Iron overdose and detection of gastrointestinal bleeding with the hemoccult and gastroccult assays.

STUDY OBJECTIVE: To determine the ability of the Hemoccult and Gastroccult tests (SmithKline Diagnostics) to detect blood in vitro in whole-bowel irrigation (WBI) solution. INTERVENTIONS: One tablet of ferrous gluconate 324 mg, ferrous sulfate 325 mg, or ascorbic acid 500 mg; or one Materna prenatal vitamin tablet (Lederle Laboratories) was dissolved in 30 mL of Colyte. Colyte alone and each test solution were tested with Hemoccult and Gastroccult slides, then retested at pH values of 3 and 8. Fresh solutions were then spiked with blood and tested with Gastroccult slides. Materna and ascorbic acid solutions were spiked with blood, then tested with Hemoccult slides. RESULTS: Positive results were difficult to detect on Gastroccult slides. Hemoccult slides were falsely positive for solutions containing only iron and falsely negative for blood-spiked samples containing ascorbic acid. CONCLUSION: Both the Hemoccult and Gastroccult tests may be unreliable in detecting GI bleeding in cases of iron overdose treated with WBI.

Ciguatera fish poisoning. A southern California epidemic.

Ciguatera fish poisoning results from the bioconcentration of a variety of toxins produced by marine dinoflagellates. Signs and symptoms vary widely, but it usually presents as gastrointestinal and neurologic complaints beginning shortly after the ingestion of fish containing the toxins. Symptoms may persist for months and sometimes even years. Although cases have been reported throughout the United States, epidemics are most common along tropical and subtropical coasts and usually involve the ingestion of large carnivorous fish. We review the literature and report the first epidemic of 25 cases of ciguatera fish poisoning presenting to area hospitals in Southern California that were successfully tracked by the Department of Health Services and isolated to fish caught off the coast of Baja California, Mexico.

Raising the decontamination level for thyroid hormone ingestions.

Ninety-two pediatric cases (age < or = 6 years) of acute thyroid hormone ingestions that were reported over a 20-month period to one American Association of Poison Control Centers (AAPCC)-certified regional poison center were reviewed to determine whether significant toxicity in pediatric patients is associated with acute ingestions of < or = 5 mg levothyroxine (T4) equivalent of thyroid hormone and the highest-tolerated milligram-per-kilogram dose. Parameters evaluated included patient weight, amount ingested, drug preparation, treatment type, outcome, management site, and relevant comments. Eight patients had mild symptoms requiring no specific medical intervention and there was no correlation between the amount ingested and symptoms observed. The maximum T4 dose ingested without gastrointestinal decontamination was 0.13 mg/kg (2 mg). A literature review was also conducted. Only one case of moderate toxicity with a dose of less than 5 mg T4 equivalent was found in the literature review. Significant toxicity is not expected with ingestions of less than or equal to 5 mg T4 equivalent of thyroid hormone.

Sunlight and the plant: a toxic combination: severe phytophotodermatitis from Cneoridium dumosum.

A severe case of phytophotodermatitis occurred in a patient who had spent several hours walking through an area densely populated with Cneoridium dumosum. This patient's co-worker experienced a similar reaction after undergoing patch testing of an area of skin and exposing it to sunlight. Voluntary patch testing by one of the authors produced a reaction consistent with the other two cases. Approximately twenty other cases were described by a U.S. Fish and Wildlife Service ranger in students who came into contact with the plant during a field trip with him to Baja California, Mexico. Cneoridium dumosum is a common native bush that grows in the chaparral vegetation zone of southern California and Baja California, Mexico. In a search of Poisindex, Medline, Agris International, and Agricola databases, no previous reports of toxic exposures were found.

Invasion of the 'killer' bees. Separating fact from fiction.

Even a single honeybee sting can lead to anaphylaxis in a susceptible person, but severe reactions can result from multiple stings, particularly if stings are from the fast-spreading Africanized honeybees, sometimes called "killer" bees. Signs and symptoms of multiple stings may include urticaria, nausea, vomiting, diarrhea, hypotension, confusion, seizures, and renal failure. Treatment is entirely supportive and requires special attention to airway patency, blood pressure, and renal function. Patients with more than 50 stings are at a higher risk of toxicity. Stingers should be removed by scraping gently to prevent further venom injection. Smoke or aerosolized deet (diethyl-toluamide) may thwart attacking bees, but avoidance is the best line of defense.

New antitumor agents containing the anthracene nucleus.

A series of 21 new compounds related to bisantrene was synthesized and tested in vitro by using clonogenic assays against a variety of human tumor cell lines, fresh human tumors, and P-388 leukemia. Those most closely related to bisantrene were less active than it was, but a subset of compounds with saturated side chains containing two basic nitrogens showed good activity. Two compounds of this subset, N,N'-bis[2-(dimethylamino)ethyl]-9,10-anthracenebis(methylamine)(6 ), and N,N'-bis(1-ethyl-3-piperidinyl)-9,10-anthracenebis(methylamine)(19 ), were very active in vitro against human tumor cell lines, but not active against fresh human tumors or P-388 leukemia cells. They had only marginal activity in mouse tumor models. Thus, the fresh human tumors and P-388 leukemia cells in vitro were better predictors than the established cell lines for the activity of these anthracene compounds in vivo against mouse tumors. These compounds appear to be distinct from bisantrene in aspects of mode of action. For example, 6 did not cause inhibition of macromolecular synthesis and promotion of DNA single strand breakage at cytotoxic drug concentrations. Toxicological studies showed that its rapid administration caused acute neurotoxicity resulting in apnea. It also produced skin ulcers on id administration, but they were less severe than those caused by bisantrene.