes to an hour. No convulsions were produced.While it is not known whether Mikedimide is a direct barbiturate antagonist, or whether it is an analeptic, it appears to be a useful drug in reversing the respiratory depression and the cerebral depression produced by harbiturate intoxication and barbiturate anesthesia.     

Impacts of harmful algae on seafarming in the Asia-Pacific areas

Seafarming to produce human food has recently intensified, particularly in the Asia-Pacific region. Disastrous impacts of harmful phytoplankton blooms, however, have been experienced during the past 20 years. In extreme cases, these render shellfish and finfish toxic or cause massive fish and shrimp kills. Problems from marine algae in the region include paralytic shellfish poisoning, diarrhetic shellfish poisoning, ciguatera, tetrodotoxin poisoning, fish kills and tainting of fish and shellfish. An analysis of 72 incidents since 1934 showed that 57% were fish and shrimp kills; almost all the remainder were PSP events. By mid-1994 there had been 3164 recorded cases of human poisoning and 148 reported deaths from these events in Asia-Pacific. Economic losses may exceed one million US dollars per event, while monitoring costs may be up to $50000 annually for each affected area. Research needs, management strategies and international cooperation are discussed. National action plan considerations include shellfish sanitation programs, public awareness and education, coastal engineering and classification of waters to protect public health.     

Impacts of Aerial 1080 Poisoning on the Birds of Rangitoto Island, Hauraki Gulf, New Zealand

Bird populations were monitored for one year (October 1990- October 1991) to determine whether the 1080 poison used to eradicate possums and wallabies on Rangitoto Island had had any detrimental effects on them. There was no significant decline in bird numbers recorded immediately after poisoning, with four species increasing in abundance (P <0.001). Twelve months after the operation the abundance of four species had increased significantly (P <0.001). The poisoning does not appear to have had any negative effect on the bird populations of Rangitoto, while the removal of browsing mammals may in future prove to have beneficial effects.     

Was Young's syndrome caused by exposure to mercury in childhood?

OBJECTIVE--To determine whether the incidence of chronic sinusitis, bronchitis, or bronchiectasis in men with obstructive azoospermia (Young''s syndrome) has fallen in men born after 1955 when calomel (mercurous chloride) was removed from teething powders and worm medication in the United Kingdom. DESIGN--A prospective study of aetiological factors in subfertile men with epididymal obstruction operated on between 1975 and 1993. SETTING--Central London. SUBJECTS--274 men with obstructive azoospermia undergoing epididymovasostomy; date of birth was recorded and illness in childhood, persistent nasal or respiratory symptoms, and previous urinary or genital infection were asked about. MAIN OUTCOME MEASURE--Site of epididymal block and association with possible aetiological factors, related to date of birth. RESULTS--146 men had hold up in the head of the epididymis (capital blocks): 119 (82%) had Young''s syndrome, and 11 gave a definite history of pink disease (mercury intoxication) in childhood. 128 had obstruction lower down towards the tail of the epididymis (caudal blocks): 64 (50%) had a history of genital or urinary infection, and only three had Young''s syndrome; none had had pink disease. The incidence of Young''s syndrome fell significantly from 114 (50%) of 227 men born up to 1955 to eight (17%) of 47 men born since then. CONCLUSIONS--The decline in incidence of Young''s syndrome in those born after 1955 is similar to that observed with pink disease, suggesting that both conditions may have had a similar aetiology--mercury intoxication.     

Acute poisoning of Red Kites (Milvus milvus) in France: data from the Sagir network

Red Kites (Milvus milvus) are avian scavengers limited to Europe, and they currently are listed as an endangered species worldwide. Accidental poisoning is often listed as one of the threats to Red Kites throughout their range of distribution. The purpose of this article is to investigate the suspected poisoning cases reported to the French Wildlife Disease Surveillance System. Dead animals are submitted to a local veterinary laboratory for necropsy and when poisoning is suspected, samples are submitted to the Toxicology Laboratory of the College of Veterinary Medicine, Lyon, France. Over the period 1992-2002, 62 Red Kites suspected of poisoning were submitted, and poisoning was the confirmed cause of death for greater than 80% of these cases. The major toxicants found were cholinesterase inhibitors (carbamates and organophosphate insecticides) and anticoagulant compounds. The circumstances of exposure include secondary poisoning after the use of anticoagulants over vast areas to control water vole (Arvicola terrestric) populations, but they also include malicious poisoning with carbamates (aldicarb and cabofuran) in meat baits. Cases of poisoning vary throughout France, with observed mortality rates ranging between 0.1/100 hundred breeding pairs/10 yr and four cases/100 hundred breeding pairs/10 yr. Additional cases of poisoning likely go undetected, and our results suggest that acute poisoning is not uncommon in Red Kites and that it should be considered in the current restoration plans.     

Species diversity,susceptibility to disturbance and tree population dynamics in tropical rain forest

Abstract. In 1964 a census of all trees > 9.7 cm diameter at breast height (DBH) was conducted on 22 plots totalling 13.2 ha in lowland tropical evergreen rain forest on Kolombangara, Solomon Islands. Over the following 30 yr (1964–1994), populations of all individuals > 4.85 cm DBH of the 12 most common tree species and amounts of disturbance have been monitored on a declining number of these plots (in 1994, nine plots totalling 5.4 ha were still being recorded). Between November 1967 and April 1970, Kolombangara was struck by four cyclones, although only two of these caused substantial amounts of damage to the canopy structure. Multivariate analysis has identified six forest types on Kolombangara (Greig-Smith et al. 1967). The species richness and diversity of trees in the 1964 census, turnover rates of the populations monitored over 1964–1975, and the amount of disturbance sustained during a cyclone in 1970, were all positively correlated across five of the forest types. The sixth forest type was a consistent outlier in these analyses and is believed to have been seriously disturbed by humans about a century ago. The floristics, turnover and disturbance data support Connell's intermediate disturbance hypothesis. The most species-rich forest types contained a higher proportion of fast-growing individuals and species that are early-successional and which have low density timber. Properties of these species rendered them more susceptible to damage when struck by the 1970 cyclone. They showed higher turnover rates because disturbance-dependent species are also characterised by higher mortality and recruitment rates. Thus, periodic cyclones appear to favour the maintenance of differences in species diversity and composition between forest types.