[Methaemoglobinaemia in a child treated with Emla(®) cream: circumstances and consequences of overdose]. / Méthémoglobinémie après application de crème Emla(®) chez un enfant : circonstances et conséquences d'un surdosage.

BACKGROUND: Emla(®) cream, a mixture of two local anaesthetics (prilocaine 2.5%, lidocaine 2.5%) has a good benefit-risk profile. However, methaemoglobinaemia can occur, especially when the cream is applied in excessive amounts or over long periods. PATIENTS AND METHODS: The authors report a case of seizure and respiratory disturbances (MetHb=20.1%) after excessive application of Emla(®) (30g) for curettage of molluscum contagiosum in a young girl with eczema. The patient's clinical condition improved after withdrawal of the cream and administration of methylene blue, and she returned home on day two. DISCUSSION: This new case of methaemoglobinaemia in a child following application of Emla(®) cream highlights the importance of strict compliance with the instructions for use of this medicinal product.

[Hemolytic anemia after voluntary ingestion of henna (Lawsonia inermis) decoction by a young girl with G6PD deficiency]. / Ingestion volontaire de decoction de henné (Lawsonia inermis) d'un déficit en G6PD.

Henna (Lawsonia inermis) is a shrub bearing leaves that are crushed and used for cosmetic purposes in Asia and Africa. In several countries, henna decoction is ingested as a traditional drug to induce abortion. One component of Henna, known as Lawsone, can induce hemolysis in G6PD-deficient patients after cutaneous exposure or ingestion. The purpose of this report is to describe a case of severe hemolytic anemia after voluntary ingestion of Henna decoction to induce abortion. This complication led to diagnosis of partial moderate G6PD-deficiency in the 17-year-old patient living in Mayotte in the Indian Ocean. This report emphasizes the life-threatening hazards associated with some plant extracts used as traditional medicines.

Toxicological risks on the human health of populations living around the Mediterranean Sea linked to the invasion of non-indigenous marine species from the Red Sea: A review.

The Mediterranean region is, by far, a prime travel destination, having hosted more than 330 million tourists in 2016, mostly for seaside holidays. A greatly increased influx of thermophilic Red Sea species, introduced through the Suez Canal in a process referred to as Lessepsian invasion (in honor of Ferdinand de Lesseps who instigated the building of the Suez Canal), have raised awareness among scientists, medical personnel, and the public, of health risks caused by some venomous and poisonous marine species. The main species of concern are the poisonous Lagocephalus sceleratus, and the venomous Plotosus lineatus, Siganus luridus, Siganus rivulatus, Pterois miles, Synancea verrucosa, Rhopilema nomadica, Macrorhynchia philippina and Diadema setosum. Recognizing that the main factors that drive the introduction and dispersal of Red Sea biota in the Mediterranean, i.e., Suez Canal enlargements and warming seawater, are set to increase, and international tourist arrivals are forecasted to increase as well, to 500 million in 2030, an increase in intoxications and envenomations by alien marine species is to be expected and prepared for.

Effectiveness of a written clinical pathway for enhanced recovery after transthoracic (Ivor Lewis) oesophagectomy.

BACKGROUND: This study assessed the feasibility of a protocol-driven written clinical pathway for multidisciplinary postoperative management after oesophagectomy for oesophageal neoplasia, and examined whether the application of such a protocol could shorten hospital stay and reduce postoperative morbidity and mortality. METHODS: Consecutive patients undergoing transthoracic oesophagectomy for oesophageal neoplasia were divided into those treated between 2003 and 2008 to whom a clinical pathway was applied for postoperative management (group 1), and a control group treated between 1998 and 2002 when no clinical pathway was applied (group 2). RESULTS: There were 74 patients in each group. Morbidity rates were similar in the two groups: 31 per cent in group 1 and 38 per cent in group 2. There were more pulmonary complications in group 2 (23 versus 14 per cent; P = 0.025). One patient (1 per cent) in group 1 and four (5 per cent) in group 2 died after surgery (P = 0.010). The median (range) length of hospital stay was 9 (5-98) days for group 1 and 13 (8-106) days in group 2 (P = 0.012). CONCLUSION: Use of a written clinical pathway in patients undergoing oesophageal resection significantly reduced pulmonary complications, postoperative mortality and hospital stay.

Zenker's and epiphrenic diverticula in a patient with cutis laxa: should the surgical technique be modified?

Currently, most of esophageal diverticula arise as the result of a pulsion effect. Some esophageal motor disorders increase the intraluminal pressure and after some time, the diverticula grow through a weak point of esophageal wall. In these cases, the surgical treatment of choice is the myotomy associated with diverticulopexy or diverticulectomy. Adding a fundoplication is accepted to avoid the consequences of gastroesophageal reflux after myotomy in the epiphrenic diverticula surgery. There are other causes of esophageal diverticula that change the resistance of esophageal wall. Cutis laxa, a congenital or acquired connective disease, is a strange one. In our patient, a good result was reached modifying the standard technique accord to its ethiopathogenic mechanism.

