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.     

Acute Paracetamol Poisoning

Of 41 cases of acute paracetamol poisoning one died of gastrointestinal haemorrhage and acute massive necrosis of the liver, three became jaundiced, and 13 others had biochemical evidence of hepatocellular damage. Liver damage is a toxic effect which is present in most patients who ingest more than 15 g. of paracetamol. One patient with liver damage survived renal failure due to acute tubular necrosis. It is suggested that the renal lesion was also the result of paracetamol overdosage.Profound hypoglycaemia and metabolic acidosis may also complicate severe poisoning. Plasma levels of para-aminophenol fall rapidly, and procedures currently used to enhance the elimination of the drug cannot be expected to prevent development of hepatic damage.     

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。     

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 tympanic cavity infiltration with effusion in a patient with acute myeloblastic leukemia

A case of acute myeloblastic leukemia with bilateral tympanic cavity infiltration with effusion in addition to right facial and bilateral auditory nerve involvement is described. Tympanotomy demonstrated the presence of leukemic cells in the effusion of bilateral tympanic cavities. While repeated examinations of the cerebrospinal fluid using the cytocentrifuge failed to show any leukemic cells, it was suspected that the bilateral tympanic cavity infiltration was associated with meningeal involvement.     

An Electrophysiological Study of Acute Tetrodotoxin Poisoning

To evaluate the electrophysiological changes in patients with acute tetrodotoxin (TTX) poisoning from ingestion of globefish (Tetraodontidae) patients exposed to TTX were compared with age-matched controls. The cohort of TTX-poisoning cases was clinically subdivided into mild, moderate, or severe cases. The motor nerve conduction velocity (MCV), sensory nerve conduction velocity (SCV), F-wave, H-reflex, and somatosensory-evoked potentials (SEP) of the median, ulnar, and common peroneal nerve (CPN) were determined using established techniques. Four of the 64 (6.3%) TTX-poisoning cases died and were omitted from the final analysis. The MCV and SCV of the median, ulnar, and CPN nerves in all the TTX-poisoning cases were significantly slower than the healthy controls. Severe cases of TTX poisoning had more significant reduction in nerve function. Thus, electroneurophysiological analysis could be used to determine the extent, course, and range of nerve system damage in patients with acute TTX poisoning.     

云南蘑菇中毒事件中的毒蘑菇物种多样性

近年来,云南省每年发生超过500起蘑菇中毒事件,造成2 000余人中毒,约30人死亡,成为我国蘑菇中毒危害最为严重的省份。系统研究蘑菇中毒事件中的毒蘑菇多样性,可以为蘑菇中毒精准防控提供科学依据和技术支撑。本研究对云南省2013年以来开展过科学物种鉴定的223起中毒事件进行了系统分析,发现云南省蘑菇中毒一年四季均有发生,主要集中在6-9月份,中毒事件数和中毒人数7月份达到高峰,而6月份死亡人数最多。地区分布分析发现云南省蘑菇中毒事件涉及14个市州,中毒事件数前5位分别为德宏、玉溪、保山、楚雄和普洱,均位于云南中部及以南地区。223起中毒事件中共成功鉴定出47种毒蘑菇,分属6种中毒类型(急性肝损害型、急性肾衰竭型、横纹肌溶解型、胃肠炎型、神经精神型和光敏性皮炎型)。这些毒蘑菇包含发现于中国的新物种16种,以及2019年以来发现的中国新记录种3种。致命鹅膏Amanita exitialis和亚稀褶红菇Russula subnigricans分别造成19人和9人死亡,是云南省最危险的2种剧毒蘑菇。青褶伞Chlorophyllum molybdites、日本红菇R. japonica、光硬皮马勃Scleroderma cepa、近江粉褶菌Entoloma omiense和发光类脐菇Omphalotus olearius位列胃肠炎型中毒的前5位。热带紫褐裸伞Gymnopilus dilepis、毒歧盖伞近似种Inosperma cf. virosum和兰茂牛肝菌Lanmaoa asiatica位列神经精神型中毒的前3位。叶状耳盘菌Cordierites frondosus是目前云南省造成光敏性皮炎型中毒的唯一物种。     

The Effect of Urography on Renal Function in Patients with Multiple Myeloma

Reports in the medical literature of seven patients with multiple myeloma who died of acute renal failure following intravenous urography prompted a study of 39 patients with multiple myeloma who were subjected to intravenous urography at the Cleveland Clinic from 1940 to 1959. Four developed acute renal failure and two died within three weeks. All four revealed evidence of renal damage, or insufficiency, or both prior to urography. Thirty-five patients, 15 of whom had renal damage, had no untoward reaction to intravenous urography. These observations suggest that urography is associated with a small but definite risk in patients who have multiple myeloma and renal involvement.     

