Complete atrioventricular block after self-ingestion of Nerium oleander for relief of hemorrhoidal complaints.

Nerium oleander is a plant native only in the Mediterranean region, but it can also be cultivated worldwide, particularly in warm areas. Biologically active oleander compounds may be used for therapeutic purposes. However, when used for self-medication, it may cause serious problems including death. We present a 30-year-old otherwise healthy man who developed complete atrioventricular block after taking a syrup of N. oleander leaves for self-medication to relive hemorrhoidal complaints. The patient was treated by oral administration of charcoal combined with sodium sulfate as well as electrolyte solutions and transient use of an external cardiac pacemaker. The atrioventricular block reverted to sinus rhythm in 30 hours and he was discharged in good hemodynamic status and general condition.

Negligible Oleandrin Content of Hot Dogs Cooked on Nerium oleander Skewers.

INTRODUCTION: The Nerium oleander plant contains cardenolides that may cause human poisoning when ingested. A long-standing belief holds that it is possible to be poisoned by eating hot dogs or other foods cooked on Nerium oleander branch skewers. Oleandrin levels in frankfurters cooked on fresh and dry Nerium oleander skewers were measured. METHODS: Hot dogs were cooked separately on either dried or fresh oleander branch skewers using a disposable charcoal grill. The hot dogs were then frozen and transported to an analytical laboratory where oleandrin content was measured via liquid chromatography/mass spectroscopy (LC/MS). RESULTS: The oleandrin content of hot dogs cooked on dried and fresh skewers did not exceed 343 ng and 701 ng, respectively. CONCLUSION: Hot dogs cooked on Nerium oleander skewers contain a negligible amount of oleandrin with respect to that sufficient to cause human poisoning. Reports of poisonings occurring in this manner are most likely the result of an urban myth.

[A non-fatal Nerium oleander self-poisoning: case report and discussion]. / Intoxication volontaire au laurier rose ; cas clinique et revue de la littérature.

Nerium oleander is potentially lethal plants after ingestion. We report a case of poisoning by these plants. Our patient complained of nausea, vomiting, and diarrhoea. He had bradycardia during first twelve hours. He was discharge after 3 days. All parts of these plants are toxic and contain a variety of cardiac glycosides including oleandrin. In most cases, clinical management of poisoning by N. oleander involves administration of activated charcoal and supportive care. Digoxin specific Fab fragments are an effective treatment.

The use of mid-trial reviews for design modifications in small scale clinical studies.

Many clinical studies such as those in the areas of toxicology, early phase clinical trials and bioequivalence studies use small samples due to the high cost of experimentation. These studies test hypotheses based on small samples. These small samples result in low power and therefore even if the alternative hypotheses may be true the chance of it being rejected is low. The sample size is determined in an ad-hoc way and no proper scientific approach is used. Sample size calculations for clinical studies are usually conducted to determine the total number of patients needed to satisfy a specified power requirement, and their validity is dependent on pre-trial knowledge of nuisance parameters and distributional and modelling assumptions. Another short coming is that often hypotheses are tested without checking the assumptions required by the test. This paper looks at design reviews in the context of small samples. It examines several design modifications done with a small internal pilot study. In the past similar techniques have been applied to large scale studies but its performance is yet to be established in small scale clinical studies thus the contribution of this paper is in justifying the validity of these techniques for small samples too. The methodology is illustrated on an uncontrolled observational toxicology study. In this paper simulations will be presented showing that the design modifications would not influence the type-I error rate and that these would be successful in preserving the power, and the implementation of the design review procedure will be described.