Reliability of new pulse CO-oximeter in victims of carbon monoxide poisoning.

STUDY OBJECTIVE: The purpose of this study was to evaluate the reliability of noninvasive real-time measurement of carboxyhemoglobin (COHb) using a pulse CO-oximeter in victims of carbon monoxide poisoning (COP). METHODS: During the 7-month study period, pulse CO-oximetry was measured on patients admitted to the emergency department (ED) for suspected COP. Each patient included in the study underwent concomitant assessment of COHb by blood sampling and noninvasive pulse CO-oximetry (SpCO). RESULTS: Twelve non-smoker patients were included. Mean age was 40 +/- 17 years. No difference was found between the two COHb assessment techniques (p>0.05). Analysis using the Bland and Altman procedure suggested good alignment of the two techniques with a slight bias (i.e. -1.5%) indicating slight overestimation by the pulse CO-oximeter. Analysis using the Passing and Bablok statistical protocol further documented the reliability of the two methods. CONCLUSION: This study documents the precision of the correlation between readings obtained with the noninvasive pulse CO-oximeter and COHb measurements from blood samples. This preliminary result demonstrates that this simple rapid noninvasive technology could be useful before and after arrival at the ED.

[Child poisoning after ingestion of a wild apiaceae: a case report]. / Intoxication par une apiacée sauvage: à propos d'une observation pédiatrique.

Apiaceae family (formerly Umbelliferae) contains several highly toxic species, including Poison Hemlock (Conium maculatum), Water Hemlock (Cicuta virosa) and Hemlock Water Dropwort (Oenanthe crocata) which are the three main poisonous Apiaceae species growing in France. Thinking he was identifying wild carrots, an 11-year-old boy without previous history ingested the root from a wild Apiaceae. One hour later, he was confused, had drowsiness, headache as well as abdominal pain, vomiting and diarrhoea. Upon hospital admission, myosis, ophtalmoplegia and a moderate rhabdomyolysis were noted. The patient recovered after 24 h of symptomatic treatments. In this case, the description of the ingested plant allowed to identify the Apiaceae family but not the species involved. The geographical location (Southern France in a humid area), the clinical features and the aspect of the ingested root, with an orange secretion led to implicate Oenanthe crocata as the origin of this unusual poisoning.

[Venomous and poisonous animals. V. Envenomations by venomous marine invertebrates]. / Envenimations ou intoxications par les animaux venimeux ou vénéneux. V--invertébrés marins venimeux.

Epidemiological information about marine envenomation is generally less extensive in Europe than in tropical countries where this type of injury is more severe and the need for medical attention is more frequent. For this reason use of the regional poison control centers in the areas where envenomation occurs must be encouraged. The purpose of this review is to describe envenomation by poisonous marine invertebrates (cephalopods, sea urchins, cone shells, jellyfish, anemones, star-fish, corals, and worms). Understanding of these envenomation syndromes is important not only in tropical areas but also in Europe where importation of dangerous species has increased in recent years.

[Venomous and poisonous animals. IV. Envenomations by venomous aquatic vertebrates]. / Envenimations ou intoxications par les animaux venimeuk ou vénéneu. IV. Vertébrés aquatiques venimeux.

Epidemiological information on marine envenomation is generally less extensive in Europe than in tropical regions where these injuries are more severe and the need for medical advice is more frequent. For these reasons use of regional Poison Control Centers in the area where the injury occurs must be encouraged. The purpose of this review is to describe envenomation by bony fish (lion fish, stone fish, and catfish), cartilaginous fish (stingrays and poisonous sharks), or other venomous aquatic vertebrates (moray-eels and marine snakes). Understanding of these envenomation syndromes is important not only in tropical areas but also in Europe where importation of dangerous species has increased in recent years.

[Agauria salicifolia intoxication]. / Intoxication par bois de gale (Agauria salicifolia).

INTRODUCTION: Several plants of the Ericaceae family produce grayanotoxins, which can poison humans. The best-known of these intoxications involves the eating of "mad honey" contaminated by rhododendron nectar grayanotoxins. The authors report a case of poisoning due to ingestion of Agauria salicifolia, an Ericaceae species endemic in the Mascarene Islands. CASE: A 28-year-old woman mistakenly ingested a herbal tea made with leaves of this plant. Symptoms were characteristic of grayanotoxin intoxication, with vomiting, arterial hypotension and bradycardia. The patient was managed in an intensive care unit and recovered within a few hours after symptomatic treatment of the low blood pressure and the severe digestive disorders. CONCLUSION: This case underlines that ingestion of some plants can be toxic.

