Biomedical subjects

J F Deng

Publications and source records attributed to J F Deng.

At least 73 records · Page 4Linked to original sources

PubMed1994

Fatal and nonfatal methamphetamine intoxication in the intensive care unit.

Methamphetamine poisoning was confirmed in eight patients admitted to intensive care 1989 through 1992 because of altered mental status and hemodynamic instability. Four patients were male and four were female, ages 20 to 34 years. Five patients were addicts and three were attempted suicides. The most common clinical cardiovascular manifestations were tachycardia and palpitations. Neurological abnormalities included agitation, hallucinations, pupillary dilatation and muscle twitching; profuse sweating was also common. All patients had rhabdomyolysis and four had remarkable elevation of creatinine kinase > 10,000 U/L. Leucocytosis was noted in seven cases. Therapy included aggressive circulatory support with Swan-Ganz monitoring, external cooling and other modalities. The three fatalities (two addicts, one suicide) presented with coma, shock, body temperature 39 degrees-42 degrees C, acute renal failure, metabolic acidosis and hyperkalemia (K 5.6-8.5 mmol/L).

Adult↗

PubMed1994

Experimental podophyllotoxin (bajiaolian) poisoning: III. Biochemical bases for toxic effects.

The biochemical mechanism underlying the toxicity of podophyllotoxin is investigated. Previous studies from our laboratories suggested that hepatocytes were extremely sensitive to the toxicity of podophyllotoxin and a disruption of protein synthesis was suspected. Dose-response and time-course studies on the effects of podophyllotoxin on protein. RNA, and DNA syntheses on hepatocellular cultures were made. Inhibitions of protein, RNA, and DNA syntheses were demonstrated, and a direct correlated dose-response relationship on such effects was also evident. Inhibition of protein synthesis appeared to be a direct toxic effect of podophyllotoxin and occurred independently from that of RNA. The reduction of DNA synthesis was reflected by a reduction of H3-thymidine incorporation, which is believed to be the consequence of inhibition on the mitotic activity by podophyllotoxin.

Cells, Cultured↗

PubMed1994

Survival of paraquat intoxication complicated with mediastinal emphysema: a case report.

Paraquat intoxication is a common medical problem in this country. The mortality is high, particularly in the cases of high dose ingestion. Mediastinal emphysema observed in paraquat intoxication always means mortality, however, we experienced a survivor. A 29 y/o female ingested about 10-15 c.c. of 24% (2.4-3.6 gm) paraquat to attempt suicide. Nausea and protracted vomiting occurred shortly after. During hospitalization, mediastinal emphysema developed on the 7th day and subsided 10 days later. Serum paraquat level determination revealed 185 ng/ml in 20 hours after ingestion and 34 ng/ml on the 6th day. She received general supportive treatments with the augmentation of sodium thiosulfate. Hypokalemia had been observed for 11 days and was intractable until hypomagnesemia was identified and corrected. So far, she had returned back to her work for more than 1 year, although the chest x-ray revealed slight pulmonary fibrosis. The high ingested dose, oral ulcers, high serum level and mediastinal emphysema of this patient all implicate a poor prognosis of paraquat intoxication; however, these contradict the observed survival of our patient. In conclusion, mediastinal emphysema observed in paraquat intoxication is not related to the serum level of paraquat. It does not absolutely lead to death and may simply come from the esophageal rupture after vigorous vomiting in paraquat intoxication.

Adult↗

PubMed1994

Adult respiratory distress syndrome and late death following imipramine overdose: a case report.

Adult respiratory distress syndrome (ARDS) after tricyclic antidepressant (TCA) overdose has been reported, but has not received as much attention in the literature as hemodynamic instability, cardiac arrhythmias or seizures. This report concerns a 33-year-old female who ingested a large amount of imipramine in an attempted suicide. She developed deep coma, hypotension, cardiac dysrhythmias and seizures. Although she survived initially, ARDS developed and she died of severe hypoxia nine days later. Her lung injury may have been the result of a variety of factors including prolonged hypotension, aspiration pneumonia, sepsis or a direct action on the lung parenchyma by imipramine. The literature pertaining to etiology, epidemiology, pathophysiology and management of TCA-induced lung injury has been reviewed. In one series of severe TCA overdose, an ARDS rate of 9% was reported. The risk of developing pulmonary edema and ARDS should be considered in severe TCA-poisoned patients. To try to prevent this complication, early intubation should be considered to avoid aspiration, and cautious volume loading, plus judicious use of alpha-adrenergic agonists, is indicated to prevent protracted hypotension.

