A case of severe paraquat poisoning treated by continuous hemodiafiltration without sequelae.

Background: In a suicide attempt, a 49-year-old male ingested pesticides. He arrived at the hospital restless and vomiting blue liquid. Case Presentation: The patient was diagnosed with paraquat poisoning at a lethal dose and experienced renal dysfunction during treatment. He underwent continuous hemodiafiltration (CHDF). Hemodialysis was temporarily initiated and found to improve renal function. He was discharged on day 36 in good condition. He remains well with only mild renal impairment and no pulmonary fibrosis, 240 days after the incident. The fatality rate of paraquat poisoning is approximately 80%, regardless of the treatment. Early hemodialysis combined with CHDF within 4 h has been reported to be effective. In this case, CHDF was initiated approximately 3 h after paraquat administration and showed a successful outcome. Conclusion: CHDF should be performed as soon as possible to treat paraquat poisoning.

The profile of Japanese Association for Acute Medicine - out-of-hospital cardiac arrest registry in 2014-2015.

AIM: To describe the registry design of the Japanese Association for Acute Medicine - out-of-hospital cardiac arrest (JAAM-OHCA) Registry as well as its profile on hospital information, patient and emergency medical service characteristics, and in-hospital procedures and outcomes among patients with OHCA who were transported to the participating institutions. METHODS: The special committee aiming to improve the survival after OHCA by providing evidence-based therapeutic strategies and emergency medical systems from the JAAM has launched a multicenter, prospective registry that enrolled OHCA patients who were transported to critical care medical centers or hospitals with an emergency care department. The primary outcome was a favorable neurological status 1 month after OHCA. RESULTS: Between June 2014 and December 2015, a total of 12,024 eligible patients with OHCA were registered in 73 participating institutions. The mean age of the patients was 69.2 years, and 61.0% of them were male. The first documented shockable rhythm on arrival of emergency medical services was 9.0%. After hospital arrival, 9.4% underwent defibrillation, 68.9% tracheal intubation, 3.7% extracorporeal cardiopulmonary resuscitation, 3.0% intra-aortic balloon pumping, 6.4% coronary angiography, 3.0% percutaneous coronary intervention, 6.4% targeted temperature management, and 81.1% adrenaline administration. The proportion of cerebral performance category 1 or 2 at 1 month after OHCA was 3.9% among adult patients and 5.5% among pediatric patients. CONCLUSIONS: The special committee of the JAAM launched the JAAM-OHCA Registry in June 2014 and continuously gathers data on OHCA patients. This registry can provide valuable information to establish appropriate therapeutic strategies for OHCA patients in the near future.

Beneficial Effects of Cocoa in Perivascular Mato Cells of Cerebral Arterioles in SHR-SP (Izm) Rats.

As previously reported, the cerebral arterioles are surrounded by unique perivascular Mato cells. They contain many inclusion bodies rich in hydrolytic enzymes, and have strong uptake capacity. They are thus considered scavenger cells of vascular and neural tissues in steady-state. In this study, employing hypertensive SHR-SP (Izm) rats, the viability of Mato cells was investigated. In hypertensive rats, the capacity for uptake of horse radish peroxidase (HRP) and the activity of acid phosphatase (ACPase) of Mato cells were markedly reduced, and on electron-microscopic examination Mato cells were found to include heterogeneous contents and appeared electron-dense and degenerated. Vascular cells exhibited some signs of pathology. However, in hypertensive rats fed chow containing 0.25% cocoa, the uptake capacity and ACPase activity of Mato cells for HRP were enhanced, and on electron-microscopic examination Mato cells appeared healthy, with mitochondria with nearly normal profiles. Signs of pathology in vascular cells were also decreased. Superoxides may impair Mato cells and vascular cells.

[Case in which magnesium sulfate effectively treated ventricular tachycardia due to overdose of pilsicainide hydrochloride].

A 34-year-old man ingested an excessive amount of pilsicainide hydrochloride (Sunrythm, total dose, 2,500 mg) with suicide attempt. On admission, consciousness was impaired and circulatory failure was evident. Systolic blood pressure was 74 mmHg. As electrocardiography (ECG) revealed ventricular tachycardia (VT), cardioversion was administered but was unsuccessful. We therefore administered magnesium sulfate. This resulted in immediate reversion to normal rhythm; however, PQ and QRS intervals remained prolonged, consistent with the effects of a Vaughan Williams class I c Na-channel blocker. Blood pressure rose to over 100 mmHg, and circulatory and respiratory function improved immediately. Plasma concentration of pilsicainide hydrochloride was markedly increased to 7.22 microg/mL (therapeutic range: 0.2 approximately 1.0 microg/ mL) on admission. We performed direct hemoperfusion (DHP) to reduce pilsicainide concentration. DHP was performed twice, and drug concentration was measured each time. DHP was insufficiently effective for reducing plasma pilsicainide concentration. In conclusion, administration of magnesium sulfate is an effective therapy for Pilsicainide-induced ventricular tachycardia.