[Systemic envenomation by jellyfish in Guadeloupe: Irukandji-like syndrome?]. / Envenimation systémique par méduse en Guadeloupe: Irukandji-like syndrome?

The Irukandji syndrome is a set of severe systemic symptoms observed after envenomation by some tropical jellyfish. The syndrome was first described in Northern Australia where Carukia barnesi was identified as the offending species. A recent report from Florida described three Irukandji-like syndromes in the Caribbean area. The purpose of this report is to describe a similar case involving a healthy young man who developed systemic symptoms after being stung by an unidentified jellyfish in Guadeloupe (French West Indies). These case reports suggest that jellyfish envenomation may not be unusual in the Caribbean.

[Poisoning with Jatropha curcas: 24 cases reported to Paris and Marseille Poisons Centers]. / Intoxications par pignons d'Inde (Jatropha curcas): 24 observations rapportées aux centres antipoison de Paris et Marseille.

Jatropha curcas L. is an inedible plant belonging to the Euphorbiaceae family that is growing in subtropical zones of all continents. We report a series of 24 cases of poisoning with J. curcas seeds or fruits reported to poison centers in Paris and Marseille between December 2000 and June 2014. Fifteen adults and 9 children ingested J. curcas seeds or fruits. All patients experienced gastrointestinal disorders, within the first hours following ingestion: nausea, vomiting, diarrhea and abdominal pain. Laboratory investigations performed in 10 patients revealed minor abnormalities: CK elevation (8 cases), dehydration (5 cases) with moderate elevation of serum creatinine levels (3 cases), and mildly increased serum bilirubin (8 cases). Complete remission of all clinical signs was observed within 48 hours in the 20 cases for which the outcome was known. Previously published cases of J. curcas poisoning were very similar to ours: As in our series, gastrointestinal disorders were always present. They were sometimes associated with neurological or cardiovascular signs, and hepatic or renal disorders; these were generally interpreted as complications of severe gastroenteritis, although direct toxic effects could not be formally excluded. In most cases, simple supportive measures were sufficient to ensure complete recovery within 24-48 hours. J Curcas poisoning incidence is certainly increasing because the plant is cultivated to produce biodiesel and is now largely present in most subtropical countries. As a consequence, local health professionals should be informed of the toxic properties of this plant.

European viper envenomation recorded by French poison control centers: A clinical assessment and management study.

INTRODUCTION: Immunotherapy is the gold standard treatment for patients bitten by European vipers in France; it significantly decreases morbidity, frequency and severity of complications and length of stay. A national prospective study was performed by all Poison Control Centers (PCC) to validate the emergency protocol for viper envenomations. METHODS: This prospective study included all cases of viper bites in France, treated or not with Viperfav(®) in 2013. RESULTS: In 2013, 277 cases of viper bites were collected: ratio M/F 2.1; mean aged 43 years (<15 years 25% 15-65 63% > 65 12%). The final severity was divided into 68 grades 0, 58 grades I, 62 grades IIA, 71 grades IIB and 18 grades III. One death was reported. Five patients had neurological signs. For the 114 patients who received Viperfav(®), all systemic signs disappeared in 5 h and in 24 h for biological and neurological signs. No severe anaphylactic reaction with Viperfav(®) was reported. Late Viperfav(®) administration increased the risk of functional impairment 15 days after the bite (OR = 3.21 p = 0.043). The administration of Low Molecular Weight Heparin (LMWH) increased the frequency of functional impairment to 15 days after the bite (OR = 6.38 p = 0.064), although Viperfav(®) was given in the first 18 h. DISCUSSION: This study confirms the efficiency, safety and recommendation of an early administration of a single dose of Viperfav(®), LMWH should not be used. It also shows the extension of neurotoxic venom of vipers in France.

Immunohistochemical detection of p53 protein could improve the management of some patients with Barrett esophagus and mild histologic alterations.

OBJECTIVE: To determine the usefulness of p53 immunostaining in identifying the subgroup of patients with Barrett esophagus who may be at increased risk of developing adenocarcinoma of the esophagus. MATERIALS AND METHODS: Tissue samples of 41 patients with Barrett esophagus and available sequential histologic data were processed for p53 immunostaining. Results from each patient were compared over time, and the results of a subset of patients were compared with each other. RESULTS: We observed a significant correlation between the percentage of samples with p53 expression and the severity of dysplasia. Moreover, in a subset of patients with mild dysplasia (cases classified as showing indefinite dysplasia), we observed a statistically significant difference in the percentage of p53-positive samples between the group that progressed to more severe dysplasia and the group that did not progress. CONCLUSION: Our results suggest that this procedure, which is technically simple, economical, and quick, could play a role in the evaluation and follow-up of patients with Barrett esophagus.