Multidetector computed tomography to detect ingested press-through packages: utility of multiplanar reconstruction imaging in the emergency department.

Case: We investigated the usefulness of multidetector computed tomography during examination in the emergency department to detect the location of press-through packages that had been inadvertently swallowed. In three patients, four press-through packages were detected on multi-planar reconstruction of multidetector computed tomography images, with three lodged in the esophagus and one in the stomach. Outcome: The multidetector computed tomography detection rate of press-through packages was 100% in patients who realized they had swallowed the packages by mistake. After diagnosis, press-through packages in the esophagus were immediately removed endoscopically. Conclusion: There are few reports on the usefulness of multi-planar reconstruction images by multidetector computed tomography during examinations in the emergency department for the diagnosis of foreign bodies in patients who have mistakenly swallowed press-through packages. Detecting the location of the packages provided useful information regarding the strategy for their removal. Therefore, proactive multidetector computed tomography use in the emergency department could be beneficial for patients who have inadvertently swallowed press-through packages.

Case of multiple organ failure due to benzine ingestion.

A 42-year-old woman was admitted to our ICU for acute respiratory failure due to benzine ingestion. On arrival at the hospital, the patient's consciousness level was GCS 3 and her SpO2 was 89% when receiving oxygen at 10 L/min. She was immediately intubated and placed on a ventilator. Chest X-ray and CT scanning showed a wide infiltrative pulmonary shadow bilaterally, and a diagnosis of acute respiratory distress syndrome (ARDS) was made. Subsequently, she became anuric and required haemodiafiltration on the 2nd day. Complications such as prolonged circulatory failure, liver dysfunction and disseminated intravascular coagulation (DIC) were then observed, and plasma exchange therapy was initiated. The patient's condition improved and a complete recovery ensued. The patient remained suicidal and was moved to the psychiatric ward for psychiatric support. Benzine is purified oil containing aliphatic hydrocarbons and is liquid at room temperature. In this case, the patient had already ARDS that required immediate intubation on arrival at the hospital. On this basis, aspiration of benzine into the lungs was considered to have occurred concomitantly with its ingestion, which therefore led to the complication of chemical pneumonitis in addition to that of circulatory shock, acute kidney injury, liver dysfunction and DIC.

Complicated interaction between psychostimulants and morphine in expression of phenotype of behavior in the dopaminergic system of BALB/c mice.

It is believed that BALB/c mice appear to be less sensitive to the locomotor effects of abused drugs compared to other strains, and several behaviors induced by abused drugs depend on genetic factors. The present study was designed to investigate the effects of the interaction between psychostimulants and morphine on behavior in BALB/c mice. Morphine and cocaine induced hyperlocomotion and hypolocomotion, respectively, while methamphetamine did not affect locomotor activity and high doses of methamphetamine significantly increased self-injurious behavior. Cocaine or methamphetamine increased the effects of morphine on locomotor behavior. Haloperidol (a dopamine-receptor antagonist) attenuated the hyperlocomotion induced by the combination of cocaine or methamphetamine plus morphine. These results indicate that the synergistic effects of methamphetamine or cocaine and morphine on locomotor activity are mediated through enhancement of the dopaminergic system and that combinations of psychostimulants and morphine enhance the locomotor activity in BALB/c mice. On the other hand, morphine completely attenuated methamphetamine-induced self-injurious behavior. Furthermore, a low dose (0.01 mg/kg) of haloperidol significantly increased the effects of methamphetamine and morphine on the locomotor activity. Hyperlocomotion induced by psychostimulants is mediated by the mesolimbic dopaminergic system, whereas stereotyped behaviors is mediated by the nigrostriatal dopaminergic system. Our findings suggest that balances of the activation of dopaminergic neurons (between mesolimbic and nigrostriatal systems) may play an important role to engender corresponding behavioral outcomes in BALB/c mice.

Involvement of free radicals followed by the activation of phospholipase A2 in the mechanism that underlies the combined effects of methamphetamine and morphine on subacute toxicity or lethality in mice: comparison of the therapeutic potential of fullerene, mepacrine, and cooling.

An increase in polydrug abuse is a major problem worldwide. The coadministration of methamphetamine and morphine increased subacute toxicity or lethality in rodents. However, the underlying mechanisms by which lethality is increased by the coadministration of methamphetamine and morphine are not yet fully understood. Coadministered methamphetamine and morphine induced lethality by more than 80% in BALB/c mice, accompanied by the rupture of cells in the kidney and liver, and an increase in poly (ADP-ribose) polymerase (PARP)-immunoreactive cells in the heart, kidney and liver. The lethal effect and the increase in the incidence of rupture or PARP-immunoreactive cells induced by the coadministration of methamphetamine and morphine was significantly attenuated by pretreatment with mepacrine (phospholipase A(2) inhibitor) or fullerene (a radical scavenger), or by cooling from 30 to 90 min after drug administration. Furthermore, based on the results of the electron spin resonance spin-trapping technique, hydroxyl radicals were increased by the administration of methamphetamine and morphine, and these increased hydroxyl radicals were potently attenuated by fullerene and cooling. These results suggest that hydroxyl radicals plays an important role in the increased lethality induced by the coadministration of methamphetamine plus morphine. The potency of cooling or drugs for decreasing the subacute toxicity or lethality induced by the coadministration of methamphetamine and morphine was in the order fullerene=cooling>mepacrine. These results indicate that fullerene and cooling are beneficial for preventing death that is induced by the coadministration of methamphetamine and morphine.

Underlying mechanism of combined effect of methamphetamine and morphine on lethality in mice and therapeutic potential of cooling.

An increase in polydrug abuse is a major problem worldwide. A previous study showed that coadministration of methamphetamine and morphine induced lethality in rodents and humans. However, the underlying mechanisms by which the lethality is increased by the coadministration of methamphetamine and morphine have not been fully understood. Therefore, the present study was designed to determine the mechanism of increased lethality induced by methamphetamine and morphine. Coadministered methamphetamine and morphine increased the lethality by more than 70% in BALB/c mice. Pretreatment with NMDA-receptor antagonists, such as MK-801 and 3-((R)-2-carboxypiperazin-4-yl) propyl-1-phosphonic acid (CPP), and benzamide [poly(ADP-ribose) polymerase (PARP) inhibitor] significantly attenuated the increased lethality induced by methamphetamine and morphine. Furthermore, the lethal effect induced by methamphetamine and morphine was completely attenuated by immediate cooling after the coadministration of methamphetamine and morphine. It has been reported that methamphetamine-induced neurotoxicity can be blocked by lowering the temperature, and this effect might be mediated by a reduction of release of free radicals. These results suggest that activation of NMDA receptors and PARP play an important role in the increased lethality induced by methamphetamine and morphine.

Recent trend of the incidence of sudden infant death syndrome in Japan.

OBJECTIVES: To clarify the trend of the incidence of SIDS in the last 20 years in Japan to provide the basis for health administration training. METHOD: We have studied the SIDS incidence rate, the infant mortality rate, the neonatal mortality rate and perinatal deaths of the last 20 years in Japan and calculated the rate at which SIDS has contributed to infant mortality. RESULT: We found that the 2001 SIDS incidence rate in Japan was 0.24 per 1000 births, which had taken a downturn since its upturn of around 1995. The rate of SIDS incidence as a part of the infant mortality rate in 2001 in Japan was 7.7%, which had taken a downturn since its upturn of around 1997. CONCLUSION: The SIDS incidence rate in Japan in recent years is on the decline.