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PubMed1990

Peroral application of synthetic activated charcoal in USSR.

This work presents a review of the enterosorption procedure, spheres of its application, the results achieved and prospects for use in the future. This technique was developed by the author in the late 1970's and is based on peroral administration of high doses of synthetic activated carbons. This review also summarises new experimental and clinical reports by Soviet researchers who studied the use of enterosorption procedure in liver and biliary tract diseases, endogenous intoxications, acute intestinal infections, renal pathologies and immuno-dependent diseases, metabolism in aged animals, in oncologic patients, abstinence syndrome in alcohol and drug-abuse patients. The peroral application of activated carbons has been known for a long time. The most extensive list of usage of activated carbons has been presented by Adler in the first quarter of this century. The powdery activated charcoal usually was prescribed in doses of 2-10 g per day, since larger doses caused nausea, vomiting and constipation, and that demanded simultaneous usage of cathartics. The Carbon sorption therapy, soon became neglected owing to development of potent antibacterial preparations, and probably due to depleted enteric content of the components which are necessary for the organism. Later, carbon sorption therapy was investigated for use in uremia. In 1979, the author of this article proposed the use of oral administration of high doses (up to 100-150 g/day) of synthetic activated carbons with diameters 0.2-1.0 mm, derived through pyrolysis of various polymeric resins. The reasons for this approach which we termed enterosorption, were good adsorptive properties, smooth surface, strength and uniformal nature of synthetic carbon adsorbents, causing practically no symptoms of enteropathy which are typical for high doses of powdery carbons. We have described our earlier clinical results of this approach. Since that time the number of studies has substantially increased in the USSR. Accordingly, the author deemed it expedient to attempt a review of the results.

Administration, Oral↗
PubMed1981

Process research data on a potent, feeling-evoking residential treatment program for the simultaneous counseling of alcohol abusers and drug users.

There are four goals in this study: (1) to describe an innovative counseling program (called CARE, Chemical Abuse Rehabilitation Effort) tailored to treat both alcohol abusers and drug abusers simultaneously, (2) to report process data on 156 residents treated in a program that emphasized the use of three potent treatment modalities, (3) to describe the clinical use of and consequences of the scream-evoking group therapy modality within a military residential program, and (4) to determine the utility of the scream-evoking group therapy procedure (that is, specify differences between clients who screamed versus those who did not) in facilitating successful program completion according to three criteria. A rating scale was specifically designed to assess the nature, intensity, and consequences of the "scream experiences." Interobserver reliability coefficients were computed for all data involving clinical judgements and/or decisions. A total of 103 alcohol abusers and 53 drug abusers were treated from August 25, 1975 to January 7, 1977. For each of the five stages (A through E), five types of process data were used to measure the immediate impact of the treatment program: (1) response to psychodrama groups, (2) response to scream-oriented group sessions (SGSs), (3) unauthorized chemical use, (4) premature exits, and (5) clinical evaluations as to whether a client was clinically progressing upon discharge. Overall, alcohol abusers and drug abusers responded similarly to the intensive, emotion-evoking residential treatment as measured by each of the five process variables. However, more alcohol abusers than drug abusers met three combined "success" criteria for program completion. The innovative aspect of this residential treatment program is the integration of three potent groups, and structured and spontaneous confrontations--that have been combined for the first time in this program. This is the first of only two programs in the military which utilize the scream-oriented group therapy methods. Fifteen methods of treatment are used to facilitate changes in problematic behaviors, attitudes, and/or feelings. The theoretical rationale for the use of these modalities is described. The SGSs are hypothesized to facilitate cathartic experiences via the scream experiences. The theoretical rationale for the use of abreactive/cathartic techniques is discussed from psychoanalytic, behavioral, and rational-emotive points of view.

Adult↗
PubMedDate not supplied

Effect of activated charcoal in 70% sorbitol in healthy individuals.

