Review of Eastern coral snake (Micrurus fulvius fulvius) exposures managed by the Florida Poison Information Center Network: 1998-2010.

CONTEXT: Envenomation by the Eastern coral snake is rare but may be associated with significant morbidity. While effective, acquisition of North American Coral Snake Antivenin (NACSAV) is difficult because production was discontinued for many years. OBJECTIVE: The purpose of this study is to characterize coral snake exposures in Florida and determine the effects of varying treatment paradigms on patient outcomes. METHODS: This study is an observational case series of cases received at Florida poison centers. Included cases were Eastern coral snake exposures occurring between January 1, 1998 and October 31, 2010. Excluded cases included those found to be unrelated or those not followed for at least 24 h post envenomation. Case comments were reviewed to obtain data. Comparisons were made between asymptomatic patients receiving empiric antivenom therapy (empiric group) and those asymptomatic patients who received antivenom upon developing signs of systemic envenomation (withhold group). RESULTS: Of the 553 cases identified, 387 were included in the final analysis. According to case comments, 56.3% of patients had no reported systemic symptoms. Most commonly, patients were reported to have pain (40.6%), paresthesias (28.4%), nausea (12.7%), and emesis (11.4%). NACSAV was administered to 252 patients (65%). Of those patients receiving NACSAV, 18.25% were reported to have had an adverse reaction. Patients in the withhold group (n = 106) had significantly fewer minor, moderate, and major outcomes than patients in the empiric group (n = 134, p < 0.01). DISCUSSION: While patients in the withhold group had favorable outcomes compared with those in the empiric group, this strategy cannot be applied to all patients presenting asymptomatic to healthcare facilities due to study limitations. CONCLUSION: Further studies are needed to determine what treatment strategy is most appropriate for asymptomatic patients presenting to healthcare facilities.

Preoperative UFT administration for patients with advanced colorectal cancer--increased uptake of 5-fluorouracil by tumor tissue is a prognostic factor.

The aim of this study was to clarify whether increased 5-fluorouracil (5-FU) uptake by tumor tissue following preoperative UFT administration is a prognostic factor after surgery in colorectal cancer patients. We examined the concentrations of 5-FU in tumor or normal tissue of 96 colorectal cancer patients who received UFT (400 mg/day) orally for 7 days prior to surgery. Patients were divided into two groups with high or low 5-FU concentrations in tumor tissue (defined as higher or lower than the cut-off value, respectively). The cut-off value of 5-FU was established based on the upper limit of the 95% confidence interval of the median of the concentration found in normal tissue (0.106 microg/g). Of the 96 patients, 62 (64.6%) were in the low-5-FU group and 34 (35.4%) in the high-5-FU group. The latter had a more favorable clinical outcome (p=0.0465). Cox regression analysis revealed that two independent variables, stage and 5-FU status in tumor tissue, were significant for prediction of survival. These findings suggest that increased uptake of 5-FU by tumor tissue following preoperative oral administration of UFT is an independent prognostic factor in colorectal cancer patients. This variable needs to be considered in the design of future therapeutic trials.

Multicenter randomized prospective study of adjuvant chemotherapy with UFT and mitomycin C in advanced colorectal cancer.

BACKGROUND: A randomized prospective trial was performed to determine the efficacy of preoperative and postoperative adjuvant oral UFT, administered with mitomycin C (MMC) after resection for advanced colorectal cancer. MATERIALS AND METHODS: A total of 126 patients were entered in the study. The patients received UFT (400 mg daily) administered orally for seven days prior to surgery and were randomly assigned to two groups immediately following surgery. Group A received MMC postoperatively; Group B received the same regimen as Group A, plus administration of UFT orally at a dose of 400 mg daily for one year. RESULTS: The survival results revealed no significant difference between groups A and B. In patients with nuclear DNA aneuploid tumors, the hematogenous recurrence rate after curative surgery was lower in Group B than in Group A (P = 0.0656). CONCLUSIONS: Preoperative and postoperative adjuvant oral UFT, administered with MMC after curative resection, may be effective in preventing hematogenous recurrence in colorectal cancer patients with nuclear DNA aneuploidy tumors.

