Survival after chloroquine ingestion in a child.

We report the case of a 17 month old, 14 kg male who ingested 4 grams of chloroquine phosphate. He developed ventricular fibrillation and cardiovascular collapse 1 hour after the ingestion. After resuscitation he was treated with diazepam 2 mg/kg acutely, and 0.25 mg/kg/hour for 4 days with no further cardiac electrophysiologic abnormalities. Gallium-67 scan showed increased radionuclide uptake in heart and renal cortex, but there was no clinical evidence of myocardial or renal dysfunction at the time of the scan. He survived with severe neurologic sequelae from the cardiovascular collapse. He had dynamic peripheral neuropathy and progressive loss of retinal function, as evidence of ongoing chloroquine neurotoxicity.

Primary afferent terminal function following acrylamide: alterations in the dorsal root potential and reflex.

The dorsal root potential (DRP) and the dorsal root reflex (DRR) were studied in acrylamide (ACR)-induced axonopathy to determine the nature and extent of primary afferent terminal (PAT) dysfunction. Cats were administered 30 mg/kg/day ACR for either 5 (ACR 5D) or 10 (ACR 10D) days. The day after the last injection, the spinal cord as isolated in situ and the DRP and DRR were elicited. It was found that only 21% of the ACR 10D animals exhibited a DRP. Furthermore, in that 21%, the DRP appeared to degrade over distance differently from the control group. There was no change in the DRP evoked in the ACR 5D group. ACR affected the DRR when evoked from the cutaneous sural nerve (SU) to a greater extent than when evoked from the medial gastrocnemius (MG) nerve. A SU-evoked DRR could not be elicited in any of the animals in the ACR 10D group and in only 20% of the ACR 5D group. There was no difference in the ability to elicit a MG-evoked DDR in either ACR-treated group when compared to control. However, the maximum-evoked area under the DRR elicited from the MG nerve was significantly smaller in the ACR-treated groups than in control. These data show that ACR does indeed impair PAT function. ACR preferentially affects the PAT processing of the SU when compared to the MG nerve, which may indicate that the selective vulnerability of the largest diameter fibers to ACR is not necessarily true.

[Ephedrine addiction]. / Efedronovaia narkomaniia.

Neurologic and psychopathologic disturbances were studied in patients with DL-ephedrine addiction. The patients were also subjected to echoencephalography. The authors identified the period of acute narcotic intoxication, the abstinence syndrome and the period of chronic intoxication. The recommendations on the treatment of the above patients are presented.

Bilateral facial paralysis following ethylene glycol ingestion.

Bilateral facial weakness, diminished hearing and dysphagia developed in a patient with a large overdose of ethylene glycol. Our case and two others previously reported draw attention to the fact that cranial nerve dysfunction, especially bilateral facial palsy, may occur in addition to encephalopathy, coma and renal failure with ethylene glycol ingestion.

Intrauterine exposure to low levels of lead: the status of the neonate.

It has been suggested that lead (Pb) at low exposure levels is a behavioral teratogen. Blood lead (Pb-B) was measured in 185 samples of maternal blood and in 162 samples of cord blood drawn from members of a cohort of mother-infant pairs. Routine newborn assessments, an examination for minor anomalies, the Brazelton Neonatal Behavioral Assessment (NBAS), and part of the Graham/Rosenblith Behavioral Examination (G/R) were administered. Maternal and cord Pb-B correlated 0.80. In regression analyses, Apgar scores, birthweight, length, head circumference, neonatal anomalies, and seven behavioral scales were unrelated to either maternal or cord Pb-B. Three scales--the NBAS Abnormal Reflexes, the G/R Neurological Soft Sign, and the G/R Muscle Tonus Scales--were related minimally to either cord or maternal Pb-B. Because of the contrast in maternal and cord results, despite the high correlation of maternal and cord Pb-B, the data were reanalyzed for 132 cases with paired data. Only the Soft Sign Scale remained significant and that only for cord, but not maternal Pb-B. Regression analysis revealed a suppression with the Soft Sign Scale related to the variance of the cord Pb-B that was not common with maternal Pb-B. The possibility that the fetus under stress tends to accumulate Pb was considered.

Neonatal effects of transplacental exposure to PCBs and DDE.