Adult↗

PubMed1993

Diagnostic and therapeutic utility of flumazenil in comatose patients with drug overdose.

From July 1, 1990 and June 30, 1991, 61 unconscious patients with drug intoxication were prospectively enrolled into this study in order to evaluate the efficacy and safety of flumazenil in the management of this patient population. Flumazenil was injected intravenously as a 0.3-mg bolus in the first minute followed by 0.2-mg and 0.3-mg doses every minute until a total dose of 1 mg was given or until the patient responded. The Glasgow coma scale and a sedation-level scoring system were checked prior to and at 1, 5, and 30 minutes after the dose eliciting response or on completion of the full dose of flumazenil. The patients were divided into two groups based on their response to flumazenil: group 1, responders (N = 55), and group 2, nonresponders (N = 6). Eleven patients from group 1 allowed us to retrieve drug information from these patients once mental status had recovered and patients were treated accordingly. In two cases endotracheal intubation and artificial ventilation were rendered unnecessary by the use of flumazenil. No undesirable hemodynamic effects were noted after flumazenil injection in this study, although none of the patients overdosed on antidepressants. Flumazenil may serve as a useful diagnostic and therapeutic tool in the management of selected cases of drug-induced coma.

Adolescent↗

PubMed1993

Measuring lidocaine metabolite--monoethylglycinexylidide as a quantitative index of hepatic function in adults with chronic hepatitis and cirrhosis.

Lidocaine is metabolized to form monoethylglycinexylidide (MEGX) via oxidative N-deethylation in the liver. To assess the clinical value of this lidocaine metabolite as a quantitative liver function test, we measured the serum MEGX concentration 15 min after intravenous administration of a single dose of lidocaine (1 mg/kg) in 24 adults with chronic hepatitis, 47 patients with cirrhosis and 26 normal controls. A fluorescence polarization immunoassay was used to obtain the MEGX value. The MEGX concentration in controls was 67 (54-95) ng/ml (median with 16th-84th percentile in parentheses), which was higher than 43 (23-61) ng/ml in patients with chronic hepatitis and 24 (7-52) ng/ml in those with cirrhosis (P < 0.05). In addition, the serum MEGX levels are proportional to the galactose elimination capacity, and inversely proportional to Pugh's score, the prothrombin time and indocyanine green retention ratio. If a MEGX concentration of below 54 ng/ml is taken as an indicator of hepatic dysfunction, its diagnostic sensitivity for hepatic disorder is 84.5%, specificity 88.5% and accuracy 85.6%. Furthermore, after a 10-month follow-up, patients with MEGX formation above 30 ng/ml had a higher survival rate than those with a MEGX concentration below this level (P = 0.004). In conclusion, the MEGX formation test reflects the severity of hepatic dysfunction quite well, making it valuable both in the quantitative evaluation of liver function and in the prognostic prediction of adults with liver diseases.

Adult↗

PubMed1993

[Toad or toad cake intoxication in Taiwan: report of four cases].

The parotid glands and skin of the toad contain toxic substances. Ingestion of toad or toad cake may result in intoxication. Clinically, it may be predominantly manifested by a digitalis-like cardioactive effect. During the last six years, the National Poison Center of Taiwan has collected four cases of toad or toad cake intoxication: two cases were toad intoxication and two cases were toad cake intoxication. All four cases manifested with general weakness; three cases showed bradycardia, vomiting and diarrhea; two cases had numbness of the oral cavity; one case had excessive salivation; and two cases showed a consciousness change. In one case, an EKG showed bradycardia, and a first and second degree A-V block; this patient died of ventricular fibrillation. The prognosis in two cases was good. We lost contact with the last patient. The treatment principles in toad or toad cake intoxication is life support. If ingested, treatment is directed at prevention of absorption, including emesis, gastric lavage, activated charcoal and cathartics. Atropine, a pacemaker and other antiarrhythmic agents may be helpful in treating cardiovascular toxicity.

Adult↗

PubMed1993

[Chloroform-induced hepatic injury: a case report].

Chemical hepatic injury is not rare in Taiwan. We here report such an injury induced by chloroform. A previously healthy 26-year-old married woman was admitted under the impression of acute chemical hepatitis in December, 1991. Two weeks before, she had used chloroform as glue to unite two pieces of plastic pencil sharpener at home. Nasty odor was sensed while working. After series of hepatitis workup, liver echo, site visit, survey of coworkers and gas chromatography for the "glue", the diagnosis of chloroform-induced hepatic injury was confirmed. This case found that neither employer nor employee was aware of the toxicity of chloroform. No ventilation system or personal respiratory protection equipment was provided. Preemployment training and Material Safety Data Sheet were obviously insufficient, also. The diagnostic criteria of chemical hepatic injury were therefore proposed to alert medical professionals, industrial hygienist, safety personnel and factory inspectors, not to prompt an early diagnosis but also hopefully to prevent the occurrence of occupational liver diseases.

