Danger of Saponated Cresol Solution in the Tohno Area ; / 日本農村医学会雑誌

We experienced a clinical case of a patient with psychotic depression who ingested the residual saponated cresol solution from a 500ml bottle of cresol, a disinfectant, with the intention of committing suicide. Through this experience, we felt it neccessary to investigate the present commercial situation of cresol for domestic use, and to come up with some safty measares.All the 128 drugstores and pharmacies in four cities located in the Tohno area of Gifu Pref. (Mizunami, Toki, Tajimi and Ena) were queried by telephone about the sale and stock of cresol.Almost 80% of the drugstores in these four cities, excluding pharmacies, were found to deal in saponated cresol solutions. They carried a little more than two 500ml bottles of cresol on average. This volume exceeds an estimated adult lethal dose of 250ml.Although it is unlikely that an ordinary household will use the whole of 500ml bottle of the disinfectant at a time, the residual saponated cresol solution could increase the risk of accidental cresol poisoning at home.So, it would be desirable not to sell 500ml bottles in ordinary drugstores. Furthermore, before selling a bottle of cresol, the pharmacists, who have a specialized knowledge about it, should kindly explain to the user about its toxicity and usage.

A Case of Lemmel's Syndrome in which Endoscopic Sphincterotomy(EST) was Effective / 日本農村医学会雑誌

A 73-year-old man visited our hospital with complaints of fever, epigastric painand jaundice. Laboratory examinations showed elevation of GOT, GPT, ALP, LAP and amylase. Abdominal ultrasonography revealed gall bladder stones. Endoscopic findings showed parapapillary diverticulum, but the common bile duct stone was not revealed by endoscopic retrograde cholangiography. He was conservatively treated and then discharged. Two months after, the patient was readmitted for cholecystitis and underwent cholecystectomy. After further 2 months, he was again admitted for the same symptoms as those on first admission. We diagnosed this case as Lemmel's syndrome and performed emergency endoscopy. Endoscopic findings revealed the meal rest inside the parapapillary diverticulum. After we removed the meal rest obstructing the orifice of the papilla of Vater using grasping forceps, we performed EST. Purulent bile gushed out from the orifice. Two years have elapsed since them. Cholangitis has not recurred during this period. Therefore, we concluded that EST is effective in treating Lemmel's syndrome.

The Efficacy of Epalrestat for Diabetes Mellitus in Our Hospital / 日本農村医学会雑誌

Control of the blood sugar level is the fundamental treatment for diabetes mellitus. However, it is extremely difficult to effectively control the blood sugar level over a long period, during which complications such as neuropathy, retinopathy and nephropathy may develop. Impaired polyol (sorbitol) metabolism is considered to be a cause of neuropathy among these complications of diabetes. Diabetic neuropathy occurs in a relatively early stage. Its incidence increases with the prolongation of the diabetic condition, and the plight of the patients suffering from extensive tissue damage is profound. In this study, assessment was made regarding the effects of the aldose reductase inhibitor epalrestat, which is expected to reverse the pathogenic mechanism of diabetic neuropathy, on symptoms of neuropathy, erythrocyte sorbitol level, and threshold of vibratory sensibility.<BR>[Subjects] The subjects were 7 male and 4 female outpatients who consistently exhibited spontaneous pain, dysesthesia, and autonomic disorders, or showed abnormalities in the erythrocyte sorbitol level and threshold of vibratory sensibility, and were taking 50 mg of epalrestat (1 tablet) before each meal for at least 6 months. The period of investigation was from October 1992 to March 1993.<BR>[Methods] The subjects were explained about the aim of the study and their informed consents were obtained. They were inquired about symptoms while they were waiting for medicine in the Drug Information Management Office. Data concerning the erythrocyte sorbitol level and threshold of vibratory sensibility were obtained from charts.<BR>[Results and Conclusions] 1) <I>Improvement rates by subjective symptom</I>: 75.0% for spontaneous pain; concerning dysesthesia, 57.1% for numbness of hands and feet, 40.0% for coldness of extremities, 33.3% for hot flushes, 75.0% for hypoesthesia, and 50.0% for itching; concerning autonomic disorders, 75.0% for dizziness on standing up, and 33.3% for abnormal perspiration. 2) <I>Effects by the duration of illness</I>: Improvements were greater as the duration of illness was shorter. 3) <I>Erythrocyte sorbitol level</I>: Improvements were generally unremarkable. 4) <I>Threshold of vibratory sensibility</I>: Fair improvements were observed in general. Neuropathy occurs from a relatively early stage of diabetes, and chronic hyperglycemia is considered to be the most important factor. Regulation of the blood sugar level is essential for the treatment, but if it is impossible, the pain and discomfort of patients may be alleviated by epalrestat, and the administration should be started as early as possible since, in this study, the drug was more effective as the duration of illness was shorter.