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Biomedical subjects

J F Deng

Publications and source records attributed to J F Deng.

At least 55 records · Page 3Linked to original sources
PubMed1996

Acute pancreatitis following organophosphate intoxication.

BACKGROUND: Acute pancreatitis as a complication of organophosphate intoxication has been infrequently addressed. Previous reports have suggested that acute pancreatitis may follow the oral ingestion of several organophosphates, including parathion, malathion, difonate, coumaphos, and diazinon, or after cutaneous exposure to dimethoate. No cases of acute pancreatitis following mevinphos (CAS 7786-34-71) poisoning have been reported to date. The possible pathogeneses of the pancreatic insult in organophosphate intoxication are excessive cholinergic stimulation of the pancreas and ductular hypertension. CASE REPORT: We describe a patient presenting with painless acute pancreatitis following an intentional ingestion of large amounts of mevinphos. Serum amylase and lipase values were increased and determination of amylase isoenzymes confirmed a pancreatic origin. A computerized tomograph of the abdomen showed diffuse swelling of the pancreas. The patient was discharged after a seven week clinical course, complicated by a delayed neuropathy. CONCLUSIONS: As acute pancreatitis in organophosphate intoxication may be more common than reported, serum pancreatic enzymes and appropriate imaging studies should be more liberally utilized. Early recognition and appropriate therapy for acute pancreatitis may lead to an improved prognosis.

Acute Disease↗
PubMed1996

Taiwan National Poison Center: epidemiologic data 1985-1993.

UNLABELLED: The Taiwan National Poison Center has received more than 30,000 telephone calls since its establishment in July 1985. OBJECTIVE: To obtain more information about poisoning exposures in Taiwan, a retrospective analysis was conducted of all telephone calls to the center concerning human poisoning exposures July 1985 through December 1993. METHODS: The following data were tabulated: age, sex, intent of exposure, route of exposure, substances ingested and clinical severity. RESULTS: During the eight years (1985-1993), 23,436 telephone calls concerning human poisoning exposure were recorded. Adults accounted for most cases (75.2%) and exposures involving males (54.2%) were somewhat more prevalent than female poisoning exposures (44.7%). Intentional poisonings (54.6%) were more common than unintentional poisonings (40.1%), with an inverse relationship in pediatric poisoning exposures. After amphetamines, the most frequently ingested poisons were pesticides, benzodiazepines, and cleaning products. Fatalities occurred most frequently following ingestion of pesticides. The mortality rate was 5.7% for all exposures. CONCLUSIONS: Human poisoning is a serious problem in Taiwan. The reduction of suicide attempts is a major objective. Childhood poisonings are underreported and of high mortality.

Adolescent↗
PubMed1996

Outbreak of obstructive ventilatory impairment associated with consumption of Sauropus androgynus vegetable.

BACKGROUND: Forty four individuals, suffering from temporary insomnia and poor appetite followed by progressive difficulty breathing after four weeks or more ingestion of the Sauropus androgynus or Sabah vegetable, were reported to the National Poison Center of Taiwan by physicians between August 23, 1994 and August 25, 1995. OBJECTIVE: A telephone questionnaire survey was designed and conducted to collect demographic data, information about use of the vegetable, past medical history and clinical presentation. Laboratory data were obtained from their physicians as available. RESULTS: Forty one patients, predominantly women, 43 +/- 11 years old, were identified in our survey. They reported a variety of sources and preparation methods for the vegetable. Difficulty breathing, identified in 36 cases, was the clinical hallmark. Twenty people gave a history of dyspnea delayed until 44 +/- 40 days after discontinuing vegetable consumption. Laboratory evidence of obstructive ventilatory impairment (FEV1/FVC 56 +/- 12%, FEV1 31 +/- 6%, PaO2 71 +/- 15%) was observed in 12 cases tested. An open lung biopsy performed in a demonstration case disclosed bronchiolitis obliterans organizing pneumonia. CONCLUSION: In this case series of 41 victims, we have identified a severe pulmonary effect and hypothesize that it is related to consumption of sauropus androgynus vegetable. Papaverine has been previously identified in this vegetable but is unlikely to be responsible for the full range of toxicity seen.