Adult↗

PubMed1992

Renal cell cancer among paperboard printing workers.

A physician's alert prompted us to investigate workers' cancer risk at a paperboard printing manufacturer. We conducted a retrospective cohort mortality study of all 2,050 persons who had worked at the facility for more than 1 day, calculated standardized incidence ratios (SIRs) for bladder and renal cell cancer, and conducted a nested case-control study for renal cell cancer. Standardized mortality ratios (SMRs) from all causes [SMR = 1.0, 95% confidence interval (CI) = 0.9-1.2] and all cancers (SMR = 0.6, 95% CI = 0.3-1.0) were not greater than expected. One bladder cancer and one renal cell cancer were included in the mortality analysis. Six incident renal cell cancers were observed, however, compared with less than two renal cell cancers expected (SIR = 3.7, 95% CI = 1.4-8.1). Based on a nested case-control analysis, the risk of renal cell cancer was associated with overall length of employment but was not limited to any single department or work process. Although pigments containing congeners of dichlorobenzidine and o-toluidine had been used at the plant, environmental sampling could not confirm any current exposure. Several limitations and a potential selection bias limit the inferences that can be drawn.

Adolescent↗

PubMed1992

Anterograde amnesia in triazolam overdose despite flumazenil treatment: a case report.

Anterograde amnesia, possibly accompanied by acute brain syndrome, is a potential side-effect of certain benzodiazepines, particularly triazolam. Flumazenil is a benzodiazepine antagonist that is highly effective in reversing the central nervous system effects of benzodiazepine overdose. We report a case of triazolam overdose resulting in anterograde amnesia after flumazenil administration had restored clear consciousness. The defect in memory may have been due to too little flumazenil being given or failure of memory consolidation affected by the character of triazolam during the induced lucent period. We feel that physicians should be aware of the potential occurrence of acute brain syndrome in patients with benzodiazepine overdose despite treatment with flumazenil.

Adolescent↗

PubMed1992

Podophyllotoxin intoxication: toxic effect of Bajiaolian in herbal therapeutics.

Bajiaolian (Dysosma pleianthum), one species in the Mayapple family, has been widely used as a general remedy and for the treatment of snake bite, weakness, condyloma accuminata, lymphadenopathy and tumours in China for thousands of years. However, the textbooks of traditional Chinese medicine mention little about the toxicity of Bajiaolian. Within 1 year, the authors saw five people who manifested nausea, vomiting, diarrhoea, abdominal pain, thrombocytopenia, leucopenia, abnormal liver function tests, sensory ataxia, altered consciousness and persistant peripheral tingling or numbness after drinking infusions made with Bajiaolian. The herb was recommended by either traditional Chinese medical doctors or herbal pharmacies for postpartum recovery and treatment of a neck mass, hepatoma, lumbago and dysmenorrhoea. Podophyllotoxin is one of the main ingredients of the Bajiaolian root. The clinical manifestations observed in our patients were consistent with podophyllum intoxication. Podophyllotoxin intoxication usually results from the accidental ingestion or topical application of podophyllum resin. However, these cases of Bajiaolian intoxication were iatrogenic and results from 'therapeutic doses' of Bajiaolian cited in the textbooks of traditional Chinese medicine.

Adult↗

PubMed1992

Dermatitis caused by dimethyl cyanocarbonimidodithioate.

Dimethyl cyanocarbonimidodithioate (CAS No. 10191-60-3) a raw material for cimetidine synthesis, is labelled as an irritant on its storage tank. There is no information available regarding the toxic effects of human exposure. We report a case of severe dermatitis clinically resembling erythema multiforme following an accidental exposure to dimethyl cyanocarbonimidodithioate in an occupational setting. A clerk sifted a handful of dimethyl cyanocarbonimidodithioate from an unlabelled bucket through his bare hands during an inspection prior to customs clearance. Five hours later, while he was washing his hands, pruritus, erythema and vesicles developed over the exposed area. The skin condition worsened within two weeks, extending to his whole body with generalized erythema and vesicles of various sizes. Some vesicles became confluent with ruptured bullae, resembling a second degree burn over 40% of the body. Elevation of the serum IgE (705 mu/mL, normal less than 300 mu/mL) and lymphocyte activation with an increased 3H-thymidine uptake by the patient's mononuclear cells suggested that this episode resulted from a cell-mediated allergic skin reaction. The skin lesions improved progressively after systemic steroid therapy for about two weeks. Dimethyl cyanocarbonimidodithioate is used as a raw material for cimetidine synthesis by some pharmaceutical manufacturers. Our experience suggests that a severe reaction similar to that caused by another H2-blocker, ranitidine and its intermediate may be caused by dimethyl cyanocarbonimidodithioate in occupational exposures. Systemic steroid administration is beneficial in treatment.