Activated charcoal in 70% sorbitol enjoys wide use in the management of acute poisonings but the effects of the activated charcoal-sorbitol mixture in healthy individuals have not been characterized. We were concerned about the possibility of sorbitol causing changes in the routinely monitored serum chemistry and hematological parameters, either directly due to the absorbed polyol or due to the diarrhea induced by it, thus complicating the diagnosis and management in an overdose setting. We assessed the action of a single dose of 30g of activated charcoal in 150 ml of 70% sorbitol and its effects on serum osmolality, electrolytes, metabolic profile (SMAC), magnesium, hepatic enzymes, and complete blood count in healthy adult individuals. The only significant change in the laboratory parameters tested was the consistent rise in serum sodium and phosphorus concentrations four hours after drinking the charcoal-sorbitol mixture. However, a similarly consistent rise in the concentrations at the same hours on another day without ingestion of the charcoal-sorbitol mixture suggested the rise was due to circadian rhythm or other factors unrelated to the cathartic. The lack of effect on routinely monitored laboratory parameters, relative palatability and the rapid onset (40-225 minutes), and long duration (7 to 127 hours) of purgation, make charcoal-sorbitol an attractive combination for use as a gastrointestinal decontaminant. Possible effects of multiple dose regimens and the effects in pediatric and geriatric populations need further study.

Adult↗
PubMed1987

Effects of activated charcoal and sorbitol on sodium pentobarbital absorption in the rat.

Three activated charcoals were tested for their ability to reduce the oral absorption of sodium pentobarbital (SP) in rats. Fasted adult, male rats were given 40 mg/kg of C-14 labelled SP by gavage (2 ml). Five minutes after drug administration, the animals were given 40 mg of either Darco (G-60), United States Pharmacopeia (USP) or SuperChar (SC) activated charcoals. The charcoals were administered as a slurry in either 1 ml of water, or 1 ml of 70 percent (w/v) sorbitol solution. Water (control) and sorbitol given alone were tested separately. Various pharmacokinetic parameters were calculated from the plasma concentration of SP determined at various time intervals after drug administration. When given in water, only SC significantly (p less than .01) reduced the peak plasma concentration and oral bioavailability of SP. Sorbitol given alone produced diarrhea but did not affect drug absorption. However, sorbitol selectively enhanced the effectiveness of G-60 and USP charcoals and, as a result, all charcoals significantly reduced SP absorption when given along with the cathartic. The results suggest that when given in water, charcoal antidotal effectiveness is proportional to absorptive surface area, and that sorbitol may enhance the antidotal effectiveness of some charcoals but not others.

Administration, Oral↗
PubMed1996

Multiple-dose activated charcoal in an accidental vancomycin overdose.

BACKGROUND: Multiple-dose activated charcoal may enhance the enterocapillary clearance of vancomycin. CASE REPORT: A 17-day-old female neonate born with congenital meningomyelocele and Arnold-Chiari malformation was iatrogenically overdosed with a 500 mg intravenous bolus of vancomycin during a shunt operation. The Red Man's Syndrome developed within minutes, characterized by sudden hypotension, skin rash and cyanosis. Serum vancomycin level at one hour after the injection was 165.7 micrograms/mL, as measured by an enzyme immunoassay method (EMIT). Multiple dose activated charcoal, 1 g/kg, was first given five hours after injection, and continued every four hours for 12 doses. The half-life of vancomycin during charcoal administration was calculated to be 9.4 h or less than the reported 13.4-33.7 h half-life in normal neonates. The neonate's renal function tests and brainstem auditory responses remained normal. CONCLUSIONS: Gastrointestinal dialysis with multiple-dose activated charcoal without cathartics appeared to shorten the elimination half-life of vancomycin.

Anti-Bacterial Agents↗
PubMed1980

Magnesium toxicity: effect on phosporus utilization by broiler chicks.

Excessive dietary magnesium (Mg) (.3, .5, and .9% additions to a corn-soy basal diet) fed to broiler chicks was found to be cathartic and significantly decreased 28-day body weight, significantly increased mortality, and induced leg abnormalities. Increasing dietary phosphorus (P) significantly ameliorated the detrimental effects of Mg toxicity except at the highest Mg level (.9% addition). Increasing dietary chloride (Cl) significantly increased body weights of Mg intoxicated chicks and significantly reduced the hypermagnesemia induced by excessive dietary magnesium. Excessive dietary magnesium increases the need for dietary P. Failure to monitor Mg content of diets may contribute to the ambiguity of ascertaining the P requirement of domestic fowl.

