Successful treatment of 5-fluorouracil toxicosis with hemodialysis.

OBJECTIVE: To describe the successful treatment of lethal dose 5-fluorouracil (5-FU) toxicosis using hemodialysis. CASE SUMMARY: A 4-month-old intact female Golden Retriever was presented to the emergency department after ingesting 20 g of 5% 5-FU cream. The puppy developed refractory seizures and became comatose with uncontrolled tonic-clonic convulsions. Because of the low molecular weight and minimal protein binding of 5-FU, a single hemodialysis treatment was employed for detoxification. The puppy improved clinically posttreatment and was successfully discharged 3 days after admission. Postingestion leukopenia and neutropenia occurred but were responsive to treatment with filgrastim. The puppy is neurologically normal and has no lasting effects 1 year postingestion. NEW OR UNIQUE INFORMATION PROVIDED: To the authors' knowledge, this is the first reported case in veterinary medicine of a potentially fatal 5-FU ingestion that has been treated with intermittent hemodialysis.

Pharmacokinetics and efficacy of trazodone following rectal administration of a single dose to healthy dogs.

OBJECTIVE: To determine the pharmacokinetics and efficacy of trazodone following rectal administration of a single dose to healthy dogs. ANIMALS: 6 healthy adult dogs. PROCEDURES: Each dog received a single dose of trazodone (approx 8 mg/kg) per rectum. Trazodone tablets were crushed into a powder, mixed with 5 mL of tap water, and injected into the rectum via a red rubber catheter. Sedation scores were assigned, and blood samples were collected for determination of plasma trazodone concentration at predetermined times before and after drug administration. Pharmacokinetic parameters were estimated by noncompartmental analysis. RESULTS: Plasma trazodone concentration remained below the detection limit for 1 dog even though it became moderately sedate. Median (interquartile [25th to 75th percentile] range [IQR]) maximum plasma trazodone concentration and volume of distribution and clearance corrected for bioavailability were 1.00 µg/mL (0.66 to 1.40 µg/mL), 10.3 L/kg (7.37 to 14.4 L/kg), and 639 mL/kg/h (594 to 719 mL/kg/h), respectively. Median time to maximum plasma trazodone concentration and elimination half-life were 15 minutes (range, 15 to 30 minutes) and 12 hours (IQR, 7.99 to 12.7 hours), respectively. All dogs became mildly or moderately sedate, and the extent of sedation was maximal at a median of 30 minutes (IQR, 30 to 60 minutes) after trazodone administration. No adverse effects were observed. CONCLUSIONS AND CLINICAL RELEVANCE: Rectal administration of trazodone may be a viable option for sedation and treatment of anxiety in dogs for which administration of sedatives and anxiolytics by other routes is contraindicated. Further research is necessary to better elucidate the pharmacokinetics and efficacy of trazodone following rectal administration and determine optimal dosing.

Suspected Acute Respiratory Distress Syndrome Associated With the Use of Intravenous Lipid Emulsion Therapy in a Dog: A Case Report.

A 12-year-old male neutered Bichon Frise presented to the Emergency Department for stupor and bradycardia after ingestion of chocolate covered 450 mg (90 mg/kg) tetrahydrocannabinol. The patient was hospitalized for supportive care, IV fluid therapy and monitoring in the intensive care unit. During hospitalization the patient became comatose and bradypneic. Treatment with intravenous lipid emulsion (ILE) therapy was instituted to accelerate toxin elimination, reduce the risk of complications related to progressive obtundation and shorten hospitalization time. Five hours after infusion, the patient developed severe respiratory distress and was ultimately euthanized. Post-mortem histologic evaluation of lung revealed severe pulmonary edema consistent with acute respiratory distress syndrome. There are infrequent reports of adverse effects associated with ILE therapy for toxicosis in veterinary medicine despite reports of complications such as acute respiratory distress syndrome in human literature. The purpose of this report is to describe the potential for a severe adverse event after treatment of a toxicosis with ILE therapy.

Electrolyte, acid-base, and hemoglobin oxygen affinity alterations following irradiation and storage of canine packed red blood cells.

BACKGROUND: Irradiation of RBC before transfusion is required to prevent transfusion-associated graft-versus-host disease for human patients undergoing hematopoietic stem cell transplantation. Additional applications for irradiated blood may exist in oncologic surgery. The effect of irradiation on canine packed RBC (pRBC) is unknown. OBJECTIVES: The aim of this study was to explore and characterize the in vitro electrolyte, acid-base, and oxygen-carrying capacity changes to pRBC immediately following irradiation and during storage. METHODS: Ten units of pRBC were irradiated using a linear accelerator. Concentration of potassium and glucose, percentage of free hemoglobin (fHb), hemoglobin oxygen saturation (sO2 ), total oxygen content, partial pressure of oxygen (pO2 ), the pO2 at which 50% of hemoglobin is saturated (p50), lactate, pH, and methemoglobin were measured before and following irradiation, and at 7 and 17 days post irradiation. RESULTS: In both irradiated and nonirradiated units, a significant decrease in pH and glucose, and a significant increase in lactate and potassium were noted. The pO2 , fHb, and the p50 value in both groups increased over the first 7 days. Immediately following irradiation, the pH was significantly lower, and the potassium, lactate, and fHb were significantly higher in irradiated units compared with controls. Small but significant differences were noted between irradiation status in pH, fHb, sO2 , total oxygen content, and p50 value at 7 days post irradiation. CONCLUSIONS: This hypothesis-generating study found irradiation and storage significantly altered in vitro properties of pRBC. The magnitude of these differences was small and the clinical impact of irradiation on pRBC may be negligible.

