Biomedical subjects
Publications and source records attributed to S Wason.
Camphor is present in several over-the-counter compounds of questionable use and therefore may be ingested by small children. Because seizures may follow ingestion of certain amounts, appropriate treatment is needed, including the use of anticonvulsants.
The case of a man who injected turpentine intravenously in an attempt to kill himself is reported. The patient developed immediate pulmonary edema and hypoxia, followed later by cellulitis at the site of injection. Although only one death to date has been attributed to this form of chemical abuse, extensive local reactions, pulmonary involvement, central nervous system depression, and febrile reactions should be anticipated, and such patients should be admitted to the hospital. Patients should be observed for local reactions and myonecrosis around the site of injection, especially as these occur 12-24 hours later.
Controversial therapeutic issues in patients with caustic ingestions concern the reliability of symptoms and signs in predicting esophageal injury, the appropriate use of endoscopy in evaluating esophageal damage, and the use of steroids in preventing late strictures. The conclusions of this review are: The majority of pediatric caustic ingestions involve a "lick and taste" whereas adolescents and adults often ingest substantial quantities. Oral burns and dysphagia are sensitive predictors of esophageal injury; however, esophageal injury may occur in the absence of the findings. Household bleach and nonphosphate detergents represent a low risk of injury whereas button batteries greater than 20 mm in diameter and Clinitest tablets represent high risk. Endoscopy should be an elective rather than emergency procedure and should be undertaken in all symptomatic patients, and in asymptomatic patients when history indicates substantial ingestion. Steroid therapy should be considered only for patients who have deep or circumferential esophageal burns.
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A previously healthy nonepileptic 11-year-old girl presented with confusion and disorientation after an acute ingestion of valproic acid. Her serum concentration of valproic acid was 39.6 mcg/ml, a range normally considered "therapeutic" in the control of seizures. She recovered without sequelae despite the subsequent attainment of higher valproic acid concentrations.
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A railroad accident in Somerville, Massachusetts, led to spillage of phosphorus trichloride liquid. Attempted clean-up with water led to the liberation of phosphorus trichloride, phosphoric acid, hydrochloric acid, and phosphorus oxides. Seventeen people exposed to this mixture were studied. Patients experienced eye irritation, lacrimination, nausea, vomiting, and dyspnea. Six patients had transient elevation of lactic dehydrogenase. Although all patients had normal chest roentgenographic findings, pulmonary function tests showed statistically significant decreases in vital capacity (p = 0.02), maximal breathing capacity (p = 0.02), forced expiratory volume in one second (p = 0.02), and maximal expiratory flow rate at 25 percent of vital capacity (p = 0.05) in those closest to the accident site. Further, patients exposed for less than one and a half hours had significantly greater maximal expiratory flow rates at 25 percent of vital capacity when compared with patients who had been exposed longer (p = 0.02). In seven patients, repeated pulmonary function tests one month later showed improvement, suggesting strongly that the acute effects may have been due to phosphorus trichloride toxicity.
Alcohol intoxication (methyl, ethyl, isopropyl, and ethylene glycol) is treated frequently in emergency room and intensive care units. Although high morbidity and mortality rates exist, effective therapies for methyl alcohol and ethylene glycol (ethyl alcohol blocking and hemodialysis) and ethyl and isopropyl alcohol (hemodialysis) are available. Prompt and accurate clinical and laboratory differentiation is needed to optimize these therapies. This review presents clinical, pharmacologic, and management data, contrasts important aspects in differential diagnosis, and suggests an appropriate approach to management of isopropyl alcohol intoxication.
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We treated five isoniazid-overdosed patients each with a single dose of pyridoxine hydrochloride equivalent to the gram amount of isoniazid ingested and compared their outcome with that of 41 patients from the literature who received little or no pyridoxine. Recurrent seizures occurred in 60% of patients who had received no pyridoxine vs 0% in our patients. Metabolic acidosis resolved in our cases but was refractory in the literature cases. In our cases, coma lightened more rapidly and was of shorter duration as compared with that in the literature cases (mean, seven hours vs 24 hours). No adverse effects of pyridoxine were seen in our patients.
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Superwarfarins consist of two classes of compounds, the 4-hydroxycoumarins and the indandiones. These compounds have replaced warfarin as an anticoagulant rodenticide. This article is a summary of the clinical effects produced by accidental and deliberate ingestions of superwarfarins. Most accidental ingestions occur in childhood and result in a benign outcome. Deliberate overdoses usually involve repeated ingestions of large quantities of superwarfarins that have resulted in prolonged laboratory evidence of interference with clotting; serious bleeding has been rare. This article suggests an approach to the management of patients with accidental and deliberate anticoagulant rodenticide ingestions.
OBJECTIVE: To compare the clinical effects of a new oral synthetic conjugated estrogens, A (SCE), versus placebo in a clinically relevant population on the reduction in the mean number of moderate to severe vasomotor symptoms. DESIGN: A total of 120 healthy pre- and postmenopausal women (72 active, 48 placebo) were enrolled into a randomized, placebo-controlled, double-blind, multi-center clinical trial. Women of all races were enrolled, using minimal inclusion and exclusion criteria. Each subject received either orally administered SCE, in doses of 0.3 mg, 0.625 mg or 1.25 mg per day, or placebo. Analysis of variance was performed on the primary efficacy variable (change from baseline to weeks 4, 8, and 12 in the mean number of moderate to severe vasomotor symptoms). RESULTS: Changes in moderate to severe vasomotor symptoms in the intent to treat population showed statistically significant differences between the active and placebo treatments at week 4 (P < .022), week 8 (P < .010), and week 12 (P < .010). By week 12, the mean percentage reduction in moderate to severe vasomotor symptoms was 81%, from an average baseline of 96.8, to 16.5 hot flashes per week for the active treatment group. The overall incidence of expected estrogen-related adverse effects was modest. Laboratory tests and vital sign measurements did not reveal clinically significant changes or abnormalities from screening to the final visit in either treatment group. CONCLUSIONS: The results of this study confirm the efficacy and safety of SCE in the treatment of moderate to severe vasomotor symptoms in menopausal women. In addition, the study also demonstrated that the use of more liberal entry criteria did not materially affect the efficacy outcome.