Animals↗
PubMed1999

Encopresis in the child with a behavioral disorder: when the initial treatment does not work.

Behavioral disorders occur more commonly in children who fail the initial standard treatment protocol of cathartics and designated toileting time. Whether such disorders are causally related or the result of encopresis, these children require a much more intensive, multimodal therapy. Treatment failures should have an in-depth history that reviews the potential developmental, emotional, behavioral, and psychosocial issues that may be causative. Use of the treatment protocols that have been outlined in this article can be time-consuming and will often require the help of a behavioral therapist. However, if they are successfully implemented, research shows that positive behavioral changes frequently occur in the child. The pediatrician can be instrumental in preventing long-term family, emotional, and social consequences by aggressively treating these difficult cases.

Anxiety↗
PubMed1993

The World Trade Center disaster. Healing the unseen wounds.

1. After the bombing of the World Trade Center in New York on February 26, 1993, hospitals were flooded with individuals who manifested not only medical problems, but also psychological trauma. 2. Various coping mechanisms were used by the disaster survivors. Some people were hysterical, while others were very quiet, almost catatonic, with blank affect and fixated posture. Some individuals, who remained strong during the ordeal, collapsed when they reached the hospital. 3. In attending the victims, nurses talked with them about the traumatic incident, the fear, and the angst--a cathartic process that helps people get better sooner. Such therapy is the key to healing unseen wounds.

Adolescent↗
PubMed2000

Tricyclic antidepressant poisoning.

Tricyclic antidepressant poisoning causes predictable electrocardiographic abnormalities and can be lethal. Cardiac arrhythmias, hypotension, seizures, and coma are common. Sodium bicarbonate is still considered the treatment of choice for severe toxicity, although a variety of supportive measures may be taken. Hypertonic saline appears to be a promising alternative. A QRS interval longer than 100 ms appears to be a better predictor of serious complications than is an elevated serum tricyclic antidepressant level. Cardiovascular toxicity is classically manifested as ventricular dysrhythmias, hypotension, heart block, bradyarrhythmias, or asystole. Activated charcoal binds tricyclic antidepressants. Give 30 to 50 g orally or by nasogastric tube with or without a cathartic (sorbitol 0.5 g/kg or 30 g of magnesium sulfate). Sodium bicarbonate is indicated if the QRS duration is more than 100 ms or the terminal right-axis deviation is more than 120 degrees. The suggested dosage is 1 to 2 mEq/kg, repeated as needed. Tricyclic antidepressants are used not only for depression but also for chronic pain syndromes, obsessive-compulsive disorder, panic and phobic disorders, eating disorders, migraine prophylaxis, and peripheral neuropathies.

Antidepressive Agents, Tricyclic↗
PubMed1979

Antibodies to Clostridium botulinum toxins in free-living birds and mammals.

Naturally-occuring antibodies against Clostridium botulinum toxins were found in Cathartes aura (turkey vultures), Canis latrans (coyotes) and Corvus brachyrhynchos (crows) by the passive hemagglutination (PHA) test and verified by the serum neutralization (SN) test. The prevalence of IHA antibodies was 18 of 20 vultures (90%), 5 of 12 crows (42%) and 25 to 110 coyotes (23%). Vultures and coyotes were seropositive by the PHA test against A, B, C, D, and F toxins. The highest antibody titer 1:8192 was in vulture serum against type C. In descending order, the highest antibody levels were against type C, D, F, E, A and B toxins.

Animal Population Groups↗
PubMed1986

Acute oral toxicity of sodium cyanide in birds.