Anatomical repair of nerve membranes in crushed mammalian spinal cord with polyethylene glycol

Acute damage to axons is manifested as a breach in their membranes, ion exchange across the compromised region, local depolarization, and sometimes conduction block. This condition can worsen leading to axotomy. Using a novel recording chamber, we demonstrate immediate arrest of this process by application of polyethylene glycol (PEG) to a severe compression of guinea pig spinal cord. Variable magnitudes of compound actions potentials (CAPs) were rapidly restored in 100% of the PEG-treated spinal cords. Using a dye exclusion test, in which horseradish peroxidase is imbibed by damaged axons, we have shown that the physiological recovery produced by polyethylene glycol was associated with sealing of compromised axolemmas. Injured axons readily imbibe horseradish peroxidase—but not following sealing of their membranes. The density of nerve fibers taking up the marker is significantly reduced following polyethylene glycol treatment compared to a control group. We further show that all axons—independent of their caliber—are equally susceptible to the compression injury and equally susceptible to polyethylene glycol mediated repair. Thus, polyethylene glycol—induced reversal of permeabilization by rapid membrane sealing is likely the basis for physiological recovery in crushed spinal cords. We discuss the clinical importance of these findings.     

A cervical ligamentum flavum cyst in an 82-year-old woman presenting with spinal cord compression: a case report and review of the literature

Introduction

Legionnaires' disease is recognized as a multi-systemic illness. Afflicted patients may have pulmonary, renal, gastrointestinal tract and central nervous system complications. However, renal insufficiency is uncommon. The spectrum of renal involvement may range from a mild and transient elevation of serum creatinine levels to anuric renal failure requiring dialysis and may be linked to several causes. In our present case report, we would like to draw attention to the importance of the pathological documentation of acute renal failure by reporting a case of a patient with acute tubulointerstitial nephritis complicating Legionnaires' disease.

Case presentation

A 55-year-old Caucasian man was admitted to our hospital for community-acquired pneumonia complicated by acute renal failure. Legionella pneumophila serogroup type 1 was diagnosed. Although the patient's respiratory illness responded to intravenous erythromycin and ofloxacin therapy, his renal failure worsened, he became anuric, and hemodialysis was started. A renal biopsy was performed, which revealed severe tubulointerstitial nephritis. After initiation of steroid therapy, his renal function improved dramatically.

Conclusions

This case highlights the importance of kidney biopsies in cases where acute renal failure is a complicating factor in Legionnaires' disease. If the presence of acute tubulointerstitial nephritis can be confirmed, it will likely respond favorably to steroidal treatment and thus irreversible renal damage and chronic renal failure will be avoided.     

Mandibular herpes zoster; with report on the use of cortisone in a case with geniculate ganglion symptoms

Herpes zoster, an acute specific viral infection, occurs more commonly than is generally supposed. It should be differentiated from other diseases involving the ear and skin; it must be considered as a possible etiologic agent in some palsies of the facial, glossopharyngeal or vagal nerves. The type of cephalic herpes zoster should be carefully differentiated; cases involving the "geniculate zone" may be other than "Ramsay Hunt's syndrome." This syndrome is now defined as a herpes zoster eruption of the external ear at the "geniculate zone" with involvement of the seventh or seventh and eighth nerves. The "topognostic" method is the best for determining the level at which the facial nerve has been affected. It is questioned whether there is a single outstanding therapeutic agent for this disease. Cortisone had no apparent therapeutic effect in a case reported herein.     

Towards a novel haemoglobin-based oxygen carrier: Euro-PEG-Hb, physico-chemical properties, vasoactivity and renal filtration

Blood transfusion is still a critical therapy in many diseases, traumatic events and war battlefields. However, blood cross-matching and storage may limit its applicability, especially in Third World countries. Moreover, haemoglobin, which in red blood cells is the key player in the oxygen transport from lung to tissues, when free in the plasma causes hypertension and renal failure. This investigation was aimed at the development of a novel haemoglobin-based oxygen carrier with low vasoactivity and renal filtration properties. Human haemoglobin was chemically conjugated with polyethylene glycol (PEG) under either aerobic or anaerobic conditions, following different chemical procedures. The resulting PEGylated haemoglobin products were characterized in terms of oxygen affinity, cooperativity, effects of protons and carbon dioxide concentration, and oxidation stability, and were transfused into rats to evaluate vasoactivity and renal filtration. A deoxyhaemoglobin, conjugated with seven PEG and seven propionyl groups, which we called Euro-PEG-Hb, did not produce profound hypertension, was 99% retained within 6 h, and exhibited oxygen binding properties and allosteric effects more similar to human haemoglobin A than the other tested PEGylated haemoglobin derivatives, thus appearing a very promising candidate as blood substitute.     

