[Case of caffeine poisoning survived by percutaneous cardio-pulmonary support].

A 17-year-old woman presented to the Emergency Department of our hospital following a suicide attempt. She reported having ingested 340 tablets of caffeine, each of which contained 200mg of caffeine, about 3 hours earlier. Soon after arrival, her blood pressure dropped, and electrocardiography revealed sinus tachycardia and ventricular tachycardia (VT). Subsequently, she developed ventricular fibrillation (VF), and VF was resistant to pharmaceutical interventions and even to cardioversion. Therefore, we performed percutaneous cardiopulmonary support (PCPS). This resulted in disappearance of VF and tachycardia, symptoms of caffeine poisoning, and improvement was observed 16 hours after the start of PCPS. In our case, caffeine poisoning symptoms disappeared without blood purification, after PCPS had stabilized her circulation. Based on our observations in this case, stabilization of the circulation using PCPS in severe caffeine poisoning with VF, a potentially fatal arrhythmia, is a significantly beneficial strategy.

[Four cases of pulmonary tuberculosis among deep-sea fishermen].

Pulmonary tuberculosis among deep-sea fishermen was reported. Four pulmonary tuberculosis cases among fishing boat members engaged in deep-sea fishing were registered at the Kesennuma Health Center during three years period from 2000 to 2002. Crew engaging in deep-sea fishing live together in a narrow cabin with inadequate airconditioning for a long period of time, about 1 year. It is difficult to consult with a medical institution in an open sea. If a tuberculosis patient breaks out in a boat, the risk of transmission of tuberculosis to other members is high. In boats of all four cases in this report, about 30 to 70 percent of crew were Indonesian. Indonesia is one of the high burden countries of tuberculosis in the world. The Japanese fishing boat members have received the medical checkup every year. Indonesians have also received the pre-employment medical checkup, however, the improvement in the quality of this medical checkup is required.

Are the effects of alpha-glucosidase inhibitors on cardiovascular events related to elevated levels of hydrogen gas in the gastrointestinal tract?

The major side-effect of treatment with alpha-glucosidase inhibitors, flatulence, occurs when undigested carbohydrates are fermented by colonic bacteria, resulting in gas formation. We propose that the cardiovascular benefits of alpha-glucosidase inhibitors are partly attributable to their ability to neutralise oxidative stress via increased production of H(2) in the gastrointestinal tract. Acarbose, which is an alpha-glucosidase inhibitor, markedly increased H(2) production, with a weaker effect on methane production. Our hypothesis is based on our recent discovery that H(2) acts as a unique antioxidant, and that when inhaled or taken orally as H(2)-dissolved water it ameliorates ischaemia-reperfusion injury and atherosclerosis development.