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PubMed2001

An unusual presentation of opioid-like syndrome in pediatric valproic acid poisoning.

We report a 3-y-o boy who accidentally poisoned himself with valproic acid (VPA). Clinical features included profound coma, depressed respiration and miosis. Treatment included naloxone, gastric lavage, and activated charcoal and a saline cathartic. The patient fully recovered and was discharged 24 h after the admission. Prompt use of naloxone is advised whenever the triad of coma, pinpoint pupils and depressed respiration concur with the clinical possibility of VPA intoxication.

Child, Preschool↗
PubMed1996

[Von Siebold's prescriptions (2)].

I have interpreted and explained 20 of von Siebold's prescriptions 4 times. Of the 20 prescriptions, 6 were stored at the Siebold's Memorial Museum (questionable 1 was excluded) and 14 at the Municipal Museum of Ohzu City, Ehime Prefecture. The 20 prescriptions used 39 types of drugs (different forms of the same drug such as crude glycyrrhiza, glycyrrhiza extract, and glycyrrhiza powder were regarded as 3 types). The prescriptions were classified according to the drug form: powders, 6 prescriptions; pills, 3; decoctions 2; confections, 2; eye drops, 2; drugs for internal and external use, 2; applications, 1; solutions (?), 1; and unknown 1. There were 2 prescriptions that use oil-sugars as correctives. The classification of the prescriptions according to drug efficacy and disease was difficult because one drug had various effects, or some diseases could be considered depending on symptoms. However, the following classification was done: digestives, 4 prescriptions; drugs for syphilis-suppuration, 3; drugs for eye diseases, 3; cathartics, 2; alteractives and resolvents, 2; drugs for scrofula, 1; drugs for scabies, 1; antitussives and expectorants, 1; rubefacients, 1; diuretics-antiphlogistic-laxative (niter), 1; and unknown, 1. Siebold's medical activities were performed mainly in the last days of the Tokugawa shogunate in Japan. Therefore, there may be only a few prescriptions remaining in other countries. Such important cultural heritage should be carefully stored.

Drug Prescriptions↗
PubMed1975

Actions of ricinoleic acid and structurally related fatty acids on the gastrointestinal tract. II. Effects on water and electrolyte absorption in vitro.

Ricinoleic acid, the active component of castor oil, and related fatty acids were studied to determine their relative inhibitory effects on water and electrolyte absorption using everted hamster jejunal and ileal segments. Differences were found between hydroxylated and nonhydroxylated congeners as well as between cis and trans geometric isomers. At a mucosal concentration of 2.0 mM, the unsaturated fatty acids had the following rank order of potency on inhibition of water absorption: ricionoleate greater than or equal to ricinelaidate- greater than equal to linoleate greater than oleate greater than linelaidate greater than elaidate. Ricinoleyl alcohol was effective at 2.0 mM but the methyl ester of ricinoleic acid was ineffective at this concentration. Among a series of saturated fatty acids including palmitate, stearate, a mixture of 9- and 10-hydroxystearate, and 12-hydroxystearate, only the last compound had any inhibitory effect on water absorption. The results define those portions of the ricinoleic acid molecule required for its effect on water and electrolyte absorption and suggest that classification of this cathartic as an "irritant" or "stimulant" should be re-evlauated.

Animals↗
PubMed2002

Recognition and management of acute pesticide poisoning.

Most poisonings from pesticides do not have a specific antidote, making decontamination the most important intervention. For maximal benefit to the patient, skin, eye, and gastric decontamination should be undertaken while specifics of the poisoning are being determined. As in most illnesses and injuries, the history of the poisoning is of great importance and will determine specific needs for decontamination and therapy, if any exist. Protection of health care workers during the decontamination process is important and frequently overlooked. Skin decontamination is primarily accomplished with large volumes of water, soap, and shampoo. Gastric decontamination by lavage is indicated if ingestion of the poisoning has occurred within 60 minutes of patient presentation. Activated charcoal, combined with a cathartic, is also indicated in most poisonings presenting within 60 minutes of ingestion. With large volume ingestion poisonings, activated charcoal may be used after 60 minutes, but little data exist to support this practice. Syrup of ipecac is no longer recommended for routine use. The cholinergic syndrome "all faucets on" characterizes poisoning by organophosphates and carbamates. Organochlorine insecticides (lindane and other treatments for scabies and lice) can produce seizures with excessive use or use on large areas of nonintact skin. Non-dipyridyl herbicides, biocides (including pyrethrins, pyrethroids, and Bacillus thuringiensis) rarely produce anything other than mild skin, eye, and/or gastrointestinal irritation on topical exposure or ingestion.

Acute Disease↗
PubMed1975

[Moreno's psychodrama].