Percept-genetic signs of repression in histrionic personality disorder.

Several types of perceptual distortions of two anxiety-arousing visual stimuli are coded as repression in the Defense Mechanism Test, a tachistoscopic, percept-genetic technique. Given the well-established correspondence between hysteria and repression, the study included a clinical validation of these variants of repression against the diagnosis of histrionic personality disorder. 41 subjects with evidence of this disorder on the Millon Clinical Multiaxial Inventory-II were compared with 41 nonhistrionic controls. Significantly more histrionics were coded for the type of repression in which the threatening figure is transformed into a harmless object (code 1:42), while animal- and statue-repressions, when combined (codes 1:1 and 1:2), were significantly more characteristic of the nonhistrionic group. As an unpredicted finding, significantly more histrionic subjects employed defensive strategies, currently coded as reaction formations (code 4:). Histrionic subjects without concomitant compulsive features were coded more frequently for introaggression (code 6:) compared both with nonhistrionic controls and with histrionic-compulsive subjects. The findings are discussed within the context of the available percept-genetic literature. It is suggested that the Defense Mechanism Test may be further employed to objectify and investigate the defense mechanisms of the DSM-III-R disorders.

Melancholia: a Defense Mechanism Test study.

The defensive organization of Melancholia was explored with a tachistoscopic percept-genetic technique, the Defense Mechanism Test. A sample of 20 women inpatients with a DSM-III-R diagnosis of Major Depressive Episode or Major Depression, Melancholic Type was contrasted with a matched group of depressed outpatients and a matched group of nonclinical subjects. Signs of introaggression on the hero, statue-repression, and stereotypy significantly characterized melancholic patients. The latter were discriminated from depressed outpatients as showing more signs of stereotypy and of discontinuity. Mask-disguise defenses were typically endorsed by Bipolar melancholic patients and significantly differentiated them from Unipolar melancholic patients. One type of stereotypy (regarding wrong age attributes of the central figure) successfully predicted a poor response to antidepressive therapy. Relevant modifications of the current Defense Mechanism Test coding criteria for stereotypy are proposed.

The Defense Mechanism Test in nonpsychotic psychiatric outpatients and normal controls.

In the Defense Mechanism Test, stimuli representing a central figure threatened by a peripheral person are presented tachistoscopically, at increasing exposure times. The threat is assumed to trigger defense mechanisms that are expressed by several types of perceptual distortions. Given that to date no experimental study has validated the discriminative power of the Defense Mechanism Test between normal controls and clinical groups, 99 normal controls and 57 nonpsychotic psychiatric outpatients were given the test. Significantly more psychiatric patients than controls were coded for presence of each of the ten main defensive signs of the Defense Mechanism Test (with a peak significance for reaction formation). Ten codings or subcodings of defense which were particularly rare in the control sample were employed to discriminate between groups. This procedure correctly allocated 85.8% of the control subjects and 85.9% of the psychiatric patients. The present findings allow a preliminary distinction between codings of defense with questionable, moderate, or strong clinical significance, in the area of nonpsychotic psychopathology.

Perceptual defense mechanisms in Crohn's disease and panic disorder.

The defense organization of Crohn's disease and Panic Disorder was studied with a well-validated tachistoscopic paradigm, the Defense Mechanism Test. Three sex- and age-matched groups of 34 subjects (Crohn, Panic, and Nonclinical) were compared on the main codings of defense. Crohn patients were characterized by stereotypy and lack of recognition of the threat. The Panic group presented clearly higher frequencies of protocols with repression, isolation, and disappearance of the threat. Especially was the strongest variant of isolation, barrier-isolation, typical of the defensive substructure of panic patients.

[Use of mini-laparoscopy in intraoperative diagnosis of contralateral inguinal hernia in children]. / Utilizzo della mini-laparoscopia nella diagnosi intraoperatoria di ernia inguinale controlaterale in età pediatrica.

Laparoscopy has been considered by some Workers an useful means of diagnosing patent processus vaginalis in children. This technique is effective in evaluating patency of contralateral internal inguinal ring and requires only five minutes of additional operative time to elective inguinal herniorrhaphy. The Authors report their experience with fifty-six children to whom this procedure was offered. Their age ranged from three to ten years--mean 6.5 years-. Congenital unilateral hernia was right-sided in eighteen and left-sided in thirty-eight patients. Overall, the contralateral processus vaginalis was patent in 44.6%, with 27.7% and 52.2% patency on the nonclinical right and left sides, respectively. Low abdominal pressure-insufflation with CO2 to a pressure of 4 mmHg and shortened operative time have permitted to avoid endotracheal intubation. We confirm great utility of laparoscopic examination in determining the need for contralateral inguinal exploration in pediatric patients.