Adult↗
PubMed1996

Two outbreaks of acute Tung Nut (Aleurites fordii) poisoning.

OBJECTIVE: Aleurites fordii, widely distributed in the Southeastern US, Taiwan, mainland China, Japan and India, is commonly known as Tung Nut, Tung Oil Tree or Chinawood Oil Tree. The seeds are the most toxic part. CASE REPORTS: We report two outbreaks of Aleurites fordii poisoning, occurring on November 27, 1992 and November 29, 1994. Thirty-five elementary school students and 29 senior high school students misidentified Aleurites fordii seeds as chestnuts and ingested variable amounts. METHODS: We conducted a survey by questionnaire to supplement the hospital record information. Simple descriptive statistics and Chi-square (Fisher's exact) tests were calculated. RESULTS: The three most common symptoms of the patients were vomiting, abdominal pain and diarrhea. The more serious clinical presentations occurred in younger victims. Our information suggests that food attenuates intestinal irritation perhaps by delaying absorption of the toxic principle. With symptomatic treatment, all of the symptoms and signs subsided within one to two days. CONCLUSIONS: Aleurites fordii can be cultivated and is easily accessible to the community and schools. Public education about the toxicity of Tung Nut seeds in areas of ready availability may reduce the chance of misidentification and subsequent poisoning.

Adolescent↗
PubMed1996

Acute isoniazid intoxication: a case report.

Since its introduction in 1952, isoniazid has remained one of the drugs of choice in the treatment and prophylaxis of tuberculosis. In populations with a high prevalence rate of tuberculosis or suicide rate, acute ingestion of isoniazid has occasionally been reported. Acute intoxication by isoniazid is known to cause symptoms of seizures, metabolic acidosis, coma, and even death. These clinical symptoms, however, are not well recognized by physicians in Taiwan, even though the prevalence rate of tuberculosis is relatively high here. This report concerns the case of a 25-year-old female with a past history of tuberculosis who presented with the symptoms of refractory seizures, metabolic acidosis and deep coma after intentional ingestion of some unknown drug. Although implicating agents were not recognized initially, she was successfully revived with basic resuscitation, anticonvulsants and correction of metabolic acidosis. A review of her history revealed that her ingestion of five grams of isoniazid in this case was responsible for the entire clinical spectrum. Given easy access to isoniazid in Taiwan, a diagnosis of isoniazid poisoning should always be considered in patients who present with the classical symptoms of refractory seizures, metabolic acidosis and coma.

Acidosis↗
PubMed1996

Clinical experience in poisonings following exposure to blasticidin S, a curiously strong fungicide.

The fungicide blasticidin S has been used against a rice blast disease. Reports on its human toxicity are extremely limited, and irritation to GI tract, eye and skin are the presenting symptoms in most afflicted cases. Fatalities resulting from profuse intestinal fluid loss with subsequent hypotension have also been recorded. In an attempt to delineate the clinical pictures of blasticidin S poisoning, a retrospective study covering an 8.5-y period was then conducted. A total of 28 blasticidin S poisoning exposures, including 24 suicidal ingestions, were recorded. The ingested amounts in most cases were rather large, while 2 cases were found with estimated dosages up to 10 g. The presented symptoms in most cases were immediate vomiting, abdominal pain, diarrhea and sore throat which were resolved after conservative treatment. Nevertheless, hypotension, arrhythmia, acrocyanosis, aspiration, and even coma occurred in severe cases. Fatalities were noted in 5 patients, in whom profound hypotension and severe aspiration pneumonitis were the main features. Poisoning following blasticidin S ingestion remains a challenge to acute health care physicians. Adequate administration of i.v. fluid and careful monitoring of electrolytes have been considered as the mainstay in the treatment of blasticidin S poisoning. Prevention of aspiration and ventilatory support are also crucial for life-saving since poisoning cases might succumb after massive aspiration.

Aged↗
PubMed1996

Tetrodotoxin poisoning in Taiwan: an analysis of poison center data.