Sensitivities of six avian species, black vulture (Coragyps atratus), American kestrel (Falco sparverius), Japanese quail (Coturnix japonica), domestic chicken (Gallus domesticus), eastern screech-owl (Otus asio), and European starling (Sturnus vulgaris), to acute poisoning by sodium cyanide (NaCN) were compared by single dose LD50's. Three species, domestic chickens, black vultures, and turkey vultures (Cathartes aura), were dosed with NaCN to determine cyanide residues in those that died and also in survivors, in addition to postmortem fate. Three flesh-eating species (black vulture, American kestrel, and eastern screech-owl; LD50's 4.0-8.6 mg/kg) were more sensitive to NaCN than three species (Japanese quail, domestic chicken, and European starling; LD50's 9.4-21 mg/kg) that fed predominantly on plant material. Elevated concentrations of cyanide were found in the blood of birds that died of cyanide poisoning; however, concentrations in birds that died overlapped those in survivors. Blood was superior to liver as the tissue of choice for detecting cyanide exposure. No gross pathological changes related to dosing were observed at necropsy.

Administration, Oral↗
PubMed1999

Peripheral neuropathy in a turkey vulture with lead toxicosis.

Clinical, electromyographic, and pathologic findings characteristic of lead toxicosis were detected in a turkey vulture (Cathartes aura). The bird had generalized lower motor neuron dysfunction that progressed over 5 days. Electromyography revealed diffuse denervation potentials and a presumed decrement in the sciatic-tibial nerve conduction velocity. Histologic examination of peripheral nerves obtained at necropsy revealed changes that could be compatible with lead-induced neuropathy. Lead toxicosis was confirmed by determination of blood lead concentrations. Lead toxicosis causing neurologic disorders in birds has been described. However, this report emphasizes the effects of lead on the peripheral nervous system and demonstrates the use of electromyography for diagnosis of peripheral neuropathy in birds.

Animals↗
PubMed1998

Acemannan hydrogel dressing versus saline dressing for pressure ulcers. A randomized, controlled trial.

Aloe vera has been used for centuries as a topical treatment for various conditions and as a cathartic. An amorphous hydrogel dressing derived from the aloe plant (Carrasyn Gel Wound Dressing, Carrington Laboratories, Inc., Irving, TX) is approved by the Food and Drug Administration for the management of Stages I through IV pressure ulcers. To evaluate effectiveness of this treatment, 30 patients were randomized to receive either daily topical application of the hydrogel study dressing (acemannan hydrogel wound dressing) or a moist saline gauze dressing. Complete healing of the study ulcer occurred in 19 of 30 subjects (63%) during the 10-week observation period. No difference was observed in complete healing between the experimental and the control groups (odds ratio 0.93, 95% CI 0.16, 5.2). This study indicates that the acemannan hydrogel dressing is as effective as, but is not superior to, a moist saline gauze wound dressing for the management of pressure ulcers.

Adjuvants, Immunologic↗
PubMed1999

[Methods of poison elimination--controversies and actual views about their use].

This paper presents controversies and current ideas about application of poison elimination methods in acute poisonings. Indications and contra-indications for single dose of activated charcoal, gastric lavage, cathartics and whole bowel irrigation are discussed. Rationale and indications for forced diuresis, repeated doses of activated charcoal, hemodialysis and hemoperfusion, enhanced elimination methods, are described.

Charcoal↗
PubMed1999

Respiratory failure attributable to moxidectin intoxication in a dog.

A 5-month-old 22-kg (48.4-lb) sexually intact male Collie was examined after ingesting a moxidectin-containing deworming medication. The dog was comatose and had respiratory arrest after progressively worsening lethargy, ataxia, and seizures. Exposure was confirmed by isolation of moxidectin from a biopsy specimen of adipose tissue, using liquid chromatography-mass spectroscopy methods. Treatment included use of intermittent positive-pressure ventilation, activated charcoal and cathartic administered enterally, nutrients administered via nasogastric tube, and intensive supportive care. The dog was weaned from a ventilator on day 6 after ingestion and was discharged on day 10. The dog was considered clinically normal during examination 24 days after ingestion. On the basis of the dog reported here and toxicologic data provided by the manufacturer of the deworming product, some Collies may have increased susceptibility to products containing high doses of moxidectin.

Adipose Tissue↗
PubMed2000

Chronic idiopathic intestinal pseudo-obstruction.

