Norovirus gastroenteritis accompanied by marked elevation of transaminases.

A 56-year-old woman was admitted because of frequent watery diarrhea, vomiting, and abdominal cramps. An examination of the stool for norovirus antigen was positive, and a blood examination revealed a marked elevation of liver enzymes. Liver dysfunction, as well as symptoms related to gastroenteritis, was ameliorated solely by supportive treatment. Although liver injury concurrent with norovirus gastroenteritis is rarely documented and its pathogenesis remains unknown, clinicians should consider liver injury as one of the possible extra-intestinal manifestations of norovirus gastroenteritis.

Intravascular gas in multiple organs detected by postmortem computed tomography: effect of prolonged cardiopulmonary resuscitation on organ damage in patients with cardiopulmonary arrest.

A 76-year-old woman was found in cardiopulmonary arrest with her head submerged in water in a bathtub. Despite cardiopulmonary resuscitation (CPR) for over 1 h by professional emergency technicians and medical doctors, the patient died. Postmortem computed tomography revealed not only pulmonary edema associated with drowning but also the presence of intravascular gas in the pulmonary artery, liver, kidneys, heart (right ventricle), and brain. It was speculated that intravascular gas was generated and spread to multiple organs during CPR procedures via the alimentary tract and lungs, which had been damaged by ischemia after cardiopulmonary arrest. Prolonged CPR procedures may involve the risk of additional organ damage and systemic air emboli.

[Indicators for insulin therapy in late elderly patients with type 2 diabetes mellitus--the relationship between plasma C-peptide on glucagon load test and insulin therapy].

AIM: Elderly patients with type 2 diabetes (DM2) are increasing in Japan. They have many difficulties related to advanced age, so it is difficult to determine the appropriate therapy, insulin or oral hypoglycemic agents (OHA). The most appropriate indicators for insulin therapy concerning pancreatic beta cell function in extremely elderly cases of DM2 were investigated. METHODS: The subjects were 43 late elderly patients older than 75 years old with DM2, who were non-obese and without advanced hepatic disease or renal dysfunction. They underwent a 1 mg glucagon load test during hospitalization. After discharge, the therapeutic modality was evaluated. RESULTS: Acceptable control was obtained in 25 cases by OHA (group OHA), 18 cases required treatment with insulin (group I) because they could not achieve acceptable control by only OHA. Fasting CPR and CPR 6 minutes after glucagon loading (CPR6), CPR increment and CPI (fasting CPR/fasting plasma glucose x 100) were significantly lower in group I (p<0.001). On the receiver operator characteristic curve analysis to discriminate the group I, the areas under the curve of CPI, CPR6, FCPR and CPR increment in group I, were 0.973, 0.964, 0.922 and 0.858 respectively. At 0.9 of CPI, the efficiency ((true positive+true negative)/total) (93.0%) and the sum of the sensitivity (88.9%) and the specificity (96.0%) were highest. CONCLUSION: It is suggested that CPI less than 0.9, shows a need for insulin therapy in late elderly patients with DM2. This suggests that CPI can be utilized to indicate the need for insulin therapy without performing glucagon load tests.

[Colchicine poisoning by accidental ingestion of the bulbs of Sandersonia aurantiaca: report of a case].

We report a case of colchicine poisoning in an 82-year-old woman. She had suffered from senile dementia and in her confused state ingested two bulbs of Sandersonia aurantiaca (Christmas-bells, Chinese lantern lily). She was admitted complaining of gastrointestinal symptoms, mainly severe watery diarrhea. The duration of her diarrhea was approximately 40 hours. On the 3rd day after ingestion, leukopenia and thrombocytopenia occurred. Although 50 micrograms of granulocyte-colony stimulating factor was administered from the 5th day to the 8th day, her white blood cell count did not increase and revealed nadir (100/microliter) on the 7th day. Her platelet count also revealed nadir on the 7th day. She died of respiratory failure in the early morning of the 9th day. The bulb of Sandersonia was found to contain colchicine at a concentration of 4.7 mg/g, and her serum level of colchicine was 6.3 ng/ml on the 6th day. Colchicine is an alkaroid extractable from the plants like Colchicum autumnale (meadow saffron, autumn crocus), and Gloriosa supra tuber. These plants belong to the lily family. Sandersonia aurantiaca also belongs to the lily family and we found that its bulb contained colchicine. To our knowledge, this is the first report of colchicine poisoning by Sandersonia aurantiaca.