Tetrodotoxin (TTX) poisonings are not infrequently seen in Taiwan, and several outbreaks have been recorded by the Poison Control Center (PCC)-Taiwan during 1988-1995. However, their demographic data, clinical features, and medical outcome have not been reported. A retrospective study analyzed the PCC data of TTX poisonings. All patients reported to the PCC-Taiwan as TTX poisoning from July 1988 through December 1995 were included. Excluding 2 incidents, the diagnosis of TTX poisoning was documented by identification of puffer fish and/or by the analysis of TTX in it. Patient age, sex, season of poisoning, substances ingested, incubation period, presenting symptoms, recovery time, and clinical outcome were analyzed. A total of 20 incidents involved 52 patients. Males outnumbered females (52% vs 41%) with sex undetermined in 4 patients. Most incidents occurred in the spawning seasons of puffer fish, eg March to May. Puffer fish ingestion accounted for 18 incidents; ingestion of gastropod mollusks and Gobius criniger were responsible for the other 2 incidents. Following ingestion of puffer fish and other poisonous marine animals, most symptoms developed within 6 h with complete recovery usually in 24 h. Symptoms of TTX poisoning were similar as those previously reported; however, unusual features, such as hypertension (24%), pinpoint pupils (4%), bronchorrhea and facial flush (2%), were also seen. The mortality rate was 13.5%. The violent neurotoxin is present in puffer fish and occurs in other marine animals. Without adequate therapy, patients may have serious morbidity or even succumb. Careful identification of puffer fish and other poisonous marine animals, as well as proper treatment of TTX poisoning patients, are mandatory to successfully handle cases of TTX poisoning.

Aging↗
PubMed1995

The clinical experience of acute cyanide poisoning.

The authors reviewed the clinical manifestations, complications, and the prognosis affected by Lilly Cyanide Antidote in 21 victims of acute cyanide poisoning over a 10-year period. The clinical signs and symptoms in cyanide poisoning are variable. Among 21 cases, loss of consciousness (15), metabolic acidosis (14), and cardiopulmonary failure (9) were the three leading manifestations of cyanide intoxication. Anoxic encephalopathy (6) was not uncommon in the severely intoxicated victims. Diabetes insipidus (1) or clinical signs and symptoms mimicking diabetes insipidus (3) may be an ominous sign to encephalopathy victims. The major cause of fatal cyanide poisoning is the intentional ingestion of cyanide compounds as part of a suicide attempt. Decrease of arteriovenous difference of O2 partial pressure may be a clue for the suspicion of cyanide intoxication. Although the authors cannot show a statistically significant difference (P = .47) for the Lilly cyanide antidote kit in terms of improving the survival rate for victims of cyanide poisoning, the antidote kit was always mandatory in our study in the cases of severely intoxicated victims who survived. Early diagnosis, prompt, intensive therapy with antidote, and supportive care are still the golden rules for the treatment of acute cyanide poisoning, whether in the ED or on the scene.

Acute Disease↗
PubMed1995

An outbreak of tetrodotoxin poisoning following gastropod mollusc consumption.

Tetrodotoxin, a violent neurotoxin, is present in puffer fish and may occur in a variety of marine animals. Outbreaks of human tetrodotoxin poisoning, following consumption of marine organisms other than puffer fish, has been rare. We here report an outbreak of tetrodotoxin poisoning following ingestion of gastropod molluscs and its clinical features are discussed. A 71-year-old woman was admitted with hypertension and other neurological symptoms developing after ingestion of some molluscs. A further 16 cases were also found to have typical symptoms of tetrodotoxication after mollusc consumption. Clinical features in these 17 cases were similar to those conventionally found in tetrodotoxin poisoning, except that there was hypertension in eight cases (47%). All except one case had mild poisoning and recovered well. The molluscs consumed comprised two different species: Nassarius castus and Nassarius conoidalis, both of which were shown to contain various amounts of tetrodotoxin. It is concluded that tetrodotoxin poisoning following mollusc consumption is a possibility. Hypertension, as an unusual feature in tetrodotoxication, is frequent in this outbreak, and should be looked for in future cases. The explanation of hypertension in tetrodotoxication may come either from an exaggerated response to sympathetic stimuli, or due to various responses of the vasomotor centre to a small dose of tetrodotoxin. Further studies are required to answer this question.