Neonatal effects of transplacental exposure to polychlorinated biphenyls (PCBs) and dichlorodiphenyl dichloroethene (DDE) were examined in a study of 912 infants. Birth weight, head circumference, and neonatal jaundice showed no relationship to PCBs or DDE. We also administered the Brazelton Neonatal Behavioral Assessment Scales, which are psychologic and neurologic tests designed for use in newborn infants. The results of these tests showed that higher PCB levels were associated with hypotonicity and hyporeflexia and that higher DDE levels were associated with hyporeflexia.

Effects of prenatal aluminum exposure on neuromotor maturation in the rat.

The oral treatment of pregnant rats with AlCl3 was realized from 8th day of gestation to parturition to determine its influence on the neuromotor development of the young rats with a bank of assessment tests. As the quality of the maternal care has an influence on young rat development, the maternal behavior had also been quantified with different parameters. The results indicated that aluminum, at the two doses (160 and 200 mg/kg), had no effect on food intake, the weight of females and their maternal behavior. On the other hand, pre-weaning mortality was significantly increased in the treated dams' young. Surviving pups showed a delay in their neuromotor development as well as a weight delay during the first postnatal week. Different explicative hypotheses have been considered.

Behavioral effects in mice exposed to nitrous oxide or halothane: prenatal vs. postnatal exposure.

Mice exposed to four or six hours of nitrous oxide or halothane differed from controls on a variety of tests conducted before weaning. Whereas many agents that produce behavioral terata have very different effects at different stages of brain development, these inhalant anesthetics had similar effects, whether exposure occurred on the 14th day of gestation or two days after birth. Both treatment times and both agents were associated with delays in the appearance of developmental landmarks and delays in the appearance of righting reflexes and locomotion. The level of general activity just before weaning tended to be low in all treated groups and was significantly depressed in males exposed to N2O postnatally. The distribution of activity scores was shifted significantly in both postnatal groups compared to controls. The data are compatible with human studies suggesting that inhalants at parturition have an effect on early behavior. The persistence of effects over the first three weeks of life does not fit with the idea that the behavioral effects are mediated by continued presence of the drug. The similar effects of the two agents, which produce very different degrees of anesthesia, supports earlier studies suggesting that the teratogenicity of inhalants is independent of the level of anesthesia produced.

Encephalopathy associated with sulindac.

Sulindac (Clinoril) is a non-steroidal anti-inflammatory drug. It is an indene derivative with therapeutic efficiency comparable with that of indomethacin. We report a case of encephalopathy associated with the intake of sulindac.

Pathogenesis of phosgene poisoning.

Phosgene inhalation in concentrations greater than 1 ppm may produce a transient bioprotective vagus reflex with rapid shallow breathing in some individuals. Phosgene concentrations greater than 3 ppm are moderately irritating to eyes and upper airways. Toxic phosgene doses (greater than or equal to 30 ppm X min) inhaled into the terminal respiratory passages render the blood-air-barrier more permeable to blood plasma, which gradually collects in the lung. Some time passes, however, until the collection of fluid provokes signs and symptoms. This period in which the patient experiences relative well-being is known as the clinical latent phase. The clinical symptoms which follow and the pathological changes underlying them are discussed in detail; dose-effect relationships are demonstrated. The regression phase after poisoning has been overcome is briefly sketched.

Myoclonus, hyperreflexia and diaphoresis in patients on phenelzine-tryptophan combination treatment.

Three cases are presented on patients on an MAOI who developed a transient syndrome of myoclonus, hyperreflexia, jaw quivering, teeth chattering and diaphoresis after L-Tryptophan was added. Caution is advised when considering the addition of a serotonergic agent to MAOI's.

Autonomic dysreflexia due to medication: misadventure in the use of an isometheptene combination to treat migraine.

