Concentrations of various forms of vitamin B6 in ginkgo seed poisoning.

A 2-year-old girl required medical attention for a sudden onset of repetitive tonic-clonic convulsions after ingesting 20-30 ginkgo seeds. Concentrations of the major forms of circulating vitamin B6, pyridoxal-5'-phosphate (PLP), pyridoxal (PL), and 4-pyridoxic acid, as well as the known ginkgo seed toxin 4'-O-methylpyridoxine (MPN) were measured in the serum and cerebrospinal fluid (CSF). PLP is an active form of vitamin B6 and necessary for γ-aminobutyric acid (GABA) production. High MPN concentrations were observed in both the serum and CSF. As the PLP to PL ratio was markedly decreased in serum and CSF examinations, we suspected the ratio to be important in GABA production. This case report provides novel information on the metabolism of vitamin B6 in humans as a result of ginkgo seed poisoning.

Electromyographic and laboratory findings in acute Solanum torvum poisoning.

CONTEXT: Solanum torvum berries, known as susumber or turkey berries, are prepared as part of traditional Jamaican dishes usually served with cod and rice. Poisoning is rare. Although toxic compounds have never been definitively isolated, previous reports suggest toxicity results from inhibition of acetylcholinesterases. We present a case of susumber berry poisoning with detailed electromyographic studies and laboratory analysis. CASE DETAILS: A 54-year-old woman presented to the Emergency Department (ED) complaining of vision, speech, and gait changes; emesis; and diffuse myalgias following consumption of susumber berries. The physical examination demonstrated an intact, lucid mental status, miosis, opsoclonus, severe dysarthria, dysmetria, mild extremity tenderness and weakness, and inability to ambulate. Her symptom constellation was interpreted as a stroke. DISCUSSION: Electromyography demonstrated a pattern of early full recruitment as well as myotonia during the period of acute toxicity. Additionally, solanaceous compounds, in particular solasonine and solanidine, were identified in leftover berries and the patient's serum. Store-bought commercial berries and subsequent serum samples were free of such toxic compounds. EMG studies, together with a laboratory analysis of berries or serum can assist in the differential diagnosis of stroke, and provide both a prognostic screening and confirmation of suspected glycoside toxicity.

Selenium and Iodine in Autoimmune Thyroiditis.

Selenium and iodine are essential for thyroid hormone synthesis and function. Selenium, in form of selenocysteine, is found either in the catalytic center of enzymes involved in the protection of the thyroid gland from free radicals originating during thyroid hormone synthesis, and in three different iodothyronine deiodinases catalyzing the activation and the inactivation of thyroid hormones. Iodine is an essential constituent of thyroid hormones and its deficiency causes different disorders that include goiter, hypothyroidism, reduced fertility and alteration in growth, physical and neurological development. These two micronutrients could be involved in the pathogenesis of autoimmune thyroid diseases, a spectrum of pathological conditions including Hashimoto's thryoiditis, post-partum thyroiditis, the so-called painless thyroiditis, Graves' disease and Graves' ophtalmopathy. Aim of this paper is to review the role played by selenium and iodine in autoimmune thyroiditis.

Unexpectedly dangerous escargot stew: oleandrin poisoning through the alimentary chain.

A female, aged 43 and a male, aged 66, experienced gastrointestinal and cardiovascular symptoms after a meal including snail stew. Twelve hours after the ingestion, they presented with nausea, vomiting, diarrhea, and cardiovascular symptoms typical of acute toxic digoxin ingestion and were hospitalized. The man's electrocardiogram was altered, and the woman's was normal. Serum digoxin levels, measured on a Roche COBAS Integra 800 with the Roche On-Line Digoxin reagent, were 1.14 and 1.00 nmol/L, respectively. Potassium levels were normal in both patients. The serum digoxin concentration decreased on the second day, and symptoms resolved on the third day with patients fully recovered (i.e., reversion to a normal sinus rhythm). Cardiac-glycoside-like intoxication symptoms follow the ingestion of leaves or flowers of Nerium oleander. The consumed snails were suspected to be responsible for the intoxication. In the homogenized snail tissue, the concentration expressed in digoxin equivalents was 0.282 nmol/g. The presence of oleandrin and oleandrigenin in the snails was confirmed by liquid chromatography-tandem mass spectrometry analysis, which was performed on a ionic-trap Finnigan LXQ instrument using an electrospray ionization interface. High-pressure liquid chromatographic separation was performed on a C18 column with a gradient of methanol/water. An extract of oleander leaves was used as reference.

Ichthyotoxic ARF after fish gallbladder ingestion: a large case series from Vietnam.

Fish gallbladders are consumed in rural areas of Asia as a traditional medicine to improve symptoms of arthritis, decreased visual acuity, and impotence. Consumption of large amounts of this traditional medicine can result in systemic toxicities; in particular, acute renal failure. We reviewed records of all admissions to Cho Ray Hospital (Ho Chi Minh City, Vietnam) between January 1995 and December 2000 after this ingestion. Clinical courses and outcomes were similar in 16 of 17 patients. Within hours, patients experienced profuse vomiting (n = 16) and diarrhea (n = 15). All developed acute renal failure, with a mean serum creatinine concentration of 14.7 +/- 3.9 mg/dL (1,299.5 +/- 344.8 micromol/L). Four patients administered intravenous fluid (IVF) developed extracellular fluid volume overload, as did 1 patient not administered IVF. Time to peak creatinine concentration was 8.6 +/- 3.0 days, which was accompanied by decreased urine volume (174.7 +/- 161.6 mL/24 h). Blood pressure remained normal, with a mean arterial pressure of 91 +/- 12 mm Hg. Twelve patients required renal replacement therapy. A mean of 1.9 +/- 1.1 hemodialysis sessions was performed per patient. Sixteen patients recovered renal function; 1 patient died of fulminant hepatic failure. Kidney biopsies showed features of acute tubular injury. Acute renal failure after fish gallbladder ingestion is characterized by a failure to respond to IVF, an 8.6-day interval to peak creatinine level, frequent need for dialysis therapy, and findings on renal biopsy consistent with acute tubular necrosis. Acute renal failure after fish gallbladder ingestion has an excellent prognosis. However, death from fulminant hepatic failure can occur.

