[Severe distal ischemic syndrome after buprenorphine volunteer intra-arterial injection]. / Syndrome ischémique distal sévère après injection intra-artérielle volontaire de buprénorphine.

High dosage buprenorphine (HDB) is a sublingual maintenance treatment of opioid dependence which have proved its substantial Public Health results, but it is also known to be frequently abused and diverted, in particular for intravenous injection, with deleterious consequences. Intra-arterial use is more rarely reported with this substance, just like its complications, mainly ischemic, potentially necrotic, phenomena. We report here such a case, with a 30 years-old man suffering from severe ischemia of the thumb, the forefinger and the middle finger few hours after direct injection of a suspension of buprenorphine crushed tablets in right radial arteria. A treatment combining surgery (video-thoracoscopic thoracic sympathectomy) and medicines (heparin, iloprost and piribedil mesilate), permitted a semi-complete digital rehabilitation (only forefinger pulp necrosis persisted and required a distal amputation), and the patient was discharged after 2 weeks.

One collective case of type A foodborne botulism in Corsica.

Foodborne botulism is rare in 21st century Western Europe. The purpose of this report is to describe a collective case of type A botulism caused by ingestion of artisanal-produced food (canned green beans and/or salted roast pork). Five of the seven persons who shared the meal presented signs of severe intoxication leading to the fatal respiratory failure in one 18-year-old girl. Three patients required mechanical ventilation for durations ranging from 37 to 78 days and developed severe infectious, respiratory and/or psychiatric complications. In 4 out of the 5 patients, trivalent antitoxin was administered between days 2 and 7 but did not avoid the need for long-term intubation/mechanical ventilation. Treatment with 3,4-diaminopyridine was ineffective in the 26-year-old man who required long-term breathing assistance. This case of collective foodborne botulism illustrates the potential severity of this hazard.

Suicide attempt by ingestion of rotenone-containing plant extracts: one case report in French Guiana.

INTRODUCTION: Several species of plants in the Fabaceae family are traditionally used for poison fishing because they contain ichthyotoxic rotenoids. In French Guiana two species of Fabaceae belonging to Lonchocarpus genus with a toxic rotenone effect are used for such ancestral practices. Rotenone is of low toxicity for humans when it is diluted, but its neurotoxicity at higher concentrations is well known to users. CASE REPORT: The purpose of this article is to describe a case of self-poisoning by an 86-year-old woman who ingested a bowl of mashed ichthyotoxic plants. Despite early onset of severe symptoms, the patient regained consciousness and resumed normal breathing within a few hours with only symptomatic treatment. CONCLUSION: The clinical pattern observed in this patient (onset of digestive manifestations followed quickly by loss of conscience and respiratory insufficiency) is in agreement with the few poisonings reported in the literature involving other Fabaceae species containing rotenoids in Asia or involving concentrated rotenone used in insecticides. In patients, who survive the initial phase, symptoms usually regress quickly.

[Accidental cannabis poisoning in children: experience of the Marseille poison center]. / Intoxications accidentelles par cannabis chez l'enfant: expérience du centre antipoison de Marseille.

OBJECTIVE: To assess the frequency and severity of accidental cannabis poisoning in children. METHODS: A retrospective study of cases of accidental cannabis poisoning in people aged under 18 years old, reported to the Marseille poison center from 1993 through 2007. We excluded cases where cannabis was definitively ruled out, and neonatal withdrawal syndromes in newborns from cannabis users. RESULTS: We collected 93 cases, including 56 boys and 37 girls, 86% of whom were younger than 3 years. The principal form was cannabis resin (hashish), reported in 80% of the cases and belonging to one of the parents or a household member. In almost all cases, the poisoning took place at the child's home. The frequency has risen in recent years, with 2/3 of the cases occurred in the second half of the study period. Five serious cases were reported, two with convulsions. CONCLUSION: Considering the observed increase in cases each year, mostly benign but potentially serious, prevention and information efforts have to be improved for drug users with young children and for healthcare professionals led to manage this kind of accident.

Asp Viper (Vipera aspis) envenomation: experience of the Marseille Poison Centre from 1996 to 2008.

UNLABELLED: A retrospective case review study of viper envenomations collected by the Marseille's Poison Centre between 1996 and 2008 was performed. RESULTS: 174 cases were studied (52 grade 1 = G1, 90 G2 and 32 G3). G1 patients received symptomatic treatments (average hospital stay 0.96 day). One hundred and six (106) of the G2/G3 patients were treated with the antivenom Viperfav* (2.1+/-0.9 days in hospital), while 15 of them received symptomatic treatments only (plus one immediate death) (8.1+/-4 days in hospital, 2 of them died). The hospital stay was significantly reduced in the antivenom treated group (p < 0.001), and none of the 106 antivenom treated patients had immediate (anaphylaxis) or delayed (serum sickness) allergic reactions. CONCLUSION: Viperfav* antivenom was safe and effective for treating asp viper venom-induced toxicity.

Poisoning by Coriaria myrtifolia Linnaeus: a new case report and review of the literature.

Coriaria myrtifolia should be recognized as one of the most neurotoxic plants in western Mediterranean area. This shrub produces a toxin, coriamyrtin, that is present in high concentrations in the berries. Ingestion of few fruits similar to blackberries may induce digestive and neurological manifestations including seizures, coma and apnea. The authors present a new case report that took place in the French Catalonia: an 8 year-old boy developed vomiting and generalized recurrent convulsions after ingestion of C. myrtifolia berries. He needed repeated diazepam administrations and was managed in the hospital. He recovered after one day of benzodiazepine treatment. In order to evaluate the consequences of C. myrtifolia poisoning, 83 cases of the literature were analyzed: the cases occurred in three countries (Spain, France and Morocco); the mean delay of the symptom development was 150 min; the neurological disturbances were the most frequent signs and 11 patients died (6 children, 5 adults) mainly in old reports.