Adolescent↗
PubMed1995

Severe rhabdomyolysis mimicking transverse myelitis in a heroin addict.

Heroin addiction is known to cause various medical and neurological complications. We report here a case of rhabdomyolysis following heroin abuse, in which a neurological lesion mimicking transverse myelitis was also noted. A 29-year-old man was found comatose in a kneeling position one day after a heroin overdose. On admission, he was awake, yet with total paralysis of his lower legs. Physical examination revealed marked swelling and tenderness of the four limbs, especially the lower extremities. Deep tendon reflexes and positional sense were absent in both legs; however, pin-prick sense was preserved. Transverse myelitis or spinal cord vasculitis was the initial working diagnosis. Laboratory tests disclosed significantly elevated creatinine kinase of 146289 U/L. Though suffering transient acute renal failure, his neurological abnormalities gradually improved over four weeks and a left foot drop was the only residual lesion at discharge. Rhabdomyolysis, a well defined complication following heroin use, may also cause concomitant neurological symptoms, for which careful differential diagnosis is warranted. With the increasing number of heroin addicts in Taiwan, more cases with rhabdomyolysis-induced neurological symptoms may be observed in the future.

Adult↗
PubMed1995

Metobromuron/metolachlor ingestion with late onset methemoglobinemia in a pregnant woman successfully treated with methylene blue.

Metobromuron, a substituted urea herbicide, is widely used for control of grasses and broad-leaved weeds in Taiwan. Major systemic toxicity has not been reported following poisoning. A 22-year-old woman at 36 weeks of gestation was admitted to the emergency department three hours after ingestion of a mixture of 25% metobromuron and 25% metolachlor. Though stable initially, she developed central cyanosis 12 hours later. Emergent cesarean section was considered but administration of intravenous methylene blue readily reversed the cyanosis and prevented the operation. Recurrent cyanosis did not develop. Normal vaginal delivery occurred 17 days after the poisoning. Follow-up for four years revealed normal growth of the child. Metobromuron poisoning, like other urea herbicides, may cause methemoglobinemia via its hydrolysis products. Administration of methylene blue is effective treatment and should be considered in the treatment of methemoglobinemia following urea herbicide poisoning.

Acetamides↗
PubMed1995

Hypoglycemia following ethanol ingestion in children: report of a case.

Ethanol is present in a large number of pharmaceuticals, cosmetics, detergents and beverages. Without adequate safety measures, the accidental ingestion of such products by children is possible. Ethanol ingestion by children is known to cause various metabolic and neurologic disorders, including hypoglycemia, metabolic acidosis, seizures or coma. In Taiwan, little information has been published regarding the effects of ethanol ingestion by children. This is a report of a 5-year-old boy who became hypoglycemic after ingestion of rice wine. Admitted in a coma, the boy regained consciousness within 30 min after slow administration of 5% dextrose. His initial plasma glucose level was extremely low and hypokalemia was also found. Blood ethanol was 159 mg/dL, 3 h after the alcohol ingestion. He was discharged in good health the following day. Ethanol-induced hypoglycemia may be easily overlooked as symptoms of adrenaline excess are frequently absent. Prompt recognition and treatment with intravenous glucose are essential and may be life-saving. Pediatricians need to be aware of the devastating impact of ethanol. Preventive measures, such as child-proof packaging and parent education, are required if ethanol intoxication in children is to be avoided.

Accidents, Home↗
PubMed1995

Acute heroin intoxication with complications of acute pulmonary edema, acute renal failure, rhabdomyolysis and lumbosacral plexitis: a case report.

After intravenous injection of heroin, a 27-year-old male with altered mental status and hypotension was seen at the Emergency Service where acute pulmonary edema was noted. The problem was resolved three days later after oxygen therapy had been administered by face mask. Acute renal failure, rhabdomyolysis and monoplegia of the patient's left leg were exhibited during his stay at the Intensive Care Unit. Neurological examination and electro-diagnostic studies (electromyography and nerve conduction velocity) showed left lumbosacral plexitis. Hemodialysis was given. Though the patient's hospital course was uneventful, satisfactory recovery from his left leg weakness, which persisted for one year after hospital discharge, was finally achieved.