Chronic idiopathic intestinal pseudo-obstruction (CIIP) is a rare heterogeneous clinical syndrome characterized by recurrent episodes of symptoms and signs of intestinal obstruction in the absence of a mechanically obstructing lesion. Dilatation of other viscera, such as the renal pelvis, ureter or urinary bladder, is identified in a minority of patients. We report the cases of two patients with CIIP presenting with abdominal fullness and constipation. Radiologic examination of the first patient revealed dilatation of the esophagus, stomach, duodenum and bowel loops up to the ascending colon. The nerve conduction velocity study of the right extremities revealed polyneuropathy and urinary bladder manometry revealed poor sensation. The patient had been admitted to our hospital three times for symptomatic relief within the prior six months. During the last admission, his symptoms persisted without response to medical treatment. Soon after discharge, the patient underwent surgery at another hospital and died of nutritional problems. The second patient was transferred to our hospital after an exploratory laparotomy was performed one month earlier. A radiographic examination revealed distention of the stomach, duodenum, small intestine and ascending colon, as well as bilateral hydronephrosis. Rheumatologic examination revealed no evidence of autoimmune disorder. The patient also had heavy proteinuria due to minimal change disease that was proven by renal biopsy. After receiving prokinetic, cathartic and corticosteroid medication for kidney disease, symptoms improved, but hydronephrosis persisted.

Adolescent↗
PubMed2000

[Poison elimination methods in acute poisoning].

This paper presents current ideas about the application of poison elimination methods in acute poisoning. The methods are divided into two groups: poison elimination before absorption; and enhancement of elimination after drug absorption. The former include washes, emesis, gastric lavage, and administration of activated charcoal and cathartics, while the latter include forced diuresis and extracorporeal toxin elimination such as hemodialysis or hemoperfusion. The indications, contraindications, techniques, and complications, associated with these elimination methods, except for extracorporeal toxin elimination, are discussed. In the treatment of poisoning, early and comprehensive poison elimination is important.

Acute Disease↗
PubMedDate not supplied

[Managing adolescent and adult victims of extra-familial rape soon after aggression].

Rape victims often experience severe and prolonged symptoms in the aftermath of the assault. Psychological assistance offered rapidly after the assault should mitigate the intensity and moderate the duration of rape-related problems. This paper tried to identify the widely-accepted therapeutic approaches from a review of the current literature; it has its roots in the clinical experience acquired by our mobile crisis service in this type of situation, too. The goal of the following practices concerning the victim and the victim's immediate family is to assist the victim to reclaim control as quickly as possible over what has happened and to return to a normal functioning. The therapist should adopt an empathetic attitude, actively and instructively, even more so, and in an even more flexible way than for other patients. Knowledge of one's potential reactions to that kind of situation is useful since the counter-transference is here particularly intense. Doubting the patient's word is part of these negative reactions and must be avoided. It is better to respect the victim's feelings of guilt in the first instance. The relating of the facts, despite its cathartic value, should not be imposed on the patient. It should be noted that these last two points are controversial. It is also important to give information, during interviews, about the symptoms which can occur, the defence mechanisms that the individual sets up for just such occasions and on the most common difficulties encountered in personal relationships. In particular, the therapist must verify that concrete measures are taken to protect the victim against another attack. As far as the immediate family is concerned, it seems particularly important to involve them and, better still, meet them. Their reaction to the rape has a determining influence on the victim's capacity to cope with the trauma and its consequences. On the one hand, the immediate family should be helped in giving support to the victim by telling them all the details of what the patient could suffer, their potential reaction towards the victim and the victim's potential reactions towards them. The question of security must also be brought up with the family, in particular the risk of suicide which can be great. On the other hand, it is important to meet the family to give them support because they too may have difficulty in coming to terms with the violence of the aggression and its consequences. These approaches are up to now the only guidelines available since no psychotherapeutic technique (based on controlled studies) has proved to be more efficient than another and since the clinical experience of the authors are leading them to opposite therapeutic options. Different psychotherapeutic techniques are recommended: short therapies such as cognitive-behavioural therapies or hypnosis, or longer ones such as psychoanalytic psychotherapy. Several of these different options, to which must be added physical techniques like relaxation and medication, are often used simultaneously and/or in succession. As for drug treatments no controlled study conducted with this population has proved their efficiency on post-traumatic stress disorder. According to us they are essentially useful in order to diminish the intensity of the symptoms of anxiety.

Adolescent↗