Clinical Analysis of Phalloides Syndrome

BACKGROUND: To review the important features and treatment modalities of phalloides syndrome. METHOD: We performed a retrospective analysis of 16 patients with phalloides syndrome who visited the Emergency Center of Seoul National University ospital, Uijongbu St. Mary 's Hospital, Gachon Medical College Hospital, and Kyungpook National University Hospital from July 1st to August 31st, 1998. Mann-Whitney U test was used for statistical analysis(p < 0.05). RESULTS: 9 were male and 7 were female. The mean age was 54 years(men 46 years, women 65 years). Fourteen cases(88%) occurred in Kyungpook area. All cases of phalloides syndrome RESULT:ed from mistaking toxic mushrooms for edible mushrooms. The doses of ingestion of mushroom were not available because the patient could not remember the exact amounts. The identification of mushrooms in 4 cases was confirmed by mycologist, 6 cases by mushroom photoatlas, and remained 6 cases were not confirmed. The initial symptoms of mushroom poisoning were abdominal pain, nausea, and watery diarrhea. The time intervals from the ingestion of mushroom to the onset of symptom were from 6 to 13 hours(mean 11.3 +/-2.68 hours). The laboratory data showed the increased GOT and GPT, prolonged prothrombin time, elevated serum creatinine level, and decreased platelet count. The initial management of phalloides mushroom poisoning was done conservatively, but the early specific treatments such as gastrointestinal decontamination, administration of activated charcoal, IV penicillin or silymarin were not perfomed in all cases. The mortality rate was 18.8%. There were significant differences in total bilirubin, prothrombin time, platelet count, and serum creatinine between survival and non-survival group(p<0.05). CONCLUSION: It is important to know the morphological differences between edible and toxic mushroom for prevention of phalloides syndrome. If the patient with acute gastroenteritis has a history of mushroom ingestion, the emergency physician should suspect phalloides syndrome and start early proper treatment. For the identification of mushroom, it is desirable to contact a mycologist.

Effect of Pentoxifylline on Ischemia-Reperfusion Injury of Brain Following Cardiac Arrest in Rats

BACKGROUND: Two major events occurring in the cerebral hemodynamics after successful resuscitation from cardiac arrest are reactive hyperemia and postischemic hypoperfusion. In this study, we examined the effect of Pentoxifylline(PTX) on the rat brain following cardiac arrest. METHODS: Fourteen rats were anesthetized and artificially ventilated. Cardiac angst was produced by chest compression and clamping of tracheal tube far 3 minutes in ketamine anesthetized rats. Circulation was restored by standard cardiopulmonary resuscitation methods. In 7 rats, PTX 10mg/kg was infused at 10min after cardiac angst(PTX group). In the other 7 rats, same amount of normal saline was infused(control group). RESULTS: In both groups, hemodynamic variables, neurologic deficit(ND) score and histopathologic findings of hippocampal CA1 neurons were observed. Hemodynamic variables and ND score were not significandy different between two groups. Delayed ischemic neurons of hippocampal CA1 were decreased in PTX group(2.2+/-2.4%) compared with control group(9.1+/-1.2%). CONCLUSIONS : We conclude that PTX prevented development of delayed ischemic neurons in hippocampal CA1 after cardiac arrest. PTX may be useful in emergency situations following cardiac arrest.

A Patient with Pulmonary Edema and Cardiac Arrest after Phenobarbital Overdose

Phenobarbital is a long-acting barbiturate causing generalized depression of neuronal activity in the brain. Its effect is primarily achieved through enhanced GABA-mediated synaptic inhibition. Its use as an antiepileptic agent was first described in 1912. Before the introduction of phenytoin, phenobarbital is used as sedative-hypnotics. It is used for the treatment of epilepsy and status epilepticus. All barbiturates, including phenobarbital, have a high potential far abuse. They were frequently used for suicide attempts in the past, but they have in large part been replaced by benzodiazepines. the onset of symptoms depends on the drug and the route of administration. Mild to moderate barbiturate intoxication resembles ethanol inebriation with slurred speech, ataxia, and lethargy. Severe acute barbiturate intoxication is life threatening. Early deaths are generally cardiovascular-related. Hypotension, shock, pulmonary edema, and cardiac arrest that occurs with large doses are caused by depression of central sympathetic tone and as well as by direct depression of cardiac contractility. The potentially fatal oral dose of phenobarbital is 6-l0g. We describe an 23-year-old woman with pulmonary edema and cardiac arrest after ingestion of 18 grams of phenobarbital. She was completely recovered by successful cardiopulmonary resuscitation and hemoperfusion. We report a case with literature review.