The role of iNOS inhibitors on lung injury induced by gastrointestinal decontamination agents aspiration

Aspiration is a devastating complication during decontamination procedure in poisoning patients. We have investigated whether S-methylisothiourea protects different pulmonary aspiration gastrointestinal decontamination agent-induced lung injury in rats. Forty-two male Sprague-Dawley rats were assigned to one of six groups (n = 7): normal saline, activated charcoal, polyethylene glycol, normal saline + S-methylisothiourea treated activated charcoal + S-methylisothiourea treated and polyethylene glycol + S-methylisothiourea treated. Normal saline, activated aharcoal and polyethylene glycol were instilled into the lungs. The rats received S-methylisothiourea i.p twice daily for 7 days. Serum surfactant protein D, oxidative stress products and inducible nitric oxide synthase expression in the lung were investigated. The aspiration of activated charcoal significantly increased all histopathological scores (P < 0.01). Only peribronchial inflammatory cell infiltration, alveolar edema, and alveolar histiocytes were increased in the polyethylene glycol groups as compared to the normal saline group (P < 0.05). Pulmonary aspiration increased serum malondialdehyde (P < 0.001), and surfactant protein D (P < 0.05) levels and decreased serum superoxide dismutase levels (P < 0.05). S-methylisothiourea treatment decreased all histopathological scores in the activated charcoal treated S-methylisothiourea group (P < 0.01) and only decreased alveolar edema and alveolar histiocytes in the polyethylene glycol-treated S-methylisothiourea group (P < 0.05). S-methylisothiourea treatment reduced elevated oxidative factors, inducible nitric oxide synthase activity and serum surfactant protein D levels. Our findings showed that S-methylisothiourea may be a protective drug against Activated Charcoal and Polyethylene Glycol-induced lung injury.     

Chemical induction of mating abnormalities and spermatophore production in the Mediterranean flour moth, Ephestia kühniella

Hexamethyl-melamine (hemel) when injected into male Ephestia kühniella induced mating aberrations expressed as permanent copulation, sterile mating and spontaneous production of spermatophore. Permanent copulation was not caused by blockage or an elongated spermatophore column but probably caused by failure of the male reproductive organs to completely transfer the spermatophore. Spontaneous spermatophore formation was induced by both cholinesterase inhibitors and nerve stimulants, the effect of the former being more pronounced. It was not caused by stress due to poisoning since DDT even at lethal doses did not induce a response. The results suggest involvement of the nervous system in spermatophore production during a normal mating.     

Role of glomerular nitric oxide in glycerol-induced acute renal failure

Myoglobinuric acute renal failure remains one of the least understood clinical syndromes and the mediators involved remain obscure. The aim of the present study was to assess the role of nitric oxide in glycerol-induced acute renal failure under normal conditions and after uninephrectomy. Acute renal failure was induced in rats by injection of 50% glycerol (10 mL x kg(-1) body weight). Half of the animals were subjected to uninephrectomy two days before glycerol injection. Two days after the induction of acute renal failure, glomeruli from some animals were isolated and glomerular nitrite production was measured. Another group of animals was used for acute clearance studies. In this case, the effect of infusing either L-NAME or L-arginine was assayed. Glomerular nitrite production was significantly decreased in glycerol-induced acute renal failure. Glomeruli from uninephrectomized animals showed an increase in nitrite production, both in normal conditions and after glycerol injection, as compared with glomeruli from non-nephrectomized animals. L-NAME infusion worsened renal function in all the study groups, but more slowly in animals with glycerol-induced acute renal failure than in control rats. In uninephrectomized animals L-NAME reduced renal function more than in animals with two kidneys. In conclusion, in this model of acute renal failure the decrease in glomerular nitric oxide production plays an important role in the decrease in renal function. After uninephrectomy, an increase in glomerular nitric oxide synthesis plays a protective role against glycerol-induced acute renal failure.     

Should patients with renal failure associated with myeloma be dialysed?

In a study of renal function in multiple myeloma seven patients presented with renal failure and three developed it 16-106 months after diagnosis. All were dialysed. Infection with dehydration was a precipitating factor in all seven cases of acute or acute on chronic renal failure. Of these, two patients recovered normal renal function and one other was left with permanent renal impairment but no longer required dialysis. Results from the seven patients with acute renal failure and for the three with more chronic features support the practice of dialysis for all patients who present with renal failure. Dialysis is not indicated for those patients with progressive myelomatous disease. The study showed no evidence that chemotherapy permitted recovery from established renal failure. The prognosis in this elderly group is heavily dependent on the presence of cardiovascular or other degenerative disease.     