Moreno's psychodrama is a technique of training and of group therapy which obeys the laws of sociometry. At the beginning of his career, Moreno as Freud, found himself in a transcultural position which allowed him to better observe the "classical occidental individual" captive of his stereotypal "Tinned culture". The psychodrama aims to the liberation of the human being alienated in his individuality thus giving him back a creative and relational spontaneity owing to the cathartic value of the collective game and drama (taken is its etymological sense). The new American society, issued from the old Europe, allowed him to practise his theoretical conceptions of sociometry. If the Psychodrama is a method of remarkable efficiency in the training of dynamic psychology of groups, its therapeutics indications must be given with the greatest caution, in order to be at any time under medical control, specifically psychiatric control.

Group Processes↗
PubMed2002

Stool-based DNA tests for colorectal cancer: clinical potential and early results.

Stool-based DNA testing is a promising new diagnostic tool with the potential to improve the overall effectiveness of colorectal cancer screening. Early clinical studies suggest that multi-target, DNA-based stool tests are capable of detecting both premalignant adenomas and cancers with high sensitivity and specificity. Screening compliance could be enhanced by the user-friendly features of stool-based DNA testing which include: the testing is noninvasive, requires no cathartic bowel preparation or diet or medication restrictions, and requires just a single specimen per screen. Large, multicenter, comparative studies addressing the performance of stool-based DNA testing in the general population will soon be completed and will promise to validate the readiness of this approach for widespread application.

Biomarkers, Tumor↗
PubMed1976

Effects of ricinoleic and oleic acids on the digestive contractile activity of the canine small and large bowel.

Oleic and ricinoleic acids or their trans isomers, elaidic and ricinelaidic acids, were administered intraduodenally and evaluated for their effects on the digestive motor activity of the canine small and large bowel. Four dogs of mixed breed were implanted with duodenal cannulas and extraluminal strain gage transducers along the circular axis of the proximal and mid-jejunum, terminal ileum, and proximal colon. After feeding 200 g of canned dog food to induce continuous contractile activil of isotonic saline was given into the duodenum as a single bolus infusion and recordings were made for a 1-hr period. A 30-ml volume of saline served as control. Administration of each cis fatty acid produced an initial stimulation in jejunal areas of about a 2-min duration followed by a post-stimulatory inhibition. Both the initial stimulation and post-stimulatory inhibition were greater for ricinoleic acid than for oleic acid. Minimal or no effects were produced in ileal or colonic areas. In contrast, the trans isomers produced little or no effect on either the small or large bowel. Alterations in the digestive contractile patterns produced by oral administration of 10 ml of oleic, ricinoleic acid or their respective triglycerides were also tested. Triolein had no effects. Ricinoleic acid and castor oil poduced a brief initial stimulation followed by polonged inhibition of small bowel motor activity. Both cathartics had a mild laxative effect. Digestive motor patterns returned to control approximately 45 min after oleic acid. There was no indication at any time of an initiation of continuous contractile activity after ricinoleic acid or castor oil which could justify the use of the terms irritant of stimulant to describe their actions.

Administration, Oral↗
PubMed1976

Gastrocolic fistula complicating benign unoperated gastric ulcer. Report of four cases and review of the literature.

Of 957 patients undergoing operation for benign gastric ulcer and its complications from 1965 through June 1975, 90 had perforated ulcers. Among these were four patients in whom a gastrocolic fistula had formed. Although two of the four patients had symptoms due to peptic ulcer dating back 12 and 68 months, symptoms of a gastrocolic fistula were the initial presentation of ulcer disease in the other two. All four patients had watery diarrhea and weight loss, and barium enema examination was diagnostic in each case. The perforating ulcers were located in the distal stomach on the greater curvature in all four patients. Although enterostasis was not present in these cases, regurgitation of colonic contents probably results in bacterial overgrowth in the small intestine, causing structural and functional damage to the mucosal cells by bacterial products, manifested clinically by diarrhea in 75% of the patients. Surgery should be advised in all cases after adequate preparation of the patient; bowel preparation with cathartics, enemas, and oral antibiotics is mandatory. The preferred operation is one-stage enbloc hemigastrectomy and resection of the involved segment of colon along with the fistulous tract. The present series brings to 43 the total number of cases of gastrocolic fistulas complicating benign, previously unoperated gastric or duodenal ulcers. There is an appreciable mortality associated with this condition - 7 of these 43 patients (16%) died as a direct consequence of their fistula.

Adult↗
PubMed1992

The many-voiced cultural story line of a case of diabetes mellitus.