Autonomic dysreflexia, a syndrome sometimes occurring in spinal cord injured (SCI) individuals, may be life-threatening. It involves, in varying degrees, hypertension, diaphoresis, headache, bradycardia, anxiety, and flushing and is believed due to unrestricted sympathetic activity below the level of the lesion in individuals with injuries above T4-6. The most frequent causes of the syndrome are urinary infections, rectal impaction, bladder distention, and decubitus ulcers. To our knowledge, medication has seldom been described as causal agent. We report here on an autonomic dysreflexic syndrome following use of an isometheptene combination (Midrin), to treat migraine. The individual involved is a C4-quadriplegic man with a long history of migraines. He was given a standard initial adult dose of the medication. Over a one-hour period, he was initially relieved of the headache, but then noted a new more severe headache, diaphoresis, and flushing. His vital signs showed progressive BP elevation to 210/130 and a relative bradycardia. Treatment over the next three hours was limited to elevation of the head of the bed and observation, during which his vital signs returned to baseline and he became asymptomatic. This experience reinforces the belief that sympathomimetic drugs in general, and isometheptene in particular, should be used in caution in patients with high-level SCI.

Perinatal caffeine treatment: behavioral and biochemical effects in rats before weaning.

Administration of drinking water containing 0, 0.02%, 0.04% and 0.08% of caffeine to female rats throughout gestation and lactation affects several behavioral parameters in the offspring. Righting reflexes, swimming ability development, motor coordination and muscle tone were affected. The activity of these animals, as measured with an open-field test at weaning (i.e., at the end of the treatment), was reduced. The effects observed were dose-dependent. However, for righting reflexes the dose-dependency was direct (the highest dose producing maximal effects), whereas in all the other tests, the dose-dependency was inverse, the lowest dose producing maximal effects and the highest dose producing no effects. This might reflect the presence of subclasses of receptors having different affinities for adenosine, mediating opposite effects and antagonized by caffeine. On the other hand, perinatal caffeine effects are certainly not mediated by blockade of phosphodiesterases, since cAMP levels at the end of the treatment were dose-dependently reduced. This study shows therefore that administration of caffeine to rat dams is able to influence the neurobehavioral development of the offspring. Moreover, all the doses utilized and corresponding to 27, 58 and 108 mg/kg, were able to produce all or some of the mentioned effects, indicating that further testing with doses lower than 27 mg/kg is required to find a dose which does not affect the offspring.

A clinical and electrophysiological study of patients with polychlorinated biphenyl poisoning.

Neurological examination of 28 patients, 4 years after serious poisoning by polychlorinated biphenyl contaminated cooking oil, are compared with similar examinations of the same patients two years earlier (in 1980). Clinical peripheral sensory neuropathy was found in 54%, headache in 36% and dizziness in 46% of the patients; these findings did not differ (p greater than 0.1) from those in 1980. Although the mean blood polychlorinated biphenyl concentration (19.2 ppb) in the patients was lower (p less than 0.001) than that in 1980 (35.9 ppb), it was still higher than the normal value (less than 4 ppb). There was no difference in the blood polychlorinated biphenyl concentration of patients with neurological manifestation from those without. Although the mean motor and sensory nerve conduction velocities (MNCV and SNCV) were still slower (p less than 0.06) than the mean normal NCV, the mean MNCV of tibial nerve and SNCV of sural nerve were improved (p less than 0.06) as compared with those in 1980. EEGs were normal except in two cases showing nonspecific slow wave changes. In addition, evoked potentials (somatosensory, visual and brain-stem auditory) were measured in this study and found to be normal in all 12 cases examined.

An increase in metabolic acidosis induced by chloralose anaesthesia in dogs after sino-vagal denervation.

Chloralose anaesthesia in dogs increased the H+ ion concentration significantly from its reference values. The findings favoured that it was most probably engendered through anaesthetic depression of neural centre regulating H+ ion concentration of blood. Such increase was largely contributed by a significant increase in its metabolic fraction. A further increase of metabolic fraction after separate and joint section of carotid sinus nerves and vagi indicated their holding effect. The section of carotid sinus nerve induced greater increase in this fraction than that of vagi. It indicated differences between the two nerves in their metabolic fraction controlling influence. Hyperpnoea after vagi section decreased the carbonic acid fraction, whereas marginally reduced ventilation after carotid sinus nerve section increased the carbonic acid fraction. Moreover, the overall changes in H+ ion concentration followed the changes in carbonic acid fraction. The present study suggested that the depressive effect of chloralose anaesthesia on H+ ion controlling neural mechanism could be largely determined by degree of increase in its metabolic fraction.