Treatment experience of acute paraquat poisoning: analysis of 87 cases / 中国基层医药

Objective To explore the treatment experience of acute paraquat poisoning,thus to explore the prognostic factors and treatment measures.Methods The clinical data of 87 patients with paraquat poisoning who were treated with combined therapy in our hospital emergency department 2014-2015 were retrospectively analyzed.Results 49 cases survived and 38 cases were died in 87 paraquat poisoning patients,the survival rate was 56.32％.The average paraquat of the death group was 65.3mL,which was significantly higher than 41.2mL of the survival group(t =16.65,P ＜ 0.01).Conclusion Amount of poisoning is the key to the prognosis,white blood cells were significantly increased,early or large areas of lung disease is an important factor in poor prognosis;early gastric lavage,cathartic and timely blood purification,application of adrenal cortex hormones,antioxidant and other comprehensive treatment can reduce mortality.

Application of Sequential Organ Failure Assessment (SOFA) Score in the Prognostic Prediction of Paraquat Poisoning

PURPOSE: To assess the ability of the Sequential Organ Failure Assessment (SOFA) score to predict the prognosis and organ dysfunction in the paraquat poisoning. METHODS: We retrospectively evaluated 281 paraquat poisoning patients who arrived at Soonchunhyang University Cheonan Hospital between Sep 2007 and Dec 2008. Sixty eight patients (68) were excluded due to missing data. Finally, 213 patents were included in this study. We investigated the degree of paraquat exposure, the Glasgow coma scale, vital signs, blood laboratory tests, calculated SOFA score, and Yamaguchi Index on first hospital day. The prognostic prediction was compared between SOFA score and Yamaguchi Index. RESULTS: The urine dithionite test, the amount of paraquat ingestion, arrival interval, aerum paraquat, Glasgow coma scale, HCO3-, potassium, and creatinine were significantly different between survivors and non-survivors. The Hosmer and Lemeshow Goodness-of-Fitness test of SOFA score (p=0.419) and Yamaguchi Index (p=0.084) indicated a good model performance. In the logistic regression analysis, p values the SOFA score and for the Yamaguchi Index were lower than 0.05 and the odds ratios were 1.930 and 0.108. At c-statistics, the area under receiver operator characteristic curve of SOFA score was 0.807 and Yamaguchi Index was 0.865. 95% confidence SOFA score and Yamaguchi Index Intervals of did not include 0.5. CONCLUSION: The SOFA score on the first day of hospital visit could reliably describe organ dysfunction and could distinguish survivors and non-survivors with reliable accuracy, as well as the Yamaguchi Index did in the case of paraquat poisoning.

The Effect of Ischemic Preconditioning on Long-term Prognosis in Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: The brief repetitive periods of ischemia and reperfusion before a myocardial infarction appears to precondition the heart, making it more resistant to subsequent longer periods of ischemia. This phenomenon is known as ischemic preconditioning (IP). We studied the long-term effects of IP in patients with acute myocardial infarction. SUBJECTS AND METHODS: Between January 1991 and August 1993, we examined, prospectively, 113 consecutive patients who had an acute myocardial infarction and arrived to the hospital within 6 hours after the onset of chest pain. IP was defined as prodromal angina within 24 hours before the myocardial infarction. Patients were divided 2 groups:Non-IP group and IP group. Clinical characteristics, laboratory findings, coronary angiographic findings, cardiac events, and mortality at admission and during follow-up were compared between these two groups. RESULTS: The IP group had 64 patients while the Non-IP group had 49. In terms of risk factors for ischemic heart disease, hypertension was more common in the IP group (p<0.05). Peak serum creatine kinase level of the IP group was 1,387.0+/-1,255.0 IU/L and that of the Non-IP group was 2,372.7+/-2,420.5 IU/L (p<0.05). The time interval between the onset of infarction and peak creatine kinase level was shorter in the IP group than in the Non-IP group (10.6+/-4.8 hours vs. 7.1+/-4.6 hours;p<0.05). For cardiac events during the follow-up period, there were more incidences of congestive heart failure and reinfarction in the IP group than in the Non-IP group (p<0.05). Mortality rate did not differ between the two groups. Univariate analysis identified five factors predictive of 3-year mortality: age, sex, coronary angiogram frequency, hypertension, and smoking. However, none of these factors were independently associated with death in the multivariate analysis. CONCLUSION: Close monitoring for cardiac events may be necessary for patients who have had IP before myocardial infarction as they had a higher incidence for congestive heart failure and reinfarction during the follow-up.

Hyperfractionated high dose rate interstitial brachytherapy for carcinoma of the oral cavity and orophanynx / 中华放射肿瘤学杂志

Objective To study the results of external beam radiotherapy plus 192 Ir hyperfractionated high dose rate interstitial brachytherapy (HHDR-IBT) for cancer of the oral cavity and oropharynx. Methods Fourty-eight patients with cancer of the oral cavity and oropharynx were treated by external beam radiotherapy (T 1,T 2 30～50 Gy,T 3,T 4 50～60 Gy) followed by 192 Ir HHDR-IBT delivering 15～35 Gy (30～35 Gy for T 1,T 2 and 15～30 Gy for T 3,T 4 in 250～350 cGy per fraction,two fractions per day). Over 3～5 days. Results The complete response rates at 3 months were T 1100% (5/5),T 2 85%(23/27),T 3 46%(6/13),T 4 0%(0/3) and the partial reponse rates:T 2 15% (4/27), T 3 54%(7/13), T 4 100%(3/3). The 3-year survival and disease-free survival rates were 79.4% and 55.8%,respectively.Multivariate analysis showed that TNM stage and pathalogic type were prognostic factors.Conclusions Carcinoma of the oral cavity and oropharynx treated with external beam radiotherapy combined with 192 Ir hyperfractionated high dose rate interstitial brachytherapy ia able to give a good local control for T 1,T 2 lesions with good functional preservation. For T 3,T 4 lesions,this method is able to offer a high palliation.