Adult↗

PubMed1992

[Flumazenil as an emergency management of patients with acute mental disorder].

From July 1, 1990 to June 30, 1991, 55 adult patients with acute alteration of mental status of unknown etiology were enrolled into this study in order to evaluate the diagnostic and therapeutic role of flumazenil in the management of this disorder. Patients who were pregnant or had severe head injury, hemodynamic instability or a provisional diagnosis of hypoglycemia, meningitis or acute cerebrovascular event were excluded. Flumazenil was injected intravenously first in a regimen of 0.3 mg followed by alternative 0.2 mg and 0.3 mg doses every minute until a total dose of 1 mg was given or until the patients responded. These patients were divided into 2 groups based on their response to flumazenil: Group 1, responders (N = 26) and Group 2, nonresponders (N = 29). Good response in Group 1 allowed the cancellation or discontinuation of brain CT scan in 18 patients; intubation and artificial ventilation in 2 and vasopressor infusion in one. The hospital stay was shortened significantly as compared with historical information in uncomplicated benzodiazepine intoxication patients who were admitted before flumazenil was introduced. The Group 2 patients who were with a great span of levels of severity in clinical courses, had higher admission and mortality rate than Group 1 (p < 0.01). We concluded that flumazenil may serve as a useful tool in the diagnosis and management of carefully selected patients. The use of flumazenil with our selective criteria will be cost effective, achieve rapid diagnosis and reduce laborious care in certain cases.

Acute Disease↗

PubMed1992

Experimental podophyllotoxin (bajiaolian) poisoning: I. Effects on the nervous system.

Bajiaolian, one of the species in the Mayapple family (Podophyllum pelatum), has been widely used as a traditional Chinese herbal medicine for the remedies of snake bites, general weakness, poisons, condyloma accuminata, lymphadenopathy, and certain tumors in China. In Western medicine, Podophyllum was first used medically as a laxative in the early 19th century. Since 1940, the resin of podophyllum has also been used topically for various skin lesions, such as warts and condyloma. Human poisonings have been reported. An animal model was established to investigate the neurotoxic effects of Bajiaolian. Podophyllotoxin, the major active ingredient in Podophyllum, was injected (ip) to young adult male rats at doses of 0, 5, 10, or 15 mg.kg-1 b.w.. The animals were sacrificed 72 h after injection. Neuronal changes were readily observable in animals treated with 10 or 15 mg.kg-1 of the toxin. Edematous changes of the anterior horn motoneurons were observed in the spinal cord. No neuronal necrosis was found. The type of neuronal swelling is believed to be only a transient change and would probably subside with time if no further assaults occur. More serious and perhaps longer term of changes were found in the dorsal ganglion neurons and the nerve fibers (axons) in the central and peripheral nervous system. Severe depletion of the Nissl substance (RNA/polyribosomes) was observed in the dorsal root ganglion neurons. Alterations in these sensory neurons would give rise to and correlate with the sensory disturbances experienced by the patients. Bodian staining also revealed a dose-related increase in the coarseness (thickness) of the nerve fibers (axons) in the cerebellum, cerebral cortex, brainstem, and spinal cord. This is the first scientific study showing the neurotoxicity of Bajiaolian, a commonly used Chinese herbal medicine. Toxicities on other organ systems by this drug certainly exist. Caution should be exercised in the dispensing and usage of this medicine.

Animals↗

PubMed1992

Experimental podophyllotoxin (bajiaolian) poisoning: II. Effects on the liver, intestine, kidney, pancreas and testis.

