Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation.

STUDY OBJECTIVE: To assess outcomes in patients treated with hydroxocobalamin at the fire scene or in the ICU for suspected smoke inhalation-associated cyanide poisoning. METHODS: Adult smoke inhalation victims with suspected cyanide poisoning as determined by soot in the face, mouth, or nose or expectorations and neurologic impairment received an intravenous infusion of hydroxocobalamin 5 g (maximum 15 g) at the fire scene or in the ICU in this observational case series conducted from 1987 to 1994. Blood cyanide specimens were collected before administration of hydroxocobalamin. The threshold for cyanide toxicity was predefined as greater than or equal to 39 micromol/L. RESULTS: The sample included 69 patients (mean age 49.6 years; 33 men), of whom 39 were comatose. Out-of-hospital deaths were excluded. Fifty of the 69 patients (72%) admitted to the ICU survived after administration of hydroxocobalamin. In the group in which cyanide poisoning was confirmed a posteriori (n=42), 67% (28/42) survived after administration of hydroxocobalamin. The most common adverse events were chromaturia (n=6), pink or red skin discoloration (n=4), hypertension (n=3), erythema (n=2), and increased blood pressure (n=2). No serious adverse events were attributed to hydroxocobalamin. Laboratory tests revealed transient alterations in renal and hepatic function consistent with the critical condition of the patients and mild anemia consistent with progressive hemodilution. CONCLUSION: Empiric administration of hydroxocobalamin was associated with survival among 67% of patients confirmed a posteriori to have had cyanide poisoning. Hydroxocobalamin was well tolerated irrespective of the presence of cyanide poisoning. Hydroxocobalamin appears to be safe for the out-of-hospital treatment of presumptive cyanide poisoning from smoke inhalation.

Vascularization in the primate visual cortex during development.

We studied the relationship between vascularization and neuronal activity in the visual cortex during postnatal development in the primate. Analyses were focused on layer IVC that displays a sequential pattern of maturation for the magno- and parvocellular systems in separate sublayers, respectively IVC alpha and IVC beta. Cytochrome oxidase and endogenous alkaline phosphatase histochemistry was used to analyse, on the same sections, the laminar patterns of cortical activity and vessel density in the primary visual cortex of the marmoset (Callithrix jacchus). Experiments were carried out in five young and two adult animals. We showed that the temporal pattern of angiogenesis differs in layer IVC alpha and IVC beta. During the first postnatal month, vessel density is higher in IVC alpha than in IVC beta and runs parallel to cytochrome oxidase intensity. In 2-month-old animals, both vessel densities and cytochrome oxidase activity are similar in IVC alpha and IVC beta. In adults, the vessel densities in IVC alpha and IVC beta are the reverse of those observed during the first postnatal month. Vessel diameter does not account for this evolution in vascular patterns. In the discussion, we suggest that such a developmental time-course of angiogenesis might be linked to the synaptogenesis requirements that proceed differently for the magno- and parvocellular systems in the primate striate cortex.