Lethal ingestion of stored Amanita phalloides mushrooms.

We report the first case of a lethal Amanita phalloides intoxication from stored mushrooms. After picking the mushrooms were kept in a freezer for 7-8 months. This case is in accordance with the well-known stability of the amatoxins and demonstrates the possibility of A. phalloides poisoning at any time of year.

[Hyperventilation test: a noninvasive screening test for coronary vasospasm]. / Der Hyperventilations-Test: ein nicht-invasiver Suchtest für koronare Vasospasmen.

3 patients with coronary vasospasms in different clinical situations are presented. One patient had typical Prinzmetal angina but coronary arteries without significant stenosis. One patient without typical angina pectoris showed sudden significant ST elevations on anterior and lateral ECG tracings accompanied by typical ischemic chest pain. At angiography, a 70% LAD stenosis was found without high degree lesions. One patient (aged 30 years) had a documented anterior infarction with angiographically normal coronary arteries. In all these cases coronary vasospasms were recognized as the underlying cause of the symptoms. All the patients were treated with calcium channel blockers and have been asymptomatic since. Currently available data comparing the diagnostic value of hyperventilation with other tests for coronary vasospasms, such as ergonovine or acetylcholine, are discussed. The hyperventilation test can be recommended as the first test in the work up of suspected vasospastic angina pectoris.

Plasma and hepatic carnitine and coenzyme A pools in a patient with fatal, valproate induced hepatotoxicity.

Reduced hepatic mitochondrial beta-oxidation and changes in the plasma carnitine pool are important biochemical findings in valproate induced liver toxicity. The carnitine pools in plasma and liver and the liver coenzyme A (CoA) pool in a patient with fatal, valproate induced hepatotoxicity were measured. In plasma and liver the free and total carnitine contents were decreased, whereas the ratios short chain acylcarnitine/total acid soluble carnitine were increased. The long chain acylcarnitine content was unchanged in plasma, and increased in liver. The total CoA content in liver was decreased by 84%. This was due to reduced concentrations of CoASH, acetyl-CoA, and long chain acyl-CoA whereas the concentrations of succinyl-CoA and propionyl-CoA were both increased. The good agreement between the plasma and liver carnitine pools reflects the close relation between these two pools. The observed decrease in the hepatic CoASH and total CoA content has so far not been reported in humans with valproate induced hepatotoxicity and may be functionally significant.

[Bacterial infections following sclerosing therapy for esophageal varices]. / Bakterielle Infektionen nach Osophagusvarizen-Sklerosierungstherapie.

Two patients with infectious complications 3 and 5 days after elective sclerotherapy of esophageal varices are presented. Both patients had liver cirrhosis (primary biliary cirrhosis and alcoholic liver cirrhosis with hepatitis B virus infection respectively). In one patient a brain abscess developed which was treated successfully by antibiotics and surgery; in the other patient pneumococcal bacteremia and gonarthritis developed. Frequency, possible causes and antibiotic prophylaxis are discussed.

[C-reactive protein and relative lymphocytopenia: early markers of acute myocardial infarction?]. / C-reaktives Protein und relative Lymphozytopenie: Frühmarker des akuten Myokardinfarkts?

OBJECTIVE: Recent data suggest that relative lymphocytopenia and elevated C-reactive protein (CRP) are early markers of myocardial infarction. We tested these two parameters to predict myocardial infarction before elevation of creatine kinase. METHODS: Over a two-year period, 260 patients presented at the emergency room of Männedorf Hospital with suspicion of unstable angina or myocardial infarction. 197 patients were excluded because of intercurrent conditions associated with an acute-phase response or changes in leukocyte counts, as well as patients with established myocardial infarction (creatine kinase elevation at entry). The remaining 63 patients were reviewed for relative lymphocytopenia (< 20.3%) and C-reactive protein levels > 5 mg/l at admission. RESULTS: Elevated levels of C-reactive protein were found in 8 of 20 patients (40%) with unstable angina and in 29 of 43 patients (67%) with myocardial infarction. A value for C-reactive protein > 5 mg/l on admission had a sensitivity of 67% and a predictive value of 78% for subsequent myocardial infarction. Relative lymphocytopenia was found in 2 patients (10%) with unstable angina and in 19 patients (44%) with myocardial infarction. The positive predictive value of both markers diagnosing myocardial infarction was 93% compared to 78% of elevated CRP or 90% of relative lymphocytopenia. In contrast, the sensitivity of both markers combined was 33%. CONCLUSIONS: At present, elevation of C-reactive protein and relative lymphocytopenia allow early diagnosis of myocardial infarction. However, the markers' sensitivity is relatively low.