Clinical Experiences Treating Edifenphos and Iprobenfos Intoxication Patients

Organophosphate fungicides include edifenphos, iprobenfos and tolclofos-methyl. Edifenphos inhibits cell wall synthesis by reduction in chitin synthase activity and inhibits the action of acetylcholinesterase. Thus, exposure to this chemical results in excessive salivation, lacrimation, urination, defecation, gastrointestinal motility and emesis symptoms, just like other organophosphate insecticides. Although edifenphos is an organophosphate fungicide, it is the only agricultural chemical which inhibits the action of pralidoxime and atropine, an activity which in turn, inhibits treatment. Thus, we have to treat these cases as soon as possible with atropine and pralidoxime, using the same approach as used for exposure to other organophosphate insecticides. In this report we evaluate the results of treatment of 4 patients who were intoxicated by fungicides (3 cases with edifenphos and 1 case with iprobenfos).

Two Cases of Post Traumatic Cerebral Infarction in Head Injury

We present cases of post traumatic infarction after head injury. Two patients were admitted to our emergency room after traffic accidents. They developed neurological deficiency after a few hours to days after the accidents. In both cases, an initial computed tomography scan of the head was normal. A follow-up computed tomography obtained later revealed a hypodense lesion at cerebral hemisphere and a diffusion-weighted magnetic resonance imaging disclosed an area of infarction. The patients were conservatively medicated. One patient died due to a medical complication and the other patient fully recovered in several weeks. Hospital admission, careful observation and early diffusion-weighted magnetic resonance examination should be considered for patients with persistent neurological deficits.

Comparison of Severity in Organophosphate Insecticide Poisoning Patients Treated with Tracheostomy

PURPOSE: This study investigated the effect on survival rate for organophosphate intoxication patients who received tracheostomy. This research was conducted to help identify appropriate treatment of patients who received a trachostomy. METHODS: This research was retrospectively conducted using the medical records of 141 patients who arrived at the Chosun University Hospital emergency medical center between Jan 2007 and Dec 2010, suffering from organophosphate intoxication. They were placed in two groups including one which received trachostomy as part of their treatment and one that did not. The effect of each variable on mortality was evaluated by regressionanalysis. RESULTS: Of 141 patients with organophosphate intoxication, 105 of them did not tracheostomy and 16 were dead cohorts (15.2%). Their size of pupil was 1mm. Factors such as amount of organophosphate ingested, PAM time after ingestion, average body temperature, arrival time, atropinization time after ingestion, AST/ALT, Bun/Cr all appeared to be significant factors in death cohorts (P<0.05). 36 patients among the total had tracheostomy and 11 ones of them were in dead cohort (30.6%) and their average age was 58 years. The facts affect the state of patients in dead cohort include the amount of intoxication which between 327.27+/-194.1 ml, performing intubation 686 mins after intubation, reaching to the hospital after 580mins, injecting PAM 744 mins after intoxication, injecting atropine 627 mins after intoxication. The largest cases of patient's state was found to be stupor with 14 patients (38.9%) the level of Cholinesterase in blood appeared to be significant in dead cohort as 391.00+/-353.9 IU/L (P<0.05). CONCLUSION: Further planned studies are necessary on the use of tracheostomy for treatment of poisoning victims, especially those intoxicated by organophosphorus insecticides.