Young male rats were orally intubated with podophyllotoxin: Group I, control animals, orally fed with vehicle only; Group II, fed with an initial dose of 5 mg.kg-1 b.w., followed by a daily dose of 1.67 mg.kg-1 b.w. for 7d. Group III, fed with an initial dose of 15 mg.kg-1 b.w., followed by a daily dose of 5 mg.kg-1 b.w. for 7d. All animals were sacrificed 72 h after the last dosing. Histopathological examination revealed dose-related fatty change of the liver, atrophy and degenerative changes of the intestinal epithelial linings and testicular seminiferous tubules. Depletion of the pancreatic acinar cell granules was also apparent in the Group III animals. No pathology, however, was observed in the kidneys. The present study demonstrated for the first time degenerative changes in the liver, intestine, testis, and pancreas of animals ingested podophyllotoxin. These pathological changes correlate well with the clinical signs/symptoms of abnormal liver function, abdominal pain and diarrhea, and reduced serum amylase in humans poisoned by podophyllum. Inhibition of protein synthesis and mitosis (disruption of microtubules) are believed to be the underlying mechanisms of these changes observed in the animals intoxicated by podophyllotoxin.

Animals↗

PubMed1991

Characterisation of respiratory health and exposures at a sintered permanent magnet manufacturer.

Sintered permanent magnets are made from the powdered metals of cobalt, nickel, aluminium, and various rare earths. During production, exposure to respirable crystalline silica and asbestos may also occur. Reported here is a cross sectional study of 310 current and 52 retired hourly employees who worked 10 or more years making sintered magnets. Each participant had a chest radiograph, spirometry, and completed a respiratory questionnaire. Illness logs were also reviewed to calculate the incidence of recorded respiratory disorders. The prevalences of abnormalities in pulmonary function and respiratory symptoms were not higher than found in an external referent population. Although the prevalence of diffuse parenchymal opacities consistent with pneumoconiosis (four workers) was similar to the referent population, one worker had radiographic findings consistent with silicosis and two workers had profusion scores of 1/2 or above, not seen in the referent group. The incidence of reported respiratory conditions in the log, including asthma, was 10 times that of other manufacturers in the same industrial classification category. Excessive exposures to cobalt, nickel, and respirable silica were shown by environmental measurements.

Adult↗

PubMed1991

Hypertension as an unusual feature in an outbreak of tetrodotoxin poisoning.

We report an outbreak of tetrodotoxin poisoning resulting from consumption of ovaries of an unidentified species of fish. Thirty victims manifested the typical neurologic symptoms of tetrodotoxin poisoning. Although hypotension is the classically described blood pressure reaction, eight individuals developed hypertension (average blood pressure 192/110 mm Hg); one died of acute pulmonary edema. Semi-quantitative tetrodotoxin bioassay of two uneaten ovaries revealed tetrodotoxin concentrations of 54 Mouse Units/gm and 287 Mouse Units/gm, respectively. To gain insight into the unusual phenomenon of hypertension observed in our outbreak, we interviewed the victims, performed a funduscopic exam for hypertensive retinopathy and checked their blood pressure periodically in the ensuing year. Mild hypertension evidenced by retinopathy and elevated blood pressure was found in all seven who manifested hypertension during the acute event and survived. We postulate that individuals with pre-existing hypertension responded to the relatively small doses of tetrodotoxin with a dramatic rise in blood pressure. This resulted in the fatal outcome for one individual with severe coronary artery disease. Hypertension should be recognized as a possible feature of tetrodotoxin poisoning, especially in predisposed individuals.

Adult↗

PubMed1991

Taiwan National Poison Center survey of glyphosate--surfactant herbicide ingestions.

Between January, 1986 and September, 1988, the Taiwan National Poison Center recorded 97 telephone consultations (49 male, 48 female) on cases of ingestion of glyphosate-surfactant herbicide concentrate containing the isopropylamine salt of glyphosate (N-phosphonomethyl glycine, CAS 1071-83-6) and a non-ionic tallow amine surfactant. Eleven of the cases resulted in fatalities, all among those attempting suicide. The average amount ingested by survivors was 120 +/- 112 mL and by nonsurvivors was 263 +/- 100 mL (p less than or equal to 0.0001). The average age of survivors was 35 +/- 15 years compared to 54 +/- 11 years for fatalities (p less than or equal to 0.0002). Irritation of the oral mucous membrane and gastrointestinal tract was the most frequently reported effect. Other effects recorded were pulmonary dysfunction, oliguria, metabolic acidosis, hypotension, leukocytosis and fever. Fourteen patients received either atropine or pralidoxime plus atropine despite the fact that glyphosate does not inhibit acetylcholinesterase. Thirteen percent of patients received a urine test for paraquat or treatment customarily used for paraquat ingestion, possibly reflecting similar initial presentations following ingestion of these two herbicides. Laboratory differentiation is essential if any doubt exists about which herbicide was ingested. Patients ingesting large volumes of concentrated glyphosate-surfactant herbicide formulations require close observation and supportive treatment.

Accidents↗