An ethnographic approach is used to conduct and describe my research into a case of chronic illness and to assist the family physician's interventions. What at first appeared to be a frustrating, difficult-to-control case of diabetes mellitus was later revealed to be an intricate drama involving multiple voices and issues: marital, life stage, family, religious, occupational, regional, economic, and physician family-of-origin. Questions such as who has the disease?, what is the disease?, what keeps the disease going?, who is the patient?, and who is the clinician? are explored in the context of this case. The case was "solved" when the loss and sadness of aging was discovered and accepted during a cathartic session involving the diabetic patient, her husband, their family physician, and myself, a consultant.

Aging↗
PubMed2003

[Case report-fatal snail bait (metaldehyde) overdose presenting aspiration pneumonia].

A-55-year-old man ingested unknown amount of snail poison bait containing metaldehyde. He was mentally retarded and presented pica. On admission, his vital sign was stable, and the extremeties were spastic. Then, gastric lavage was unsuccessful because of massive unbited food. Activated charcoal and cathartic were administrated. On the next day, general convulsion occurred and respiratory distress advanced, so he was intubated. On the 3rd day, infiltration shadow appeared on chest roentogenogram and, his respiration was assisted mechanically. Thereby, acute lung injury advanced regardless of tracheostomy, kinetic therapy, antibiotics and steroid pulse therapy. He died of respiratory failure on the 33rd day. Serum test showed HBs and HBe antigen, CT scan revealed ascites and splenomegaly; the clinical course might be worsened by liver cirrhosis. HPLC revealed metaldehyde in the serum (total 80.6 microg/ml). He ingested 2.7 g of metaldehyde maximally estimated. Although Japan Poison Information Center reported that snail poison bait poisoning is often in dogs in Japan, human poisoning is rare.

Acetaldehyde↗
PubMed2003

[Managing childhood lead poisoning].

This paper reviews the clinical management of children with lead poisoning. A first step is to define the measures to be used in their assessment and be aware of the limitations. Measurements of blood lead levels can be made on anticoagulated whole blood samples using either: atomic absorption spectroscopy or anodic stripping voltametry. However a more accurate method is fluorescent RX'ray of the skeleton or systematic biochemical tests of lead levels in urine. Remedies include elimination of lead in the environment, changes in children's behavior and dietary checks for adequate calcium and iron intake. Chelation therapy, using Ca edetate and succimer eliminates lead from the skeleton, which is then quickly excleted using a cathartic to help prevent re-absorption. Chelation may save lives where BLLs are very high. There is usually a short term reduction of BLLs with a subsequent rise. Serious cases may require repeat therapies. Chelation should be considered in children with BLLs > = 45 micrograms/dl. Chelation therapy reduces BLLs and associated symptoms. However cognitive decline may be irreversible, indicating that emphasis should be on prevention rather than cure. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Child↗
PubMed1992

The contemporary management of poisoning emergencies.

Most patients who ingest toxic substances can be properly managed with basic supportive care, and only infrequently is more extensive intervention necessary. Basic supportive care includes the use of clinical toxicology's primary tools-syrup of ipecac, activated charcoal, and cathartics. Appropriate use of these agents decreases the morbidity and mortality associated with poisoning emergencies.

Emergency Nursing↗
PubMed1997

Gastrointestinal lavage for colon cleansing.

Colon cleansing preparations for diagnostic and surgical procedures continue to be evaluated in an effort to improve the quality of colon exam. Modifications of older barium enema x-ray preparations have led to the development of many alternative forms of bowel cleansing. Formal study has allowed carefui comparison of gut lavage, diet and cathartic as well as oral sodium phosphate preparation. Gut lavage with electrolyte lavage solutions represents the most popular form of bowel preparation. Patient variability and special circumstances such as gastroparesis, surgically altered anatomy or patient preferences may dictate selection of colon cleansing preparations.

Journal Article↗
PubMedDate not supplied

[Constipation. Proposal for a new classification and therapy].

The Authors propose a new classification for constipation according to which 84 patients were selected (63 females, 21 males) for a functional rehabilitation programme. Patients were subjected to a diagnostic protocol involving the performance of a number of instrumental tests. Degree and symptomatology of constipation were established by taking the clinical history of the patient. The rehabilitation protocol involved the simultaneous performance of physiokinesitherapy, electrostimulation and biofeedback of the pelvic floor. Patients underwent 3 weekly sessions, each lasting 60 minutes, over a series of 15 consecutive sessions, followed by a series of 6 consecutive sessions every three months. One-year results showed that 77 patients (92%) reported achieving regular intestinal activity with at least one evacuation a day and at intervals of no more than 3 days, and with a modification of faecal consistency and discontinuation of laxatives and/or cathartics. The other 7 patients (8%) continued using laxatives at a minimal dosage but had an improved evacuation rate and faecal consistency. The results show that many patients with constipations can undergo rehabilitation procedures with encouraging and remarkable therapeutic success.