Serum luteinizing hormone, testosterone, and thyroxine and growth responses of ram lambs fed locoweed (Oxytropis sericea) and treated with vitamin E/selenium.

Sixteen ram lambs (5 m.o. old, 45 +/- 1.5 kg) received a control diet (50% concentrate, no locoweed, n = 4), locoweed (20% locoweed for 21 d, n = 4), MUSE (2 mL i.m. of MUSE containing 5 mg selenium and 50 mg vitamin E/mL, n = 4) on Days 21 and 35([Day 0 = first day of trial]), or locoweed + MUSE (n = 4). The rams were maintained in individual pens (3 x 9 m) with free access to feed, water, salt and shade. On Day 7 after initiating locoweed, serum alkaline phosphatase (AP) increased (P < 0.01), and serum thyroxine (T4) decreased (P < 0.01) in locoweed-fed rams. Effects on serum AP and T4 remained constant in rams during the 21 d of locoweed feeding. Treatment with MUSE did not influence (P > 0.10) AP or T4. Locoweed-fed rams had reduced (P < 0.05) intake and body weight for the 2-wk period after locoweed feeding ended. The MUSE regimen or diet had no effect on intake or body weight (P > 0.50). Neither locoweed nor MUSE affected serum LH before or after GnRH administration on Day 22 (P > 0.10). On Day 50, however, area under the LH curve (AUC) was 966 units in locoweed-fed rams and 1,373 units (+/- 154) in controls (P = 0.09). Serum testosterone (T) was reduced in locoweed-fed rams before and after (P < 0.05) GnRH on Day 22. On Day 50, the T AUC was numerically lower (P = 0.14) in locoweed-fed rams (1,252 units) than in controls (1,539 +/- 130 units). Conversely, MUSE treatment resulted in increased (P = 0.02) T AUC on Day 50 (1,148 and 1,643 +/- 130 units in control and MUSE-treated ram lambs, respectively). During the 6-wk period after locoweed feeding, serum immunoglobulin G averaged 14.0 and 18.6 (+/- 1.1) mg/mL in control and locoweed-fed rams (P < 0.01), respectively. Twenty percent dietary locoweed for 21 d exerts adverse effects on feed intake, growth, and reproduction in young ram lambs and MUSE was not effective in reversing these effects.

Antiphospholipid antibodies in patients with eosinophilia myalgia and toxic oil syndrome.

OBJECTIVE: To explore whether antiphospholipid antibodies (aPL) are markers of vascular related damage or merely evidence of toxic related autoimmunity, we investigated the presence of different aPL in patients with toxic oil syndrome (TOS) and compared the profile with patients with eosinophilia myalgia syndrome (EMS). METHODS: Reactivity against cardiolipin, P-serine, P-inositol, and P-choline was investigated by ELISA in the blood of 266 patients with acute and chronic TOS, 25 healthy relatives of TOS patients, and 48 patients with EMS. RESULTS: 32% of TOS and 13% of EMS patients had IgG antibodies against cardiolipin and other polyanions. 20% of both TOS and EMS patients presented IgM antibodies against anionic and zwitterionic phospholipids. 36% of TOS healthy relatives had IgM antibodies against differently charged phospholipids. Among 200 patients with chronic TOS, there was no significant association between antibodies and clinical manifestations. CONCLUSION: aPL with different specificity are present in a high percentage of patients with TOS and EMS. The significance of these antibodies remains unclear.

Association between blood polychlorinated biphenyl concentration and serum triglyceride level in chronic "Yusho" (polychlorinated biphenyl poisoning) patients.

The association between blood polychlorinated biphenyl (PCB) concentration and serum triglyceride level was investigated in 259 "Yusho" patients (PCB poisoning) who underwent health examinations for Yusho in 1988. Geometric means of PCB and triglyceride were 3.84 ppb (95% confidence interval: 3.54-4.17) and 114.3 mg/dl (106.6-122.6), respectively. Both correlation and multiple regression analyses showed a weak but statistically significant correlation between these two variables. The mean triglyceride level adjusted for age and sex was then calculated for comparison among four PCB levels, using analysis of covariance. This indicated a progressive increase with increasing PCB: 98.36, 117.78, 117.84, and 127.65 mg/dl at < 2.7, 2.7+, 4.1+, and 6.1+ ppb, respectively (F = 2.01, P = 0.113). Comparing PCB levels, the difference in adjusted mean triglyceride levels was marginally significant between the first and second (P = 0.088), and the first and third quartiles (P = 0.066), and reached significance between the first and fourth quartiles (P = 0.021). Thus, a weak but significant association between blood PCB and serum triglyceride was observed in the patients 20 years after exposure, although their blood PCB and serum triglyceride were relatively close to the normal levels.