Time-dependent haemoperfusion after acute paraquat poisoning.

Early haemoperfusion (HP) therapy has been found to be very effective in acute paraquat (PQ) poisoning, but the effective rescue window is still uncertain. Demographic data and the type of therapies administered of 621 patients were included as confounding factors in this retrospective study. After receiver operating characteristic curve analysis and intra-group/subgroup analysis, the initiation of glucocorticoid therapy within 3 hrs of exposure with a second treatment given <21 hrs after exposure, HP initiated within 4 hrs of exposure with a second treatment given <20 hrs after exposure, the appearance of pulmonary lesions ≤8 days after exposure and six other variables were used in a multiple analysis. The strength of positivity of the PQ urine test on admission, HP initiated within 4 hrs of exposure with a second treatment given <20 hrs after exposure, the appearance of pulmonary lesions ≤8 days after exposure, and stage III AKI on admission were independent factors of survival probability. HP therapy for acute PQ poisoning was the main therapeutic intervention investigated in this study. Outcomes were time dependent, and the crucial factor was the initiation of therapy within 4 hrs of PQ poisoning followed by a second treatment within 20 hrs.

Pseudoaneurysm of the aortic arch: A rare case report of pulmonary cancer complication.

BACKGROUND: Pseudoaneurysm of the aortic arch is uncommonly associated with cancer, and is extremely rare in pulmonary cancer. Here, we report an unusual and successfully treated case of aortic arch pseudoaneurysm in a male patient with lung squamous cell carcinoma. METHODS: A 64-year-old male patient was admitted to the Emergency Department, presenting with massive hemoptysis (>500 mL blood during the 12 hours prior to treatment). The diagnosis of aortic arch pseudoaneurysm was confirmed after inspection of computed tomographic angiography and three-dimensional reconstruction. We processed the immediate endovascular stent-grafting for this patient. RESULTS: This patient recovered with no filling or enlargement of the pseudoaneurysm, no episodes of hemoptysis, and no neurological complications during the 4-week follow-up period. CONCLUSION: Herein, we compare our case with other cancer-related pseudoaneurysms in the medical literature and summarize the clinical features and treatment of this unusual case.

A case report of severe paraquat poisoning in an HIV-positive patient: an unexpected outcome and inspiration.

We described and analyzed the treatment process of an HIV-positive patient with severe paraquat (PQ) poisoning. A 34-year-old man ingested about 50 mL of a 20% solution of PQ in a suicide attempt. He was treated with gastric lavage, oral administration of adsorbent, and symptomatic treatments at the local hospital, and was transferred to our emergency department. Ten hours after the exposure, the concentration of plasma PQ was 2.17 mg/L and was substantially above the survival limits of the severity index for PQ poisoning (SIPP) curve (0.30 mg/L). The equation produced by Jones et al (Jones AL, Elton R, Flanagan R. Multiple logistic regression analysis of plasma paraquat concentrations as a predictor of outcome in 375 cases of paraquat poisoning. QJM. 1999:92;573-578) predicted a 20.5% probability of survival at admission. Unfortunately, the patient was diagnosed as HIV infected, and CD4 lymphocyte count also confirmed that the patient was in a state of mild suppression of immunological function. Immediately, the patient received normative immunosuppressive therapy and hemoperfusion (HP). On the 15th day after poisoning, the patient recovered well and was discharged. All along, the evolution of the patient's status was in accordance with the characteristics of PQ poisoning, but the extent and duration of damage was mismatching and drastically alleviative by the previous biological indices. The particular case of treatment may be indirectly supporting the effectiveness of immunosuppressive therapy in treating patients with PQ poisoning.

Successful treatment of patients with paraquat intoxication: three case reports and review of the literature.

OBJECTIVE: To report on three patients with paraquat (PQ) intoxication surviving after combined therapy with hemoperfusion (HP), cyclophosphamide (CTX), and glucocorticoid. METHODS: Three patients suffered acute renal failure in a few days after ingesting a lethal amount of PQ. Chest computed tomography (CT) scans revealed obvious pulmonary inflammation, pleural effusion, and fibrous lesions several days after ingestion. HP was performed immediately, followed by large doses of glucocorticoid (methylprednisolone, 500 g/d) and CTX (approximately 4 g). RESULTS: After 50 d of treatments, all three patients were discharged in healthy condition, with chest CT showing small fibrous lesions, exudation, and both lungs clear of auscultation. CONCLUSIONS: The protective effect of the lungs may have been due to timely treatment at adequate doses.