Lead poisoning from complementary and alternative medicine in multiple sclerosis.

A patient with multiple sclerosis is described who was treated for neurological symptoms thought to be a progression of his disease but subsequently found to be caused by lead poisoning secondary to the use of alternative medicine. His clinical signs improved with oral chelation therapy. Neurologists should consider asking about the use of complementary and alternative medicine before simply attributing symptoms and signs to exacerbation of multiple sclerosis.

Toxicity of Passiflora incarnata L.

BACKGROUND: Herbal medicines may have significant adverse effects which are not suspected or recognized. CASE REPORT: A 34-year-old female developed severe nausea, vomiting, drowsiness, prolonged QTc, and episodes of nonsustained ventricular tachycardia following self-administration of a herbal remedy, Passiflora incarnata L., at therapeutic doses. The possible association of symptoms with passiflora was not recognized for several days. She required hospital admission for cardiac monitoring and intravenous fluid therapy. CONCLUSIONS: Passiflora incarnata was associated with significant adverse effects in this patient. It is important to ask specifically about the use of herbal medicines in patients with undiagnosed illnesses.

Unique reactions of scrotal skin to topical agents.

Topical agents that do not produce irritant reaction elsewhere on the skin readily produce irritant dermatitis and even ulceration when applied to scrotal skin. As Shelley and Shelley state: "The scrotum must be recognized as a skin area with remarkable permeability. It provides a unique percutaneous doorway for the entrance of drugs into the circulation and is thus uniquely susceptible to toxic and irritant agents."

[The state of the central glucoreceptor mechanism of the regulation of gastric secretion in patients with duodenal ulcer with different variants of its course]. / Sostoianie tsentral'nogo gliukoretseptornogo mekhanizma reguliatsii zheludochnoi sekretsii u bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki s raznymi variantami techeniia.

The time course of the levels of glycemia, gastric secretion of acid and pepsin, and indices of variation pulsometry in response to intravenous injection of glucose (0.66 g/kg) was studied in 42 patients with duodenal ulcer and in 11 healthy persons. It was established that in duodenal ulcer the reactivity of the central glucoreceptor mechanism regulating acid and pepsin secretion, was considerably elevated, especially in patients with complicated forms of disease and gastric hypersecretion. A hyperglycemia-induced degree of acid and pepsin secretion suppression was 1.5- 2-fold higher in the study group than in the control group. The authors proposed that the ratio of a degree of a decrease in acid production (delta % AP) and pepsin production (delta % PP) to the level of glycemia increment (delta % Gl)--acid-glucose (delta % AP/delta % Gl) and pepsin-glucose (delta % PP/delta % Gl) indices should be calculated for overall assessment of a reaction to hyperglycemia of the hypothalamic glucose sensitive mechanism of gastric secretion regulation. These indices reflected a degree of hypothalamic dysfunctions and could serve as markers of the gravity of disease. In the patients with uncomplicated duodenal ulcer as compared to the control group, the acid-glucose index was 2.6-fold and the pepsin-glucose index 1.6-fold higher, and in the patients with complicated duodenal ulcer the indices were 4.6- and 2.9-fold higher, respectively; the indices were higher in the patients with basal acid hypersecretion and hyperplasia of parietal cells.