Effect of 4-Methylpyrazole for Acetaminophen Hepatotoxicity in a Rat Model

BACKGROUND: Hepatic necrosis after acetaminophen overdose results from the increased formation of a highly toxic intermediatc(N-acetyl-p-benzoquinoneimine), produced by acetaminophen metabolism through the cytochrome P450 mixed function oxidase system. N-acetyl-p-benzoquinoneimine is normally detoxified by endogenous glutathione, but the increased production induced by an acetaminophen overdose may depletc glutathione stores, allowing the intermediate to react with and to destroy hepatocytes. METHOD & MATERIAL: We have estimated the hepatoprotective effects of 4-methylpyrazole(500mg/kg and 50mg/kg), inhibitor of cytochrone P450 isoenzyme, when given at two hours after single oral overdose of acetaminophen(2,000mg/kg) in rats. RESULTS: As far as overall protective effect of 4-methylpyrazole on hepatic necrosis score concerned, seam transaminase(AST, ALT) level were found to be decreased in 4-methylpyrazole-treated group compared to untreated group after acetaminophen overdose. No consistent difference in hepatoprotective effect was demonstrated between rats with high dose of 4-methylpyazole(500mg/kg) and rats with lower dose of 4-methylpyrazole(50mg/kg). CONCLUSION: We concluded that oral administration of 4-methylpyrazole apperas to protect hepatotoxicity effectively to acetaminophen overdose.

A Clinical Analysis of Hospitalized Patients During the Period of Flood in Ujungbu

BACKGROUND: Flood is the most common natural disaster in our country. Lots of victims occurred during the period of flood in the northern territory of Kyoungkido on August 5, 1998. We tried to describe the characteristics of the flood-related injury and illness, management and medical requirements. METHODS: We interviewed the patients admitted to 8 hospitals in Ujungbu and reviewed medical records from aug 5 to Aug 14, 1998. RESULTS: There were total 102 patients, male were 52%and women were 48% Most of patients were between 30's and 60's. Most of them were minor, and less than 3%of them needed critical care. The diagnosis were laceration(39.2%, contusion(22.5%, fracture(13.7%, infectious disease(7.8%, ligament rupture(7.8%, aggravation of chronic illness(5.9%, dermatitis(2.0% and traumatic hyphema(1.0%. The laceration occurred in the foot(37.9%, lower leg(27.0%, thigh(16.2%, hand(10.8% and head(8.1%. The location of ligament injury were achilless tendon(62.5%, hand(25% and knee(12.5%. The 67.5%of flood-related laceration patients progressed cellulitis, especially in sutured wound and a typical tetanic patient was developed. Of hospitalized patients, 2 patients showed evidence of post-traumatic stress disorder(PTSD). CONCLUSION: During flood, civils have better to be educated about prevention of injury, such as wearing of shoes and clothes. Although laceration was minor, lacerated wounds should be thoroughly irrigated, debrided the margin and considered delayed closure, tetanus immunization. Reportedly, there is an increased prevalance of PTSD and depression after disasters. Therefore mental health care will be required in the future.

Spontaneous Pneumomediastinum: Natural History and Clinical Significance

STUDY OBJECTIVE: We evaluate the clinical characteristics and natural history of patients presenting with spontaneous pneumomediastinum (SPNM) . DESIGN: A retrospective case series was conducted to identify patients diagnosed with SPNM. ICD-7(J98.2) discharge codes were used for Jan. 1993 to Aug. 1996 at four institutions , and emergency department(ED) records and admission charts were reviewed. Clinical features, interventions, complications, setting, etiology, symptoms, and length of hospital stay were recorded. PARTICIPANTS: All ED patients more than 12 years old with a diagnosis of SPNM. RESULTS: Thirteen cases were identified. Age range was 14 to 58 years(mean 24 years). Presenting symptoms were chest pain in eight(62%), dyspnea in six(46%), both symptoms in three(23%), no complaints in three(23%). Seven(54%) patients complained only of throat discomfort. Seven(54%) had subcutaneous emphysema, and two(15.3%) had a small pneumothorax. Two(15.3%) were smokers. Three(23%) had normal esophagograms and another three had normal chest CT findings. Two cases(15.3%) were associated with inhalational drug use and three cases were due to exercise. Nine cases(69%) had a history of "Valsalva-type" maneuver. Two patients(15%) had a history of antituberculous treatment and one(7.7.%) had suffered from bronchial asthma. Mean hospital days were 7.3 days(range 3 to 14), none of all needed any intervention. Specifically, no patient developed a subsequent pneumothorax or airway compromise. Seven cases(54%) were received prophylactic antibiotics. CONCLUSION: Most simple SPNM cases are benign disease and most of them(78%) had shown typical chest pain, dyspnea and subcutaneous emphysema. Inhalational drug use is not a main cause of SPNM yet, but increase in use of bronchoinhalers is a suspicous cause of SPNM.