Controlled concealment of exposed clearance and immunogenic domains by site-specific polyethylene glycol attachment to acetylcholinesterase hypolysine mutants

Cholinesterases are efficient scavengers of organophosphates and are currently being developed as drugs for treatment against poisoning by such compounds. Recombinant ChE bioscavengers have very short circular longevity, a limitation that can be overcome by complex post-translation manipulations or by chemical modification such as polyethylene glycol conjugation. Series of multiple Lys-Ala mutants of human acetylcholinesterase were prepared allowing the generation of homogenous and well defined polyethylene-glycol conjugated AChEs with either one, two, three, four, or five appended polyethylene glycol (PEG) moieties/molecule. The rank order of circulatory longevity of these molecules was dependent on the number of PEG appendages up to a certain threshold: 5 = 4 > 3 > 2 > 1 > 0. Hypolysine acetylcholinesterases (AChEs) carrying the same number of PEGs, and therefore with identical masses, allowed us to demonstrate that circulatory longevity correlates with the predicted extent of concealment of the AChE surface. Furthermore, circulatory profiles of high number and low number PEG-AChEs differing in their sialic acid contents demonstrate a direct relationship between PEG loading and the effective seclusion of AChE from the hepatic asialoglycoprotein receptor clearance system. Finally, an inverse relationship is found between the extent of PEG loading and the ability of the human acetylcholinesterase to elicit specific anti-HuAChE antibodies. In conclusion, these findings suggest that for the extension of circulatory longevity, protein surface domain concealment exerted by polyethylene glycol attachment is at least as important as its effect on size enlargement and highlights the role of PEG attachment in masking interactions between biomolecules and their cognate receptors.     

Studies of the fiber to crystal transition of sickle cell hemoglobin in acidic polyethylene glycol

The crystallization of deoxygenated sickle cell hemoglobin in acidic (pH 5.2) polyethylene glycol (10%) has been studied in order to determine if the mechanism of crystal formation under such conditions has features in common with the mechanism of crystal formation at higher pH values in the absence of polyethylene glycol. The existence of a common mechanism of crystallization under different conditions is relevant in validating the use of the known high resolution crystal structure to interpret the fiber structure. Our findings indicate that deoxygenated sickle cell hemoglobin crystallization in acidic polyethylene glycol is initiated by fiber formation. Fibers, in turn, convert to larger structures called macrofibers within several hours (Wellems et al., 1981). Fibers and macrofibers (and their respective optical transforms) formed in acidic polyethylene glycol appear to have the same structure as their counterparts formed at higher pH values in the absence of polyethylene glycol. Early in the transition one can observe macrofibers in the process of alignment and fusion. The structural characterization of the intermediates leaves little doubt that crystallization in acidic polyethylene glycol is mediated by the same mechanism as that occurring under more physiological conditions, and that fibers are a metastable intermediate whose ultimate fate is to crystallize.     

Renal Failure in Cirrhosis of the Liver

The clinical course and autopsy findings of three patients with acute renal failure terminating the course of cirrhosis of the liver are presented. Review of the literature demonstrated that where decompensated cirrhosis is present the renal blood flow is characteristically low, although the total cardiac output is elevated. This circulatory disturbance results in the production of urine low in sodium, although normal in solute content. It also renders the kidney more vulnerable to further, sometimes minor, reductions in renal blood flow. As more patients with hepatic cirrhosis live through episodes of gastrointestinal bleeding and hepatic coma, death in acute renal failure will undoubtedly become more common.     

Porcine pancreatic lipase partition in potassium phosphate-polyethylene glycol aqueous two-phase systems

This research study examined porcine pancreatic lipase partition in aqueous two-phase systems formed by polyethylene glycol-potassium phosphate at pH 6.0, 7.0 and 8.0, the effect of polymer molecular mass, and NaCl concentration. The enzyme was preferentially partitioned into the polyethylene glycol rich phase in systems with molecular mass 4000-8000, while with polyethylene glycol of 10,000 molecular mass it was concentrated in the phosphate rich phase. The enthalpic and entropic changes found due to the protein partition were negative for all the polyethylene glycol molecular mass systems assessed. Both thermodynamic functions were shown to be associated by an entropic-enthalpic compensation effect suggesting that the water structure ordered in the ethylene chain of polyethylene glycol plays a role in the protein partition. The addition of NaCl increased the lipase affinity to the top phase and this effect was most significant in the system polyethylene glycol 2000-NaCl 3%. This system yielded an enzyme recovery more than 90% with a purification factor of approximately 3.4.