Sublingual administration of atropine eye drops for treating organophosphorus poisoning.

An 89-year-old patient with fenitrothion toxicity received sublingual atropine eye drops, reducing the intravenous atropine requirement. This alternative method enabled rapid rehabilitation, and he walked unaided, leading to discharge.

Guanfacine poisoning resulting in transient ST-segment elevation: a case report.

BACKGROUND: Guanfacine is an alpha-2 adrenergic agonist that decreases norepinephrine release and sympathetic outflow. With the increased use of guanfacine for attention-deficit hyperactivity disorder (ADHD), reports of guanfacine poisoning have also risen. CASE PRESENTATION: A 15-year-old male (height: 170 cm, weight: 48 kg), who was taking 2 mg/day of guanfacine for ADHD, was brought to our emergency department after ingesting 40 tablets of guanfacine due to poor exam results. He presented with impaired consciousness and sinus bradycardia on an electrocardiogram (ECG), leading to diagnosis of guanfacine poisoning. Gastric lavage (5 L) was performed, and activated charcoal was administered. Although his consciousness gradually recovered, he developed ST-segment elevation on the ECG. Despite the absence of chest pain and elevated myocardial enzymes, coronary artery stenosis was not observed on coronary artery computed tomography. As his blood guanfacine level decreased, his ECG returned to normal. CONCLUSIONS: This case highlights the need for careful monitoring of guanfacine poisoning patients due to the potential for various cardiovascular events.

Changes of cerebral oxygen metabolism and hemodynamics during ECPR with hypothermia measured by near-infrared spectroscopy: a pilot study.

BACKGROUND: The 2010 CPR Guidelines recommend that extracorporeal cardiopulmonary resuscitation (ECPR) using an emergency cardiopulmonary bypass (CPB) should be considered for patients with cardiac arrest. However, it is not yet clear whether this therapy can improve cerebral circulation and oxygenation in these patients. To clarify this issue, we evaluated changes of cerebral blood oxygenation (CBO) during ECPR using near-infrared spectroscopy (NIRS). METHODS: We employed NIRS to measure CBO in the bilateral frontal lobe in patients transported to the emergency room (ER) after out-of-hospital cardiac arrest between November 2009 and June 2011. RESULTS: Fifteen patients met the above criteria. The tissue oxygenation index (TOI) on arrival at the ER was 36.5 %. This increased to 67.8 % during ECPR (P < 0.001). The one patient whose TOI subsequently decreased had a favorable neurological outcome. CONCLUSION: Increase of TOI during ECPR might reflect an improvement in cerebral blood flow, while decrease of TOI after ECPR might reflect oxygen utilization by the brain tissue as a result of neuronal cell survival. NIRS may be useful for monitoring cerebral hemodynamics and oxygen metabolism during CPR.

Localized skin mottling associated with acute gastric dilatation.

We present a case of a 55-year-old woman complaining of abdominal distension owing to acute gastric dilatation. Her localized skin mottling had spread from the lower abdomen to both knees. The skin mottling in the area affected by gastric dilatation improved immediately after stomach emptying using a gastric tube and upper endoscopy.

Coronavirus disease 2019 with Chilaiditi sign.

In patients with the Chilaiditi sign, pulmonary lower lobes collapse occurs because of interposition of the bowel between diaphragm and liver. When such patients suffer from COVID-19 pneumonia, clinicians should carefully monitor respiratory status.

Intestinal obstruction caused by consuming diet food containing psyllium.

A 26-year-old man presented to our institution with abdominal pain and nausea after eating food containing Psyllium to lose weight. Since patients undergoing extreme slimming regimens may cause intestinal obstruction if psyllium is taken without adequate fluid intake caution should be taken when eating psyllium.

Commercial massage tool-induced spinal epidural hematoma.

Background: Spinal epidural hematoma (SEH), which may develop into an emergency condition, is a rare disease. Here, we present the case of a patient with SEH caused by cervical massage using a commercial massage tool. Case Presentation: A 75-year-old man was brought to our hospital with a chief complaint of posterior neck pain during sleep. He had used a commercial massage tool before going to bed. Upon arrival, hypotension and respiratory failure were observed. His muscle strength in both the upper and lower extremities rated 0 on the manual muscle test, and sensory loss below the papillae was observed. His symptoms resolved spontaneously after 2 h. Magnetic resonance imaging suggested a spinal cord epidural hematoma at the C2/C3 to C3/C4 level. On day 6, the patient was discharged without any impairment. Conclusion: Fatal complications could occur by cervical massage using a commercial massage tool.