Adolescent↗
PubMed1991

Effect on sodium sulphate on the adsorption of chloroquine and mefloquine to activated charcoal.

The effect of an added saline cathartic (Sodium sulphate) on the in vitro adsorption of chloroquine and mefloquine by activated charcoal were determined. Chloroquine phosphate at 125, 250 and 500 micrograms/ml had 10.0, 23.0 and 38.4 percent adsorption to 50 mg charcoal. When the concentration of activated charcoal was increased from 50 to 200 mg, there was no significant difference in the amount of chloroquine adsorbed. The amount of mefloquine (400-1000 ng/ml) adsorbed ranged from 60.62 to 95.8 percent. The common saline purgatives sodium sulphate at 7.5 mg/ml increased the B-50 for chloroquine slightly from 376 to 444 mg whereas it has little or no effect on the adsorption of mefloquine to activated charcoal.

Adsorption↗
PubMed1991

[Carbamazepine poisoning].

Due to the increased indications of using carbamazepine, a higher number of intoxications is to be expected. A case report is given of a 42-year-old patient who took about 250 tablets (50 g) carbamazepine (Finlepsin) in a suicide attempt. The maximum serum level of carbamazepine was 118.74 mumol/l. After a gastric lavage and the use of activated charcoal the detoxication was carried out by forced diuresis and one-time haemodialysis. The unconscious patient was ventilated for 8 days after intubation. Two hours after admission three generalised seizures occurred. A long-term hypotension and electrolyte shifts were balanced and a bronchoscopy and lavage were necessary. Bronchopneumonia occurred as a complication. The patient became conscious on the 5th day of treatment, the extubation was accomplished on the 12th day and on the 15th day she was transferred to the psychiatric clinic for further treatment of the basic disease. Since a specific antidote does not exist, general intensive therapeutic measure after carbamazepine intoxication are discussed. After gastric lavage to eliminate the poison, the patient should receive hourly doses of activated charcoal plus vigorous cathartic-like solutions of mannitol and sorbitol and forced diuresis. In case of complicated coma haemoperfusion is recommended.

Adult↗
PubMed1991

[Clinical and experimental studies of rheum on preventing progression of chronic renal failure].

Rheum, a well known herb unique in its cathartic effect is now introduced to prevent progression of uremia. A clinical prospective trial was conducted to evaluate its effect in comparison with the Captopril. 30 cases with initial Scr level of 344.8 +/- 114.0 mumol/L were allocated randomly to 3 groups. Rheum E treated group, Captopril treated group and Rheum E + Captopril group. The long term (6-22 mos) follow-up results showed that the progression rate of renal failure, calculated by regression analysis of 1/Scr vs time, was found to be retarded after treatment, being more marked in both Rheum E and Rheum E + Captopril group. Uremic symptoms improved after the treatment with serum albumin level increased. To explore the mechanism of therapeutic effects of Rheum on CRF, a series of experimental studies were performed. Rheum can suppress the proliferation of glomerular mesangial cells in culture. In 5/6 nephrectomized rats, the O2 consumption of remnant kidney was obviously decreased by feeding the animal Rheum E and the hypermetabolic state was ameliorated as well. A group of 5/6 nephrectomized rats were fed with Rheum E for 28 wks. It was found that the level of azotemia of this treated group was lessened remarkably as compared with the controls. The serum albumin and transferrin contents of the treated animals were much higher than the controls while the blood cholesterol and triglycerides decreased unexpectedly. In conclusion, both the in vivo and in vitro studies have proved the effectiveness of Rheum in preventing the progression of CRF.

Adult↗
PubMed1991

Endocrine crises. Hypermagnesemia.

Hypermagnesemia is an often-overlooked problem in acute medical care situations. Magnesium is used in several areas of medicine and for various reasons. It also is found in many seemingly innocuous cathartics and gastrointestinal medications. Magnesium replacement in enteral or parenteral feeding and magnesium deficiency is addressed often. Despite the necessity to consider magnesium in several situations, many physicians are relatively unfamiliar with the use of magnesium in their patients. Magnesium is often used in patients with renal insufficiency, which further increases the risk of hypermagnesemia. Fortunately, the evaluation and treatment of hypermagnesemia is relatively straightforward. Calcium reversal of life-threatening sequelae, diuresis or dialysis to augment elimination of magnesium, and supportive care until the acute manifestations of the disorder resolve are the mainstays of therapy for hypermagnesemia. Recognition of patients at risk for the disorder and careful consideration of magnesium therapy will allow for prevention or early diagnosis of the disorder.

Adult↗