Multiple-dose activated charcoal compared to urinary alkalinization for the enhancement of phenobarbital elimination.

BACKGROUND: Urinary alkalinization and multiple-dose activated charcoal are modalities advocated for the enhancement of phenobarbital elimination in poisoned patients. However, no studies exist comparing the efficacy of these two means of elimination enhancement. We compared their effects on the pharmacokinetic disposition of intravenously administered phenobarbital. METHODS: Ten healthy volunteers participated in each of three randomly ordered study phases. During each phase, 5 mg of intravenous phenobarbital per kilogram of body weight was administered. During phase I, no interventions were made in attempt to enhance phenobarbital elimination. In phase II, participants underwent 24 hours of urinary alkalinization. Throughout phase III, volunteers received six doses of activated charcoal and two doses of sorbitol over 24 hours. RESULTS: The phenobarbital elimination half-life was 148 hours, 47 hours and 19 hours during the control, alkalinization and charcoal phases, respectively. Statistically significant differences in the elimination of phenobarbital were detected when each of the following phases were compared: I vs II, I vs III and II vs III. CONCLUSIONS: Both urinary alkalinization and multiple doses of activated charcoal are effective for the enhancement of phenobarbital elimination but multiple-dose charcoal was superior to urinary alkalinization in our study population.

Drug- and toxin-induced seizures.

Seizure is an omnimous sign when it occurs in relation to drugs or toxins. Knowledge of those drugs or toxins that have a predilection to cause seizures may prove invaluable when one is treating such a patient. Aggressive treatment with the appropriate therapy may have a significant impact on outcome. As seen from this article, many drugs and toxins are associated with seizures. Fortunately, the majority of these seizures can be managed with supportive care, using the standard anticonvulsant drugs. Management of the seizure in a few drugs and toxins requires additional intervention. It is the addition of these specific treatment modalities that may prove to be lifesaving despite drug- or toxin-induced seizures.

[A significance of dual parameter flow cytometric DNA analysis using the anti-keratin antibody].

Flow cytometric DNA analysis using the anti-cytokeratin antibody was carried out in order to estimate more reliable measurement in single cell suspension obtained from solid tumors. It was difficult to detect a DNA aneuploidy with DI of 2.0 by one parameter analysis of DNA. Whereas it could be detected easily by using dual parameter analysis of cytokeratin and DNA. And also, the pattern of DNA multiploidy could be selected for cytokeratin positive cell population by gate analysis.

[Changes in cell cycle and RNA content in cultured cancer cells treated with cis-diamminedichloroplatinum (II)].

Recent reports have shown that CDDP interacts with RNA and protein as well as DNA. We studied the alteration of cell cycle, cellular RNA content and the effect of nucleic acid metabolism on cultured cancer cells after treatment with CDDP by flow cytometry and 3H incorporation assay. The alteration of cell cycle was found to be accumulation of cells in after delay S phase in cytostatic concentrations, CDDP inhibited 3H-TdR uptake markedly at this time and 3H-UR uptake earlier. Increase in RNA content accompanied accumulation of cells in G2M phase. This increase was not a specific phenomenon caused by CDDP, because increase in RNA content was also induced by other inhibitors of DNA synthesis. It is more likely that the direct alteration of cell cycle and cellular RNA content due to action of DNA-combined CDDP rather than that of RNA-combined CDDP.

Gastric plasmacytoma with rod-shaped intracytoplasmic inclusions. Report of a case studied by light and electron microscopy and immunohistochemistry.

A 78-year-old man with primary gastric plasmacytoma showing massive rod-shaped intracytoplasmic inclusions is presented. The patient was initially diagnosed as having a benign gastric ulcer and underwent partial gastrectomy. Around the ulcer of the resected stomach specimen, diffuse proliferation of plasma cells with massive rod-shaped intracytoplasmic inclusions was noticed by light microscopy. Immunohistochemically, these cells were found to contain IgM-kappa-type immunoglobulin upon peroxidase-antiperoxidase (PAP) staining. Electron microscopy showed that the intracytoplasmic inclusions were localized in the rough endoplasmic reticulum and had a lattice structure with a periodicity of about 120 A.