Acute Disease↗
PubMed1995

Features of centipede bites in Taiwan.

In order to define characteristics that would help differentiate a centipede bite from a viper bite, we designed a prospective study using the data collection system of a Poison Control Center. The clinical goal is to rapidly distinguish envenomations for which antitoxin may be indicated (viper) from those for which palliative care only is appropriate (centipede). During a year period, 31 cases, including two cases receiving double bites in each event, were reported. Centipede lengths were estimated to range from 3 to 20 cm. Ninety-two per cent of the bite marks were pointed in shape. A local reaction developed at the bitten site, but usually remaining localized to a 10 x 10 cm area of involvement. The length of the biting animal, the bite mark characteristics, the presence of haemorrhagic vesicles, the wound size and the progression of local reactions are useful in the rapid clinical differentiation between centipede bites and viper bites.

Adolescent↗
PubMed1994

The role of flumazenil in the management of patients with acute alteration of mental status in the emergency department.

There are a few case reports which suggest that flumazenil can be used as a diagnostic tool in coma of unknown aetiology but no large scale studies have proved its efficacy and cost-effectiveness. Fifty five patients with acute alteration of mental status of unknown aetiology were enrolled prospectively during a time period of one year. Flumazenil was injected intravenously in a regimen of 0.3 mg in the first minute followed by alternate 0.2 mg, 0.3 mg doses every minute until a total dose of 1 mg was given or until the patients responded. Patients were divided into two groups based on their response to flumazenil: Group 1, responders and Group 2, non-responders. The hospital stay was shortened significantly and interventional procedures, such as CT of brain and endotracheal intubation, were rendered unnecessary in several patients in Group 1. The Group 1 patients had a more favourable outcome than that of Group 2. We concluded that flumazenil may serve as a useful tool in diagnosis and management of carefully selected patients with acute alteration of mental status.

Adult↗
PubMed1994

The climate and the occurrence of carbon monoxide poisoning in Taiwan.

Taiwan is an island situated in the subtropics. The lowest average temperature is around 15 degrees C (59 degrees F) during winter). Despite the mild climate, carbon monoxide intoxication still occurs frequently, especially during the winter. We studied which meteorological factor(s) affected the occurrence of carbon monoxide poisoning in Taiwan. Retrospective data over a period from December 1, 1986, to December 31, 1991, from patients who reported with carbon monoxide poisoning to the Poison Control Center, together with meteorological data were analysed. We found that a lower daily average temperature, especially while a special regional circulation pattern, called a 'cold front' or 'cold surge' (during winter) covers the Taiwan area, is strongly related to the occurrence of CO poisoning.

Adult↗
PubMed1994

The clinical implication of theophylline intoxication in the Emergency Department.

We reviewed the clinical manifestations of 53 episodes of theophylline intoxication in 50 patients over a one year study period, in order to identify the specific features as they presented to the Emergency Department (ED). There was a trend to an increase in the serum theophylline concentration with increased severity of clinical features, but the difference between the mild and the moderate cases was not statistically significant. The most common symptoms and signs were gastrointestinal complaints, sinus tachycardia, and atrial arrhythmias. Mixed atrial and ventricular arrhythmias, which are rarely mentioned as a specific feature of theophylline intoxication, were found in 16% of our patients and accounted for 29% of the cardiovascular manifestations. Four patients developed rhabdomyolysis, which presumably was secondary to a seizure or profound hypokalaemia. Cases of theophylline intoxication presenting to the ED had higher serum concentrations of theophylline and tended to have more severe toxicity than those patients in the non-ED group. Delayed diagnosis may contribute to the severity of the outcome, since severe cases in the ED were usually suspected to have developed intoxication at some point later in the stay in the ED than at the time of presentation, or after admission to the hospital, thus permitting the occurrence of an additional iatrogenic component to the intoxication. They also complained of symptoms not associated with the theophylline toxicity, which may have diverted the physician's attention from recognizing this concurrent problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