Early induction of hypothermia during cardiac arrest improves neurological outcomes in patients with out-of-hospital cardiac arrest who undergo emergency cardiopulmonary bypass and percutaneous coronary intervention.

BACKGROUND: Therapeutic hypothermia for comatose survivors of out-of-hospital cardiac arrest has demonstrated neurological benefits. Although early cooling during cardiac arrest enhances efficacy in animal studies, few clinical studies are available. METHODS AND RESULTS: The 171 patients who failed to respond to conventional cardiopulmonary resuscitation were studied prospectively. Patients underwent emergency cardiopulmonary bypass (CPB) plus intra-aortic balloon pumping, with subsequent percutaneous coronary intervention (PCI) if needed. Mild hypothermia (34 degrees C for 3 days) was induced during cardiac arrest or after return of spontaneous circulation. Of the 171 patients, 21 (12.3%) had a favorable neurological outcome at hospital discharge. An unadjusted rate of favorable outcome decreased in a stepwise fashion for increasing quartiles of collapse-to-34 degrees C interval (P=0.016). An adjusted odds ratio for favorable outcome after collapse-to-CPB interval was 0.89 (95% confidence interval (CI) 0.82-0.97) and after CPB-to-34 degrees C interval, 0.99 (95%CI 0.98-0.99) when collapse-to-34 degrees C interval was divided into 2 components. Favorable neurological accuracy of a collapse-to-CPB interval at a cutoff of 55.5 min and CPB-to-34 degrees C interval at a cutoff of 21.5 min was 85.4% and 89.5%, respectively. CONCLUSIONS: Early attainment of a core temperature had neurological benefits for patients with out-of-hospital cardiac arrest who underwent CPB and PCI. (Circ J 2010; 74: 77 - 85).

Decreased activated protein C levels as a clinical predictor in patients with ST-elevation myocardial infarction.

BACKGROUND: Circulating markers that indicate atherosclerotic plaque instability may have diagnostic and prognostic value in patients with acute coronary syndromes. We evaluated activated protein C (APC), which has antithrombotic, anti-inflammatory, and profibrinolytic properties, as a possible clinical predictor in ST-elevation myocardial infarction (STEMI), including return of spontaneous circulation after sudden cardiac arrest. METHODS: Patients with STEMI whose APC level was measured upon arrival at the emergency room were enrolled in this study (n=335). The primary end point was inhospital death from any cause. RESULTS: The APC level ranged from 29% to 142% with a median of 80%. The unadjusted death rate increased in a stepwise fashion with decreasing APC levels (33.7% in quartile 1, 12.7% in 2, 6.0% in 3, and 3.6% in 4, P<.001). This association remained significant in subgroups of patients with STEMI only (P=.04) or with return of spontaneous circulation (P=.01). After adjusting for independent predictors of inhospital death, the odds ratio for death among those in the first quartile of APC levels was 9.4 (95% CI 1.1-81.6, P=.04). A cutoff APC level of 65% had the highest combined sensitivity and specificity in predicting death. CONCLUSIONS: Measuring APC levels provides predictive information for use in risk stratification across the STEMI spectrum. Decreased APC levels may be a unifying feature among patients at high risk for death after STEMI.

Severe Hypertriglyceridemia Possibly Masked Acute Pancreatitis and Led to a Difficult Diagnosis in an Obese Patient with Ketoacidosis-onset Type 2 Diabetes.

A young obese man with ketoacidosis-onset type 2 diabetes mellitus, associated with severe hypertriglyceridemia, was admitted to a local hospital complaining of abdominal pain. Although the abdominal pain worsened, his serum amylase level remained normal with persistent severe hypertriglyceridemia until the second day of hospitalization. The next day, computed tomography showed severe acute pancreatitis (AP) with serum amylase elevation, while the patient's triglyceride level decreased to 558 mg/dL. He was transferred to our hospital and recovered after intensive care. AP accompanied by diabetic ketoacidosis is not rare but an early diagnosis can be difficult to make due to normal amylase levels in the presence of severe hypertriglyceridemia.